Impatience

The report on Cathy is good, but we're all a little impatient.  This surgery has brought a higher degree of soreness and a greater feeling of being generally uncomfortable than the last surgery.  All of that means that Cathy is moving a little slower than she would like.  The blood and clots are still flowing in the drain.  Sometimes the clots clog the drain and the blood won't flow.  After Cathy or I strip the drain, the blood flows more freely, undoing the sense that quick healing is occurring.  Cathy and I find ourselves in a frustrating pattern that we are able to recognize and laugh about.  Cathy wants to be normal Cathy and do all of the things that she normally does.  I want Cathy to rest and heal while I do the things that she would normally do.  Neither of us are doing a very good job of either of those things!

So, we're both a little impatient with the situation.  We both had the realization that we're coming up on a year of dealing with cancer next month.  Spending an entire year or longer with this is a bit frustrating as well.  We will go as long as it takes, though!

There is good news.  So far, Cathy feels symmetrical - at least to an acceptable degree.  She did not feel symmetrical after the last surgery.  How many of us have symmetrical bodies anyway?  Her incisions seem smaller than the last surgery.  She is able to sleep and can stay on top of her pain and meds.  Tomorrow we will go to the one week follow up and see what that holds for Cathy.

Surgery Report

Cathy's surgery went as expected yesterday.  She was in the OR for two full hours and apparently had to have some pretty significant anesthesia administered to allow her muscles to relax for the best removal of the scar capsule.  She was really sleepy for about 3 hours after she was in recovery.  Today she is pretty sore, more so than her first implant exchange, but less than with her mastectomy.  Dr. Butterfield put a drain in the right side, the side with the hardest scar capsule.  She told me that removing the capsule caused more bleeding and that excess bleeding can increase the risk of future contracture.  Hopefully, the drain will be removed next week when Cathy has her follow up.  Cathy is doing well.  Her spirit is predictably good, but she would certainly prefer to not be dealing with this.

Surgery Tomorrow

Tomorrow Cathy will go under the knife again.  With Dr. Drosick's thoughts on her joint pain and psoriasis flareup, Cathy has gone with her gut feeling that another try with implants is the way to go.  Cathy will have a capsulectomy and explantation of her current silicone implants.  She will have them replaced with saline filled implants in hopes that the scar capsule won't contract this time.  Dr. Butterfield has been very straightforward in her (and the profession's) lack of understanding of what causes capsular contracture.  She has also put Cathy's odds of dealing with it again at 50/50.  We'll just hope and pray that she's on the good side of 50.  I will update her progress as the day goes on tomorrow and the next few days.  Thank you for your prayers and concerns.

A Little Clarity

Cathy had an appointment with Dr. Drosick on Tuesday.  We left the appointment feeling very good.  Cathy is thinking that giving saline implants a shot is the best move.  Neither of us is 100% sure of that, yet, but we think it is worth a try.  Here's why:

Cathy's bloodwork for autoimmune disease came back negative for everything.  No rheumatoid arthritis, no lupus, nothing of the sort.  She does have some rocking psoriasis, but Dr. Drosick feels very strongly that the psoriasis flareup and the arthritis are both the result of her body's reaction to chemotherapy.  He said that some morning about a year from now she will wake up and have no pain.  It will just vanish.  We don't completely understand because it's so complicated, but he said that the chemo suppresses the psoriasis, so when the chemo is gone the body attacks itself with an increased vigor because the immune system has been confused.  The immune system and autoimmune responses are such difficult things to understand, that I feel good taking his word for it with my limited comprehension of the information I've read.

Knowing that Cathy is negative for autoimmune disease (aside from psoriasis) and that the pain she's having is from chemo, we're thinking that her issues are not silicone related.  We still don't have an explanation for her poor vision in the right eye, but everything else is making sense.

With that in mind, saline sounds like a good solution - or at least worth a try.  We both think (and Dr. Drosick agrees [Dr. Butterfield, too]) that microvascular flap surgery is too traumatic of a surgery for Cathy to endure with too long of a recovery.  She doesn't have fat enough to consider adipose stem cell fat transfer, so it really comes down to saline or no reconstruction.  Cathy has a strong desire to give reconstruction another shot.  She's a beautiful and strong person.  She doesn't want reconstruction for any vain reason.  She just wants Clara to grow up familiar with her mom as a normally developed woman.  Cathy hopes for Clara to see herself as the same kind of person as her mom.  If that works out, Cathy will be very happy.  If it doesn't work out, Cathy will be disappointed, but I think that she is confident, strong, beautiful, and still the same person.  We both wish things could be the way they were before, at least physically, but Cathy knows that we will love her any way she is.  I'm so thankful that she's here and that she's going to continue to be here for a long time.  I praise God for healing her and I'll take her any way He'll let me have her.

More Challenges

Not too long after Cathy completed her chemotherapy treatment, her psoriasis returned just as strong as before cancer or perhaps a little stronger.  While chemo cleared up Cathy's psoriasis during treatment, Dr. Drosick told us that it is common for psoriatic chemo patients to have a flare-up of psoriasis that is pretty powerful after chemo is finished.  We had expected its return.  We also hoped that it would settle down over time.  As Cathy's psoriasis worsened, she began to develop some joint pain, as well.  Cathy's hands and elbows hurt, then her knees, hips, ankles, and shoulders.  The logical connection that I made (perhaps mistakenly) was psoriatic arthritis.  We thought that maybe this would settle down also.

