Friday, August 25, 2023

Patient review: stacked PAP flap breast reconstruction post mastectomy

 Warning, if you don't like medical language or if breast cancer is triggering, this isn't the post for you!

But if you are recently diagnosed with breast cancer, or are a breast cancer survivor, and are considering an autologous tissue reconstruction I.E. using your own body tissues instead of an implant, and you want to know what this version is like, read on. 

I know there's maybe other BJJ ladies-- or heck, just ladies of any flavor, but particularly athletic ladies-- out there who may need to research this someday. I used to write about training and competing, but I don't feel I have very useful comments on all that. Maybe never did but certainly don't anymore. This might be a place and topic I can help people understand better, so here goes. 

By the way this is intensely personal for me, so while I welcome any questions, I really don't want to hear anything judgey or nasty. Thanks. 

So, I met with my surgeons starting about 9 months ago to discuss my options.

BACKSTORY: I had a mastectomy in 2016 and had (serially) 2 implants installed. First one had healed, but developed a horrible strep B infection and after being hospitalized without any IV antibiotics working, they took it back out, let me heal, and I got a second implant. That implant was recalled by the FDA for causing lymphoma. I don't have lymphoma, to my knowledge, but did have some horrific scarring and the implant was constricted in the scar tissue pocket, and basically glued to my pectoral. I could do crazy pet tricks by tensing up the muscle, but I couldn't do pushups or lift kettlebells and it SUCKED. Haven't trained BJJ regularly since mid 2018, either, so I'm just fat. 

Anyway, a year or so ago I decided it was time to pull the implant and fix things and I started interviewing plastics people (my original plastics guy was awesome but he only does emergent reconstructions for cancer patients and doesn't have time to eat even so... Def doesn't have time for later reconstructions. 

I ended up being extremely happy with the surgeon I picked and he brought in his med school professor/mentor who trained under the doctor who invented this procedure. If my surgeon did the procedure alone, it would take some 16 hours which is no good for doc or patient. 

Thus, teaming up took only 8ish hours and while that didn't sound bad to me, now that I've done it, I realize there's an enormous difference between waking up from 4-5 hours and from 8-8.5 hours, even if you do the superior anesthetic protocol recommended by MD Anderson's people... ****That's a topic for another post, but until I write it, suffice to say never, ever do gas inhalational general anesthesia, for any fucking reason. Do TIVA (total intravenous anesthesia.) Email me with questions and eventually I'll edit to add a link to the post I haven't written yet.****

Anyway... I felt like I understood our discussions well, so uncharacteristically for me, I did no research into the specific procedure I was going to have!! I'd done so much reading on breast cancer, mastectomies, chemo, radiation, anesthesia etc years ago that I kind of took this lightly. Well, I wish I hadn't, if only to really understand what was coming. 

If anyone wants to read what breastcancer.org says about the PAP flap reconstruction, you can read here:

 https://www.breastcancer.org/treatment/surgery/breast-reconstruction/types/autologous-flap/pap

But-- I can tell you what's not quite accurate or what didn't come true for me. I had the PAP flap version, meaning they used the fat from my inner thighs and the "PAP" arteries to do the transplants. Well and good. I didn't have any fat on my stomach or back to do another kind of transplant. But apparently I didn't have enough fat in the place where the arteries go, so instead of one moderate 6-8"cut in a straight line where a bathing suit might cover the scar...noooooo, they basically made TWO 14-16" long cuts, one on each leg. 

And on mine, to get the fat plus the arteries, the cuts are L-shaped. One 8" long, following the line where your panties elastic for the leg hole goes around your inner thigh, on each side, and then a right angle, and another 8" incision straight down the back of my hamstrings. So where this article says oh yeah, scars will be hidden... That's a fat lie. Yours truly is feeling 100% pure Frankenstein here 😎

All in all I feel good, except the incisions both around the breast and on both legs are super itchy (they say that's good, a sign of healing) and they're also so tight I can't basically walk, sit, bend over, get up from sitting down, put on shoes, wash my feet etc. So, I walk like I have a stick up my butt, spend most of my time reclining in bed or on the couch, only walking as much as the surgeon told me it's okay.... wearing loose pajamas, with occasionally dirty feet, order in food, and just can't wait to go for my first check up on September 11.

