It's a Bosom Thing: caffeine

Friday, July 14, 2017

Phase 2 Surgery: Pre-op Visit and Plans

Here we are in mid-July already! Hard to believe how quickly this year is moving along. A lot of days, I can almost forget that any of this breast cancer stuff has actually happened...then I'll roll over in bed and feel a pinch on the side of my breasts where the drains were or catch a glimpse of my incisions in the mirror. The scars honestly don't bother me that much...battle scars aren't all bad. However, I am most definitely ready for the nipple reconstruction portion.

Yesterday, I met with Dr. O's nurse, Crystal. She went over all of the pre-op and post-op instructions for my upcoming Phase 2 surgery, sent in my prescriptions, gave me my lab orders, and scheduled my follow-up appointments.

Here's what I learned:

The scar revision portion is "as needed". Crystal explained that any areas where the abdominal incision scar might be wider than necessary, raised, or have hard spots is where Dr. O would target. As I've shown y'all before, my abdominal incision has healed quite nicely so I'm not sure how much (if anything) he will do there.

The nipple reconstruction is pretty much exactly like the video I included in my previous post. The new nipples will be large at first (in addition to swollen) because they anticipate them reducing in size by 50%!! Wow! I have read from a lot of women that over time their new nipples flattened out and were no longer 3D, so I asked my nurse about that. She said that this was very patient-specific and had to do with skin elasticity and health more than anything else. A diabetic patient or a patient with lots of stretch marks on her breasts will have a harder time with the nipple reconstruction staying as intended. Makes total sense since the new nipples are made out of the skin flaps that he placed during my Phase 1 procedures. Since I do not have any issues with elasticity or healing, Crystal believes I should have great results.

The fat grafting portion of the surgery is probably the biggest portion and the one that'll leave quite a bit of bruising and soreness. Dr. O had told me that my thighs would be significantly sore. He will liposuction my flanks and the abdominal area to remove those "dog ears" and smooth things out as needed. What he takes from there and my thighs will then go toward building up some size and the overall shaping of my breasts.

Pre-op for this one is easy. I only had to get two labs and an EKG (which I took care of yesterday after my office visit). Dr. O wrote for an antibiotic for 1 week post-op (I picked it up yesterday too!)....I didn't have to take one for Phase 1 interestingly enough. I am allowed to take Tramadol for pain if needed (but the pain meds make me nauseated, so I'll most likely skip this) or just Tylenol and Ibuprofen. She also recommended having the Colace around again...constipation is pretty common after anesthesia and especially with the pain meds. I also had the option of a script for an anti-nausea med....again, I think I took one pill last time, so I'm not worried about needing this.

I will wake-up in a bra similar to the one I had after the first surgery...not attractive but it does the job. I will only wear it for 3 days this time! At day 4, I can switch to the underwire-free bra of my choice lined with breast pads...like the ones used by breastfeeding moms. Crystal instructed me to cut a hole in the center of the pads "like a bull's eye" and to stack 3-4 of them on my new nipples. The goal is for there to be enough padding to keep my new nipples from being smashed by my bra. It was a little weird buying a box of these yesterday...haven't purchased any in 15 years!

I will also wake up in a compression garment. This one will go from just under my breast to my knees. My nurse recommended that I purchase a similar one (Flexees, Spanx, etc.) since I will wear it 24/7 for 4-6 weeks (Not to mention the fact that it'll be August in South Texas at that time!!). She informed me that the one they provide is quite thick and VERY tight so most patients are more comfortable in a store-bought version. I was able to find one like she described at Walmart yesterday for ~$20.

I liked the Flexees brand abdominal binder best after my last surgery too.

I am not allowed to drive for 1 week and no lifting over 10lbs for 2 weeks. Exercise is limited to walking. Unfortunately, it's back to showering with the water only on my back for about a month and no side or back sleeping for at least 3 weeks. That will take some getting used to again!

Follow-up with the nurse at 2 weeks and with Dr. O at one month. Crystal said that the stitches in the nipples will usually dissolve in 3-4 weeks. Good news: NO DRAINS with this surgery!!! That's definitely a BONUS!

So, that's pretty much it. Obviously, all MDs do things a little differently, but this might give you a starting point for asking questions as you discuss your surgical plans.

Y'all know I like to have a plan and the details so I can be prepared. Now that I've got that, I'm good to go. The only things left to do is a little housecleaning and grocery shopping next week. (I'm actually working Sunday and Monday before my Tuesday morning surgery so I won't have time to do anything the day before.) Surgery is at 0730 (got to be there at 0530) and is outpatient so I should be home by late

afternoon/evening.

Any of you already been thru this Phase 2 and have advice? Please comment below and share.

Counting down....T-minus 11 days...

MY TIMELINE:

12/22/16 Routine Screening Mammogram

01/18/17 Repeat Imaging and US of left breast; LUMP found.

01/20/17 Core Needle Biopsy

01/24/17 Biopsy results positive...Stage 0 DCIS, left breast

01/25/17 Meeting with Breast Center Navigator and Genetic Testing

01/30/17 Consultation with Surgical Oncologist, Dr. K

02/08/17 Consultation with Plastic Surgeon

02/21/17 Pre-op Visit with Dr. O's nurse

02/27/17 Pre-op Labs and Testing

03/05/17 Lymph Node Injection

03/06/17 SURGERY DAY!

03/10/17 Home!

