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Monday, November 30, 2015

6 month follow-up with Dr. Moore

Clearly it was 'back to work' for those doing their 9 to 5 today.  The parking lot for Dr. Moore's office was packed.  There were a few cars circling for free spots.  I made one trip through and was lucky enough to snag a spot, but it was on the far end.  I can use the exercise.

It's hard to believe that my mastectomy (part two) was six months ago. When I made this appointment in May, it seemed so far away.  Little did I know I would be having a quite interesting medical journey since that time.  I was also questioning the relevance of this appointment since I was fresh from reconstructive surgery and the surgery performed by Dr. Moore was altered. How could he comment on my recuperation?  I decided to keep the appointment anyway.

At the check in, it was a typical Monday with the 'system' not cooperating.  Apparently in preparation for some Obamacare changes, there is a new coding system, but not all the bugs have been worked out.  What would normally take 5 minutes, took a half hour.  Even after that they had to 'fudge' the system to accept payment.  I was told to, "Hold on to that receipt".  [Hmmm, I see myself talking to a 'representative' of the billing department sometime in my near future.]

I was called into the examination room and Dr. Moore joined me almost immediately.  He asked how I was doing.  I bought him up to speed with what transpired since we last met.  He did mention that he had conversations with both doctors, Mehta and Chatson.  So he was more up to speed that I thought.  I had mentioned that I thought this appointment didn't make sense given my recent reconstruction.  He agreed, but said he wanted to take a look anyway.

I removed my shirt and undershirt and he had me lie on the examination table.  I thought it was funny when he started examining my right breast.  I had to remind him that he worked on the left. [Granted he sees many patients and it's probably hard to recall which side for each.  But, I took this as validation that the reconstruction is coming along.]

Dr.  Moore examined my lymph nodes/arm pit for lumps and said, "There are none."  I had mentioned that I was concerned with a portion of my left breast (where the liposuction was performed).  To me, it felt like a large mass.  He assured me that it was normal swelling and possibly some fluid.  "I'm not concerned with it.  It's normal", he said.  Hearing that made this appointment valuable.

He said, "I prefer to stagger some of these appointments.  Since you are having a six month with Dr. Mehta in June, I want to see you next year. We can talk about our Thanksgiving."

So it's Dr. Moore on the Monday following Thanksgiving.  I'm sure this time will also fly by.

More to come.

Wednesday, November 25, 2015

Stitches removed

It must be because of the pre-holiday work day, because it took me just 20 minutes to get to Dr. Chatson's office.  I had planned for 45 minutes, so I arrived very early.  So there were many places to park.

Today is the day the sutures will be removed.  Good thing because they are starting to get itchy and seem to cling to fabric (and pull). 

The Physician's Assistant took me right in and checked my vitals.  I was asked to strip from the waist up and wait for Dr. Chatson.  Not too long after, he arrived and wished me a Happy Thanksgiving.  Looking me over he said, "Things are looking good." He asked me to mount the examination table and he prepared some surgical instruments.  While talking about what comes next, he snipped away the stitches with a minimal amount of discomfort.  Apparently, the next surgery will be some time in March.  He said he'd prefer to have about three months of recovery before he was going to place the proverbial cherry on my new left breast.  He asked me to consider if I prefer that he "attempt" to match my right nipple, or reduce the current size of the existing one and make both flat. "No need for a decision today."

I'll think about it, but my first reaction was to leave nature as it intended and create the man-made nipple to resemble what exists today. My thoughts today - tomorrow, who knows?

While the sutures were removed he said that he would also remove a skin flag I found as his Thanksgiving gift to me - no charge.   [Hmmm, we now have to have Thanksgiving gifts, I thought.]   I accepted with gratitude.

As I was dressing, he asked that I schedule an appointment for about a month out.  Also he looked over my folder and interjected with, "Oh, just so you'll know.  The tissue I removed from your right breast reduction came back as non-malignant - cancer free."

Now THAT is something to be thankful for!

Monday, November 23, 2015

3 month check-in - Dr. Mehta

It's a good thing to know back roads. 

Heading out to my appointment with my onchologist today, I noticed that 495 South was at a standstill.  With some quick thinking I headed towards the New Hampshire border and took Rosemont to Hilldale to Monument to Rte. 97. I meandered my way to West Lowell Ave and into Methuen.  Smart move.  Apparently there was a huge pothole on the bridge spanning the Merrimack which had caused a traffic tie up since 9:30 AM.  Close call.

