I can't believe I haven't posted any updates since my surgery!  It has been a long 4 months of recovery and it turns out I have needed every week of my approved leave for my recovery.  I initially thought 16 weeks off work was crazy and that I wouldn't need near that.  I was very wrong!  I ended up needing that and then some!

 

My reconstruction on April 13, 2020 was a huge success.  The surgery lasted 11 hours and I was then in the ICU for 2 nights then transferred to a post op floor.  There were some hiccups throughout my hospitalization.  My first morning after surgery my heart went into an arrhythmia that they thought was atrial fibrillation.  I remember hearing my alarms going off a couple of times but was still pretty out of it and on pain medications.  But there was one occurrence where the nurse was with me and my monitor was alarming and I heard the nurse calling the desk asking "is my patient in afib".  I initially assumed she got a notification for another patient and was talking about someone else but I then began to feel my heart racing and got extremely light headed and dizzy and realized my heart rate was in the 130's.  This feeling quickly passed thank god, and the ICU doctor ordered blood work, an EKG and an ultra sound of my lower legs to ensure I didn't have a DVT (blood clot).  Everything came back normal and they went back and looked at my EKG.  They don't think it was atrial fibrillation but instead some sort of a "sinus arrhythmia".  Fortunately there were no more issues with this and I got quite a few doses of potassium and magnesium so hopefully it was just a result of some electrolyte imbalances.  It was quite scary though.

 

The whole experience was pretty strange though.  With COVID I wasn't allowed visitors which was very challenging given my entire core and upper body took a hit.  So not being allowed anyone to help me on top of some not so great experiences while in the hospital, I was ready to get the heck out ASAP.  I managed to be discharged after 4 nights and was able to get home and recover in my own home. 

 

I was discharged home with 4 drains (two from each side of my chest and 2 from abdomen).  The breast drains came out 1 week post op but the 2 abdominal drains remained (ideally until 2 weeks post op).  Right before 2 weeks hit, I was resting on my couch one night and began to feel feverish and developed worsening pain all over.  I let my plastic surgeon know the next morning, who got me in immediately and looked at everything.  He placed me on an antibiotic with strict return precautions and wanted to see me on Monday after the weekend.  That was a weekend from hell.  My fever never went below 100, going up to 103.2.  I tried to manage it with tylenol, ibupforen and toradol and was back on pain meds because there was an obvious infection causing pain all over.  However, being an ER nurse myself, I knew this wasn't ER worthy nor after hours phone call worthy.  I was on antibiotics that would take some time to take effect and I was managing my pain and fever, plus I knew I would be seeing him on Monday.  Throughout the weekend I communicated with some fellow nurses and doctors I work with and was able to get through the weekend.  I saw Dr. Dickinson on Monday morning and the drainage from my abdominal drains was looking infected and given my fever, he wanted to put me on an additional antibiotic and removed the two drains.  He said that sometimes the drains get to the point where they can cause more harm than good and decided to remove both the drains with a follow up on Thursday.  He said if things don't improve in the next day to call the office and return, as he may have to go in surgically.  

 

That night (Monday) around 9 PM I got a phone call from him.  He was thinking about my situation and said that he really thinks it may be best to go in and clean everything out rather than wait until Thursday to see if I improve.  He said to give him a call the next day and let him know how I was doing so we could make a decision.  Well, I am glad he called, because that night around midnight I got up to turn off the lights and go up to bed and as I was standing there doing nothing I felt drainage running down my groin and leg.  I didn't know if it was blood and an incision opened up or what.  I looked down and I saw gross infected drainage pouring out from a tiny hole in my incision.  I had to get in the shower and got cleaned up and placed a bunch of bandages and dressings over the area to get through the night.  I called Dr. Dickinson first thing in the morning and he had me added on to the OR list for 4 PM that day to go back into surgery.  I had to go through the ER since this was an urgent, unscheduled surgery.  Thank God I have the best co-workers who kept me company and laughing while waiting in the ER for OR to come get me.  I am so lucky to have such an amazing work family.  Side note - I also owe a huge thanks to my mother for staying with me for 5 weeks!

 

So I went back to the OR and Dr. D had to re open my abdominal incision in a couple of areas and did a complete abdominal washout to clear the infection.  There was also an area of my right breast that had blistered and was discolored, because it just didn't heal right after being radiated so much.  So while in this surgery he went ahead and cut that area of skin out and re-closed that breast incision.  I had to stay overnight and was admitted to receive a ton of antibiotics.  Multiple doses of vancomycin, zosyn, ancef and fluids later, I was discharged to go home the next evening.  They were worried I may be septic so they took multiple blood cultures, blood work and cultured the drainage from my abdominal wound. 

