29 February 2012

A bicycle pump would just be inappropriate

The day after I received the all clear from Dr. Surgeon, I went to Dr. PlasticSurgeon so she could survey the damage. But before she could gasp in horror, her minion had some fun with a magnetic stud finder. The device is basically a magnet suspended in a little plastic holder, with which the minion was able to locate the metal marker indicating the injection site of the expander. Of course the site was under the tape Dr. Surgeon used to hold my boob together, which meant that after a week of dread, I finally got to see the extent of the horror.

Much to my dismay, the scar is about five inches long, and mostly horizontal. While the spot indicated by the stud finder was marked, I poked at the scar, trying to make it go away. I failed.

A piece of medical tape with a daub of topical analgesic was placed over the mark, limiting my poking range. After about five minutes, all poking was ceased as the numbing goo had taken effect. A white surgical drape was placed around the area, which was cleaned with an iodine drenched swab. Dr. PlasticSurgeon further sedated the area with an injection of some sort. Then came the scary needle.

While I watched with a fascinated horror, a two inch needle pierced the muscle and entered the expander. To confirm the needle was in the correct location, the doctor drew out some blue liquid. When she filled the expander during the first surgery, Dr. PlasticSurgeon mixed the initial saline with methylene blue. Bright blue liquid is generally not naturally produced anywhere near the boob, so the blue liquid gave her reasonable assurance that the needle was in the correct location.

Having verified the needle's insertion, it was time to start filling. A 200cc bag of sterile saline was hooked up to a bizarre pump. When released, the pump filled with saline from the bag. When compressed, the saline travelled down a tube, through the needle, and into the expander. Oh, and it made a loud and highly disconcerting noise after every compression.

After only 100cc, the pressure made it uncomfortable for me to breathe on my left side, so she stopped for the day. That more than doubled the size of the expander to 170cc. Though the expander has a maximum size of 500cc, Dr. PlasticSurgeon expects to reach the correct size around 450cc. This will be accomplished over four fillings, though it could be done in just one. By spreading it out over weekly fillings, the skin is less likely to develop stretch marks. Also, filling it at once would create even more pressure, preventing me from breathing easily or comfortably.

The expander is fairly football shaped, though it's not particularly obvious yet. With the latitudinal scar, Frankenboob will look particularly footballesque once fully expanded. While clearly not the ideal shape for a boob, it does the best job of readying the surrounding muscle tissue for the permanent implant. Sadly, I will be stuck with a malformed Frankenboob until approximately six months after radiation is complete. At that point, the expander will be replaced with the permanent implant and a 50cc implant will be inserted under the muscle on the right side. I'm a big fan symmetry, especially when it comes to personal pillow perkiness.

To relax the muscle holding the expander in place, as well as to immediately knock me out, more Valium was prescribed. In other words, I spent the rest of Thursday and most of Friday slipping in and out of consciousness. On the rare occasion that I woke up long enough to be cognizant of my surroundings, I spent most of it begging Matt for pain medicine. Just think, I'll get to repeat this process after each inflation!

Right before leaving the office, I was given an implant card. It has my name, the type and serial number of the expander, and the doctor's information. While I don't have to carry it with me, some people choose to keep their cards in their wallets. Since I had a few empty slots in my wallet, I figured I might as well put it there. Just in case they find my charred body in a ditch. With my wallet. And all the other cards are melted.

For whatever reason, the card made me think to ask about MRIs and other magnetic scanning devices. Shockingly, they are no longer a good idea, assuming I don't want further damage to Frankenboob. Also, the TSA's nude-o-scopes may be able to detect the implant, though the operators are supposed to know what they look like and to not cause a problem. Since I refuse to go through one of those machines as a matter of principle, I guess I'll never find out.

25 February 2012

Haute Cupcake

The following is best when read aloud with a snobby English accent.

This season's biggest fashion trend? Why it's the cupcake! Just take a peek at luxury retailer Louis Vuitton's current window display, featuring a chocolate cupcake with sparkly white icing in a gold wrapper.

