Appointment update

I went with my mom this morning to get a pedicure at the cosmetology school my sister in law attends. It was nice, I always enjoy the massage and now my nails which I usually keep some shade of pink are now sparkly red (for July 4th).

Later I had another follow up with my plastic surgeon. He checked the boobs out and said they looked good. He doesn't think I need to strap them down at this point. He thinks the outer edge of the pocket is formed well enough that they won't drift too far to the sides. This is good news.

I'm going to admit to something a little embarrassing here. It was probably Wednesday night. Monday night after I had the bandages removed and the bandeau off I slept with just a soft bra on. When I woke up I thought my boobs had moved apart from one another, so Tuesday night I slept with the bandeau on and I felt better about them in the morning, so I did it again Wednesday night, but then I woke up in the middle of the night with some arm numbness and boob pain, and had this intense fear that I had the bandeau too tight and cut off the blood supply and spent a couple sleepless hours afraid that the skin was going to die and I'd lose my ability to be reconstructed. Ugh. So that didn't happen thankfully, I'm sure I was thinking less than rationally, however I've kept the bandeau off and they seem to be okay.  And I was reassured when the plastic surgeon said they still looked good. He says there is some fluid in there and that's okay, we just need to stay vigilent in watching for infection.

I also told him about the numbness I have been experiencing.. basically my arms fall asleep easily, numerous times a day and at night when I'm sleeping. His thought is that the surgery may have disrupted something and or the swelling is causing it. I think the swelling is a likely explanation because the numbness seems to start on the lower portion on my armpit and spread from there and I definitely have a fair amount of swelling there. So I'm still happy with them.

Tomorrow I am going to the local FORCE group meeting. I'm excited to see everyone again and maybe meet some new people! attends

The pre-op for exchange surgery

At my pre-op appointment on wednesday I got to sign all the forms again and got somewhat different paperwork since it's regular implants not expanders.  I also got a little booklet from Allergan (which is the manufacturer of my future implants).  It has a spot in there for the ID cards for my implants when I get them.  I also got my prescriptions and hibiclense and all my check lists.

Then finally the conversation I've been waiting for... determining what size of implant I'm getting.  So right now my expander is 12 cm in diameter and is filled to 250ccs, they add about 50ccs for the expander material to better equate to the size of a real implant.  So essentially I'm at 12 cm in diameter and 300 ccs.

I really want more projection (how far they stick out).  So I was wanting a high profile implant.  His initial concern was that would give me a more "augmented" (fake?) look.  Then we came to what I think was the mutual conclusion that the way my pec muscles it wouldn't be too fake looking and I am not opposed to a somewhat "augmented" look.

The problem we have is that the 12 cm in diameter high profile implant is 400 ccs.  Even though we plan to open it up a little he's concerned he may not be able to close me up around an implant that big. So then we started looking at the moderate profile and my concern for the 12 cm is that its only 320 ccs, which is i'm guessing not noticablly bigger than I am now (which I want to be).  Going any bigger in the moderate profile means a larger diameter as well. 

So ultimately we've decided that he will have on hand 5 implants, ranging from the Allergan Natrelle™ Style 40 Smooth Round Moderate Profile Silicone Gel Breast Implant 320 ccs at 12 cm to the 400 ccs at 12.7 cm, PLUS the Allergan Natrelle™ Style 20 High Profile Silicone Gel Breast Implant 400 ccs at 11.9 cm. 

The goal is to get in the style 20, he'll use a sizer and have the others on hand and he knows what I want so he'll try to get there. So i'm going to go into surgery hoping for what I want but prepared for the smallest of those options, which technically would still be 20 ccs larger than I am now.  He thinks I could reasonably expect the 360 ccs at 12.5 cm

So we'll just have to wait and see!  I'm okay with that.  I'd rather go in with the possibilty of getting what I want, than settling before hand and not getting what I want and then wondering if it would have been possible.

Here is a picture that shows the difference in profiles with the diameter remaining constant

http://www.drconnall.com/breast/implants/breast-implant-dimensions.aspx

Recap of Surgery Day and Hospital Stay

Tuesday, October 4th, I woke early to shower with the special hibiclense soap given to me by the plastic surgeon.  I was impressed with how smooth it made my skin feel, despite it's extreme medicinal smell.  We woke up the kids and got the youngest ready and my husband was in the car ready to take her to daycare when my mom pulled in the drive way to take me to the hospital. 

Once we all got to the hospital we went up to the second floor and waited only a few minutes before they called me back to go to the presurgery area around 7 am.  This presurgery area was set up similar to some emergency room areas I've seen, where it's just a little room with the front wall being a curtain.  It seemed really busy and there was not much privacy.  I had to explain to this nurse the whole autoimmune thing, why I'm taking the medication I'm taking and so forth.  Then the anesthesiologist came in and asked similar questions.  They then brought my husband and mom back to the room to hang out with me.  I had already been drawn on by the plastic surgeon so the nurse and anesthesiologist decided I could have some relaxing medicine.



