52 & 53: Reconstruction

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I’ve never been one for selfies but I wanted to share how much my hair has grown and how curly it is! My hair BC (before cancer) was curly but not as curly as this…. I will take what I get as some women that were given Taxotere are not getting hair growth back.

June 20th marked one year since my last Radiation Treatment, I had a total of 29 rounds to the Left chest wall at The Pacific Cancer Institute on the island of Maui, from May 11th to June 20th. The plan all along has been to do delayed reconstruction. My team at PCI thoroughly explained skin care to me which I followed to a tee. The week after I started Radiation treatment I was referred to a physical therapist for John Barnes’ myofascial release technique massage. I saw my therapist twice weekly thru the month of July 2016.  I was also prescribed Mometasone Cream for me to “gently” apply post treatment. Hence, my skin flap is pliable, and not hardened.

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These pictures are of  just two types of reconstruction surgery known as Autologous of “Flap” Reconstruction. This is not the type of surgery I will have but the surgeon did go over the details of these two types of surgery. Reason being, IF my body rejects the Implant Reconstruction, this is “Plan B”. I will pray that my body does not reject the implants as these surgeries are more invasive.

 

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53:  A Show and Tell Moment

In February of this year at my first meeting with my Plastic Surgeon he gave me homework. He wanted me to research as to how many cc’s I wanted my implants to be. I told him on how before cancer my breast were not symmetrical, my left breast was larger than my right breast. Although this was not noticeable with clothes on, I was limited to style of bras and swimsuits because of this. So, I told him I wanted them to asymmetrical (same size)…..he smiled and said he can do that. My husband chimed in and asked the surgeon if he can place a set on my back so he would have something to hold on to when we slow danced!!!!! We burst into laughter….got to love my husbands sense of humor!!! ( I hope this doesn’t offend anyone)

So, how does one determine reconstruction size? You google it, Pinterest it, or simply ask a friend! I was at the Cancer Center talking to my good friend and fellow Mammography Technologist Extraordinaire. I mentioned my dilemma to her, before I know it Catherina and I are in the bathroom for A Show and Tell Moment. She was quite impressed with how pliable my skin sparring mastectomy is, as Mammographers we are oh too familiar with what a post radiated breast can look like. She showed me her implants and her size, decision made, I will shoot for a “C” cup! I also have to keep in mind and make it clear to my readers that mine is a “reconstruction, post mastectomy” and not a “breast augmentation”, so end result can vary…..I will have no nipples, they can get tattooed on later!

Exactly what is a Modified Radical Mastectomy, Skin Sparing? Basically my nipple was removed (I opted for non-nipple sparring) along with all the breast tissue. For those of you that have been following my blog from the beginning, you will recall that the Breast MRI that was done when I was first diagnosed found an additional cancer on my left breast,  4mm away from the fascia of the chest wall, straight back from the nipple at clock face 12:00. What is left behind is a deflated breast, all my breast skin was sparred minus the glandular tissue…….I have a deflated boob.

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I was in Redlands last week signing a release of medical records for my primary doctor in Palm Springs, he wants surgical notes of my Hysterectomy/Oophorectomy from 2009. (I sure am missing a lot of parts now!!). I stopped in at the Women’s Health Imaging Center to say hello to Renee, we chatted a bit about my blog amongst other things. I showed Renee this picture and how I wanted to share what a “skin sparring” mastectomy was. I took this the above picture after doing my exercises, I was cooling down, stretching. But I wanted to show more, I wanted to share the actual skin flap.

So what does a good friend do….offer to take photos for your blog!!! Renee and I quickly go into one of the mammography room, off comes my blouse, bra and Betty (that’s my prosthesis name) another Show and Tell Moment! Mahalo Renee for taking these pictures for me on a whim!

