recovery – day 5

day 5

Originally uploaded by l@in.

Recovery has been both better and worse than I anticipated. I think I already mentioned that the implant was removed (and reinserted!), which resulted in the increased level of pain that I’m experiencing. And again, the drain didn’t help (although, I know not having it could have been disastrous.) However, I am feeling better quickly. My range of motion is pretty good and while I’m not trying to lift anything of any significance, I can pick up a glass or a plate in my left hand and carry it a short distance without an issue, which is nice. I’ve even been able to knit small projects! I listened to my Dr.’s exercise mantra, “you can walk”, and did 30 minutes on the treadmill today at a really slow pace. It’s better than nothing, and I’m so happy we were able to get that before the surgery.

I’ve done this enough that I feel like I kind of have a system. I try to do whatever I feel compelled to. If I feel like laying down, I do. If I feel like I need more pain meds I take them (and if what I feel I need seems unreasonable, I know there’s a problem). If I think I can tackle some house work I try and if it doesn’t hurt, I do it, and if it does – forget it. It really helps that I’ve been able to work from home this week, and can hang out with the laptop in bed if I need to.

And if I’m hungry, I eat. This is probably the most complicated thing for me because I do love to eat. I’m also trying to be healthy for many reasons, one of which is because I’m, of course, concerned about the cancer returning. So I try to eat healthy, exercise, and do all the things you’re supposed to do to stay in optimum health. Did I mention I love to eat? And I love sweets? I know when I’m exercising a lot, I feel like I can cut myself some slack, but now that I’m struggling with a 28 minute mile (ugh! it hurts just to type), I don’t really have that luxury. So I stocked the freezer with pasta sauce, chili, and soup, and Joanna has been great about getting me out of the house to find yummy healthy things with the occasional flake (like a delicious chocolate cake from whole foods). I am looking forward to being able to handle the damn blender again – I miss my green smoothies!

Chapter 7 – Wherein the author confesses her addiction to plastic surgery

So, I had another surgery today. My left implant seems to be encapsulating slightly. It’s certainly not terrible, but the changes have been noticeable over the past few months, prompting me to see my plastic surgeon. When I saw her she agreed that it looked as if there was some encapsulating going on and told me to wait , and come back in a few weeks to see if things seemed to progress, and they did.

So today I had a revision done to my reconstruction on the left side. Dr. Otero took out the implant, removed some skin, made a revision to the dent (seriously a dent developed around my armpit), and then popped the implant back in. I don’t think I realized that the implant would be taken in and out so I’m feeling a bit more rough than I expected to. And I have a drain, which I was hoping not to have but Dr. Otero said there was a lot of fluid in there, so better safe than sorry. Certainly better than an emergency drain insertion as I’ve had before and it can come out first thing Monday, which is great. Essentially one of my fake boobs needed a lift. WTF?

I didn’t have to spend the night, so I’m home. Joanna is on a prescription run. I feel pretty rough and am in more pain than I expected, but I’m hoping the recovery will be speedy and the pain will dissipate quickly.

Tonight I’m going to watch Wife Swap, eat matzo, drink diet ginger ale, and pill pop. I’m hoping for a weekend of movies and bad tv on cable. Pedestrian as it is, I am okay with that.

Washington Hospital Center – Follow Up

In December I blogged about my less-than perfect experience at Washington Hospital Center, during my stay after breast reconstruction surgery. Since then I’ve received 2 letters of apology, including one from the pharmacy that took a bloody decade to dispense my drugs (why the drugs have to be dispensed by the pharmacy and aren’t more readily available to the nursing staff to be administered quickly to patients in the hospital is completely beyond me, especially when the drugs have been prescribed by your doctor.) Some responses sounded more sincere than others, but overall I’m pleased at the response and genuinely hope that improvements are made so that someone else doesn’t have the same lousy experience I was treated to.

That said, the nicest response came from the head nurse of the ward that I was in. Not long after my surgery, I received a call from her. She apologized, talked to me about my experience, and said that she was looking into the matter in the attempt to make sure that it didn’t happen again. It was a nice thing to do and she sounded genuinely concerned.

