A PSA for the Lat Flap inclined

We all know that my raison d'etre for this little blog, for life in general, is to give people sound and yet critical advice on how to train, such that they too can become a triathlon goddess like me. Well, or at least dream about it. Hey, I can only do so much. And while I have a vast expanse of knowledge in a number of different areas, naturally, I try to keep that useful advice and pearls of wisdom limited to the world of triathloning, what with the cogent thoughts on running, swimming, the serious core workouts, etc. By maintaining this constant laser focus on these areas, I feel I’m giving “the little people” the best shot at success, as I simultaneously encourage their hopes and dreams. “If you can dream it, you can achieve it!” I always say.

Okay, I don’t really say that, because quite frankly, most of you should stick to your day jobs, but still, the thought is there. Somewhere.

But I’m deciding to branch out a bit here, as a public service to those who are thinking about getting the lat flap as their breast reconstruction operation-of-choice. Because really, you’d think there’d be tons of information on there about these kinds of things, but there isn’t. At least not the really useful stuff other than the basics on the procedure and what it is. Nothing on how you can expect to feel (like crap), how long you might be under the weather (a long time), what you can and can’t do (nothing/everything), what you should watch out for (all of the above), etc. Not even on blogs did I find this kind of info. I suspect this is because everyone is in a drug-induced haze for weeks, and then tries to forget about the whole thing.

So here is that info – which will be very boring for most of my twelves of readers, but might provide a modicum of usefulness for those looking for info on the lat flap and what it entails. Sorry, Twelves, I promise we’ll get back to the critical training information you’ve come to expect from me in the next blog post, or thereabouts.

• Okay, starting with the surgery. You know what this involves – it’ll probably take 4-5 hours, as there’s a lot going on here. You’ll probably feel great immediately after the surgery, but don’t be fooled. It’s the drugs talking. Insist on “the patch.” Everyone was extolling the virtues of the anti-nausea patch to me, which I of course didn’t get. Hence, extreme nausea that first night. Yay.

• In addition to the IV (fluid and pain meds), you might have these electric compression thingies around your legs that keep puffing up then deflating. That’s to prevent blood clots, which you’re at increased risk for if you’re on FatSurly, aka Tamoxifen. They’re weird but harmless. The compression thingies, that is, not blood clots.

• Even though they’ve probably told you to expect to be in the hospital 2-3 days, they might be ready to kick you out the next day. That was the case with Cori and me. Well, once I managed to pee, that is. Yes, peeing might be a problem, thanks to the anesthesia. It’s annoying, but don’t sweat it. It happens. It doesn’t mean that you’ll never pee again and will be relegated to the ranks of the elderly cathetered crowd for the rest of your life, stuck in bingo halls and Denny’s with “your people.” You’ll think this, but it’s only temporary.

• Don’t let them kick you out if you’re going home to madness and lots of activity. Seriously. I was fine because I went to my mom’s cushy abode, where I basically had to do nothing but sit on my ass and putter away on my computer, while my mom cooked and basically did everything for me, practically bringing me bonbons on a silver platter. Yeah, I know, rough life. Cori went home to kids, a dog, and asshole hubby who wondered why she wasn’t more “grateful” for everything she had. Fuck off, pal, now is not the time. As a result, she pulled something in her chest and has been in serious pain, unable to sleep. That sucks.

• Speaking of pain, if Vicodin makes you queasy (and first of all, always take it with food – now is not the time for a wacky diet), get something else before you leave the hospital, or you’ll be in a world of hurt. And for the meds, don’t miss taking them – stay ahead of the pain by just taking them on a regular schedule, whether or not things hurt. They don’t hurt because you’re taking the meds, trust me.

• For what to bring to the hospital, keep it simple. Basic toiletries, button down shirts, comfy pants. They’ll give you socks to shuffle around in, but slip-on slippers would be good too because you won’t want to be bending over to deal with things like socks too often. Don’t bother with books – you’ll be too tired to read, and your eyes will probably be goofy after surgery, making reading impossible. Pretty pictures in trashy magazines work to kill some time though.

• Your nurses will love you if you shower them with cookies and cake. Not necessary, but it definitely makes for a more festive atmosphere. Nurses rock. It's not their fault they have to give you shots of stuff that stings, like Heparin - they're just the hapless messengers. Be nice to the residents too – they’re trying to learn so that they can help other people down the road. Plus you might get lucky and have a totally hot group of residents like I did, which provides some nice eye candy on an otherwise dreary day in the hospital.

• You’ll leave the hospital with drains; this is normal. They’re annoying in a way, but think of them as your little helpers, getting rid of the fluid that would be stuck in you anyway and needing to be drained. I had this after my last surgery, no drains and fluid buildup, which was very painful, so I had to go in to get drained. The drains are goofy but better. Plus, when combined with the Sad Cancer Face, they give you a lot of leverage to get other people to do shit for you. Use that to your advantage.

• My drains have been in for 2 weeks so far, which seems normal. I’m hoping I get the last 2 out this week, which should happen, though one is right at the edge of the 30ml you need to be at to get them taken out. Drain 3 was taken out last week. Cori had all hers taken out last week –but then she needed to get fluid drained from her back today, so it’s kind of a crapshoot.

• Don’t forget to try shopping at Target or Wal-Mart when you still have the drains in – or the Village Discount, where they’re REALLY paranoid about shoplifters. Because that’s what you’ll look like, with the drains providing a lot of bulk under your shirt. I haven’t done this yet, but boy, talk about entertainment! “Excuse me ma’am, what’s that under your shirt?” “Oh, you mean these DRAINS? That I have because I just had surgery related to my CANCER? This is an outrage - where’s John Stossel??!”

