Guy's Gotta Talk About Diabetes, Breast cancer, and Alzheimer's: Reconstruction

Showing posts with label Reconstruction. Show all posts

Sunday, May 29, 2022

GUY’S GOTTA TALK ABOUT BREAST CANCER #51…After Explant and Slow Going

The FIRST surprise came when they told her “You won’t be able to do anything

‘normally’ for another six months.”

WTH???? The doctor clarified that she’d be unable to lift large objects for that period of time. That the “large objects” included our almost-three-year-old-grandson was not what we expected. Fortunately he’s of the “always running at high speed until he conks out for a nap” kind of kiddo! He doesn’t USUALLY let us carry him anymore.

The second surprise was that she couldn’t life ANYTHING for the first two weeks; and she COULD NOT UNDER ANY CIRCUMSTANCES reach for anything over her head for some time – an indeterminate number that depended on several factors – rate of wound healing, condition of the skin as the wound healed, and “pain indicators”, ie, “If it hurts, don’t do it!”

Why?

Well, it involved, in my wife, after the removal of the implant and the scar-tissue capsule that had formed around it, “The muscle is often times sewn back down after an explanation. As long as the capsule is removed the muscle will scar and stick back down. There is raw tissue on both sides that the body will heal together.”

But, like all major surgery, it doesn’t happen FAST. Unlike the external incisions which form scabs to protect the healing injury, internal healing takes more time. It’s also the reason “drains” are placed under the skin to drain away any serous fluid that gathers post-surgery. Sometimes there is a small amount of blood as well. My wife’s physician’s assistant took out the tubes. The procedure was simple: a couple of stitches that held the tubes in place were snipped and the tubes pulled out without any real discomfort. My wife was fine with it at the time. She’s still experiencing some pain as she heals, but the doctor assured us that that is normal.

We’re not teenagers anymore! Not even in our fifties anymore. ALL injuries take longer to heal. My wife sometimes tries to do too much (I know, SHOCKING!), then has to back off an rest. Considering it’s been a GRAND total of nineteen DAYS since she was under anesthesia for three-and-a-half HOURS!!!!, I think she’s doing pretty good. She just wants to do MORE!

The doctor was pleased with the result, and now, like all good things, it will take some time to be back up to full speed!

[While there ARE YouTubes regarding explant surgery, I didn’t watch them myself as I don’t have the background to judge whether what they say is true or deals with explant surgery realistically. Feel free to Google them and judge for yourselves!]

Resource: https://www.realself.com/question/chico-ca-muscle-repair-explanting
(Answers the question: “How is muscle repair done when explanting?”); https://www.realself.com/question/new-york-new-york-drains-after-breast-implant-removal-collect-fluids-tissue (Answers the question:
Do drains placed in the chest after explant collect fluids and tissue?)
Image: http://wrex.images.worldnow.com/images/23784252_SA.jpg

Sunday, May 15, 2022

GUY’S GOTTA TALK ABOUT BREAST CANCER #50…Drain Pains, and Chest Wraps, and Pain Meds, OH MY!

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Well, it’s over.

The surgery, anyway. Now we’re coming up on the end of the first week, post-operative. It’s funny, the routine is so similar to the radical mastectomy, and the implant surgery, that it feels like no time has passed at all; almost like we’re replaying a milder version of the whole experience like a movie; and back at the beginning.

But 11 years ago, I was only 54 and had a lot more energy than I do now. OTOH, the kids were 19 and 23 when my wife was first diagnosed, they’re 34 and 31 now with spouses and kids of their own. Everything the doctors told us that would happen was mere speculation; a dream (or nightmare if, you will); and not truly comprehensible. We’d nothing to compare it to…

The implant surgery two years later, was also not truly comprehensible, but it lacked the raw terror of the diagnosis and demand for instant-if-not-sooner from the hospital and her doctor of the diagnosis and headlong rush to stop the monster from eating my wife; their mother, sister, sister-in-law, daughter-in-law, friend, neighbor....

During those days, we measured the time from the morning we checked into the hospital for the double mastectomy surgery to the end result as a matter of a few hundreds of hours. Then there was the benevolent abuse of chemotherapy, as hair vanished and weariness was the order of the day. Breast reconstruction two years later lacked the terror and seemed to be a good thing.

