Embarrassing question - post-op

itfinallyhitme · March 2017

OK, I might as well just ask. Because I need to know what to expect.

I'm having radical bi-lateral mastectomy in a few weeks. I'm likely to be alone mostof the time. I had a bit of range of motion trouble with the first partial mastectomy and SNB on the right (I'm right-handed).

So, what might I expect as far as trouble keeping things clean with toileting? I've long thought bidets are wonderful ideas, and it's too bad they are foreign to Americans. (I've never used one, btw.) But am I going to be able to manage? I've seen hand-held bidets that are basically squeeze bottles with nozzles. Do I need one? Or maybe I won't be able to squeeze. I've seen battery ones too, which I guess don't need to be squeezed.

Or am I worrying for nothing. I likely won't have anyone around to help, and REALLY don't want to have to ask, or to endure insufficient results, especially since I can't shower for three weeks (though I am PLANNING to shower from the waist down. Surely there can't be anything wrong with that? Just keeping drain area dry, right?)

Thanks for any insight.

AmyQ · March 2017

I cannot recall having any troubles in this regard. I didn't end up with any range of motion troubles whatsoever. I think you should be fine, but if not, a quick shower ought to do the trick.

Much luck to you.

Amy

badger · March 2017

hi itfinallyhitme, sorry you find yourself here but welcome. I had bilateral mx with sentinel node bx seven years ago in Feb 2010. It's amazing how many chest muscles are involved. *TIP* when you leave hospital after mx, bring a small pillow to put between you and the seat belt. Rearrange your living quarters so what you need is at or below shoulder height - toothbrush, coffee pot, etc.

RE: toileting, I couldn't reach back to wipe from behind but could reach forward through my legs. Wipe from front to back. Don't wipe from back to front, to avoid cross-contamination. We have a hand-held shower so I could hose off my nether parts as long as I kept drains pinned up and incisions dry. A squeeze bottle is a great idea!

I know people who recommend rectal wipes but I worried about flushing them. If the need arose, I used a washcloth. Did a weekly load of laundry with bleach anyway so no big deal to add a few small items.

Best wishes and ((gentle hugs)).

exbrnxgrl · March 2017

Are you sure that you're having a radical bmx? Those are rarely done these days. it involves removal of the underlying chest (pectoral) muscles and is no longer in common use. I had a bmx with axillary node dissection on one side. I don't remember toileting difficulties, though I moved slowly and gently in the beginning. I did use moist wipes. A radical would be far more debilitating, but is very much the exception, so check with your surgeon and best of luck.

PS: I did some googling and found that radical mastectomies fell out of favor in the 1970's and is only used under unusual circumstances. Having all muscles removed is not only extreme and disfiguring but would certainly have a major impact on range of motion.

Luckynumber47 · March 2017

Well, here's the silver lining - the pain meds they give you will cause constipation for several days so you may not need to do that thorough cleaning for a while.

I just couldn't reach up for a while so I let the hand held wand in my shower hang down and then used it to shower from the waist down.

I was worried about all that myself but it ended up being a non issue.

Best of luck with your surgery. Do lots of things to pamper yourself. I got new robe/slippers/jammies. Got a pedicure with pretty polish. I listened to guided imagery before surgery and was surprisingly calm (well, the klonopin helped too). I had boxes of tissue all over the house because I was sure I'd be bawling my eyes out. Never did shed a tear. I just looked at surgery as the beginning of healing and that's a positive thing.

candles1 · March 2017

If you want to/need to use moist wipes, there are flushable ones on the market, so buy those.

I've not heard of anyone unable to reach to wipe after BMX, but range of motion might be an issue for you to milk and empty your drains if you will be totally alone. Make sure to go over a good drain milking strategy with your nurse before you leave the hospital. You will have to reach around, with both hands, to a few inches below your underarm area. This is where the drain tube will exit your body. I had no trouble with range of motion at all, but I can see how drain management could be hard for someone who does have range of motion difficulties.

itfinallyhitme · March 2017

Thanks so much for the replies. And the info!

Now I'm really concerned, I might have misunderstood something. I'm going to find out if chest muscles are involved.

I actually buy flushable wipes (and don't flush them, because the package says they aren't good for our septic system). It's good to know I can probably manage. Worst case scenario, I do have shower unit in a hose. Good point to remember to leave it hanging down! I'll have to see what else I need to put down low.

And I'll definitely ask about the drains. Somehow I thought they'd be in the front.

