Eva (00:07):
This is a story about what happens when you have breast cancer, told in real time.

Eva (00:17):
Well, what a great day. We're here to talk about what is called the port, or what is sometimes called the mediport, which is put in for chemo. Turns out to be kind of a big deal, but probably minimized in a lot of people's cases so we thought it'd be a good idea to have a conversation about this particular procedure. And with me today are of course, Kristen, who has had a port in the past, for how many months did you have your port in, Kristen?

Kristen (00:43):
It was in for about seven months.

Eva (00:46):
Okay. But it's gone now.

Kristen (00:47):
It's gone now.

Eva (00:48):
Right. And then also with us is Natasha, who does currently have a port in because she's in the middle of chemo. Good morning, Natasha.

Natasha (00:57):
Hi, good morning.

Eva (00:58):
And then finally, our special guest is Dr. Aaron Fritts who's an interventional radiologist based in Dallas. Welcome Dr. Fritz. Will you tell us about yourself?

Dr Aaron Fritts (01:08):
Yeah. Thank you so much for having me. I'm an interventional radiologist here in Dallas, practicing out of the Plano area. I have recently cut back to part-time because I do have my own medical education platform called BackTable, which is mostly a podcast network, covering multiple specialties. And so with that, I've cut back to part-time so that I can put more time and energy into that. That being said, I still enjoy my practice and I really actually enjoy the topic we're going to cover today because it's an important topic. It's something that I see often. And I do like to make sure that patients are educated before we proceed with the procedure.

Eva (01:45):
When we met, at a podcast conference actually, that was one of the most memorable questions that I asked you at lunch was, "How do you find the patient when you go in to do this?" And I think you said sometimes you talk to them for 20 or 30 minutes before you even start because they have no idea what's about to happen.

Dr Aaron Fritts (02:04):
That is correct. So what I've found is that oftentimes, it's not anybody's fault, but because the oncologist, it becomes a routine thing where they order, just like they might order a CT scan or they might order labs, they order a mediport to be placed. And the order comes to us and usually it's an outpatient, but a lot of times nobody's really spoken to the patient about what's involved with placement of the mediport. And the patient gets scheduled. They talk to somebody on the phone. If they're lucky, they might talk to a nurse the day before to answer the questions, let them know what to expect, but oftentimes I walk in the room and the family and the patient don't really know what's about to happen. They don't know about the sedation. They don't know what the post-op care is. So I do try to spend a good amount of time beforehand before we even wheel them back to answer any questions.

Eva (02:54):
So before we get to the fun of port placement, first can you just help us understand what an interventional radiologist is and does and where we might find one in the wild?

Dr Aaron Fritts (03:05):
Yeah, it's the million dollar question, because it's frustrating to fit IR into a well described box. We have a PR issue that we always talk about because, one is our training is unique. So we are trained, at least the way I was trained, was you do your medical school training for four years. Then you do a one year internship in either medicine or surgery. And then you do four years of diagnostic radiology. This is what I did. This was my pathway. Four years of diagnostic radiology, where you learn how to read CT scans, MRIs, ultrasound, all the imaging. And then you sub-specialize into one of the subspecialties, which might be MSK radiology, which is musculoskeletal. It might be breast radiology. It might be neuroradiology. But there's also this field called interventional radiology. The full name is actually vascular and interventional radiology because it was founded on vascular procedures, back 40 something years ago. Charles Dotter had the idea of putting a catheter into a vessel and injecting contrast to get a better idea of what the diseased vessel might look like. And then it evolved into somebody actually taking a balloon that was on a vessel and expanding the balloon within the vessel to try and open up any blockages or narrowings. And then it's evolved since then with more therapeutics.

Dr Aaron Fritts (04:24):
And what we do really covers the whole body. Atul Gupta, who's an interventional radiologist, the way he describes it is we do imaging guided therapies, which are minimally invasive. And so we're not doing big incisions on people. We're doing procedures that involve like basically a pinhole size or small, very, very small incision, putting catheters in the body or putting needles into the body to obtain biopsies. And so it covers a wide variety of different pathologies and we overlap with a lot of other different specialties. So it could be challenging to describe when I'm telling my parents friends what I do. So a lot of times if I'm trying to give it short, I just say I'm a radiologist, but if I really want to kind of geek out on it with somebody, then I go into the full detail.