Well, the joint pain is worsening and the vision in Cathy's right eye has begun to blur a little bit.  As the symptoms increased we felt the need for a little research and some doctors' appointments.  The doctors' appointments haven't happened, yet, but the research has yielded some interesting information.  We both encountered many stories written by women of silicone implants triggering autoimmune responses.  We read about blurry vision, joint pain, skin problems, and saw scary words like rheumatoid arthritis, fibromyalgia, and lupus.  Most of these stories indicated that within two years of the implants being removed the autoimmune disease vanished.

Further investigation led us to many research studies that have shown no connection between silicone implants and autoimmune disease.  Many of these studies included implants made of silicone gel, as well as saline implants encased in silicone.  While the research is pretty conclusive on this subject, the anecdotal tales of women with horrible autoimmune disease are pretty convincing.

We have a lot more research to do and a lot to learn before Cathy's surgery on April 23.  Any prayers for pain relief and improved vision would be appreciated.  Prayers for insight and guidance in decision making would also be appreciated.  Any readers in the medical field who could guide me toward respected and reliable medical journals that would help me gather information are welcome.  It's hard for someone outside the medical profession to know what research deserves merit.

The Daily Grind

It's been almost a month since my last post.  While it has been my intention to keep this focused mostly on Cathy, my own "stuff" has prevented me from writing.  The primary obstacle to regular posts is all the stuff we do every day.  Carving out regular time to write is very difficult!  The daily grind has become my regular excuse for not writing, or exercising as much as I'd like, or doing a whole host of other valuable things that don't fit into the category of primary immediacy.  I tell Cathy all the time, "When I have the energy I don't have the time and when I have the time I don't have the energy."  That statement applies to a dozen or more things.

My other main obstacle to blogging has been the same issue that's prevented me from journaling my whole life.  A lot of times I just don't have anything worth saying!  I subscribe to the philosophy that I should say what I mean and mean what I say.  Most times I only talk when I feel like I have something that is important for others to hear.  If it's not important, I usually just keep my mouth shut.  This approach to life generally serves me well, but sometimes it's a social handicap.

On to the purpose of the blog in the first place - Cathy.  Cathy is scheduled for surgery on April 23.  At that time she will have a capsulectomy and a replacement of the implants.  Her pain is stabilized or decreased slightly.  I think there are two factors at play there: (1) I don't think the capsule is hardening or contracting farther, and (2) Cathy has been stretching, doing yoga, and exercising pretty regularly.  Even though the capsule is pulling on the muscles, her muscles have much better strength and flexibility than they did a month or so ago.

Cathy seems less discouraged by having to go back in for more surgery.  She's more just ready to do it and move on, I think.  Her comfort has increased to a point that things seem to be more like normal.  Like normal is what has allowed the daily grind to take a stronger hold on both of us.  This next surgery will slow down the grind a bit and bring the new normal back to the forefront of our lives.  The new normal will be a topic of discussion for another day.

Peace to you all!

A Little Setback

We have to take the bad with the good, right?  Cathy had a little setback this week.  It's not a cancer related setback, but a reconstruction related setback.  As she has been healing from reconstruction she has been feeling a particularly powerful tightness on her right side.  The left side, which is ironically the side that was troublesome with the expanders, has felt pretty good.  After seeing Dr. Butterfield, we've learned that Cathy has developed capsular contracture.

Capsular contracture is a condition that deals with the scar tissue that the human body develops.  Because the implant is a foreign body, Cathy's body has developed a capsule of scar tissue that surrounds the implant to wall it off from the rest of her body.  This process is normal.  It's one of the body's defense mechanisms to fight off foreign invaders.  In her left breast, the capsule of scar tissue is thin, light, and supple, allowing for normal healing.  However, the capsule in her right breast is tightening and forcing the implant to shift in position.  The capsule of scar tissue is connected with other tissue, like skin and muscle, so as the capsule contracts it pulls on the tissue to which it is connected, causing some considerable discomfort.  

There is a grading system for degrees of capsular contracture.  It's called the Baker scale and it looks like this:

• Grade I — the breast is normally soft and appears natural in size and shape
• Grade II — the breast is a little firm, but appears normal
• Grade III — the breast is firm and appears abnormal
• Grade IV — the breast is hard, painful to the touch, and appears abnormal

In Cathy's instance, her contracture is a Grade IV.  So, all of this boils down to another surgery.  Sometime in April, Cathy will have to have a capsulectomy and then have her implants replaced.  The silicone implants will be replaced by textured saline implants that will reduce the likelihood of another capsular contracture.  The bad news is that once significant capsular contracture occurs the odds that it will recur are about 50/50.  We're praying that Cathy will be on the good side of that 50/50.  We're hoping things will turn out well, but if they don't the only further options are another surgery with no reconstruction or microvascular surgery using tissue from her buttocks.  Neither of those options is preferable.