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Topic: PORT PLACEMENT - Detailed description of process

Forum: Chemotherapy - Before, During and After — Regimens, side effects, and support from others going through chemo.

Posted on: Sep 27, 2008 06:55AM, edited May 24, 2013 05:55AM by Moderators

tbird57 wrote:

Hi everyone

I just got my port placed yesterday and I had such a hard time finding a detailed description of the procedure, so I thought I would share this for anyone who is apprehensive or likes to know exactly what they are going to do to you:

1.  I arrived at the hospital and registered.  I was then taken back to the outpatient surgery/recovery area, got undressed from the waist up and took off my shoes, IV started, EKG hooked up, blood pressure and blood oxygen meter hooked up, and paperwork completed.  A small bag of Levaquin antibiotic was hooked up to my IV.

2.  I was taken back to a holding area outside the OR where they were going to place the port and the procedure was explained to me.  It takes about 1/2 hour to actually place the port.  They don't completely put you under for this procedure - they give you a sedative of morphine and fentanyl so that you "don't care" what they're doing, but you are awake and able to respond if they speak to you.  The sedative is the reason why you have to stop eating 6-12 hours before the procedure, and the reason why you have to wait an hour after the procedure before you can leave.   In addition to this sedative, they give you several local numbing injections in the areas where they are working in your upper chest below the collarbone and the base of your neck.

3.  I rejected the sedative and did this procedure with locals only.  Being able to go home quickly appealed to me, and I'm just the kind of person who feels like I'm not in control when I am sedated but not completely under - either put me completely under or nothing!  So this worked well for me.  (I asked the nurse if every man they worked on today had the "happy juice" and she emphatically stated, "you got THAT right!" - LOL)

4.  They transferred me to the operating table from my gurney bed; actually, I transferred myself by sliding over.  They gave me a warm blanket, took my right arm out of my hospital gown and gave me a small pillow for my head.  They also pulled and taped my skin down on the right side to simulate where the skin would be when sitting up for chemotherapy.  I was reconnected to the EKG, blood pressure and oxygen monitors too, and my hair covered with a surgical cap.  An imaging device was placed over my chest so they could check the final position of the catheter above my heart to be sure it was correctly placed.  They cleaned my skin in the surgical area with a strong blue solution and then draped my entire body and head in a blue surgical blanket.  They had a frame under the blanket where my head was and made a "window" on the side so I could look out.  A lovely nurse stood right by my head to soothe and talk to me throughout the procedure.  I was awake and alert, and curious and continued to talk to the surgical team, asking questions about the process.

5.  When I was prepped and ready, the surgeon came in.  The first local injections were in the base of my neck on the lower right side, where they begin the process by threading the catheter into a large vein, and pushing it in until it rests just above your heart.  The local injections sting and burn just like at the dentist, but once they take effect you are numb.  Any discomfort comes from the pushing sensation in your neck and you can feel pressure in the side of your throat, but it's not painful, just uncomfortable and strange.  The team kept me informed about what they were doing throughout and I kept them laughing with a funny story about a recent visit to the dentist which involved injections to the roof of my mouth - which was WAY more painful than this, I might add!

6.  When they finished with the neck part, the doctor gave me several more numbing injections in the chest for the actually port placement part of this procedure.  More stings and burns, but totally tolerable.  In this part of the procedure, they make an incision in your chest for the port which is about the size of a quarter, placing it under the skin below your collarbone, and then they make a tunnel for the catheter sticking out of your neck (at this point), push it under the skin down to the port, and connect the two.  There is a fair amount of pulling, pushing and tugging in this part of the process but it wasn't painful - again, just strange and uncomfortable.  It doesn't last long, and then they begin to stitch you up.  The subdermal layers are stitched with dissolving stitches and the top layer is glued with steristrips placed over the incisions.  You will have one tegaderm dressing over a small gauze pad a the base of your neck, and another on your chest below your collarbone.

7.  I was instructed to change the dressings every 2 or 3 days, and to keep the dressing on the neck wound for 5--7 days, and the chest wound for 10-14 days.  I was given supplies for 3 rounds of dressing changes. I was told it was okay to shower by wrapping the site in saran wrap but no soaking baths and ensure the area is kept dry.  The port can be used immediately, and does not need to heal before it can be accessed.

