Tuesday, 24 September 2013

I'm Not Doing It, The Port That Is

Just a quick update, folks. After much thought, and discussions with nurses and my husband, I have decided not to go ahead with the insertion of the Port-a-Cath on Thursday.

The key factor for me was that my current treatment is oral Tamoxifen daily and infusions of Herceptin and Pamidronate every three weeks . These drugs don't damage the veins like chemo does. So I don't really need the port now. At some point, I should expect that this treatment will fail. Eventually I will have to go back on chemo. At that point, I will need either a port or a PICC. But I will wait until then.

For those of you who are deciding whether to get a PICC or a Port-a-Cath, here are the pros and cons as I see it. Please check with Dr. Google to learn about other aspects that I didn't experience:

Note: as soon as I hit "publish" I thought of more items for the list. They are marked with a "*".

Port-a-Cath

Pros
  • Protects veins from chemo.
  • Once the incision heals, you can shower and swim normally.
Cons
  • Both inserting and removing the port require minor surgery. Healing from the port insertion feels like you've been kicked by a mule. I was aching and taped awkwardly, which made me walk like Igor from the old horror movies.
  • *The port site is exactly where your child's head cuddles you. Seat belts and bra straps will also irritate the site.
  • The port may erode the skin above it. In my case, I had persistent bruising at the port site (not normal) and later an infection.
  • I could feel where the wire looped up my neck. It was a little painful. Definitely icky.
  • In Ottawa, an appointment with a nurse is required to use the port for a blood test. If you want to leave the Gripper needle attached between the blood test and treatment, sterile dressing is required. So much for showering normally.
  • If your port isn't accessed every four weeks, you need a nurse to come to flush it.
  • The incisions (there are two of them) and the port site could form keloid scars. At the suggestion of my dermatologist, my doctors injected Kenalog (a type of cortisone) at the incision site to reduce the chance of keloids forming. It worked, so far.

PICC

Pros
  • Protects veins from chemo.
  • Painless accessing of the PICC for blood tests and IV medication.
  • Removing the PICC is easy. They slowly pull it out. I watched; it was cool.
Cons
  • You walk around with a bit of tubing sticking out of your arm the whole time. This is covered with sterile dressing. It is annoying in the summer. I had a weird tan that year.
  • A nurse must come weekly to change the sterile dressing and flush the PICC line.
  • You can't swim.
  • To shower you have to wear a plastic sleeve to keep the dressing dry. Your arm never gets a good scrubbing.
  • In Ottawa, an appointment with a nurse is required to use the port for a blood test.
  • If you are sensitive to adhesive, like I am, you may need to use Mepore (paper dressing) to avoid irritation. I later changed to IV3000. My skin was fine while I had the PICC, but I had some scabs form after the PICC was removed and the dressing taken off for good.
No PICC or Port

Pros
  • No holes in your body.
  • You can swim and shower normally.
  • You can walk in for blood tests either at the hospital or a local blood lab. No appointment necessary.
Cons
  • Chemo can damage your veins.
  • Blood tests and treatment will require a poke in the arm. If your veins are hard to find, as mine sometimes are, maybe two pokes. You may bruise at the site of the poke.
That is all I can think of. I hope these pros and cons will be helpful to someone that's just starting out with cancer treatment. I know I will come back to the list when I have to start chemo again.

Please add a comment with your experience with PICC lines and ports.

12 comments:

  1. Great write up of the pros and cons Kate... I didn't realize that you had a PICC, or I had forgotten. I reacted to the PICC adhesives, we tried a few different types but my skin was always in some form of irritation. I didn't make notes on the brands... Here in Calgary you have to make an appointment as well, for any access to the PICC line.

    No one other than chemo nurses could access my port, it was not a power port so that meant the techs at CT scans etc couldn't access it either. There was a problem where the tubes of my port entered the artery and it was removed. I have a lot of scaring from the incisions, and could see the port and the tubes inside my chest, very strange for sure. They told me there is risk of clotting with the ports in your chest.

    Personally, I think you made the right choice... hugs...

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    1. Thank you, Carolyn.

      I forgot to mention that the ports on the left side like mine tend to have more problems.

      ~Kate

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    2. Here's hoping that if you need one on the right it will work stellar! My next will have to be on the left.

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    3. I was told that the staff here in Ottawa were trained in how to use power ports but then the hospital decided that not enough of us would use them for it to be cost effective. I wish...

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  2. Another con, especially to PICC lines, is that they can get infected by the time you are done with chemo. DH had an infection, which they successfully treated, which of course was succeeded by C. diff, because the initial antibiotic killed beneficial bacteria.

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    1. I was really scared that my port infection would result in sepsis. There's no fooling around with these infections. ~Kate

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  3. Great post! I'm still sorting through my feelings about this port business. One thing: I'm only on herceptin but my veins are already quite damaged from years of chemo. The port stops me from becoming a pincushion and a source of great stress for all.
    As you know, I miss my left-side post and have found out that my original port surgeon, actually preferred the left side. I'd love to know why.
    Also: puppy pictures, please.

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    1. I wish I'd had a better discussion about the pros and cons of each side before getting it installed in the first place. I am pretty sure they went left because they thought I might get radiation on my right breast because that's where the tumour was. What they didn't seem to understand is that I have Stage IV cancer and there is little point in using surgery or radiation on my breast at this point. Geez, I'd need radiation head to toe!

      And I will post the pictures soon. Our puppy Mango is beautiful, though troublesome. ~Kate

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  4. My husband's friend Donald Cyr shared another consideration which I'm copying from Facebook:

    "Something I can add to the pros/cons of ports thanks to what my cancer support group members taught me during last week's session is that they can (and do) set off some security alarms at some airports. Apparently it is advisable to either travel with the card that comes with the port or a letter from the person's doctor. As well, ensure that whatever documentation you are travelling with has been translated into the language of the country you are travelling to. One of our members mentioned having a lot of difficulty with security at a Barcelona airport due to his documentation only being in English."

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  5. Thanks for the helpful info. I completely lost it and broke down right in my doctor's presence on the day I learned I'd be needing a port...

    I'm glad you made the decision that feels right for you at this time.

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    1. Looking at the bruise forming on the back of my hand (from treatment Friday), I ask myself if I did the right thing. Still, all in all, I think the port just isn't for me. ~Kate

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