Louis Vuitton window display in Century City
While they do not actually sell cupcakes or any products with images of cupcakes, Swarovski more than made up for this author's disappointment by providing mini-cupcakes to all visitors.

Swarovski Crystal Society 25th anniversary celebration in Century City

You'll note not only the glitter in the frosting, but the edible pearls topping each delicious piece. If you are more concerned with how you look than how you dine, perhaps a trip to kate spade is in order.

kate spade in-store t-shirt display in Century City
I assume that since this $58 t-shirt is size XXS, they simply didn't have room for the "CUP" part of cupcake.

The great cupcake takeover is not limited to the high-end retailers. Ubiquitous bookseller Barnes & Noble is filled with cupcakes at prices more affordable to the commoner. This book of platitudes, journal, and notepad are each less than $10.

Barnes & Noble themed display in Marina del Rey
Should you desire something more sparkly with which to contact your dear compatriots, these notecards on a nearby shelf may suit your needs.

A selection of the notecards in the same Barnes & Noble
If what you desire is something a tad more tacky to suit your proletariat tastes, Aahs! has you covered. Where else would you go for cupcake bandages, toothpicks, and stress balls in an assortment of fluorescent colors?

Aahs! cupcake-related display in Westwood
One need not spend a dime to enjoy the cupcake phenomenon. Two industrious girls offered me one of their chocolate cupcakes that they generated in their domicile. Not being a fan of chocolate and having already dined on one of Swarovski's delectable confections, I chose to enjoy my bubble tea sans cupcake.

Homemade cupcakes spotted in Boba Loca in Westwood
Others choose to express their fondness for cupcakes in more artistic ways. After opening a random magazine to a random page, I discovered this model with no less than three cupcake tattoos.

Seventy Arniotis's photo spread in Inked, March 2012
The left photo shows one large cupcake tattooed in each armpit. A close examination of the right photo reveals a third cupcake on the inside of the model's left ankle.

As I encountered all of these cupcake instances over the course of one day, I must wonder where the pervasive cupcake will next appear? I can only hope it is in front of me, preferably in a scrumptious form.

22 February 2012

One good surgery deserves another

Every time some bit of me is cut off, an unfortunate soul wearing rubber gloves gets the highly enviable job of examining the piece of me. In case that wasn't stimulating enough, the hapless lab tech then gets to compile all the minutiae into a captivating missive known as the pathology report. Once it's ready, Dr. Surgeon walks into the examine room with my exponentially growing chart and delivers the inevitably bad news.

During the mastectomy, Dr. Surgeon checked visually and tactilely for anything untoward, but did not find anything unexpected. As a result, he merely excised the nipple and areola and left the surrounding skin intact, per the original plan to save as much boob as possible. The pathology report told a different story; there was a tumor in the subcutaneous fat. The size and location of the tiny tumor left me with two options.

The first option was to remove the nearby skin in case of any cancerous invaders. The expander would be deflated so that the remaining skin could be sewn together. The second was to bombard the area with extra radiation. Dr. Surgeon stressed that both were medically acceptable and that it was entirely up to me. For once in my life, I made a decision instantly. I'll repeat that for those of you in apoplectic shock - I made a decision instantly. Everyone resuscitated? Can we move on? Excellent.

When could I be scheduled for further Frankenboobing? Dr. Surgeon wanted to perform the excoriation before any more healing took place, so he managed to squeeze me in for the next morning. In other words, more surgery before I was even a week out of the hospital! And, as Dr. Surgeon put it, it was a shame to ruin the good work that Dr. PlasticSurgeon had done. But he did agree with my decision. After some phone calls, so did Dr. PlasticSurgeon and Dr. Oncologist. With that, everything was set for the next morning.

