Updated: Jun 22, 2021
Together, Tammey and Griff look back and dissect the real cost of pain in recovering from lifesaving surgeries. With vulnerability, openness, and humor - they speak through more than four years of experience, chronicling the hazards and setbacks of drug side effects, depression, self-image, relationship impacts, and the teamwork that brought them through it all in the face of the unknown. Please listen in as they illuminate their whole picture of recovery from a life-altering illness and the subsequent life-altering treatments.
Topics in this Episode:
A guide through hardship
For you: I will fight!
The skills of suffering
Fear of the unknown vs. the power of Spiritual certainty
Afraid to hope?
The prize of privation
A vantage point of helplessness
Know thyself and thy partner!
A Thousand little things
Most wounds are hidden
Requirements for success
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Tammey Grable-Woodford: Hello, and welcome back to Your Killer Life. We are so excited to be talking to you today, and we are going to be talking about drugs, and no, this is not the DARE mobile. This is not the this is, this is not a throwback to the ’80s or even ’90s, but we are going to be talking about drugs when it comes to all of the fun stuff associated with all the surgeries.
And, uh, gosh, before I get too far into this, I’m your host, Tammey Grable-Woodford.
Griff Woodford: Griff Woodford
Tammey Grable-Woodford: Also, host, and this is going to be an interesting topic. Um... Goodness. There are a lot of different drugs that get tossed at you. And I have had, for those of you that may have missed a previous episode, with breast cancer I had my biopsies, which were huge and they just gave me Tylenol for... and we’ll talk about why maybe we’ll talk about why that was just not nearly enough for 1.4 centimeters of tissue removal out of my breast with that stereotactic biopsy. Not a good night.
Um, then I had, so that was February of 2015. In March of 2015, I had my bilateral mastectomies. In June of 2015, I had my expanders placed, and we’re not going to go into that today, but we will do some episodes on reconstruction and expanders, cause that is a big deal and a big, painful deal.
Griff Woodford: It is.
Tammey Grable-Woodford: Whew... And then in December, uh, no, September of 2015, I had my first, um, was that when I had the first implants or was that December of 2015? It’s been so many; I want to say December 2015.
Griff Woodford: Ooo, I think it was
Tammey Grable-Woodford: And then we had those redone in April 2016. And then September 2016, I had my nipples reconstructed, and then just in April of 2019 had my, uh, implants done again because I was having some complications and went from under the muscle to over the muscle. And we’ll do an entirely different episode on that because that was, that’s a big deal. And there’s a lot of, uh,
Griff Woodford: Yeah, it was life-changing...
Tammey Grable-Woodford: Yeah, and a lot of stuff to talk about there, especially as we talk about pain, because as we walk through this process, we will talk about pain, but today, we’re going to talk pain mitigation and the double-edged sword of drugs.
Griff Woodford: Exactly
Tammey Grable-Woodford: So you want to kick it off, or you want me to?
Cornucopia of pharmacopoeia
Griff Woodford: Uh, well, I, I would start by, um, uh, stating to the, uh, the viewers and listeners that, uh, In terms of any longterm disease diagnosis and the mitigation of those diseases, you will be prescribed a pharmacopeia of different medications. And the reality is, is that it is your responsibility as a patient, and of course the caregiver to do your best to keep detailed logs, so you talked about medical journals before, on what you’re being prescribed, um, doses you’re being prescribed and the uh, ideal outcome of that. So that, you know, should you have to change physicians or something, something occurs within your care that, you know, what works for you, given your, your individual self, and then also what works in, uh, different stages or different terms of that disease or in our case surgeries, as they’re not all created equally.
And, um, You know, it’s just some of the escapades that we had early on is, uh, you know, now, of course, I wasn’t there in, well, my current context, uh, for the original mastectomies. So that was something that you were doing more or less on your own, but, um, after that, once the expander started coming in, and then all of the subsequent surgeries I was, of course, part of that.
