NOLA in September?
Comments
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These op reports are so hard to understand. Thank you Betsy for the resection description. I didn't realize that meant they took some of my sternum. I have said it feels like someone has their thumb on my sternum and is pressing really hard 24x7! Makes sense.
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Dragon, do you think you should call about the slightly "hot" nipple? I think I would.... just in case they want to put you on an antibiotic?
JustLaura, WHAT A GREAT STORY!!! That was a fascinating read. Let's tell people to go to page #378 and read Laura and BettyeE's testimonies! Who can remember page 378?? ha.
There is also another angle about going wtih NOLA vs a "local" DIEP doc. (not all, but at least this is what happens around here!) Local (very big famous hospital) DIEP doc will switch over to Tram and take your stomach muscle (!!) if it looks too comlicated to do DIEP. They don't offer GAP, and no stacked! (I would never give up my core muscles!!)
BettyeE, it is always good to hear from you! Thank you for your "Story" too. Great insights! It sounds like having a lovely recon is very good for you psychologically, well heck, it's good for all of us!! But your insights about recon and stae iV are wonderful. I am glad you got it, girl!!
BrandyB and Betsy, I added your details above.
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I sent pics to Stacy, she showed them to Laura. They said stop wearing the nipple guards and let the fresh air get to them. Also said to wash the nipple are with a little soap and water, put soap on your finger and gentle glide finger over nipple area, lightly pat dry, allow the nipples to air dry, do not apply betadine.
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hmm, why wouldn't they say sternum dissection instead of rib dissection? they are connected but they are two different things. Not that it really matters, I just am facinated by anatomy and want to know what was done to me while I was asleep!testing inserted a pic as I can never get this to work...
yay it worked! :-)
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I'm pretty sure they take rib cartilage. I've never completely understood why it's done though. Compensating for short vessels in some way.
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I don't know about the ribs... that was my best guess after hearing Dr D describe it... maybe Paula knows since she had lung issues that may have been related to the sternum? My understanding is that they take a small piece of sternum out for EVERY patient and it has something to do with the vessels.
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First rib resection is a surgery to ease the symptoms of thoracic outlet syndrome. The first rib
near the neck is removed to make more room for the blood vessels and nerves. This takes
pressure off the blood vessels and nerves. The pain and numb feeling should lessen when
the pressure is gone.This is the description of rib resection... so now I am for sure confused, except for the blood part.
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Re: rib resection - Dr. D told us that they cut a little window in the cartilage between the ribs in order to connect the blood vessels for the new breasts' blood supply. He said there is a hole in the cartilage between the ribs for a few years that eventually is recovered by scar tissue.
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Rib resection vs "first rib resection" - herein may be the confusion. When they are referring to thoracic outlet syndrome and they do a first rib resection - it is exactly that: resection of the first rib - meaning the one at the very top. - Dang, I want to take Denoument's picture and put it on this page... but computers are not something that I know very much about - the human body is more my thing... LOL. A rib resection - can be any of the ribs - if you said "resection of the fifth rib" - that would describe exactly which rib it is. In the case of perforator flap surgery - a rib is resected to allow access to the internal mammary artery and vein, so that the flap can be attached. I am going to look and see if I can find it for you somewhere... but the blood vessels that they connect the flap to are under the ribs, so they have to remove a small piece to gain access to them. My understanding is that doing rib resection is somewhat controversial, but I would say that I think the docs at the center would try to keep the section that is resected to a minimum - too large would create a deformity and as far as I know none of us have that! Hope that helps!
Sandy - I am so, so sorry about the pathology from your son's appendectomy. Please keep us updated and know that you and your family are in our thoughts and prayers.
Spring - I share in your anger and sorrow over losing Robyn. Where you two were surgery buddies for your stage 2 and her stage 1, she and I were surgery buddies for our stage 2's. I was away when all of this happened... I caught up a little on FB, but was able to read this thread as we finished out our drive home this afternoon. Robyn is the third person I have personally known to lose their battle with cancer (one of my friends was to lung cancer). I can't say exactly what makes it easier to cope with. I run the whole range of emotions... but anger and sadness seem to prevail in losses like these. For me - it helps me to believe that we all continue on after this life - free of pain and with a body that is whole and strong - and that someday we get to be with our loved ones again. But everyone has a different philosophy - whether it is religious, spiritual or scientific... this one is simply mine and I hold on tight to it. For me, it is the only thing that helps to shed a ray of light. I do find that there are times I have what is known as "survivor's guilt" - where I wonder why I am still here, when others are not. (Usually there is someone around to remind me that the person that has passed is really nice and that I am too friggin mean to go anywhere... if that is the case, I am going to be a mean, crotchety old woman... ) Anyway... Maybe someone else will come on here and give their insight. Just know that you are not alone in feeling p*ssed about the loss of Robyn. I spoke to her right before we went on vacation... she always remained so optimistic even though at that point she knew that it had spread to her brain. She remained focused and positive, with a zest for life that was so refreshing. I miss just knowing she was there... able to answer the phone when I called. My heart aches for Jeff and her family and the young girls that they love so much. And selfishly... my heart aches for me. Because I miss her already.
Stupid cancer. 0 -
Hi Susanna! I must have been writing my dissertation while you were posting!
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ok... so when I googled rib resection it described FIRST rib resection which is different... now I get it... it is more of my first explanation (the sternum)...?!?