Thanks again

candles1 · March 2017

The drains are sort of in the front ... but off to the side. Don't stress over it; they will surely be placed somewhere reachable for you. Your nurse will instruct you.

exbrnxgrl · March 2017

Don't worry. When your doc first discusses your surgery with you, your mind is so overwhelmed that it's easy to not recall everything correctly. It's very unlikely that you'll be having a radical mx, but do clarify with your doc. As for the drains, I was able to strip mine unassisted, though I did have someone help me at first because I'm a bit squeamish

kcat2013 · March 2017

The only problem I had in that regard was I couldn't reach around to where the toilet paper is situated in my bathroom. It's kind of to the side and next to the back of the toilet. So my husband fixed that by hanging a roll of toilet paper on a hanger in front of the toilet so I could reach. So I'd just take a look at where yours is situated in relation to the toilet

Bravenurse13 · March 2017

I recently had a modified radical mastectomy on the right, and simple mastectomy on the left (my choice), 4 weeks ago.

I worried about the same thing, and I came from the front, cleaning front to back to prevent e-coli contamination. I also bought a hand held shower and kept drains out of the way to shower, no problems!

I will tell you I was really sore and my range of motion was limited on the right side, due to lymph nodes were taken so more work on that side as well as trauma.

I started exercise with pulleys and I must say it has been such an improvement for my range of motion so far.

I will need to be able to raise my hands over my head for radiation treatments which will be possibly be in the next couple weeks. All is well.

You may be surprised how well you will do. I was apprehensive as you were, and I have been surprised how well I have done. Be positive, be brave, and know that you have others here that will support you, and never feel embarrassed.

As far as being alone, that is going to be a challenge. Especially getting out of bed for the first week. Hopefully you can arrange to have a recliner, if you don't have one already. Hopefully you can have people check on you periodically, if you have home health, a nurse can assist you to get assistance for you if you are alone. Start Freezing meals so they can be warmed up with no meal prep. Get protein shakes ready to go, just take out of fridge with no prep. Make it as easy on yourself as possible.

Most likely you are having a modified radical (one step up from simple mastectomy). I know I kept calling it a radical mastectomy, and I am a nurse.

Good luck and keep us posted.

candles1 · March 2017

Another tip if you are alone and find yourself with limited range of motion: make sure your microwave is placed at counter height, not elevated. You might have trouble reaching up to put plates and meals in a higher up microwave.

Icietla · March 2017

If you are having modified radical mastectomy on both sides at once, I believe you are going to need assistance, at least through the first few days and nights. I do not think you should be left alone. Besides all the things you will be unable to do, there is one that you must not do -- you must not fall. If you do not have someone who can assist you and watch out for your safety through the first days, please tell your Doctor so a longer hospital stay or some home health care might be arranged for you.

Icietla · March 2017

Yes, chest muscle is involved.

itfinallyhitme · March 2017

Thanks again, everyone.

I'll call the surgeon's office tomorrow and ask about the exact type of surgery. I know I need to get busy cooking meals. I had a partial mastectomy with SNB last year, and a second surgery (no clear margin) and I remember how hard it was to get up having one arm restricted. I had cording from the SNB so that arm was useless, but I could use my left.

I just heard from an old friend who wants to come stay with me, if she is able, after the surgery. That would be a lifesaver. But it's still very much unsure. I can get someone with me a few hours here and there, but otherwise, I'm not sure. I'm supposed to be in hospital one night only (I guess assuming things go well). I'm not sure if something else can be arranged or not, but thank you for letting me know so I can start asking. I really want to get back home ASAP, but on the other hand, I hadn't thought about falling. Thank goodness ... I have intermittent dizzy spells that come and go (inner ear thing, not really a problem in itself) and it's just about cleared up from having it for some months again. I'd better let them know that too, just in case.

I'm glad I have several weeks more to prepare. It still seems overwhelming! I wish my aunt could come - she's like my second mother, but she won't be able to. I live pretty far from my family.

Thanks again for the info.

Icietla · March 2017

I had one total mastectomy and one modified radical mastectomy. On each side the surgery took down to and including the deep fascia.

Yes, inform your Surgeon of your balance issues, and have your Surgeon make sure to direct the Hospital to supply you with a walker to take home with you.

This is very important -- Your Caregiver should be a person having no substance abuse problems nor close connection with any persons having substance abuse problems -- None! And while they are your Caregiver, they should not have any visitors of their own.

itfinallyhitme · March 2017

Ah, I had not thought of substance abuse. I'm not sure. It could be an issue in the case of one person. Ugh.

I was given Tramadol for the first surgery, which I'm hoping to get again (or for that matter I probably have plenty left as I only took a few). Narcotics in general tend to give me nausea rather than help much with pain, so I usually refuse them (or request a prescription only be filled for 2-3 JUST in case). But I hadn't even thought of that.

Yes, that could be a problem - I'm just not entirely sure - in the case of the person I might have gotten to stay with me.

Thank you. For their sake as well as mine, I wouldn't want there to be a problem.

