Drain, drain, go away.....

Well, I couldn't make it to my next appointment with this seroma. My stomach was so tight and all that I could feel was pressure. My regular doc was not in, but his nurse came in to see me. The "fill-in" doc said that this would resolve itself on it's own if we had left it, but since I was there, we would try and see if we could drain some out. If there was a lot, he would decide what to do.

The first thing that he did was take out the remaining Penrose drain. Then, he inserted a long skinny tube in the area where the drain was. He attached a "turkey baster" syringe to the tube and began draining some of the fluid. (I was happy that he didn't have to use the needle. Not gonna lie....) He withdrew two full syringes (60mL) and decided that there was more in there than he thought. It went across my whole belly area.

Plan B: Insert a new drain. I can't believe that I am going to say this, but I was kind of excited to get a new JP. I know. I am a freak. It is just so much easier to maintain when all of the fluid goes to one place as opposed to catching it in a pad and not knowing how much is actually draining. So, the doc took out the syringe line and put in a shiny new JP drain.

By the time I drove home and emptied the drain, I had already released another 50 mL. So, for the next two weeks, I will be recording drainage again, in my comfy sweats. Someday  I will be drain free, just not today ! <p>

Is that a seroma, or are you just happy to see me ?

Seroma. Ick. It all started a few days after my "conversion". Once the doctor cut the bulb and drain off, there is no longer suction to the tube in draw out the fluids left in the body. Unfortunately, I think that some of those stringy tissue things have blocked up my drain and I went from changing my pad out every few hours to absolutely NOTHING draining. As the days go on, I have developed a bulge from the fluid building up.

At first, I thought maybe I was imagining it and the draining was just done, but even my husband could tell and he does a daily inspection to tell me that it has gotten bigger. I can see the bulge when I look in the mirror. One side of my belly button is flat, while the other is puffed out.

As much as I hate calling the doctor after hours, I put a call in and the on-call doctor told me not to worry. It was not likely to become infected, I just need to come in and then we could decide what to do. Of course, with my luck, this all began on New Year's Eve, so the office is closed New Year's Day and then we got a major snowstorm last night. So, I have an appointment set up for tomorrow to see what we can do. Hopefully they get the roads clear or this thing starts draining !

I am hoping that the build up will create some pressure and push the tissue stuff out of the way. So far, not so good. :(

A drain, a drain...... What's in a drain ?

Ahhhhhh........ The JP Drain. Loved by some, hated by most. These little buggers can make recovery and life in general difficult. Generally, you will have drains placed during surgery. You may be lucky enough to have one or more removed before you leave the hospital. You will most likely leave the hospital with at least one. Here;s a little bit about drains and how to care for them.

The Jackson Pratt Drain (JP Drain) is a common drain that is used for TRAM Flap or other reconstruction procedures. One is pictured below:

The white tube will be inside the body, up to the tapered end, which will be stitched in place during surgery.

Before you head to the hospital, you might want to consider a camisole that has pockets to place drains. These camis are not the most attractive things on earth, but trust me, if you forget to attach the bulb once or twice and feel the pull on your tube, you will be wishing you had one. Here is an example of what they look like. They run about $45-70 each. Your insurance may cover the cost. You also may be able to buy one at a medical supply store.

If you are good with a sewing machine, check out this pattern using a T-shirt. You could probably even make one with an over-sized tank top and some Velcro. The important thing is to make sure that it is easy to open and close from the front. My doctor suggested bringing a few sizes of sports bras to the hospital, but I felt much more comfortable in the cami. Due to the swelling, you may not even want to wear a bra for a few weeks, unless you are leaving the house. I was more comfortable wearing an over-sized shirt or a tank with a built-in bra (Confession- it was a maternity one, so the extra space was nice).

Another option is to wear jackets with pockets inside. Pants can be tricky if you have a drain in the groin area. You should wear pants that are loose enough so that they do not put pressure on the drain. You also need to be able to pin the "grenade" to your pants or tuck it into a pocket. Underwear is the next issue. I solved this problem by taking an old pair of underwear and cutting out a circle large enough that would allow me to move the bulb through the underwear. Just be careful when you remove the underwear. It is easy to forget that the drain is still attached and you may pull on it by accident.

When you are at the hospital, your nurse will care for your drains. She will show you how to strip your drains and measure the fluid. You will want to record these amounts and show them to your doctor when you go for your appointments. The amount that you are draining will help your surgeon to decide when to remove your drains. Usually, they will not remove the drain until you are draining 30mL or less per day.