Ultimately, I’m glad I sent the letter. I would encourage anyone else in a similar position do the same. It doesn’t hurt to send praise to an institution where you’ve received exceptional care either. Up until the point that I was admitted to my hospital room, my experience in recovery at WHC was so good, I was already composing the letter in my head, between injections of pain killer and nausea medication.

an open letter to Washington Hospital Center

To whom it may concern,

I am writing to relay my experience at Washington Hospital Center on the December 20th-21st.

I was scheduled to have the 3rd step of my breast reconstruction with my plastic surgeon, Dr. Susan Otero, after being diagnosed with breast cancer in 2006 and undergoing two mastectomies at another hospital in 2007. Prior to my surgery date the WHC staff called me for my pre-op check-in and were also very attentive during the check-in process at the hospital. I was very pleased with the treatment and care I received prior to surgery and post-op during my recovery. Three nurses in particular, Birdie, Claudia, and Joan provided me with very high quality care. I was very pleased with the treatment I received in recovery.

However, the first major problem came when my initial recovery nurse, Birdie, called repeatedly to find me a room. My surgery was over between 2-3pm, and I recall being fully awake and able to be moved to a room around 5pm. Around 8pm I was moved to a different, larger recovery area and put under the care of Joan and Claudia, and told that I would be moved to my own room soon. After over a four hour total wait, I was finally transferred to my own room around 9:30pm.

By this time I had missed all the meal times and was hungry and tired and wanted to be in my own room, which should have been much quieter than the hustle and bustle of the recovery area. When I finally got to my room I was checked in and asked about getting food of some kind. I was told that the meal times were over. I pressed the issue as I was very hungry, not nauseous in any way, and definitely feeling up to eating a small meal. I was told that a boxed lunch could be ordered for me. In the interim, my nurse brought a large cup of juice.

Around midnight no food had arrived and it had been about four hours since I had received pain medication. Around 12:30 when my nurse, Jillian, came into my room I told her that my pain was increasing and asked for more pain medication as well as lozenges for my throat which was very sore after being intubated. She said she would order the medication and told me that no meal had been brought. She eventually found some cereal and milk for me, which was kind of her, as the food that was ordered apparently never arrived.

At approximately 1:30 I received throat lozenges. Around 2:30am I still had not received any more pain medication and my incisions felt like they were on fire. It was almost impossible for me to rest. I had not been seriously uncomfortable post-op until around midnight when I had asked for the medication and as I stated before, had been very well cared for. In recovery I was asked about my level of pain and the nurses responded appropriately. Therefore I went from being very comfortable to being in an unacceptable amount of pain for an extended period of time even though I knew that my surgeon had ordered Vicoden for me during my recovery in the hospital. I paged my nurse. She said that the drugs hadn’t arrived from the pharmacy yet but if they didn’t arrive in 10 minutes she would go check on them herself. About 15 minutes later she came with the pain medication, apologized and she told me that it would probably take me two cycles of drugs to really feel better since the drugs I had received so much earlier were almost completely out of my system.

Around 6am my surgeon arrived and told me that I would be discharged that day, which I had expected. My nurse followed shortly thereafter and brought another round of medication. I was feeling much better by then and was awaiting breakfast since I had yet to really eat anything. When breakfast did arrive, I discovered chicken broth, jello, and more juice even though I had already eaten solid food and had requested a vegetarian meal. I was not able to eat any of the food that was brought for me. I paged a nurse and a tech arrived. When I told him about the problem, he got the person who was delivering the meals and explained the situation. The delivery person said that he had an extra breakfast and would bring it to me. It never arrived. By this time I wasn’t surprised and simply wanted to get out of the hospital so I could recover properly.

I am amazed that I was able to receive both the best and the worst care I have ever had in a hospital at the same facility in 24 hours. My diagnosis has necessitated six surgeries in the past 14 months and I have never had to wait so long for medication or food in any hospital – especially things prescribed for me by my doctor and/or things that I could have had at home. I would have fared far better if I had left the hospital and gone home after my time in the recovery area, which is unacceptable. I am at a loss as to the reason why I was not able to get the medication prescribed for me, in the hospital. Considering that during previous recoveries in other hospitals I had serious issues with nausea and required far more pain medication, my experience at WHC does not make me feel confident that it could provide me with a level of care that would keep me well and comfortable. If it was so difficult to get the medication specifically prescribed for me, I can only assume that if I became nauseous or needed a non-prescribed drug right away there was no way I would have gotten it.

