I went for my baseline MRI after DIEP flap breast reconstruction this week. Additionally, I had blood work drawn which I do every four months to monitor tumor markers. I actually forgot they had to inject contrast dye into my veins during the last part of the MRI; double sticks, two appointments with lots of needles!
Breast MRI #1
I have been mentally preparing myself for this day for a few weeks now. The last time I had a breast MRI was in April of 2014. It was ordered by my breast surgeon to determine if a mastectomy was the best course of action after my second breast cancer diagnosis. It was the first time I ever experienced the face down position MRI; the kind where your breast are sort of hanging, or suspended in air as the images are taken. The 2014 MRI is when I had my “original” breasts prior to my double mastectomy.
The 2014 MRI was far more nerve wracking than this second one, sort of. OK, they were both nerve wracking, just in different ways. I discussed the pre-mastectomy breast MRI with my breast surgeon. I mentioned to her I am claustrophobic and didn’t do closed spaces well. She offered me some “happy pills” in the form of Clonazepam. Here is what it says about the drug on the National Library of Medicine website:
Clonazepam is used alone or in combination with other medications to control certain types of seizures. It is also used to relieve panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Clonazepam is in a class of medications called benzodiazepines. It works by decreasing abnormal electrical activity in the brain.
Handling Closed in Areas of MRI
I think decreasing the electrical activity in my brain the day of my pre-mastectomy MRI was just what I needed. I was thinking about the results and how I was going to handle them. Knowing full well I am a light weight when it comes to medication, she suggested I take half a pill about 30 minutes before the MRI. I followed her orders. Suffice to say I started giggling on the way to the imaging office. My husband was looking at me sideways but knew how easily affected I am by medication. I told the kind, young woman who showed me to the dressing area I felt like I was back in high school at a party. Now we were both giggling; me because I was on happy pills and the young lady, she was simply laughing at me. I slept the entire way through the MRI. Mission accomplished!
Breast MRI after DIEP flap
Not so for my MRI this week! I didn’t take anything. I went by myself and I wanted to be 100% clear minded for this test. This was my baseline MRI after my DIEP flap. There are various protocols for monitoring reconstructed breasts from those who will be part of your breast surgery team. I followed my plastic surgeon’s recommendation for two reasons: 1. it made sense to me to have a comparative baseline for any lumps/concerns in the future. 2. I trust his opinion because we have always discussed options in a shared decision making approach. Read his blog here to see what he has to say. Your surgeon may follow a different post DIEP flap surveillance. The key take away here is patient and surgeon (plastic surgeon or breast surgeon) discuss protocols in a shared decision making conversation. The patient knows why the protocol was followed and has peace of mind about the decision for post DIEP flap breast reconstruction surveillance.
The MRI Procedure Begins
I checked in to the imaging center and paid my 10% co-pay of roughly $100. I always reflect how grateful I am I have good insurance and support. There was a gentleman who entered the area at the same time I did. He was a bit disheveled but very talkative. He was obviously brought in to the imaging center by an organization who assists those with no transportation or family. This gave me great pause and a sense of appreciation as my situation appeared to be far less challenging than his. I signed paperwork for MRI safety information, patient information, and consent for IV contrast.
The Needle Stick for the MRI
The staff escorted me back to the dressing area. I disrobed down to my underwear and socks, no bra, and donned some immensely baggy surgical pants and two robes, one facing front and the other facing back. The next room I was taken to was to place the IV for the contrast used for the MRI. I am not needle phobic at all and always go into these situations stating to the nurse I have lousy veins from chemo years ago. I only use my right arm since my left one has been worked on twice. My go to vein is in my hand but you might be able to use the one at the fold in my elbow, blah, blah, blah. The same routine occurs every time I go in for blood work or get stuck for any reason.
I mentioned to her I would also be getting blood drawn after the MRI and was concerned about my lack of options for good veins. She told me she could leave the IV in but I smiled at her and said, “We’ll just cross our fingers there is a good one left after you stick me for the MRI.”
Feeling Very Vein!
