saltine

Heartburn Doth Strike

Heartburn appeared pretty much as soon as the cocktail of “pre-meds” wore off (one of which was a dose of Zantac). I felt really good on treatment day (apart from being high as a kite from the Benedryl), and the next day too. Then after a fab dinner of chili, Liam and I went to his Grade 9 Open House where I proceeded to SUFFER. 

As a consequence I am now armed with heartburn information and meds. Here are the highlights:

What is heartburn?

It’s often called Acid Reflux. Basically it’s when acid from your stomach that is there to digest your food goes starts to hurt you. Generally speaking, the acid in your stomach splashes up into your esophagus (food tube). There might be too much of it, your stomach might be too full or the muscle that acts as an elastic band between the stomach and esophagus might be too weak.

The official name for it is GERD (Gastroesophageal reflux disease) which is a disease that affects the muscle I was talking about. The official name is the Lower Esophageal Sphincter (there is more than one, sphincter! Ha!). As I mentioned, the LES is between the stomach and esophagus – it’s a band of muscle. GERD can also happen to pregnant women since the LES is more relaxed due to all of the hormones. Also, the baby pushes up against the stomach which drives food up through the LES. (I ate a lot of Tums.) Other folks who have a hiatal hernia can get GERD. That’s where part of the stomach and esophagus get pushed up into the chest wall where it doesn’t belong. 

Here’s a diagram that I drew for you (including my recent incisions and my portacath too). It  shows you where things are:

heartburn
Should have put the diaphragm in. Forgot that. 

Why does heartburn affect people on chemo? 

Chemo targets cells that divide at a really fast rate because that’s what cancer cells do, they multiply and take over and wreak havoc in the body. So any other cells in my body that also rapidly divide will be KILLED by the chemo. And the cells in the lining of my stomach and esophagus, which protect my digestive organs from acidic stomach acid are in the list of fast growing cells.

So basically, during chemo any stomach acid in my digestive system is going to hurt me because the protective coating (cells) are being killed off. I don’t have GERD per se, but during chemo I will have the same symptoms as GERD. Make sense?

What can I take for heartburn?

This is interesting! There are 4 different ways to go:

  • Tums, Rolaids: These are acid neutralizers that contain calcium and act as a buffer between you and the acid – but they can actually cause more acid to be produced once the barrier is gone (called acid rebound). Use occasionally. 
  • Gavisgon: This contains alginates (derived from algae) that also act as a barrier (coats the stomach). Very cool. Makes a “raft” and prevents the acid from getting up and out of the stomach. I think I will try the raft. 
  • Zantac: H2 receptor blockers (such as ratinidine) that reduces the amount of acid from building up but increase the risk of cardiovascular problems and osteoporosis – GAH! And I bought this! 
  • Nexium, Prevacid: Getting stronger now – prescription strength! These are “Proton Pump Inhibitors” that also prevent acid from forming – they seem to be like Zantac but are stronger, and not for occasional heartburn. These are for people who suffer badly from GERD and their esophagus is getting damaged. Lots of side effects. Avoid avoid! 

What can I do to avoid heartburn? 

Being a person who likes to avoid taking drugs, I am aiming to prevent heartburn rather than having to take the medications listed above. (Of course I WILL take it if I have to – I’m not into any extra suffering at this point!)

Prevention tips 1 and 2:

  • eat smaller amounts at a time
  • eat more regularly (this is a LOT harder than it seems)

Most importantly though, I have to stop ingesting:

  • caffeinated tea and dark chocolate – ok, anything with caffeine
  • wine / alcohol
  • oily / fatty foods (don’t even talk to me about this category, I can barely manage the first two)
  • citrus
  • tomato based foods
  • spicy foods
  • garlic & onion
  • more good stuff
  • more good stuff 
  • more good stuff

Basically, I’m going to eat BLAND food, very regularly, with lots of water. Oh boy. 