We find ourselves 11 years later, wondering what happened, and the images of my wife with chest drains and on pain meds (all the while worry that if she takes too many she’ll become an ADDICT!!!), chest wrapped in an ace bandage, and a visual inspection of the end result and being impressed by the neatness of the stitches; glad that it’s over…again. Those same intentional, healing wounds inspiring a shortness of breath in me and tears and countless phone calls from our kids, kids-in-law, and foster-kids.

And yet…and yet…when the doctor made the incision to remove the implants and their scar capsules, there was a faint fear that she would come out and say, “I’m sorry, but we found more cancer.”

But that’s NOT what she said. She said, “The surgery went very smoothly and we’re done a bit before we estimated we’d be done. She’s doing very well.” Those were the only words we needed to hear and so today I write from a place where my wife is steadily healing and growing stronger every day!

For those of you who are Christians, please join me in thanking God…He is worthy…please sing along with congregation of Christians in giving praise to Him: https://www.youtube.com/watch?v=fs7Kah6wnY8

Image: http://wrex.images.worldnow.com/images/23784252_SA.jpg

Sunday, May 8, 2022

GUY’S GOTTA TALK ABOUT BREAST CANCER #49…Almost the Day For the Explant

My heart still skips a beat, not because I’m ACTUALLY afraid, rather because of a vague sense of anxiety for the future.

After the original mastectomy, which was essentially an emergency once the breast cancer diagnosis was verified – medical care was reduced to countless visits to hospitals and clinics for pre-op, post-op, then chemotherapy consults, followed by weeks of chemo administered at a clinic across town, then the OTHER clinic visits for Neulasta to control what the chemo did to the did to my wife’s immune system, followed by more pre-sessions…

Two years later, we did another round because the breast cancer appeared to be gone…then my wife jammed her finger against a wall, a doctor said, “Don’t worry.” And then she had full scale lymphedema (which at the time wasn’t considered the business of the breast cancer community on any level, and was “just bad luck, oh well, thank you very much for your concern, *slam!*”).

And so today, after a revolution within the breast cancer community declared that lymphedema was real, but there was no cure for it and very little help…we’ve just learned to deal with it and learned to navigate the things we need to do.

Then the breast implant surgery, followed by ten years of pain…and now here we are. To say that the past eleven years have been a roller coaster begs me to point out that it was an amusement park roller coaster – it was a roller coaster IN AGONIZINGLY SLOW MOTION.

Tomorrow morning, we hope to enter the absolutely final step of this expedition Explant Surgery. What is Explant Surgery? “Explant Surgery and En Bloc Capsulectomy/Implant removal (or explant surgery) is an option for patients who are having problems with their breast implants, or who now simply prefer to be implant-free.

“The procedure removes the implant, usually along with part or all of the surrounding scar capsule. ‘En bloc’ capsulectomy involves removal of the implant and [scar tissue] capsule as one specimen... When performed alone, explant surgery is usually an outpatient procedure. The incision used to remove the implant is usually based on the patient's prior surgical history. The amount of capsule that needs to be removed in conjunction with explant surgery is [also] influenced by several factors (…diagnosis, surgical plan, patient preferences, etc), and is determined on a case-by-case basis.)”

As well, because there were two methods of doing the implant surgery – either UNDER the chest muscle or ON TO OF the chest muscle – hers will be removal from under the muscles. That requires the repair of the chest muscles and necessitates two weeks of extremely restricted movement, followed by two more weeks of limited lifting.

Two weeks from today, I’ll have more to say. As for now, “anticipatory stress” is all I have to deal with. And my wife is doing very well – she’s been baking, cleaning, preparing for the month of inaction, so she’s got things in a good perspective.

I’ll let you know more later!

Resource: https://www.bustle.com/wellness/explant-surgery-breast-implant-removal-experts, https://www.breastimplantcancer.org/treatment/#:~:text=What%20Is%20an%20Explant%3F,response%20to%20a%20foreign%20object.
Image: http://wrex.images.worldnow.com/images/23784252_SA.jpg

Sunday, April 24, 2022

GUY’S GOTTA TALK ABOUT BREAST CANCER #48: END OF AN ERA – Removing the Implants…

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Yesterday, my wife went in for a consultation to – after nearly 10 years with discomfort that began almost immediately – remove the breast implants that, along with a platform and removal of several muscles, were the “breast cancer reconstruction”. The removal of breast implants is also called an “explant”.

