Port Placement
I had my port placed on August 30, 2024
For anyone who doesn't know, a port is a tube that goes down a major vein down into the heart (or near it) so that medication that may be caustic to smaller vessels can be delivered safely and more conveniently if the treatment will be repeated frequently. At the near end of the tube is a bulb with a diaphram to be punctured by the IV needle. The whole system is implanted under the skin, usually in the right upper chest, with the tube going down the jugular vein.
My port placement was very routine, but there were three notable stories that I figured I'd share here. The first is an insight into our medical insurance system, the second was my first real sobering and scary moment of this ordeal, and the third was a touching experience at the hospital and the aftercare that has changed the was I approach my job.
1. Insurance
Everyone who has ever been exposed to medical insurance knows that it is an absolute nightmare. That being said, I have a very good insurance plan where I have a fairly low deductible, low maximum out of pocket maximums and spectacular coverage so far. I am still very vigilant, though, making sure that every provider, facility, prescription, test, etc. are in-network, prior authorized (if needed) and covered. When I was scheduled for my port placement, I was on a hightened alert due to an issue I had run into years ago at the same hosptial...
[Story within a story]
Years ago, I was playing racquetball with Shaun and a doctor we worked with. Naturally, I was absolutely destroying both of them, but went to hit a twisting shot off the back wall when something in my calf popped and I was immediately down on the ground in pain. Honestly, my racquetball game has never been the same! Anyway, my wife was working at the hosptial so I called her and asked if I should go to the ER. I said that I would go if she recommended it, but didn't want to show up just to have them wrap it in an ace bandage and send me home with a set of crutches and instructions to stay off of it for a month or so. She recommended that I get it checked out, so I showed up at the ER, was brought into a room, and immediately told that there is nothing that they do for calf muscles besides wrapping it in an ace bandage and giving the patients crutches to stay off of it for a month or so. I immediately rolled my eyes over to my wife, but we just had a good chuckle about it...until we got a bill in the mail for $750. Apparently the hospital was in-network, but the provider who saw me INSIDE THE HOSPITAL was "out-of-network". Luckily, I was able to appeal the claim and never had to pay the bill, but I've been on high alert ever since. From my job, I know that for a procedure you'll get separate bills from the facility, the doctor, anesthesia, pathology, etc. and any of those may be denied.
[Story within a story within a story]
After a couple weeks of hobbling around on crutches, we hada planned trip to visit my in-laws in Nebraska. While we were there, as I lay helpless on the couch, my father-in-law (who is an internal medicine physician) asked me what happened. I explained my racquetball injury and he asked to take a look at it. He pressed on a spot and asked if that was where it hurt. It was. Then he pressed a couple nearby spots and guessed that neither of them hurt. He was right again. He told me that i hadn't torn my calf, but had torn my plantaris tendon which was basically vestigial. Furthermore, when a lot of new students dissect down to this tendon in gross anatomy, it apparently looks like a nerve, so the plantaris tendon is also known as the "freshman nerve". Most importantly, it required no special treatment so I could immediately take off the ace bandage, get off the couch and start walking around like the MAN he thought had married his daughter. If you know my father-in-law, you know that I'm kidding, but it wasa a nice relief to get off those crutches.
[Back to the story...]
In an attempt to do my due dilligence before my port procedure, I showed up at the hospital a couple days before I was scheduled and went to admitting to confirm that it had been prior authorized and that the hospital, physician, lab, etc. were all in-network with my insurance plan. I then called my insurance carrier and confirmed the same. I didn't know exactly who would be performing the implant though, because it's such a simple procedure that whenever you're prepped, the hospital staff just grabs anyone walking around in the halls to do it. I was assured by the insurance company that anything that happened within the walls of the hospital would be covered as in-network. I took notes during that call and got a reference number. The day of the procedure I actually got another call from my insurance company and I once again got confirmation of covered, in-network status, so I got another reference number and showed up for my port. I really hope those reference numbers come in handy, though, because I recently got Explanation of Benefits which states I owe $19,653.07 because the hospital was out-of-network.
2. Reality Check
The night before the port placement, I pulled up a video of the procedure. I had a pretty good idea of what was involved, but wanted to watch it for myself. So I went to YouTube and pulled up this video: https://youtu.be/-jWMYh0Y6gg?si=eBFLz5rdYTrmcf63. The video was very helpful and confirmed most of what I expected from the surgery. Very straightforward and ironically similar to the pacemaker implants I have been involved in for 20+ years.