What is the silver lining? 

Let’s just be clear. When people mention the “silver lining” to a shitty situation, it’s akin to saying “there are plenty of fish in the sea”. Just shut up already. But if I had to pick the silver lining for this one, it’s 

Ok I can’t think of one. 

 

toxic logo

Toxic

Chemotherapy medicines are toxic. So therefore, when you’re receiving chemotherapy, anything that leaves your body is toxic. You have to be careful where it goes and who comes in contact with it.  

Naturally there are some basic safeguards – some that make tons of sense, some that are perhaps a bit surprising. Here’s the basic list:

1. Pee

You may not think that this is a big deal. Just flush it down and Bob’s your uncle (I know, he IS!). There are actually rules to the flushing. First one is to sit. Not a problem for me, as I always do. But dudes have to sit to pee. Not that that has anything to do with me, but I tought it was notable. Secondly, put the lid down before you flush. Who does that? Last, and the most disturbing to me, double flush! 

Flush sign

This may not seem upsetting to anyone … but I’m an environmentalist. Having grown up at a cottage, I’m already conditioned to NOT flush unless it’s very very yellow & stinky or brown. (Note: At home I do flush after I pee (promise), but I flush once.) So I find this to go against my principles. (I can tell you this, though, if I’m peeing during the time that I am receiving treatment at the cancer suite, you can bet I’ll be flushing twice! People track you with their eyes and likely listen for the double flush.)

The other thing about pee is that when you’re female of a certain age, it tends to be less able to stay in it’s correct location when coughing or sneezing or laughing or jumping on the trampoline.

I have been told that each time any pee gets on me I have to wash thoroughly (probably twice since that seems to be the norm) and if it gets on my clothing or sheets I have to wash them TWICE. Separate from other items. Geez. This seems like a lot of work. (Am I going to be wearing Depends?)

2. Sweat

I told the nurse that I don’t sweat. She raised her eyebrows as if to say “reeeeaally” or “you don’t sweat YET”. She then asked about hot flashes and night sweats. Hmm, well, I don’t sweat much …. ok, I’ll wash my sheets more often. Fine.  (But I’m not washing them twice.)

3. Vomit

I’m hoping I don’t have any issues in this department, but if I do, I have to follow the same rules as above – two flushes two washes. Of anything it touches. (I think I’m in denial on this one, but I’m not a puker.)

4. Stool

Who says stool?? It’s POOP, people!! I don’t think this will be a problem at all, since I haven’t generated very much since my 1st treatment. I know. It’s not a good thing. I’m on it …

poop inducers
Pear juice, herbal tea, bran muffins and a supportive mug. Bam!

5. Vaginal Fluid

Hold the bus. What? Yep – it’s toxic. So sex must involve covering it all up. Uh huh. A condom… and for other activities enjoyed by women, a dental dam. Ya, that’s not happening. 

What’s not on the list:

I asked the nurse why saliva is not on the list. I am going to try to reiterate what she said, but it didn’t make any sense to me so I’m not going to sound convincing. It’s ok because it is less likely to come in contact with someone. Um … what if I cough? Not enough. Or spit on someone? Funny look. What about kissing? Not enough. (Ok that woman must be a dry kisser.) I let it go. 

Some of the Additional Rules:

  • Anyone who deals with my “body fluids” has to (obviously wash it off their body asap, twice?), wear gloves and be given a medal. 
  • Any “body fluids” needing to be cleaned up are collected with paper towel that is then sealed in a plastic bag and put in the garbage – which is then sealed. (Of course I’m wondering what will happen if I toss it in the fire instead …)
  • If any of my “body fluids” get into my eyes or someone else’s eyes (ok … what??), the eyes must be flushed 2 or 3 times. Hard to get that image out of my mind. Projectile vomit? 

Good times, people, good times. 

And yes, you can visit me. Just stand back a safe distance. I’m toxic.

