Wednesday, March 6, 2013

The Road to a Mastectomy with DIEP Reconstruction

Preoperative Testing (Boring... but in case you were wondering)


I was pretty much living free and clear for weeks in February before the medical B/S started picking up. On Thursday February 21st I had to have fasting bloodwork done. I hate fasting bloodwork. Don't you want to see how my blood really looks because I will tell, my natural stage is not fasting. Quite the opposite.  No big deal though, Quest Diagnostics now takes appointments and they were really easy to get into right by work by 10:30 am.

PreOp with the Breast Specialist


Tuesday February 26th was my first preoperative appointment with Dr Lindfield.  My appointment was at 3, I was 5 minutes early, and I waited a half hour. Really not that bad compared to Dr Burke's office. Dr Lindfield's nurse took vitals, told me all my blood was perfect, and explained to me something called Lympedema.  Every time I went to Dr Lindfield's office I saw the poster for Lymphedema but nobody ever pointed it out to me so I assumed it did not apply to me. I was wrong. Lymphedema is a condition that is a risk whenever lymph nodes are removed rom around your extremities. In my case, they will be removing a few lymphnodes under each of my armpits to see if they are cancerous.  So I learned that if I end up with Lymphedema one or both of my arms would swell 10x their size.  If I know I am at risk, they can do things to prevent lymphedema, like using a special sleeve to prevent swelling. The test is $300 and insurance doesn't cover it. I opted to have it done and so they did it right there in the office. I didn't even know they were doing the test, it involved putting a sticker on my ankles and wrists and then getting a reading. I asked what the reading meant and they said nothing until they take a post-surgery test in 3-4 weeks. 

PreOp with my Primary Care Physician

Through-out all this I did not have a primary care physician. Dr Lindfield was not requiring that one sign off on my surgery but she did recommend I find one. I was referred to Daisy Wen by Dr Dougherty but she couldn't see me will May. Then I was referred to Christian Lates by my friend Kate and she said he was funny... big plus! So he wouldn't see me until May either. OK, whatever, I made an appointment to see him. His office did not like that I was going into surgery without his approval so they told me I must be wrong, they must be asking for a surgical clearance, so they pushed me in on Monday March 4th at 3:00 but come at 2:30 to fill out paperwork. I guess a full weeks noticed wasn't enough time to mail me those papers.

When March 4th came, I left work at 2 to get there by 2:30. I got there right at 2:30 and the receptionist told me I was already in the system so I was good to go. Well thank you, you could have checked that when I made my appointment, but afterall, it's just MY time. Clearly not as important as the doctors. However when I arrived at this appointment I was hit with something competely new and fresh... I sat down at 2:30 thinking I had 1/2 hour (and then some) to burn until my appoinment time, when a guy opened the waiting room door and called my name. So I went in. It was not a nurse or a receptionist, it was the doctor himself! He said he was waiting for the next patient to be queued and set up by the nurse, so he would occasionally try to see patients while he was waiting. He brought me in, got my basic info (Why I was there) but then he said "oh, you are BRAND new... I am sorry, for you I need the nurse to see you first to make sure you are set up in the system. I am so sorry".  I felt bad for him but I was amazed at this new process that I have never seen before.  We have all seen it... Appointment at 3, get called back at 3:15, you see a nurse at 3:40 and then you finally see a doctor at 4, 4:40, or later. And you sit in the office and seethe about why they can't stick to their own schedule. This doctor explained to me that half of his patients are here because they are sick and he can see them and determine what is wrong while in between patients... then when the nurse gets caught up, she can come do all the documenting, vitals, paperwork, etc. He said he saw no point in wandering around the office waiting for the nurse to get another patient ready, so he just sees people while they are waiting. Very "Doc" from Little House on the Prairie. Isn't that so cool???? Unheard of, right?

Well anyway since I was new I did have to wait for a nurse but she was in and then the doctor right afterwards.  By 3:30 I was out of there. The nurse and doctor were both dumbfounded that nobody was requiring their clearance for a DIEP flap mastectomy surgery, but either way the doc said I was a perfect candidate for surgery. He also mentioned I should consider a gastric-bypass surgery because even though I consume about 1600 calories a day and exercise regularly, a gastric-bypass would reset my hormones and help me lose weight.  I disagree with this statement 1000 times over but that is a whole different blog post. This one is about curing cancer.

CT Angio


Because I was having a mastectomy with reconstruction using  DIEP flap, the blood supply in my belly area was very important.  The plastic surgeon needed to know before surgery where to find the main blood flow in my gut so he knew where to connect it to the blood flow near my chest. This was important if the skin that was going to be transplanted from my belly to my chest was going to live and survive the transplant.  For this, I had to go to ECMC 2 days before surgery. ECMC is a very scary place.  There is so many medical companies all conglomerated into one building. It attracts many different type of people.  My first visit to the radiology dept just about scared the crap out of me. They didn't know why I was there, they had no script for my procedure, and worst of all, it was 11:00 and I had been fasting for this.  "please figure it out soon because I need a bottle of water stat or I will pass out...".  The good news is that once they got the script from Dr Burke (who said the script was sent up 2 weeks ago). I was in an out in 10 minutes.  The CT Angio involved me laying on a CT table on my back while the table brought me into the tube 2 times.  Then they gave me a radioactive dye injection that would highlight my arteries in my gut. Then they took 2 more pictures, and that was it.  Except for the stress of being at ECMC, this test was pretty easy.

Sentinel Node Injection

Less than 24 hours prior to surgery, I needed to go into Dr. Lindfield's office for a sentinel node injection.

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