 

Before I was discharged my infectious disease doctor, Dr. Allen came and saw me and informed me the cultures came back positive for MRSA.  She sent me home on a new oral antibiotic and I followed up with her the following week.  

 

The next 6 weeks were not fun.  I had two opening in my abdominal incision, one about 4 inches long and the other about 1.5 inches.  Both had to be left open and I had to pack them with gauze type material every day.  The first time I had to shove this stuff into my abdomen was a trip.  My mom helped by holding a mirror for me but it was easier for me just to do the packing.  She only came close to fainting a couple of times before she learned to look away.  She did eventually get more used to it and was able to look.   

 

I battled a lot with asking the doctor to sew me back up once the infection appeared clear but I knew this wasn't best for me and both Dr. Dickinson and Dr. Allen really wanted me to leave the openings to close up on their own from inside out.  The risk of any infection remaining and getting trapped in a closed wound was too high.  I still had weeks of having to wear my abdominal binder and wasn't able to do anything anyway, so I decided to do what I knew was best and allow them to heal and close up on their own.  I had to continue packing them until they were closed and overall it took about 6 weeks.  This was a pretty decent set back because it delayed my recovery.  I was limited in what I could do having open wounds in my abdomen.  It affected how I could move around, get up and down, I couldn't do a twisting motion or put too much pressure on my core.  This ended up delaying my ability to start physical therapy and to move forward in my recovery. 

I am so thankful we caught the infection so quickly and Dr. Dickinson wasted no time, otherwise this infection could have really gotten bad.

Once my abdominal wound was healed up for the most part, the area of my right breast (cancerous side) incision that had blistered previously began to split open.  It's like when it scabbed over and the scabs came off, the incision just slowly split.  This is the exact area where my tumor was, which means it is also where I got 5 weeks of radiation PLUS the targeted extra boost week localized to this area.  So this specific area of my breast has really had a hard time healing due to the effects the strong doses of radiation had on my tissue.  It looked extremely painful but fortunately I didn't have any sensation so I don't know if it was painful to be honest.  It was basically four inches of this incision that just split open.  So Dr. Dickinson and I watched it for a couple weeks, putting antibiotic cream on it and keeping a dressing over it so I didn't ruin every bra and top I own with the blood/drainage and cream 😆 . 

After everything my body had been through we tried everything we could to not have to go back to the OR.  Unfortunately after 2 weeks, this area made ZERO progress so we had to go back to the OR.  A lot of people have asked why the OR, but because it had been open for a couple of weeks, it needed to be cleaned out well,  and needed sutures internally AND externally now.  Internal sutures weren't going to be enough we learned.  External stitches weren't ideal for aesthetic purposes but it was our only option.  So June 5, back to the OR it was.  This fortunately was a quick in and out surgery, unfortunately though some cultures still showed some resistant MRSA that I was put on more antibiotics for.

The external sutures ideally would have been in for a couple of weeks but they had to remain in place for the maximum 4 weeks.  This area just didn't want to heal.  After 4 weeks, the incision healed up pretty well.  There were a couple areas where there were little holes from the external sutures tugging.  But other than that the incision closed up nicely.

Fast forward another couple of weeks and a small area popped back open which was where the stitches had been tugging.  I battled with this for another couple weeks and we were going back and forth on whether or not I would need to go to the hyperbaric oxygen therapy wound clinic.  Fortunately after applying an ointment and paying extra attention to that area, it decided to kick it into gear and for once it healed on its own.  This all occurred just in the last couple of weeks, and it is actually still healing and not entirely healed up, but it's no longer deep and looks really good.  I'm still paranoid every time I look to check though and am afraid of seeing some area split open 😩 .

So I was FINALLY able to start physical therapy now that all my complications seemed to be handled.  So I've been going to physical therapy twice a week.  My therapist specializes in lymphedema and works at the cancer center so I was assigned to her.  This has been a blessing as she is so knowledgable in stuff specific to breast cancer and she really wants me to have a compression sleeve to wear while I work since my work requires so much physical work.  So she had my insurance authorize a compression sleeve which I went and got fitted for last week and should be ready for me to pick up next week.