Did I mention the surgical drains? How could one forget those little leashes connecting me to the pouches of love? ALL LIES. I hope to have the 3 surgical drains removed ASAP... They are literally sewn into the skin near the incisions and def not comfortable. 

I don't mean to complain too much, I am unbelievably blessed to have survived cancer so far plus getting the equivalent of 4 quality boob jobs (2 in 2016, this surgery, and coming in November one more "alignment job") plus the equivalent of two thigh lifts and one tummy liposuction in 2017 (to smooth out the original mastectomy contours) and oh yes--thank goodness for health insurance.

And thank God for the Democrats who made sure to include a requirement in federal law saying women with breast cancer are ENTITLED to reconstruction of their breast(s) and insurance HAS TO cover it. 

And thank goodness for wonderful loving women in my family, I don't really discuss in this level of detail with many friends. I'm only blabbing here because I would've liked to know this before I had the surgery. 

I should be healed enough to have the current restriction (I'm not allowed to drive or ride in a car) lifted in about 4-8 weeks. Planning the "alignment" surgery for November so I can take advantage of having paid the whole deductible this year. And then hopefully my surgeon will clear me to train BJJ again.... And hopefully I can get back on the mats next summer.

I'll write a post about anesthesia and my research on that topic soon. 


PS-- the blog post is titled "stacked" flaps because the "flap" (not the skin, just the fat and blood vessels) for the top of the breast comes from one leg, and is stacked on top of the flap from the other leg, which comprises the bottom half of the breast.  And I will note with pleasure that my doc listened to me!!! I said, you take out all the fat you can find without making me look gross when I heal.... but don't you put it all back into me. I wanted smaller breasts as the end result. A cups are fine by me. So he did... And in November the other, OEM breast will be reduced and aligned so they look as symmetrical as possible.

If only there was a way to do liposuction on my fat derriere without the end result looking lumpy bumpy. I want the equivalent of A cup butt cheeks, but there's only one way to do that and it's called work your ass off.

Oh one more question I have heard a lot... That is, why not just do liposuction on your inner thighs or whatever and squirt the fat into the pouch created by the removal of the implant? And you know, when I had the implant put in, at the end they did lipo on my tummy and squirted the fat back into my breast to smooth things out. 

But the problem is, liposuction is really hard on the fat cells that get sucked out. It bursts a lot of them, so they die, and the ones that didn't pop still need a blood supply to live. Only when you have a mastectomy, the surgeon is trying to get you clean margins ie no cancer cells on any perimeter. So that means (at least in my case with a clean margin of only 0.48mm) that virtually all the blood vessels in your original breast tissue are gone. 

The medical profession used to try to do autologous fat transplants for breast reconstruction by liposuction and they ended up with lots of "oil cysts." That means pockets of dead and rotting fat cells instead of a boob. So this procedure, transplanting pieces of fat with all the nerves and blood vessels and stuff, and connecting those up as best they can, produces (I'm told) a real live breast made of fat that lives. And crazier still.... those reconnected nerves? They're working. I can FEEL where I couldn't feel anything for the last 8 years.

Ok, that's enough for now. Thanks and good luck. 

Wednesday, August 23, 2023

Quite the layoff....

 Geez, it's been over a year since I thought I was coming back.

Well, I've had to have surgery, and I have another surgery coming. So I kind of allowed the laziness to continue being in charge. I hope I'll be done with surgeries and done with healing by next spring, and I hope I'm allowed to come back to BJJ without risking my health. I should say, I hope coming back to BJJ won't risk my health, because that's the only reason I wouldn't come back.

