Saturday, November 3, 2012

A Port In Every Storm

"Looks like you are healing well from the biopsy. That's good." Dr. Spotts took my hand to help me sit up after the exam. Before I'm fully upright, she added, "You have cancer."

July 27, 2010. She dropped the bomb just like that.

The room started to spin. I held my breath. My husband's face slowly came into focus. My first thought was not about myself but about how sad for him that his wife had cancer. Before my first tear fell, the nurse put a tissue into my hand. Sharon was good at her job.

"You need chemotherapy. I'm sending you to an oncologist. She will devise a treatment plan," Dr. Spotts said this quickly. No breaks in her speech to ask a question or give a voice to my state of shock.

At the time, I'll admit, I thought she exhibited less than ideal bedside manner. It didn't take long to realize that she, too, was good at her job. Dr. Spotts knew I was headed for a meltdown and when that happened I wouldn't be able to digest anything she needed me to know. Todd, my husband, would be in the same shape. Get out the important parts. Deal with the tears. Keep moving forward. I had family and friends to help with my emotional state. She was in charge of keeping me alive. I admire her handling me this way.

The prospect of chemotherapy scared me most of all. I'd seen many movies about people with cancer. I knew how sick it would make me and how I'd wish that I wanted to die before it was over. Consenting to chemotherapy felt like giving a doctor permission to poison me, kill every good cell in my body, and turn me into a rag doll in the process.

Thank God there have been advances in treatment and the management of side effects related to chemotherapy. My experience was nothing like on the big screen in the same way that actual childbirth is nothing like it's depicted on film.

I completely turned myself over to my new oncologist. I trusted her and hung on every word she said. I followed every direction, except one. Dr. Allison explained that many, if not most, chemotherapy patients opt for a PICC line or port to be placed in their chest. That way the chemicals would be delivered without damage to my veins.

"But you have very good veins. You're young and otherwise healthy. I'll leave it up to you," she said.

"Let me try it without the port. Can I get one later if I change my mind?" I asked. It seemed so invasive to have a permanent catheter placed under the skin below my collarbone. And very scary to contemplate a cannula inside my right internal jugular vein for several months.

"Sure. It's your call." Dr. Allison typed instructions into her desktop computer and scheduled my return to begin Chemotherapy in a few weeks.

TAC Chemotherapy is one of the most caustic chemo cocktails on the market. It works, but in the process it burns up the small to medium-sized veins it passes through. After the nurse inserted an IV into my arm and flushed my vein with a little saline infusion it was time for the first drug. Adriamycin, sometimes called doxorubicin, is a bright red fluid injected very slowly into an IV by syringe.  It's administered this way because the nurse must control the speed by which the Adriamycin makes contact with my vein, monitor me for adverse reactions, and monitor the IV site to be sure the cannula is still in my vein and not leaking fluid (nicknamed The Red Devil) into my surrounding tissues.

I knew I might have made a bad decision when I turned down the PICC because immediately my right arm started to burn, not on fire burn, but bad enough to make me question my judgement. Three weeks later at my second treatment, it took the nurse three tries to find a viable vein for my IV. 

"Why don't you have a port?" she asked.

"I thought I'd try without it first," I answered, sheepishly.

"Ok. You've tried it. Now get one before I see you again."

Yes Ma'am, I thought (picture me saluting her).She was right. Having a PICC line or port inserted turned out not to be so bad after all. I was asleep during the procedure. The incision healed quickly. The port under my skin looked like a raised bubble on my chest but I didn't care. It was much preferable to further damaging the veins in my right arm.

So, don't be a hero. If your doctor offers you a PICC line or some other form of catheter port before chemotherapy my humble advice is DO IT. Save your veins. You'll need them for the rest of you life.

My arm a few days after a blood draw

Every time a nurse attempts to start an IV or a tech pokes me multiple times to draw blood, I am reminded about what a martyr I can be at times. From only two exposures to TAC therapy the best vein in my right side collapsed leaving behind a valley running up my arm. Imagine a dry river bed or a flattened plastic tube. That's my vein. And it, most likely, will never be any better. Don't let this be you.

The bruising got worse before it got better

In short, I stand firmly on the pro port side of the argument. If there is an argument to be had. Who knows? The only conflict might have been with myself.


  1. Just got this from an old friend. I thought it was important and asked his permission to share it.



    Hey. Enjoyed your blog entry on ports and PICCs. As one who puts them in and takes them out, I can also say that many patients also have them removed prematurely only to need another one a few months (or even weeks) later. Hang in there - you are a great inspiration to many.

    Thank you for sharing this. I worried that I might be getting it out too soon. It was about 4 months after I finished Chemo. The surgeon took it out when she performed my mastectomy. So far, I have not needed it and hope that I never do again. But if I do, I won't hesitate.


  2. Lisa, thanks so much for this post. It's timely for my family. It looks like my mom will need that amputation--right leg below the knee. She's trying to hold out until after Thanksgiving, so they gave her a PICC line to test her blood and give her antibiotics. It will help them know right away if they need to get her into surgery early. Also, Mike's veins have been taking a terrible beating with all the blood tests and the iv contrasts he's had to undergo. He's really worried about his upcoming surgery. The idea of getting a PICC, so that they don't have to keep stabbing for every drug and every test, is comforting. On the positive side--today (Sun 11/3) he's halfway through his chemo (Xeloda tablets) and he already passed the halfway point for radiation on Friday. He should be done with both right after Thanksgiving. Then it's 6 to 8 weeks to regain some strength before surgery in January. Take care and thanks again. Somehow, reading this post was like being an explorer heading to the Americas and getting the chance to read Christopher Columbus's travel journal. All the rip tides and perilous reefs mapped out ahead of time!

    1. Carrie Ann,

      I'm sorry to hear that your mother has to have the amputation. Please know that she is in my thoughts and prayers. Thanksgiving will be a bittersweet day for you. Chemo ending for Mike and upcoming surgery for your mother.

      I feel for your family. I'm glad that the post helped. The bruises where from a recent visit to the doctor so it was timely for me to talk about this subject too.

      Thank you for supporting this blogging effort. I really appreciate it. Best wishes to your family and to you!


  3. This comment is from Facebook about this post:

    Lisa, the first 2.5 months I spent in the local community hospital I just had IVs. They continually failed. My veins on my left arm are barely usable and iffy on the right. When I needed 24/7 IVs a PICC line was installed and we learned to care for it ourselves. It was a huge annoyance but WAY better than multiple attempts to set up IVs over and over. I sure was happy when the line was removed. Over a year ago, I learned I'd have to get chemo five days a month so I asked for a port. What a huge lifestyle improvement!!! I've still got it in some 15 months later. Never a problem with it (the PICC line did get clogged periodically) and I can completely forget about it, except when it is needed. Like you, I was creeped out by the whole concept, but it really is the best solution. Wish I'd have had one from the start of this journey. Blessing, my dear. So glad you're doing this blog. C.

    This was my response:

    Thanks for sharing Carolyn. Until I got sick I never even thought about the ins and outs of Chemo administration. I mean, why would I? It's a different world when you have a serious illness and are doing everything you can to recover. You know that too, don't you? Hugs to you,


Talk to me. I want to listen.