Monday, January 09, 2006

Arms and the Woman

In my surgical-drain-removal-induced glee (five words I daresay were never before strung together), I neglected to mention that I have had a somewhat unusual complication from the surgery last week.

First, some background:

When you've had breast-cancer surgery in which lymph nodes are removed (which I first did back in March 2001), you are thereafter at an elevated risk for a lovely side effect known as lymphedema, which, to oversimplify for the moment, is swelling of the arm (more on this in a future post). I think the one good thing that can be said of lymphedema is that it is not life-threatening. It is, however, in my surgeon's words, uncomfortable and unsightly.

There are many things one can do to reduce the risk of lymphedema, most of which involve avoiding breaking or burning the skin on the "affected arm" (the one on the same side from which lymph nodes were removed). This is why I wear I wear rubber gloves when I do the dishes and why I carry Neosporin and Band-Aids with me nearly every where I go (so that if I do get cut or burned, I can make sure the skin stays clean and dry, doesn't get infected, and heals as quickly as possible). If I gardened (sorry to disappoint anyone who thought I did), I'd wear gardening gloves, too.

You get the idea.

The other big key to lymphedema prevention is to make sure that, going forward, any blood draws, IVs, and blood-pressure readings are done only on the unaffected arm. This means that when I had chemotherapy in 2001, it was always done through an IV in my right arm. And because chemo is, well, poison (to oversimplify again), those eight treatments did a number on the veins in my right arm. (See earlier post about my MUGA scan and the friendly, disbelieving phlebotomist.) Now every time I have to get blood drawn or have an IV started (fairly often, especially of late), it has the potential to be a pretty big production—finding a viable vein (usually down at my wrist or on the back of my hand), getting it on (one can only hope) the first try, etc. (And this is why I will need to get something called a port before I start chemo this time around. More on that joy in a future post.)

So the key things to know before I explain the somewhat unusual complication from last week's surgery are that A) any IV or blood-pressure reading has to be done on my right arm and B) the veins in my right arm are shot.

Last week (and three weeks before that), I had something called MAC—monitored anesthesia care—instead of general anesthesia (which I had for my surgeries in 2001). To once again oversimplify, MAC enables the anesthesiologist to knock you out entirely (it is not a local) but avoids the nasty after-effects of general anesthesia. With MAC, everything goes in through an IV—there is no mask.

So the anesthesiologist started an IV down by my right wrist, and the next thing I knew I was awake and it was over. But the next day, my right arm started to hurt. My left arm hurt, too—that was expected—but I couldn't figure out why my right arm should hurt. It didn't three weeks earlier, after the last surgery. I didn't really focus on it, though, because of all of the aforementioned surgical-drain-induced discomfort. Still, I remember that my forearm was slightly swollen and slightly red.

Two days later, though, Zach and I went to a new doctor, and the phlebotomist there tried to draw blood from my right arm. No dice. I tried drinking a couple of bottles of water to help the cause (dehydration just exacerbates things), and I pumped my hand until I practically reached muscle failure. Still no dice. And, to the credit of the phlebotomist, she didn't even try to stick me. She tied a tourniquet on a couple of times, did that thing phlebotomists do when they're trying to find a vein—flicked my arm in various places to try to get one to overcome its shyness and protrude a bit—and eventually told me to come back another day.

After that, Zach and I headed over to see my fantabulous surgeon (she of the surgical-drain emancipation), and I mentioned that my right forearm hurt. By then, it was redder and slightly more swollen (perhaps because of the tourniquets that had just recently been applied further up my arm).

Redness and swelling after surgery (even somewhere other than the site of the surgery) are never what a surgeon wants to see because the most likely explanation is a none-too-welcome infection. But I had no other symptoms of infection (and was already on a standard post-surgical antibiotic), and the redness and swelling very clearly tracked the vein into which the anesthesia was pumped, so she thought it was most likely a chemical irriration from something in the IV or possibly superficial thrombophlebitis, which sounds ominous but is not a big deal—it's pretty much treated with anti-inflammatories and a heating pad.

My fantabulous surgeon sent me home with a prescription for a different antibiotic so that, on the off chance that this was an infection that just wasn't responding to the first antibiotic (which I'd know because the symptoms would get worse), I could fill the Rx over the weekend and go from there.

The good news is that the symptoms didn't get worse. On the other hand, they didn't get a whole lot better. So, at today's follow-up appointment, my surgeon had me switch to the other antibiotic, start taking anti-inflammatories, and continue using the heating pad. I'm supposed to call her tomorrow with a status report, and we'll go from there.

Meanwhile, my left arm (which seems more like the unaffected arm at the moment) is in pretty good shape. My incisions look great (so says my surgeon—I can't really even see them without some serious contortions—plus we don't have a bathroom mirror, or a bathroom, just yet, in which to try to see them). My range of motion is pretty good and will continue to improve with some specific exercises that I have already started doing.

All in all, things are fine. I will be happier when my right arm bounces back (for one thing, I need to have some blood drawn, but that will have to wait for now), but it's clearly not keeping me from typing. . . . .


Anonymous Anonymous said...

Wow, you are a far better woman than I, Gunga Din. (?!) Very impressed with the nonchalance (and humor!) with which you are experiencing all this!

Funny about how different folks react to anesthesia: I never got sick after gas-induced, but the one time I had the IV method, in 2002, I did. Weird. Even my anesthesiologist boss will tell you there are LOTS of things they still don't understand about how it all works (or...doesn't).

Good luck with the port-- I suspect (and hope!) that in the long run, it'll be way easier than getting stuck multiple times. And hey, it's gotta be prettier and make you feel more glamorous than the ##$$%^& drain you just had out! ;)

ra ra, LOVE your commentaries-- THANK YOU!

And please tell my cold-ridden brother I hope he gets well soon.

--love, Torre

January 9, 2006 6:16 PM  
Blogger Zachary said...

I've nearly shaken it, sis. Thanks.

January 9, 2006 7:30 PM  
Anonymous Anonymous said...

First this post made me feel woozy from the medical discussion. Then it made me laugh hysterically...from the medical discussion. Neat trick!

Love from across the river...


January 10, 2006 8:16 PM  

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