Wishful thinking! The kind nurse did a great job and hit the go to vein in my hand even though it was ice cold. She put the syringe in to flush out the IV. We both looked at the syringe with puzzlement. The seal was faulty and a pool of saline and my blood began to form on the floor. She looked at me and said, “Oh dear. This is a faulty syringe and has only happened to me once before.”
All I could think was, “There goes my good vein and could we please stop this pool from getting larger on the floor!” The young attendant came into the room, quickly put on his gloves and began to clean up the crimson mess on the floor while she took the IV out and began putting pressure on my hand.
Now what? Which vein? She went for the one in my wrist so the phlebotomist had a good one left for my blood work draw later in the day. Any hope of using my hand was gone as it was already turning blue and puffing up from the first attempt.
Educating the Techs About DIEP Flap
She was so kind and apologetic and it was no fault of hers. The radiology technician walked into the room to gather some information from me. I began my discourse of why I was there sharing him he wasn’t really imaging breast tissue but it was tummy tissue after DIEP flap breast reconstruction. I asked him if he knew about DIEP flap surgery. The nurse was still in the room. They both had a quizzical look on their faces and I sensed they vaguely knew about it. I get that look more often than I want to. In my true advocacy fashion, I began to educate them on the procedure of DIEP flap breast reconstruction. The technician was amazed at the notes I had in my head regarding my previous scans as well as the information I shared about DIEP flap. Be your own best advocate!
Go in to Baseline MRI after DIEP Flap Breast Reconstruction with Information.
Misinformation, lack of information or not knowing what procedure you’re having can lead to a number of misdiagnosis, undue concern or need for further tests. Be prepared to discuss your DIEP flap procedure before you go to these important appointments. If it is something you need assistance with, ask for a friend or partner to go with you. Perhaps a patient advocate at the facility to be a second ear and support might be available.
It was interesting to me the nurse stated her amazement at the information I gave them. It gave the technician and the nurse clarity as to why I was there and also valuable information to pass along to the radiologist who would be reading my films. She remarked to me, “Many patients come in here not knowing what an MRI is, what procedure they’re having, or what the results will actually mean”. All I could think was, “Perhaps this is part of the problem in our healthcare system.” But, it was time to get on the table and begin the MRI.
The nurse entered the room with me and closed the door as well as the curtains to the window where the technician was sitting. His name was Omar and he was ready to get the process started. It takes about 30-40 minutes total. The nurse told me my gowns needed to be turned around so I took the opportunity to ask her if she wanted to see the results of a DIEP flap procedure.
Admiration of Amazing Work!
I opened my gown and showed her and her mouth literally dropped wide open as she said, “Wow! Absolutely amazing work! I’ve never seen anything that good.” Her natural instinct was to reach out and touch my breasts. I nodded my head in approval to let her witness they were warm, soft and natural like real breasts. She stood there in astonishment and wanted to know who my surgeon was. Of course, in my usual advocacy fashion… AGAIN… I told her.
A Bing Crosby kind of Merry Christmas MRI
She began preparing me for the ear-blasting, Bing Crosby, Merry Christmas MRI! I laid face down and made sure my breasts were in the two openings on the MRI table. My face was on a covered, padded pillow like you might see at a massage salon, open in the center so I could breathe. She placed a wedge pillow under my legs so they were elevated and at an angle, ask me to place my arms above my head, adjusted the IV so it wouldn’t get tangled, placed the earphones over my head and ask me what music I wanted to listen to. It was December and not really thinking much about it I said, “Christmas sounds good. How about some Bing Crosby Christmas?”
The Sites and Sounds of an MRI
The process began. The table started to move into the enclosed small tube. I closed my eyes and glad I was facing downward so I couldn’t see how truly enclosed I was. Bing started crooning away with White Christmas. It was a bit of a distraction but not much. I suddenly felt like I was in the middle of a construction site on steroids! Whir-bang-bang. Droooom, buzz, buzz. The sound was deafening and I knew this was going to be an exercise in mental endurance for the next thirty minutes. Thirty minutes, I can do this!