Until then, I'm still here, lurking in free live streams (like the Celestino 'guard retention' Livestream hosted free from digitsu this Friday afternoon (noon central time...)

Wishing you the best.... 

Wednesday, July 27, 2022

Blue belts quit. Purples take layoffs.

Hey everyone!  Can you believe it?   It's been roughly four years since I last trained. And... I'm back!



 This is me right after my first gi class, yesterday at lunch. 

I kind of figured I might start blogging again, too. . . I finally have something to talk about. I felt like I was saying the same stuff over and over again, before...

So, now, I think (maybe) I'll be talking about sustainable jiu jitsu for the older, more-sore, physically banged up group. I'm turning 50 in August. I've survived breast cancer and a mastectomy and all the plastic surgeries associated with that... then a while after I last trained in Dallas, I rolled over in bed and herniated a disc at L5-S1, and I survived a very successful microdiscectomy surgery that made me pain-free.

But then the pandemic happened and I've gained 30 lbs due to me being a lazy butt. I'm happy with my work and happy with the house I bought, happy with my dog... but not happy with the weight or the lack of something I'm passionate about. So let's talk about all those things, and a funny saying I heard at the gym today...

Blue belts quit.  Purple belts just take layoffs. 

Let's talk about layoffs and coming back and getting older.

Happy to be back and happy you're here!


..edited to add...  I looked around at my blog list and WOW, lots of BJJ bloggers not bloggin' no more. 

I'll tell you one of my FAVORITE jiu jitsu guys that I lost track of YEARS ago... Dev! Devlin! of "Fueled by Fear" fame (yes, some of my oldest gis still have his patch on them.)  He moved to somewhere in South America with his wife, working for the US Govt... and we lost touch.

His blog was Fueled by Fear, devbjj.blogspot.com. I wish I knew where he was. If anyone knows feel free to comment please!

Sunday, September 12, 2021

Coral belt and convicted pedophile Joao Marcos Pierini opens BJJ school in Malaga, Spain

 https://www.bjjee.com/articles/convicted-pedophile-bjj-coral-belt-under-reylson-gracie-opens-bjj-academy-in-malaga-spain/

I just heard from a member of the BJJ community there and we spoke briefly about some steps she could take... Safely.... to hopefully get this the kind of press and public pressure that motivates solutions. I will keep you posted!

Sunday, March 19, 2017

Did Rigan Machado knowingly promote a sexual predator to black belt? if not, who did?

You may recall my post almost four years ago about Austin Texas jiu jitsu instructor Paul Saucido, convicted of two counts of indecent exposure and one of unlawful restraint, stemming from twice sexually penetrating a nonconsenting woman in 2009... at the time of my first post, he was a brown belt under Rigan Machado and was trying to teach women's self defense seminars at his new school in East Austin.

I also posted about it on MMAUnderground.

http://www.kxan.com/dpp/news/metv_producer_faces_sex_assault_charges was the original link.  It's so old, it's down, but still preserved on the Wayback Machine here:
https://web.archive.org/web/20111101073146/http://www.kxan.com/dpp/news/metv_producer_faces_sex_assault_charges

http://austinvida.com/city-culture/2011/saucid-probation-sex-offender/
Wayback version: https://web.archive.org/web/20160917124303/http://www.austinvida.com/city-culture/2011/saucid-probation-sex-offender/

And the Texas state website: https://records.txdps.state.tx.us/SexOffender/PublicSite/Application/Search/Individual.aspx?IND_IDN=12321661

In my original  post I was happy to share that his instructor and former employer Rigan Machado was disavowing any connection with Paul, not teaching seminars for him and generally distancing himself from this inserter-of-a-penis-into-a-woman's-sex-organ-without-her-effective-consent (for those apologists who objected to me calling him a rapist since the 2009 offenses he plead guilty to in 2011 were unlawful restraint and indecent exposure.)

But until this afternoon, Paul bragged that Rigan promoted him to black belt.  Here's a screen grab from the morning of March 20, 2017. Second sentence.





