Surgery Tomorrow

 CW: medical procedures (ick)

Surgery on Monday

Today my husband and I are heading to Seattle for my surgery. On Monday I will be having a lumpectomy (remove the tumor in my breast) and a sentinel node biopsy. We are leaving the day be fore because we have to be at the hospital at 7am for the procedure that precedes the surgery. Then my surgery is in the afternoon and they want us to stay in Seattle Monday night, in case of complications, I think.

I wasn't sure if a mug with a port-a-cath would be gross to some people, so I tried this heart shaped almost-port on some mugs instead

The morning procedure will be a procedure to mark where the tumor is. If I had been going in the day before (or Friday), I would be getting a Savi Scout in my tumor. This is the same marker that they tried to place in my lymph node back in February (but they couldn't find the cancerous lymph node or the previous marker put in during my original biopsy in November). The Savi Scout marker would have been placed using a needle that kind of pops it into place. It makes a popping sound when they inject the marker (ick).

these port-a-cath bulbs have their first layer of underglaze in this photo and are in the kiln with their second right now 

Because I did not want to drive to Seattle on Friday and again on Monday, and because they don't do Savi Scout procedures on Sundays, they are instead doing a wire locator technique in the morning. My understanding is that they stick a wire through my skin into the lump and it sticks out. And that is the total sum of how much I am going to think about that one (ick!). 

Of course for me I also had to do a couple of port-a-cath mugs

Sean and I went to Seattle at the end of April for the consult with the surgeon for this surgery. Nothing much had changed from what we were told at the start of this process in November and December about what the surgery would be. Both surgeons (the one in Yakima and the one in SCCA) always recommended a lumpectomy and a sentinel node biopsy. 

I threw 25lbs of clay last week and trimmed the next day (and wore myself out!)

Lumpectomy 

The lumpectomy was recommended based on the size of the lump, which is now smaller than it was when first diagnosed. Basically if the tumor is small enough in relation to the size of the breast, they can do a lumpectomy instead of a mastectomy, meaning they take out just the lump instead of the whole breast. The research indicates that survival and recurrance rates are the same for both procedures, but the recovery time is better for a lumpectomy. 

port-a-cath bulb after the first underglaze layers

The only variable back in November/December, was the result of my genetic testing. Had I tested positive for genes known to be linked to breast cancer, they might have wanted to take out more tissue to reduce my risk of more cancer developing. But, as I don't have that gene mutation, my risk remains low.

port and heart mugs in progress

Sentinel Node Biopsy

The sentinel node biopsy is done when there has been cancer in the lymph node or nodes. We know, based on the original biopsy, that I had cancer in at least one lymph node. That means that the cancer had spread from the original site to the nodes. These lymph nodes are all over the body and help drain stuff, like if you have a bruise, they'll drain away the blood that collects outside your vasular system in that area. During the pandemic, we learned that they also help drain away stuff that happens because of getting a vaccination. That's why your lymph nodes might swell after a shot; your body reacts to the shot and then that stuff gets drained away. My use of "stuff" here is a strategic attempt to make this medical jargon accessible and not a total lack of knowledge of the right terminology (right? yeah, totally, lol).

partway through the first layer of underglaze

During surgery, they will inject some dye (radioactive or blue or maybe both) into my breast. The dye will drain, like it is supposed to, through the lymph system into the lymph nodes. The dye won't go to all nodes (at least not immediately), meaning that only some nodes are the place that dye (or any cancer bits) goes to first. So they will remove only those first level nodes.  The doctor said that she will probably remove about 3 nodes. 

new bulbs, only 3 with port-a-caths (because sometimes that's too much work)

Checking for Clean Margins & Cancer in Nodes

After my surgery, sometime in the next week, the pathologist will check my nodes and the lump for cancer. With the lump, they will want to check that they have clean margins, meaning that they got all the cancer and didn't cut through the edge of the cancer. If they cut throught the edge of the cancer, if there's any bit of the lump that doesn't have a boundary of non-cancer cells, they'll need to go back in for a second surgery to get that last bit (or risk having it grown into a new lump). The surgeon said that there is a 10-20% chance that they don't get the whole tumor and that she'd have to go back in for a second surgery because of this.

port-a-cath mug in progress

My nephew also had his cancer tumor removed and they got clean margins the first time. Obviously we're hoping that I have the same results. The fact that, when last measured, the tumor was 12mm on the longest dimension, down from 45mm in December, seems like it should help make it easier to get good margins. Also the fact that we're doing this surgery in Seattle with someone whose whole job is breast cancer surgery seems like it helps our odds.