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Needless to say, I am ready for reconstruction. Today June 21st I went to the Plastic Surgeons office, the appointment went well. My husband Jack was with me. There was a moment of laughter when the topic of the prophylactic mastectomy was discussed, the surgeon asked if I was going to spare (keep) the right nipple? I said no, I don’t want to be like a one-eyed pirate when the nipple is hard! I closed one eye and said “arrrrggg”, the surgeon laughed……it was a funny moment. So what’s next? The  Breast Surgeon’s office will be contacting me to schedule labs, chest x-ray and an EKG. The surgery will then be scheduled. The Breast Surgeon Dr. Laura Lee will do the Right Prophylactic Mastectomy and the Plastic Surgeon will be doing the reconstruction placing the expanders. Post operative I will have four drains, two on each side. Two of them come off one week post-op. The other two come off after the fluid drainage has subsided. Expanders will be expanded every week until desired fullness is obtained. Then, three months later, like in December sometime the expanders will be switched out for the implants.

Holy smokes this is a long blog! If you read it to the end, many thank yous.

Mahalo, Pina

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51: De Quervain Tenosynovitis 



De Quervain Tenosynovitis ,  well that is a mouth full! I had my appointment with the Orthopedist on Monday and that is what is causing all my pain!  I received a cortisone shot in the joint space and my wrist/thumb was placed in this lovely immobilizer. I am to wear this contraption for six weeks preventing movement of wrist and use of thumb. IF after the six week period condition is not improved, surgery will be an option! Hummmm, the challenge for me will be resting it……six weeks…..really?

I have a couple of weeks before I see my Oncologist, so I won’t know the results of my CT scan till then. This is going to be a short post, just to update you on my wrist condition, kind of awkward typing not using left thumb ! 

Best news yet is the fact that our medical coverage did not change and I am able to keep all my current doctors. For those of you that read my last post, there was a possibility that our insurance coverage was going to change. It was a blessing and a huge relief when I found this out……was truly worried. 

Thank you for reading my blog😊

Pina

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50: Ganglion Cyst


Ganglion cyst…………really? How is it possible that a cyst could be the cause of my pain, at times having me on the verge of tears because it is so painful ? Well apparently my cyst is not so small as one would invision. It is impinging on a nerve, which is extremely painful, and more and more my use of my thumb is limited! Arrrrg……so frustrating! What has me concerned is the fact that it is on my left wrist. Due to my left breast mastectomy and the removal of lymph nodes, I am at risk for lymphedema. To avoid lymphedema (the arm swelling up) I am to avoid getting cut, burned on my left arm. I don’t have blood drawn or blood pressure taken on the left either. I know it can not be ignored because at times I can not use my thumb, it effects day to day tasks and I am starting to drop things,  I think I can grab it but don’t have the strength ! 

 We will see what the Orthopedist that I am being referred to will tell me. I go see him on Monday May first. 

Personal update: Our shipment of stuff we shipped from Maui finally arrived! Little by little boxes were unpacked. Mainly I had been waiting for my Pilates Reformer! One of the bedrooms in our home is now “the Pilates Room”! I really notice a difference in the way I feel when I do Pilates on a regular basis. The aches and pains from the Arimdex is unbearable at times however much more tolerable if I do Pilates regularly. I belong to a couple of on line breast cancer support groups and one of the most common topics that comes up is the effects of the medication on our bodies. The women that exercise regularly tolerate it more then those who don’t !  Some women that chime into the conversations simply don’t exercise because of the pain they are in, and I know everyone is different . There are days when I don’t want to do anything but I force myself, even if it’s just 1/2 hr of gentle stretching! ………we can’t let cancer win!!!!! ( I refrained from cursing) 

The flower in the picture above is from my front yard, it is one of many different colors of long bearded iris’s that I have growing. Going to sign off now, mahalo for reading my blog.

Pina

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49: Scale of 1-10

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Just a quick blog to keep you updated on my journey. Since moving back to California from Maui, I have established with my new medical team. As previously mentioned the prophylactic mastectomy (mastectomy of the non cancer breast) will happen in July. Since then I have been staying busy with multiple doctor appointments, monthly port flush, blood work etc….