Wait... this was Rigan's stance at the time:



This was Carlos' position:




Fortunately both Carlos and Rigan reacted promptly to my original version of this blog post. Whatever they did, by this afternoon, Paul's website was changed:

http://www.zenfitaustin.com/instructors/bio/id/169


My understanding is that Carlos Machado has no affiliation with either Paul or Rigan, according to Lindsay Machado, Carlos' wife, and a written signed statement by Carlos.














Rigan also prepared a statement:





 It seems, and I hope, that Paul was lying for the obvious credibility boost of being a Rigan Machado blackbelt.



Here's what I do know.  He's teaching girls and their moms. Does mom know you're a registered sex offender? August 2013.


October 2013.


February 2014.

 
July 2014.


November 2014 with Rigan. No relationship, no ties.



And here in January 2015, he has his black belt. 
 

September 2016 he's promoting students to brown.


October 2016 he was promoting a Rigan seminar (that link no longer works so I cannot confirm if it was a seminar Paul hosted or just promoted.)


January 2017 he's presenting at least two instructors at his academy as Rigan blackbelts.  Maybe visitors? (Screen grab from 3/20/17.)
 


Why do I care? I have no financial stake in this-- I'm not an instructor, don't own an academy. Don't even train any more while I recover from some surgeries.  I have no personal animus towards Paul (despite the rumor that we had a relationship, it was never more than casual acquaintanceship, and I think he came and trained at the Relson school in Austin with us once or twice.) Well, other than my disgust that he forced himself on a woman passed out drunk at his own birthday party. He refused to give her her panties back because "she wouldn't want a reminder of that night." I'll bet.

I care about women (and men) who have survived an assault and come to jiu jitsu seeking safety, empowerment, healing and prevention. I care about people who seek to prevent being assaulted. And I think they should know who their instructor is. If Rigan didn't promote Paul then who did? and why? why afford such a position of respect and power to a predator?

Let Paul make his living wherever, however... but I want his students to be aware. To have the privilege of knowing consent that his survivor that night in 2009 didn't.



Tuesday, August 16, 2016

Griddled oatcakes

From Epicurious:



INGREDIENTS

3 1/2 cups (or more) water
1 3/4 cups steel-cut oats
1/2 teaspoon salt
1/4 cup whipping cream
2 tablespoons pure maple syrup plus additional for serving
1 tablespoon (packed) dark brown sugar
1 tablespoon vanilla extract
Melted butter (for brushing)
2 pints strawberries, hulled, sliced

PREPARATION

Butter 13x9x2-inch metal baking pan or rimmed baking sheet. Bring 3 1/2 cups water to boil in heavy medium saucepan. Add oats and salt. Bring to boil; reduce heat to medium-low, cover, and simmer until oatmeal is tender but still firm to bite, stirring often and adding more water by 1/4 cupfuls if too thick, about 30 minutes.

Add cream, 2 tablespoons maple syrup, sugar, and vanilla; stir until mixture thickens, about 3 minutes. 

Spread oatmeal in prepared pan. Cover with plastic wrap and chill until firm, at least 4 hours. 

DO AHEAD: Can be made 1 day ahead. Keep chilled.

Cut chilled oatmeal into squares or triangles. Heat griddle or heavy nonstick skillet over medium heat. Brush griddle with melted butter. 

Cook oatcakes until golden brown and heated through, about 3 to 4 minutes per side. Divide oatcakes among plates, drizzle with maple syrup, spoon strawberries over, and serve.

Monday, August 01, 2016

Instructional review: Flow Jitsu by Mike Bidwell

I was really tickled to get an advance peek at an instructional by Mike Bidwell called Flow Jitsu. I'm enjoying BJJ in my forties but I am really working on being less rigid and smashy, more fluid and crafty what with all these young twenty-something monsters on the mat. This sounded just up my alley.

The video is available in digital download format only at Jiu Jitsu Brotherhood Gear for $49.95 and is about an hour long.