Not sure if it were the lunch hour or the effects of the traffic, but Holy Family was a ghost town.  I had to check my appointment card to ensure that I was truly supposed to be there.  Every cloud has a silver lining and things were smooth sailing.  I was in and out of vitals check and had my labs taken care of in just 15 minutes.  I hardly had enough time to check some emails when I was called into the examination room. While waiting to Dr. Mehta to arrive, I was researching the symptoms of DVT (deep vein thrombosis). DVT has been known to be a side effect of Tamoxifen.  Today, I woke up with some pain in my calf.  Thinking it's because I haven't been able to do my regular regimen of exercise (due to my recuperation from recent reconstruction surgery), I had taken a three mile walk at 10 AM.  The pain I had was more - muscle soreness, but my heightened awareness to side effects immediately placed me on the path to DVT.  I did want to discuss this with the doctor.

Dr. Mehta arrived shortly after and was surprised by my 'new look' (my hair is growing back and I now have facial hair). He said that I was looking good.  [I bet he says that to all his cancer patients LOL].  He asked me to tell him everything - meaning any and all side effects, aches pains, and concerns.  We discussed my progressing cataract condition.  He said that Tamoxifen has been found to cause vision problems, he did say that stopping Tamoxifen would not reverse the condition.  He suggested trying some over the counter remedies (visine, omega 3 supplement) which he said may help.  But he did say that as the cataract(s) progress, surgery is the only option.  So we'll continue to monitor its progression.  At this point it's more of an aggravation.  I'm thankful that my left eye hasn't shown symptoms - yet.

Dr. Mehta looked at my list of reported side effects and asked how each was doing.  The back pains in my flank area seemed to have dissipated, my stamina is improving.  There are still some stubborn pockets of neuropathy that persist (finger and balls of my feet). He asked if I had noticed any lumps.  I had mentioned that I recently had surgery and he asked to take a look.  He said, "Things are coming along nicely".  He then began feeling for lumps/masses.  He was gentle, given that things were still in the 'tender' stage.  He said he didn't feel any masses. [It's scary to think that with everything I've been through, that I still have to be super cognizant of new lumps.  Yup, scary.]

He asked if there was anything else. I mentioned this new calf pain that started today.  He asked me to raise my pant leg and began feeling and positioning my foot while asking, "Does that hurt?"
Other than a 'sore muscle' sensation - no it didn't hurt.  He said, "If you had DVT, you would be in much more pain."  I'll monitor this.  It's tough being super sensitive - because you have to.

Dr. Mehta said, "At this point, your labs are all good, your marrow is producing, you didn't need a boost.  So I'll see you in 6 months.  No labs are required.  However, if your tolerance to Tamoxifen changes or side effects manifest (or worsen), please make an appointment."

I thanked him and said Happy Thanksgiving and he responded with, "Happy Thanksgiving, Christmas, New Years and all the others.  I'll see you in 6."

One chapter placed on hiatus.  Reconstruction continues, then on the Triple A.  Will cataract surgery jump the line?  We'll see.


Wednesday, November 18, 2015

Follow-up with Dr. Chatson

Had to deal with a lovely commute for an early appointment with Dr. Chatson.  Even with back roads it still took me 45 minutes to go 10 miles.  I'm certainly not missing my 2 - 3 hour commutes to Boston.

Since my surgery Monday, I've been encased in a compression vest.  I once again had the drain, although this time there was no drama.  I feel sore but mostly tired. It seems that I can't get more than 2 hours of sleep without waking from discomfort (back and neck).  I sooo want to be able to turn onto my side and just stretch things.  Well it's not in the cards yet.  This morning I was waking up every 15 to 20 minutes.  I decided to get up at 3 AM and sit in a chair.  I think I slept for a few hours, but there is a cost - my arms and/or leg fall asleep. [Pins and needles - hate it]

I was able to address the areas of velcro on the compression vest that felt like they are digging into me by strategically placing folded tissue.  Not the best solution, but it definitely helped.

Upon my arrival at Dr. Chatson's office I was greeted by the physician's assistant who took me into the examination room right away.  Once seated on the examination table, the compression vest came off and she began removing the dressing.  Because the output of my drain had diminished to less than 10 cc's a day, she decided to take it out.  The removal wasn't half as bad as the last time.  She indicated that I was given a smaller drain and it hadn't been in too long.  Whatever the explanation it was gone!  She told me that the doctor would be right in.

