Category: Surgery

I’m not yet sure how I feel about it, but today’s appointment with my oncologist was kind of weird. He did examine me and validated that it is “just a stitch“. I have no outward signs of breast cancer, and as such, this means I officially remain in remission or NED (no evidence of disease). So, today my oncologist said see you in a few months and then put on the report to book a follow up in six months. So, I’ve officially graduated from monthly follow ups to six month follow ups (as long as I remain symptom free). This can only be a good thing!

It does, however, mean a transition. It means that my oncologist is no longer my first point of contact for medical issues. It means that I go back to seeing my primary care physician (PCP – or in Canada we use the term family medicine doctor). I am mostly OK with it, in part because I’m still seeing my plastic surgeon on a weekly basis, and will remain seeing her until I’ve recovered from my next surgery (currently scheduled for March 17th). I’m also still seeing other specialists, who are helping with my recovery. So, I don’t feel like I’ve been abandoned just yet.

At my weekly follow-up with my plastic surgeon we went through the pre-op and consent signing process for my upcoming plastic surgery. Mostly she will be cleaning up scar tissue and doing some abdominal and breast liposuction to make for a more contoured abdominal area. She will remove fat from my sides, where there is more than there should be, so that my breasts and my torso look well proportioned. She won’t be doing any lipo on my thighs. If I decide later that I want larger breasts, she can move fat from a different donor site (thighs), but that isn’t warranted at this time (any enhancement I want can come from the fat that is removed from my abdomen and sides/hips). Mostly, I’ll be happy with just getting this surgery done. My open abdominal wound is healing well and has shown significant decrease in size. Now that the infection has cleared, we have re-installed a SNaP device. As long as my skin doesn’t reject it, it will stay on for the next week (with a dressing change on Monday), at which time we will re-assess.

And so, today I graduated from the care of my oncologist – it is bitter sweet.

I never thought I’d be asking myself that question. I did a nipple sparing breast reconstruction, so I have all my own skin – and mostly the breast skin – but my areola’s have faded. Since they didn’t have a lot of colour to begin with, fading means that they are barely there. So, now I need to decided if I want tattoos to re-add some colour to the skin. I need to make this decision relatively quickly, as it affects how my plastic surgeon (PS) does the scar revision. She will do more or less cosmetic clean up depending on whether I plan to tattoo.

I also need to decide if I want to change the size of my new breast. The PS will use liposuction to do some  re-shaping of my breasts and abdomen to make the the shape more flowy and natural – that is, remove some of the bulges that occur as a result of the long scar across my abdomen. She (my PS) did such a remarkable job the first time, that these are all pretty minor – but enough to make clothes fitting a challenge – which is my challenge for this morning – finding something in my closet that is appropriate to wear to an academic conference!

In my limited time this week – it is a crazy week – I need to do some more research on liposuction – what it entails, and what the recovery is like. I also might go and buy some temporary nipple tattoos to see what I think of the whole idea. If you want to read more about them, see CoffeeMommy’s blog post on a package of self-confidence that came in the mail – http://coffeemommy-at-work.blogspot.com/2014/09/a-package-of-self-confidence-arrived-in.html

I am watching wantingly as many of my Canadian friends share their photos of cross country skiing. February and March are the best months for it – the temperatures usually warm up a little in late February, and there is ample snow to keep the trails fresh. As I see the photos, I can smell it.

And yet, I am glad that I’m not experiencing winter this year. I need to recover more before I’ll be able to ski, but even more so, to contemplate doing things outdoors in sub-zero temperatures. This is one of my new risks. I now have body parts (my new breasts and belly) that I can no longer feel. They are living flesh, warm to the touch, but they lack sensation. I need to re-learn what normal feels like, but also, I need to learn how to check myself to ensure that I’m not getting frostbite.

I’m also exploring what it now means to do a breast self-exam. This is how I caught my cancer. I examined my breasts every time I got in the shower. I saw the change almost immediately – a lump and some non-clear discharge. But now I don’t have breasts with breast tissue. My nipples are still my nipples, but they don’t leak anymore. They are unfeeling and unresponsive but still warm to the touch.

Now, I still examine my breasts but I’m looking for something completely different. I’m not looking for lumps (they are just stitches afterall!). Instead, I’m examining the skin. I’m looking for damage – damage that might have happened but I didn’t notice because I cannot feel it. Women who have reconstructive surgery are often advised not to wear underwire bras – it isn’t because the bras themselves are problematic, it is because if the wire were to poke at you, you wouldn’t feel it. It would go unnoticed until it had done some serious damage.

So part of my new normal is this exploration of my new body. I’m now exploring my areas of no feeling, but also trying to find the boundaries – the areas where feeling fades from something to nothing. I want to see if these boundaries change. I’m told that I could regain some of my feeling, but only time will tell (nerves can take up to three years to grow back). For now, I’m happy that we are not in winter, and that I’ll have at least a year or two, maybe more, before I need to contemplate what snow and cold temperature mean for my new body.