And just one example of that, of why keeping your own individual logs and being quite fastidious about it is because we, we knew early on the best possible combination of uh, pain... you know like narcotic pain relievers or benzodiazepine pain relievers, as well as, uh, high-test NSAIDs, so nonsteroidal, anti-inflammatory drugs.
Uh, so we had that really well dialed in with the minimal amount of side effects and really positive pain control. And then something as simple as a slight change in insurance provider. Well, OK. Now we can only get half of that equation. And the, as far as the, uh drug cocktail, if you will, trying to supplement that ended up being nearly a year of test fire and just, in some cases, crash and burn with something just as simple as, as a high strength NSAID, so being very conscious and cognizant and fastidious in your record, keeping, being able to not just say the dosage and the individual, or I should say, group of drugs, you’ll probably be prescribed, but also your personal effects of them.
So the potential of developing a low strength allergy or low-intensity allergy, even just due to a prolonged use of a specific drug, which that’s something that, uh, that we ended up having to deal with and, um, was very confusing for a while.
Tammey Grable-Woodford: Yeah, it was. So, goodness, so I think I want to back up a little bit. And just talk about sort of the the different, well, I want to talk about pain for starters, because if you’re listening to this and you’re a caregiver, it is, I think often misunderstood the amount of pain that comes with this process. And I think that two of the biggest misconceptions, and I’m going to say from the guy’s side, um, would be that you end up with Victoria’s Secret boobs at the end of this and that it’s like an augmentation. And if you do research on augmentation, no, it is nothing like augmentation. And not that that doesn’t have its own pain and, and whatever that comes with that. But this is nothing like that.
So one, that is not what that’s like.
And two, you know, I was not subtle when I said a few episodes ago, episode seven I think it was, that this is an amputation.
Griff Woodford: Yes
Sensations and confusion
Tammey Grable-Woodford: And with that comes a whole bunch of weirdness from ghost nipples, because your nerves are gone, and your body’s confused, to the pain of your nerves trying to regenerate, to just the pain of all the trauma that has happened.
And so I did say, and it’s true that like you’re numb to sensation. But... that’s the skin that’s that... and you actually described that really well. There was the, is it the, what’d you call the muscle sensation versus the, is it dumb, dumb nerves versus...
Griff Woodford: Oh, right. Um, external sensory nerves versus internal less sensory nerves. So smart nerves - dumb nerves.
Tammey Grable-Woodford: So those smart nerves, all severed and confused, don’t know what’s going on. The muscle nerves that, that provided like this weird burning tingling, like your foots asleep. And so, and then, of course, just random ghost pain. Of not having the breasts anymore and all of a sudden having, having that happen.
And so in all throughout this process, and like I said, we’ll talk about reconstruction later. There’s a whole bunch of stuff going on with your muscles, with your body, which, you know, you said in a previous episode, you know, you talked about how it’s a, even if it’s a sterile knife fight, it’s still a knife fight. Your body is...
Griff Woodford: Right
Tammey Grable-Woodford: Yeah. You know, you’ve been hit by a Mack truck. You’ve got some healing to do.
So there is a ton of pain that comes with it. So postoperatively and for me, because we’re so far away from Seattle, I always had an overnight, and not everybody has an overnight. And so as soon as I was out of recovery and into my room, then I had whatever was the, um, the, the postop drug of choice of my surgeon.
And. Initially, and I have an amazing surgeon, by the way. I, Oh my goodness.
Griff Woodford: Yes. She absolutely is.
Drugs and recovery
Tammey Grable-Woodford: Absolutely fantastic. But the first, so... to the... back to the drugs, the first part of that, the first few surgeries, when I came out, it was morphine. And morphine, I would have a morphine pump, and so every seven minutes or something, or eight minutes, I would hit the button, and then I would have relief, and we found that my body processed it so fast.
Griff Woodford: Yes. So with morphine, in particular, there is, well, I would say more rapidly metabolized than something like a Dilaudid or even a benzodiazepine based pain reliever. So the it’s very commonly prescribed or at least has been, but again, because of it’s long, I would say long-term ineffectiveness. Because it can be very effective in the in the short term, but having a long las... long-lasting, excuse me, um, intravenous, uh, narcotic, it’s really not great for, again, that, that long-term pain relief.