Kristen (05:12):
That's awesome. I had no idea what I was getting into. And so I really am excited to hear how you can explain this to people easily and that we're having this conversation. Our audience is a lot of women who are just at the beginning, maybe newly diagnosed, or just starting to learn about what they're going to go through.

Dr Aaron Fritts (05:33):
Sure.

Kristen (05:33):
I was diagnosed almost a year and a half ago and it's just exactly like you described. I went to my oncologist. She said, "Here's what we're looking at. Here's your to-do list." And it was literally bone scan, CAT scan, port placement, appointment with Dr. Ali. And I didn't know what a port placement was. So of course I went to the internet and pulled up this visual and it was a very simple graphic, it was black and white, that just showed where the port went. It showed it went up to your carotid artery and then it showed that there was a catheter that went down into your vena cava, I think? And basically your major artery that goes into your heart. So at this point, I know I'm going to get chemo. There's going to be a catheter that goes into my carotid artery and then straight down to my heart, and I was completely freaked out about that. And they said it was vascular surgery.

Dr Aaron Fritts (06:29):
Yeah. Just real quick, because it is hard to find good, accurate information on the internet.

Kristen (06:35):
Absolutely.

Dr Aaron Fritts (06:38):
And you don't know. I mean, Google's kind of random like that. It just brings up stuff that's popular. So if misinformation could be popular and then that's what you end up with.

Kristen (06:48):
Yeah.

Dr Aaron Fritts (06:49):
And so you may have found something that said it was a carotid artery when it's actually the internal jugular vein. The carotid artery would be a dangerous place to put a catheter because it's a high pressure vessel that's feeding your brain, basically. The internal jugular vein is also at the base of the neck right next to the carotid artery, but it's the low pressure venous system that's actually draining the head and feeding the blood back into the heart. And so that's the difference.

Kristen (07:17):
That's a huge difference.

Dr Aaron Fritts (07:18):
Yeah.

Kristen (07:20):
That's major, right?

Dr Aaron Fritts (07:21):
Yeah.

Kristen (07:22):
That's why the Google isn't always the greatest doctor.

Dr Aaron Fritts (07:27):
Yeah.

Kristen (07:28):
And Natasha, what was your experience like?

Natasha (07:31):
So mine was quite different because as a nurse, I've seen many ports, I've worked with many ports. As a nurse practitioner I've talked to patients about getting a port, that they would love a port, it's much easier. I mean, the secret is it's a lot easier for nurses if people have ports as well, because we use this weird word access. I'm not exactly sure, but you can get the needle into the port really quickly whereas people who've had a fair bit of chemo, their veins just become harder and harder to find.

Natasha (08:05):
So I, when I met with my oncologist, she's like, "Oh, and port. Will you want a port?" And I was like, "Yeah, of course I would get a port." But then I sort of back pedaled in my own mind. And I said, "Well, do I need a port? I mean, everybody else needed a port, but I don't know if I actually need a port."

Natasha (08:23):
And initially I was scheduled for weekly chemo and I was pretty sure with weekly I would get a port, but then they're like, "No, it's every three weeks." So it's like, "Come on, like six." It was the thought of having a procedure. I've lost a lot of weight since the beginning of my diagnosis and it continues to go down. So I knew the port would be really quite visible and it is. Even now there was a bit of vanity. But it was, yeah, I wasn't sure I was going to go for a port.

Natasha (08:52):
And then I just realized my own stupidity and like, "Of course." And also my treatment will last a year because being HER2 positive, I'll get the two hormonal treatments to round out a year. I'm glad now that I did it. So my experience, it was pretty straightforward. What I had not been counseled on was how much pain I would be in that night. It was really surprising. And I wasn't ready. I didn't have much more than a dusty old Vicodin from a tooth surgery and some Tylenol and ibuprofen. And I don't know if that was unusual, but I was really shocked by the pain that night.

Kristen (09:32):
Mine was tender and I couldn't really lay on it. I don't think I had the extreme pain that you had. And it's probably because I had a little more, I had a little more padding in that area.

Dr Aaron Fritts (09:45):
Where was the pain? At the base of the neck or down by the incision?

Natasha (09:49):
It was right down by the port hub.

Dr Aaron Fritts (09:51):
Yeah.

Natasha (09:52):
Yeah. If they had said, "It's going to be really painful tonight." I would've said, "Oh, okay, sure. I just had something put in my body." But it was a big surprise. And then I worried that there was something wrong with it.

