Day 127 - Oophorectomy Surgery, Breast Surgery & Breast Reconstruction Surgery

Sorry that I haven't been posting as frequently. I have been busy at work, getting over a cold and just busy when I get home to get to the computer to really post. Most of you may be wondering what happened at my three appointments on Thursday. Well, two out of three of them went well...

First appointment was with the Gynecologist Oncologist or gynoc. The appointment started off well enough. I went in and we started discussing the oophorectomy. Somewhere during our discussion the appointment went from a consultation to a pre-op appointment. The doctor left and told me she wanted to examine me and to get undressed. Then she came back in and looked at me and did a pap test and more. Then she left and said we'll discuss more of the surgery when she returned. But before she returned, her nurse came in with a tray full of blood. I said what are those tests for? She said she didn't know and said she could go and ask. I said yes because I didn't want to give blood without knowing. She left and then came back in. Turns out she was getting blood for pre-op stuff. I said, no. I didn't want to give any blood through my port because I was going to be talking to my other surgeons and they might want some other tests done and I didn't want my port accessed twice in one day. Hell no. Then I just broke down in tears because it was happening all so fast and the doctor didn't even tell me what the hell was going on. She had disappeared and said she'd be back to talk about the surgery. I figured we'd talk more about what went on and ask more questions. At that time the doctor came back in and I asked her what was going on. I said I came in for a consultation and where did this turn into something else? She replied that "You seemed certain that you wanted the surgery so I went ahead and made this into a pre-op appointment." I said, "Where did that change?" I told her I was a planner and I don't like surprises and I feel like I am being surprised right now and it doesn't feel good. It was at that time that she actually took time to discuss with me the procedure and what sort of other tests are she's going to need... blood, ultrasound and something else. I refused to give blood, so they set it up that after I meet with the other surgeons, I can get my blood drawn. We also talked about if I should get my mastectomy with immediate reconstruction and the oophorectomy done at the same time. I hadn't decided because I hadn't talked to the other surgeons yet. So after that discussion, we went through the pre-op stuff, like the risks and what not. She does laproscopic surgery. She'll make up to 6 incisions in my abdomen to snip and drag out the fallopian tubes and the ovaries. Once they are taken out, they are sent to the lab to be "staged" - to see if there were any microscopic cancer cells/tumors. In about two weeks the results come back. Now normally if I wasn't BRCA positive, they would stage in the operating room. But they want to be certain that everything is okay. The surgery takes about 2 hours and if I was doing this as a stand alone surgery, I would go home the same day. I asked Brad if I was overreacting about the whole appointment. He said no, because he thought that this was going to be a consulation appointment and not a preoperative appointment. He noticed that it changed its course with no warning. I am not sure if I want to go with her. I may talk with Brooke or Christine about her because I am not sure if I want to go with her because of her bedside manner.

Following that disasterous appointment, Brad and I walked to the Old Spaghetti Factory for lunch. That was a nice walk... it's about a mile away if that. We had a nice lunch and then walked back to OHSU's Center for Health and Healing for our next two appointments. We meandered our way back because we had about an hour to kill.

We got to our appointment about 20 minutes early and then were led back into a room about 2.30p. On our way there, I saw Maureen one of the CNA who works with Dr. Luoh. Then I passed the nurses station with the schedulers and Brooke was there. She ran out to give me a big hug. We talked for just a moment before we went to the our room. To make a really long wait short... I wandered out of the room and up to the nurse's desk to talk to Brooke. I told her about the disasterous Gynoc appointment. She and the scheduler, Sierra, were happy that I stood up for myself and said No and stopped all procedures from happening. They said that many patients don't advocate for themselves and just go with it. I always try to be in the know and so that way I am prepared. In any case, I saw Dr. Pommier, the surgeon who put in my port while I was chatting with the ladies. He called me out and asked, "How's it going Mrs. Rake?" I laughed. Finally after 3p, I finally got in to see Dr. Naik. She was finishing up with a patient. She looked at my boobs and was impressed that I responded so well to treatment. We talked about surgery and the whole appointment was driven by me and Brad asking questions. My first question after she examined me was "Would you suggest that I be a candidate for a lumpectomy now - IF I wasn't BRCA positive?" She said yes. That's all I wanted to know. I don't want a lumpectomy, I just wanted to know if I responded well enough to the treatment where a lumpectomy was a possibility. I'm still getting a double mastectomy. I asked how long the surgery takes... normally 4-5 hours. We discussed whether we should do an oophorectomy at the same time. She said that some patients do, but recovery time is longer. She suggested that I not do it at the same time. The oophorectomy will have to be done after her surgery, so that would mean I would be under anesthesia for 6 hours at the minimum and that's too long. Good to know. We talked about drains (a question she deferred to Dr. Thaker), good clothes to wear afterwards, pain protocol (narcotics, she uses IV pain, then changes to pill form as soon as the patient can handle pills), port removal (she's going to take out the port during the surgery - hooray!), is surgery scheduled for morning or afternoon (morning). I also asked what kind of lymph node dissection she will do. She said she would do an axillary dissection. She will take out 10-20 nodes depending on how many are there. Each person has different amounts of nodes in their body. She said that she will take out the cluster that was affected under my arm... and that may be anywhere between 10-20. I asked about the different levels of node dissection. She said that they normally do Level 1 and 2. Level 3 is where it's deep in the body and she normally doesn't do those unless she has to. Brad asked if the incision would be bigger or smaller now that the tumor has shrunk. She said that it would be a bit smaller. I asked how many nights I can expect to be in the hospital. Dr. Naik said anywhere from 1-2. I will have the drains in my body 10-14 days. I will be sore for a couple of weeks. My next course is another pre-op meeting where we go over the nitty gritty information and get waivers of consent. I will need an EKG and blood work. We asked her about blood work... which she wants about a week before the surgery. She said that since my last treatment was a week ago, my blood counts will be out of whack. It won't be a true representation. (Um, then why did the gynoc want my blood today? She should know that right after chemo, my blood counts won't be a true representaton) We said cool. I can't wait for the next step. Dr. Naik said that I look good and she can't believe that time has passed so quickly. I so believe it!