I did an entire series starting in April of 2013 and if you want to read it, the links are at the end of this essay.

Needless to say, the date of the consultation, originally made two years ago…and then cancelled due to the global COVID-19 pandemic…was met with (for me) incomprehensible trepidation. In other words, deep fear that was truly impossible for me to understand.

My wife had seen the surgeon on a television interview on a local news station, and unlike the male surgeon who performed the initial reconstruction, was a woman. She seemed to be the perfect match for my wife, in that she was also an oncologist. If anything were to go wrong, this is the doctor who would know what to do next.

So yesterday, my wife set off for the long, long delayed consultation, with her oldest and closest friend at her side…because I was sitting with my middle school grandson who had come down with influenza (which was, of course, sweeping through the middle school…which is a surging mass of coughing, sneezing, touching pre-and-mid-adolescents…don’t get me wrong, I really loved my decade as an 8th grade Earth science teacher. I WAS however burned out and gladly advanced to teaching high school…albeit BARELY more civilized ninth graders.)

At any rate, the two coincided and I sat while my wife and her best female friend headed to the clinic. I can’t give you details of what transpired there, but she went in pensive and mostly silent while I was in the car. The biggest concern was if the surgeon would still do the surgery with the threat of lymphedema hanging over her head.

I won’t draw it out, but she texted me 45 minutes later (BARELY enough time for them to get to the clinic, let alone enough time to discuss the explant and make plans!) she was on her way to pick me up from my grandson (who was fast asleep)...

But that’s what happened. The doctor was very matter-of-fact, sympathetic, and authentic. My wife liked her, and they discussed what the expectations are for both the end result and the actual surgery. As might be imagined both the surgery and the recovery are significantly less invasive than the reconstruction was. The explant is standard procedure for any woman with implants, and should take place between 10 to 15 years. (See this link for an article on what, precisely is done: https://breastcancerreaper.blogspot.com/2022/03/related-medical-issues-right-now-6.html)

Recovery will involve the same kinds of adaptations to post-surgery procedures: chest drains, restricted lifting, stretching, reaching, or other day-to-day movements that will have to be approached with caution until healing is complete. They talked about other issues, but one unexpected bonus, was that the doctor gave my wife a contact for getting her compression sleeves covered by our insurance.

Sunday, March 13, 2022

RELATED MEDICAL ISSUES RIGHT NOW! #7: Removing The Implants…FINALLY!!!

From the first moment my

wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

From the first moment I discovered my dad had been diagnosed with Alzheimer’s, it seemed like I was alone in this ugly place. Even ones who had loved ones suffering in this way; even though people TALKED about the disease, it felt for me like they did little more than mumble about the experience. Not one to shut up for any known reason, I added a section to this blog…

The immediate crisis that was Breast Cancer and Alzheimer’s have passed. There are, however ancillary issues like testing and treatments that may not be directly related to BC or A but intersect with them. Harvested from different websites, journals and podcasts, I’ll translate them into understandable English and share them with you. Today: Removing the reconstructive breast implants.

From shortly after she healed from the surgery that had placed implants in her chest to mimic the real breasts that had been removed during a radical mastectomy and chemotherapy to right now...my wife was in pain.

Not from the surgery, though that was rough, but from the implants themselves. Healthline suggests that there are reasons for the discomfort: “Although breast implants don’t expire, they have a limited life span. The American Society of Plastic Surgeons states implants should be removed or exchanged every 10 to 15 years…breast implants may need to be removed or replaced is because scar tissue can harden around the implants…[and] cause pain and discomfort…” My wife had the initial mastectomy on April 3, 2011; the breast replacements/gel implants were placed on October 13, 2013. A bit short of the “10-year warranty”, she’s thrilled that the process is once again moving forward (COVID-19 delayed her by two years).

It all seems pretty straightforward, but there appear to be other issues to consider, such as the “tissue capsule”: “Removal of the implant and tissue capsule. This part of the procedure depends on your implant issues or surgery goals. Over time, scar tissue naturally develops around an implant, creating a tissue capsule. Some surgeons will only remove the implant and leave the tissue capsule. Others will remove the capsule — a more time consuming procedure — or a portion of the capsule.”