Dr Aaron Fritts (10:03):
Right.

Kristen (10:04):
So can you describe what a port is and the procedure of putting it in and exactly what it does?

Dr Aaron Fritts (10:11):
Yeah. So a port, it's also been called mediport, power port, portacath. Usually port is part of the term that we use. It's a small reservoir that typically is placed in the upper chest just below the collarbone. So it sits in the subcutaneous tissues, basically outside the ribs, under the skin. And it's used for giving medications like chemotherapy, in the setting of cancer, but can also be used for giving fluids for hydration, for giving other kind of nutrients or if somebody's deficient in magnesium or potassium. It can be used for blood draws. It can be used for giving contrast for CT scans.

Dr Aaron Fritts (10:54):
And so it's very useful for nine times out of 10, I'm getting the referral for somebody with cancer who needs it for chemotherapy. And as you guys had already mentioned, not everybody who has cancer requires the mediport. My dad had cancer and the specific type of cancer he had didn't require the cadence of treatments where it required the mediport. And he had pretty decent veins so he felt comfortable with just getting blood draws by his arm.

Dr Aaron Fritts (11:23):
So starting with the pre-procedure, typically you'll get a phone call the day before from staff. Usually it's a nurse or maybe an MA and they'll remind you to be NPO for the procedure, NPO, meaning basically you need to fast because you're going to get some anesthesia. Typically six hours of no food or drink before you show up. And clearly liquids is a shorter time period but in order to clarify things, we just want to make sure the stomach's totally empty for anesthesia. So this prevents the possibility of getting sick and aspirating during the procedure if your stomach's empty. That's why we do that. If you're not NPO, like if you woke up and you had a bagel or even coffee with cream, then typically we'll reschedule, and that's just for your own safety. So just keep that in mind.

Dr Aaron Fritts (12:08):
So the patient then shows up in pre-op and the doc, I'll go visit, talk about the procedure, we get consent, we answer all the questions for the patient and their family. And then the staff will get the tech and the nurse will grab the patient, bring them over to the interventional suite, in our case. They'll also sometimes go to the cath lab, which can be shared with cardiologists. So when we say cath lab, typically it's wherever the interventionalist is working. They'll be placed on a fluoroscopy table. Fluoroscopy is a fancy word for real time X-ray, because during the procedure we're going to be using ultrasound and we're going to be using fluoroscopy. The ultrasound is used to access the internal jugular vein, like I mentioned at the base of the neck, and the x-ray is used to be able to see where the catheter goes inside close to the heart, inside the chest. And I'll get to that in a minute.

Dr Aaron Fritts (13:02):
The patient is prepped and draped under sterile technique. So we clean the area really good with a ChloraPrep or Betadine. The physician scrubs their hands really good, their hands and arms. And then they walk into the room with their hands clean. The team does a timeout with the sedation nurse, so that everybody's on the same game plan. "Hey this is Mrs. So-and-So. Her date of birth is this. She has no allergies. We're here to do a mediport of the right chest." And so that way, it's announced, everybody knows what we're doing, everybody knows the side, and we're good to go. And then you're given a combination of IV versed and fentanyl for the conscious sedation. And then once the patient's sleepy or feeling sleepy, then we start by putting a little dose of lidocaine under the skin, an injection of lidocaine.

Dr Aaron Fritts (13:49):
Actually we're going to get access into the vein first at that right internal jugular vein, using ultrasound guidance. We just take a skinny little needle, get access into the vein. And then we place a wire through that needle. It goes down into the superior vena cava, and then we place a little catheter that goes over that wire. The catheter stays there while we create a little subcutaneous space. You have a little incision that's about inch to an inch and a half based on the size of the port that we're placing. And that'll go about an inch just below, just south of the collarbone, if you feel, so it's right around here on the chest. And once we create that space, and that's an important time, that's when I'm going to be asking the nurse to look at your face to make sure you're not wincing.

Dr Aaron Fritts (14:38):
And that's when I say, "Hey, if I'm hurting, just say ouch, but you're going to feel some pressure." We create that pocket. And then we tunnel the catheter under the skin into that access site that's at the base of your neck. And then that catheter, under x-ray, we watch it and it goes down right at the cavoatrial junction, which is right close to the right heart. And we want it to be in that spot, again, to help so that when you're getting that chemotherapy, it's being diffused into a big bloodstream. It's not going to cause any sort of vascular injury or irritation or inflammation. And it's also so that blood clot doesn't form on the tip of that. And we can also do blood draws easily. So once the port's in place, then we suture it up with some deep absorbable sutures and some more superficial absorbable sutures. And then we place some Dermabond or skin glue over top of it to help seal it. And then we inject a little bit of heparinized saline inside to help keep it from clotting within the catheter itself.