Dr. Chatson came in shortly after.  He looked at the areas and said he was pleased with the results. He asked that I wait another day before showering and try to wear the vest until Monday.  There was no need for new dressings and he indicated that the sutures would be removed next Wednesday. He did say that I should continue to 'take it easy' and don't do anything strenuous, he gave an example, raking leaves.

When I got home I took a look at the 'work' and could see the potential (once healed).  I decided to put on a tee shirt before zipping into the compression vest.  Now no need for tissues.

So far I've only had to take one pain pill.  I'm happy to report that my 'regularity' has returned. Now if I can get some 'good' sleep I'll be even happier.

More to come.

Tuesday, November 17, 2015

Day of Surgery

Well I made it through surgery.


I was the first to arrive at Holy Family at the day surgery unit, and when I say first, I was but there were no staff.  Why they told me to get there at 6 and not be called until 7:10 is beyond me [but par for the course].

When called into the unit, I was greeted by Carmilla who led the way to my 'home base'.  I'm thankful that someone was paying attention to details, because the bed was ready and the extender (to accommodate my height), was in place. I was instructed to strip down and don the lovely johnnie laid out on the bed. After completing that task, there was a steady stream of health professionals and doctors stopping by to review/update my chart.  Their motus operandi was fairly consistent . Each asked me to verify my credentials then followed up by asking pretty much the same line of questions.  [ I guess I passed, since all my answers where consistent.  At one point there was a general feeling that I was staying overnight.  There may have been some confusion as to what was actually going to be done to me today.  Someone interrupted one of the many visits and proclaimed (in their hospital/medical speak) that I was having breast construction, breast reduction and fat grafting.  I heard a collective sigh of 'oh, now we know'.  I guess it all started when I was asked, what I'm in for today?  My answer didn't jibe with their cheat sheets, so had to acknowledge (not trust) and verify. I'm was relieved to know everyone was on the same page (no pun intended).

During this in and out period, they managed to do an EKG and check my vitals a number of times. Getting closer to the time for my procedure, Nurse Tammy stopped by to insert my sent for the IV. Since my left arm was christened with a pink wrist band that read, "Restricted Extremity", Tammy was forced to use my right.  My four sessions of chemo had done a number on my veins and she was searching for a 'good' one.  It looked like the only one that could be used was near my wrist on the upper side of my hand.  Not having lots of tissue in the area, she asked my permission to use it, which I granted.  I asked what she would do if I declined.  "I'd have to use your foot", she said.  I said, "Go right a head and use the hand.  Yes it was a bit more painful, but a necessity.

Not too long after, Dr. Chatson arrived and after an exchange of pleasantries, he said, "So this is your day."  He reviewed what he was planing on doing for this surgery (first of two) then asked me to stand so he could visually inspect the areas and place marks on me using a sharpie.  I got re-dressed and was just getting into bed, when explained that we had to fit the compression vest.  Apologetically, he asked me to stand again.  The vest is one size fits most and has many panels of velcro (thus making it a universal piece).  It was tight, but that was to be expected.  He adjusted in certain places and had the nurse help him remove it. It will be placed on me just prior to my leaving that afternoon.

Dr. Chatson said, "I'll see you in there", smiled and left.  Shortly after, a few nurses and the anesthesiologist arrived to wheel me in.  After being moved to the operating table it seemed like minutes before I was asked to breath deeply - I was out.

I vaguely remember hearing someone calling my name and asking how I was doing.  Still groggy, I was in a degree of pain and asked for pain meds.  Those started working but the pain was still kind of high.  The nurse gave me more, then I was comfortably numb - and tired.  Every time I'd just sink into a deep slumber the low oxygen  level alarm would sound.  Each time this happened, my tubes were checked/arranged and finally they placed a 'reader' to my forehead.  I tried dozing off, but the alarm was persistent.  So I decided to concentrate on my waking up and becoming lucid.

Eventually I was wheeled back to my home base. I was offered crackers and fluids, which I nibbled on.  The pain as this point seemed to be more of an aggravation that pain - the meds were working.
A call was placed to my transportation and the vest was brought out.  All signs that I'm, going home.
The vest was snug, but I was able to tolerate it. I was able to dress then visit the facilities then I received notice that my ride was there.  After hoping into a wheel chair I was officially discharged at the curb.