What exactly IS a “tissue capsule”? “…fibrous scar tissue forms around [the implant], creating a sort of ‘bag’ that holds the implant. The body forms a protective capsule like this around any object it recognizes as foreign. The tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place.” This is removed along with the intentionally deflated plastic bag that held the gel that gave the implants the rounded, "more-or-less" breast-shape.

So, once they implants are removed? Healing (obviously), and then, just like we’ve done all along these past eleven years – my wife will deal and I will be there beside her, supporting her in whatever way I can.

Oh…and once again blogging the Guys Gotta Talk About Breast Cancer.

Resources: https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options/breast-reconstruction-using-implants.html, https://www.healthline.com/health/breast-implant-removal#when-needed
Image: https://pubs.rsna.org/cms/10.1148/rg.2017170025/asset/images/medium/rg.2017170025.fig1.gif

Saturday, June 14, 2014

The Reconstruction Era – History and Future! Part 13

“It appears that the next event is breast reconstruction!”

Today will be a bit of history regarding breast reconstruction and a glimpse into the future.

“Documented cases of breast cancer date back to 6000 BC...George Washington’s mother, Queen Mary, and Nabby Adams (daughter of John (second president of the US) and Abigail Adams) succumbed to breast cancer...Breast cancer surgery was revolutionized by Dr. William Halsted, who popularized the radical mastectomy as the treatment of choice for any woman with breast cancer...the latter half of the 20th century [saw] the modified radical mastectomy...breast conservation therapy...sentinel lymph node biopsy and radiation was developed...[and] the emergence of breast cancer reconstruction.”

Initial attempts at reconstruction were crude, though as the years passed, certain of those techniques finally met adequate technology. For example, in the 1800’s, there were attempts to transplant a lipoma (fat slice) to a mastectomy site. This lead to techniques that were largely unsatisfactory, but were clear precursors to the current successful practice of the microsurgery that allows for TRAM flap reconstruction. As well, initial use of silicone breast implants, the subsequent frenzy that toppled the Dow Corning corporate giant, and the FDA’s recanting of its 24-year ban on the same implants; has led to the use of both saline and silicone implants preceded by insertion of expandable “bubbles” to stretch tissue in preparation for the implant, and cadaver-harvested, cell-free matrix that holds the expander in place.

What exactly does the future hold?

Some possibilities:

“Adipose derived stem cell breast reconstruction...is still considered experimental...” and involves the removal of fat tissue. One half remains as it is, but the other half undergoes a process that concentrates stem cells. This “concentrate” is then mixed with the original fat tissue and injected into the breast. The stem cells take on the characteristics of the fat and grow into fat cells. There is however, good evidence that this procedure is becoming more generally accepted. (http://www.futuremedicine.com/doi/abs/10.2217/17460751.4.1.109)

“skin-sparing and nipple-sparing mastectomy” in which the surgeon removes cancerous breast tissue through a small incision usually around the areola area of the nipple.

In New Zealand, “[A new] tissue expansion...technique allows soft tissue [to be made into a] meshed matrix of connective tissue [where] small amounts of fat can be injected into separate small tunnels.” The method has been in use for 30 years, but this is a new and exciting possibility for reconstructing human breast tissue – with even less invasion of the body than ever before.

The future is not only on its way – it may actually be here!

Resources: http://www.breastreconstruction.org/ReconstructionOverview/breast_cancer_reconstruction_history.html, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884724/, http://www.medpagetoday.com/Blogs/CelebrityDiagnosis/31043, http://www.breastpreservationfoundation.org/skin-sparing-mastectomy/, http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11219885&ref=rss

Image: http://thedemarcationproblem.files.wordpress.com/2012/06/surg2.jpg

Saturday, May 17, 2014

The Reconstruction Era – Part 12

http://cdnpix.com/show/imgs/e563e4adcff26429de48a29ff869eddc.jpg

“It appears that the next event is breast reconstruction!”

You know, it probably seems like I’ve been harping on this whole subject of lymphedema WAY too much.

In the whole SCOPE of things, you might say, this is barely a blip! I mean the cancer is gone, the breasts reconstructed, she looks natural, and we’re even planning on taking part in a public event in which we, for the very first time, publicly acknowledge that she had breast cancer.

