Nurses with Breast Cancer

Hello all:

I've been mostly reading now x six months. Kinda shy...

Anyhow, I just completed phase 2 of reconstruction

(ie. Fipples, lipo hips and ultrasound-guided lipo(for thumb-

sized necrosis to B breasts)

No lift.(per PS--dunno why not)

Much better than my 8/6/10 B MX w/tram flap; I had 3 months of visiting

Nurses coming by to dress my wounds!)

Less nausea after the anesthesia. No BM yet and Surgery was 3/21/11

But I'm taking Meds for that.

I have B arm pain generalized; and b chest. Area pain& bilateral belly pain; at about 10 w/o

Meds and goe to about6-7 after pain Meds! Any tips please advise. Thank you

Oh yeah I'm a school nurse but I'm not sure I'm going back(strenuous) to school nursing!

I do have off until 8/10 to decide. Anyone else give up dreamjob after

Going through this?? My administration was unfair, an unjust throughout the

Past 9 months!! (mainly insurance issues; but nasty discriminatory derogatory

Unjust letters added so much stress; not sure I can go back physically or emotionally!

WARNING--RANT AHEAD----WARNING--RANT AHEAD

There's been a lot of talk over the years about nurses eating our young.   I would like to propose that nursing students have begun eating nursing faculty and instructors.  I know, because it's happening to me.  I am a full time faculty in a 2 year ADN program.  This is my fourth, and will be my final year teaching.  Why am I leaving teaching?  Because I cannot figure out how to teach competent, quality nursing while simultaneously pleasing the new breed of "student consumer."  Earlier this semester, a semester in which I was dropped into a new clinical facility without any orientation or support, with about 2 week's notice, the students complained to the program director that I wasn't providing them with the experiences they need.  They weren't getting OR observations (it took me a while to figure out who to contact and how to reach her to set that up), that I was not allowing them enough independance with med administration, that I wasn't giving them enough different experiences, especially not enough complex wound care, that they didn't like getting doubled up on patient assignments.  So I changed the way I did things.  I pushed them into more independance with med admin.  I don't double up the assignments at all anymore.  I arranged extra OR rotation times.  I have continued to double check that diagnoses and problems aren't assigned to a particular student more than once.  Today I called into a meeting with the director. Why?  The students are complaining that I am not supervisiong them closely enough during med admin.  They're getting patients that are too hard to manage without a second student to help.  Three of the 7 seven stufdents didn't get one of the "best" OR rotation slots.  Only one student gets the complex wound care patient when there is one on the unit.  I"m trying to hurry them up too much and not sweet and pleasant when I'm doing so (this means that I come and get them out of  the break room when there patient rings the call bell).  Somehow I'm supposed to magically fix this and make the last 3 weeks of clinical perfect.  

Fuck it.  I've already turned in my resignation for the end of the semester.  I told the director today that I'm not sure I can go back to clinical with this group, and I really don't want to.  Right now I am seriously considering going back to the office over the weekend, packing up all my stuff and disappearing.  Send them all an e-,mail that I am resigning immediately so they can get an instructor who better meets their needs.  (little history--we were 5 weeks into the semester before all the clinical instructor positions were filled.  No way they'll find another instructor to finish the semester. Not that they know that.)  

You know what the topper is?  Whoever it was that complained actually told the director that I must be expecting special treatment because I had cancer.  

In the mail today is a request to teach a summer session.  7 weeks, once a week for 2.5 hours, getting LPNs up to speed  and ready to jump in at the second year level next fall.  For $825.00,  I'm sending it back with a take this job and shove it note.  

2Hands--I have already had a second interview for a home health position with the agency I already do some per diem work for.  I also have 2 other applications out for direct care jobs.  Any one of them will nearly double my income in addition to being direct patient care positions that I will enjoy and be good at.  My choice now is to try to finish out the semester or walk away now and make a statement.  Another long term faculty member is retiring at the end of the semester for pretty much the same reasons (plus age) and another one announced her retirement today, and I know she has had similar experiences recently. 

I am scared to death about what is going to happen to patient care in the future.  I'm even more scared about what is going to happen to me when I have to be a paitent in the future. Nursing education is becoming a business of recruiting students, getting their tuition and passing them through.  As long as they pass NCLEX everyone who counts is happy with the school. Nurses have no responsibility to the profession or patients anymore.  

Native Maine,Nursing has changed so much. Agreed,work ethics have changed with the younger generation of nurses.Not sure what you did in the end,keep us posted.At my job we are struggling with new nurses. We had a big retirement incentive and with that ,nurses left with tons of knowledge and experience. Standard of care is declined and definately not dedicated as before.

Happy Oncology Nursing Month.  ONS Video Contest:

http://www.youtube.com/playlist?p=C686AEDE9943C68F

Some will make you LYAO!

