Port placement and Clinical Trial Cycle 2, Day 1

November 26th, 2013 § 17 comments

IMG_7813On Friday morning after I sent our three children off to school I traveled to Memorial Sloan-Kettering Cancer Center (MSK) to have a port implanted. My first appointment of the day was at 10:15 to have an electrocardiogram (EKG/ECG). MSK requires an EKG on one of their machines within 48 hours of the port procedure. It takes longer to find the bathroom than it does to have this test done. Electronic leads are attached with sticky sensors to specific points all over your body and hooked up to a machine. After about one minute of recording you are done, and the sticky round patches and the attached wires are removed. Easy as can be. The test measures the electrical activity of your heart to make sure it is normal. I won’t go into details on this test because it’s such a piece of cake and so common.

After that test was complete (by 10:08) I went to a different floor in the same building to the Interventional Radiology department. There, a friendly team checked me in and sent me to the waiting room, a large attractive area brimming with patients and family members. After a little while a woman called my name and I was taken back to be prepped for surgery about 30 minutes before my scheduled 11:15 arrival time. I will say that for every test and procedure I’ve had so far at MSK’s main hospital they have been on early or on time. This has been a pleasant surprise at such a large medical center.

Once we reached a small prep room a very cheerful nurse gave me a garment bag to store my clothes in and I changed into a standard issue hospital gown with   a thin navy blue bathrobe to wear over the top. She weighed me, measured my height, and reviewed my medical history. This was the first surgery I had at MSK so I had to review my surgeries and allergies along with current medications, etc. They wanted to do another pregnancy test but I refused on the grounds that I had an oophorectomy and the test was unnecessary. Because the surgery had not been done there they didn’t have the exemption in my file. They confirmed that I had not used any blood thinners (including medications or pain remedies that can act as blood thinners) in the days prior to surgery.

I then met the surgeon for the first time and he and I discussed the precise placement site of the port and also the ramifications of my sensitivity to adhesives. Usually it’s not too much of an issue but for this procedure the surgeons usually close the incisions with Dermabond (skin glue) and my skin cannot tolerate that. Sutures would be used instead.

The surgeon pinched the skin between my collarbone and the top of my breast implant and said that there was enough tissue there to use the preferred port, called a MediPort or PowerPort. Each person has a different amount of fatty tissue in this area, and a mastectomy may affect this as well. Age, body type and other factors can affect which model of port can be used and where it will be positioned. Obviously, children and people using a port for only a short period of time may have different limitations and needs. There were a few times during the day when someone said to me, “You’ll just have this for a while and won’t even know it’s been there after it’s gone.” They assumed that I would only need it temporarily. “It’s here for good,” I said more than once.

There are many different kinds of ports. They have changed a lot over the years. The one I have is quite small and is triangular in shape. This shape is an indicator that the port can be used for injections of contrast dye (these are called “power-injectable”) in addition to being used for blood draws and any future IV chemo. The power-injectable feature means that when I go for CT scans, bone scans, or PET scans, the technician can inject any dye that might be needed for that test into the port rather than having to use an IV line into my hand or arm. This is one reason I decided to get the port. Being in clinical trials now means frequent blood draws and scans.

The nurse started an IV in the holding area and I was wheeled through a maze of hallways until we stopped outside the operating room. I got off the gurney, walked into the OR, and hopped onto the table. After a lot of prep  including hooking me up to monitors and draping and cleaning the area, they finally pushed Fentanyl and Versed into my IV. I didn’t actually go to sleep but probably could have. They numbed the two incision areas with local anesthetic and after about 15 minutes including a few periods of tugging and pushing it was over. I’m going to just link to the actual description that MSK gives about the procedure itself. I’m not sure I can explain it any better than they do.

I stayed in the OR for about ten minutes and then was wheeled to a very small private recovery room where I stayed for about an hour. The one surprise is that in the Interventional Radiology department’s recovery area at MSK they do not give you anything to eat or drink after procedures. So I needed to wait until I left to have anything (tip: if you are going to have a port placed, tuck a snack and drink in your bag. After fasting until the procedure you will want something convenient to eat and drink afterwards and radiology departments might not provide them the way that surgical recovery areas often do).

My husband was able to join me in this recovery area after I was settled. A nurse reviewed my discharge instructions. I needed to wait slightly longer to get the incisions wet than usual because I did not have the Dermabond.  Usually it’s a 1-2 day wait. I was quite sore immediately after and was glad I had put a cushion and pillow in the car. If your port is put on the right side, as mine is, the passenger side seat belt will not be pleasant so I recommend bringing a padded seatbelt cover or other method of cushioning the strap. I was quite sore for about 24 hours, but quickly that shifted from being generally aware of the pain to being very localized and only when using that arm. That quickly became localized discomfort if touching it. Today (three days later) it’s still sore to the touch but otherwise not bothersome. I did not use any pain medication.

