April 11, 2013 - Recap of the birth of Boob 2.2

April 11: We made it home yesterday, later than we would have hoped. By the time we got morning meds infused, waited for the surgeon to come by to pull the drain (have I mentioned how much I detest the drain but also detest the process of getting it pulled?), then waited for everything to be arranged through home health it was almost 2pm before we left the hospital. It was so great to be headed home. Just 5 days ago, on Friday, we were on our way out of town to visit my mom and our plans got derailed.

Let me back up a few days to give you the full story. Thursday afternoon I was sitting in clinic and noticed there was a spot on my breast that felt odd. You couldn't see anything on the surface, but underneath my skin there was an area about 3 inches x 3 inches that felt a good bit like a pulled muscle. But what an odd place to pull a muscle. I didn't think much of it, but as the day rolled on, with each hour it got more and more painful. Email to lead plastic surgeon where he asked me did I have fever (non), was it red or irritated (no), just muscle pain (yes), was it warm to touch. Now this is where the day had a little humor in it. For the life of me, I couldn't objectively tell if one was warmer than the other so I reached out to a coworker to "touch a fake boob" and tell me if one felt warmer than the other. She was happy to take one for the team because she knew the question was an important one, and yes in fact it was warm to touch. (and now she has that for her resume/cv). After we controlled our laughter, I emailed him back that yes one was warmer than the other. Watch and wait and call if it showed signs of redness or I got a fever. On my way home, the pain had spread from a 3x3 area to the entire boob and I was in tears trying to control the steering wheel. Got home, went to bed early and hoped rest would take care of the issue. If it was in fact a pulled muscle, I need to let it relax. Unfortunately, I tossed and turned all night because of the pain. Still no visible redness or fever.

Now it's Friday morning around 8 and Ron has already left for work. I knew I wouldn't be able to drive into work because the pain was so very bad. This was the first time i felt warm, so I checked my temperature to find I was febrile. Call to the surgeon again. "Sally, why don't you come in and let me check it out.You're right, it's probably nothing, but let's play it safe. I can fit you in a 12. See you then." I was quickly realizing I would probably need a dose of antibiotics for the fever then Ron and I could keep driving from the appointment to see my family. We packed a bag, loaded in the car and arrived at 12 for our appointment. Here we go again. As soon as I was in the office, I realized how much I had NOT missed the breast appointments. Ron helped me get into my gown where we immediately noticed the entire right breast was flaming red. (This had developed in the last hour). It was now obvious this breast "pulled muscle" was progressing by the hour. The surgeon walked in, I made him drop his dollar in the jar (just kidding!) and he examined the breast. The first thing out of his mouth. I need to admit you for cellulitis. So there you go, weekend plans ruined, and Ron and I head over to the hospital for what we thought would be about 24 hours of IV antibiotics then transition to oral antibiotics and head home. What an inconvenience for our restful weekend plans! And how did this happen????? we had such smooth sailing since October. Turned out, we are assuming that during a dental procedure I had 4 weeks ago, I must have absorbed some of the bacteria from my tooth and it settled into the Imposter. (this is documented in medical literature and the timing was perfect). The crazy thing is that I take antibiotics before every dental appointment to prevent this very thing. Well the prophylaxis let me down this go round.

We got to our room, a peripheral line was placed to get the first dose in then I was sent to the OR to get a central line placed for antibiotic administration. This was my first clue that 24 hours of IV antibiotics was not going to be my future. We got the line placed then watched as over the next 12 hours the redness continued to progress. The surgeon came by at 7pm and said he could decide in the morning if I was responding well enough to watch and wait or to if the cellulitis was progressing and I needed to go to the OR. Tails won and I was off to the OR the following morning. I remember them coming to get me and rolling me through the hospital to the OR, the OR doors opening and the nurse assigned to my case saw the tears rolling down my cheek. I don't know why now of all times it had hit me. I'm losing Boob #2! We had developed a bond, I had let it down, and now it was headed to the mortuary ( a little dramatized, but still...). I didn't know what the outcome would be. Lead Plastic Surgeon had said there would be 2 options and he wouldn't know up from down until he got inside and saw how extensive the damage was.

Option 1: The cellulitis is isolated to the surface of the skin thus leaving the implant intact. We could take the implant out- wash the area out- toss the Smooth Round High Profile Gel Implant- insert a brand new Smooth Round High Profile Gel implant - insert a drain and close me back up with stitches.

Option 2: The cellulitis is deep enough to impact  the tissue integrity and implant. Take the implant out. Leave the implant out for 4 months (hello, floppy boob), then go back in in the Fall and place an extender for several months to regrow the space, then later replace the implant.

Drum roll please- option 1 was the big winner, and therefore I was SUPER duper happy. Well as much as one could be having to do either option at all (which reminds me I need to get an updated Implant card...flashback to post last fall titled "card carrying member"). So five days later after getting nothing more than 1 hour of sleep in succession each night for five nights in a row I survived option #1, had a funeral for Boob #2, welcomed boob 2.2 to the family, had my drained removed and finally got discharged from the hospital. So here we sit at home with 3 hours of infusions in the morning, 45 minutes in the afternoon, and 3 hours again at night. take premed since you are allergic to both antibiotics, swab cap with alcohol, flush the line, hang the med (2 hours), flush the line, hang the med (0.5 hours), flush the line, insert heparin in the line, clamp the line, cheer for the success of the husband who has zero hospital experience and the wife who is used to being on the prescribing side of that medication dose. For two educated adults, we felt like brand new parents starring at umbilical cord of a new born baby wondering what in the world we were supposed to do. I've successfully navigated 1 infusion, and Ron has 1 under his belt as well. Score tied and 10 more days to go. Thankfully the home infusion nurse is coming today to take a peak at the central line which is oozing just a tad this morning. Surely not a reflection of our skills, but rather a reflection of yes there is in fact a whole in my arm with a line leading from the arm up through the top of the chest and dumping out very close to the heart. Why would it not be bleeding?

Peanut butter and jelly helps. And cut in triangles too. That was about all we could muster this morning. No worries. My friend Amy, lined up dinner deliveries for us so we can cut the chaos of our evenings in half. Sometimes you realize you are in fact an idiot when you think you are self sufficient. That revelation happened at about 11 pm last night.