Surgery (and some cool research projects)

Yesterday was my surgery day, and it seems to have all gone well. Here's a little summary of the day. One of the things I was most dreading was having to fast all day before surgery, so we cooked up a delicious meal the night before. I've been getting creative with the contents of our weekly veg box, and this week we got some celeriac, so made a celeriac hash, with ham hock, mustard, gruyere and duck eggs. Absolutely delicious! I then permitted myself two pints of water at 5.50am on the morning of surgery, and that was it. We had to be at the Percival Potts ward at 7am, situated in the attic of one of the old St Bart's buildings. With pointed windows and a sloping roof, it felt more like a school dorm than a hospital wing! I had to give an extra urine sample so they could do a pregnancy test (hilarious!) and then was ushered into my own room, which was ridiculously overheated and the windows were painted shut. 

Then followed a stream of various people wanting various things. Firstly, a nurse to issue sexy compression socks for me to wear during surgery (to avoid blood clots), take my blood pressure, check allergies etc. Next up was a woman from the clinical trials unit at Queen Mary University, with detail of two programmes they were asking me to participate in. Regular readers will know of my desire to get involved in clinical trials and 'give back' to medical science and potentially help cancer patients in the future, so I was very interested. The first research programme is a tissue bank, and they are requesting that I agree to a piece of the tissue from my cancer being stored in this bank in order that they can conduct research on it, compare it with other cancer tissue, study its molecules and potentially see how it could respond to different drugs. Of course I complied and signed all the forms, totally happy to help out! The second programme is a huge NHS initiative run by Genomics England (a company owned by the UK Department of Health) and is called The 100,000 Genomes Project and is really pretty cool. This is a huge country-wide project and will definitely change the future of cancer treatment, so I was very keen to be involved. It will involve my whole genome being sequenced (Tanai was a bit jealous!) and it differs from usual research projects in that the data is not anonymised. They wanted to collect a blood sample and a sample of my cancer, and will use this to shape the personalised medicine of the future. In the not too distant future, people will not be routinely given the same old treatment as everyone else. No, their DNA will be sequenced and they will be given the appropriate treatment for their very specific needs. In order to be able to gather as much data as possible for this, they need to be able to access my entire medical history, and will continue to access it for the rest of my life, and beyond. It will be analysed by several global teams and compared with the 99,000 other genomes they choose to sequence. They will also contact me if any of the research on my sample unearths anything of interest or relevance to me. Of course I signed up straight away, and it feels great to be able to contribute to such a groundbreaking project.

My next visitor was the anaesthetist, a tall, skinny guy with an infectiously calm manner. He asked me various questions and explained what he would be doing later to get me ready for surgery. Not only would he administer my anaesthetic, but would also have to place a breathing tube down my throat in order for me to breathe during surgery. And after he left, my surgeon, Miss L___, and a registrar came to visit me. They asked me to explain in my own words what I thought was going to happen. They seemed content with my response and she then rather unceremoniously scribbled all over my chest just below my collarbone to remind her what to do later on, I suppose, so she didn't mix me up with any of the three other women she was operating on that day. We also discussed my allergy to the various dressings they use at the hospital, and sticking plasters. She said she would use a milder dressing, but we shall see if it works.

R = Right breast, WGWLE = Wire Guided Wide Local Excision, SNB = Sentinel Node Biopsy

Sexy compression socks

My first task for the day was to pop over to the West Wing and have a wire inserted into my breast so that the surgeon could later locate the cancer (I explained a bit about this here). When the ultrasound technician tried to find the remaining cancer she had trouble: apparently it has shrunk to less than half a centimetre! So instead of using the ultrasound to guide in the wire, I had to have it guided in while being compressed in a mammogram machine. Those of you who have had a mammogram will know how uncomfortable that was. This was because they decided to aim for the titanium clip which remains in my breast from the biopsy, rather than aiming for a tiny tumour remnant. They know that this clip was placed in the original tumour, so if they aim for that, they should catch what's left of the cancer. I suppose it's quite difficult for the surgeon to operate, when she can't see the cancer (it doesn't look any different from my normal body from the inside, I suppose). So she operates with all my ultrasound and x-ray photos all around her, guiding her as to where it is likely to be located in my breast. The wire helps with that, as she can just remove it and a bunch of tissue around the base of it, and hope she got it all. I wonder if in future someone will invent glasses that surgeons can wear that will give them the ability to see cancer.

As an aside, while I was having my ultrasound, the nurse in the room just happened to be the same nurse who was there in February when I had my first biopsies, F___. Back then, before I had even received my diagnosis, she held my hand through 9 painful biopsies, and was so kind and thoughtful, I have not forgotten it. I was so glad to have the chance to tell her how much that had meant to me, and thank her for her kindness.

So with a wire hanging out of my boob (no, really!) I went back to my room to wait. And I waited, hungrily, for hours. I was 3rd out of the 4 women having surgery that day, but I think they scheduled the most complicated op first. Finally, at 3.30pm, I made my way to the theatre. My lovely anaesthetist was there, and we had a delightful chat about hiking on the Isle of Skye while I slowly drifted off to sleep. And 3 hours later, I woke up! It really is quite remarkable, medical science. 

The other part of the op, which I mentioned before, was the removal of some lymph nodes. Having been injected with radioactive dye the day before, they apparently used a geiger counter to find where the radioactivity was collecting, and that, combined with the blue dye, helped them locate the sentinel nodes to remove. I just find that so astonishing, what an incredible technique.

Coming round from the anaesthetic wasn't too much fun, but after a bit of anti-nausea medication and some sips of water (finally!) I felt vaguely human again, so they wheeled me back to my room, and to the welcoming arms of a rather worried-looking Tanai. I then proceeded to gingerly eat some of the leftovers from the day before (I'm sure I'm the only person to have broken their surgery fast with celeriac hash and duck eggs) and soon felt much more stable. Miss L____ came to check in on me, informed me that she'd removed two lymph nodes (as far as she could tell) and that it all seemed to have gone well. I'm to keep my dressings on until I go and see her on 3 November, when I'll also receive my pathology reports. So that's when I'll find out if the surgery was successful in removing all of the cancer, and if my lymph nodes are cancer-free. Fingers crossed I won't have to have any further surgery.

I then got dressed and we made our way downstairs. All along when preparing for surgery, everyone we've spoken to has insisted that we get a cab home, but it was such a charming, cool evening and I was feeling strong, so we defied advice and walked home through Smithfields market. It's only an 8-minute walk and we made it home fine. After some pumpkin soup which I'd made the day before I collapsed, exhausted into bed and slept very soundly.

So that's it! Surgery is ticked off the list (hopefully for good). I feel fine today, a little sore but I haven't had to have pain relief yet, and I still have some movement in my right arm. I keep having to remember not to pick things up with my right hand (which is tough as I'm right handed), and Tanai has taken the week off work to help me out. We managed a little afternoon walk today in the autumn sunshine and now I'm resting on the sofa. I'm wearing very comfortable clothes, a soft post-surgery bra (which I also have to sleep in) and I have a fabulous pillow which my friend Dee sent me, which hooks over my right shoulder and prevents my arm from chafing my armpit wound. I can shower as normal as the dressings are all waterproof. I'm sure it will get sore over the coming days, especially when I start to do my exercises (which I've been given in order to maintain movement in my right arm) but hopefully all will be well. If I have any problems I can just head straight over to St Bart's and they'll sort things out. So now I just have to rest and recuperate, and spend some time relaxing, reading books, listening to podcasts and catching up on some movies.

My fabulous arm pillow

This afternoon's walk through the St Bart's courtyard