Wednesday, 12 July 2017

Bye Bye Boobies!

After months of anticipation, countless meal prep, cleaning of the house and trying to get myself in the best shape possible, the big day was finally here for my bilateral mastectomy with immediate latissimus dorsi flap reconstruction. I had been called by the hospital admitting department the day prior to instruct me to be at the hospital the next day at 7:00 a.m. One year and 13 days after my lumpectomy, I was going in for surgery once again to ensure that any residual cancer cells left in my breasts were gone.
When I arrived at the hospital, one of the intake nurses went through a long list of questions with me about my current medication, medical history, etc. and then had me change into a hospital gown. I would have two surgeons working on me that day, a general surgeon to perform the bilateral mastectomy and a plastic surgeon to perform the breast reconstruction. The general surgeon came into the room and asked me if I was ready. I don’t think you can ever truly prepare yourself mentally to go through this type of surgery but he assured me that I would do great.

The plastic surgeon then came in and began his artwork on me, drawing the lines of where he would be cutting away my skin, my body, my breasts. He would be removing the scar from my lumpectomy along with my nipples and taking a flap of skin, muscle and tissue from my back to help construct my breasts along with expanders. As he finished and left the room to prepare for surgery, I looked at my body in the mirror one last time and said goodbye, wondering if I would remember what it once was.

A few minutes later, the nurse came in and told me they were ready for me. We walked down to the operating room where the surgeons, nurses and anesthesiologist were gowned and prepping for what was likely to be a 4 hour surgery. I laid down on the operating bed and felt nervous about what my body was about to endure. In less than a minute though, the IV had already been inserted and the anesthetic was running through my veins, quickly rendering me unconscious.

The next thing I remember is waking up to the bright lights of the recovery room. As my senses awakened, I became increasingly aware of the tight sensation across my back and chest. I had been cut around almost the entire circumference of my body, save a couple inches around my breasts and spine, leaving it difficult for my rib cage to fully expand and take a deep breath. I suffer from mild claustrophobia so the feeling of being confined and constricted threw me into a state of panic and anxiety. It felt like someone had duct taped my body so tight and I wanted so bad to just cut it off so that I could take a deep breath. I tried to calm myself down by trying to slow each breath but it wasn’t working and I finally had to ask for some medication to deal with the anxiety.

Once the anesthetic began wearing off, I started feeling the nausea wave over me and was given an extra dose of anti nauseants to keep it at bay. As I became more stable, I was transferred to the post surgical floor for close monitoring over the next three days. When I came out of the elevator, I saw my husband sitting in the waiting area and smiled. It gave me so much comfort to see him there and to have him holding my hand as the nurses settled me into my room. I was hooked up to oxygen and an IV and had what felt like a blood pressure cuff squeezing and constricting my legs which I later found out was an intermittent pneumatic compression (IPC) system to help the blood flow through my veins and prevent blood clots.

Although I felt really tight across my body, it was more my back that I was experiencing pain and discomfort in. I didn't have a lot of sensation left in my chest (which was probably a good thing) and slowly realized I hadn’t even thought to look at what lie beneath my gown. I was nervous to see what remained of my breasts but knew that I had to face the inevitable. Once I looked down though I was pleasantly surprised with the results. The flaps from my back had been stitched into the middle of each breast and an expander had been placed underneath the skin with 120cc of saline. I actually had breasts! There were steri strips overtop the stitched areas to help close the wounds and a bandage across my back as added protection since I would be lying directly on it. I also had 4 drains coming out of my upper body, 2 in my breasts and 2 in my back, to help drain the excess fluid.

I was barely able to keep my eyes open that night even as the nurse came in every few hours to check my blood pressure and oxygen and to administer the next round of medication. Along with the anti nausea and pain meds, I was given antibiotics as a preventative measure as my white blood cell counts were still quite low even though it had been months since chemo ended. My breasts were also closely monitored to check for any changes in temperature or colour since there was the risk of my body rejecting the donor tissue.

When I awoke the next day, the hot flashes I had been experiencing since starting hormone therapy in December had increased ten-fold. I had cold towels on my head and neck to try and cool myself off but nothing seemed to be helping. Between the hot flashes, nausea and pain medication, my body finally had enough and I became sick. Thankfully it seemed to push a reset button on my body and I finally felt able enough to sit up in bed and get some food in me. Shortly afterwards, the general surgeon came in to see how I was doing and gave me an update on how my surgery went. He let me know that he successfully removed all the breast tissue and that he didn’t see anything suspicious but we still needed to wait for the pathology report to come back to confirm. That was a relief to hear!

The visitors started pouring in which was such a great distraction after everything I had just gone through. My best friend and my family were there with fresh flowers and fruit. I sat up in bed and felt somewhat normal being able to laugh and smile despite the circumstances. And my husband even offered to rub my feet and legs after being stuck in that IPC machine for the last 24 hours. It was a great way to relax after all of the stress and anxiety from the day before.

My plastic surgeon came in later that day to check up on me and I was surprised when he said he wanted me up and walking. The last thing on my mind was getting out of bed! He said the quicker I was getting up and moving, the quicker I would heal. So, I mustered up the courage to get out of bed later that day and was instantly taken aback at how hard it was to move my legs after being in bed for just a short time. I could barely lift my legs or feet managing only to shuffle my way along the floor. By the time I reached the door 10 feet away, I was exhausted and told myself I would have to try again the next day. I was physically and mentally drained from the day and what I really needed to right now was rest.

