…and NEVER come back!

Success! It’s finally gone! I finally reached the point where I was able to have the drain removed. This happened yesterday, so today I was able to resume a more “normal” life, as in I was able to have a full shower! And oh yeah…return to work too!

In other exciting news, I had my follow-up appointment today with the Surgical Oncologist, where we discussed the results of the pathology report from my surgery. The results indicated that of the 12 lymph nodes removed from my underarm, four of them were cancerous. This wasn’t really big news, as the Oncology team was pretty sure beforehand that there were at least three of these nodes that were “bad guys”.

The results also included the pathology on the primary tumour that was located in my breast. The report indicated that only 5% of the cells in the tumour itself were still cancerous. As many of you know, I like to get grades closer to 100%, but in this case, I’ll take that 5% and smile from ear to ear! When the surgeon removed this tumour he also removed some of the tissue surrounding it, called a margin. More importantly, the report indicated that the whole margin was deemed to be “clean”, that is, there were no signs of cancer in the surrounding tissue. What does all of this mean? Well, from all indications of the pathology report, not only did we make the right call in opting for the less invasive surgery of the lumpectomy, but even better, the surgeon got it all.

Recovery is going pretty well. Both incisions are healing nicely and I’m happy to report that I am now staple-free! Being my squeamish self, the two things that I was most dreading about the post-surgery period were the staples and the drain. At least the staples are now gone and I managed to not ever look at them…not even once 🙂

While there is less metal in my body now, I can not say the same for plastic tubing. Yep…the drain is still here. As I may not have mentioned much about the drain before, I will explain a little bit about it now. The lymph nodes in our bodies move a fluid called lymph around inside of us. Now that the lymph nodes have been removed from my left axilla (underarm!), the lymph needs somewhere to go, and for now, that somewhere is a Jackson-Pratt Drain. This drain (also called a JP Drain) is commonly used as a post-operative drain for collecting bodily fluids from surgical sites. The device consists of an internal drain connected to a grenade-shaped bulb via plastic tubing (Thanks Wikipedia for an excellent description!).

Since I have had this drain for over a week now, you may be wondering what happens with all the fluid that is collected in the bulb. Well, the super squeamish patient (me!) is responsible for emptying the fluid that collects in the bulb into a measuring container. Three times a day. Great fun! The fluid has to be measured as the volume of the fluid is the indicator for when the drain is ready to come out. Once the daily cumulative amount is less than 30 ml for two days in row, the drain can be removed. I’m not there yet, but I’m getting close! I’m still hopeful that the drain will be ready to be removed by this Sunday. Especially since it is getting somewhat uncomfortable around the drain site, despite my repeated use of extra-strength Tylenol.

Another big part of recovery is figuring out what I can and cannot do. My range of motion for my left arm is very limited right now. I’m supposed to do normal things using my left arm such as brushing my teeth and eating, but I can not do anything that involves reaching too far from my body or lifting my arm above my shoulder. In case you don’t already know, I’m left-handed, so having this arm become somewhat useless is challenging! And, the “no lifting above the shoulder” rule actually applies to both arms, as when you reach with one arm, it creates strain on the other. So yep, limited.

It has also been a fun time with the post-surgical effects on my left arm. The removal of the lymph nodes involves the cutting of some nerves, so this does some weird things over and above the pain and discomfort around the incision area. It makes the whole arm quite tender along with some other funky sensations. One of these is called cording. It literally feels like there is a cord running down my arm that is being pulled taut. This feeling is not constant and has only been really annoying a few times so far. The other weird thing that is happening is that the skin on the inside of my upper arm feels like it is chafed. I keep checking it repeatedly, and it’s not actually chafed. It just feels that way. Like I said…weird! But all of this is normal and most likely will go away over time.

Beyond this, other than not sleeping well, everything is progressing well so far. Once the drain is removed I can move on to the actual rehab portion of this whole thing. The rehab program will get me ready for the radiation treatments. In order to have the treatments completed, I need to be able to comfortably keep my left arm raised over my head for 20 minutes. The Radiation Oncologist will not start my treatments until I can meet this physical requirement. Despite the fact that radiation for me is insurance, not treatment, it is still in my best interest to be rehabilitated quickly so we can get this show on the road!