And that's how Matt and I found ourselves back at the hospital the following morning before even the sun bothered to get up, much less the valets. Mom, who I ever so subtly told to not to go home a few days prior, stayed at home with the leaky puppy and Zero, since the whole mess wasn't supposed to take more than a couple of hours. I think it was just a rouse to stay in bed. Anyway, I checked in and was lead into the workshop within fifteen minutes, leaving me with little time to dehydrate and shrink every vein in my body.

Along with the standard no eating or drinking after midnight, I was told no pills. This included the antibiotics, which I couldn't care less about at the time, and the incredibly important narcotics that made life worth living. I was told I had to wait until the IV was in and a doctor approved the pain killers, so I was thoroughly shocked when the nurse got the IV in my arm on the FIRST try.

About that time Matt was allowed in to see me. Unfortunately for him, I was more interested in narcotics. Shortly after his arrival, the anesthesiologist came over to introduce herself and check for allergies, a standard practice. The IV was in, a licensed doctor was in front of me. The first thing out of my mouth was, "Can I please have some Dilaudid now?"

Clearly that was not the right thing to do. "How do you know about Dilaudid?" was not the response for which I was hoping. Thankfully Matt was there to explain that I'd had a mastectomy the previous week, complete with a Dilaudid PCA, and that I'd been denied pain medicine since midnight. Still not convinced that I wasn't a druggie and apparently incapable of reading the giant binder at the foot of my bed, I had to wait for Dr. Surgeon'sAssistant for relief.

Per normal procedure, Dr. Surgeon'sAssistant confirmed the doomed side and wrote "YES" above the existing bandages. A few minutes later, Dr. Surgeon himself came to make sure everything was ready. When I mentioned that the "NO!" on the right side was fading, he rewrote it and even underlined it a few times. There would be no tormenting of the behaving boob that day.

Instead of general anesthesia, I was given sleepy meds and local anesthesia. As a result, I was much more aware of my surroundings when I was wheeled into the operating room. My attention was drawn to the whiteboard on wall with spaces to fill in all sorts of information. I remember asking about them, but the only one I remember was labeled "FRED." I wish I remember what it meant, but all I recall is laughing hysterically at its existence.

Presumably I woke up in recovery and Matt drove me home, but all I can recall from the rest of that day is feeling like absolute crap. I planted myself on the living room couch and refused to move, eat, or breathe for the rest of the day.

A week later, I was both off the couch and in one of Dr. Surgeon's examination rooms, waiting the inevitable. This time the bad news wasn't nearly as horrible. There were tumor emboli in the skin they removed, which further validated my decision to have the skin excoriated. However, the margins were nice and clean. Oh, and he removed 180cc of the initial 250cc from the expander. But more importantly, no more surgery! At least none involving Dr. Surgeon! I practically skipped out of the office, with Matt trailing behind me. Okay, that was a total lie. Skipping would have hurt like hell. But I was rather elated at the news. Good-bye for now, Dr. Surgeon!

17 February 2012

Medical grade things I forgot to mention

Before I get into the new stuff in the next few days, there are a few of things of note from the past two months that will certainly amuse the internet. The oldest was my finding a new way to get myself sent to the emergency room. Without thinking, I stretched my arms above my head while sitting at my desk at work. Normally this would make my arms ready to resume typing, but a searing pain in the stupid boob left me fighting back tears. Last I checked, boobs aren't supposed to feel like they popped, much less make a popping sound. While the pain subsided after about ten minutes, my left arm decided to lose feeling. It started near my armpit and gradually crept down until even my thumb was numb.

At this point, it was time to go home and call the doctor. Dr. Oncologist was worried that I might have dislocated my shoulder or caused similar damage and sent me to the ER. My favorite place! At least this time I was able to walk in under my own power, a nice change from my previous visits. On the flip side, the triage nurse looked at me funny when I said that I popped my boob and that I was losing feeling in my left arm.

After much poking and some X-rays, the doctor determined that I snapped scarred tissue inside my boob. Somehow the snap hit my left radial nerve, causing the numbness down that side of my arm and hand. If feeling didn't start returning within a day or two, it would behoove me to return for further tests. Thankfully, feeling was coming back by the time I woke up the next morning. And I got an amusing story.