So, you know, with, with your example of that is effectively maxing out your, your, the the the timeout feature on your morphine pump and was still not effective. Then when we made that, I shouldn’t say we, when, uh, you know, the attending doctor realized that was a problem, changing that prescription to, um, actually the same milligram dose of Dilaudid. Uh, that was a big, a huge difference.
Tammey Grable-Woodford: Yeah, I just slept. Which was nice.
Griff Woodford: Right. Right. Which I mean, thinking about in terms of recovery, you know, the more that you can sleep and sleep peacefully, the faster the physiological recovery is going to going to occur.
Life defined by “side effects”
Tammey Grable-Woodford: Right. And I know with me, you know, the morphine there’s with all of these, to your point, knowing the side effects is really important because it’s not just the pain meds, they were also the NSAIDs, and there were also muscle relaxers. And so it was, you know, this is why we called it the, uh, the Elvis Presley repair kit, because it was just this, you know this bag off of whatever. And um... trying to find that combination that really worked. But I think one of them, the more important things I wanted to talk about today was the mental health when it comes to the side effects of all of this.
Griff Woodford: Yeah, absolutely. And I would say from, well, with certainty as a caregiver. So understanding that any patient that you are inconsistent, and severe at times, physical pain, you know, we as caregivers, we, we under, we certainly understand that factor. It’s something we can see, something we can dialogue, and something that we have um, at least a somewhat known path of how to, how to fix. You know, if you have a pain attack, OK, well, then you get another one of X and another one of X, and that should bring you back to a manageable level.
Now, the, what I personally had the most difficulty with and the observed experience of other caregivers who really didn’t know where to begin, in terms of that as the psychological side effects and the emotional side effects of long-term high tests, narcotics, benzodiazepines, um, cyclobenzaprine, there... it is, um, I don’t know if confusing is the right word, but really not going into with a full conceptual understanding of what, um, what can happen when on those long-term dosages and relatively high dosages?
Um, not surprisingly about every aside from the the NSAIDs, um, every muscle relaxer, every tranquilizer, every narcotic, every synthetic narcotic that was prescribed... one of the main side effects is depression.
On all of them, at one point, we had four different medications on board that we were dosing daily, that one of their main side effects was depression. So. Oddly that happened. And to a degree that frankly was frightening. And as a caregiver, I couldn’t figure out where it was coming from, you know.
And it was also, I don’t know if interesting... well... additionally confusing... because the trend was, at least in my mind, is that those significant and dark places of depression would usually come after some sort of incremental gain, whether it’s surgical or in the healing process, there would be in my mind as a caregiver, there’d be something to be kind of happy about, you know?
We’ve, we’ve passed a milestone, you know. We’ve, um, you know, are getting closer to a milestone. Where in reality, it was within a relatively small amount of time of those, those instances was this very dark and frightening depression that would just seemingly come out of nowhere.
You know, again, uh, I think, well, I know that for, in the beginning, neither of us were really understanding where it was coming from. And that was, that was frightening, you know, particularly just not knowing where to even begin.
So going deeper into research and trying to understand is, is this a chemical response? Is this a physiological response? And, and finding out that well, 80% of the medications that you’re currently on all have within the top three bulleted side effects of depression.
So the, um, again, it’s not just the physical side effects, the central nervous system depressant type thing that needs to be addressed and known, also the psychological and emotional effects.
And with that is knowing how to combat those side effects. What are some things that you can put in place, whether it’s through activity, through well, any process that’s going to help mitigate those, well, almost certain side effects.
Tammey Grable-Woodford: And I have been accused my whole life and being perpetually optimistic. Ben sunshine and Pollyanna.
Griff Woodford: Right.
Tammey Grable-Woodford: Yeah. So, so for me to be in these dark places was uncharted territory, and it was so dark.
Griff Woodford: Yes.
Tammey Grable-Woodford: And typically, you know, your pharmacist is your friend. And, but this is where it gets a little bit different because you come out of surgery, and you’re not the one talking to the pharmacist.