8.  Because I didn't have the happy juice cocktail, I was able to get dressed and leave right away!  A big plus to me.  Last night, the surgical areas were numb, and really didn't completely wear off until the wee hours of the morning - about 10 hours later.  There is very little pain involved, but it is uncomfortable to turn your head too much, and I am definitely favoring the area.  I also could not sleep on my right side last night, but was able to sleep on my left side just fine.  I don't plan on doing any housework today, but I'm able to do light cooking, work on the computer, etc. 

9.  There are very good pictures of what the placed port and scars look like on this site:  http://diehlmartin.com/infusion/.

I hope this is helpful.  I was searching high and low for this kind of detail prior to the procedure, but couldn't find it.  I wish us all the very best of health,

Teena

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Sep 27, 2008 07:07AM badboob67 wrote:

Teena,

Great post! We need to keep this one "bumped" up to the top for everyone. I've had two ports--the first was not placed well, so with the second the interventional radiologist let me trace around my bra strap beforehand to be sure the port was placed where it wouldn't be irritated.

(((HUGS)))
Diane

When you're down to nothing, GOD is up to something! http://bb67.wikispaces.com/

Dx 2/15/2006, IDC, 5cm, Stage IV, Grade 2, 24/27 nodes, mets, ER+/PR-, HER2-
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Sep 27, 2008 07:43AM tbird57 wrote:

Thanks Diane - I was hoping it would be helpful - great tip about the bra strap.  I'm leaving my bra off for the weekend.  It's not over the port, but the pressure on my chest and shoulder is bothering me a little.

Love and prayers for you, and all of us dealing with this,

Teena

Love, love, love - that is the soul of genius. Mozart

Dx 5/2008, IDC, <1cm, Stage Ib, Grade 3, 0/2 nodes, ER-/PR-, HER2+
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Sep 27, 2008 07:52AM Mandy1313 wrote:

Hi Teena

Great post and really informative.

Thanks for taking the time.

Mandy 

Dx 6/2008, IDC, 1cm, Grade 1, 1/2 nodes, ER+/PR+, HER2-
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Sep 27, 2008 07:55AM badboob67 wrote:

Teena,

I have sent the mods a message requesting this post be "pinned" to the top of this section. It will be so helpful to so many!

(((HUGS)))
Diane

When you're down to nothing, GOD is up to something! http://bb67.wikispaces.com/

Dx 2/15/2006, IDC, 5cm, Stage IV, Grade 2, 24/27 nodes, mets, ER+/PR-, HER2-
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Sep 28, 2008 09:04AM golfgirl wrote:

Teena -  I'm so grateful to you for relating your experience and pointing us to the deihlmartin website.  (Such a wonderful brave man).  I'm getting a port put in on Oct 6th and was very anxious about it -- but no longer.  It's the unknown that makes us fearful and now that I'm armed with knowledge I no longer fear it.  After my experience with 4 trys to get a vein just for my PET scan I'm now looking forward to getting a port for the chemo.  I really do hope they pin this to the top.  Thanks again, golfgirl

Dx 7/16/2008, IDC, 2cm, Stage IIb, Grade 2, 1/20 nodes, ER-/PR-, HER2+
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Sep 28, 2008 11:17AM bourscheid wrote:

Great description, Teena!  I took the sedative and don't remember a thing except them asking me to move to the gurney.  I guess I moved!

I received a waterproof dressing over a gauze pad.  No need to change dressing and can shower without any fear of getting incision wet.  Great product but a bear to get off!

I ached for 3-4 days but now just have a pulling sensation occasioonally (got my port on Monday).  Driving was fun the next day but I was able to go to work (5th grade teacher).

Lori

Dx 8/18/2008, IDC, 6cm+, Stage IV, Grade 3, 27/29 nodes, mets, ER-/PR-, HER2-Surgery 08/18/2008 Mastectomy (Left)Chemotherapy 10/02/2008 AbraxaneTargeted Therapy 10/02/2008 AvastinChemotherapy 01/09/2009 XelodaChemotherapy 09/10/2010 carboplatin, TaxotereChemotherapy 01/18/2011 XelodaChemotherapy 11/19/2011 HalavenChemotherapy 04/24/2012 AbraxaneHormonal Therapy 01/10/2013 FaslodexChemotherapy 01/10/2013 Doxil
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Sep 28, 2008 11:46AM sweeeeetpam wrote:

  I have not made my appt yet for this 3 other tests this week!! So many net week, I am trying to put off my first chemo for 3 weeks does anyone see aproblem with that???