Waiting room

In the Brown Recliner

Prior to this cancer journey I didn’t pay any mind to the recliner chair. I began to see the light a few days back when I had my information session with a Cancer Centre nurse. Her job was to be sure I understood about the chemotherapy, the side effects, and the procedures at the Centre, but she actually helped me to understand the power of the recliner. Specifically the brown recliner.  

What I found out:

– The name of the place that I get my chemo is called “the suite”.
– The chairs for patients are all recliners.
– The brown chairs have a massage feature in them.
– It is chilly in the suite. Blankets are recommended.
– The brown chairs heat up. 
– There are less brown chairs than beige chairs.
– Wednesdays are the busiest days (this has to do with Tuesdays being the days that most of the oncologists meet with patients – which happens the day before treatment)
– Since I go on Wednesdays I may not get a brown chair.
– People can bring me food and drinks but they can’t eat or drink with me.
– TVs are all on mute. I must be able to read the closed captioning.
– There is one chair beside every beige and brown recliner … I can only have one visitor who is not eating or drinking.
– The washrooms in the suite are not for visitors.
– I cannot go to Tim Horton’s but I can go and pee with my IV pole. But not with my visitor. 

What I noticed on my tour:

– There are 4 sections in the suite, each one assigned to a different nurse. 
– Each section has 4 or 5 recliners. A couple of them are brown.
– There were only 6 patients in the suite, scattered in the different sections. All of them were in brown recliners. None of them were talking.
– As I walked through, each of the patients glanced at me with a knowing look.
– Chemo drip bags come through a hermetically sealed window at the far end of the suite. 
– There are 2 washrooms. (For patients.)

What I determined:

No picnics. No singing. No visits from loud friends. No way I’m missing out on a brown recliner. 

Brown chair
Coveted.

My first treatment is happening while I write this. And yes, I got here early, in hopes of a brown chair. Oh ya, you guessed it … I got one! 

Me in the chair.
Very comfy indeed.

My bum is nice and warm.  

What I’m Doing in the Chair Today:

Schedule for the today (week 1):

– begin with a “loading dose” of Herceptin (8ml / kg) that lasts 90 minutes (the next doses are not as big … they are called maintenance doses with 6ml/kg)
– They watch me for 1 hour. For side effects, but likely also to see what kind of patient I am … complainer? Rule breaker? Under prepared? No friends? Chatterbox? Eavesdropper?
– Then I get approx 1 hour of “pre-meds” before the taxol. They include 4 things:
1. Oral dose of anti-nausea pills that I have to remember to bring with me each week. Oh oh. 
2. Benadryl (oral)
3. 15 min of Zantac drip (coats the stomach, helps with nausea)
4. 15 min Dexamethadrone drip (steroid)
– FinallyI get the nasty stuff, Taxel for 1 hour and 15 min.
– Then I get a ride home at around 2.

My drip
Very impressive system!

Extra Curriculars:

I’ve got a load of things to keep me amused. All the technology: iPhone, iPod, ipad (yes, Apple junkie). Lunch & drinks. Knitting. Journal. Book & magazine. Etchasketch. 

Better get busy! Lots to do. 

 

 

Portacath

Port Me

Tomorrow I am going to have my toxic drug portal installed. It will deliver all of the nasty chemicals to my cells without any fuss or muss or burning skin. Ahh. How nice! It’s called a portacath, meaning a portable catheter. It’s made up of two parts: a small disk (port) and a long tube (catheter). Hence the name. 

Port-a-cath

Where does it go?

It will be inserted in my chest, just under the clavicle. Each time I go for a treatment – whether it be for the 12 doses of Paclitaxel (chemotherapy) in the first 12 weeks or the Herceptin (the targeted therapy) in the remainder of the year (18 doses) – the drugs will be delivered through the portacath. Nurses can also take blood through the portacath, even though my veins are quite charming and easy to take blood from. 

