Part V: The Plan Disrupted

As loosely outlined in my last few posts, the weekend did not go as expected. My unplanned weekend getaway is at the luxurious Virginia Hospital Center, where the food turns out to be overrated and the best options were the first things I ordered. Here's what happened - to answer all or most of your questions, if I have the answer:

Thursday: All was going well, I received wonderful PET scan results (no sign of cancer elsewhere in my body) and I finally had a drain removed!

Friday: It was an okay morning, but I took a long nap and was still feeling pretty tired. After some small tasks around the house and some stretching, trying to gently work on my range of motion, I was super sore. By 5 pm I was aching all over and had a very low temp (99.5). By 7:00 pm, my fever was 100.4, so I called my surgeon. Because I could not see redness on my breast and my fever was still relatively low, she was not terribly concerned. Still she told me to monitor, and check my drains frequently. I woke up around 10:30 pm with a fever of 102.2. After our generous neighbor came over to stay on our sofa, while the boys slept upstairs - we headed to the ER. (See very apropos license plate of the car we were behind on the drive.)

Saturday: Although the ER here is super speedy compared to our NYC experiences, it was the wee hours of Saturday when we learned I would stay overnight. Tests were still pending on blood work, but they were starting to see redness on my right breast and it was particularly sore. The ER consulted with my surgeons, admitted me and started IV antibiotics. After a nice dose of dilaudid (wow that is an impressive drug!), I sent Dan home to relieve our neighbor and take over childcare duty.

Throughout the morning on Saturday, I had visits from the husband and kids, my plastic surgeon, my oncologist, my new infections disease doc, and again my plastic surgeon. The topics of discussion: whether to remove and/or replace my expander on the apparently infected side, when/how to delay chemo, which antibiotics I should get, and for how long. I also learned that my white blood count was about 6.5 on Wednesday right before my PET scan, but when I got to the ER, it was 16.8 (and normal tops out at 11). I went in for surgery at 4pm with the plan for my surgeon to remove the existing expander and "clean things out". Because of the site conditions in there, she opted to not replace the expander at this time (which was also the preference of the infectious diseases doc).

Sunday: By the wee hours of the morning, my white blood count was down to 12, headed in the right direction. I am feeling much better today, although I only remembered late in the day how the surgery meds carried over for a day or so the last time. AND then I started to feel more crappy. Also, now that I have no expander on the right side, I have a very weird looking deflated boob! I get one more night in the hospital so I can keep getting my IV antibiotics until I have a PICC Line put in tomorrow. The PICC line will allow me to self-administer IV antibiotics for the next 6 weeks.

How does this change The Plan?

What I know: I will definitely not be getting my mediport placement this Wednesday and I will not start chemo on December 14th as planned.

What I don't know: Although my oncologist initially just bumped the chemo two weeks to December 28, that was before the infectious disease doc visited and told me the plan for 6 weeks of IV antibiotics. And it was also before the determination that my expander could not be replaced right away. There are three doctors who will be chatting soon to work out their recommended plan for the order and timing of the next steps - my plastic surgeon, the infectious disease doc, and my oncologist. Do I get the replacement implant before chemo? If so, how long would that postpone chemo? Will the full 6 weeks of antibiotics be required? If so, does chemo need to wait until that is finished? I think the oncologist gets the strongest voice here (other than me of course!) The aesthetics and convenience of my reconstruction are secondary to killing this nasty cancer. I suppose the oncologist will then work out with the infectious disease doc the details of when I am sufficiently recovered from the infection to start the chemo.

One question multiple people have asked is whether the infection was triggered by or related to my drain removal on Thursday.  This also belongs under the things I don’t know yet.  They are still waiting on cultures from the surgery that will hopefully help fine tune the antibiotics.  But I’ve neglected to ask my surgeon’s thought on that since the surgery and based on what she found. Not sure any of us really want those details!  She did her job for the weekend and handed me off to the infectious disease people!  

And the really bad news? My first meal in the hospital was my best from the hospital kitchen. It has been all downhill from there. But I want to express my sincerest gratitude to my husband for delivering quality coffee each morning, for trying his best to find everything on my list to bring to the hospital (even if he doesn't seem to know what cross stitch fabric looks like), for his attempts to show patience with our children during this difficult time, and for bringing me some palatable food.