So here we are. Surgery is done. And I am quite possibly cancer-free. I’m not sure I have embraced this concept yet, as I don’t think I have ever fully embraced the fact that I ever had cancer in the first place!

My surgery took place on Tuesday, and as I briefly mentioned before, it all went very well. I believe the surgeon referred to it as being “textbook…everything went according to plan”. And from my perspective, I would wholeheartedly agree!

I had been a little more apprehensive about surgery when I found out about the wire-localization procedure, but that part turned out to be a breeze! Before the procedure began, the nurse told me that the wire-localization is way easier than the biopsy, so that was very reassuring. It also helped that I got lucky again, and ended up with the same doctor who did my original biopsy back on June 1st. This made me feel more comfortable since I had dealt with her before. Plus, it made me feel good to be able to show her my success story of how much the chemo had shrunk the mass that she identified 5 1/2 months ago!

After the wire was inserted, I went to pre-op, where Dr. Reedijk, my Surgical Oncologist, stopped by to review the plan for the day. Then the pre-op team did their bit to get me ready for the surgery by checking my vitals, getting the IV ready for the anesthetic, and giving me a nerve blocker. I was pretty comfortable as I was able to lie on a gurney in pre-op for all of this. Everyone was really great with keeping me busy which prevented me from worrying about what was about to happen.

A few minutes after I was all set to go, Dr. Reedijk returned to pre-op and started wheeling me down the hallway, where he was joined by the Anesthesiologist. I found it a bit odd that the surgeon was moving patients around. Then Dr. Reedijk tells me that he was in the O/R ready to go, and got tired of waiting for someone to bring me to him, so he decided to get me himself! I received total VIP treatment!

Once in the O/R, I met the rest of the surgical team, and after I asked them if they’d brought their game (I really did ask that!), the Anesthesiologist did his thing and the next thing I remember is waking up in Recovery.

I did not excel in Recovery. In fact, I was so slow to recover that I actually asked the nurse what time they closed. I told her that I’m used to being an overachiever and that not recovering quickly was a foreign concept for me! But eventually I did feel well enough to start drinking some gingerale, which perked me up enough to have Andrea, my “big sister”, come in to help me get ready to be discharged. And for the first time in my life, I was transported in a wheelchair!

As I have mentioned before, I was able to return home on the same day as the surgery. I have been happily recovering in my own bed for the last three days, with help from some narcotics! While I am still taking Tylenol for pain management, all is going well so far. I am eating fairly well and getting lots of rest and fluids. My parents are staying with me for the time being to help me with functioning on a day-to-day basis. Now that a few days have passed, I am pretty mobile (when I’m awake!), but I am not able to do certain things, like anything that involves reaching, lifting heavy items, or repetitive motions, like vacuuming or sweeping…(gosh darn it!)

So it’s done and it’s all onward and upward from here. But before moving on I would like to circle back to the beginning of this week. Heading into surgery I received many hugs, emails and texts, all of which were special and provided me with lots of encouragement, hope and many, many prayers. I would like to tell you about one in particular. A colleague (a friend!) is on vacation in Japan this week and on the day I had my surgery, he visited Kinkaku-ji, The Golden Pavilion, a Zen Bhuddhist temple in Kyoto. While there, he lit a candle for me – a special “Cancer – Get Well” candle (it may be hard to see in the first photo, but there is a little sign over the box of candles). I’m sure that the candle has burned out by now, but the photo and the prayer are everlasting.