Still groggy and loopy, I was looking forward to sitting in my favorite chair and recuperate.  The compression vest was beginning to feel uncomfortable in certain areas (but not the surgical areas). I have that lovely drain which I need to empty and record output three times daily.  Just from the time I got home until bedtime, I had 50cc (total) of bloodied fluid. While draining, I was able to 'poke around' to determine that the source of my vest discomfort was the velcro potions touching my skin.  I managed to place some tissues near the aggravated spots, which helped somewhat. [I now have a better appreciation for woman who have to deal with uncomfortable bras.]

Last night I mostly channel surfed and watched the Voice (that I had to rewind a few times because I dozed off].  I was able to have a light supper and ended up going to bed around 11.  Sleeping was tough.  I can't turn or lie on either side, so I could only have 2 hours of sleep before having to wake up.  I did finally take a half pill of the pain meds - then another half later in the night.

More to come.

Sunday, November 15, 2015

Ready for the next chapter

All systems are go for tomorrow's first of two surgeries for the reconstruction.  I'd be lying if I didn't say I am a bit apprehensive.  After having months of 'good days' peppered with some continuous aggravations (pains related to getting back into things; dealing with declining vision, etc.), I'm not looking forward to having new pains and having limits on what I can do.  It is what it is.  I'll have to deal with - 'whatever' -  as it arises.  I'm telling myself that this too will pass and be a fading memory much like my cancer surgeries and subsequent chemotherapy.  But I have to get through it first.

I do have some concerns.  These procedures will be affecting my upper torso (waist to breasts - even though I currently have just one breast).  During my recuperation from my last surgeries, I recall not being able to lie on my side while sleeping.  Granted I had my other side to use, but it just wasn't the same for the 'side sleeper' that I am.  Questions that I have (and will be answered in time):
  • How am I to sleep and get the needed rest for recuperation? 
  • Will I need to sleep sitting up in a chair?  
  • What will happen if I sneeze?  
  • What if it snows - will I be able to do any light shoveling? 
The plain answer is: I'll know, when I know.  Until then I'll hope that sneezes and snowfall remain scarce - or at least manageable.

I'm also concerned that this 'step back' will affect my recent musical proliferation.  Given my flexibility to follow my muse at any time of the day, I've managed to write a dozen songs since September.  Yes, I'm channeling the challenges of the Spring and Summer into something positive.  I've been producing a menagerie of eclectic music, from dark and brooding; manic and dissonant to soft and uplifting.  I'm pleased with the output, but fearful that the creativity could once again be blocked if I'm distracted by this latest chapter.  Hopefully it will provide even more fodder and inspiration for another dozen - or more.

I won't be out in the clear just yet.  I still have my abdominal aeortic aneurysm (Triple A) to address.  I'm also monitoring the effects of the cataracts that seem to be progressing in my right eye.  Oy - it's always something.

So I'll be enjoying my last day by doing some 'seasonal' chores that require some physical exertion (the fallen leaves - for joy).  Until my next post, thanks for reading and of course thanks for the support.

Monday, November 2, 2015

Happy November - already?

2015 has certainly been flying by.  For me, I'm sure this "tempus fugit" is exasperated by my battle with cancer and its after effects. However, I'm enjoying this brief respite, taking in the change of seasons (again), getting back to the new normal and enjoying retirement.

Halloween has come and gone and I've enjoyed that as well as I could considering everything.  I really owe it to myself to make next Halloween the best. I have one more week before my next chapter begins - the reconstruction.  [I hope I don't have to deal with any carpet-baggers.]

I continue to have 'good' days and I've regained most of my stamina.  I'm working on getting my voice back into shape and have spent much time honing my chops on the guitar.  I am spending more time playing the keyboard and trying to get that 'back' again. All things in time.

The only noticeable health issue has been my vision.  Early September, the eye doctor said I had the beginnings of cataracts (more pronounced in my right eye).  I was given a prescription for corrective lenses (for use while driving).  I don't drive as much now, but when I do, I have noticed some improvement, especially at night.  However, I'm more cognizant of the blurriness in my right eye.  At times, when covering my left (good) eye I can't see portions of my field of vision in my right eye. But, when I use both eyes (and don't think about it) I see clearly.  My left eye is compensating.

I have a follow-up with my oncologist, Dr. Mehta, at the end of November.  I'll monitor this progress and discuss the possibilities of it being caused or hastening the progression of the deterioration.