Dr Aaron Fritts (15:35):
This whole procedure takes about 30 to 45 minutes. And then once we're done, we kind of wake you up a little bit, send you back up to day surgery, get you some food. And usually get you out the door within an hour, unless you're real sleepy or having some pain or discomfort, then we would address that. But that's pretty much it. So if you come in for a 8:00 scheduled port, I'm usually trying to get you out of the door by 11.

Kristen (16:00):
Wow.

Eva (16:01):
What an incredible technology. It really is remarkable.

Kristen (16:06):
It truly is.

Dr Aaron Fritts (16:06):
Yeah.

Natasha (16:07):
Yeah, that's how they put my port in. And it was a, I mean, I wouldn't say a pleasant experience, but it wasn't unpleasant at all. And I think I even took a nap. I mean, I don't remember being awake for the whole procedure, but I don't also don't remember getting fed. I'll have to talk to them about that.

Kristen (16:23):
No, I'm get any food on that one. I didn't get a cracker, man.

Natasha (16:28):
I'm curious, has much changed in the science of ports and what they look like and how they work in the past decade or so?

Dr Aaron Fritts (16:36):
Yeah, I would say so. I mean, so nowadays they're power injectable and they didn't used to be. So power injectable means that you can get a CT scan and they can really power inject the contrast into the port in order to get that contrast throughout the body when they're doing the CT scan. They didn't used to be power injectable. So you couldn't use it for when you got a CT scan, you would still have to have your vein stuck to get an IV in to get power injection. That was probably 20 years ago when they started developing those.

Dr Aaron Fritts (17:04):
But we still see non-power injectable ports out there, which is surprising. They've got dual lumen ports. So in case you have two different types of chemotherapy to be injected, and they don't mix well, you can have two different lumens so that those medications don't mix when they're being injected into the body. And then there's different port designs. One of the latest that I really like is the clear view, which is a full silicone body and it's a slim. That is what they call it. And that allows me to make a smaller incision for that port pocket. So they've become more sleek, I would say, so that there's just like less damage, smaller incision, again just more minimally invasive.

Kristen (17:46):
Hmm. Wow.

Eva (17:48):
So the port actually is under your skin after it heals. So, Natasha or Kristen, what does it mean when it's actually getting accessed? Are they going through then the skin with a needle and trying to hit a specific spot in the port?

Natasha (18:06):
It's a weird word that we use, access, but it basically means, yeah, like you're saying , putting the needle through the skin, but it's actually about the size of a dime, maybe a little smaller. So they have a large-ish area. They're not looking for like one tiny, tiny, spot that they need to find. So there's a little bit of leeway. And the needle's really sharp. It's like getting a flu shot. So, you can have the option of, they'll give you some lidocaine gel that you can put on about half an hour before the nurse is going to access the port, as we'll say, but I never actually used it because I'm not organized super early in the morning. And for me it's like maybe a second of pain, it's like an ouch. But I know a lot of other people, I think, Kristen, you've been using the gel, is that right?

Kristen (18:56):
Yes. I didn't want a second of pain. I didn't want a third of a second of pain. And so what I was advised to do is to really slather lidocaine cream, really slather that on. And then this is really like rudimentary, but to take a piece of Saran wrap and put it over it and tape it over it so that it stayed on there, and to do that ideally 45 minutes, half hour, 45 minutes before the blood draw. And there was one time that I didn't do it enough in advance and I felt it and I was like, "Oh, I never want to feel that again."

Eva (19:37):
When you go for the blood draw, is it sort of like an IV at that point and they leave something in for the day.

Kristen (19:44):
Yeah. They leave a tube. So what it is they go in and they do the blood draw and then they put a tube on there and then they put a bandage over it. But you walk around with like a little tube that's closed at the back.

Eva (19:56):
Looked like you just had a little contraption taped to your chest.

Kristen (19:59):
Yeah. And it was like a long tube and it was closed off so nothing was going to get in there. But if you use the lidocaine, it just feels like there's a little bit of pressure. And I don't know, I think Natasha's, she's a little tougher. She's a nurse. She can tell people to suck it up because she's done it now.

