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Patient Story: Post-Cancer Reconstruction

April 29, 2011

 

Personal Description: In 2010 I was diagnosed with metaplastic carcinoma of the left breast, locally advanced to the left axillary lymph nodes.  I had just turned 59.  

 

The good news is that the CT scan revealed no spread to liver or lungs! After chemo, I had surgery consisting of Bilateral Mastectomies and Left Axillary Node Dissection (6 nodes removed) with Dr. Rona Cheitfetz, then Right Alloderm implant insertion and Left tissue expander insertion with Dr. Macadam. After surgery I received radiation therapy for 5.5 weeks ending in October 2010.  

 

I had also started physiotherapy for my left arm. By the end of radiation, the skin on the left and the right of my chest was damaged and very thin causing the incisions to break open in places.  Physiotherapy was put on hold After a series of attempts at “re-stitching” the incisions and an additional surgery Jan. 7, 2011, it was evident by February that the skin was just not going to cooperate.

 

Fortunately for me, Dr. Macadam had another option to spare me the fate of a flat-chested future. To avoid risk of infection, Latissimus Dorsi Flap surgery to the left breast with a smaller implant and revisional surgery to the right breast was quickly confirmed for the end of March at UBC hospital.

 

Pre surgery:

 

I’m feeling like a seasoned veteran - get blood test, ECG, pre admission telephone call, orchestrate transportation to and from the hospital and someone to stay with me after I come home. (If you’re an obsessive type, making sure the house is tidy and the bathroom is clean for the Homecare nurse and visitors).

 

Still, there is apprehension - compared to my first surgery, a longer stay of 2, possibly 3 nights in the hospital plus the unknown level of discomfort incurred from an additional incision on my back and those niggling “what if” worries given my track record with skin, or some other complication.

 

Tips: Use Dr. Macadam’s website.  It’s an excellent resource that addresses most of the common questions and concerns for your surgical procedure. Learning about the procedure also helps one articulate specific questions at consultation appointments.

 

Get prescriptions for antibiotics and painkillers filled prior and in house so one less thing to do en route home from the hospital I  purchased Senokot (or generic brand) to have on hand for the first few days as the anesthetic and painkillers play havoc with your "plumbing" and who needs that discomfort along with everything else?

 

Confirm homecare arrangements are in place prior to leaving hospital. Have a pillow in the car to place in the small of your back to absorb bumps during the drive home.

 

Day of Surgery:

 

6 AM front and centre at UBC hospital to check in. Process paperwork and get wristband (sadly, this one doesn’t guarantee little umbrella drinks like the all-inclusive resort). Proceed to waiting room, my name called and a double check that my info and name matches what’s on file.

 

Proceed to change room to swap my clothes for the hospital issue gown, attempt a last nervous piddle and then proceed to pre-op area.

 

Pre-op:

 

Nursing staff review my information, insert IV lead, and help wrestle on long white compression stockings. Dr. Macadam appears accompanied by resident surgeon, and a medical student– it’s amazing to listen as Dr. Macadam, black marker in hand, map out and explain the game plan.

 

Next the Anesthetist comes by, introduces himself, reviews my information, pain medication and explains that post surgery I will be given a self medicating button to push for pain management.

 

8 AM it’s time to don my blue surgery party hat  and walk to the operating room, which is a hive of activity as I am assisted onto the table. Its then “lights out” and Dr. Macadam and her team work their magic to create something out of nothing.

 

Post Op:

 

4 PM (because I asked) woke up in the recovery room - very groggy, cold and thirsty, but not much pain other than sore on the left side of my breast – maybe a 3 on the pain scale of 1-10. (10 is that involuntary-yelp-out-loud pain) Dr. Macadam came by - it went well. Moved to my room, settled in my bed - with the magic “pain button” in my right hand and the call button near my left, I slipped in and out of consciousness.

 

In the middle of the night I awoke feeling anxious, too hot and very thirsty.  I had a feeling of tightness across my chest and discomfort in my back from the drain - let’s hear it for those buttons! The nurse came, removed the extra blankets and got me settled - the pain level we decided was 2 for discomfort.  

 

Day 1

 

Today is get up and walk day. Pain level is about 2, soreness and discomfort category – very tender under my left arm, especially the drain site. Dilaudid drip and leg compression sleeves removed and catheter out – I’m on my own now!

 

Resident surgeon came by to check on me - everything OK and looking good.

 

Physiotherapist in – went over a few simple exercises and then up and walking arm-in-arm in the hallway – felt good to be up.

 

Had something to eat and then back to bed to rest although it’s tricky finding a comfortable position with all the drains. Up and brushing my teeth when the “pain management” doctor came by. Total of 1.2 mg of hydro morphine used in the last 12 hours (not much apparently). My best buddy came to visit, brought me peanut butter sandwiches and laughter – the very best healer.

 

Slept intermittently – difficulty finding comfortable position with drains and cement pillows. Day 2 6 AM up to stretch and walk around. Not much pain – mostly categorized as discomfort -very tender under left arm, sore down the middle of back and a feeling of numbness on lower back left side. Feeling restless and ready to go home – the sun is shining!

 

Dr. Macadam came at noon, checked me out, and yes, I can go home today! The sore spot on my back is a “dog ear”, a piece of skin from the incision which will resolve fairly quickly – OK to lie on it. Dressing changes, last antibiotics IV, and a “how to check the drains” briefing. Off with the compression stockings, on with my drawstring pants and hoodie and with drains stuffed in my pockets, my buddy escorts me to the car and home I go to my own bed and puffy, soft pillows and uninterrupted sleep.

 

Week 1

 

Laying low - my niece is staying with me keeping me out of trouble and reminding me to take my antibiotics. Everything is sore, but not unmanageable. Trying to raise my left arm and getting into and out of bed is a bit challenging.

 

I take my prescription pills for pain when I’m going to bed to guarantee sleep - maybe it’s the placebo effect, but it works for me! The health care nurse is in each day to check that the drains and dressings are OK.

 

Day 5, drains out on my right side. On Day 6, I see Dr. Macadam.  My “plastic wrap” dressings come off (OUCH) and the drain on my left side is removed – what a relief!  Everything is looking good. My lower left back feels numb. Apparently that is normal and will remain so for about a year.

 

The drain in the back will remain for another week, but with new dressings and 3 out of 4 drains gone, I’m beginning to feel human. I am to start physio this week to get my left arm mobile.

 

Week 2

 

No health care nurse this week – I’m on my own. Appointment with Dr. Macadam and the last drain is out – how liberating!  Also got a compression bra to keep everything in place and now I’m sporting cleavage. Physio twice this week to work on arm mobility and also a sore lower back – a result of favouring my left side. I am able to drive although it’s not that comfortable for me.

 

I’m walking to the store and trying to remember to keep it light. I’ve taken a couple of “pajama days” where I just nap and read and take it easy and I definitely feel better for the down time.  

 

Week 3

 

I’m into week 3, going to physio and feeling much better and definitely less sore with each passing day. Hopefully I will soon be ready to go back to work, subject to Dr. Macadam’s OK.

 

I know that each individual’s experience will differ from mine, but it helps when you are feeling sore and frustrated to: - Focus on the “finished product” – the worst is past. - Avoid “well-meaning” negative people! - Be extremely grateful you are in the care of Dr. Macadam who has the skills, dedication and compassion to ensure the very best end result possible, given one's unique circumstances - I know I am!"

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