At the end of the video, where you are prompted for other videos you may like, I saw a video posted by a guy - @DrDanSays about his port placement and first day of chemo where they use the port. Curious to see a video of access to a port similar to the one that would be under my own skin, I clicked the link. The first thing I noticed was that this guy was about my age and was in great shape. He was a practicing chiropractor, and although he was diagnosed with Stage 4 rectal cancer, he was very confident that he would beat the odds due to his age and health. As soon as the video started, though, my eyes were drawn to the comments below the screen, each with some sort of RIP message. Here is the link to the video: https://youtu.be/_h5XK4FBtdw?si=XjMe7h7ZkTCr7fu6. After watching that video, I made the mistake of watching the final video he recorded before dying. He looked and sounded 30 years older, like a man about to die.
NGL, those videos really stuck with me for a couple days. Even now, as I write this, I forget that although in my case the odds are in my favor, there is no guarantee that just because I'm young and healthy, that I'll be in the 80+% that lives through this. I tend to get hung up on my treatment plan and trying to avoid surgery to save my current lifestyle, but I do have to step back now and then to remind myself that as long as I'm still here in 5 years, it's a win. If I do die, though, at least I know that my legacy will live on as the record holder of the most bowls of chicken tortilla soup eaten at Islands Restaurant in Tempe.
3. This Thing In My Chest
As I mentioned above, the port placement proceudre is very similar to a pacemaker implant. A vein is accessed with a needle and a guidewire is introduced, which is then replaced by a catheter and then yada, yada, yada and the body of the unit is implanted under your skin. The pre-op and post-op instructions are almost identical to a pacemaker as well - show up to the lab an hour before your procedure time without eating for 12 hours; after the procedure, don't shower for a couple days, keep an eye out for anything that looks like an infection and control your arm movement to avoid strain on the implant or stiches. These instructions are explained to the patient while they are in the pre-op area, getting their medical histroy reviewed, IV placed, etc. For the port placement, a nurse passes this information to the patient, but for a pacemaker implant, its the rep (me) who gives the instructions. I've given these instructions hundreds of times over the course of my career, but had never been on the receiving end of this conversation. I've been very quiet about my diagnosis, especially early on, so very few people knew at this point. But, when I checked into the Special Procedures Lab, the department where the port would be placed, the nurse who checked me in happened to be a fellow dad from our daycare, who I've known for years and see on a fairly regular basis. He let me know that he was shocked to see my name on the schedule and asked if I was comfortable having him care for me. Of course, I was happy to have a friendly face treat me, but I could tell that as we chatted through my pre-op instructions I was throwing him off his game. I'm sure he saw me as another dad with small kids, like him, and even though he sees patients like me every day, seeing me may have really hit home. At one point, I think I even noticed his voice starting to waver and crack a little, but he kept himself composed and got me prepped. He started my IV, took my history and then gave me the post-op expectations/instructions speech that was almost identical to the one I've given countless times. After that, though, he stayed with me the entire time - every second - as I waited for a surgical suite to become available, as they wheeled me through the hospital to that suite, as they put me on the table and prepped, as I woke up afterwards and all the way until I was discharged. Now I was completely comfortable about this procedure going into it. This is about as ho-hum, low-risk and routine as you can get while still being placed under sedation. I was not worried or nervous in the slightest that day, but still, having a friendly face with me every step of the way was comforting beyond words. I have no idea whether that was him just doing his job and the same attention is given to every patient, but it really made a difference for me!
Now the post-op. As I mentioned, I've given the post-op expectations/instructions hundreds of times, maybe thousands. The general bases that are covered are care for the incision site (not picking or peeling off the glue or strips over the sutures, when you can get it wet in a shower, pool, etc.), movement/lifting restrictions so that you don't move anything out of place, how to keep an eye out for any type of infection, and an explanation of how your device works and how you'll use it in the future. What ISN'T covered is what it's going to feel like to have a new foreign object sitting under your skin. The morning after the procedure, I woke up and just felt sensations all over the area of my port placement. I felt a tugging sensation in the skin around the bulb, a tightness in the areas around it, pain around the part leading up my neck and around the incision sites (especially the small site near my jugular) and a pressure-like senation in my lower chest near my ribs along my sternum. I also had pretty significan bruising/discoloration around the implant site. I knew that all of this was completely normal and absolutely nothing to worry about, but I thought about all of those patients who we've implanted with loop recorders, pacemakers, defibrillators, Optimizers, etc. and sent home a few hours after surgery with those same instructions and how they probably don't know what is normal and nothing to worry about. I thought about the patients who come into the office with lingering sutures, which are quickly and easily clipped off without a thought. I have one of those too and they are unbelievably annoying, like a dangling scab that you're not supposed to pick but wont just fall off. I thought of the nervous patients that are worried about their bruising or tugging on their leads; and of the ones on the other side of the spectrum - the patients who have come back with their device completely eroding out of their skin and haven't mentioned anything to anyone. Its not that I haven't been sympathetic to these patients in the past, but having the chance to experience it first hand has given me a new appreciation for what patients go through, even during a very routine procedure. I plan to start working some of this into my pre-op speeches, and will definietly spend more time just talking it out with patients at the first visits after their implant.
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