Maybe the best picture of me since Tuesday October 4th!!  Nice huh.



I remembered very little from there.  I know that the breast surgeon stopped in, but I don't remember what we talked about.  I was mentally prepared to go awake into the operating room, but I really don't even remember falling asleep.  I was there with my mom and husband and then suddenly...

I was waking up, having a hard time opening my eyes, and my arms were in excruciating pain.  I was crying and I couldn't move my arms at all.  They were asking me what my pain level was at, and I told them a 10, and tried to explain to them that I couldn't move my arms and it felt like they were being crushed.  They put my glasses on for me which was nice, so I could see who I was talking to and differentiate people who were new from people who had been there continuously.  It was difficult for them to get the pain down. They would feed me icechips.  They finally got me pillows to put my arms on and that started to help.  I felt like they thought of me as needy, but I was really scared about my arms and the pain meds they kept giving me didn't seem to be working well enough.  I was in there awake for about an hour and a half that I remember anyway, until they finally got my pain to a bearable level and moved me to my room.

Once in my room they tried taking my vitals and put the blood pressure cuff on my arm, but as soon as it started filling up it hurt so bad I asked them to stop, and they seemed surprised.  From then on I instisted that they did it on my leg, which I did have to remind them them of a couple times as they approached my arms. 

My mom and husband were in the room waiting for me along with some beautiful flowers from my ex mother inlaw.  My mom and husband filled me in on what they had been told about the surgery - I was on the table for 7 hours, everything had gone well.  The lymph node biopsies were negative, and they didn't see anything abnormal in the breast tissue.  No Cancer!

Later that evening the nurses had called an anesthesiologist to come in and talk to me about my arms.  I was really worried that it was lymphedema or some severed muscle or nerves.  I was scared that it could be permanent and how life changing that would be.  His explanation at the time was that it was likely from the position I was in as they operated.  They had my arms strapped down over my head for the entire 7 hours with out moving them.  Apparently during long surgeries the patients arms are periodically moved to avoid this, but in my case with them operating under my arms and then so closely to them, they didn't move them like they mornally would.  He said they would keep an eye on it and someone would check with me in the morning

I had difficulty pretty much the entire hospital stay with the nurses and pain meds.  For some reason they were having trouble getting drugs from the pharmacy, and had to override something, and it seemed to be a big hassle for them.  Late in the first night I expressed that the demoral (sp) didn't seem to be working enough and asked to try something else.  They said we could try the oral "roxies" and that those should last longer and then they could use demoral for the "breakthrough pain".  They allowed me 1-3 Roxies every 4 hours.  The problem was that they got the pain down maybe only a 4 at best and then wore off after 3 hours and took atleast 30 minutes to kick in, and when I asked the nurses for the demoral they seemed to think it shouldn't be necessary and kept reitterating it was just for "breakthrough pain" and I shouldn't be taking it on a regular schedule.  The night nurse that first night finally came around and we got a system down, plus she finally realized that I couldn't use my arms and would give me the pills one at a time in my mouth as my husband held the water with a straw for me to drink from.

The day after surgery, the new nurse was far worse about the pain meds than the first one.   When the plastic surgeon came in he asked if the breast surgeon had been in to see me and what she said about me leaving.  The nurse then chimed in and said she had talked to her on the phone and she had said I was fine to go home if that was okay with him.  And he was obviously aware enough of my situation to realized I was not ready to go home and quite pointedly told the nurse that they weren't going to kick me out.  We needed to get my pain under control and it clearly wasn't.  He then said I could have as many Roxies as I needed.  If 3 didn't work, I could try 4 and if 4 didn't work I could 5, and if 5 didn't work I could have 6, and so on.  So at that point I was somewhat irritated that they had been so stingy on the meds the first night.  He also reitterated that the arm numbness and pain was probably from the position I was in during surgery, but the fact that I could move my fingers indicated it wasn't a severed nerve, but an overextended one and based on which fingers were numb he exactly which nerve was affected.  He said he didn't think it would take more than a couple days, but could possibly take weeks or even months.

