Having surgery and removal of lymph nodes

Telling my son was the hardest part. I left it until two days before the surgery. I seriously thought about not mentioning anything until it was over, but I realized that if anything should go wrong he might feel betrayed or angry. I wrestled with the question, “Is omission the same as lying?” I’m pretty sure I have never lied to him and I hope I never will. Omission could also be defined as protection - I wanted desperately to protect him. In the end, I decided to be straight but simple; keeping it about what is and not venturing into what might be.

I rehearsed something along the lines of, “I’ve got something to tell you, but I don’t want you to worry…” It sounded stupid as everyone worries when a sentence starts with I don’t want you to worry. “We need to talk…” is equally threatening. I can’t remember how I started it, but I know it took three attempts to get the words out of my mouth. I went to speak but choked with emotion each time. He sat calmly, watching me with soft eyes and staying free of expression or interruption. I loved him for that; it said “take your time, I am fully present and supporting you.”

When I did speak, he held my gaze and encouraged me to keep talking until it was all out. He didn’t say much more than, “Will you be okay?” I felt like I had thrown something ugly or dirty into his world and he had responded by wiping it off and letting me know that it was all taken care of. Quiet, understated strength – how classy!

He drove me to the hospital at 6am. I was calm and chatted to other patients as we waited to be signed in. By 8am I was back at the mammogram department to have the hook-wire inserted. The procedure was similar to the last one, but this time I had taken a Panadol, which made a lot of difference to my comfort. The staff were more considerate and interactive this time and that also helped. I was back on the table with the whole in the centre and my breast was back in the vice again. I was given a local aesthetic and the needle gave only a slight sting. Two thin wires were inserted into the area where the calcium deposits were. Where the wires cross is the area the surgeon will excavate. The mammogram took about 1/2hour as the measurements need to be exact and a number of angles need to be taken. Between takes a nurse rubbed my shoulder and spoke softly to reassure me.

I was then taken to another area to have dye injected into the lump and then more mammograms were taken and measured. (Normal mammograms not the one with the vice) This is to show the surgeon which lymph nodes are the most likely ones to take up any cells if they have moved outside of the tumour. The big prayer is that all the nodes will come back clear. This procedure was mildly uncomfortable, but the girl was gentle and considerate and kept me informed throughout.

I was then taken back to the admissions area and sat with about 30 other people waiting for surgery. My op was booked for 1.30pm, so I was lucky that I had been allowed to have a light breakfast before 6am and fluids up until 10am. Many in the waiting room had not been allowed to eat or drink from midnight and they were now becoming quite grumpy and impatient. Having a theatre booked at a public hospital is an estimated time only as the emergency department has priority. Some people waited there all day and were told about 4pm that they would not get in until the next day. My surgeon sent someone to let me know that he was also waiting and that he estimated it would be around 3pm before were would get in. By 4pm I was taken to a room and someone else came up to say that Ming was prepared to come back and do the op at 8pm.

I was wheeled down to theatre, had a mask put over my face and told to breathe deeply… it was goodnight Sonya.

I was back in my room by 10pm feeling alert, hungry and thirsty. I was in no pain at all and chatted happily with two other patients as I ate sandwiches and drank tea.

The nurse woke me at 6am and asked if I wanted to pee. “Why on earth would you wake me up to ask me to pee?” (Like I wouldn’t have done so, on my own accord, in my own time.) She explained that I needed to pee as I needed to pee out the blue dye within a certain time. I was really annoyed with her and argued that as she had woken me up she should make me a cup of tea. She argued that breakfast was not until 8am. It became mildly tense between us before we agreed that I would pee and she would tea.

I felt really good, no pain; just a mild tightness and a little discomfort with a drip hanging off me. That is, a thin plastic hose was inserted into the wound so that lymph fluid could be drained down into a plastic container which was clipped to the bottom of my shirt. It was later explained that a nurse would come to my home each morning to measure and empty the container, which looked like a plastic CD case. Apparently, years ago, people needed to stay in hospital for days just for this one reason. Someone sensible decided it would be better and cheaper to send people home and have nurses do a daily round to clean and dress wounds and measure fluids. I was able to leave hospital the day after surgery.

Mary, Ming’s assisting doctor, came to tell me that all had gone well and that the main lymph node had come back clear. The other nodes would take a few days to be tested, but this was the best news as it was the most likely node to have picked up cells if any had spread. Relief swept over me and I realized I was breathing again. When my sister showed up you could almost hear us sing lah, lah, lah, like the little pig did in the movie Babe. I wanted to dance across the lawn and twirl in a full skirt. By 11am we were sitting in a trendy restaurant having a big breakfast and laughing. What a beautiful day. The people were friendly, the food was terrific, the location and buildings and cars and street noise – all of it – Magical!

When I finally got to see the damage, I was amazed at how clever Ming was and how lucky I was. Almost no swelling or bruising and only small thin wounds up near the armpit. I could feel a small dent about the size of a finger print, but couldn’t see anything other than that. Ming said later, that he had taken about one and a half inches of tissue, but he must have been very skilled to get that without disfiguring me. I healed very quickly and the drip bag was taken off in 4 days instead of a week. By the end of the week, the wound was so clean that I stopped applying adhesive bandages. The left breast was back to normal, the right breast was still a bit stiff and tight but good enough to manage my physiotherapy with relative ease.

I am so lucky, so grateful and so happy. I feel like I have been given ‘a get out of jail free card’. I’m alive and loving it and life goes on. I can now admit to myself that I have been scared. I have been so focused on getting through this, without allowing fear to trip me up, that I can almost melt from letting myself relax.

Sonya Green www.reinventingmyself.com

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