Next we waited for the last surgeon... Dr. Thaker. She came in and was so upbeat, energetic and I really like her. She said that I look great! She remembered the first meeting and she said that I look so much better than that meeting. Um, yea. :) Her first question was if I wanted to stay the same size or if I wanted to go bigger. I said, after all this, I want to be bigger. She laughed. She said that we will go with our original plan to do the tissue expanders and then after radiation, we'll switch out the expanders with the implants. Hooray! This appointmet was again driven by Brad and I. We had questions... the surgery will last about 1-3 hours. If all goes according to plan, as soon as Dr. Naik is done with the first breast, she will be called in and she will place the tissue expander under the pectoral muscle. She says usually when she's done with that, Dr. Naik is done with the second breast... so it's sort of a tag team. Wonderful. Less time under. She also uses a product called AlloDerm. AlloDerm is used because the pectoral muscle will not cover the whole expander and it creates sort of a sling. It's made of collogen, so blood flow and cells will begin to take over it. She calls AlloDerm as an empty apartment, and my body just needs to move in! I like her - did I mention that? After the expanders are in place, she will put in some saline so at least I will have little boobs after surgery. She doesn't want to fill them too big because she doesn't want to stretch out the skin and cause bad healing. Apparently when Dr. Naik goes in to do the mastectomy, she takes away a lot of the blood flow, so my skin needs to find new ways to deliver blood to other areas of the skin. I didn't know that. That's interesting. After about two weeks, I will see Dr. Thaker and the injecting the saline in the expanders. She'll start off small and then increase (100mL max). She said that it usually takes about 3 appointments until the desired size or about 4 weeks. Hooray! It's going to be cool because she said that I will be taking my new boobs out for a test drive. I don't have to guess. All I have to do is say "stop" and that will be it! So when I reach my desired size she'll put a little more in to for some "padding" and that will be it. Then I go to radiation and do that. Following that, she waits 3 months to make sure the skin has healed. If my skin does well, then it's on to the implant switch. That surgery will take about 2-3 hours. It is at that time that I think I will do the oophorectomy. Dr. Thaker said that would be fine. I asked about nipple reconstruction. That can be an office procedure at a later date... and tattooing would be done in office as well. I told her that I will be flying in September and since the expanders have metal in them, what happens. She said that she can write a letter stating I have expanders. She said that if I go to some remote area, then they may not take the letter... but she does write letters and says that normally security doesn't ask, nor does it cause problems. She said that when she was going through security at LAX, the security person asked if she had implants. She said, "No, but I have a lot of patients who do. Thanks for asking." I laughed. She said that I will have several drains... the breast and I may have one in the lymph nodes. They will be taken out in the office and held in by a stitch. As for pain management she puts in a pain pump which is a tube that that goes into the breast and numbs it, similar to novicain at the dentists office. It usually lasts about 3-5 days depending on how much I use it. When it's done, I can pull it out at home! Oh yes, she said that Brad can administer the saline into the tissue expander... um, no. She also said that when I am expanding, she will give me some pain medication to take before going to bed. She said that it's more uncomfortable and most people have the pain when they're going to bed and trying to relax. Our next appointment will be a week or so before surgery for the consent form and to go over the actual surgery. Fantastic. She'll also show me what the expanders look like. Oh yes, at a later date, she may take some fat from another part of my body and insert it onto my chest to make the breast look more natural - rather than two cantalopes. Ha. She then showed me pictures of breasts before, tissue expanders and then implants. Looks good! I can't wait.