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Betsy - In all my knowledge it is not the sternum that is resected. The sternum is not considered a rib - the ribs however, articulate with the sternum (form joints - there actually is movement of the ribs on the sternum - although very small - different type of joint than say, your shoulder or hip which are ball and socket joints and have a ton of movement) via costal cartilage. It is the costal cartilage that is resected - right next to the sternum. If they cut into the sternum at all it would have to be called a sternal resection - as the sternum is not a rib.
http://www.daviddarling.info/encyclopedia/R/rib-cage.html
I wish I was as technologically adept as Denoument - I would copy the picture from the above link and paste it... Alas, I am not... you will have to follow the link! I hope that helps explain it!
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PS - when I was trying to find information specific to perforator flaps and rib resection - I believe they said the internal mammary blood vessels were usually somewhere around the second and third rib area - the link to the picture above will help you to better visualize this!
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Nordy - I think your medical knowledge offsets your lack of technical knowledge. Thanks so much for the info - that is very helpful.0
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well... whatever it is, they do indeed take a little piece out, which I didn't know until I was visiting NOLA for my consult and Jerusha or Dawn told me... no way around it, so what will be will be. Thanks for the explanations... and illustrations!!
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Can you all help me with my current situation? I am 6 weeks out from my hip flap. I still have my drain and it is still producing at about 65ml/day. I finished the antibiotics for the infection I had last week and, while the fluid production is down from the highs, it is not anywhere close to the 30ml/day I need to remove this drain. Is there a limit to how long it is safe to have a drain in? Basically, at this point is it riskier to keep the drain in or take the drain out? While I would love to have it gone, I really want to avoid a seroma. Has anybody kept a drain in longer and then was able to achieve low production and no problems to follow?
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What does NOLA say?
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Ah, okay that helps, so it's costal cartilage resection not really rib resection I guess? And we think it's 2nd or 3rd rib? Do they need to repair the section removed or does scar tissue form to close it up? Thanks for your help Nordy! As I said, it doesn't really matter, I'm just facinated by this stuff...
Lemme see if I can strike gold twice and put that pic up...looks like the pic needs a direct link online to post it, can't be a pic from your computer...
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ref... I had my drains in FOREVER. And then when they came out I developed seromas, had multiple aspirations and then my local PS put new smaller drains BACK in for 2 more weeks. The hips are an area that tends to produce a LOT of fluid. Call NOLA, but do not be surprised if they tell you to keep them in. Hang in there... someday soon this will be a distant memory!
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Nordy - thanks. I'm really trying to avoid having to go for aspirations. I have been in frequent touch with Celeste, but not yet this week. The last word was to still wait for the under 30ml/day for 2 days. I've been managing fine with the drain but it's just getting old - or too hot with this compression garment in july! It seems like this drain will be with me a while yet.
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Nordy, laughlines, Dana, thanks for the rib info! It is indeed fascinating. I read one of the papers on diepflap.com that not doing the rib resection to get to the mammary vessel is an upcoming trend. That paper was a couple years old though. So I guess something about it is a bit controversial, but I don't know what. It helps me understand that, yeah, there will be some sternum pain (even though the sternum is not touched) for quite a while. I can feel the pain when I put pressure on the area, either when I press it (then don't press on it!) or laying on my side or belly. And while mild, the pain lasts a little while.
It wasn't me with a lung issue. I have muscle issues and am working with a PT.
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Might have been me she meant with the lung issue . . . I developed a pneumothorax, but I cannot say for sure what the reason is. I was told - "they do a lot of work in that area". It is gone now - absorbed on it's own.
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Yes, it was Amy not Paula... sorry.
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They need to acess the internal artery to connect the flap to the blood supply via that artery.
Oops I saw this has already been answered!
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ref - I think I've heard up to 8 weeks...but they don't like it in much longer. I was happy to pull them out (they were about 26 for one drain and 22ccs in the other and I still got seromas) and go in for aspirations. Couldn't stand the drains. Of course, now I'm back to aspirations with my hematoma. Again, happy to have the drains gone!
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Hi all...re: rib disection..I was at my Oncologist office and he was listening to my heart, he looks up at me with a puzzled look and asks if I have a valve? (guess he meant artificial heart valve) I said no. but I tell him that I had diep and then I remember part of rib removed. He says wow it's like I have a direct window to listen to your heart...creepy huh
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Kathryn - Celeste thinks Dr. Sullivan is going to say to pull the drain. He doesn't like them in much past 6 weeks. We are going to talk again tomorrow and decide what to do. I may be up to my last few days with my 6 week friend. I won't miss him! Hopefully my body will cooperate but, if not, I will join you with weekly aspirations.
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Ref, I had a friend locally who had her hip drains for 8-9 weeks she was also a NOLA girl. She told me even when the drains came out, she was leaking fluid like mad, UNTIL she wore really really tight compression, really really tight and squeezed the heck out of herself! Then it all stopped.
Maybe you should call and get a smaller/tighter compression garment sent to you from NOLA? It's worth a try. AND I don't know if this is true, but I've also heard moving around a lot causes more fluid. Staying still (if you can) reduces.
I was not a juicy one, had my drains the minimal time. I swear, this was one good thing that was thrown my way. We all take it where we can get it, whatever it is!!!
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Spring - Funny you should say that about compression because I was just saying to my husband that if they ask me to take the drain out, I would double up on the compression (maybe put the abdominal binder over the garment) to try to help absorb the fluid. But I think yours is a good suggestion about the smaller size garment. I will ask Celeste for that tomorrow. Thank you!
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dana - how'd you post the picture?
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