Usually, your caregiver or someone has gone and picked up the drugs for you.
Griff Woodford: Right.
Tammey Grable-Woodford: And so you’re home, and yes, you have the package insert to read. And I’m sure that I read them. And I’m sure that I don’t remember reading them...
Griff Woodford: Of which you have no recollection.
Tammey Grable-Woodford: Exactly. So let’s just be real there. So this is one of those things that I kind of learned as I went along, that I needed to do a little more research with. And for me personally, the muscle relaxer was probably the hardest on my system, mentally. And it’s not just mentally, I mean, when you’re looking at the side effects, almost all of these also the other side effect is constipation.
So you know what wel... wel...welcome to real talk about breast cancer because that is also so a challenge that is not a fun one. And you want to talk about being incredibly vulnerable in, in a vulnerable space and having to... you had said on a previous episode. There’s no more secrets after, after something like this.
Griff Woodford: Right
Tammey Grable-Woodford: How true that is...
Griff Woodford: Indeed
Do your homework and make sure the pharmacist does theirs
Tammey Grable-Woodford: But your pharmacist is your friend. I do want to say that it’s still... as amazing as my doctors have been, there still was not a lot of conversation around the side effects of the pharmaceuticals outside of the things that would be sort of urgent or emergent.
Griff Woodford: The immediate risks to health, you know physiological health. Again like a central nervous system depressant, rapid heartbeat, you know, um, temporary blindness... dying. What have you. Um, but I mean, in all seriousness, that is one thing that. Uh, I mean, in both cases, we’re were glossed over, you know, and that was my job for months of having direct and accurate conversations with a pharmacist at the window while you are in surgery, recovering.
Um, I need to know exactly what to look for. I need to know everything I need to know about it. And whereas it was... I won’t say glossed over, but the, uh, the impact was certainly understated with every pharmacist that I spoke to or any pharmacist aid that I spoke to. It wasn’t through actually living through it and trying really urgently to figure out what exactly was going wrong.
That, you know, you... well, I was just able to even find the information and then make those correlations.
Tammey Grable-Woodford: Yeah, it was, you know, a oh goodness. It’s just so interesting that whole process. I mean, we’ve joked about things that I have said to you. I have no recollection of... like, apparently, I have a preference for non-pink Barbies. That’s that is, that is something...
Griff Woodford: Yeah, you uh...
Tammey Grable-Woodford: I made that very clear.
Griff Woodford: Yep, completely asleep. Absolutely unconscious and a full conversation about how you will not stand for me to buy you the pink Barbie. You wanted the blue one.
Tammey Grable-Woodford: Is there a blue one? I don’t even know! (both laughing)
Griff Woodford: And you are asleep. You you are genuinely asleep. You’re unconscious. And we were having this conversation
Tammey Grable-Woodford: Full conversation? Lovely. Thank you for not recording any of that.
Griff Woodford: You are welcome.
Psychological and physical health
Tammey Grable-Woodford: Yes. So, but I think that you know, I really, I do want to get back to the depression, because this is a tough one. You know, it typically. Postoperatively. You’re really only on these things for a couple of weeks. It was during the expansion phase that I was on them for an extended period of time.
And during expansion, they place a, and I’ll go into deeper depths of this, another episode, but in a nutshell shell, they placed this very, very hard implant underneath your pectoral muscle. And every couple of weeks, they add saline to it, and they expand it. And as they do that, they’re stretching your pec muscle.
And as they stretch your pec muscle, that impacts your neck muscles, your shoulder muscles.
Griff Woodford: Everything.
Tammey Grable-Woodford: Oh, my gosh, there’s so much pain. And then I also had a lot of pain after I had fat transfers.
Griff Woodford: Yes. That was, aside from the actual mastectomies that was, uh, easily the most violent procedure that you went through.
Tammey Grable-Woodford: Oh yeah, definitely.
Griff Woodford: The amount of edema and retained fluid, just the swelling, um, that all settled around your pelvis.