• As for movement – you won’t be able to do a lot of it. Forget lifting things. Opening doors. Cutting apples. Even getting up from a sitting position will hurt because it uses muscles and strains everything. You’re basically kind of helpless – and don’t attempt to do any of that stuff, because you don’t want problems or more pain. Sleeping will be tough. I could only sleep on my left side, since the right side has the scar on the back, the drains going in under the arm, and of course all the surgery. By comparison, the left side with just the implant? Piece of cake. Be warned that you might wind up feeling like a turtle, stuck on your back unable to move. This was the case with both me and Cori. You can’t turn to your lat flap side, and you can’t use the lat flap side to turn in the other direction, because of the surgery and muscle impairment. So you’re kind of stuck. I always managed to turn eventually due to my finely honed athletic physique, but be prepared to have someone else help you.

• Speaking of physique, please, for the love of god, try to get into some semblance of a shape before your surgery. Because otherwise you’ll be in a world of hurt. Cori is super-skinny, and I consider myself to be in decent shape though not skinny, and both of us had a host of problems in getting around. I can’t imagine what this would be like for the not-in-shape or seriously overweight. If you’re not in shape it’ll be tougher to be mobile, and if you’re large, well, you’ll have a bigger incision area, more stitches – in general a lot more crap to deal with and a lot more potential for complications. I personally don’t care what anyone looks like – I’m just saying that as far as surgery is concerned, the better shape you’re in going in, the easier time you’ll have out of it.

• Friends will want to do stuff for you – let them.

• You'll think the doctors and nurses are obsessed with bowel movements the way they keep yammering on about Colace and things of that ilk, and how the pain meds will basically make everything come to a halt. Listen to them. Promise me that you'll listen to them. Take a Colace every time you take a Vicodin, and you'll be okay. Brilliant person that I am, I pooh-poohed this (no pun intended) when I had my cancer/collarbone surgery, and even though I was in a brain injury haze for pretty much the whole month after that surgery, I remember VERY well the day I was basically hallucinating, half from stomach pain, half from meds, half from the brain injury. Colace is your friend.

• As far as recovery is concerned, you might be surprised at how long you feel like crap. I know I’ve been. I thought I would feel worse the week after the surgery than I actually did, and was surprised that I wasn’t totally incapacitated – well, other than just sitting around like a lump all day. But now it’s been 2 weeks, and I’m surprised at how crappy I still feel. Shuffling around, things still hurting, especially when I first get up or try to do anything revolutionary like, say, move. I’m still getting stabbing pains in my back on occasion, and when I try to walk more than 2 blocks, like I did on Saturday when Deanna and I walked to lunch, my back kills. I don’t know how much time people take off of work for this stuff normally, but unless you work from home and can just sit at your computer (which I can – that doesn’t bother me), then plan for at least 4 weeks if possible. This is major surgery, kids, be aware of that.

• And as far as the lat flap is concerned, it’s supposed to be the “easier” one compared to the TRAM or DIEP – I always get confused as to the difference between those two, but they both involve taking skin from your abdomen. I think one involves the muscle and the other doesn’t. But those are supposedly a lot more complicated, so keep that in mind.

• It’s normal for the skin to look bruised or darker around your stitches even 2 weeks later – Cori found this out this morning at the doctor’s office, as she was worried about it. If the skin looks grey? That’s bad.

• Did I mention that you’ll still feel like shit after a couple of weeks? Yeah, I thought I did. Just reiterating that.

• There’s other stuff I don’t know yet – how will this affect my cycling? My wicked slap shot? – so I’ll report on that as the weeks go by. I didn’t find a whole hell of a lot of info on that either.

There you go folks, boring but useful for some people, I hope. Now back to your regularly scheduled programming, i.e. the truly important stuff……

Addendum (added 2/4/10)

I've decided that I'm going to try to add any new information that might be useful to this post, so that all the info is in one place, even as I write about it elsewhere on the blog. So with that said:

• The stuff I said above about the drains being your little helpers? Yeah, that's true - until it's not. There's a fine balance between getting the drains yanked out early and winding up with seromas (which you don't want, because the fluid apparently provides a good breeding ground for bacteria to grow), and waiting to get them yanked out until they've really become a pain, literally. They've been keeping me up at night, making it hard to walk, move, etc. I think they were growing into my skin, as any movement of the tubes just plain hurt. A lot. So if/when they get to that point, even if you're not *quite* at the 30ml per day (okay, I confess, I wasn't), just get them yanked. At that point it's better to go in and get drained than be that miserable.

• And related to that, do not freak out in the first few weeks if you're feeling like crap, you're feeling this weird muscle-type pulling pain when you do something simple like raise your hand, etc. I felt that, and thought, shit, what have I done, I'll never be able to ride a bike again or play hockey, what the hell have I done??! Then I got my drains out today. And feel a million times better. The pain is gone, I can move my arms, swing them around, stretch, reach, lift, you name it. I still have to work on it and build up the strength on that side, and my back still hurts when I walk or stand around too much, but man, I am SO relieved. So be patient, and wait to assess things until TFD (Those Fucking Drains) come out!

Added 6/1/10

• So I was wondering how not having a lat would affect my bike riding, which I do a lot of. As in hours and hours of cycling out in the boondocks. I'm happy to report that thus far - all is well. The lack of a lat bothers me not at all. Soreness? Nope. No pain, no stiffness, nada. I'll be doing a hell of a lot more riding this summer, thanks to that crazy trip to the Alps that my friend Stacey talked me into - so I'll add more info as I slog on. But for now? I'm relieved!