Who is Mike Bidwell?  He is a blackbelt under Phil Migliarese and Ken Kronenberg, founder of blog BJJ After Forty, creator of Flow Jitsu, and he persevered through a very long brown belt phase from 2001 to 2014.  So, I think he knows how BJJ can become a grind. In his introduction with Nic Gregoriades, Roger Gracie blackbelt, Mike emphasized that he believes in the ideas of flow, movement, adaptability, and the importance of acknowledging and working with any limitations on your physicality by seeking easily-replicatable techniques for all skill levels. Does he deliver? Let's see!



First, let's talk about technique content: As the name suggests, all his techniques connect one to the next to create a flow. Here's the first few "modules" as he terms them--

  1. Outside Kimura Sweep from Closed Guard
  2. Inside Kimura Sweep
  3. Kimura Sweep Counters
  4. Chaining Sweeps and Setups
  5. Americana Setups from Mount
  6. Americana to Peek a boo [I didn't know this term]
  7. Seatbelt Counters [chockablock with submissions!]

... and the list goes on. A consistent theme is his desire to avoid meeting resistance with resistance, strength with strength... instead, he teaches an approach of setting up chains of stimuli that take advantage of their natural defense instincts and go with their momentum to get what you really want. If that doesn't work, well hell, go with that too because all paths lead to a submission.  That's a lot of fun to think about and plan for.

Here's an example from Module 3, Kimura sweep counters:



Mike is careful to regularly show adjustments to use these techniques in a nogi context, demonstrating alternatives to gi grips and alternative submissions. In addition, he shows you alternatives you can use if you are stiff or sore, or lacking flexibility in some element of the movement.

As far as non-BJJ-technique issues: what a nice instructional, overall.  The download comes as an MP4 on a player with intuitive controls and handy buttons for rewind 10 seconds or fast forward 30 seconds. However, I found the lack of a menu with chapter headings (or "module" bookmarks) a little weird.

The lighting and audio are excellent.  Most techniques are demonstrated from a side-on view, with the camera adjusting almost seamlessly to capture a closeup where needed.  Sometimes, you get a nearly bird's-eye view. The background/mats are blue, and while he wears a white gi, his partner wears black, so everything is very clean and easy to see. It's nitpicky to say I found his phrase at the start of every module-- "All right, ninjas!"-- to be a little annoying. It really doesn't get in the way of his instruction since he only says it once each chapter.

I distinctly found this instructional to be more upper-level. There are excellent basic techniques taught in every chapter-- kimuras, back mount, americana, omoplata etc.-- but he gives fewer details and moves right along with a quicker pace to his speech and the amount of repetition. It is refreshing to have basically a "dense" and efficient dose of technique. You could watch this on your phone and feel like just a few minutes were fully packed with things to play with. There are few to no drilling sequences and while he reviews techniques as he goes, it never gets excessive.

One thing I liked about his relatively minimal level of detail compared to some instructionals is that I'm getting set in my ways, and I find that when someone teaches a detail which directly contradicts something that works really well for me, I mentally debate it. I challenge it or counter it in my mind and get distracted. This did not happen often in the video, which was refreshing. I found it to be like the end of open mat, where some brown or blackbelt is showing someone else something, and while it goes by quickly, it contains all the information you need to plug it in to your already-working technique library and expand it in new ways.  It does tend to assume you are familiar with the language and positions so if you are a rank newbie this may go a little bit quickly for some.

Another thing I liked was the constant stream of sub attempts. It's a facet I would like to include more in my style-- attack attack attack. However, I did think that some of his techniques assume some equality of size and strength between partners. He did such a great job talking about compensating for other limitations of physicality, I wished he could have included some adjustments us smaller-folk could make to tweak the techniques. If I had my druthers, he would have stepped back and had a smaller person demo against a larger one to illustrate such possibilities, a la Emily Kwok and Stephen Kesting.

Mike did a great job on this instructional. It's a very solid efficient hour, worth your time and money.