All went well today…I survived the surgery and am back home, happily resting in my own bed! A more robust update will follow…in a day or two 🙂

My surgery will be taking place in approximately 36 hours. There will be a few things happening that day, which I will discuss in a moment. Before getting into the details of that, I have some fun news to share. It looks like my hair has started to grow back! My head still looks like I have baby duckling fuzz all over it, but there is distinctly more of the fuzz! No real signs yet of colour or texture, but at least it’s on its way. Now on to the slightly less fun stuff…

Tuesday’s surgery consists of multiple procedures: the axillary node dissection, which removes the lymph nodes from my left underarm, and the wire-localized lumpectomy, which removes what remains of the tumour from my left breast. What does “wire-localized” mean, you may ask? Well, that is an excellent question and it probably would have been a good for me to have asked the surgeon when I met with him back on September 28th! I was just so excited to have my surgery date that I neglected to ask an important question or two! Needless to say, I became enlightened when I went to my Pre-Surgery Clinical Assessment two weeks ago.

It turns out that knowing about wire localization is kind of important. What it means is that before the aforementioned surgeries take place, I will have a completely separate procedure where a radiologist will insert a wire into my breast to mark the location of the tumour. This wire will guide the surgeon during the lumpectomy. I have to be awake for the hour-long wire localization procedure. There will be some local freezing, but I’m not exactly thrilled about the “awake” part (as you may have noticed by now, I’m a fainter!), but I will get through it. Once the wire is inserted, I will be ready for the actual surgery which is scheduled to start at 10 a.m. The lumpectomy and the dissection will take about two and half hours to complete. Thankfully, I get to sleep through the rest of this.

Despite the multiple procedures happening on Tuesday, this will still be a day surgery. One of my earlier apprehensions about all of this was the prospect of staying overnight in the hospital. Since Women’s College Hospital is one of the few hospitals that treats these procedures as a day surgery, I will actually sleep in my own bed that night. Knowing this helps, as as I am getting a bit nervous about Tuesday. However, I keep reminding myself that this is the next step to becoming cancer-free. I have to do this. There just isn’t an alternative!

I have been woefully remiss in “keeping up with myself”… however, this means that I should have lots of updates, right? So, moving on to the good stuff…

Going back to the last round of the nasty Docetaxel that I received on October 12th, I can start by reporting some good news…I did not end up at Emerg…I repeat, I did NOT end up at Emerg! This was a breakthrough on my part. By increasing my liquids and making sure that I wasn’t overly bundled up in my comfy clothes, I managed to keep my temperature below the Danger Zone of 38 degrees. I did register temperatures that were a bit feverish for about a day, but nothing registered high enough that meant having to visit my local hospital. Don’t get me wrong, it’s an excellent facility with wonderful staff, but I feel I’ve already spent enough time there for this year!

What was more challenging is that the last round of Docetaxel really knocked me off my feet. For the other rounds of chemo, I have typically bounced back within a week, but the October 12th round really took a toll. It was almost two weeks before I felt “normal” again. Meaning my “chemo normal”, not my “normal normal”! And of course there were other fun things happening like losing the ability to taste. Everything tasted like metal for about 10 days. There was zero flavour and basically everything tasted the same…BAD!!! Thankfully that issue rectified itself eventually, so I can now enjoy consuming food and drink again 🙂

I had my 7th and last “big” treatment at Princess Margaret this past Thursday. This treatment consisted of the last dose of Perjeta (the $20K drug) along with a dose of Herceptin. The good news is that with these drugs I don’t need to get the immune-boosting injection of Neulasta. And while there are still side-effects from the two drugs,  they are not knocking me out the way the Docetaxel does, so these last few days have been a lot more pleasant.  I’m pretty tired, my legs are quite sore and I’m fighting off a cold, but at least I feel significantly more human that I have after the other treatments!

This round has also been made more pleasant with a visit from my friend Heidi who has flown over from the U.K. to help take care of me this week. Heidi and I met on our first day of Grade 11…so that was a few decades ago! We haven’t always lived in the same town, province, or even country, but somehow our friendship has lasted 29 years. And since she’s been living with me for three days and we haven’t killed each other yet, I think we are on track for at least another 29 years, if not more!

All in all, I’m looking forward to the rest of this week. And the countdown continues…by this time next week I will be in the recovery room post-surgery! Surgery day – November 14th – is coming up fast, and I’m still pretty excited about it. I’m sure that I will soon hit an inflection point where I start to become more nervous than excited, but it doesn’t matter. As each day goes by, it means that I am one day closer to being cancer-free!