The Next Step

Yesterday I had an appointment with my surgeon, Dr. Topstad, to discuss surgery. She was very pleased with the effectiveness of chemo in reducing the size of my tumour. I was hopeful that I would not have to have any lymph nodes removed. However, that is not to be. There is a fairly new procedure called sentinel lymph node biopsy wherein a blue dye or a radioactive substance is injected into the nodes. The sentinel nodes, the ones that pick up the dye first, are the ones that are draining the breast of fluids that may contain cancerous cells. The blue or radioactive nodes are examined under microscope. If no cancer is found the rest of the nodes are left in place. This procedure is not very effective for someone who has undergone chemo, like myself. Thus I will have lymph nodes as well as breast removed. One of my friends, who had one breast removed, said she wished she had had both removed. She finds an imbalance in the weight of the prostheses and the weight of her remaining breast. As a result she has frequent pain in one shoulder, even with regular exercise. I asked Dr. Topstad about having both breasts removed. I explained my concerns regarding imbalance, and also the risk of cancer in the second breast. She said that the imbalance concern is a valid one. The risk of cancer in the second breast is quite low. However, she said, the removal of both breasts, especially after chemo, is a difficult surgery. She said she would only perform surgery on one. If I still wanted the other removed I could do that in a later surgery. She believes that undergoing a second anaesthetic is preferable to having both breasts removed in one surgery.

Dr. Topstad is going to try for surgery on February 26th. She has to contact the Cancer Center to coordinate surgery with my schedule for treatment with the antibody Herceptin. I have an appointment for Herceptin on February 11th. She needs to make sure that surgery two weeks later is okay. If not, either the Herceptin appointment or the proposed surgery date will have to be altered. After surgery I will be in hospital one night for sure, and possibly two depending on how well I am feeling. I will have bandages and drainage tubes (to remove blood and lymph that accumulates during healing) for about ten days following surgery. Regular exercises for my shoulders and arms will be necessary for mobility. After surgery, the next step is radiation. How much radiation depends on the results of the pathology report on the tissue removed. At the very least it looks like I will have my chest wall radiated. This means going to Calgary or Edmonton. I will plan to go to Edmonton.

I asked Dr. Topstad about the best time for removing my PICC line and replacing it with a Porta Cath. She recommended that I wait until after my surgery. After my appointment with Dr. Topstad I went to the Cancer Center to have my PICC line flushed and dressing changed. The nurse Sonja told me that Herceptin is not hard on the veins like chemo is, that I have good veins, and that I should not need to have either a PICC or a Porta Cath. They are going to check this out with the oncologist and I will check it out with Dr. Topstad. It looks very likely that I will have my PICC line removed next week. Yay! I look forward to short sleeves and going swimming.

It is now a week since my last chemo. My energy levels are quite low. I still have some numbness in my fingers and toes. In addition, I have had some inflammation of the skin covering the knuckles on both hands. This is the first time I've had this side effect. It is looking a bit better today, though. I have not had any soreness in the roof of my mouth, or any difficulty swallowing so far. My taste buds do not seem to have been affected to the same extent as in the past. It is good to know that once I bounce back from these side effects I will not have to face another chemo treatment!! I truly feel like I've had enough!!