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Thursday, October 1, 2009

Is it real? Or is it Memorex? Decisions, Decisions

I hate pain. The pain and recuperation after my Cesarean section with Nathan were enough to catapult me into the whole natural childbirth thing head long and full steam ahead. Rolling over for the first time and feeling like my guts were going to spill out onto the bed is the stuff of nightmares. Speaking of nightmares, the nightmares I had while on covered IV poles, for instance (and we all know how I hate hair not attached to heads) still haunt me. Yet, the day they took my morphine away from me ("Give it one more click, honey, and then let's get you up to the bathroom" and I came back, and it was gone, gone I tell you...but that baby with a conical head, looking remarkably like a Saturday Night Live character from the 70s was still there, waiting to suckle like something from Erasure Head....) is one of the saddest days of my life. Maybe it was because I was nursing and the medical establishment seems to want to punish people for doing that (or did in '92) that caused them to then offer me ibuprofen and benadryl as a replacement (hell-fucking-lo! after being filleted like a perch, having my bladder cavalierly tossed onto my upper abdomen, and having a baby's head disengaged from my pelvis...yes, the doctor had to stand on a step stool to get enough leverage to unstick him...and then being stapled back together like Frankenstein you think Advil is going to make a difference???)...regardless, I had a lot of pain. Good thing I could lean on my flashy "first baby" stroller because standing upright was something I tried to avoid for quite some time.

Come to think of it, before I had my next baby, I had a list of demands should I have another c-section: I wasn't coming home from the hospital without first having someone replace our regular toilet seat with a raised, handicapped seat and the purchase of a new bed to replace the low futon that we had at the time. I had experienced the lack of joy of crawling, literally, out of bed and pulling myself hand over hand up the door frame only to have to use those same sliced muscles again to get off the toilet in the middle of the night. Wasn't going to happen again. No siree, Bob.

For the record, I went on to have three vaginal births after that cesarean. All babies were larger than than the stuck one; one baby was over 11 lbs and was born in my living room.

But I digress. I thought I'd worked through most of this....hmmmm.....maybe not.

I meet with the plastic surgeon tomorrow. Until this very evening, I was all about using my own tissue for reconstruction. Then I read. And watched. And read comments and discussion boards. put it all in perspective: 6 rounds of chemo over 18 weeks; mastectomy (still to be decided if single or double, but at least one side will go down to the muscle and remove two levels of lymph nodes); 8 weeks, 5 days a week of radiation; reconstruction surgery (which could involve the removal of my right breast if not done earlier); and then nipple work (that's kind of fun to say...try saying it 5 times knipple a word? It is now. Would you like salad or knipple with that?) and I'm looking at...well...a lot of pain. I don't like pain.

If I choose to use my own flesh for reconstruction, that involves major abdominal surgery and at least double, if not longer, recovery. Recovery which involves severe limitations on lifting and carrying for 6-8 more than 5-8 lbs for that whole time (my laptop weighs 6 newborns were all over 8 lbs...that's not a lot of weight), a longer wait to resume normal activities, such as driving, and a longer wait for any sort of exercise. With the removal of lymph nodes, there is always the risk of lymphedema, which is compounded by a lack of exercise. Current research shows that weight bearing activity reduces the occurrence of lymphedema....but if I can't lift more than 5 lbs for 8 weeks....that seems to me to be a conundrum.

On top of all that nastiness, how much more am I willing to put my family through? As it is, they've endured some huge changes, among them being forced into public education and losing at least one vacation. Their wife and mother spends most of her time right now either in the classroom or in bed. We won't even discuss the financial implications of all this, but even with good insurance, we are bleeding green and the bills have just started coming in. We are stuck in a 3 week cycle of good and bad days. Now that my husband is off work, I get up 30 minutes before I have to teach, teach, and within 30 minutes of my last class ending I'm back in bed for at least 1.5 hours--or sunning myself in the yard--until I regain enough energy to continue with the day. I have a hard time imagining 8 weeks of daily radiation and what that will mean to our lives. Is it even fair for me to contemplate adding 8 weeks of recovery from a more expensive surgery to the list?

Ultimately, I think not.

Given the increased risk of complications from double major surgery, increased time in the hospital (where people get sick and die on a daily basis), increased risk of tissue death due to the tissue flap not "taking"; given the increased expense; given the increased recovery time; given the increased incapacitation; given the increased pain...I'm now 90% convinced I will do simple implant reconstruction.

Yes, implants need to be replaced approximately every 10 years, but from what I read, that is such a minor surgery compared to the flap surgery, that it is hardly worth mentioning. Plus, at some point, I figure I'll get old enough that I really won't care any more if I have boobs (and no one will be looking closely enough to be able to tell). And, truthfully, I'm still scarred enough from seeing my 90-something year old great aunt's looooooong boob flaps 35 years ago to think that implants might save me from that fate, whereas my own flesh will change as flesh changes over ass might droop to the backs of my knees, my back might droop to my ass, but my boobs will defy gravity.

Ok, so that's the plan I'm taking to bed with me tonight.

Now, let's see what the doctor says tomorrow.

Oh, and my students today asked for my blog url....perhaps not.....I wonder if they'd look up the work "knipple."


Theresa Williams said...

Dawn, I know what you are saying about the morphine. After the morphine I was on Percocet for a time and when the perscription ran out I was depressed for weeks and weeks; it was like my best friend had died. But it's got to beat the pain, right? Sister, you've got a long road ahead. Laughter turns the pain into medicine. xoxo

Jennifer said...

Look! It's the Knipple family crest!

And here's a song called Pi-Knipple, by Jello...

Jack Smith said...

Maybe it was because I was nursing and the medical establishment seems to want to punish people for doing that.
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