She gave me exercises to complete and spent most of our sessions massaging the incisions and trying to soften some of the areas of scar tissue.  Of course this couldn't go without a hiccup either though.  Due to the major surgery to my abdomen, the focus was on rebuilding my core.  Well, a few weeks ago I don't know what I did or how it happened, but I strained a muscle in my abdomen pretty good.  It was so painful, my abdomen was visibly inflamed and puffy and I couldn't sit up without using my arms or perform the things I was starting to be able to do.  I mentioned it to my therapist who confirmed that the left side of my abdomen was extremely rigid and the muscle was hard.  She spent two full sessions just massaging my abdomen muscle trying to soften the muscle and I have had to take a break from all my exercises to allow it to heal.

This of course resulted in a phone call to Dr. Dickinson who wanted to extend my leave by another week due to the physical nature of my job.  My abdomen is still not 100% better.  The muscle is still hard and I can feel the discomfort with certain movements, but it's way better than it was!

So here we are... I was supposed to return to work this week, but due to the muscle strain in my core I am now scheduled to return to work next week.  I am crossing my fingers that my return to work goes smoothly.  The game plan now is for me to go back into surgery in December for him to do final touches and to revise scars.  Due to the complication with the abdominal infection requiring the incision to be reopened, it unfortunately is not very pretty so he will have to go back in an revise it along with any of my other scars that didn't heal nicely.  Ideally he wants to do this 9 months after my reconstruction as this is when all the tissue has settled and he will be able to see what needs tweaking and what not.  So as of now the plan is for this surgery to take place in December.  Fortunately this one should be a quick and easy recovery 🙏 . 

This is a very bittersweet and busy time of year for me.  Along with my constant plastic surgeon check ups and physical therapy, I am also coming up on my 1 year cancer free.  This time of year is a very busy time of year because it's when I was diagnosed with cancer.  This means I have blood work, imaging (CT/PET), and oncologist follow up coming up in the next couple of months.  I also have to follow up with my radiation oncologist for my 1 year post radiation check up along with my breast surgeon.  It doesn't end there though!  I also have to stay on track with my OBGYN check up as my monitoring for ovarian cancer is crucial.  So needless to say, these next few months will be filled up with many appointments, emotions and some anxiety.  When I was diagnosed I learned the term scanxiety and I have quickly learned it couldn't be a better term.  The anxiety that comes along with my annual PET scan is real.  I saw my oncologist for a check up last week and we reviewed my blood work and he ordered my PET scan which is a long scan with a lot of rules (certain diet and restrictions prior to the test).  So now I wait for my insurance to approve that so I can get that done in the next month before I follow up with him again.  All my blood work looked good when I saw him last week.  Every other month I get blood work done which includes basic lab work, kidney function, liver function and a breast cancer marker called CA 27.29 (I think that's what it is) that helps to catch recurring breast cancer early.  At my last check up in May my cancer marker was 21 and when I just saw him last week it was 26.  That sparks instant anxiety in me.  In the past its been 13, 18, etc. but this is the highest it has been.  My oncologist wasn't phased by this though.  I asked him if I should be worried by the cancer marker result and he said no, it's normal for it to fluctuate within the normal range.  I trust him entirely and know he is one of the top in his field and knows his stuff, so I am trusting him.  Of course it leaves me nervous though and in the back of my mind I can't help but be a little scared.  

So needless to say it'll be a big few months with my 1 year cancer free coming up, assuming all tests come back negative for any signs of cancer of course.  But that's not an option so I just don't even let my mind go there.  Side note - if anyone is looking for a good song, I've got one for you.  A couple weeks ago I had a break down.  I've only had a handful of them (okay maybe two handfuls by now) but when they come they really hit hard.  I had a break down and was crying and venting to my mom (lucky her).  I had to go to the grocery store, I was still upset but pulled together.  I turned my car on and the first song that came on was Hard Days by Brantley Gilbert.  For anyone who has been through anything hard, which is all of us, you need to listen to this song.  I was instantly in tears as I felt like the words were written for me to hear in that exact moment.  And it was just what I needed to hear.

Okay, that should be enough of me rambling on.  I will note a few positive things that have happened throughout these last 4 months of my recovery though.  I became an Auntie for the second time to another sweet nephew Hunter.  I also found myself a great guy when I least expected it.  I went for my first tent camping trip last week which was a success!  It was just a quick 2 night trip up the Big Bear but it was so nice to just get away and relax for a couple days.  Jack jack is great but will not be happy with momma returning to work.  I'm sure there's other good things that have happened but I'm exhausted after reliving these last 4 months!  

As always I hope everyone is staying safe and hanging in there.  Thank you all for all of your support.  I've said it many times and I won't stop anytime soon...I couldn't have gotten through these last couple years without the support system I have had.  I've got years ahead of me before I am hopefully "in the clear" but I know I have a solid support system to get me through these years ahead.