Well somehow I managed to irritate my left wrist. Back in November of last year I remember my left wrist starting to ache. Because the Arimidex causes body aches I just brushed it off as a side effect of that. I don’t remember any trauma to my wrist, but maybe with packing, moving, coming back to Cali and gardening I did something to it. The pain is now traveling to my left shoulder, scapula and neck making everyday task extremely challenging….even typing this blog is uncomfortable not to mention driving!

An X-Ray of the wrist was negative, so tomorrow I will have a left wrist MRI. My primary doctor is determined to find the cause of my pain. I was asked on a scale of 1-10, 10 being worst what is your pain level….my answer 15! With certain movements of my wrist, I literally come unglued…..so painful.

This month I will also be having my follow-up Bone Density Scan and my Chest CT. I asked my medical team if these scans can be done the month of April instead of May, as come May 1st my insurance coverage is going to change (covered under husband, his company got bought out). I was just informed by the Cancer Center that we have almost met our deductible, if our insurance changes May 1st we will have to start over again…..just grateful to have insurance. I just hope that I don’t have to switch doctors, because I really like the doctors that I have established with.

The picture above is a Long Bearded Iris…..my wrist is hurting, but my flowers are beautiful!!!!

Mahalo for reading my blog

Pina

 

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48:Time Flies!

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Aloha everyone, my how Time Flies! It has been one whole month since leaving Maui back to our California home in Yucaipa. I am adjusting daily, the hardest thing has been the weather. I don’t believe there has been a day where it has reached 70 degrees! The above picture was taken last night from my home…..one can never used to how beautiful sunsets are.

I have established with my new medical team here in southern California. My new medical Oncologist is at the Cancer Center where I used to work prior to moving to Maui. I have had two appointments with him last month, the first being on February 13th. I was a bit overcome with emotion on that day, it was just surreal to walk in there as a patient and not an employee. Everyone that recognized me gave me hugs and well wishes, again the morning was rough for me. I really like my new Oncologist, he took the time to talk to me about my past treatment and the plan moving forward. I still have my medi-port, so he had the nurse flush it, and draw labs before I left. I have nurse visits for port flush for the next two months with my next Oncologist and labs appointment on May 25th. I established with a Primary Care Physician (PCP), also in the Palm Springs area, he ordered labs as well, I go back to see him next week to discuss the results of those labs. My PCP also asked about my decision to do a prophylactic mastectomy. My response “dense breast”. For those of you that have been reading my blog from the beginning you will recall that my breast cancer was not caught early due to the composition of my natural breast tissue. Which brings me to the picture below! Looking at the formation of those clouds reminded me of my dense breast tissue!! The white represents dense tissue and the blue representing fat. LOL….only a Mammography Technologist will look at the clouds and compare it to breast tissue!!!!…..yay,  try to find a tiny cancer starting in that hot mess!

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Plastic surgeon appointment:

I met with a plastic surgeon to discuss my reconstruction options. My husband was with me which words can not describe how much his presence there made a difference to me. The plastic surgeons office had an extensive questionnaire which was emailed to me and I had plenty of time to properly fill it out. We talked about the options of reconstruction (which I will save for another blog)

Basically, my last Radiation Treatment was on June 20, 2016 I had 29 rounds…..so, he will not do the surgery until one year has passed from that date, giving my skin enough time to heal from the mastectomy and the radiation treatment. My next appointment with him is on June 21st, which at this time we will proceed and get the prophylactic mastectomy and reconstruction scheduled.

Mahalo for reading my blog

Pina

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47: MDI Ohana

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Much mahalo MDI for all the love and support since my Breast Cancer diagnosis! God has a plan for all of us and I truly believe I was meant to discover my breast cancer while living and working on this beautiful island of Maui. My decision to stay here and go thru my cancer journey here with all of you was the right choice. Because of all the love and support from my MDI Ohana, the Maui Canoe Club, friends we have made on this island and my family, I was able to kick cancers (you no what!) It was an honor to work with such an amazing team. My Oncologist thought I was nuts when I refused to get put on medical leave during my treatment, this job is what kept me motivated, and helped me thru the aggressive treatment with flying colors!