Sunday, July 31, 2016

Texas jiu jitsu instructor convicted of sexual assault of student

Former owner of BQuick Brazilian Jiu-Jitsu in Stephenville, Texas has been found guilty on July 27, 2016 of sexually assaulting a student who was 14 years old at the time. The jury had reached the verdict in less than an hour in Erath County.



Samuel Lewis was promptly escorted out of the courtroom following a guilty verdict. He was arrested back in January 2014 and charged with sexual assault of a child, a second degree felony.
According to a local news report  the victim testified saying she began training under Lewis in the summer of 2013. She also said Lewis claimed to be unhappy in his marriage. The victim testified that Lewis knew she was a high school freshman at the time. The teenager felt bad for him saying: “I felt bad and was sympathetic towards him.” She said the two communicated through text messages and Facebook, and that the relationship turned sexual on Christmas Eve 2013 when they had sex in the bathroom inside the gym.

Soon after, the victim’s mother learned about it after finding an incriminating facebook exchange- which was followed up with a police report. Lewis’ ex wife also testified against him saying she became suspicious of the relationship between Lewis and the victim. Soon after she went to the victim’s mother with her concerns.

Lewis attempted to commit suicide shortly after arrest and while he was in recovery the wife asked him about the incident: “I wanted to know why. Was it because she was pretty? Was it because she was young? Was it because she did Jiu Jitsu? Because I thought I was a pretty good wife,” she said. “He said it was because of Jiu Jitsu and that was the only time he mentioned it at all.”

Edit to add: scary comments on Reddit about this. https://www.reddit.com/r/bjj/comments/4vlsvl/bjj_instructor_samuel_lewis_from_texas_convicted/

Monday, June 27, 2016

Spartan Fit book coming out soon! Plus discount on Spartan races!

Joe DeSena’s new book "Spartan Fit!" comes out this summer. I have lots of jiu jitsu friends and sambo friends who do tough mudder and Spartan-type races. This book is a great training and motivational tool.

All of the info including the first chapter download (Free!) is here:

http://spartanracemedia.com

If you like what you read, you can (and should) pre-order it HERE:  http://bit.ly/spartanfit_preorder

I have SO much respect for people who run these Spartan races. They are tough! One of my good friends, a Caio Terra blackbelt near Dallas, runs these suckers and he's pretty addicted. Talk about functional fitness.

You can hunt for a Spartan race in your area by going here.

And if you use the code SPARTANBLOGGER you will get 10% off your entry fee.


Tuesday, May 17, 2016

Enormous jiu jitsu class makes it into the Guinness Book! And personal update...

I found an article about the top ten coolest martial arts records in the Guinness book, and one of them dealt with jiu jitsu-- the largest BJJ class ever.  Thought you might be interested!

I haven't trained hardly at all in the last 3 months. I swear I'm going back but it's been so hard with my work schedule. I am going to ask for an extended lunch so I can go to the noon class.  I get off at four p.m. and evening class starts at seven, so it's just hard to motivate myself to stay at work late, and my house is the opposite direction from the academy (with work in the middle.) So I know I'm making excuses, but... there it is.

Edited to add:

Thanks y'all for your words of encouragement and support!

I was approved for a 2 hour lunch, hooray!

Yeah, given that I prefer coming in to work at the obscenely early hour of 530-6am, there was no possibility of doing the morning class. And going to the academy to roll or drill for an hour or two before class at night wasn't good either, because, well, I was dating someone and did that for months with him, and then we broke up, and it was/is brutally painful... so, he ended up quitting BJJ, and it just absolutely sucked going to the academy without him. That's a big part of why I wasn't training the last while. I do not like having put on ten pounds, so I just need to buck up and go back. I think going back to a different class with different people will help change things up a bit.

Also, I have a set of kettlebells at home, and I've been doing bodyweight exercises-- pushups burpees and deep squats-- to slow down the slide into fatty. I miss seeing good definition in my arms and back!