Tammey Grable-Woodford: It just pooled...
Griff Woodford: And that’s where it stayed, was um, frankly shocking.
Tammey Grable-Woodford: Yeah.
Griff Woodford: Uh, that was one of the things physiologically. I was not prepared for. I’d never seen that before.
Tammey Grable-Woodford: Yeah. So we will definitely have some episodes on that. Cause those were some eye-opening moments, but typically it is just for a couple of weeks postoperatively that you have those pills. I don’t like taking them. So you were really more of an advocate. I’m like, just give me a, not Tylenol because Tylenol, Oh my goodness.
You know, just give me a, an Advil, give me an Aleve. Give me an Excedrin. Give me a... I don’t really want to take these things. But you were very much an advocate for it. And I mentioned on a previous episode that I would have so much pain that I was adapting to and just pushing through because I didn’t want to take these at work because I was still trying to work.
I was driving myself to work. Right? So all of this stuff, like you just kind of suffer through the pain as painful as it is. And. Those three months of expanders were absolutely the worst because I was on pain meds because it was so painful, and I was on muscle relaxers because my muscles were fighting the expansion, causing even more pain.
Griff Woodford: At all times.
Tammey Grable-Woodford: Right. And that double dose really threw me into the darkest of the darknesses. I think.
Griff Woodford: Yeah, certainly, I would attest to that, um, uh, to, to me, not just as a caregiver, but just as a partner, those were the most difficult times for me as far as actually questioning whether or not this is going to even work as it was so, not just the darkness, I understand darkness. I get that. But not being able to see any correlation to what was happening, like in, in, in my view of the world and what I’m experiencing with you having no idea where this is coming from and not having any clue of what to do.
You know, your... you’ve always been, at least since I’ve known you, always very optimistic and very logical and rational, and the side effects of that combination of drugs for that period of time completely took that away. Yeah, it was the exact opposite on not a daily basis, but with enough frequency to where, again, just not having any clue where this is going and not, and why it’s even happening.
Tammey Grable-Woodford: I think that it would actually be worse that it isn’t daily because then you’re just getting hit with it by surprise as a caregiver. And so you’re used to, you know, one and we are still getting to know each other also. So remember that.
Griff Woodford: There is that too. (both laughing)
Tammey Grable-Woodford: You know, as we go through this process, we had been friends. So we knew each other, you know, from, from that aspect.
And then, you know, kind of jumping into being a little bit more and being supportive and and figuring all of that stuff out and stepping into the caregiver role. But, to have someone that there’s no way I could have been a consistent me. I, you know, just all of, all of the mental trauma of loss and fear and frustration and the lack of confidence. I mean, just everything being annihilated is stepping out of my career, you know, just that whole loss of hope and all of the heaviness around that will take even the most optimistic person to a, an area of how many silver linings can I look for in this, this cloud of crap. Right?
And then add to that this... the drugs, and then add to that... you’re going through the reconstruction process, and, and you, you are not being reconstructed into anything that you looked like before, and especially at that point.
Griff Woodford: Right.
Tammey Grable-Woodford: So there’s depression around that. And so it just seemed like there was so much pain.
And then I would think from your side, just the, like you said, you know, with the expanders were placed, this should be a good thing. And then in my head, a) I’ve got, you know the the drugs that are playing and then I’ve also got the, but I still look like crap, and I don’t see how this is ever going to look like how I looked before.
Keeping the end-state in focus
Griff Woodford: Mmhmm. Yeah. And, you know, I, I certainly can understand the, um, the feeling of like disfigurement. And we talked about that specifically about that before it was the the term that you used, you know, I certainly in that moment understood that, um, And, and, you know, and, um, future context as well, which we had a lot of conversations about that.
And mainly like when we were in the middle of it is that honey, we’re not done. We’re not done. This is something that you and I have to be very patient. And as to this is not where it stops, but. Each additional step forward requires a lot of time in between. Right. You know, I know that we all want it to happen right now.
