pre-op discussion

My sister and brother-in-law came with me for my pre-op meeting with the surgeon. It’s a bit like being a bunny hit by headlights at these meetings; the mind reels from too much information. The surgeon (Ming Yew) is beautiful; calm and direct. Each time I have spoken with him, I have had the impression that his world is extremely fast and efficient, and yet when he is talking to me I am the only person who exists. There is a quiet gentleness about him and he radiates warmth and sensitivity, but I also know that he knows his stuff and that this is not just a job to him – this is who he is – this is his purpose in life.

Prior to the meeting we met with a lovely lady called Leslie. We filled in a questionnaire and she explained that all the info goes to a database which is used worldwide to be used for future research purposes. She outlined what would happen the day of surgery and answered our questions and generally put us at ease. She also measured me for a new soft bra which would be given to me as a donation from the Berlei Lingerie Company. Good on Berlei!

Ming explained that the left breast had pre cancerous cells and that I was going to need 2 lumpectomies. I argued that if they were PRE cancerous then why would I not wait and see what happens. Isn’t it possible that they would disappear on their own? How could we know if and or when they would even become cancerous and why fix what isn’t broken? He said that once the cells become cancerous they would spread and that’s when it becomes very serious. They first move into a lymph node and then another and then off and away. The worst thing that can happen is that the cells will then travel to other parts of the body. Taking out the pre cancerous cells is a matter of getting them out of there - before they have a chance to move. I wanted to take a gamble; I wanted to believe that they would go away or at least wait until I felt a small lump and then take it out. Really, I just didn’t want to have a great big dent in both my breasts; I didn’t want 2 operations, I had only just come to terms with the main one and I wasn’t willing to double the trauma.

I wanted more time, I wanted to make an informed decision, and I wanted other options. Ming was patient and answered all of the questions and concerns, but really, I am sure he has to deal with this all of the time and he must just think “Denial” but he didn’t show it.

It only took a few minutes to realize that leaving the pre-cancerous cells would ultimately do my head in. They could take only a month or two to activate or they could take a few years. I had to admit that I would feel like I had a time bomb inside me if I didn’t remove them now. He said the main lump would require the removal of about 1” of tissue and probably about the same for the other breast. He expected that I would be slightly disfigured and might have almost a ¼ of each breast indented. I felt lucky that we were talking the armpit side of the breast and not the cleavage which would have been more noticeable.

He mentioned that I would be injected with a radio-active dye and then an x-ray would show which lymph node would be the first to take up any cells if any had moved from the lump. I assumed that lymph nodes would work systematically for all women, but it was explained that that is not the case. Years ago, Surgeons took the entire breast off and anywhere from 20 - 40 lymph nodes. It sounded like they had to go digging around blind to find the lymph nodes. Obviously that would have been, in many cases, totally unnecessary. Lymph nodes don’t just follow a pattern of one, two, three, so the dye and x-ray system makes tracking the path more exact. They send the first (Sentinel node) to pathology while doing the lumpectomy and usually get the results back before the op is finished. If the sentinel node is clear they take about 3 others to be further tested as an added measure. If the sentinel node comes back with cancer cells then they take more nodes and keep tracking, as in the worst case scenario, the cells could escape and take up somewhere else in the body.

My left breast, with the pre cancerous cells, did not require lymph node removal. However, my lump was easy to get at because it was near the surface of the skin (rather than deep within the issue) so it could be felt. Pref cancerous cells can only be located by referring to the mammogram images. Ming explained that I would need to come to the hospital early in the morning to have a hook wire inserted prior to the operation later in the day. A hook wire sounded like a crochet hook going in and fishing out the cells. But no, a hook wire is going back into that bloody awful vice and having two thin wires inserted into the breast and having mammograms taken for exact measurements. Where the two wires meet or cross is the exact location of the cells and the surgeon will follow the wires and cut into this area and remove the surrounding tissue.

After the meeting we spent more time with Leslie and she explained the importance of physiotherapy. Having lymph nodes removed from under the arms can cause lymphedema which can cause swelling of the arm and an increased risk of infection. I already knew that the lymph system was a major part of the immune system and as I was relying on my immune system to get me out of this nightmare I took her advice seriously. We also spoke about massaging the scar area with vitamin E to soften the scar tissue and aid healing. We asked her a heap of questions and she seemed to answer them all clearly and with great consideration.

We couldn’t help but feel immensely impressed with the whole system at Royal Perth Hospital. I am a public patient with no health cover other than Medicare. I can’t imagine that private cover could possibly have more to offer. These people were amazing; I came away fully informed, feeling totally confident and more than willing to trust these people with my life. Cancer was not a life threatening disease anymore; it was just an inconvenient, scary little bugga, whose days were numbered. I had gone there thinking I would be talking about cancer and surgery, but really, I went there to talk about healing and to meet the people who could save my life.

It was truly wonderful to have my sister and brother in law with me. They were so great to talk with afterwards as they had their own questions and interpretations to share. I can’t ever remember having such a need for support and as usual they really came up trumps. Being able to say anything, good, bad or ugly, and having someone listen, laugh, cry and worry with is unbelievably important and stabilizing.

I actually felt rather elated. I was so happy to have support and professional help. I was so lucky to have breast cancer (it’s really only fatty tissue) as opposed to having cancer in a vital organ. I was so lucky to have the option of a lumpectomy rather than a mastectomy. And so, so, lucky to have caught it in its early stages. I I can get through this it will be a breeze but it now all depends on the lymph nodes coming in clear. Time to pray…

Sonya Green www.reinventingmyself.com