Natasha (20:15):
So, and is the port something that can be put in during another procedure? Like if you're getting a biopsy or a lumpectomy or does it have to be its own surgery?

Dr Aaron Fritts (20:27):
It can be, yeah. And oftentimes when the surgeons are doing it, like a breast surgeon, they do it at the same time as a lumpectomy to save you having to come back for another procedure. We see that pretty often. We sometimes will be asked to do a biopsy and a mediport on the same day, which also works out well because, again, they don't have to return for another procedure.

Kristen (20:50):
In using the port, so what happens when you are accessing that port? Like, do you just put the chemo in? How do you keep it clean? All that kind of thing.

Natasha (21:00):
It's interesting having taken care of ports as a nurse and now having one myself. I think as a nurse I was a lot more careful about sort of keeping the area clean for patients. It doesn't have to be a sterile procedure, but it's supposed to be kept clean. Now my port's just like under my t-shirt. I'm not really paying it very much attention. You want to keep it active. You want to make sure that it's still working, that this still has good blood flow. So for some patients whose port hadn't been used for maybe three or four weeks, they would come in and we would flush it just to make sure that there's no little clots in the pipeline. The last thing you want is a clogged port. That must be a nightmare for interventional radiology.

Dr Aaron Fritts (21:46):
Yeah. When we put them in, we pack them with heparinized saline. It's usually a 100 units per CC or milliliter, and that helps keep it open. It helps prevent clot forming. Typically clot will form like around the tip of the catheter. The other way that we get around that is if we place the tip of the catheter close to the right atrium, like right at the cavoatrial junction, that catheter is always moving, it's always kind of flapping in the breeze, and that helps keep blood clot from forming on the catheter tip and informing like a clot ball that would keep it from being able to be used.

Kristen (22:24):
I'm sure that you can speak to this because you see this quite often, my tumor was in the right breast.

Dr Aaron Fritts (22:29):
Yeah.

Kristen (22:29):
And so they chose to put it on the left side.

Dr Aaron Fritts (22:31):
Yeah.

Kristen (22:32):
And so can you speak to that a little bit? Like why would they do that? Because they explained it to me, but I think I was under?

Dr Aaron Fritts (22:37):
Yeah, that's a great point. And so that's the other important thing that when I'm talking to them before the procedure is I will say, "What side is your breast cancer on?" And if it's on the right, then I will say, "Look, I'm going to place the mediport on the left. And the reason for that is that I don't know what your treatment course is going to entail. It might entail radiation. It might entail further breast surgery. And so I want to make sure that port is out of the way of any other procedures that you may need done." So that's why I put it on the left side, after I've learned that information.

Kristen (23:10):
So have you ever had to take a port out and put it back in or what happens when the things go wrong with the port? I mean, we've talked about flushing and stuff like that. What are some other things that can go wrong and like what happens?

Dr Aaron Fritts (23:22):
Yeah. So after the procedure's done and I actually tell them about this before we start, but some of the things to expect, keeping a clean and dry for seven to 10 days. I'll tell them to when they're in the shower to put some cling wrap over it or some kind of plastic to keep it dry. We use absorbable sutures so you don't have to come back and have them removed, but we also put some skin glue over top of it to protect the incision. Usually it's like 10 days where the little scab is peeled off and it looks like a healed incision and you can go ahead and shower, you can swim, you can submerge in water, but you want to keep it clean and dry to prevent infection. Infection is the main thing, because if they come back in a week later, one of the sutures gave out and it's opened up and it looks red and they've got fever, then they're infected.

Dr Aaron Fritts (24:10):
And so we typically will just take it out at that point, especially if the incision is opened up. We're just going to take it out, put them on a course of antibiotics, bring it back after it's died down and put another one in. That's rare. And I like to think that's rare for me because I give them clear instructions on how to keep it clean and dry and making sure to keep out signs for infection. I don't want them lifting anything heavy for that period of time. Because again, let's say it's on the right side and they want to lift a heavy suitcase, that force can stretch that skin so that it opens up that incision.