The following day, I noticed that I had a couple of reddish lines running down my wrists. I called the nurse in and upon looking at it, realized that the vein attached to the IV had collapsed. She tried to find another vein, and then another, and failed at each attempt leaving me in tears. It brought me back to my chemo days when my veins started to hide and the nurses had to poke me numerous times to get the IV going. A call was made to my surgeon and he came in to see how I was doing and to put in an order for me to start taking my medication orally. I was so thankful I wouldn’t have to go through feeling like a pin cushion again a hundred times over.

My family and friends came in again throughout the day to talk and visit and brought me some of my favourite foods. The hospital meals left much to be desired so I was thankful to have something other than creamed oatmeal and questionable meat. My husband had also stock piled my night stand with a bunch of emergency healthy snacks. When everyone had left for the day though, I realized I still needed to get up walking and asked one of the care aides if he would help walk me down the hall. He took my hand and talked me through each step encouraging me to make it a little further until I finally needed a break. It was hard to believe that just 2 days ago I was walking 5km and now could barely make it down the hall without feeling out of breath.

When I returned to my room, I felt nauseated and exhausted. The nurse came in to take my blood pressure which began reading abnormally high and I felt like I was on the verge of getting sick again. I was given an extra dose of anti nausea medication and crashed out for the night barely able to be roused awake for the nurse to do her checks. As I awoke the next day though, I felt like the storm had finally passed. My nausea and blood pressure were beginning to settle and I became hopeful that I would get the all clear to go home. After being in the hospital for 3 days, I was ready to leave.

The plastic surgeon came in to do his assessment around noon and determine whether I was ready to be discharged. I was out walking the hall with my husband following doctor’s orders and chuckled when I seen him walk into my room and then quickly out with a puzzled look on his face. When he finally noticed me, he smiled and told me it was a good sign that I was out of bed. I slowly made my way back to the room so he could have a look at my incisions which he said were healing great. I was told that if I felt comfortable going home, I could go home, but if I wanted to stay that was okay too. No thanks. I was ready to break out!

I'm going home!
One of the nurses came in and went through my discharge instructions before leaving: no showering for 3 days, no driving for 4-6 weeks, no lifting more than 5 pounds - just to name a few. When we arrived back home, my husband propped me up on the couch with half a dozen pillows around me for support and I began binge watching The Keepers on Netflix. SO good! Trying to find a comfortable position to lay down at night though was the most challenging. It was hard to put pressure on my back due to the pain and discomfort from the incisions but I couldn’t lay on my side or chest either. My husband didn’t want to risk rolling over in his sleep and hurting me so we decided that it would be best if we slept apart until I was more healed. Between the discomfort and the hot flashes that continued to rage inside my body, I was left with little sleep.

Peace out drains!
I quickly realized at home how little I could do and how much help I was going to need. I could barely get my arms into the sleeves of a button up shirt or lift myself up and down off the toilet, and getting out of bed was one of the hardest things to do. It's amazing how much you use your back and chest muscles for everything! I couldn’t prepare food, bathe myself, or bend down to pick up something off the floor. Even holding a full glass of water warranted the use of both hands to support it. So, I focused instead on what I could do like working on my range of motion and keeping myself moving. I began setting goals for myself, walking to the end of the driveway and then moving on to the end of the road. My legs were still a bit shaky so I held onto my husband for support and attached the drains to a lanyard around my neck. I reminded myself to stretch my arms overhead a few times a day and pushed just a little further each day.

A week after my surgery, I went to see my plastic surgeon for my first follow up appointment. He was pleased with my range of motion so far and told me that the 2 drains in my breasts were ready to be removed. I had been packing these 4 little drain bulbs around like a new accessory and was so relieved to have less tubing to pack around and untangle. What I was really looking forward to though was getting the drains out of my back. They were burrowed under the skin in the lower left and right quadrants of my back and were incredibly uncomfortable. At night, it felt like I was laying on a cot...without the mattress. Not fun.

In order for the drains to be removed, there needed to be less than 25-30ml of fluid output in 24 hours. So, I drained the fluid from each bulb every morning over the next couple of days in the hopes that I could finally get rid of these pesky things and was excited when they finally began measuring less than 25ml. I went to the local clinic to have the nurse remove the drains which I knew would be a painful process. My husband held my hand tight as she pulled the drains out a few inches at a time, finally removing the 8 inches of tubing that was looped under the skin in my back.

I cried tears of joy that day and celebrated having my drains out with some ice cream. But once the weekend had ended and my husband returned to work, everything came crashing down on me. My emotions began spilling over, leaving me in a pool of tears that wouldn’t dry up. I had been suffering from insomnia due to the relentless hot flashes and discomfort in my back, my freedom and independence felt like it had been stripped away, and I was going stir crazy being at home. I felt alone and isolated and that people only saw how "good" I looked on the outside and didn't see the layers of emotional anguish beneath the surface.

After letting myself have my own pity party for a couple days, I realized it was time to shift my focus and get back on track. It had been two weeks since my surgery and I was scheduled to go into the clinic to get the steri strips removed from my breast and lat flap incisions. As the nurse gently pulled them away, she let me know that everything was healing up nicely and the incisions were almost entirely closed up. I still had a ways to heal and tissue expander fills in the upcoming weeks but so far I was really happy with the results.

When I got the call the next day from my surgeon letting me know that the pathology report came back clear, I felt a huge sense of relief come over me. The chemo and radiation treatments had worked and whatever residual cancer cells had been lingering in my breasts were gone. It was time for me to move forward and keep making the most of this life that I was given. Best news ever!

1 comment:

  1. Loved reading this post. I just started my journey and your posts are always so inspiring!!!