Today I saw my surgeon for the first time since surgery for a check up. Actually, the bruising has faded substantially, and I'm feeling very well. One thing I have noticed is that when I extend my arm, or twist my wrist (as if to open a door), I get a shooting pain in my arm. This is caused by "axillary web syndrome" or "cording". Axillary web syndrome is a common complication that occurs when there is trauma to the lymph nodes in the armpit--usually after surgery to remove lymph nodes. Apparently the cords are obstructed lymphatic vessels. Axillary webs look like cords, and the symptoms are pain and tightness, and limitation of movement. The cording can be located just in the arm pit, or it can spread down the arm, all the way to the thumb and onto the chest. My cording just goes down the arm up to my hand.
My surgeon has recommended that I get physical therapy to give me better range of motion, and to treat the cording. She mentioned that I do have Stage 1 lymphedema (reversible), and that I should wear my compression sleeve all day, every day. Lymphedema is a condition that occurs when the lymphatic drainage system is impaired to the extent that the amount of lymphatic fluid within a given area exceeds the capacity of the lymphatic transport system to remove it. In other words, the lymph fluid doesn't have the routes to drain, it puddles in tissue, and makes your arm get puffy. I had 14 lymph nodes removed, predisposing me to lymphedema. Hopefully, with the PT, I'll be able to manage this.
It was driven home to me at the radiation center, where the doctor made it clear that I had to protect my arm from: bug bites, sunburn, bumps, bruises, scratches, cuts, and burns for the rest of my life. Any of those things can cause the onset of severe lymphedema.
I'll just have to be careful...
Monday, March 29, 2010
Friday, March 26, 2010
This is getting ridiculous! 3/26/2010
On Tuesday, as I was finishing up my marathon chemo session, I was given 2 appointment cards. One was for my next chemo session on April 13th. The other was for another blood draw to determine Coumadin levels for today. In addition, the second card showed that I had an appointment with the Nurse Practitioner in the Oncology office right after today's blood draw. I asked why I needed to see Dottie, but was told that that was just what Dr. Brown (my onc) had ordered. Okey dokey...
So today I haul myself in for another blood draw. The poor nurses there are at a loss as to where they can stick me that isn't bruised, clotted, or in danger of causing lymphedema. But, champs that they are, they got the blood draw they needed. I trotted upstairs to the oncology office, as requested for my appointment. Within a few minutes, I was brought in, had vitals checked, etc. Then Dottie came in and asked "Why do you have an appointment today? All you needed was a blood draw for Coumadin levels."
Are you kidding me? This cost me a copay? And insurance paid the balance for nothing?
Then there's the issue of my time...
So today I haul myself in for another blood draw. The poor nurses there are at a loss as to where they can stick me that isn't bruised, clotted, or in danger of causing lymphedema. But, champs that they are, they got the blood draw they needed. I trotted upstairs to the oncology office, as requested for my appointment. Within a few minutes, I was brought in, had vitals checked, etc. Then Dottie came in and asked "Why do you have an appointment today? All you needed was a blood draw for Coumadin levels."
Are you kidding me? This cost me a copay? And insurance paid the balance for nothing?
Then there's the issue of my time...
Wednesday, March 24, 2010
Port issues 3/24/2010
Yesterday was Herceptin and blood draw day. Since surgery is done, I have been able to resume taking Coumadin, a blood thinner (taken to prevent further blood clots from forming in my body). I still have not reached a therapeutic dosage of Coumadin, and the latest instructions I had was to take 17.5 mg of Coumadin until yesterday's labs. When I have a chemo treatment, I typically have an appointment with the doctor as well. That appointment was nice and early (8:40)--presumably early enough for me to get labs, see the doctor, get the Herceptin infusion, and be out the door before noon. Not so fast....
The labs and doctor's appointment went as planned, and I was ready for chemo by 9:30. My attending nurse had planned ahead and had the drip ready for me. All she had to do was to access the port (stick the needle in), make sure the port was not blocked and connect me up to the drip.
After the nurse puts the needle in the port, she typically flushes the port with Heparin, an anticoagulant that cleans out the port to make way for the drugs. After the Heparin goes in, the nurse then draws back on the syringe creating a suction that should draw blood through the port. It's a confirmation that the port is completely open. It wouldn't be good to be putting chemo drugs into a port that's plugged up.
The problem came in the blood return phase. The nurse just couldn't get any blood return, an indication that the port was plugged. Since this was not the first time this had happened, I knew the drill: get up and move around, bend over, raise my arms to see if that would coax the blood back into the syringe. No luck. Next came the Cathflo--a drug to dissolve the coagulation that might be blocking the port. One problem--you have to wait 1-2 hours after administering the Cathflo to allow it time to work. OK, I thought, no problem. Watch a little TV on Hulu. By 11:30, we were ready for another try at a blood return. No luck. Another dose of Cathflo. Another 1 1/2 hours of waiting. More Hulu. Another try at a blood return. No luck. Next up is a port study with contrast, a test that shows if the port is actually open or plugged. They inject the port with dye and take Xrays of the port. Results? The port was open and working. Think of a straw going into a flexible tube. If you suck on the straw, the wall of the flexible tube may collapse. That's what was happening with my port and the artery it goes into.