Dr Aaron Fritts (24:43):
And then the other thing that I worry about is bleeding. So I've seen, and this is rare, but people who have been on blood thinners, like they've been on full dose aspirin and they either didn't inform anybody or it just kind of flew under the radar, where they come back with a hematoma around the port, blood formed around the port within the pocket. And the problem with that is, A, you can't use the port because it's got a big hematoma around it. So you got to wait for that to heal down. And then the second problem is that hematoma can get infected as well. So we usually start them on a course of antibiotics if that happens, do some warm compresses, let that hematoma settle down, and then bring them back a week or two later and make sure that we can actually use the port.

Dr Aaron Fritts (25:24):
Those are the main things that I educate the patient on and that we look after. And then sometimes, yeah, the port just stops working, for whatever reason. The third issue that can happen is ports can flip inside the pocket, especially if somebody has a lot of tissue in the upper chest and that port, if it's got a big loose vacuous pocket, that port can flip. There's patients that they'll play with their port and they'll actually accidentally flip it. And that's why I try to make a nice snug pocket so that's not even possible. Some people will tie the port down to the tissues. I don't think that that's absolutely necessary as long as you make a nice snug pocket. And again, the new low profile ports allow for that. And you see the flipping a lot less with the new low profile ports.

Dr Aaron Fritts (26:09):
And if they flip, then you go back in, you untwist it and you tie it down to make sure it's not going to flip again.

Kristen (26:15):
Wow. Talk about like some fidgeting.

Dr Aaron Fritts (26:19):
Yeah, yeah, totally.

Kristen (26:20):
I'd have to really want to fidget to make myself do that.

Dr Aaron Fritts (26:23):
I know. It's crazy.

Kristen (26:26):
Something that I was asked quite a bit. How long does the port have to be in before it can be accessed?

Dr Aaron Fritts (26:33):
It can be accessed immediately. Sometimes, when it's an inpatient and we're doing the mediport in, we just leave it accessed so that they can use it upstairs on the floor.

Eva (26:42):
If you had to guess, Dr. Fritts, how many times have you put one in? Are we talking in the thousands?

Dr Aaron Fritts (26:51):
That's hard. I don't know. At least hundred. I mean, it's definitely hundreds. It could be thousands. I mean, it is a very common procedure. I've done a good amount of them. And even in training, I mentioned working at a cancer hospital when I was in residency, it's one of those first cases that you kind of learn as a trainee. And because it's a venous access case, you learn your ultrasound skills, getting access into the internal jugular vein. You learn how to do a cut down. You learn how to suture. So it's a good teaching case for a trainee.

Dr Aaron Fritts (27:22):
That being said, you as a patient have the option to ask for the attending to do the procedure. Don't be shy. Ask who's going to do the procedure. If the person who comes in to get consent looks like they're 22 years old, ask them, "Hey, are you doing my procedure?" Because sometimes they just send the student or the resident in to get the consent, but you want to know who's doing it. And if you're not comfortable with a trainee doing it, that's okay. The team should respect that. And the most seasoned person, chances are, can put that in for you. It's an elective procedure. It's not an emergency.

Eva (27:57):
That's great advice.

Kristen (27:59):
Yeah. Can you speak to who should access this? Because I was told very clearly not everybody should be accessing this port.

Natasha (28:09):
I'm so glad you asked that question. I was going to ask something similar, because there's often so much drama around who's allowed to access this, especially for blood draws. And it can be upsetting to patients when they've made the decision to have the port to then be told, "Oh, but no, this person isn't allowed to and they're going to do your blood draw through your veins."

Dr Aaron Fritts (28:32):
Just like everything it takes experience. I don't think that, yeah, the patient does not want somebody just jabbing because a Huber needle is not small. They don't want somebody just jabbing a needle into their chest, hoping that they're going to reach that port. Usually most access centers where people are undergoing chemotherapy, those nurses are highly skilled at getting access, but sometimes a patient shows up for lab draws and the person's never accessed a port before and that can be kind of tricky.

Kristen (28:59):
An experience real quickly that I had, it was my first day going in to get my port accessed, and this has stuck with me and I just wonder how common this is if either of you know. The nurse in there, I said, "So when do I get this out?" I had it in like a week and a half. I'm ready to get it out. And she said, "Well some people, they leave it in because they think it's bad luck to take it out." And I was like, "Really? Because I think it's bad luck to leave it in, like you're going to have to have chemo again."

Dr Aaron Fritts (29:29):
I agree.

Kristen (29:30):
I was shocked, but go ahead. I'd love to hear what you have to say about that.