While I appreciate the kindness and dedication of the majority of the WHC staff which I came into contact with, overall I am appalled by my experience there. As portions of the WHC were rated among the US’s best this year, I have to believe that I experienced huge flaws in an otherwise well-functioning system. Nonetheless, I consider my experience to be unacceptable and I feel I would be remiss if I did not relay the details of my situation in the hopes that the system can improve and others can enjoy at least a modicum of good quality care that was missing in the majority of my experience at WHC.

home from the hospital

holiday slippers for the hospital

Originally uploaded by l@in.

feeling good.

oop! bagels are here. more later.

random per-blogging

The last few weeks have been a little whirlwind with starting a new job and finally getting back to feeling more normal after my last surgery. I’ve recently gotten a gym membership and have been going off and on for the past three weeks. Even though for the first week and a half I was only walking on the treadmill, I developed a little bruising and would be in so much pain the day after that I had to go visit my plastic surgeon. Apparently all was well, but the internal sutures hadn’t dissolved yet, so were causing all the trouble. My surgeon gave me a refill on my Valium prescription to take as needed. The combination of that and the dissolving sutures (you can seriously tell that they’re slowly going away because they’re poking out of my skin) has allowed me to exercise more often and for a longer period of time, which at this point, feels like a luxury. The next surgery is scheduled for December 20th – looks like I’ll be getting new boobs for Christmas.

This weekend I saw Ani Difranco at the Meyerhoff. It was a great show. I love to see how she adapts her show to the space in which she’s playing. I also got to eat at one of my favorite Top 5, Top 5 restaurants – the Helmand. I haven’t been there in years, but the food is still amazing. Four of us had bread, appetizers, an entree, wine, and Turkish coffee for $30 a person including tip. It’s quite a deal.

Speaking of food I seem, to have developed a slight addiction to pretzel dogs. If you like tofu dogs, you should really try these little things. They’re quite yummy, and relatively healthy. It’s too bad that I’m not supposed to have a serving of soy more than once a week or I think I’d be eating them all the time… now that I’m thinking about it, maybe it a really good thing I’ve got to limit my soy intake…

I think I’m fighting off a cold, so I’ve got the first pot of vegetable soup of the season on the stove, and I think it’s off to bed with me early tonight.

and today’s gold star goes to…

me.  had a 100cc expander fill (about 3.4 fluid oz.) and i’m at work.

had i not seen the actual fill done, i would be convinced that someone inserted a grapefruit into my chest during the night.

that is all.

I can take it

Today I met up with my Castle Connolly, top rated plastic surgeon, for the 2nd post-op visit. She asked me how I was doing with the pain. I was honest and told her that when I was able to rest whenever I wanted during recovery, I was down to taking the pain meds from every 5 hours to every 8 or so, which was a big improvement. Yesterday I had some appointments and errands to run downtown, so it was kind of my test run day to see how I’d do on the metro, walking all over the place and generally having a more normal day than I’ve had since surgery. As I informed my Dr. this pushed me back down to needing the meds every 5-6 hours again. I told her that I had been doing pretty well but refused to suffer in pain when I didn’t have to. She quickly agreed that there was no reason for me to suffer through it needlessly and that I was smart enough to figure out when I didn’t need the drugs again. I also told her that I’d been taking some darvocet that I had left over from severe back pain that I was experiencing this summer which seemed to knock me out and make me feel a little more out of it which let me sleep (otherwise I would wake up in the middle of the night for meds, or sleep very badly and wake exhausted). So she gave me a prescription for that as well.

Since I was still in pain, she said that she’d wait to fill my tissue expander until next week. I said, “No, no, no!” as I had geared myself up for it, had taken some anticipatory drugs and had the rest of the day off. She asked if I was sure, and I said, “Absolutely – let’s do it!” She called my favorite nurse, who gathered the needle and the saline bag and then used a magnet to find the metal valve in my expander so the saline could be inserted. When she got to 100ccs she asked me if I wanted to stop – I told her, I’m ready, I’ll take as much as you’re willing to give me. She stopped at 150ccs, which, according to my understanding is quite a large expander fill and if I have the conversion correct it’s about the equivalent of about 5oz. So now there’s essentially just over a serving of juice that’s been injected to a silicone container which sits half under and half over my newly split pectoral muscle supported by alloderm, and a whole lotta stitching.