Having already confirmed that I can still hurt myself in new and interesting ways, I had to show the world that my ability to get truly and thoroughly ill has not been adversely affected by cancer. With just two weeks to go before Frankenboob Day, I found myself feeling worse and worse as a Monday wore on. By Tuesday morning, I was clearly sick. The coughing up yellowy-green phlegm and fever were dead giveaways.

Despite my protests, Matt dragged me to Dr. Oncologist for my triweekly Herceptin dose on Friday. Along with the standard regiment of blood tests, the doctor listened to my chest. I jokingly offered her a tissue full of goop I coughed up, but she actually wanted to examine it for color and consistency. Eww. She also took a look at the less pathogen-infected lab results. My white blood cell count was just over twice its normal value. A week and a half before major surgery and I managed to get sinusitis with bronchitis. This needed to be remedied, and fast. To the Zithromax!

Despite being a five day course of antibiotics, there was no improvement by Monday. Not only did I have bronchitis, I had antibiotic-resistant bronchitis! Per Dr. Oncologist's instructions, Matt called her to say that I was still dying. With little time to spare, it was time for the big guns - 875mg Augmentin tablets, twice a day, for ten days. In case 875mg didn't sound large enough, each pill consisted of 875mg amoxicillin and 125mg of clavulanate. You try getting 1000mg pills down a horribly sore throat.

I went to bed still feeling yucky on Wednesday. Miraculously, I woke up feeling mostly human on Thursday morning. I was still coughing up random internal organs, but I was not contagious and ready to get the hell out of the house. Just in time to spend three days skiing at Mammoth, the perfect place to recover from bronchitis! And yes, the doctor said I could go if I felt up to it. So there.

Fast forward to Frankenboob Day, and I received a patient ID bracelet covered in 2D barcodes. Well, at least the parts without my name, doctor, et cetera were covered. They were all the same code, repeated around the bracelet. Upon scanning mine, I discovered that I am part number AC29113791854. A nice round designation, if I do say so myself.

Lastly, the blasphemous drain is back, and this time it brought a friend. Two drains at the same time, and each one worse than the last. So when Dr. PlasticSurgeon declared it was time to remove the larger, more depraved of the two, I practically threw a parade. Then she pulled the flagitious thing out. My dad, who had set up shop in the waiting area down the hall, heard the scream. Instead of just being the medical-grade equivalent of fish tank tubing, it got wider at the end. The tunnel it was dangling out of had to get wider to compensate VERY quickly. And yes, I was full of happy narcotics, and it still hurt that much.

09 February 2012

The Frankenboob... it's alive!

Hospitals are built on the principal that if you have to wait long enough for treatment, you'll either die or decide that it's not bleeding *that* badly and go home. Either way, that's one fewer patient needing medical assistance. Ergo, I shouldn't have been surprised that arriving promptly at nine, the time they said to arrive, was unnecessarily early. First they decided that my surgery was scheduled for one, and therefore I had checked in a mere two hours before they expected me. Shortly after noon, someone realized that I wasn't due for chopping until THREE THIRTY! I could have, oh I don't know, slept, instead of slowly losing my grip on reality in the waiting room.

Finally, after three days of waiting in the world's most uncomfortable chair, I was more than happy to donate my body to science. One of the nurses gave me the standard unisex gown and asked if it happened to be that time of the month. Of course it was, or I wouldn't have bothered mentioning it. The nurse disappeared for a minute and returned with "the latest from Victoria's Secret." After a cursory examination of the offending garment, I was forced to ask which side was the front. Let's just say the unfortunate regalia was one size fits no one, and I was no exception.

