Man oh man, did I ever have some serious anxiety before having my port placement surgery.
For those of you who aren't familiar with what a port-a-cath is ...
A port-a-cath (port) is a device that is usually placed under the skin in the right side of the chest. It is attached to a catheter (a thin, flexible tube) that is threaded into a large vein above the right side of the heart called the superior vena cava. A port-a-cath is used to give intravenous fluids, blood transfusions, chemotherapy, and other drugs. It is also used for taking blood samples. A port-a-cath may stay in place for weeks or months and helps avoid the need for repeated needle sticks. (source)
Your doctor may recommend a port for you if:
you need IV therapy many times over 6 months or longer
you have small veins and need multiple pokes to get an IV in
your IV treatment must be given through a port (for example, when getting chemotherapy multiple days at home)
Your nurse can use your port to collect blood samples, and to give:
fluids
medicines, like chemotherapy and antibiotics
a blood transfusion
IV nutrient (food) — this is called Parenteral Nutrition
high speed injection during CT scan or MRI testing (source)
Between begging my oncologist (to no avail) to have me put under when all it required was conscious sedation, to popping two (ok, maybe three) Ativan in the waiting room on the day of (to my poor mother's horror), I was not looking forward to this at all.
And it didn't matter how many people told me (from their own experience) that it was an easy procedure, I was still a nervous wreck about it.
I mean they were going to implant something in my chest AND thread a rubber tube (catheter) through my superior vena cava, which is a big ole vein that drops down into my heart .... and they weren't going to knock me out first?!?
Oh HELL NO!
I even put it off once.
I started chemo on September 11, 2018 and was scheduled to have it placed a week later. Only I came down with a brutal cold after my first infusion. I'm talking sore throat, bronchitis and the worst cough ever. So the last thing I wanted, was to be healing from something being implanted into my chest AND vein, with a cough so bad that I almost peed myself every time a fit would come on. And thankfully my oncologist agreed (or obliged), and it was rescheduled for October 5th.
Don't get me wrong, I understood why it was necessary. I mean my veins were tricky before cancer, so there's no way they'd hold up to being poked and prodded every three weeks for (touch wood) many many many years to come.
So I woke up on October 5th, put on my big girl panties, and headed in to Toronto General with my mom.
I had an awesome pre-op nurse who had the magic touch when it came to putting the IV in. And she did her very best to calm my nerves by assuring me that the drugs they were going to give me would be FAR stronger than the Ativan(s) I'd taken. But she, like my oncologist, told me that full sedation was absolutely not necessary - and not even an option at this point anyways, as they didn't have an anesthesiologist scheduled. FML.
The tears didn't start until I was being wheeled into the procedure room. They weren't like a broken faucet or anything, but they were definitely there. As were some pretty serious body tremors.
I remember the OR nurse asking me if I was cold, and thinking to myself "ummm, no bitch, I'm scared!!".
I didn't say that of course, because I needed her on my side so that I could get a double dose of whatever meds they were going to feed me. I was going to be asleep for this, come hell or high water!
And when I told her I was just super anxious, she did her best (like the other nurse did) to put me at ease.
At that point the OR doc came in. He went over my file with me, and asked a few questions. And we decided that while most ports go on the right side, that we'd put mine on the left given that the cancer was in my right breast. His reasoning for this was that IF I required radiation down the road, it would have to swap sides anyways, so we might as well get ahead of, and avoid that - just in case.
And from there, they administered shot one (of two) of the conscious sedation - which didn't do a whole lot. The second shot definitely started to work it's magic, but I knew that one more would likely knock me out. So even though I was feeling suuuuper relaxed, I put on a bit of a show - and it worked! They gave me one more dose. And that, along with the pre-party favours (3 Ativan) I'd taken ahead of time, did the trick!
I was out like a light before they even put the local freezing into my neck. Thank Gawd!!!
The nurse said I was so deep asleep, that I was actually snoring. Hah!
I came to just as they were sewing me up. I was obviously out of it, and while I could kinda feel the pressure of the sutures being pulled tight, I was feeling absolutely no pain. I think I may have even tried to crack a joke or two.