The port is much smaller than I would have thought. It’s placed so low that it won’t be visible in a tank top. The surgeon was very careful to try to pinpoint a location that would be cosmetically most appealing which I appreciated since this will not be temporary. Eventually I will need IV chemo and this will be used for that as well. For now there are two red incisions but I know those will fade. They are far more visible than the port, a bump under the skin the size of a quarter.

I will not be able to use the port for blood draws that I do near my home and many people are not aware that not all phlebotomists can access the port. Only certain people  (most often at hospitals and oncology offices) can access the port because you need special training and also special equipment. In addition, if you do not use the port for a period of about 30 days you must go to have it flushed (with saline and Heparin) to prevent clotting. It only takes a minute to do that.

I’m happy to answer any questions that readers have about the port or anything I missed in the description.

…………………………………

Today I was back at MSK for my regular clinic day for Cycle 2, Day 1 of my clinical trial of Genentech GDC-0032 + Faslodex. I met with a nurse first who checked my weight, blood pressure, oxygen saturation, did a physical exam, reviewed my side effects (I won’t go into those in this post). Next I met with the Principal Investigator on the trial who is the one in charge of my care during this time. I gave her the four remaining pills of my 30 day supply (two each of 1 mg and 5 mg capsules of GDC-0032) and signed and turned in my medication log which lists what time I stop eating each night and what time I take my pills each morning. We discussed scheduling for the month which includes my CT scan three weeks from now where we will get our first look at what, if any, effect the drug combination is having on the cancer.

Next I went to the chemo suite to get my Faslodex injections and have my blood drawn as required by the protocol. I had a different nurse this time from the last two times. I told her that I had a new port and asked her to explain the process for the draw now. She warned me it might be sore as she palpated it to find the right spot to insert the needle and also said the actual needle stick might be a bit more painful today depending on the exact location of my incision.

We each needed to put masks on to cover our nose and mouth during the blood draw to minimize the chance of infection. She gently felt for the circular center of the port where the reservoir is and inserted a special needle to access it. It was a bit tender but certainly not at all more painful than my usual stick on the back of my hand. It really was just a second and it was great to know there was no chance of “failure”… blood would flow! And it did. Six tubes were done quickly and then she flushed the port with saline and Heparin to prevent clotting. The needle was removed, a gauze and paper tape bandage applied (no adhesives for me) and then we removed our masks. Easy and no anxiety. These steps must be taken every time.

Next it was time for the two nasty Faslodex injections. As I’ve written before these are two jumbo intramuscular injections, one in each butt cheek. The nurse kept apologizing and saying how she hates to give them because they’re just so big and painful. They are always very sympathetic when administering these. Today’s were painful, I think the worst of the 3 rounds I’ve had. I think it’s just chance about where they hit and also that I’ve had to do them every two weeks this month during the loading phase. Now I will only need them every month so there is longer recovery in between from the soreness and muscle pain. I find that a heating pad is the most comforting way to ease the pain, I’m definitely getting used to it and also knowing what to expect.

Once done I stopped into the pharmacy (right next to the chemo suite) to pick up my next month’s supply of GDC-0032. I needed to wait to take today’s dose until after my bloodwork. I took my pills with a glass of water while still standing in the pharmacy and noted the time in my new medication log. I would now need to wait one hour before eating or drinking (as I always do when I take my dose each morning).

I went down one floor to scheduling, made my next appointments, and was on my way about 2.5 hours after I first walked back to the exam room. I met a friend for breakfast and had that blissful first cup of coffee at precisely the time allowed. I took the train home, and fell asleep on the way.

I’ll be back at MSK in two weeks for an appointment with the doctor and bloodwork. The week after that will be my scan and then I’ll be back again a few days before Christmas to begin Cycle 3 if all is stable.

If my cancer has grown (“progressed”) by 20% or more, however, the drug combination is deemed not working. I will stop the trial (and be dropped from it) and I will need to move on to something else. I’m already at work researching what that next choice should be.

…………………………………….

We are entering a fragile time of year. The holidays are difficult for many people. Some miss loved ones who have died. Some mourn their own lives, no longer what they were. Grief takes many forms. The pressure to create memorable and uplifting occasions can sometimes be oppressive.

Be kind to those who are struggling during this time; physical and mental illnesses can be especially difficult to manage. Understand that happiness and sadness can coexist. Reach out to others if you can.

Find a bit of beauty in the world. Share it. If you can’t find it, create it. Some days this may be hard to do. Persevere.

 

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§ 17 Responses to Port placement and Clinical Trial Cycle 2, Day 1"

  • Merva says:

    Your writing is so educational and honest, Lisa. Thank you for sharing and teaching about these experiences. With your words, you are helping so many people.

  • lyn says:

    Hi Lisa.

    You have inspired me to be kinder at all times – not just at this Festive time.