Here is a video on how to strip drains and measure your drainage. 




The video shows a purple-colored liquid, but obviously, you can expect your fluid to be in the yellow-orange-reddish-pink range. If your drainage is any other color or if you drain blood or puss, call your doctor immediately. If you see any small, stringy "worm-like" tissue particles, don't worry. That is normal.

This is NOT normal:

I woke up one morning and was like "What ?" After a quick call to the doctor's office, I was told to not worry about it, a piece from the connection between the bulb and tube had come out. This piece allows the drainage to come out of the tube, but keeps anything from going back in. At my next visit, the nurse switched out the bulb for a new one and I was good to go. I joked that she gave me a shiny new bulb for Christmas, but she wasn't amused.

When you are ready to have a drain removed, be prepared. It may be a little painful, but it is over quickly. It is over within seconds, but it is a bit uncomfortable. So, hang in there and think about how great it will be once that thing is removed.

Drains are usually removed once the amount that you are draining has decreased to a certain level. As I was told by my nurse, it is not "normal" to be draining a large amount at 4,5,6 weeks after surgery, but some people do. There is no explanation or anything that can be done. However, the JP needs to come out.

This is referred to as "Converting to a Penrose Drain". Basically, the bulb and tube are removed, but the white tube is kept in place. You will continue to drain, but you will be unable to collect the fluid and measure it. It is quite a bit messier than the JP Drain, but it does get rid of the tube, which is a plus. Each week, the doctor will "back out" the drain, meaning, he will remove the stitches and pull on the tube, removing a section. He will then restitch the tube. The area may become a bit irritated. Call the doctor if it is hot, red or if any puss come out. It is important to try and keep the area clean and dry, which can be difficult. It is not ideal to go through this, but it does buy you some time if you are still draining heavily. If the doctor removes the drain too early, the area may close up and the fluid may build up under the skin and cause a seroma.

A Christmas Miracle ! (Almost)

May be TMI- Don't read ahead if you are offended by fluid, maxi-pads and underwear talk. ;)

So, it is Christmas Eve and I have an appointment. Weird, but I was looking forward to this one because I still have my last ab drain in (5 weeks post-op) and I was really hoping that the draining would slow down and I could have it removed. My doc told me the week before that we could probably remove it if the draining slowed down. He also prescribed me an anti-biotic, in case there was an infection that was causing the fluid. Unfortunately, nothing changed during the week.

When I got into the room, I chatted with the nurse and we discussed the drainage. I asked her if it was normal to still be draining so much fluid. She said that it was not "normal", but it did happen to some people. I asked "Why ?" and she really had no explanation. Yeah, me. Once again, I am abnormal. :)

When the doctor came in, he looked over my drainage chart and asked a few questions and told me that we would "back the drain out" weekly. I didn't get it at first, but he numbed the lower area with a series of shots, then he cut the bulb and tube off. All that is left is the plastic tube that has taken residency in my body (Penrose Drain - The long white tube with the holes in it pictured below).

Each week, I will return and the doctor will remove another section of tubing, hopefully buying some time for the fluid to get out. The nurse put a pad on the area to collect the fluid and told me the best way to deal with it is to buy maxi-pads and tape them on or attach them to my underwear. Sounded easy enough.

When I got home, I put a new pad in my underwear and hoped for the best. We were having company over, so I really didn't want to leak everywhere. Thank goodness, I was good for a few hours, then I went to change the pad and it was 100% soaked. Gross.

This drain is continuous. Even when I sit down to go to the bathroom, I have to put gauze or toilet paper near it to catch the flow. The maxi-pad shifts and doesn't always catch the fluid, leading to soggy pants. Sleeping is interesting. I want to lay on my back because I am still having some breast pain, but I am afraid that the pad won't catch everything that comes out at night. I tried to wrap an Ace bandage around myself, to keep it in place, but it is in such an odd spot, it is hard to keep it from moving.

In the big scheme of things, this is no big deal. Things could be much worse. It is just another uncomfortable part of recovery that I get to experience. On the positive side, I can wear pants again and not have to worry about the tube hanging out or getting caught on something.

I am worried about the area getting infected or something getting into the tube and back into my body, but the doc said that there was nothing different that I should do to clean it, so I guess I will just keep a close eye on things and hope for the best !