The battle of meds continued with this nurse all day.  We established a schedule of taking 2 pills, then 2 hours later taking 3, then 2 hours later taking 2, and so on so that every 4 hours I was taking 5 without that lapse in time with them wearing off and waiting to kick in.  So seems like it wouldnt be a problem right?  well when it was due at 2, i would wait until like 2:15 and ring the nurses bell and a CNA would stick her head in and ask if I needed something, and I would say yes... my pain meds?  and then she'd say Okay I'll go ask your nurse... and then the nurse would come in like 10 minutes later and ask what I needed and I'd say "it's time for the pain meds". And she'd ask me what my pain level was at, and the day nurse would just put them in a cup and put it in front of me, and my husband had to give me the pills and the water, and she'd look at me like she didn't understand why I was being so pathetic.  (maybe I was a little over sensitive and assuming the worst).  as the day went on I gained a little more mobility in my right hand and was able to shakily pick up a pill between my pinky and thumb if they were placed on a flat surface.

It seemed like the day nurse was finally coming around when the shift change came and my nurse from the previous night was back.. I was happy to see her!

Enough about the nurses and meds - I think you get the picture.

My husband was absolutely amazing while we were in the hospital.  For each meal (the hospital I was at has great food and a huge menu)  he cut up my food, and even fed me the first 2 meals when I couldn't use my hands at all.  He'd help adjust my pillows under my arms.  And bring the straw of my icewater to my mouth so I could drink.  I have to say I was not thrilled about being in a position where this level of care was necessary, but he performed this level of care with out making me feel humiliated by it.  I was really impressed with him. (still am impressed).  He'd scratch when I itched and helped with my first non shower bathing, he really went above and beyond, I really beleive he meant the vows, for better or for worse, in sickness and in health.  He's a great guy.

I was happy to have visitors, I enjoyed having people to visit with and it gave my husband opportunities to go home and shower and do things with the kids without leaving me alone (with the crazy nurses).

Initially I had thought it would be a 3 day hospital stay, so when they told me I would leave the next day I was shocked!  And I ended up not leaving the next day because of my numbness in my hands and my uncontrolled pain, but I tell you what - on the second day, once they pain was okay and I could semi use my hands, I was totally ready to get the heck out of there!!

I'll try to post more tomorrow, to bring events up to date.  I'm also going to see about creating a picture diary and attaching it to the blog, but having it separate so that if you don't want to see pictures you can still read the blog.

Goodnight.

1 week to go

So a week from now I will probably be taking my night before shower with my special soap the plastic surgeon gave me.  This is probably going to be the longest week ever!  And maybe the shortest when it's done (funny how that works).

I had my hospital preop and my breast surgeon preop today.  I found out all the details  OH Shoot, i just realized I forgot a question I meant to ask.  Is it even worth asking if it doesn't make a difference?  Hmmm maybe I'll email her.... ANYWAY, I guess I found out almost all the details.

Monday afternoon I will go into the hospital to "Nuc Meds" to get radioactive dye injected into each of my breasts.  I will then hang out for a couple hours while the dye travels it's way through my breast tissue to my lymph nodes to identify "The Sentinel Node(s)".  They will then do some scans to insure the injections did their job.

Tuesday morning, I will go to the rear entrance (ER entrance) of the hospital at 7am and use my "Express Admit" aka "Hall Pass" to go up to the second floor and get things started for my surgery time of 9am. 

Basically what I was told by the nurse at preop is that a nurse will come in and have me change my clothes and ask me a bunch of questions, then anesthesia will come in and give me an IV and ask me a bunch of questions, at some point my surgeons will come in and draw on me and see how i'm doing, then I'll get something in my IV to relax me, we'll go to the operating room and get me situated on the table and next thing I know I'll be waking up 8 hours later with nurses asking me a bunch of questions.  I'll spend an hour in recovery and then be taken to my room where my family can join me. 

Not sure how I feel about having to be awake going into the operating room... Now that I'm really concentrating on it I do have some vague memory of it now with my other general anesthesia surgeries.. kind of creepy.

So the for the 8 hours of surgery - I really have 7 1/2 if everything takes exactly how long they said it would.  So 45 minutes for sentinel node biopsy for each side (1 1/2 hours total).  Then 1 1/2 hours per breast for the mastectomy (3 hours).  And 1 1/2 hours per breast for expander placement reconstruction (3 hours).

There was a moment in the hospital today that I was a little concerned... The preop nurse was looking through my stuff and said "okay so on Tuesday we're going to be doing bilateral reconstructive surgery with expander placement with Dr. W?".  and I thought a minute and realized they had only ever to that point mentioned the plastic surgeon.  so I said "after I have a bilateral mastectomy with Dr. P...."  and she looks surprised and looks at the paper and says "Oh what, you're doing both at the same time??"   "yes....."  Then she found the other surgery paperwork and all was good.  Had me a little worried though for a minute (thank goodness for preop - I'd prefer to avoid that kind of confusion on surgery day!)

My hormones are out of whack... probably the stress.  It feels like boobs are aching in anticipating of this.  They are incredibly sore.  A friend pointed out today that after next week I won't have this problem anymore!  Way to find the silver lining!   That works for me.  I just need to get through this week without losing my mind.