Wednesday, December 2, 2015

Six Months Post-Mastectomy: Seromas and Serenity

I watched the calendar a lot more carefully with my first cancer, counting the days until I reached the magic three-year mark for TNBC, then the five-year mark. This time, meh.

I’ve been doing fine, healing well after six months, with a few mild complications, as is to be expected with major surgery like a double mastectomy. But I am less attuned to this cancer than the last. I take fewer notes, do less research, just basically live my life with cancer in the rear-view mirror.

Enough, already.

I sort of think I know enough: eat well, exercise, breathe deeply, love, and laugh. That’s basically it, with or without cancer.

I am blessed with only occasional discomfort and no real pain. My chest is still pretty numb, but I am getting a bit more feeling. I have learned to gently massage the area formerly known as my breasts, which eases discomfort. If I get ahead of the game, it can prevent it. I use vitamin E oil on my scars.

Both give me a sense of pampering myself. Both feel good, period.

I wear my fancy breast prostheses sometimes, and sometimes not. No big deal either way.

But because I had already had a lumpectomy and sentinel node dissection plus radiation, I had to have a radical mastectomy on the affected breast the second time. This meant the possibility of more complications, especially seromas, or a build-up of fluids at the surgical site. That’s why we get the wonderful drains during surgery—to draw the liquid, or serum, from the wound. Sometimes, though, seromas return. Again and again, as they did in my case.

I was given the all-clear from my surgeon a month after surgery—no fluid build-up. All was good. We headed to our Colorado cabin where I apparently forgot about my surgery a tad too much. We’ve been trying to rebuild our land after a forest fire in 2013, and this year meant weed control. I tried to be reasonable and not pull the giant thistles , as I would otherwise have done. Instead I clipped their heads off. I also hiked a lot.

More damningly, possibly, I took several trips on the incredibly bumpy road to town—16 miles of a mix of dirt and gravel that has been worn by fire and logging trucks and torrential rains. Once I wore my Fitbit on the trip and it recorded that I climbed 52 sets of stairs, even though I was sitting in the car. Plus, I wore a seatbelt that dissected my chest, adding even more pressure. 

So, who knows exactly which of these activities caused it—maybe all, maybe none—but I ended back in the surgeon’s office with a 50 cc seroma. Then it was back to the land, with a somewhat modified routine. 

But we had no choice but to use that road. On one trip back from town, I was in huge pain by the time we got to the cabin. I pulled out the ice and Tylenol, but the next day I had a big red bruise in the crescent where my left breast had been. It got more colorful the next few days, and I could feel the fluid building up. It was nearly time to leave anyway, so we closed up the cabin and headed back to Iowa and the surgeon’s office.

This time he diagnosed it as an ecchymosis, basically a bruise, or a large hematoma. And he drained 165 cc of blood from it. Two weeks later, he drained 50 cc, but two weeks after that, nothing. I went another six weeks without a problem. Six weeks in which we drove more than 2,000 miles, exercised a lot, and acted normal, doing things like picking up my adorable grandsons (4 and 6) whenever I could—or whenever they would let me. No problems.

Then I got an interminable cold with a nasty cough that lasted more than a month. I hacked and wheezed and, soon, there was the red crescent on my chest again. Ugh. Did I cough so much I bruised my chest? Was it the drugs I was taking?  Both? Neither? Whatever, this time the doc drained 60 cc. I went back the next week and he said there was too little to drain.

So, a few steps forward, a few back. Quite the dance, but I have decided to stay home from this particular prom from now on.

I plan not to go back to the surgeon. He’s a great guy and I like him a lot, but I am tired of needles and other sharp things on my chest. I have returned to my acupuncturist, who is working on getting my lymphatic fluids moving. I am beefing up my mobility exercises and my pampering.  Should I get the bruise again, I will ice it and massage it more regularly and help it resolve itself.

I will be more proactive, less reactive. But I will always go on with my life.

Enough of the rocky road, figurative and real. Docs are not sure why seromas dog some women and not others. I certainly was at risk because of previous treatment, including radiation that weakened my skin. But, sometimes this just happens, and stewing about it gets you nowhere.

The fact is that seromas are not life-threatening. They are uncomfortable and annoying and, as a doctor friend told me, “frustrating for patient and doctor alike.” But I have never worried that they were a precursor of something more serious. There is no evidence of that.

I remember a moment when I was undergoing treatment for my first breast cancer, when I had this overwhelming feeling come over me, the certainty that I would be fine. And I was. Nine years with no recurrence. The second cancer certainly was a shock, but it was a tiny thing and was a second primary cancer, not a recurrence, so my prognosis has always been good.

The other day, I was engulfed in the same sort of feeling: that this was a turning point and things were going to settle after this. That, again, I would be fine. It just came over me unannounced, leaving me in spontaneous smiles. I am not sure of the source of this sense of wellness, goodness, and positive energy. Whatever it is, I will take it and run with it. Or, probably. walk.