Giving blood
I think the nurse had performance anxiety. I can’t recall ever having had a drop of blood spill – or it hurting. Serves me right for taking a picture. 

How is it put in?

Usually this procedure is done in Surgical Outpatients and I would be knocked right out, requiring that a breathing tube be inserted. But as I’m obviously an early adopter, I’m having it done in the Diagnostic Imaging department instead with “twilight anesthesia” (yes, I’m the very first one). This means that I will be in a semi-conscious state. No pain, no anxiety, no need for a breathing tube, no memory of what happened. (This last part is unfortunate, because I’d really like to watch if I’m going to be semi-conscious. I have many questions.) 

In fact today during my teaching session (in which someone tried to teach me…) I asked the nurse how it’s done and waxed on about my vision of the procedure. She gave me a blank look. All she said was “There are 2 incisions.” Blew apart my whole vision, in which … of course I’m going to tell you … I think that the tube is inserted first – it looks like it has to run up and over the collar bone and then down into the Superior Vena Cava. (Remember that one from Biology class? It’s the large vein that runs in to the heart.) The disk is then attached to the tube, and slid under the skin. A couple of stitches later and it’s all done. But likely that’s not how it happens. If I come out of the twilight I will let you know what I see. 

Here is a professional diagram, proving that I am likely very close to being right. 

Diagram of Port-a-cath

How does it work?

Once it is in my chest, each week the nurse just has to poke the special needle through the skin into the top of the port and start the drip. It’s not inconvenient like a PICC line, which is inserted in the arm and has an external port that you have to look after. Apparently I can sleep on my stomach (although I’m not sure if it will be comfortable) and I can swim with it (you can’t with a PICC line). Plus it will make me look like I have an alien microchip implanted in my chest, and that’s cool. 

Bump in chest
See? Cool.

Why Not be a Wig Maker?

Well, I’m going to lose my hair. Chemo starts next week and I’m told I have about 10 days before it falls out. So I’ve decided to be proactive. I’m going to cut off my braids, grab my glue gun and make them into a version of a wig. Not kidding. 

I was inspired by Scout. On the run, she hacked off her pink tipped and therefore very obvious hair, fashioned two cute pigtails and then plopped a little black toque on her head. 

Scout
This is Scout. She’s a cute Netflix movie character that you really must meet. Dial up “About Scout”.

Well if she can do that and still look like a million bucks, so can I. Check it out: 

My plan

So on Monday I’m going to see Jenny, who has agreed to help me out. She will cut off my braids. (I realize that this could be a delicate procedure … I’ll have to secure the top somehow so it doesn’t unravel.) I’ll set them aside while she fixes up whatever is left on my head (seriously folks, it’s going to be gone in 2 weeks. Who cares??).

Then I’ll hot glue the braids to the inside of a comfie black beanie that I found laying around the house. (I’ll have the exact location of the braids marked on the beanie ahead of time, don’t you worry.) Later on I’ll sew a soft band of something over the hair, sandwiching the braids to the hat. This will help to avoid irritation from the glue and ends of hair rubbing against my bald bald head. 

This is what it should look like in the end, when I plop another hat on top. 

goofball
Of course I won’t have eyebrows…

So ya, that’s the plan. Handmade wig making. Why not?? FYI, a short haired wig (made with real hair) costs $1800 and long hair is around $2500. Can you believe that?? Omg. I’m going to get me a turban, plop it over my cool skull cap with braids and I’ll be good to go. 

 

at Lakeridge

Word of the Day: Receptor

Before my breast cancer journey began, I might have guessed that a receptor is a mechanical part of a TV tower. Or something like that. Perhaps I wasn’t paying attention in Biology classes. (Sorry Mr. Bailey! But thanks for the quilt!)

receptor definition

What are Receptors?