We will be walking in our local Relay For Life event. We’ve never done one before. Haven’t done the Susan B. Komen Race For The Cure. Nothing like that. I am on a school faculty team, my wife

will be doing a Survivor’s Lap, we will be in front of my students.

Lymphedema and all and, according to her therapist – lymphedema FOREVER.

For those of you who don’t know what lymphedema is: a swelling of body tissue “caused by a blockage of the lymphatic system (vein-like tubes that run parallel to veins and arteries but carry a clear liquid called ‘lymph’), which are part of the immune and circulatory systems. The blockage prevents lymph fluid from draining well, and as the fluid builds up, the swelling continues.”

Specifically as regards breast cancer...hang on, let me point out something to you. GOOGLE breast cancer lymphedema. After three ADS, a cluster of scholarly articles, you come to the meat of the thing, which is a listing of places you can read about lymphedema. My new problem is that few (if any) people talk about lymphedema as a side-effect of mastectomies – in which not only is a breast or both breasts removed – lymph nodes in the armpit are often removed as well

The first article says: “a potential side effect of breast cancer surgery and radiation therapy that can appear in some people” (emphasis mine)

The second article: “Women who have been treated for breast cancer may be at risk for lymphedema in the arm, breast, and chest.” (emphasis mine)

The third article: “Lymphedema is one of the most common side effects of breast cancer treatments.” (emphasis mine)

Finally in the fourth article, we get: “It is common after a mastectomy, lumpectomy or breast cancer surgery and radiation therapy” (emphasis mine)

Do you see the progression there? The first practically guarantees that there won’t be any such thing as lymphedema; that it’s a “potential” problem. [So is water in my basement because we live on reclaimed swampland. But after 20 years here, we’ve never had it. To ME, that’s what a “potential” is.] My wife’s doctor assured her that there was nothing wrong after she rammed her hand into the wall on Thanksgiving Day two years ago. That was the day her arm began to swell as white-blood-cell-laden lymph rushed to the scene to make sure there was no infection after the injury. Once there however, the lymph had nowhere to go because 21 of 40-some lymph nodes – which when compressed, move the lymph – had been taken out during the mastectomy. So her arm swelled and the doctor continued to tell her it was no problem.

The next two admit that lymphedema is a problem, but only a “risk” or “one of the most common” [By implication, there are other side-effects that are more pressing, so don’t really worry about this one...] After she changed clinics, the therapist was appalled and gave us a number of things we could do, including massage that would push the lymph back to the remaining nodes so it could be redistributed. This worked. Sort of. She also prescribed a compression sleeve (that stopped about three inches short of the shoulder) and an oven-mitt kind of arm cover to be worn at night. While things got better, the lymphedema remained obvious and, for my wife, ugly. So things remained for about a year.

We continued to hear that “lymphedema can be cured!” from my sister, who works in a wellness center in a city far south of our home that is world-renowned for its medical center. Kings and presidents have been treated there. The problem was that regular treatment would involve a long, long drive, so my wife began to look closer to home. After half a dozen “referrals”, she finally arrived at a place where not only did people take lymphedema seriously, they also began an IMMEDIATE and immediately effective regimen. The immediately prescribed a tight set of wrappings alternating with heavy gauze, and prescribed a two-piece “body armor” kind of device worn for four weeks. Within two months, the swelling was down, they took measurements, and my wife now has a compression garment that not only fits her hand and goes up and over the shoulder, it’s also hard to see! It also came with a device that helps her get it onto her arm alone!

So we met the people who believed that lymphedema “is common” after mastectomy, who treated it aggressively, and who have in a comparatively short time, won. They were also very clear that this is a FOREVER thing. Health insurance also recognizes that it’s a forever thing because they will pay for TWO compression garments a year. This new one has also helped treat some nagging lymphedema over the breast implant. Once that went down, my daughter and wife discovered that: ““Blinkin’, fix your boobs! You look like a bleedin’ Picasso!”” (From the Mel Brooks movie, “Robin Hood, Men In Tights”)

*sigh*. If it isn’t one thing, it’s another...

Image: http://cdnpix.com/show/imgs/e563e4adcff26429de48a29ff869eddc.jpg