layered ports with glaze and underglaze

With the lymph nodes, the pathologist will chop up the nodes and check for any cancer. The hope here is that there is not even a trace of cancer. If they find any cancer, they will need to go back and take out more nodes. There is a 75% chance that someone who had cancer in the lymph nodes at one point will still have some cancer. If that is the case, they'll have to do a second lymph node surgery, this time called an axillary node dissection, where they remove most of the lymph nodes under the arm. They want to try to avoid this because of taking out so many lymph nodes increases the risk of lymphedema or arm swelling throughout my lifetime.

heart mugs in progress

Axillary Node Dissection

If they do need to do the axillary node dissection, that risk of lymphedema is 20-30% and I would need to take a variety of precautions (pretty much for my whole life) to prevent that from happening. As a fairly active person, both professionally and personally, this seems like a risk I wouldn't want to have to live with. I'd basically want to prevent bruising or other kinds of damage that would impact the lymph system.

heart-a-cath bulbs

My surgeon recommended that if I need an axillary node biopsy, I may also want to have a second procedure with a plastic surgeon to reconnect and reroute the lymph channels. This surgery would reduce my lymphedema risk to just 5%. The catch? Apparently it isn't covered by insurance. But it sounds like it is totally worth it. And I may yet be in the 25% that doesn't have to do the axillary dissection at all.

spiky port bulb

The odds of 75% look bad, but I already have some good indicators (they couldn't find the cancer in the nodes using ultrasound in February and they couldn't find the cancer in the nodes using MRI in April). 

wiggly tubes (hope they don't break)

Results of Surgery & Next Steps

We won't know the "results" of my surgery for about 5 days after the surgery. I am scheduled for a post-op follow up with the surgeon on May 26, but we don't know if a possible second surgery would be scheduled before or after that visit. I am hoping to ask tomorrow before the surgery.

I threw, trimmed, handled, and decorated just 8 mugs and was exhausted afterwards, but I wanted to get them done in between chemo and surgery (before I have restrictions on my arm)

They will also be taking out my port-a-cath, so I plan to ask if I can keep that (for art purposes, of course). Though another art person I know recently told me that she wasn't allowed to keep hers.

My finishing chemo present to myself was an unrestricted trip to Inklings!

Family

My folks are in town this week. We hadn't seen then since September, before my diagnosis, because we didn't travel over Christmas, opting instead to start chemo. They ended up spend a lot of time in New Hampshire over the winter helping with my brother's family while they dealt with my younger nephew's cancer and treatments. As my nephew is going better (and other family is helping out now), they were able to get to Washington. 

my incredible daughter made a colorful port-a-cath necklace for me for Mother's day because she is 100% incredible 

My folks are going to stay with my daughter while Sean and I are in Seattle. On the two days we went to Seattle in December, she stayed home alone both nights. While she is totally capable of staying home alone, and while we've had lots of generous offers that she can stay with friends in town, I think she'll feel a lot better staying at our house with her grandparents (and the cats, of course).

that necklack though!

In the last week a number of people have told me that I'm doing a good job or being brave or whatever. For me, it is funny, because I'm just doing what the doctors tell me to do. Knowing that my prognosis is that the cancer will be gone by the end of the month (if not tomorrow) makes it much easier for me to maintain a good mood and a cheerful outlook. Of course it helps a lot that the chemo is done and that the last 10ish weeks of chemo were relatively mild. 

bulbs after the first underglazing firing

My brother asked how I was feeling about surgery and I'm not nearly as scared of the after effects of surgery as I was before chemo. Also, after dealing with the last two doses of A/C chemo in January, I don't anticipate that this surgery could be worse. I won't feel good, but I've done that before.

another port-a-cath layered bulb (because I'm obsessed)

I've also been asked several times about how Alison is doing or feeling. She is enjoying track and has lots of projects going in school and at home. She's pretty excited about her grandparents being here, and, for the same reasons as the rest of us, doesn't appear to be very concerned about the cancer stuff. She knows that my prognosis is good. I just asked her how she feels about the surgery and she said that she was more worried before the first surgery (for the port). Now she knows that I came through that surgery (and Sean came through his the year before) just fine, so she's not particularly worried.

I took a (morbid?) before chemo picture like this and here's the post-chemo version. I'm doing fine ;-)