Turns out receptors are a big deal when it comes to breast cancer. There are three types of receptors on a breast cancer cell:

  • estrogen receptors
  • progesterone receptors
  • HER2 receptors (human epidural growth factor receptor 2)
breast cancer cell
This drawing is similar to one that my surgeon drew for me (I added labels for your convenience).

What does it mean?

When you have breast tissue removed and sent to the lab, they identify whether or not the 3 receptors are positive or negative:

POSITIVE: This means that the cancer cell IS receiving signals from that hormone or protein, telling the cell to grow.

NEGATIVE: The cancer cell IS NOT receiving signals from that hormone or protein to grow. 

Why is this important?

It determines your treatment. If any of the receptors come back Positive, then you are a candidate for “targeted therapy” – treatments that target specific characteristics of cancer cells. Good thing. Because other therapies like chemotherapy is a systemic therapy that targets all quickly growing cells … such as those that are in your gut, mouth, vagina, and that grow hair and nails. Yes, vagina. 

So, for example, if you test positive for one of the two hormone receptors, then you can use hormone therapy to cut off the supply of estrogen and / or progesterone to the cells. These are called targeted therapies. Boom! Dead cancer cells without the need to throw a ton of chemotherapy at your body. (Note: This is when a positive result is actually positive … not like my last post when a Negative is a Positive.)

With that in mind, a triple negative pathology is NASTY … since only chemotherapy can be used. 

What’s my pathology?

Let’s take a look (this is the 2nd path report btw):

results

My hormone receptors are both negative – so no hormone therapy for me. Move on to the HER2 receptors. Positive. WOOT WOOT!

What’s HER2?

HER2 are proteins that control how a healthy breast cell grows – until they stop working properly, get out of control and replicate in a crazy ass way.

This is the first thing I read about HER2, from the American Cancer Society website:

“For about 1 in 5 women with breast cancer, the cancer cells have too much of a growth-promoting protein known as HER2/neu (or just HER2) on their surface. These cancers, known as HER2-positive breast cancers, tend to grow and spread more aggressively. ”

Oh great. That doesn’t sound so positive… 

So what’s next?

So to be sure that there there are no rogue cells journeying around my body, we have to hit those HER2 positive cancer cells with some drugs. And the best treatment is to combine some of the targeted therapy (good) with some of the systemic therapy (not as good). This is what my oncologist has recommended:

1. Herceptin (this is the brand name – the medical name, trastuzumab, is hard to say):

  • This is a monoclonal antibody (a man-made immune system protein).
  • It blocks the ability of the cancer cells to receive chemical signals that tell the cells to grow.
  • Sometimes it is given alone and sometimes accompanied with chemotherapy.
  • Causes flu like side effects (fever, chills, nausea, muscle aches).
  • Oh, and it can cause congestive heart failure … more on that in another blog post…

2. Taxol (chemical name Paclitaxel)

  • One of the taxane chemotherapies that interfere with the cell’s ability to divide.
  • In order for it to find the cancer cells it needs to hitch a ride on herceptin, which incredibly knows where to go (because it’s targeted …. remember?).
  • It uses solvents to dissolve paclitaxel, the main ingredient, so the medicine can enter the bloodstream. I will have to take pre-medications to minimize reactions to the solvents. Oh can’t wait for that.

So that’s where we’re at folks!! I know what’s coming … just have to firm up a few dates and get myself fitted with a portacath! 

Oh so many more stories to come… like what I’m going to do with this stunning hair before I lose it all!! 

hair that will fall out

results

When Negative is a Positive

When looking for signs of malignancy in a pathology report, a negative result is a good thing. A positive result is a bad thing. My biopsy was positive for cancer. Bad. Treatment? Take it out. Done. 

This week I received the first pathology report that gave data on 3 things that were removed during surgery: Lymph Nodes, Right Breast and Left Breast. Since I knew that the Right Breast contained cancer cells, it wasn’t expecting any huge surprises, just more details. The Left Breast was removed prophylactically (for my convenience) so I wasn’t expecting anything there. But the Lymph Nodes? Now that data was going to be important. 