Dr Aaron Fritts (29:35):
I love taking them out because it's like I get to kind of celebrate a little bit with the patient. I love going up and talking to the patient before we take it out because I always say, "Congrats, you're done with your chemo. You're done with your treatment. High five." Yeah, I wish I had a bell to ring. It's like, "I'm done."

Kristen (29:52):
Huge.

Dr Aaron Fritts (29:52):
"I'm onto the next chapter." And you get to be part of that, which is awesome. My dad went through cancer treatment where he was done with his last treatment and that sort of relief that I could feel from him and sense from him, it made me want to kind of really emphasize that more with my patients as well when I'm taking their port out, it's just like, "This is a big day. Let's celebrate it." I wish I could give them cake when they go up to like post-op or something. It's just good. It's a good feeling.

Kristen (30:22):
That's really good to hear.

Eva (30:25):
Natasha, in the beginning you talked about patients who went through chemo who did not have a port. And I want to ask you to tell us some of those stories or at least one so that we can understand, if we're trying to make the decision, what we might go through if we didn't have one.

Natasha (30:43):
Yeah. I have memories from that as a nurse, but actually an experience this last infusion that I had when my port was accessed in, I don't know, it's a second really, and there was a lady in the chair next to me who I think she was on her third treatment, and an older lady, very anxious even coming in. You could see that the whole experience was not good for her. And she had made the decision not to have a port or it hadn't been offered. I mean, I don't know the background. And the nurses were having such a hard time finding her vein. They were using this thing called a vein finder.

Dr Aaron Fritts (31:25):
Yeah.

Natasha (31:25):
Which is like you've gone like one step beyond just feeling for a vein. You've now gone for a machine looking for a vein. And there's kind of an unwritten rule in nursing that you try three times and then you pass it on to somebody else because as a nurse, your anxiety is getting higher, but also the patient has completely lost confidence in you to be able to find a vein.

Natasha (31:48):
But we were into like a 40, 45, minute attempt to find veins in this poor lady, who's crying. And I have to watch myself sometimes and remind myself that I'm a patient when I'm getting my treatment and not a nurse and it wasn't my place to be doing it at that point. But I did say to her nurse, "Talk to her about getting a port." I don't know why. It just seemed to add so much more stress to her day and make it so much longer. And as I said at the beginning of the show, like a lot more stress for the nurses, it takes a lot more time and it's a horrible feeling not being able to get an IV into somebody. And I'm guessing you can get a port halfway through your treatment, Dr. Fritts, is that right? It's not a decision on day one or nothing. Is that right?

Dr Aaron Fritts (32:39):
Yeah. No. I mean, because if you think about it, people have issues with their ports and we ended up having to replace them. I don't think there should be a reason why you can't just get one later, unless they're on some sort of blood thinners or something like that. But even then we just pause the blood thinners and put the port in. So, yeah, I wouldn't see a reason why.

Natasha (32:57):
I felt very happy with my decision when I was seeing what this poor lady was going through. It seemed an unnecessary stressor for what's already a pretty stressful day.

Eva (33:09):
Before we say goodbye for the day, I want to ask each of you, from your perspectives, which are similar but also extremely different, what advice would you give to somebody? If you could only tell them one thing when they're about to go in for this, what would each of you say? Why don't you start, Kristen, and then Natasha, and then Dr. Fritts.

Kristen (33:35):
What keeps going through my mind is that it makes it so much easier in a process that's really hard. When you're going through chemo, when you have a breast cancer diagnosis, the last thing you want to do is have to think of anything else. And you want something that is going to reduce the amount of pain, the amount of frustration, and simplify things. And that's what the port did for me. I feel like I'm getting sponsored by a port company by saying that or something, but if breast cancer treatment can be streamlined, this was like a little teeny piece that was able to streamline it a little bit for me.

Eva (34:15):
Natasha?

Natasha (34:17):
Yeah. I would second a lot of what Kristen said. I mean, I must confess, I don't like looking at it. Mine's very visible. Even the catheter itself is very visible. But I have a long day when I go for my chemo, I'm also doing the cold caps and I get four drugs. So to be able to do the blood draw and to start the chemo within like a second of sticking a needle in the port rather than fishing around for a vein like they did for that poor lady last week, I have no regret at all. But I actually do have, I do have a question. When I had my port placed, I came out with a package, including like a medical bracelet and a card. And am I supposed to wear the medical bracelet and have the card in my wallet? Or is that just like a PR thing? And I guess this is to you, Dr. Fritts. Should I have taken that seriously?