It wasn’t uncomfortable except for the one spot by my sternum. Lying on it with pressure is a bit tender from where they removed a small piece of my rib cartilage to access the blood vessels during my DIEP flap surgery. Other than that, I just had to get through each session of images. Omar was very good at talking me through it on the headphones and always asked how I was doing so far. At one break I told him I was just having a very Bing Crosby kind of party on the table. He chuckled.
Dye Injected for the MRI
One of the final images would include starting the injection of dye into my veins. I won’t kid you. It was uncomfortable. I could feel my vein swelling at my wrist, which is not an ideal place to have an IV. The contrast was very cold going into my veins. At this point in the process my arms were very cold from having them over my head and beginning to fall asleep. But, Omar assured me we only had another eight minutes left. I can do this, I thought.
I completed the process, sitting on the table briefly to get my bearings. Feeling a bit dizzy from lying face down I left the room slowly. Omar thanked me again for all the information and told me the results would take a few days because of the number of images he took. He shook my hand and it was so warm. I smiled at him and mentioned how good his warm hands felt so he gently took my hands in his again to warm them up for me; a kind man, indeed.
Sending MRI Results Out of State
I got dressed but before I left I made sure I had signed all the necessary paperwork so my plastic surgeon could have the results. Since I went out of state for my DIEP flap they would not automatically send the results to him unless I signed a release. Be sure you ask about this if you had your DIEP flap in a state different than where you would have your MRI done.
As an aside, I go to an amazing lab to get my blood drawn. They know me well there. The two phlebotomist who are frequently there, always give me a hug when they see me, and ask how I’ve been doing. I told them what had happened during my MRI. They did use the vein in the fold of my elbow and hit it the first time for my blood draw and lab work. One of them looked at me and said, “You are so cold. You need to go get a nice warm eggnog latte.” Next stop, Starbucks!
The conversation should take place!
Discuss follow-up surveillance with your plastic surgeon after your DIEP flap surgery. It is an important part of your breast reconstruction journey. Remember, protocols will vary. It is important the conversation take place.
Hi Terri. Having been through several breast MRIs myself I find your description here very accurate. The MRI biopsy that I had was quite an ordeal, which I hope I never have to have again, but a straight up MRI is doable. I appreciate your touch of humor in your approach to educating us. It is surprising to see how many of the technicians have no clue about what some of us have been through or where we are going. I too have to educate them on what I’ve had done over my two bouts with DCIS – partial mastectomy, radiation, second partial mastectomy six years later, reduction by Dr. Liu, and finally a contralateral reduction by Dr. Liu. Keep up the great blog!
Gone fishing lately?
What a pleasant surprise, Connie! I appreciate your comments. Humor is often the best medicine during cancer treatment and all events following to monitor. 🙂 I’m glad you are your own self-advocate as well as informing others, even in the healthcare community, about your own health. Once an educator always an educator, right? Dr. Liu… what a treasure to the breast cancer and breast reconstruction community. Not only is he kind gentleman but also a very skilled micro-surgeon. I wish you a year of health and happiness. Fishing? Not since we spent that great weekend together with Casting for Recovery. But, I hope I can revisit that sport in 2016. I loved it! ~ Terri
Hi Terri. On December 1 of this year I had my DIEP flap surgery. It has been an amazing journey so far. Tomorrow I will get my last tummy drain removed. That, in itself, is going to be like Christmas! I look and feel amazing. I, like you, have tremendous confidence in the surgical team I chose. Can’t say enough good. I used Dr. Fallucco with North Florida Plastic Surgeons in Jacksonville, FL. Amazing work. Best yet, no cancer in lymph nodes, no chemo, no radiation. My onchologist recommended the Oncotype test on the tumor and I await those results. Good words you had. I read every one. I plan to be a supporter and aid others in this “out of no-where, change your life” experience called cancer. Cheers to a New Year!
Alesia, I am very happy to hear that you have had a good experience. You are still recovering so to hear your positive words is uplifting. No more drains…. excellent! They are that “necessary evil” but short-lived. It is so important to find a micro surgeon that you are confident with. This is all very gratifying news and I wish you all the best in the 2016! Thanks for your comments.