Bottom line? I started the drip at 2:30 and left the chemo center at 4:30. What a waste of a day!
The labs and doctor's appointment went as planned, and I was ready for chemo by 9:30. My attending nurse had planned ahead and had the drip ready for me. All she had to do was to access the port (stick the needle in), make sure the port was not blocked and connect me up to the drip.
After the nurse puts the needle in the port, she typically flushes the port with Heparin, an anticoagulant that cleans out the port to make way for the drugs. After the Heparin goes in, the nurse then draws back on the syringe creating a suction that should draw blood through the port. It's a confirmation that the port is completely open. It wouldn't be good to be putting chemo drugs into a port that's plugged up.
The problem came in the blood return phase. The nurse just couldn't get any blood return, an indication that the port was plugged. Since this was not the first time this had happened, I knew the drill: get up and move around, bend over, raise my arms to see if that would coax the blood back into the syringe. No luck. Next came the Cathflo--a drug to dissolve the coagulation that might be blocking the port. One problem--you have to wait 1-2 hours after administering the Cathflo to allow it time to work. OK, I thought, no problem. Watch a little TV on Hulu. By 11:30, we were ready for another try at a blood return. No luck. Another dose of Cathflo. Another 1 1/2 hours of waiting. More Hulu. Another try at a blood return. No luck. Next up is a port study with contrast, a test that shows if the port is actually open or plugged. They inject the port with dye and take Xrays of the port. Results? The port was open and working. Think of a straw going into a flexible tube. If you suck on the straw, the wall of the flexible tube may collapse. That's what was happening with my port and the artery it goes into.
Bottom line? I started the drip at 2:30 and left the chemo center at 4:30. What a waste of a day!
Friday, March 19, 2010
May 17th! 3/19/2010
Yesterday I visited the radiation center to get my body mapped out for the positioning of the radiation beams. The technician applied tape with soldering wire affixed to it in a perimeter around the breast to delimit the area that will be radiated. Then he took CT scans of the area. I must say that it's an interesting process, albeit one I wish I never knew about. I now have 4 tattoos (just little blue marks) that will help them set up radiation exactly where they need it to go.
I also received the schedule for radiation, that has me finishing up on May 17th. Disregarding herceptin infusions every 3 weeks til September, I should be all done treatment on that day!
My hair is starting to come back in, and looks like baby bird fuzz...
I also received the schedule for radiation, that has me finishing up on May 17th. Disregarding herceptin infusions every 3 weeks til September, I should be all done treatment on that day!
My hair is starting to come back in, and looks like baby bird fuzz...
Monday, March 15, 2010
Liberated 3/15/2010
Hallelujah!! Got the last drain out this morning, and I do feel liberated! It felt so good to be able to get back in the gym, and then take a GLORIOUS shower--not a half or three-quarter shower, but an over the head and shoulders shower. Like the song says: "Don't it always seem to go, that you don't know what you've got til it's gone...."
Friday, March 12, 2010
Onward! 3/12/2010
Just got the pathology back from the second surgery (last Friday). After reading through all the "scientific speak", I find that the surgeon was able to get clean margins on this cut. So I won't need another surgery to remove more tissue.
At this visit to the surgeon's office , I had hoped to have not only the Japanese squeeze torture wrap removed, but also both drains. Not so fast... the PA attending me wanted to leave one drain in for the weekend to make sure that there was no fluid build-up in the wound. So I still have one drain attached.
Without the pressure wrap on, I was able to see myself for the first time since surgery. Boy, if I had a hard time finding a comfortable and well-fitting bra before, that's going to be a MAJOR issue now! Seriously, I feel pretty well, and am just sore and black and blue (BIG TIME) from the 3 surgeries.
Next up is a meeting with the radiation center doctor next week to map out my treatment there. They will tattoo me at the exact spot where the beam needs to hit. I'll have 28 treatments, once daily (M-F). Looking ahead, I should be done with that by mid-May at the latest (but who's counting?). Is that a light at the end of the tunnel I see?
At this visit to the surgeon's office , I had hoped to have not only the Japanese squeeze torture wrap removed, but also both drains. Not so fast... the PA attending me wanted to leave one drain in for the weekend to make sure that there was no fluid build-up in the wound. So I still have one drain attached.
Without the pressure wrap on, I was able to see myself for the first time since surgery. Boy, if I had a hard time finding a comfortable and well-fitting bra before, that's going to be a MAJOR issue now! Seriously, I feel pretty well, and am just sore and black and blue (BIG TIME) from the 3 surgeries.
Next up is a meeting with the radiation center doctor next week to map out my treatment there. They will tattoo me at the exact spot where the beam needs to hit. I'll have 28 treatments, once daily (M-F). Looking ahead, I should be done with that by mid-May at the latest (but who's counting?). Is that a light at the end of the tunnel I see?
Monday, March 8, 2010
Third surgery is the charm? 3/8/2010
It turns out that there was a torn vein in the wound as well as another bleeding vein resulting in a hematoma. That's now fixed (hopefully) and I can expect the pathology from the Friday surgery this week. They sent me home bound tightly around my chest--like I would imagine Japanese breast binding to be. I have 2 drains again.
Not feeling too perky now, so I'll sign off. Love you all!
Not feeling too perky now, so I'll sign off. Love you all!
Subscribe to:
Posts (Atom)