Icietla · March 2017

I am thinking something stronger, and add a zero. Have a little something (solid food) in your stomach already and go to the bathroom before taking a dose, so you can be still for at least an hour after dosing.

When in doubt about anyone -- you are not able to receive guests.

meg2016 · March 2017

Two things that might be helpful- squeeze bottles full of water next to the toilet. Can work a bit like a bidet and can often be used from a further distance. Flushable wet wipes are also extremely useful.

itfinallyhitme · March 2017

I really appreciate the advice re:pain meds, and I'll talk to the surgeon. And if I have to take anything alone those lines, I'll definitely be sure I can be still. Nausea was probably not a strong enough term. The last time I had codeine, I was vomiting non-stop, even moving my eyes made me sick - and I found out it's impossible not to move my eyes. They gave me a synthetic morphine while in hospital and again, non-stop vomiting so they had to give me something in an iv to counteract that and then something to make me sleep. I'm honestly afraid to take anything closely related, but I don't know now anything about drug classes

itfinallyhitme · March 2017

Thank you, meg. I'm considering having those available.

Denise-G · March 2017

Suggestion - ask your doctor to send a Visiting Nurse if your insurance will allow. I refused when i went through it, and I live alone so I stayed with family. When my sister had a Diep Flap, she said yes to visiting nurses and was so happy she did.

It REALLY helps especially when you live alone!!

Lula73 · March 2017

Excellent question! I had this same question and did some research on this topic before deciding to bite the bullet and purchase a bidet toilet seat for use after my BMX with immediate revonstruction. I was so glad i did. I had never used one before either so it was a little interesting at first but well worth it in the end as reaching behind really wasn't happening for me.

Now, the trick to purchasing one is to get one with a dryer-otherwise how will you reach behind to dry yourself off? I went with Bidets Plus for my purchase as they had several seats that had a satisfaction guarantee or your money back. I spoke at length with their representative about why i needed one and my anticipated range of motion issues. I went with the Blooming bidet seat with remote as it was reported to have good angle for women's parts (as well as rears), it has instant warm water, and it had the most effective dryer. The remote option meant i didnt have to worry about range of motion at all when using it. And itwas not difficult to install.

Hope this helps!

mustlovepoodles · March 2017

I had some limited mobility after my bmx but no problem managing toilet hygiene, nor stripping drains.

Di2012 · March 2017

I have used SCOP (scoplemine patch placed behind the ear BEFORE SURGERY) lasting 3 days .......I requested them for 2 surgeries and Never had nausea post surgery....they are also used for sea sickness. WITHOUT them I am a very sick puppy.

NO problem toileting after my BMX.. but did NOT have imediate reconstruction....drain tube wanted to hook on to cabinet knobs...that hurt!

No showering, when I had drains.....hair washing wash on my knees with head in shower stall and hand held shower.

Di

itfinallyhitme · April 2017

Thank you again for the further replies. Sorry for not responding sooner. This is a very intense time of the year for me personally (which is why I scheduled surgery for after it) and I'm also trying to get everything ready for surgery, so having time online is hard sometimes.

I do thank you all SO MUCH though - I couldn't have known about these things otherwise, and I'm making a list for my doctor.

sbelizabeth · April 2017

Three weeks with no shower...wow. I wonder why. My surgeon was fine with brief showers a couple of days post-op. No soaking--bathtubs, spas, swimming pools are no bueno (like you'd be swimming an Olympic event post-mastectomy). But having small streams of clean/soapy water run down a healing incision doesn't hurt anything.

Post-op instructions are so variable, depending on how the surgeon was trained, experiences, and (probably) age.

sbelizabeth · April 2017

Itfinallyhitme, my sister can't take any commonly prescribed post-op opioid pain meds because they give her the mondo-pukes, like you. But she can take Tramadol (Ultracet). It's better than plain tylenol but isn't nearly as pukeaceous as standard opioid meds.

itfinallyhitme · April 2017

I've been wondering if Tramadol is some different class of drug. I took it a few times after my first two surgeries and did ok. I'm afraid to take codeine, or morphine, or hydrocodone, or anything related though.

And I think too it must not be absolute (the shower thing) since some surgeons do allow it. I'll have to see. I'm trying desperately to clear up another skin issue before surgery, because not showering will cause problems with that one, but I saw a dermatologist and it's doing better.

I have a large kitchen sink with a spray nozzle on a high arced faucet, so I think washing my hair in the kitchen sink would be relatively easy. My hair is fine as long as I wash it 2-3 times a week. But not washing my upper body is bugging me to think of

candles1 · April 2017

I think the shower restrictions may have something to do with the way your PS protects the sutures and the drain incisions. Some (mine did) use some sort of water resistant product so that streaming shower water is ok. Others may not use this technique, so the incisions would be more prone to infection.

Embarrassing question - post-op

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