To all the patients that have reached out to me to wish me well, I thank you from the bottom of my heart. Mahalo Ruth (printed with permission) for the dinner date, I enjoyed our visit and will keep in touch

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Today was my last day working at MDI, this time next week I will be on a plane to California. This will be my last week end living here, so until February 3rd, I will be tying up loose ends before I leave and enjoy the island.

Mahalo Maui for being so therapeutic for me!!!!

Mahalo for reading my blog……Pina

 

 

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46: Spirit of Aloha

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The past three days have been spent on the island of Oahu. I had my Nuclear Medicine Bone Scan and a Chest CT on Wednesday. This morning my Oncologist, Dr. Clayton Chong gave me the great news that my Bone Scan was Negative for Malignant Neoplasms! The chest CT was done for that nodule that they have been keeping an eye on, it has not changed since the last scan!!! My office visit went well with my Oncologist, I told him I was moving back to California, it was sad saying good-bye to such an amazing team. Doctor had one of the nurses flush my portacath, and instructed the nurse to give me copies of all my medical records for me to give to my new doctor. I also got copies of all my post treatment scans from medical imaging……three CD’s! I am ready to transfer my care. By me hand carrying my medical history, it will make the transition a lot smoother…..I hope.

The picture above, was at a restaurant we ate at  Thursday morning. I asked my daughter to take a picture of it because it depicts the true meaning of the Spirit of Aloha. Living and working here on Maui since July 2014, I have met so many wonderful people. I love the way the keiki (children) refer to me as “auntie”. I am going to go thru some serious ocean withdrawals, and will miss the patients that I have imaged working at MDI. I was at Safeway the other day and ran into three people who I have done their mammograms, one lady heard that I was leaving from a friend…..word is spreading.

I also wanted to mention about my colonoscopy that I had done on December 8th. Well, it turns out that I did have two new polyps, they were both removed and both of them came back to be “tubular adenomas”. Yes, if you have read my previous blogs, those are the ones that can turn into a cancer (considered pre-cancerous). So, with that being said, when I establish with my new medical team in California this will be one topic that will be discussed. The G.I. doctor here says that I could wait to  have another exam in 2 to 3 years, which concerns me. Not sure I want to put it off that long.

Well it is 9:57 pm here on Maui, and I want to go to bed, I plan on paddling out with the Maui Canoe Club in the morning.

Mahalo for reading my blog….Happy New Year!!!

 

 

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45: How Much Can a Mother Endure?

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Just last month I was in California for my sisters Bert’s celebration of life. My sister chose palliative care after being diagnosed with Stage 4 Breast Cancer, she lived for 16 months after given 2-4 months without treatment. We were emotionally and spiritually prepared for my sisters passing.

What we were not prepared for, was a phone call  last week on Friday December 9th from a Hospital telling us that our youngest brother was on life support and would not survive his illness. We were blind sided. This past week has been an emotional rollercoaster for the entire family. Our mother did get to visit and sit with my brother, leaving his bedside on Monday December 12th, just one day after her 79th birthday. Our mothers birthday was on Sunday, she spent the day by my brother’s side.

How Much Can a Mother Endure?

My heart aches for my mother, this being the third family member to pass away this year. On May 20th of this year my niece Desi Quezada tragically passed away. She was the eldest of my brother Eddies daughters. On October 22nd, my sister Bertha Alicia  and now this morning Friday December 16th at 845am my brother Eduardo Francisco Quezada passed away, he was 50 years young. The medical staff did everything medically possible for my brother, he was in complete organ failure, his passing was peaceful.

Eddie was the youngest of six children. With my brothers passing that now makes three of my siblings gone. Our brother Victor passed away in May 13th of 2007. Our father passed away on Christmas Eve of 1983. I was talking to my mother and she knows that she know has three of the children that she bore in heaven with our father.

Please pray for my mother and family, the next couple of weeks will be rough for everyone. We are a large close knit family and I know with love and prayers we will be fine.