Path report snippet

Such great news! Negative! Woot Woot! 

Before we go too far along, let me explain a bit about the lymphatic system – that will give you an idea of why this is such a big fucking deal. 

The lymphatic system carries lymph – a clear fluid (from Latin lympha, meaning water). Lymph works in conjunction with the circulatory system (which carries blood). It travels along and filters through lymph nodes (we have between 500 and 600 in our bodies). Here’s a look at the area of interest to me:

Diagram
In other words, armpit. 

Lymph nodes and the lymphatic system are very important in the cancer world, because when you have cancer, the lymphatic system acts as a highway (to hell). It carries cancer cells all over the body where it can take root, grow and kill you. That process is called metastasis. I’m sure you’ve heard of metastatic cancer. Sucks. 

When cancer cells travel in lymph, they will get caught up in the lymph nodes. This is why, when looking for any spread of cancer, the surgeon first figures out which nodes the cancer tumor drains to, and then does a biopsy of those nodes. With breast cancer the surgeon takes out one or more axillary lymph nodes. They are in the armpit as you see in the diagram above. In an earlier post I told you a bit about how I was prepped for the sentinel node biopsy. I found out later that only one node “lit up”, which was a good thing since the surgeon only had to take one out.

sentinel node biopsy
This is what they do to figure out where the “hot” node is.

Of course, since it’s deep in the armpit, the surgery involves digging and scraping through the pectoral muscle so it’s a bit tender. But I digress. My “hot” node was negative, and that’s what’s important. No cancer in my lymphatic system. Phew!

The second set of results were details about the cancer in the right breast – which we knew a bit about already, mainly that it was Ductal Carcinoma in Situ (DCIS) with microinvasions. That means that there was cancer in the duct with some invading out of the duct.  Details from the pathology report:

  • the cells are Stage 3 invasive ductal carcinoma
  • there were multiple foci of microinvasion in the 4cm x 3.6cm area (as shown in the MRI … so mastectomy was the right call). 🙂
  • the two foci were 2.5mm and 2.1 mm
  • there were clear margins around the larger area
  • It is named “high grade comedonecrosis” or “Grade 3”, positive for EIC (extensive intraductal component) Which translates roughly to “really fucking bad”, as my surgeon pretty nearly said, but without the swearing. 
Pathology
Pretty easy to understand, all things considered.

The data revealed that it was bloody good that they did a mastectomy, rather than a partial mastectomy (otherwise known as a lumpectomy). It was a bit of a crap shoot to do it since MRI results can often be a “false positive”. I decided to err on the side of caution and had both breasts removed. Glad I did. 

Next step is to meet my oncologist. He / she will read the next pathology report that identifies my cancer cells’ receptors. These receptors indicate what makes my cancer cells grow, and so from that, they determine the treatment plan. But that’s for another blog post. 

Thanks for hanging in! 

sticky goo

Coming Unglued

I’m coming up to 3 weeks since having my breasts removed. Since I left the hospital I have subconsciously been measuring my progress by the amount of gluey bits that I’ve been able to remove from my body. I know this because now that it’s almost all gone, I’m still not healed. And I’m appalled. But I’m getting ahead of myself. 

glue in the armpit
Just kidding – these are bruises from where they taped me to the table. (OMG, really? Yes.) But note the tape going WAY up into my armpit!! Seriously excessive.

I came home a few hours after surgery. I was hopped up on oxycodon and therefore didn’t care that the tape attaching the bandages to my body came high up my chest, straight around under my armpits and across my back. The next day, when I realized that the tape was preventing me from moving freely, I pulled back a few centimetres along the perimeter and tucked it in on itself, like a rebel. Thus began my journey into tape removal, and in my mind, recovery. 

big ass bandages
This first bandage was more like a halter top. Note my work on the edges to make a nicer finish.