Dr Aaron Fritts (35:16):
It's for the power injectable aspect of it. So if you're going to get a CT scan, they would probably like you to wear that bracelet so that the tech knows, "Oh, this port is power injectable so I can use it for the CT scan instead of having to put an IV in you." That's usually what those are for.

Natasha (35:32):
It's not something you can see just by looking at the port itself from the outside?

Dr Aaron Fritts (35:37):
Not from the outside.

Natasha (35:38):
Okay.

Dr Aaron Fritts (35:38):
You can do an x-ray and it says CT, like a lot of them will say CT on the inside so that you know. But yeah, that's what those are for.

Eva (35:46):
What other messages did they send you through the x-ray? Does it say like?

Kristen (35:52):
Wait, Eva, do you remember us talking about this? I mean, it was really early on. I said something about, because I got the documentation too. I said, "Oh, I have a smart port."

Dr Aaron Fritts (36:01):
Right.

Kristen (36:01):
We talked about, is it going to send you messages? Is it tracking you?

Dr Aaron Fritts (36:08):
Right.

Eva (36:08):
That would be great.

Dr Aaron Fritts (36:09):
That would be cool if the app tells you you have clots forming on the inside or something. That's what it's for. And my advice for patients is don't be afraid to ask questions. This is kind of coming back to what we talked about at the beginning, it's like, there is misinformation online. There's a lot of good information online. If you're going to find information, go to a legit source like Mayo Clinic, or a big academic center usually will have a whole page dedicated to mediports, but also don't be afraid to ask your doctor questions. So when they show up just say, "Hi." Have them written down so you don't forget and be sure to ask these things. And if you're on blood thinners, let them know. Don't try and hide that because that can cause a hematoma and can cause issues. So that's my main advice.

Natasha (36:59):
So would you get a port?

Dr Aaron Fritts (37:01):
I would, for sure. If I needed chemotherapy regularly I would definitely get a port.

Kristen (37:05):
Well, and that's not going to happen. And I can say they took my port out and there's just a little bit of a scar left.

Dr Aaron Fritts (37:13):
Yeah.

Kristen (37:14):
And I can massage that and it can go away, but it's like a little badge of honor, now. I will say that. It's a weird tattoo kind of club situation, maybe.

Eva (37:27):
Thank you all so much. This is really, really, really, really interesting. What I'll put in the show notes is a couple of links to good info and maybe you can help me just confirm those, Dr. Fritts. I'll send you some and we'll-

Dr Aaron Fritts (37:40):
Yeah. And if any patients want to take an even deeper dive into mediports and how they're done, BackTable has an episode, Episode 153, where Chris Beck and I talk about the procedure in detail, and we're talking about different techniques and stuff, but we also cover a lot of this. But if you want to kind of hear more about that from the physician's perspective, it's Episode 153 on backtable.com.

Eva (38:03):
Yeah. I'll put that in the show notes too.

Dr Aaron Fritts (38:04):
Sure.

Kristen (38:05):
Great.

Dr Aaron Fritts (38:06):
Thank you guys.

Kristen (38:06):
Awesome. Thank you for your time. Thank you.

Natasha (38:07):
Thank you.

Eva (38:11):
Thank you for listening to Breast Cancer Stories. To continue telling this story and helping others, we need your help. All podcasts require resources, and we have a team of people who produce it. There's costs involved and it takes time.

Kristen (38:25):
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Eva (38:40):
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Kristen (38:59):
You'll get notes and thoughts from me related to each episode and links to the most useful resources for all the breast cancer things. So if you have chemo brain, you'll be able to just go read your email, find anything we talked about on the podcast without having to remember it.

Eva (39:14):
The link to sign up is in your show notes and on the newsletter page at breastcancerstoriespodcast.com.

Kristen (39:20):
We promise not to annoy you with too many emails.

Eva (39:25):
Thanks for listening to Breast Cancer Stories. There's a link in the show notes with all of the resources mentioned on this episode and more info about how you can donate. If you're facing a breast cancer diagnosis and you want to tell your story on the podcast, send an email to hello@theaxis.io. I'm Eva Sheie, your host and executive producer. Production support for the show comes from Mary Ellen Clarkson. And our engineer is Daniel Croeser. Breast Cancer Stories is a production of The Axis, the axis.io.