             Thanks for the advice even thou it scared the..... out of me!!!

                       Pamela

Dx 9/9/2008, IDC, 2cm, Stage II, Grade 2, 3/26 nodes, ER+/PR+, HER2-
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Sep 28, 2008 04:35PM priz47 wrote:

Good post! Unfortunately not all ports are "local". It depends on your surgeon and their experience. I unfortunately did not have a good outcome. They accidently punctured my lung and I ended up in the hospital for a week with 2 chest tubes. I signed the permit where that was explained to me as a possible complication. Most ports are fine. My son had one for 2 years. His surgeon placed his low, below the brest since "boys always hit each other in the shoulder'. I was thankful for that. Mine is covered by my bra strapTongue out. But I don't wear a bra all the time , so no problem. Glad that yours went well.

D

Dx 4/22/2008, ILC, 1cm, Stage II, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Sep 29, 2008 02:09PM hopefullady wrote:

I just wanted to add that things are not the same for everybody.  My surgeon placed the port with only one incision near the collarbone.  I had a dressing that I was to take off on the 3rd day, so never had to change it, and then just the steri strips over it.  She said that they could use the port right away, but I didn't have chemo until four days after it was in.

Chris 

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Sep 29, 2008 07:27PM tbird57 wrote:

Saw the chemo nurse today, and she said I didn't have to wear the dressings any longer, just the steristrips - and that I can shower and everything! 

Love, love, love - that is the soul of genius. Mozart

Dx 5/2008, IDC, <1cm, Stage Ib, Grade 3, 0/2 nodes, ER-/PR-, HER2+
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Oct 1, 2008 10:31AM Sassa wrote:

I only have one incision from my port placement.

As I had it placed during my mastectomy, I have no idea what they did.

Dx 11/6/2006, IDC, 1cm, Stage I, Grade 3, 0/9 nodes, ER-/PR-, HER2+
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Oct 2, 2008 06:32PM AusAla wrote:

Another adding that I only had the one incision too.  I've had two different ports in my chest.  My third one is inside of arm just below the bend of my arm (elbow).  I think this is rare placement for port.  But I love it!  Never even know it is there.  They tunneled the line up to the upper chest area, where my previous ports were placed.  I do have to have it flushed with more saline and heparin since the "line" is longer.  A vascular surgeon was the one to insert this port.  Oh, and all three ports were placed under heavy/light anesthesia, as was the removal of the previous two. I was never aware of anything that went on....which is fine with me..lol.

This is a good thread, Teena.  Thanks for getting it 'pinned', Dianne.  This thread will help a lot of people!

Hugs,

Bethie

"I don't want to be in a battle, but waiting on the edge of one I can't escape is even worse! Pippin, Lord of the Ring: Return of the King

Dx 5/13/2002, IDC, 2cm, Stage IV, Grade 3, 3/17 nodes, mets, ER+/PR+, HER2+
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Oct 3, 2008 11:52AM getwell wrote:

Hi Ladies,

    Thank you all for the helpful information. I had my report removed 15 months ago and now will need it back. Is it possible to reopen the original incision and place it in exactly the same spot? I did not like the pulling feeling I had with the port. It was very annoying and I HATED THE PORT. Obviously I liked the convenience it afforded but I dread having it again.

Dx 5cm, Stage IV, Grade 3, 11/25 nodes, mets, ER+/PR-, HER2-
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Oct 10, 2008 02:06AM GramE wrote:

Very good and detailed information.  My port is on my right side, so no heart to worry about.  Two incisions, and I was semi alert - more like la la land and I could respond to questions.   My arms were beside me and a sort of clamp devise was used and pushed down to keep me from moving them - not hurtful at all, but I could wiggle my fingers.   NO antibiotic drip as I am allergic to most antibiotics - had a bit of disagreement until I pointed out I am ALLERGIC...    Made the surgeon phone my primary doctor to confirm..   