Once I was appropriately defrocked, it was time for the IV to be jammed in my arm. The standard veins in my right elbow are so scarred from chemo that they are no longer valid options. My entire left arm is off the table due to the removed lymph nodes. That just leaves the right forearm. A small shot of lidocaine, and then attempt one. Even with some unsettling wiggling, the nurse couldn't get the standard gauge needle in my vein. After examining my arm, the next shot of lidocaine was aimed at the back of my hand. Coincidentally, so was the next IV needle. Sadly, it was also the second failure. At this point, the nurse was complaining about how thin my veins were due to dehydration. How on earth could that have happened? Maybe it was the doctor saying that I couldn't eat after midnight since I had to be at the hospital by nine?

Apparently lidocaine causes further constriction of the veins, so the stabby nurse tried my hand again, this time with a full dose of agony. An IV in the elbow, when done properly, is not that painful. Everywhere else, well, that's just not the case. Despite my loud opining on the procedure, the nurse failed a third time. Time for the big guns and a smaller gauge needle.

Dr. Anesthesiologist and his minion joined the party. The minion was introduced as a medical student who would be observing. Not wanting to wake up at an inauspicious time, I asked for clarification on his role. In other words, would he be actually doing anything? No. Are you sure? Yes. Any chance of that changing? No. Okay, minion accepted.

With my safety ensured for later, it was time to return to the current predicament. The next venture into my arm was performed by Dr. Anesthesiologist. He, too, noted my dehydration for posterity. However, after failing to properly puncture the top of my forearm, he successfully got the needle in a bonafide vein, near the inside of my wrist! I may have screamed in pain as the sharp pointy thing forcibly reinflated my desiccated vein, but at least it was the last stab. In case you lost count, that was two shots of lidocaine and five IV needles in decreasing gauges.

The first thing the IV was hooked up to was a bag of hydrating something or other. While my veins dilated, I was allowed some time to panic in the company of Matt and my parents. We had some extra time together due to Dr. Anesthesiologist and his minion disappearing. Good job putting the patient at ease.

In the meantime, Dr. Surgeon and Dr. PlasticSurgeon took turns marking me up. Dr. Surgeon asked me to confirm which was the victim boob. He marked it with a giant "YES." But what about the good one? After months of nightmares in which too many boobs were removed, I wasn't leaving anything to chance. He inscribed a large "NO!" on the good boob.

Dr. PlasticSurgeon was much more methodical. She had me standup, then went to town with a tape measure. Between the dots, dotted lines, and solid lines, I looked like a demented runway from an airport requiring the planes to land upside down.

After Dr. Anesthesiologist reappeared and some amount of slicing and dicing, I woke up in my berth. First order of business: how many boobs do I have? Surprisingly enough, the number was greater than one. The right side was still intact, so the total wasn't due to two partial boobs. But the left side wasn't nearly as flat as expected. As it turns out, even after removing the nipple, there was enough skin and room behind the chest muscle to inflate Frankenboob to approximately 3/5 of normal size! In retrospect, of course there was some room behind the muscle, otherwise how would normal people get boob jobs without always requiring expanders?

The less pleasant surprise was that the patient-controlled analgesia would only fork over Dilauded once every eight minutes. The button would helpfully light up when a dose was available, but that didn't stop me from jumping up and down on the damn thing in hopes of getting a more useful dose. The other "problem" was that the Dilauded made me too groggy, so I spent the first day and half barely conscious. Eventually, I was switched to Norco pills, which failed to fully alleviate the pain, but at least kept me aware of my surroundings. Considering I was still stuck in the hospital, I'm not sure that this was the greatest trade-off ever.

At some point during my stay, the IV started to really hurt at the insertion site. A nurse, whose sole purpose in life was to set up IVs, removed the current one and inserted a new one ON THE FIRST TRY. I was in love. Then I realized that the removed IV wasn't where the one from the hour of poking ended up. At some point during surgery or delirium, they had switched the IV location. In other words, I was on my seventh IV, and I had the black and blue marks and holes to prove it.

I spent the next couple of days in my hospital bed, occasionally getting up to pee when absolutely necessary. I was happily discharged after my fourth day of hospital food. The dogs were happy to see me, though confused as to why they weren't allowed near me. While I was happy to see them, I was more happy to see my own bed.