I am coming to Cali earlier than originally planned, arriving Sunday evening. I have medical appointments the second week of January which I need to keep. I will be officially moving back on February 3rd.

Mahalo, Pina

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44:Leaving da Island

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It is hard to believe that one year has past already. This time last year I had just finished my 4th chemo treatment, which for me chemo number 4 thru 6 were the worst. With the love and support of my family I managed to get thru a very aggressive chemo cocktail that in the words of my Medical Oncologist was going to “knock me off my ass”, yes those were his words exactly! Bar none he wanted me to understand how important it was to receive all 6 treatments and not quit on him. ” For this to be successful you need all 6 treatments, this is going to knock you off your ass, you are going to want to quit, number 5 and 6 will be the worst” “Are you ready?” I was ready, and I continue to be ready for anything that is thrown my way!

With that being said, I am home early today from work to prepare for a follow-up Colonoscopy. In February 2015, six months before my Breast Cancer diagnosis I had my baseline Colonoscopy. The results came back that they found and removed Tubular Adenoma Polyps. Because those are the kind that can turn into a cancer, I get to repeat my exam. I was supposed to have it done in February, I was given a pre-op appointment in November 2015 for a Colonoscopy in February 2016! The problem was that I was too ill from chemo #4 to leave my home to keep the pre-op appointment. I then asked my primary doctor if I can just wait till I was thru with chemo, surgery and radiation treatment before revisiting the whole repeat colonoscopy exam! Not exactly my favorite exam, the prep is the worst. Hence my appointment is tomorrow morning.

Leaving da island

For those of you who know me personally, you know that my husband works all over the map. However since May of this year his job has kept him on the mainland. After the expense of staying on the island of Oahu, post mastectomy in March, I have been contemplating  going back to the mainland for the next phase of my surgery. However, now that my husband is indefinitely working near our home in California it is no longer practical for me to remain on paradise without my husband. My prophylactic mastectomy and reconstruction will be done in Palm Springs where I used to work. I will not be returning to Maui to work after being released.

I have given my employer notice, my last day working at MDI will sadly be on January 27th. I will keep my Oahu appointments in early January. January 11th, 12th, 13th I will have multiple appointments which include Chest CT and Bone Scan, Medical Oncologist and a follow-up Dr. Nakashizuka.

Today is the 75th anniversary of the bombing of Pearl Harbor by Japan. Living and working here on Maui, I have met people who remember that day, or have been told stories by their aunties and uncles of that “infamous day”.  Prayers to the people of Hawaii and descendants of people lost on December 7, 1941. Mahalo to all military personnel over the generations. Today also marks my fathers birthday, if he were alive he would have turned 88 today.

Mahalo for reading my blog

Pina

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43: Mammogram Appointment

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Breast Cancer awareness month has come and gone. However for me, as a Mammography Technologist it is everyday of the year. And now as a Breast Cancer survivor, bringing awareness is just that much more important.

I had intended to blog about how to prepare for your Mammogram Appointment prior to the month of October, but it just did not happen. Preparing for the Voyage to Lana’i , paddle for life took precedence over everything.

So here it goes:

Be on time

You are given a check in time and an appointment time. There is a reason for this. We are only given a certain time slot per patient. At my work we are given 15 minute time slots per patient for a routine screening, 30 minutes for a diagnostic appointment and/or a patient with an augmentation.  And please, IF you have an augmentation (implants) please mention it when making the appointment if you are not asked that question by the scheduler. Some patients register, then proceed to talk on the phone or just be on their smart phones instead of doing the questionnaire given to them. So, the purpose of you check in time is to complete all necessary paperwork prior to you appointment time.

No lotion, powder or deodorant. 

You are probably wondering about the picture above., I will explain that in a bit.