That would be certainly the most, most pleasant, but that’s not how this is going to work. You went through a catastrophically large surgery that has altered so many things. And I think that, well, I don’t think, we will be talking about the, um, the differences between subpectoral and extra pectoral implants, which uh... a little bit of a spoiler alert, I, as, as someone who has been in the medical profession before, I, I genuinely don’t understand how that is still a practice, how you can...
Tammey Grable-Woodford: There are, no there are, there are uses for it. Yeah, there are because you have to keep in mind like I didn’t have radiation damage. I didn’t have... my inframammary fold on one side was damaged from the mastectomies, and that was originally why because we didn’t know if my, my skin would hold and they...
Griff Woodford: Oh yeah, yeah, I remember...
Tammey Grable-Woodford: Yeah. So there’s a lot of, there are, there are times for it, but I will also say that back when I had mine done it also, wasn’t done very often.
And so. That was also a reason. So, but oh my goodness. That is, that’s going to be, that’s going to be an eye-opener for anybody on the caregiving side.
The full cost of pain
Griff Woodford: Yeah. That’s a very in-depth conversation and dialogue about, um, the, uh, unrepentant difficulties that that particular procedure presents. And of course, there’s many, many others that are associated with long-term disease. And it really in the same categories, they’re not done very often when they are done, they’re relatively special cases.
So the, um, the experience may be unique to this context, but there is a lot of applicability or application for the side effects and not just the physical, of course, the constant and consistent high level of physical pain, but also the subsequent um, issues and side effects that come up from just dealing with that pain.
Um, and also not just the, uh, the pharmacological aspect, but the psychological aspect of just being in pain all the time. No, there’s only so much medication you can take before you endanger yourself. And so having to stay in that ground at 24 hours a day to where nothing feels good, there is no complete relief for months at a time.
It’s it is just absolutely draining. And again, as a caretaker, who is... who has seen the ravages of long-term disease before, before you and I even met. And then, of course, being romantically involved with you as I am, I am with you. I am here. It’s, it’s, it’s a lot more personal than just a simple caretaker role.
And seeing that, seeing the the... the collateral damage from that, it was certainly easier for me to understand where a lot of the, uh, the depression came from the some of the darkness. But again, with the. The gravity of that. And the inconsistency of that as well was very, very difficult for for me to even just conceptualize.
And again, I’m, there’s, there’s nothing about that. That was your fault, or there is... the same thing with anyone going through that they are not to blame period. That is not how this is. This is not how that goes. And the reason that we’re even bringing it up is, is for both parties to understand that there are significant hurdles that you have to attack as a unit, not as individuals. I mean, of course, there’s individual responsibility, but this has to be approached as a team in both people have to be on their game as much as they possibly can be, or it is, it will rapidly spiral out of control.
Tammey Grable-Woodford: And I will be very Frank. This is a very vulnerable episode for me because I don’t remember so much of it, and the reality of it is that, um, frankly, it was a shift in my, these drugs caused a shift in my natural personality. And so for Griff to say, “You're not always rational," which by the way, is, is much nicer than you're being irrational. Side note. (both laughing)
You're not always rational or, or having the ability to use your words to reframe conversation. It is more work on the side of the caregiver, and it is fatiguing. And so here's the other thing, there's a certain amount of grace the first time someone's going through it. And then you get to the second surgery, and then you get to the third surgery, and it is this roller coaster where you're like, you go through all of this stuff, and you're a little bit irrational, and you're on these pain meds.
And then you're, you know, you're like leveling out and then all of a sudden you have another procedure, and you're going through all of this stuff, and you have... and it is just this up and down that as a caregiver has got to be, frankly, a little bit of hell. Because you've got the love for this person.
You want to, you want to see this person... you want to help this person... You want to heal this person. And from my side, you guys... there, I am sure I am sure... I said things that were not nice if not downright unkind and perfectly irrational, like jumping your butt. I think you mentioned that I jumped your butt about coasters?
Griff Woodford: Yes. FOR sure (both laughing)
Tammey Grable-Woodford: Right. OK. So...
Do not remember that conversation at all. And you can tell that whatever I did