I guess that my tape removal = healing theory came from the premise that this healing thing was going to continue on a predictable trajectory. Tubes out, big pad of bandages off, staples out, smaller bandages off, steri-strips on, steri-strips falling off, … no tape. Done! HA! How easy was that?? 

steri-strips
Look at how the glue turns black – even on the edges of the steri-strips! Yeech.

Now, as I have gone off all drugs except for the odd extra strength ibuprophen, I’m ALMOST glue free, and yet … what’s that I hear? Oh. It’s nerve endings yelling at me! Wearing a shirt hurts. Wearing anything hurts. That is, unless it’s really tight. I feel like a deep pressure junkie. I stand around pressing my hands flat against my chest to make the sensation go away. It’s not quite pain, it’s more like a humming, or the feeling when you’ve had frostbite and then you come into the heat. Burning. Pins and needles. It’s very distracting. Driving with an ice pack under the seat belt is distracting (but feels so great!). 

It’s actually fascinating to probe around the scar tissue and feel the edema in some areas (soft and pillowy) and scar tissue (?) in others (hard and unrelenting). I don’t know exactly where the surgeon dug and scraped to get at the sentinel lymph node, but I can guess. 

scar
This is a nicer section of the scar. (There are some very nasty spots!) Note the bits of glue. Sigh.

So ya, I’m almost 3 weeks from surgery and still unable to do basic stuff without wincing, such as:

  • wipe the table
  • pull open the cutlery drawer 
  • drive standard 
  • braid my hair
  • take off a shirt (how come it’s easy to put it on?? makes no sense)
  • sleep on my side 
  • push myself up from a seated position

At my last appointment my surgeon drew me a diagram to explain it. There are nerves that run up through the breast tissue from the chest wall to the skin on top of the breast. He’s cut all of that tissue out, and in the process cut the nerves. So now I like to think that they are talking to each other. “Hey!! Where are you??” Not sure how long it takes for the nerve endings to chill out and the swelling to subside so that the skin can meld with the chest. 

chest diagram.
This is my version of the doc’s drawing. Lou can weigh in on how well I did.

In the meantime, tomorrow I will work on removing the last few bits of glue. 

 

staples out

Staples Out, Chill Out

A couple of days ago nurse Bonnie took out my staples. I had to lay on the bed while she took them out. No standing allowed since some people pass out. (Oh great. Isn’t that foreshadowing??) She seemed to be struggling a bit with the disposable staple removal device … I think mainly because she had baggy rubber gloves on. I was close to asking her to take them off, but she looked so determined. She took out one or two staples that didn’t hurt at all and then the digging began. Now that was not so pleasant. “Oh this one is hard to get a hold of. We’ll come back to that later.” Oh great. 

remover
This little removal tool is pretty clever! Shove it under, squeeze. It crimps the staple in the middle, causing the tucked under part to shoot up and out.

When it was all said and done, 53 staples were out and 12 steri-strips were put on. Why? Well, “just in case the incision doesn’t hold”. Oh, ok. Great.

steri-strips
The staple holes will heal along with the incision. The breast-shaped bruise is pretty impressive don’t you think?

Any special instructions about the steri-strips? (I’ve learned to ask this.) Oh yes, says Bonnie… 

  • no lifting anything over 5 lbs
  • no pushing
  • no pulling
  • no reaching over your head
  • anytime you are doing exercises, stop when it hurts – don’t push past that (read: no shampooing the top of your head)
  • no baths

Piece of cake. I’ll just go ahead and do NOTHING. 

icing the chest
This is me going slowly bonkers. Keeps the swelling (and tenderness) down though…

She didn’t say no knitting, so I knit up this cowl (thanks to Dana for the wool). 

goofy cowl shot
Again with the crazy eyes…

It’s a basic pattern except that I added in a little triangular part on the bottom edge so that the wind doesn’t whistle into my coat above the top button. I HATE that about cowls! They are just a bit too short for coats that you don’t button right up to your chin.

cowl
This is the chilly spot… 

Next up – go to see the surgeon. I plan to ask him a whole lot about the surgery itself, such as:

  • Where exactly were the lymph nodes taken from … that really swollen and painful spot or is that something else?
  • How many were taken?
  • And do you realize that the left side of my chest looks a LOT different from the right? 
  • Did the resident do one side and you did the other? 
  • And what did you do with my gorgeous nipples? I should have donated them. Or bronzed them.

