327- DFSP 8 - PostOp recovery

So, a few days ago, I had my DFSP (Dermatofibrosarcoma protuberans) surgery, where my tumour was removed and sent to the lab as a third biopsy, to make sure all cells have been taken out and that there is no need for further operations.

The good news is that this should be the case, with 90% chance that everything was indeed removed. The 10 remaining % do call for caution and vigilance, for which I'll have regular dermatology appointments as well as at-home checkups of the skin and my other moles for any signs of changes that may point to another alarm.


90% chance, though, is a rather highly encouraging possibility that from now on, I can concentrate on my post-op recovery, in stages, each with its own set of guidelines laid by the surgeon.

All stages, and for an entire year :

If the operated area is insensitive (as in : lacking sensation) I have to avoid sun exposure ; avoid wearing black cloths when I go out in the sun ; wearing high-UV clothes and sun protection. This shall be one of the toughest parts of my recovery, as I haven't hiked in over 2 years, and shall have to re-think and protect myself better than ever. It's a good thing that I had started to buy UV clothes (I think I have 2 thus far, as they tend to be expensive). 

Stage 1 : surgery to stitch removal

Since the 26/01 (the day after surgery), and subsequent 2 weeks, I have a nurse coming every other day to change my bandage. The operation bandage was huge, 14x10cm, but the ones prescribed for use now are 10x6. The first nurse was very nice and both she and my wife said the stitch-work was done really well. I say first, because there may be different ones, as I called an office with a team of over 10 nurses, and since I need this change done every 2 days, and some will be on weekends, I may not get the same persons each time.

The nurses have to clean the skin and apply a soothing, repairing solution, before putting the next bandage.

After the 2 weeks elapse, my surgeon shall remove my stitches (apparently there are about 15!).

During this stage, I am being extra cautious in my movements, so I don't bump my leg into anything and cause complications. 
I also keep it elevated for most of the time, on the sofa's recliner, with varied activities (reading or playing PS3 games, listening to music or watching shows/movies). I am less online, because my computer desk doesn't let me raise my leg properly. I can, however, phone or skype with friends even on the sofa, by borrowing my wife's laptop if necessary.

I am also not doing much in our apartment, leaving the dishes, cleaning and other tasks to my wife, as I'm not allowed to big efforts at the moment. 

For the time being, the doctor suggested that I cover my lower leg (shin & calf) during showers, thus protecting and maximizing my bandage from water contact. 

Stage 2 onward to week 14:

2 weeks after stitch removal (starting around Feb 23rd, at the start of week 5), and for 3 months, there can be a daily 5 minute long energetic massage of the scar area, without cream.

Baths are allowed 2 weeks after the crust disappeared and after the scar fully closed (currently unknown time-frame).

Bathing in pools or the sea are allowed 2 additional weeks to the previous statement. However, as I never bathe, these 2 rules don't apply, unless I had to start bathing.

All sport practices are forbidden for 3-6 weeks after surgery - the doctor went rather deep and this was a tumour, so I must be mindful of any efforts, not only sport, but also grocery shopping, that I'll have to let others do for a while (my wife, my mother, and some friends can relay one another in the tasks).

What to expect of my skin during recovery:

There are a number of indications that are normal post-op changes, but some that should alert me to contact the medical team for immediate checkups.

First, I'll discuss the normal changes:

• A discreet redness and some itching are normal between the 2nd and 9th post-op months
• Moderate pain and soreness (the latter already started, the former not yet)
• A light bleeding (I already spotted tiny blood specks through the bandages) 
• When my nerve endings shall start re-building and re-connecting, I know that I'll have some unpleasant and probably rather high pain levels, expressed mostly as electrical jolts of varying intensity and frequency, which, based on a previous surgery (2&half years ago, in the sole of my left foot) where this happened, shall reduce after several months, even a year. I'll discuss this more with my surgeon when he removes my stitches, as I forgot to ask specifics for this case

Second, I'll discuss now alarming aspects that should make me consult the doctor in an emergency:

• an significant pain
• persistent bleeding 
• swelling of the scar or around it 
• very pronounced inflammation, shows as redness and pain which can be accompanied by flow of (??) 
• dark purple aspect of the skin 
• pain in the calf, and/or  important breathlessness
• Some scars can become redder, painful and embossed ; this is a hypertrophic  wound healing, or even keloid, which aren't normal and I'd need a specific medical intervention.

As I didn't know these words, I'll send to wiki and explain the important relevant aspects for each. Beware, there are a few photos that I didn't look, and so my text is a summary and if you want to read but are fragile or sensitive like me, you should temporarily block all images before clicking. 

Hypertrophic healing, as in Hypertrophy is the increase of volume of the tissue ;

Keloid, or keloid disorder, or Keloidal scar are all terms to describe a type of scar where tissue is replaced by collagen. Although benign, this can develop into itchiness, pain and changes to the skin, and I assume this is why the post-op guideline paper the surgeon gave me indicate these issues. 

Post-op mental health recovery and specific needs:

The whole biopsies, stitch removals and subsequent diagnoses were tough experiences. The toughest aspects were mental, on several levels, which I can sum up with the terms depression, anxiety and phobias - most notably emeto and hemophobias.

Post-op, in view of the many physical restrictions of movements, especially the first 2 weeks in which I currently am, can yield at least the same struggles as above, which I'll now explain: 

Anxiety, as to possible pain ; as to those 10% recurrence risks ; as to bandage changes and stitch removal. 

> to reduce these anxiety causes, I have to remember than pain is temporary and use pain-killers when needed ; to remember that there are 90%, or 9 times as many chances that there won't be any need for further operations ; for bandage changes, I've been taking my anti-anxiety medication about an hour and a half before the nurse is supposed to arrive, and thus far have handled it well. As for stitch removal, I'll take that as well as pain killer, and remember that though an unpleasant moment, I've had some before and that it doesn't always go as tough as back in October. 

Avoiding emeto triggers for these instances: I eat a long time before/after the nurse comes to change my bandage, or stitch removal at the doctor's office. 

Both emeto and hemo (blood phobia) avoidance : I don't look at any of the procedures. I close my eyes and breathe. 

Depression : due to the diagnosis was a tough one already, but dealing with post-op isolation, being cooped at home, can be even tougher, especially as I passed the first 3 weeks of January with a bad cold, speaking only with my wife, 3 times with my mom and once with my aunt, 2-3 with friends online and the rest were medical appointments and phone calls.

This depression is the one that I made an effort and asked my friends' support and presence, to help me pass the tough and isolating aspect of post-op. I'll discuss the importance of asking for support and receiving it in a special post on February 1st, which is Time to Talk day 2018.

Depression relief shall include as ever : 

Self-care, varied activities at home (reading, playing games, listening to music, chatting with friends, inviting some to come offer company and distraction or support, and many others to help alleviate feelings of isolation, and later on, I'll be able to go back outside, while respecting all the guide lines discussed above.