To give you an idea of what this feels like, it’s as if someone has placed a concrete block on the left side of my chest, and occasionally pokes the outer perimeter with an ice pick. The actual filling process is less intense, but still increases according to the amount of fluid being inserted. If you’re familiar with the Peaches song Operation, where she all but screams, “I can take it!”, that’s what was going through my head towards the end of the fill.

Now I’m safely at home with a nice cocktail of valium, vicoden, and darvocet-n coursing through my veins, and thanks to Joanna, sushi waiting for me in the fridge. You should be impressed that I was able to type this out at all.

drains are pulled!

jackson-pratts

Originally uploaded by l@in.
woo hoo!

I went to see the wonderful nurse at my plastic surgeon’s office and she pulled pulled my jackson-pratts. By the time I went in today I was draining well under the 20-30ml of fluid in 24 hours required to have them removed. Hopefully there won’t be a fluid build up like last time which required emergency drain re-insertion. I feel like in April I had them removed 5-7 days post mastectomy. This time I had them in for 13 days so, cross your fingers.

I still can’t shower until Saturday morning (it’s worse than a camping trip) but it feels amazing not to have this constant pulling around the exit area of the drains and the stitches that attached them to me. While there’s still pain, it’s no longer constant. This is quite a boon, not to mention that I no longer have to find places to hide them in my clothes when going out in public. This time, the drain tubes were long enough that I could tuck them into the back or side of my skirt or slacks, which just made my ass look lumpy.

Again – it’s nice to have them out.

it’s the little things

nick & nora cow slippers

Originally uploaded by l@in.
After my second overnight stay in the hospital this year, I think I’ve figured out what I need to make myself comfortable without over packing the way I did for the first mastectomy. I thought I’d share just in case someone else needed to make similar plans.

• trash magazines. – lots of pictures and and little written content is best. this time i think i took curve, the fall fashion issue of elle, northern virginia magazine, venus zine (for the MIA article), and bust. i just wanted something to glossy flip through. as the time went on, i was able to do a little reading, but very little.
• ipod – i didn’t end up actually listening to it this time, but last stay when i was overwhelmingly sick, i don’t think i could have done without the distraction. the important thing is to attach it to something since they’re so small so they don’t get lost in the sheets, fall on the floor, etc. i used an athletic strap to attach it to a stuffed animal which also served as an arm prop. it worked rather well.
• lip balm – being intubated left my lips incredibly dry. one kind nurse even applied vaseline to my lips in recovery. i used the lip balm a lot while i was in the hospital.
• slippers with treading – the hospital usually provides slipper socks with plastic treading, but i usually find them ill fitting and scratchy. this time around i got cute little slipper sock things kinda like these with rubber tread that were nice and soft and warm and made me really comfortable. the nurses all loved them too.
• snacks from home – last time i was so sick i didn’t eat anything until the next morning which, i think, was some sherbet. this time i actually felt like eating, at least a little but was never given any menu selections so every entree was meat, meat, meat, which just made me feel ill, especially the smell of it. i think i ended up eating sherbet and squash one night and some frightening wonder-like wheat bread for breakfast. i had packed joanna some snacks – nuts, seeds, dried figs and crackers and ended up eating some of those, which made me feel much better. pete also brought me a 2 liter of diet ginger ale, the contents of which i drank almost all of before checking out the next morning.
• This may be mastectomy specific, but for the trip home, a button or zip-up shirt to wear as well as pull-on pants and slip on shoes were invaluable. For the car ride a pillow was essential to put between the seatbelt and the foob (fake boob). it still hurt, but certainly lessened the impact, especially over bumps, around sharp turns, and at abrupt stops.

It should go without saying that it’s important to develop a nice rapport with your nurses and nurse technicians if possible. That said one shouldn’t be afraid to ask for things that you need – that’s why the nurses are there. I will say that most of my nurses were kind and attentive, especially the night nurses who happily untangled my IVs from my pole when I returned from late night bathroom trips, poured me endless cups of ginger ale over cups of ice they supplied, and brought me extra blankets.

Just a little food for thought for making it through a hospital stay without losing your mind.