Hi, Carolyn, welcome to the club no one should ever have to join.  The first peice of advice I would give you is to take your time, do your research, don't let anyone rush your decision making.  The second piece is to not let anyone know you are a nurse.  Once the docs/office staff etc find out you are a nurse they stop giving info, assuming you know everything you need to know becuase you are a nurse.  They won't stop and think that pediatric nurses never take care of breast cancer patients.  I had a bad time with rads (someone's got to be in the less than 5% who gets the bad side effects, after all) so I won't speak to that at all.  As to mastectomy/recon, that's a personal choice, and no one approach is right for everyone.  I finally had the other breast removed and both reconstructed becuase I couldn't deal with the annual mammogram appointment for the remaining breast, with the inevitable extra views every year.  While reseraching reconstruction be sure you talk to a PS who does DIEP recons, PS's who do not do them often give the wrong info about them and surprsingly few actually are accrediteded to do DIEP.  No PS in Maine is, despite a couple saying they do the procedure.  There are implant procedures, skin sparing mastectomies,  and lots of options, besure to take your time looking at all of them before you decide what you want.  How old are you and how old was your sister when she was diagnosed?  If either of you were younger than 50 then BRCA1 and 2 mutation testing is in order.  These mutations inc the ris of breast and ovarian cancer and strengthen the argument for mastectomy (and sometimes oopherectomy). 

I personally had DIEP reconstruction.  I was emotionally upset at the thought of putting a foreign body (implant) into my breasts after having them removed.  I opted not to have skin sparing procedures becuase that felt like only doing half the job to be.  I know that 's not statistically true, but the emotional response is as important as any other response you have, and worth paying attention to.  I was not a candidate for tissue exapnder/implant on the irradiated side anyway, since the tissue was so damaged by the radiation. 

Some things to consider regarding mastectomy/recon:  where the scars will be and what they will look like--tissue taken from another site leaves a scar at that site.  Recovery time, with lifting limitations and the like vary from procedure to procedure.  There are areas of numbness left by any of these surgeries, often permanent, and it's important to know where those areas will be.  The total length of time of the entire recon varies by procedure.  Almost all procedure except the skin and nipply sparing ones are multiple step, requiring multiple procedures/surgeries.  If you opt for non-skin sparing mastectomy, then you will need to think about nipple recon and arueole tattooing to "finish" the job.  I put finish in quotes because I chose not to have nipples made or tattooed, so I am considered "unfinished" in the recon world.  Not that I care.  

Another thing to keep in mind is that recon can be done anytime.  I had a lumpectomy, rads, mastectomy due to rads damage, then spent a year researching recon and wound up going out of state for bilateral DIEP.  Which is another factor, what procedures are available locally and which require travel with associated extra costs and time.  

So have you got twice as many questions now as before I started?

Hi All,

Had my appointment with the surgeon yesterday who suggested just what I had guessed, lumpectomy with rads and tamoxifen.  I asked about an MRI and he was intially not on board until I reminded him of my family history and explained that I had reservations about rads and tamoxifen. I told him I understood that this could show addidtional areas that would require biopsy, but even though they would most likely be benign, it might push me more toward MX. I am 48 years old and my sister was diagnosed at 52, so he also decided to do the genetic testing.  After talking to his nurse, I found out that a large percentage of recons fail after rads, and may docs won't even attemp it.  Anyone have any input on that?

At this point I am scheduled to meet with plastics on Jan 5 and Genetics on Jan11.  I assume that if I proceed with BMX that I won't need to take the Tamoxifen does anyone know if this is true? 

I know that BMX seems a bit extreme and I don't want to overeact, but I feel as if I'm making a decision based on facts and not emotion.  I do however, want to make sure I have all my facts correct.

I have an HMO, so I am resticted to the system.  If I choose to do the BMX with recon, they do not perform the DIEP procedure.  My general surgeon said he was comfortable with a skin sparing and possibly part of the areola, but not the nipple.  I assume this may provide a better cosmetic appearence. Obviously, the plastic surgeon will be able to provide me with better info regarding this.

Does anyone have a ballpark estimate of how much DIEP would cost without insurance?  There are several docs in the area who actually do perform the procedure.

Has anyone had the BMX and really regretted the choice? All opinions welcome, as I want to consider all angles before making this huge decision.

Nativemainer, thank you for all the information!!!  Now I have all kinds of good info to ask the PS.

RC778, Thank you too for your response!!!  What made you choose implants over a DIEP or TRAM procedure?

  Support is a wonderful thing!  Without sharing too much sappy info, I've meet some fantastic women through support groups.  I had a child with Angelman Syndrome who taught me so many wonderful things, one of which was how to deal with difficult situations...  So, this is just another bump in the road.  I am thankful for all of you wonderful women who are willing to share your knowledge and experiences.

