Breast cancer: re-excision and a midnight trip to A&E - Feb 2021

Kia ora tatou, nau mai, harae mai.

Two weeks after the lumpectomy and lymph node biopsy I had a call from the surgeon to say that while there was no evidence that the cancer had spread (yay!) there was still some pre-cancerous cells left behind (boo!). This meant I needed to go back for a re-excision to remove all the DCIS cells.

Due to the cancer being Grade 3, which is a fast-growing type, this needed to be done as soon as possible. The surgeon asked how full my calendar was. "I'm currently in a caravan, babysitting a duckling" I replied. "So my schedule is pretty wide open these days"... confused silence... "how is Wednesday?"... "Wednesday is good" :)

Although it was a blow to have to go back in for more surgery, my overwhelming feeling is gratitude that I spotted it early and that it's being dealt with quickly. Not everyone lives in a country with free healthcare, and not everyone in this country is able to access the same quality or speed of care. We need to protect and expand our health service and remove inequities so everyone who needs care can access it fully. (I'm not sure exactly how we as individuals can help here, but it's something I'll be researching and writing about as we go along).

Happily this procedure did not require the hook wires or blue dye of the previous surgery, and, even better - it was done at the hospital closer to home. It all seemed to go very well and by mid afternoon I was sitting outside on our lawn, happily toasted and glad it was over. However, over the course of the afternoon and evening the swelling got worse until at 11pm I realised something had gone badly wrong. My breast was the size of my head and felt like it was made of plaster of paris. I had to hold it with both hands and the pain was excruciating. It clearly wasn't right, so I called the hospital but didn't get an answer so I called an ambulance.

Not my exact ambulance, but pretty close.

Learnings: unless you are having a heart attack, you're best to make your own way to hospital. They didn't send anyone for over an hour, by which time I was having a pretty serious panic attack. Also, we live an hour away from the hospital. I wish the operator had said I was low priority so we could have chosen to drive instead of waiting in pain and fear. But they did eventually arrive and we did eventually make it to hospital.

I was pretty upset and in a lot of pain, and was grateful to be seen by a doctor fairly quickly. I'm glad it wasn't a weekend night, just a relatively quiet Wednesday. The house surgeon wanted to wait for the morning team to operate and I was pretty unhappy with this as my boob was getting worse by the minute. But around 4am the bleeding finally stopped and I was sent to a ward to await the morning triage. My poor room-mate endured all the lights being turned on at about 5am when I arrived, but happily he didn't hold a grudge and we had good chats to pass the time. It's lovely how people know when you're at a low ebb and can be so incredibly kind.

It would have been a truly miraculous pregnancy!

There were at least 3 attempts to get me to pee in a cup, me asking if it was for a pregnancy test - yes it was: "well, I don't have a uterus so we're good, please don't make me stand up and drag my monster boob anywhere please god please don't make me stand up please no".

But a tricksy sod finally got me to pee in said cup by shaking me awake and saying they wouldn't operate if I didn't pee. So off I shuffled, only to come back and find that yes, it was in fact a pregnancy test, and no, they hadn't read my notes. Good grief. Even my roommate was getting mad and shouting "she DOESN'T have a UTERUS!", which was strangely moving. Thank you, nameless roommate, you made things better. Learnings: just pee in the cup the first time they ask, it's easier.

I was still pretty zonked from the previous general anaesthetic, the ton of pain relief I'd had, and the lack of sleep so I don't remember much after that. I signed forms while horizontal in bed. I didn't have to walk myself to theatre. My nervous joke-telling was minimal, if at all. I don't remember the first recovery room, and only vaguely remember my partner visiting. I asked to not be sent home in case it all happened again and they were very much in agreement.

I had a haematoma, which is where a blood vessel was bleeding inside of my boob. This is a known risk for this type of surgery and can happen when a blood vessel that has been cut is in spasm and so isn't bleeding when they are looking around before sewing up. After stitching, the spasm ends and the bleeding begins. Bruises are like haematomas, but they come from small capillaries rather than large blood vessels. It looks like mine was a large vessel that took many hours to seal itself. The real danger with haematomas occur when the skin isn't getting blood supply, so there were regular checks to make sure that the blood returned quickly when the skin was pressed down. I was fine in that regard, hence them being comfortable with waiting for the main surgical team to arrive. They opened the cut for a third time and removed as much of the blood as they could, then stitched me back up again.

I stayed that night and got worried as my breast started to swell again. I had lost confidence in my ability to judge what was normal so asked nurses to help me check throughout the night. Also, my heart was beating very fast (tachycardia), which I think started when I was freaking out about the lack of help the night before. But that all righted itself eventually and at about 1am I was delivered earplugs and morphine to get me some sleep. Ahh, sleep. My precious.

I was very glad to get home the next day, and it took at least four days before my brain fog lifted and I felt somewhat normal. In just eight weeks I've had a cancer diagnosis, an abdominal hysterectomy, and three breast operations. No wonder I'm feeling tired and a bit down. Waiting for the ambulance was the first time I've really lost my composure, and I wish I had kept my shit together better. But it's totally ok to be scared and freak out. I've done really well and felt positive a lot of the time but this is BIG stuff and I find myself randomly crying lately. And that's all ok. This too shall pass.

A week later and I'm feeling pretty good, I'm planning to start work next week - just a couple of hours a day to ease into it. I work from home, thank goodness. We are taking care of a duckling, which I'll write more about in my next blog, and she's a lovely distraction. The surgeon did a checkup yesterday and I'm healing well, and so now we wait for the results and pray for no more DCIS cells. I really hope surgery is behind me. But if it's not, I'll make sure I don't get sent home same-day as I don't want a repeat of last week.

Not my boob but sounds the same

A few days ago I noticed a sloshing sound - like a half-full water bottle - and realised it was coming from my boob! WTF? Apparently a seroma has formed, where fluid has partially filled the cavity where the tumour came out. This is quite normal for this type of surgery, and while it can be drained, that raises the risk of infection. So I've opted to leave it as-is for now and roll with it. Freaking weird though. I keep thinking I'm carrying something making the noise but no, it's just my boob having a good old slosh!

Thank you for reading along, and I'll see you back here for the next one. I'll know then if this surgery stage is behind me, and we'll be moving on to chemo convos. I'll also have some jewellery to show you, after a recent creative day - the first one in a long time. It's a cruel reality that even though I've had all this time at home I really haven't felt like doing anything other than napping and hanging with the animals.