I am allergic to scrub soap and adhesive tape also, so they put dermabond over the steri strips and I was able to get it wet after 24 hours but not soak or rub.   pat dry and hair dryer works really good to make sure all is dry.   I was out of there 3 hours later, but a bit of   a delay due to the antibiotic allergy "disagreement"...  Maybe 3 days after dermabond started to peel off so i snipped the loose parts.   

ON the way home, my son drove me and I remembered a hint to bring a blanket, towel or pillow for seat belt, which I really appreciated due to more pressure but not pain.    I still use a small pillow or towel under seat belt just to keep from getting rubbed or bumped against.   

I am a stomach sleeper and had no problem except first night with a bit of tenderness.

Adding couple of other things:   NO lifting for 48 hours, and then only 5 pounds for 2 weeks.  NO stretching or reaching high over head for 2 weeks.   NO vacuuming ( whoo  hoo ) for 2 weeks...

AND:  they would not release me without someone to drive me home.  Did not need anyone to "stay" with me once I got home.  

Suggestion:  have couple of meals prepared ahead of time, even if frozen nuke em dinners.  Sandwiches, salad already chopped up, fruit, yogurt - so it is easy / easier when get hungry.  

The oddest part for me was NO follow up.  Stitches self dissolve, so no need to have them removed.  

Another thing to remember:  IF the area is red, swollen and/or feels warm to the touch, phone IMMEDIATELY - could be infection,which is rare, but a possibility.   and the other possibility - IF you stretch, reach, bump, the port can get misplaced - again rare, but i like to have ALL the information available since I live alone.   This is not meant to scare or discourage anyone, but I feel being informed is better than no then having something going on that be harmful.

Thanks again for posting this information.      Hugs and Good luck to all,  Nancy 

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Oct 10, 2008 05:42AM, edited Dec 4, 2008 12:00PM by Linn

This Post was deleted by Linn.
Dx 11/2007, IDC, <1cm, Stage II, Grade 3, 2/12 nodes, ER-/PR-, HER2-
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Oct 11, 2008 12:51PM mrschilicook wrote:

Thank you so much.  I'm having a port placed in two weeks (begin chemo on the 30th).  This eases my mind alot as to what will really happen.  I had a catheter hanging out of my breast for mammosite radiation and my biggest problems were no showers and keeping the dog (young lab) away from my left side. 

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Oct 13, 2008 01:15AM GramE wrote:

  When the nurse flushes the port you can have a very nasty metallic taste in your mouth.  Ask to have the flush given SLOWLY and suck on ice chips and/or hard candy.   I never felt more than a 2-3 second ouchie when the needle was inserted or removed - no need to put any numbing cream for me.  And I am not " into pain "...

The first chemo I had in my arm in June and the area got very inflamed and horrible purple bruise 4 inches long.  Apparently they can use different size needles and I should have had a smaller needle.   The area is still like a pigmentation discoloration, but the onco says it will eventually go away.   

Since I have not had surgery yet and then will get herceptin thru July or August 2009, the port will remain in at least till then.  I understand it can be left in like for a couple of years or so.    

When you go for treatment with the port, wear a low cut tank top or button blouse or zip front top so it is easier to access.  DO NOT wear a turtle neck or high collar....   There will be a tube extending from the port to the IV tube hook up, mine is about 4 inches, but they tape it down to the chest so  you do not accidentally pull it out. They use a large clear "plastic type" bandage that covers the entire port area and then tape the end of the tube to my chest. 

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Oct 18, 2008 09:03AM, edited Oct 18, 2008 09:04AM by Brenda_R

I was given 'twilight sleep" for my port placement and don't remember anything after making sure they marked which side the port would go on. They tried to tell me it was going on the same side I'd just had my lumpectomy on, and I said, "no it's not!"

When I went in for the lumpectomy, the paperwork had the wrong side on it too, so they had me write Yes on the correct side and no on the other.

So make sure you are marked while you're awake.  