Deodorant, deodorant  mimics micro calcifications. Some micro calcs get worked up, meaning additional images and after the additional images IF they are deemed “indeterminate” by the radiologists they are either followed up in six months or he/she gives a recommendation to biopsy them! Lotion or powder can come out in the image, especially if it has some type of shimmer to it. Also with lotions and or body oil, it makes the breast slippery making it easy to move when in compression, causing motion. An image with motion will be rejected and repeated. I had a patient that had coconut oil all over her body, her breast were small, there was no friction between her skin and my paddle. I was using my small half paddle for her but her breast kept popping out from the compression paddle. She agreed to go into our bathroom to wash her breast off with soap/water and we proceeded. And of course by now we were well into her 15 minute time slot for her mammogram.

When I bring a patient in the room I will ask I they have product on. If they did come in with deodorant on we offer baby wipes to wipe it off. I document it in my paperwork when a patient comes in with deodorant on. I have had a patient get called back for possible “residual deodorant vs micro calcs” therefore, I do not recommend coming into your appointment with deodorant on.

Sand

Here on Maui I have come across sand artifact on a mammogram. I did one view on a patient, then when I did the oblique view (side view) I noticed that on my image there was artifact where there was no breast tissue. My image receptor had all these sparkly things on it. I remembered that when she came in she had on a beach cover-up with a swim suit top on. I asked her if by any chance she was swimming in the ocean this morning? The answer; “Yes, but I rinsed off at the park before coming here”.   Well there was enough sand in her suit that clung on. Solution, my schedule fortunately was pretty open that day, this was the patients baseline mammogram (first one) she lived literally in the neighborhood of our clinic so she went home and took a proper shower then came back and I worked her in!

The Picture

I begin to position my patients first view, and I can feel that there is some kind of product on my patients breast. I continue to compress the breast, my positioning light is on, and with the compression this white stuff seeps from my patients breast tissue!!! I lift my paddle off of my patients breast and ask her, again if she has product on?

Me: I thought you said you did not have lotion on?

Patient: I don’t

Me: oh, what’s this…..as I point to my paddle

Patient: It’s sunscreen

Me: (with a puzzled look on my face) were you not asked NOT to wear  any lotion, powder or deodorant?

Patient: YES, they didn’t say I couldn’t put SUNSCREEN on! ( in a very harsh tone)

SERIOUSLY!!!!! OMG I COULD NOT BELIEVE HER RESPONSE TO ME AND HER TONE.

Me: I walked over to the baby wipes, asked her to please wipe, said that I would take one image, if I saw artifact on my view I would delete it and cancel the appointment. I then grabbed my cell phone and told her that I was going to snap a photo of my paddle to show the scheduler how these products interfere with the imaging. I tilted the unit at an angle for the image.

Wiping this sunscreen off of the unit made a mess. I managed to get it all cleaned up and we were able to complete the exam……of coarse this exceeded her 15 minute time slot!

Prior Mammograms

If it is your first mammogram at a facility and you have had priors elsewhere, please arrange for you priors to be sent to the imaging facility. I we receive them ahead of time the images are imported and prior reports are scanned, we have everything for our radiologists to make a comparison when he looks at the current study. IF, you don’t make those arrangements, we get you to sign a release for priors, we look up the location of your priors, and it helps if you know where your last mammogram was at. Last week, I spent 22 minutes with a patient on the computer looking for a facility on the mainland. She knew the state and city and part of the name of the facility (her prior was a 2015 study, how can you not remember)  We managed to find it. Release signed, we got started at 825 am, by then my 815, 830 and 845 patients were registered…….THEN….she had implants and was not double booked!!! My morning snowballed after that. You can not rush through a mammogram to get caught up, it was not until a patient called to reschedule an appointment that I was able to get caught up from my morning fiasco.

Clothes

Make every attempt to wear two piece clothing and not a dress. We only require you to change from the waist up, when a dress is worn to the appointment the patient is standing in her underwear with a long paper gown on (my clinic uses paper disposable gowns). I have had patients not have under clothes on,  which made it pretty awkward. In this case I got creative and taped a gown creating a skirt like cover-up, then a half gown on top. I do not understand why someone would not wear under clothes to a medical appointment!

Time to sign off, Mahalo for taking the time to read my blog, was not my intention to make it this long.

Pina

 

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