Of course I will also get the first set of results from the surgery – information about the lymph nodes. Big question – was there any cancer in them? If there was, then they will likely want to take out more nodes … but not necessarily. Or they may want to radiate the lymph node area … but not necessarily. If there is no cancer (obviously a good thing), they won’t take more nodes, but it doesn’t mean I’m done with treatment. That will depend on what the breast tissue says … and that’s another 2 – 3 weeks. Could be radiation, could be chemo.

One step at a time. 

In the meantime, knit. And make a plan for physio and massage therapy. (This surgery does quite the number on your shoulders and back.) And watch a little Netflix. Recommended last night are: Ozark, Shameless and Lion. Oh and Melissa implores me to watch Coronation Street, but then I’d drive people bonkers with my British accent.

staples

Stapled

The other day Ripley starting barking, so I knew I had company. I looked out to see a van coming up the lane. A man hopped out and headed toward the front door with a large paper bag. I’m thinking “Hey someone ordered Chinese Food for me!” Nope. It was a bag of medical supplies. The packing slip said “Staple removal kit.” 

paper bag
Looks like Chinese Food…

Of course I’ve been anticipating the procedure. It’s next, after all.

First though, let me tell you just a wee bit about how I survived nurse Amanda removing my drains. It was quite easy. She cut the suture, then I braced myself by putting my hand on her shoulder and followed her instructions. “Take a deep breath in, now breathe out …..” Then I swore a lot.

Here’s one of the drains that came out:

drain
The white flat part with holes is the section of drain that was inside my chest. No wonder I’m super swollen since she pulled them out!

At any rate, I got through that. No problem.

drain hole & bruising
This shows the drain hole that is healing, but check out the pattern of bruising! Turns out that tape affects bruising a LOT! The angled bruise marks above the hole are from tape, the rectangle around the hole is also the same shape as the bandage. I think that’s all rather weird.

So now, the staples. I have 26 staples across the left, 27 staples across the right. The surgeon explained that depending on the stretch / tension in the skin he would either be doing invisible stitches or staples. I got the staples. 

26 staples
Here’s a glimpse of my left chest (can’t really say it’s a breast anymore, but with the swelling it kind of looks like one…)

What exactly does that mean about my skin? It’s tighter? I’m more apt to be an idiot and do too much each day? I would NEVER do that! Anyway, I wonder about his choice. Because the staples are very very cruel. They look cruel and feel cruel. When the pain meds wear off they tingle and sometimes burn. I can’t sleep on my side or hug anyone. I know that they are doing their job and allowing the incisions to bond together. They’re just a bit much. 

At any rate, Amanda told me the date that the next nurse would be coming to take them out (day after next…) and I asked “soooo, how exactly do you take those out”? 

I of course was imagining the various staple removers that I have used – one that looks fairly sinister, with 4 fangs that come together when the hinge is squeezed, and other that seems to rely on a measured thrust under the staple. Neither of these seemed like good options for my chest. I waited with some dread as she rooted through her kit to find hers. Finally she pulled out a slim device and showed me. 

This one is from the paper bag (yes, I had to open it, what can I say?):

She explained it in simple terms which I will do my best to pass on here:  the device bites the staple in the middle, crimping the staple and forcing the curved ends (that are nicely tucked under my skin) to pull up and out. Just like that.   

I’d rather have Chinese Food.