Dx 12/12/2006, IDC, 3cm, Stage IIIa, Grade 3, 1/17 nodes, ER-/PR-, HER2+Surgery 12/29/2006 Lumpectomy (Right); Lymph Node Removal: Axillary Lymph Node Dissection (Right)Chemotherapy 01/28/2007 Adriamycin, CytoxanRadiation Therapy 05/01/2007 ExternalTargeted Therapy 07/10/2007 Herceptin
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Oct 23, 2008 02:00AM TorchSong wrote:

Wow, this is great. Thank you so  much for posting this! Knowledge is reassurance for me--even if my experience isn't exactly like yours, at least I have an idea.

I was worried about my tattoo--I have just one, it took me years to decide to get it, and I LOVE it--but it's right over my heart, and I didn't want them to have to cut into it. Silly and vain, considering what the port is for, but still...my tat is a cherished possession!

And now, besides knowing what placement will be like, I'm not worried about my tat--thank you!

http://www.caringbridge.org/visit/marthadaniels

Dx 9/10/2008, IDC, 1cm, Stage IIa, Grade 3, 1/20 nodes, ER-/PR-, HER2-
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Oct 23, 2008 05:33AM mrschilicook wrote:

Well, the port placement went well on Monday.  A friend drove me home and like others, I'm here by myself and had no issues. It went more or less just like Teena explained.  My doctor also did the plastic covering so I don't have to change dressings or do anything other than have him take a look at it the day before chemo begins.

 Of course, it ended up right under my bra strap!  So I have pinned a tiny small pillow (about 3 X 3) between the port and my bra strap.  Hardly any discomfort at all.  It's the little pillow the ACS gives you in their little care package if anyone wants to get one. 

My doctor said that he's had several patients that have just left the port in place so that blood draws could be done from the port rather than the veins.  Not so sure about this one long term for me. 

So thanks again for all of the information. Knowledge is often power.

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Oct 26, 2008 01:14PM bluedasher wrote:

My doctor must believe in wearing a belt and suspenders because I had the glue wound closure (dermabond) but also had gauze with the plastic dressing over that. I wish he didn't because I again got a bit of allergic reaction all around the edge of the dressing but it is calming down now. The dressing was suppose to stay on for 48 hours but I took it off at about 40 because the itching was really bugging me.  When I took the dressings off they were totally clean.

Mine ended up a little under my bra strap too. I drew on the outline before I went in but the front close bras that I've been wearing since the lumpectomy have very wide straps and there wasn't enough real estate to put the port in without having it partially under the strap. But it hasn't been a problem.

My port was put in on Thursday and I felt pretty crumby Friday and Saturday. The tender area around the neck incision and the port (I had two incisions like TNT) bothered me any time I moved. I was really starting to wonder whether I could stand it any longer. Fortunately it has been much better today. Now it is a little tender if directly pressed on but I can move freely without hurting.

I don't think the port can be left in long term mrschilicook. The information that came with my port says that it has to be flushed every few weeks if it is not being used.  

The whole world is a narrow bridge and the main thing is to not fear.

Dx 9/2008, IDC, <1cm, Stage Ib, Grade 2, 0/5 nodes, ER-/PR-, HER2+
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Oct 29, 2008 01:27PM nancyu wrote:

When the catheter part of the port is placed, they try to access a vein that runs along the top of your lung.  Hence, the chance of a collapsed lung (very painful) if the lung is perforated.

I am always a challenge to my physicians and surgeons, including having lousy veins.  My surgeon, who is very good, ended up having to go all the way up my neck until he could access my jugular.  There were other problems.  My OR report was interesting.  It took 4 different procedural attempts, and he had to call in Interventional Card.

 Luckily, I was under general because I was also having a wide area excision (lumpectomy).  My other breast had already been removed. 

My port worked for my first chemo.  The second time, they could not get blood drawback, and ended up doing the infusion in my good arm - IV push.  I was sent back to Interventional Card for dye studies to identify the problem.  It ended up that the port worked going in, but not out, and it was used for future infusions.  But, no drawback.

Nancy

Dx 4/2007, IDC, 3cm, Stage IIIa, Grade 3, 5/18 nodes, ER+/PR+, HER2-
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Oct 31, 2008 05:54AM TorchSong wrote:

Port went in yesterday--all went well except for power outage (c.2-3 seconds) that required a computer reboot and my getting the final xray check in the regular xray room.