    Since I was diagnosed with breast cancer everything about me and the world I lived in changed.
    I have
    learnt so much about myself and others. Some things wonderful and other behaivour so unbelievably bad it was beyond getting upset about and found myself having a damn good belly laugh!
    I discovered another world outside
    of the one I used to live in and in spite of the pain and sadness that brought me to this place, I am so content and happy to be part of it. Like meeting with you through your blog. As well as the other people who comment. I know I am not alone in the universe at any time.
    I count my blessings with sincerity and heart felt gratitude and with that some
    sincerity wish you and your readers the same.

    I made a decision to simplify my life as much as possible where I can.
    I dont have the time or the inclination for the unneccessary nonsense I used
    to avail myself to. However my sense of humour is still in pristine condition.

    Thank you so much for sharing your journey with us. It has changed my life
    and I add this to my daily blessing list.

    With loving gratitude
    Lyn

  • Caroline says:

    Great post. If your port is sore when they access it, ask for an ice pack for about 15 minutes prior to numb the area slightly. It was a big help. Eventually – month or so? – it will not hurt at all when it is accessed. Good luck.

  • Lindsey says:

    Sending you lots of love, Lisa. I’m inspired by you to see the small bits of beauty in life. Every single day. Thank you. xoxo

  • JoAnn says:

    thank you

  • Marisa says:

    You are a wonderful writer…and teacher.

  • lisa says:

    My favorite lines: “Be kind to those who are struggling during this time; physical and mental illnesses can be especially difficult to manage. Understand that happiness and sadness can coexist. Reach out to others if you can.” Thank you.

  • Rebecca says:

    Your port is different than the one my husband had temporarily, and in a different spot. He was able to self-administer saline and Heparin. I don’t know if you will be able to do that or not. I am curious, is the port comfortable under your clothes? It sounds like it is pretty small, but being under your shirt and maybe under your bra, is it bothersome?

    I also like your last lines, reminding us to be kind to one another. Very often an illness is not visible to the naked eye and it can be easy to forget that a friend or relative is suffering even when we know they are ill. I hope you and your family have a joyful Thanksgiving.

  • Lisa Mayers says:

    Lisa,

    As a fellow traveler on the journey (mTNBC) and a fellow “Lisa”, thank you for sharing your experiences with us. I just recently discovered your blog and really appreciate your writing. Although I wouldn’t wish this journey with cancer on anyone, it is comforting for those of us experiencing it to know we are not alone.

    I was happy to read that your port placement went so well! My first port placement (that unfortunately was removed just months before my first recurrence) was quite painful, but once in was trouble-free and very comfortable. I have a double power port now on the other side of my chest that is less comfortable and sadly, almost immediately developed a clot that prevents blood draws from it. Ugh.

    Anyway – I wanted to mention to you a tip that another survivor gave me before my first port access…lidocaine spray! The nurses are very accommodating with it, but I have always had to ask for it. While the port access isn’t terribly painful, it’s nice to have something so simple minimize it further – especially with two port reservoirs to access and flush!

    I’ll be starting my next step – Xeloda – right after the Thanksgiving holiday. Here’s to great success with both our treatments! Happy Thanksgiving!!

    Peace, love, and a cure…
    Lisa

  • There is something for everyone in this post. Thank you, Lisa. And, have a blessed Thanksgiving.

  • Diane Turner says:

    What lessons for everyone you impart here. Sending you healing and hugs.

  • Jenny says:

    You state ” moving on to something else and researching what that next choice should be.”
    Is palliative care one of those choices?
    My sister made this choice earlier this year and I was angry…at first.
    At 6 years into a stage 3 diagnosis and a retired nurse, I have come to realize that I want quality, not longevity. I have expressed this to my family and in my Advance Healthcare Directives.
    I would appreciate your thoughts.
    Jenny

    Jenny

    • Lisa Bonchek Adams says:

      I have an Advanced Directive. They are very important. Palliative care accompanies all levels and stages of treatment, not just end of life. I assume you mean withholding treatment altogether. No, that is not an option at all right now. I have barely started the options available and am at the beginning of my treatment. When that time comes, yes, I would, but fortunately I’m far from that right now.

  • Jessica says:

    Thanks for sharing your personal journey. I have been following your blog. My mom was dx with metastatic bc 1.5 years ago. She is taking falsodex as well. One nurse gave her the suggestion of icing the area for 15 minutes prior to each injection and it’s made a world of difference. Hope that can help you. We also warm the shots up really well beforehand. All the best to you.

  • Meg says:

    Thank you, Lisa. You write so well. I believe you are one of the beautiful beings in my life right now and i am thankful!

  • JoAnn says:

    thank you again

  • Susie Simmons says:

    This post is readily understandable and informative. I marvel at your superb writing skills and compassion for others when it would be reasonable for you to be absorbed in your own life and treatment. I admire your fierceness, sensitivity and courage. Excellent post. Well done; your beauty is stunning.

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