I hate changing my dressings. At the moment, I  am required to do it three times a day. The breast dressing is no big deal. It is a matter of ensuring that it is adequately moist – so adding a little ointment and slapping on a new patch of xeroform. The stomach dressing, well that is a whole other thing.

As I mentioned previous post, I have a hole in my belly. I have an appointment on Thursday afternoon where I am hoping to have a SnAP negative pressure wound system installed. Once it it is in place, I won’t be changing my belly dressings. They would get changed twice a week at the Stanford Would Care center by someone who knows that they are doing.  Until then, I need to pack damp/wet gauze into the wound three times a day. I don’t mind the packing, I just hate the unpacking. I remove the gauze which is a particular shade of blue and red (http://dttocs.smugmug.com/photos/i-JxKRZJz/0/M/i-JxKRZJz-M.jpg), and has a smell that I have come to dislike. It isn’t infected. It is all “normal”. What gets removed with the gauze when I change the dressing promotes healing (at least that is what I’m told), but I still hate doing it. I’m so looking forward to not needing to!

So this morning I’m delaying. I’m catching up on email, watching videos of all the crazy snow in Kitimat (the town were I grew up), drinking coffee, and writing this blog post instead of doing my dressing change.

OK, time to end the procrastination and get ‘dressed’.

It is odd not having feeling on your chest. This is something that surgeons have a nasty habit of forgetting to tell you. My surgeon certainly didn’t say anything about this lack of feeling. I’d read about it, so I thought I was prepared, but really, I wasn’t. On one front, the lack of feeling is a good thing – it means you don’t feel the horrible wounds as they heal. But, on the other front, it is completely disconcerting. I can understand not feeling implants, as they aren’t a part of your natural body, but when you do a flap reconstruction, they are part of your body, and yet you do not have feeling.

Imaging what your face feels like after going to the dentist for a filling. You know the side of your face is still there, but it does not have feeling. I look down and I can physically see that my breasts are there. I can touch them with my hands. I can feel that they are warm. But most of my front (breast area and belly area) are numb – just like after the dentist – only, I don’t know if my body will ever grow nerves in these areas. I don’t know if I’ll ever feel that area again.

I first noticed this lack of sensation when I was carrying a box up from the car. The box was light but bulky. I noticed that when I held it, I had no sense of where my body was. I couldn’t tell how much pressure I was using with my arms, because I didn’t have the sense of response to the pressure in my chest.  It was very weird.

I was reminding of it again when I did a chair massage at Stanford on Friday. They have massage therapists that give free chair massages to anyone who is waiting. This was the first time I’ve had the time to do it. When I climbed into the chair, it occurred to me, that leaning forward was going to produce the oddest of sensations. I did lean forward into the chair, but I found I had to visually check to see. I didn’t have the the sensory cue that I was leaning against something.

I was chatting today with a women who has implants. One of the challenges she has is that they make her hyper sensitive to both hot and cold temperatures. It is worse than having nothing, because, instead of having living flesh she has saline implants against her chest wall – which get cold or hot very easily. This was one of the reasons why I didn’t want implants. I had heard that they can be cold (and really an issue as a Canadian who someday will again experience living through winter), but I had not heard that they can also get hot. That would make Ottawa unbearable much of the year! Since I don’t have implants, my construction is living flesh, they feel warm to the touch – just like the rest of my skin. It occurs to me now, that I’ll need to be extra careful about frostbite – as I won’t feel them getting cold. I won’t have the cue to warn me that I need to do something. This is one reason why many plastic surgeons don’t recommend underwire bras after surgery. If the wire were to break through into the skin, you wouldn’t know it.

The impact of not having feeling is just starting to settle in. On Wednesday I will be 8-weeks post surgery, and will be allowed to lay on my stomach again (putting weight on my chest). This matters because it means I can get a proper massage. But the whole idea of laying down on my chest is also rather scary. Without feeling, I cannot tell if there is something wrong. I just can’t feel it!

While walking today I found myself reflecting on why I no longer take selfies when I walk. Early on, and throughout chemotherapy, I always took a selfie of me smiling while I walked along the trail. I don’t do that anymore.

One reason, is that I’m in theory finished treatment. Although my body aches, I am done with the cancer. One of the reasons I started taking selfies, was that I wanted there to be lots of pictures of me smiling. If I didn’t make it, there would be lots of happy memories for my funeral. Sounds pretty morbid, but that, in part was what I was thinking. I also wanted to show my family who live on the other side of the continent, that I was doing OK. My smile was the one thing you saw in every picture – to show that I’m doing just fine.

I am still walking, and this weekend I will start biking again. My plastic surgeon did caution me, that I’m still healing. She was pretty clear, until 8 weeks have passed, I’m healing and I’m not to overdo it … I don’t want to over do it, I just want to do it! Walking is painful. I’m slow, but my feet also hurt. The neuropathy pain gets worse the more I walk – so it is challenging to do – but since it is the only exercise I can do, I do it … almost every day. I’m so looking forward to adding biking into the mix. Crossing my fingers it all works out.