Mine ended up on my neck as well. I've been told I have "small veins."

Stiff and sore today, although I did make it to work!

http://www.caringbridge.org/visit/marthadaniels

Dx 9/10/2008, IDC, 1cm, Stage IIa, Grade 3, 1/20 nodes, ER-/PR-, HER2-
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Nov 1, 2008 04:14PM hopefullady wrote:

Bluedasher, many people have their ports in for years.  The type I have would need to be flushed every four weeks, but that is quickly and easily done.

Chris 

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Nov 2, 2008 05:33AM TorchSong wrote:

How long did people have achiness, pain, stiffness? This is the fourth day (had the port inserted on Thursday, it's Sunday), and my neck/shoulder/chest are very sore and painful. It feels like a pulled muscle in the back of my shoulder, if that makes any sense--and it hurts to swallow (my neck hurts, not my throat). It's not unbearable, just very uncomfortable.

Am I just whiny? I already have an appointment to see my onc tomorrow, so I can have him check it, just wondering if this is unusual or not.

http://www.caringbridge.org/visit/marthadaniels

Dx 9/10/2008, IDC, 1cm, Stage IIa, Grade 3, 1/20 nodes, ER-/PR-, HER2-
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Nov 2, 2008 08:30AM bluedasher wrote:

I think I had the sore neck for about 5 days - it was so nice when it was gone. One night I went to bed with it still feeling sore and the next morning it was much better. I"m still aware of the tube being in there going from my neck to the port but it doesn't hurt - just feels kind of weird.

The port area in the chest is still a little sore. It has been about a week and a half. And I have a bit of a rash near the area of the neck where the tube went in. I don't understand that. 

The whole world is a narrow bridge and the main thing is to not fear.

Dx 9/2008, IDC, <1cm, Stage Ib, Grade 2, 0/5 nodes, ER-/PR-, HER2+
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Nov 2, 2008 09:37AM CristlC wrote:

I am getting a arm port on Thursday.  Does anyone have information on that type?

Pathology from Bi-Lateral showed IDC (.4cm) in same breast as DCIS and nodes negative

Dx 6/25/2008, IDC, <1cm, Stage I, 0/0 nodes, ER+/PR+, HER2+
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Nov 2, 2008 10:10AM hopefullady wrote:

ChristiC,  Check out the thread called Ports, Piccs, or Pokes for Chemo on this forum.  I think that you are getting a Picc line.  You should find some information there.

Chris 

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Nov 2, 2008 12:42PM bluedasher wrote:

hopefullady, there have been posts by at least one preson whose port was placed in their arm instead of chest.

CrIstlC, I think it is pretty much the same except that the tubing is longer. 

The whole world is a narrow bridge and the main thing is to not fear.

Dx 9/2008, IDC, <1cm, Stage Ib, Grade 2, 0/5 nodes, ER-/PR-, HER2+
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Nov 3, 2008 01:59AM DebbyLearning wrote:

I was actually surprised to find that the port was more difficult to deal with than the lumpectomy and removal of 17 lymph nodes. I really was foolish. I have not been asking enough questions. I had a second lump in the other breast. The surgeon decided (inexplicably) that although the first lump was cancerous, the second other lump (located about four inches from the first) did not need to be biopsied, but only watched. I was not comfortable with this. That wasn't my understanding. They called me to have my mediport installed two days after surgery. I assumed it would be installed in the affected breast. He installed it over the lump that we were 'watching'. I didn't realize until two weeks after the surgery, when I could finally touch it again. I'm so upset. I feel stupid. I should have asked more questions. I should have been more assertive. I was sent back to him for a CNB, which he refused to do. He repeatedly told me that this was not a big deal, that even if 'something was there', I was having chemo which would kill it. He also shook his head and said, "Women like drama..." Long story short? I'm now headed to Pittsburgh to have this situation evaluated. They cannot do an MRI. The mediport makes it difficult to assess this lump. It is delaying my chemo. I'm just frustrated at him, AND at my self. If they wind up doing surgery on this lump, it will delay chemo even longer.

Dx 10/7/2008, ILC, 3cm, Stage IIa, Grade 3, 0/17 nodes, ER+/PR+

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