Thanks again,

Carolyn

Hi,  I am RN dx in Sept this year.  I am scheduled for AC x4 every 2 weeks and taxol with herceptin every week for 12 weeks. 6 weeks of radiation and herceptin every 3 weeks to complete a year.  This is so overwhelming, initially thought i would be having lumpectomy and radiation- but dx changed after surgery.  I work 3 12 hour nights in an ICU.  My main concern is being able to continue to work through all this as I don;t have much sick time accrued.  I did really well after my 1st AC and am scheduled for my 2nd on Mon.  It's kind of hard having some knowledge- I just took care of apt with heart failure secondary to the AC he received for treatment of leukemia:(  Trying to have a positive attitude and taking one day at a time!  Jen and Carolyn good luck with your appts!  We CAN conquer this!

I didn't know this thread existed!  I just had my exchange surgery yesterday.  It went very well--not too much pain and they already look so much better than the TEs.  Feel much better, too.  My invasive component was too small for chemo, but I am on tamoxifen.  It's been about 6 months now and it hasn't been too bad.  Hot flashes, some joint and muscle pain, and a little foggy brain.  I work with mostly menopausal women, so I joke that I fit in better now!

I was an L&D nurse and now have been a full time faculty in a community college (ADN) program for 2 1/2 years.  I LOVE my teaching job.  I teach fundamentals and OB (we do 2 quarters a semester).  I have excellent clinical sites and great support from my peers.  Native Mainer--I'm sorry you had such a bad experience.  That is not the culture of our program.  I can't imagine my director calling me in for something like you have described.  We are a public school, so the tuition issue isn't there.  I have heard some horror stories about the private, for profit, schools popping up around here.  

I almost always tell them that I am  a nurse and then follow that with the fact that this isn't my specialty so they need to explain everything very well.  They can just explain it at a higher level which is nice for both of us.  The second night in the hospital for the BMX, I had the cutest young new grad who must have been told I was an instructor.  She gave me the most complete head to toe I have ever had.  I smiled the whole time--she even checked my pedal pulses and strength!  For the most part I have had good care.  Yesterday was an outpatient procedure and they were great.  I get pretty goofy when I'm nervous and then with the drugs.  We all laughed a lot.  My poor husband... 

Hi 3girls, You and I almost look like diagnosis twins! I see you had 1/1 nodes as well which is unusual to see...



regards Jenn

Can't believe I have never seen this thread, but glad I found it.  I graduated in 1986 with an associates degree in nursing.  I have been working night shift all these years, but know I would feel better mentally and physically if I were on dayshift. I was unable to work during chemo due to being neutropenic starting with 2nd round of Taxotere and Carboplatin and low H/H with 4th, 5th, and 6th rounds.  I had a lot of nausea also.  Just finished Herceptin in October.  Will begin the reconstruction process soon. )

Jenn28,  yes we do look the same!  I see u declined the ALND I did as well, but I keep getting second thoughts after finding out that I was her2+ as well.  My onc says there is a 20-50% chance that there are additional + lymphnodes so it feels weird leaving them in.  He says the chemo and radiation would take care of it- but I feel like I am leaving cancer in my body.  I am sure I will feel better after I talk to a radiation oncologist.

Hi All,

 So, I'm a little over a week out from my stereo biopsy and I think I'm developing a seroma.  Anyone have any experience with this?  I just noticed it yesterday.  Lump measures about 2.5cm.  It's a little tender, but not reddened or weepy. 

Carolyn 

Nice to see this thread resurrected!

NativeMainer, I read through your last posts with dismay. I would have had no clue what to do in your situation, but probably would have left before I got sick from the stress of it. Is this what we'll be turning out for nurses? What's going to happen when they have to work a double shift, or take an extra load when there's no one else to work??

I have not been in education, other than my current job at a college health center. How does one manage to keep a thick skin, and be tough but fair in assignments and opportunities and expectations?

Is this unique to younger nursing students, I wonder, who are definitely a spoiled lot (helicopter parents have ruined this genration!)?? A friend of mine went back to school at age 52, to an ADN program. She was probably the hardest worker and most conscientious in her class, and is one of the really good nurses out there, a throw-back to the old days.

I haven't done hospital nursing since I became an NP 20 years ago. Not sure I could return to that setting if I had to. It's the toughest job in our profession. Good on ya for trying to impact a new generation of nurses. And good on ya for being true to yourself and leaving.

NativeMainer,

Thanks for the imput!!  I called this am and was told it is probably a hematoma which is very common, but they would see me Tuesday if I wanted.  When I got up this evening, it seems like it might actually be a little smaller, so I guess I'll see how it is in the AM.  I'm scheduled for my MRI tomorrow evening and they got me in to genetics for Dec 29, so things are moving along.  Thanks again for the response  Carolyn