03/16/17 10 day Post-op Visit with Plastic Surgery nurse
03/20/17 2 week Post-op Appointment with Surgical Oncologist, Dr. K

04/07/17 1 month Post-Op w/Plastic Surgeon, Dr. O

04/16/17 Returning to work!
05/19/17 Appointment with Dr. O to schedule Phase 2 Surgery!

07/13/17 Pre-op Visit with Dr. O's nurse; Pre-op Labs/EKG

07/25/17 Phase 2 Surgery!!

Thursday, March 2, 2017

Pre-op...getting ready for the BIG day!

Today I am less than 4 days away from the BIG SURGERY!

On 02/21 I went for my pre-op with my Plastic Surgeon's nurse. Even though I had read through all of the information they gave me ahead of time, there was still new information and instructions.

C gave me all of my prescriptions on this visit and went over instructions for their use. Post-op, I will need to take:

Celebrex as an anti-inflammatory and pain med x 1 week
Gabapentin for nerve pain x 2 weeks
Phenergan for nausea as needed
Oxycodone as needed for breakthrough pain
Extra-strength Tylenol for pain as needed
Baby Aspirin to prevent blood clots x 2 weeks
Stool Softener and Milk of Mag for constipation daily until regular bowel movements resume

I was also instructed to drink 2 protein shakes (think Ensure or Boost) per day for this entire week before surgery. They also recommend a high protein diet after surgery to promote healing.

She gave me a pre-op carbohydrate drink that I have to mix with water and take the night before and the morning off surgery. Other than that, nothing after midnight.

C also gave me the order for my pre-op labs and tests. These are in addition to the ones Dr. K, my Surgical Oncologist ordered.

I had already read that I would not be allowed to have caffeine for 2 weeks prior to surgery and 4-6 weeks after surgery, so I have been weaning myself off of my caffeine for the last several weeks. It's a good thing too, because I had terrible headaches at first! If you are a caffeine-aholic like me, I highly recommend you start weaning yourself in the beginning of your journey rather than waiting until just before surgery.

The kicker to this one is that it means I can't have chocolate either!!! So, the protein shakes mentioned above have to be vanilla or strawberry or something else. Of course, it happens to be Girl Scout Cookie season here!! I just received my Thin Mints the day I was to start being caffeine-free!! At least they taste great frozen....they'll be waiting in my freezer after recovery. :)

While I was in the office, C showed me the mastectomy bra and the abdominal binder I will need to wear 24/7 for 2 weeks after surgery. These two items will be fitted and supplied while I'm in the hospital (staying 3-4 days post-op). The only time these come off is for daily showers and while being washed/air dried.

They also made me sign a statement saying that I understood that I would need 24 hr care for the first 2 weeks!

Something I did not have on my list and had to pick-up was a package of cotton t-shirts. C instructed me to buy a larger size t-shirt and cut it up the middle. I am to put it on like a jacket (nothing over my head) to wear underneath my bra and binder....this will protect my incisions and also help keep the bra and binder cleaner. Good to know.

Here are just a few of my post-op restrictions:

No lifting greater than 10lbs and no repetitive motions. It actually says no housework!!! Woohoo! Too bad insurance doesn't cover a maid, huh?
No sleeping on my stomach or sides for 3-4 weeks.....I'm a side-sleeper, so this should be interesting.
Also, no sitting in the sun or heat for 3-4 weeks. It can cause swelling and firmness. I live in South Texas...it's been in the 90's several days in February! :)

On 02/27, I had labs drawn, an EKG, and a chest X-ray. I waited longer than the actual tests took. Other than the blood draw, nothing is invasive or painful.

People keep asking me if I'm getting nervous.......the answer is "not really", but I am feeling a little more like it's actually going to happen. I also feel like there's things I wanted to get done and haven't....more cleaning around the house and stuff. But, I think that's just me trying to keep busy.

Words of Advice:

Life goes on...good and bad. So much has revolved around my diagnosis this last month and a half. I really haven't had very many days that were free from work, appointments, getting things ready, etc.

It's easy to get bogged down by the diagnosis and let it take over...don't. I have tried to continue to make room for normal life. My son still has school and tennis season coming up and a science project due.

Example: Last Sunday was beautiful outside...a perfect Spring day for getting our container garden going. I almost didn't do it because for a moment I thought: "What's the point? I'm not going to be able to take care of it." But, that's not right....we always have a garden and it is something my son and I share and enjoy together. There aren't that many things a 14 year old wants to do with his mom! I'm taking advantage of every one! I don't want this whole year to be a bad memory of hospitals and scary diagnoses. We planted our garden, mulched a flower bed, trimmed trees....it felt great and I'm so happy we did it. And, walking out back to clip herbs will be one of my exercises during recovery. :)

This week, I came home late from work to find our electric water heater burning...like actual smoke coming from the bottom element! It smelled so bad! It was scary too. Needless to say, I wasn't planning on replacing my water heater 4 days before surgery, but life seems to be throwing me some curveballs lately. On the bright side, I'm so glad it happened when I was home to catch it and when I could get it replaced....it would really be bad to have no hot water post-op! And, grateful for friends who volunteer their time to help....a friend installed our new one tonight!

Life doesn't slow down just because you have breast cancer. It is times like these though that you can truly appreciate the help, love, and support of friends and family! So many people have bought t-shirts in my fundraiser/awareness campaign, have sent gifts, and offered their encouragement, prayers, and their time.

Potluck at work tomorrow with my amazing coworkers....it's going to be hard to be away from them for 6 weeks. Birthday celebration with my family on Saturday night. Church, packing for the hospital, and lymph node injection on Sunday. Then....that's it...I have to be at the hospital at 0530 on Monday morning!!