On 4 October I had my first Herceptin injection. Regular readers will know that this is a monoclonal antibody (I explained how they work here) which I have had intravenously during my last 4 rounds of chemo, along with Docetaxel and Pertuzumab. Its actual name is Trastuzumab but Herceptin is the brand name and widely used. Herceptin blocks the growth factor HER2 from helping the cancer cells to grow, and so the cancer cells eventually die. It has been shown to be hugely effective at preventing cancer from returning, so I have to continue receiving a dose of it every 3 weeks for a year in total. It took about an hour to receive it through an IV but now it's administered via a large needle in the thigh for a couple of minutes. Although this is much more convenient it bloody stings! My friend Jana came with me and distracted me and held my hand while the needle went in.
Next up was my pre-op assessment on 10 October, at my regular Breast Clinic in the West Wing of St Bart's. First they weighed and measured me again, so that they can calculate how much anaesthetic I need, then they took my blood pressure, took some blood for testing, and swabbed my nose, mouth and groin to check for staphyloccocus. I explained that I had actually had an outbreak of staphyloccocus aureous on my skin recently, but was on a course of antibiotics to get rid of it. It's highly infectious apparently, and can have major developments if not treated properly, so they have to control its spread in hospitals. Apparently if the tests come back positive, I will have to be last on the operating table that day, so they can scrub thoroughly after me.
Then I had to answer a whole heap of questions from a nurse, including whether I'd had general anaesthetic before, when I last had bronchitis, whether my ankles had swollen recently, and loads of other seemingly non-related questions. I had a general anaesthetic when I was a child for a multiple tooth extraction, I haven't had bronchitis since 2014 and yes, my ankles are swelling every day at the moment, in case you're interested. They are particularly concerned about some of the questions we're investigating to do with my heart, so they sent me off for another ECG and a doctor came to listen to my heart. Once again, the ECG seemed fine, but as I have an appointment with the cardio-oncologist next week, they're going to hold final judgement until then. Fingers crossed I'll be good to go for surgery on 24 October.
The patterns my heart makes
The nurse explained a little about what would happen which I will outline here for those of you interested. Firstly, the day before surgery, on Monday 23 October, I have to visit the nuclear medicine department for a Sentinel Node Scan. They'll inject some tracer near my breast and they track its progress in the lymph system by taking pictures over the course of 3 hours using a gamma camera. So basically I have to lie extremely still in a huge nuclear camera machine for the best part of half a day. Fun times. This will then guide the surgeon who will be removing my sentinel lymph node as well as the rest of my cancerous lump.
Then on the morning of 24 October I am not allowed to eat anything. Those of you who know how hangry I can get can appreciate that this is one of the things I'm most worried about. No food from midnight onwards and no water from 6am onwards. I'm going to get cranky! I also have to remove all nail varnish, and I'm not allowed to moisturise that morning or use an oil-based shower gel. I have to arrive at the hospital at 7am when I'll be greeted by the team and meet my anaesthetist. At this stage I don't know what time my surgery will be, as they decide on the day what order they will do everyone in.
So essentially the procedure is this. I am having two surgeries in one. Firstly, a Wire-Guided Wide Local Excision. This is the name of the procedure for removing the remainder of my cancerous lump. In the morning, they will use an ultrasound machine to guide a wire into my breast and they will leave the end of it right at the base of the remaining cancer. I will then have to go about with a wire hanging out of my boob until I head into surgery! This is to guide the surgeon, Miss L___, as she removes the cancer including a margin of healthy tissue so that we can be happy it's all gone. She will go down to the end of the wire and remove that along with the cancer. She will also take out the titanium clip which they put in there right back in February when they were doing my original biopsies.
And secondly, I'm having a Sentinel Lymph Node Biopsy. This is to check that the cancer has not spread into other parts of my body. The Lymph nodes are small, bean-shaped glands throughout the body. They are part of the lymph system, which carries fluid, nutrients and waste material between the body tissues and the bloodstream, and is an important part of the immune system. Cancer co-opts the lymph system in order to travel around the body and settle elsewhere, which is why it's possible to have Breast Cancer in your lungs, brain, and other organs. If my cancer has spread, it would do so via the lymph nodes in my armpit, so the surgeon is going to remove the first couple of glands and send them off to the lab, to see if they can find traces of cancer in there. The way they do this is quite funny. While I'm under anaesthetic, they inject my boob with blue dye, and then see where it goes. The first couple of nodes it appears in are the ones they will remove. They will take out 1-5 nodes (the average is 2.2). Apparently my breast can remain blue for up to 18 months after surgery! I think that Smurf Boob will be my new pirate name. Maybe I should audition for the next Avatar movie!
Once they're done, as long as there have been no complications, I can leave hospital the same day, and don't have to stay overnight. The lump and nodes will go off to a lab, and I will get the results 2 weeks later. If they have managed to take enough margin round the lump and my nodes are clear of cancer, I will not have to have any further surgery, and can go on to have radiotherapy a few weeks later. If the margins are not clear, or if there's cancer in the nodes, they will have to operate further.
I have been given an information sheet from Breast Cancer Care containing exercises I must do each day to ensure I get my full motion back in my right arm. There is a risk of Lymphodema, which is a permanent swelling of the arm due to there not being enough lymph nodes to fully drain from the arm and upper body. Also, I will not be able to have any blood pressure tests or blood taken from my right arm for the rest of my life! Let's hope my left arm can do all of that for me in future.
So now I'm feeling quite prepared for the surgery. I will take 2 weeks off work afterwards to recover, and hopefully will be fine to return after that.
And to further examine my heart, yesterday I had what's called a 'stress test' on my heart. This was quite a tricky test, I had to sit on a kind of exercise bike, but one where I was laying back at 45 degrees so they could put heart monitors around my chest and back. They set the 'bike' on a course which got increasingly difficult, and I had to keep pedalling in order to push my heart rate up. The tricky part was that they had to tilt the machine to the left in order to get the ultrasound wand and take photos of my heart. Riding a bike until your heart rate reaches 150, while tilted to the left so you feel as though you're going to fall off is quite challenging! But we made it in the end and they got all the pictures and videos they needed. I will see the cardio-oncologist on Tuesday for the results.
And my other hospital visit this week was on Wednesday, when I went back to the Royal London for the results of the biopsy on the skin tag I had removed a while ago. All good, I don't have skin cancer, hurrah! It was just a bundle of blood vessels so nothing to worry about.
One more week until surgery! It's a busy week at work but I'll be resting lots in the evenings and continuing to build strength and energy to help me see it through.
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