Having this condition gives you a whole body workout. It shoves you a million miles out of your mental, physical and spiritual comfort zones. You’ve all been great companions on the mental journey I’ve insisted on (over?) sharing. So for a change I thought I’d describe what’s occurred on a physical level.
At midday on Monday 12 August, my huge cloud of prayers, love and light and I were wheeled into theatre where two surgeons were waiting to do their work.
The first was the cancer surgeon, Dr. Leong.
For her opening trick, she performed two sentinel node biopsies, which will identify if any cancer has spread outside the breast (it better bloody not have.) Here’s my layman’s understanding of the process. On the morning of my op, in preparation for the biopsy I went through a complicated process to find out which of my lymph nodes was the first to take up the fluid – and potentially cancerous cells – from my breasts and into my body. So their unceremonious swan song was for each to receive three injections of radioactive dye. As the pathology unit had once again given Dr. Dreamy the day off, the needles were inserted by an old duffer with hairy nostrils who insisted on reiterating the fact it’d sting six times, and wincing each time he inserted one. If he was trying to reverse psychology me into making it not hurt, it worked. He then gave each breast a little massage to expedite the draining process (so weird I know! And I promised to give the ‘mental’ a rest.) Next I was to wait an hour before spending forty minutes having imaging taken by an exceptionally sophisticated and no doubt incredibly expensive camera. At the end of this process a technician took a thin-tipped magic marker and put an ‘x’ just inside the fold of each armpit, about 0.5cm away from where it gets tickly.
In theatre, Dr. Leong took a gamma machine to the armpit to help confirm the precise location of the first, ‘sentinel’ node. She then made the cut, found the node (good news, they don’t always make themselves known) biopsied it and prepared a sample for pathology. Twice. Performing this on the right side, where the breast has shown no signs of cancer and was removed prophylactically, is a sign of an extremely cautious surgeon. But there is no testing the nodes after a mastectomy so it was then or never.
She then went on to perform two kinds of mastectomy. On my right breast was the least invasive it is possible to have – known as ‘nipple sparing’. The incision occurred under the fold of my breast and the fat, tissue and nerves are scooped out, a bit like taking the flesh from a melon, leaving the skin and nipple attached.
On my left, I had a ‘skin sparing’ mastectomy, which is the second least worst type you can have. According to the MRI, which is the most accurate imaging tool available, there were signs of ‘abnormal activity’ right up to the nipple. You can attempt to ‘save’ the nipple in this instance but it’s risky. If you try when imaging suggests there’s cancer you are obliged to have the skin behind it pathologised during surgery to see if there are cancerous cells there. My surgeon told me the sample needs to be as close to the tip of the nipple as possible, as all you need is one bad cell to survive at the tip for post-mastectomy breast cancer to reoccur. But if you take the sample too close the nipple’s edge, you compromise its blood supply which means you could save the nipple during the mastectomy only to have it shrivel up and fall off down the track.
Can you believe this shit?
I will not know for certain whether the MRI was correct until this Thursday at 1.30pm, when I visit Dr. Leong for hopefully the last time to collect my pathology results and, I very sincerely hope, the all clear. Need more prayers and light and all that then, please people – having undergone the gold standard cancer treatment I have zero desire to go on a crash course in wigs and hats.
Anyway to be on the safe side my left nipple was removed during surgery. So on this breast the incision was made all the way across the middle with an almond shape cut either side of the nipple which was once again prepared for pathology.
Dr. Leong’s work was done.
Next up is Dr. Moko, my plastic surgeon. She inserts two expanders under my pectoral muscles. Each expander is a round plastic pouch about the size of a drinks coaster, and each will be injected with saline over the coming weeks as part of the reconstruction. She kicks the process off by inserting 100ml in each pouch, which explains how come when I wake up, my chest is not concave as I had expected it to be. It’s all kinds of wrong, but not concave. Anyway, back on the operating table four plastic tubes – attached to drains and surgical bags – are inserted a few centimetres south of each node biopsy site. Over the next four days they will collect a total of more than a litre of blood and fluid and will get in my way each time I try to use the loo or walk anywhere.
I am stitched up. At two sentinel node sites. Under my right area formerly known as breast. Across the middle of my left AFKA breast, pulling the almond shape closed on its way. The tubes on the drains are held in with a stitch. All of the stitches – read ouchies – are covered in masking tape and I’m brought out to recovery where I scoff an ice lolly. The whole process takes five hours.
Five days later, I finally leave hospital minus the drains. Because I am not allowed to get anywhere that is taped wet, I feel only semi clean and will remain that way for several weeks.
On day one back home, I was shocked to discover I could not manage even light duties and I’m to strip off the sackcloth and concentrate on recovering/getting over myself. As instructed, I take 4 x 2 Paracetomal daily to elevate my baseline pain threshold and control any further pain with a codeine tablet. The codeine works, but I use it sparingly because it extracts a price of nausea, dopiness and constipation.
I am able to take short walks, and know to turn back before I expect to need to. On Monday, I dialled in to my weekly directors’ meeting and enjoyed a long catch up of the happs both in the business and out, before excusing myself for a lie down.
I’ve been home five days now and while holding Theo is still impossible, I can feed him and play with him whilst he is in his high chair. The girls – having been reminded a dozen times – are respectful of my limitations and have adjusted pretty well, calling on me for stories and as a hair model. I’ve got about 60% motion in my arms. I can’t carry anything heavier than my phone or a cup of tea. I can reach forwards and partly to the side but crossing my arms in front or reaching high is a no go. I could do the Charleston and a robot dance, but not Saturday Night Fever.
Today, I went to see the plastic surgeon again for a further saline injection into the expander. I need a bit of a break before penning a post that will probably be called something like Needles, mirrors, tears and pain.