Fast forward a couple of hours, and I was at home in my comfy recliner ... hardly feeling any pain at all! Maybe a little discomfort, but thankfully nothing that I could complain too loudly about.
Looking back now at how much of a baby I was, I obviously feel pretty fuckin' ridiculous.
It really was an easy procedure like everyone had told me. But for whatever reason, this was the thing that got to me! I'd kept it together pretty well up until this point. I didn't even have this much anxiety before my first round of chemo.
But to my absolute surprise and delight, the procedure, and even the recovery (save a couple of days a week later) was a breeze!
POST PORT PLACEMENT SURGERY TIPS
Someone had told me to ice the port site for 15-20 minutes, every hour or two, for the first couple of days. And that was an invaluable tip!
I also wore a very loose fitting sports bra 24/7 for the first week or so. Even when I was sleeping, and in the shower. I've got Double D's, so gravity was about the only thing that caused me any pain while I was healing. And as long as I kept the girls in their loose fitting hammock, they were all good!
I also slept in my recliner the first night. Laying on my stomach or either side were definitely not an option. And even laying flat on my back put a bit of uncomfortable pressure on the site.
As far as pain management went - regular old Tylenol and Ibuprofen were enough. The nurse sent me home with a Percocet, but I didn't even need it. That's not to say I didn't take it. But I really didn't NEED it.
About four days after the procedure, I did have a day of pretty intense pain across my chest. It kinda jumped around. And it was painful enough that I called the triage line at Princess Margaret for the first time. And the nurse was quick to tell me that this was perfectly normal. It was simply my body getting used to and becoming acclimatized to a foreign object being placed inside of it.
This was a huge relief to hear, because Herceptin, one of the hormone blocking drugs that I was (and still am) on can cause weakening of the heart muscle. And I'll be honest, I was a little paranoid that maybe that's what was going on with the pain in my chest.
It was all still pretty new. I'd only started treatment five weeks before, so I was beyond hyper aware of every single little twinge that was happening in my body. And I had pretty much memorized every potential side effect that all of the drugs could cause. So, while I was pretty level headed about things, most of the time, I still had my moments of imagining the worst and feeling a bit overwhelmed.
And this pain in the chest was one of those moments.
But the nurses explanation made complete sense to me, and I immediately felt much better (mentally).
The pain didn't go away quite as quickly as the paranoia, but it only lasted a day or two. And it really wasn't a severe pain. It was just a more intense pain than I'd been feeling up until that point.
I had a week to heal up before the port was accessed for the first time. The area was still a wee bit tender, but it was definitely much quicker, easier, and less painful than accessing a vein in my arm. So I sucked it up!
TIPS FOR PAIN FREE ACCESS
I purchased a tube of Emla cream, which is a numbing cream that you put on topically an hour before the port is accessed. This worked great, but it ain't cheap. And it wasn't covered by my insurance, so once that first tube ran out, I opted to go for the poor mans alternative .... which is to ice the site. This is FREE, and trust me, it works just as well. Plus, I don't have to remember to bring anything with me, or put it on an hour before hand like I did with the Emla cream. Just ask your nurse for a bag of ice, and five minutes is all you need to numb it up good!
As far as my range of motion goes - while I don't think I would have been heart broken had it been hindered to the point that I couldn't exercise (just kidding ... kinda), that is so not the case. I have full range of motion.
On occasion if I sleep all crunched up, I'll wake up feeling a bit of a crimp in the tubing. But that doesn't hurt, and it goes away in like 15-20 minutes.
And I'd advise you to avoid hitting it if at all possible (DUH!). I nailed it pretty good picking up my paddlboard one time, and I saw stars. And my cat jumped down off the back of the couch one time, and landed square on top of it. That didn't tickle either.
But those situations aside, I hardly even know the port is there. And I seriously can't imagine not having it. I mean it makes infusion days, and CT scan days so easy. There's no more chasing rolling or hiding veins. I sit down, I chat with my nurse, and before I even know it, I'm all hooked up and ready to go!