On Monday Scotty and I went to see the surgeon to receive the pathology from the ALND (axillary lymph node dissection) surgery. Originally the PET scan showed that there appeared to be more than one node involved, however, the pathology came back showing only one. We obviously had questions.

First, and most important, did they get all the tumors out or was there more in there that they some how missed?! After further discussion with the surgeon, and him actually calling and talking with the doctor that had done the dissection, we think the reason the imaging showed more than one node with cancer was because of two reasons. The lymph node biopsied had a metal medical marker clip put inside it. This procedure left an indentation on the node and also removed a chunk to be sent off to confirm that it was cancer. All of that was done prior to the PET scan so it made that node appear to be split in half or more like tightly bundled grapes. The second reason could have been simply a false negative on the PET scan. Bottom line is that all the nodes in the region that had the cancer node were removed.

Second, we wanted to know how many nodes were removed. There was a total of 16 nodes taken out. Each ALND is different because all of us have a different number of lymph nodes. I was told that if you are heavier you tend have more nodes and if you are thinner you have less. This means there is no magic or correct number of nodes that should be removed because it varies based on each individual. And again only one of these nodes came back as having cancer in it.

Overall the pathology report was great news. Not having any additional physical tumors growing is what we wanted and not having any microscopic cells inside any others is pretty amazing.

During that visit I was also able to have my drain removed because it was well under the 30ml threshold. Let me tell you that this surgery was not as painful as the bilateral mastectomy but the drain is 500 times more painful. I’m not sure if it was because of where it was located, the amount of “digging” done on the inside of my body causing bruising, or if I am suddenly becoming a wuss, but holy heaven above did I want that thing out. One other difference from the drains after mastectomy versus ALND was that the incision where the drain is placed takes much longer to close up and heal. With the mastectomy drains I had to wait about 24 hours before I could shower and remove bandages. Today is Thursday and the incision is still not fully scabbed over allowing me to shower.

My mom took this picture about a week after my surgery so I could see where the incision was and how long it was. The puckered looking line is where they opened me up to get out all the nodes and below you can see the bandage, that is where the drain was. The stitches are on the inside and then it is glued together (the puckered skin). Plastic surgeons like to use glue to close instead of stitches to decrease the visible scars after. I guess I got lucky and my surgeon does this. I didn’t know that prior to surgery. In the grand scheme of things this body of mine is no prize. It wasn’t ever a grand showcase but God gave me it and I have tried to treat it like the temple it should be. I have accepted that whenever the end comes for me this body will probably be riddled with more scars than perfection and beauty which I am fine with. Each scar is a visible representation of me fighting to live, and living is all I care about.

Above is a picture I took this morning after I cleaned the drain incision and before I re-bandaged it. Since I did chemo my skin hates all bandages and medical tape. The red surrounding the area is just the irritation from that. You can see bruising and I don’t know why that is there, my guess is from all the digging and pulling during the surgery.

This week I also started doing the physical therapy exercises to prevent lymphadema and to help me regain my mobility back. It is depressing. I am in a full body sweat attempting to do these. Today I also went for a walk. Also depressing because I am slow. No offense to anyone out there but I feel like an 80 year old woman. Mentally I am very frustrated with part. I had just gained back almost full mobility after the mastectomies and was able exercise with 15 pound weights. It has taken a year to get back to that point. Now here I am back where I started. UGH.

Tomorrow I am meeting with my regular oncologist to finalize the treatment plan. Once I am done with that appointment I will post an update.

I love to be prepared for what is going to happen to this body. How many more scars I am going to own is a fun guessing game and to make a logical guess I scour the internet to understand exactly what is going to happen during each procedure. Since I wasn’t able to find any great pictures prior to my biopsy I thought I had better post some. Some of you are here because you are my tribe, so sorry you get to see my jacked up body. But others might be going through a similar situation as me and I pray that these might help you with what you are gong through in some small way.

The biopsy was done in the radiology office, the same room as the ultrasound to confirm that it was suspicious after the CT scan. All bandages had to be left on for 24 hours and then removed. This was how it looked after 24 hours and bandages were taken off.

After removing the steri-strips this was all that was under there, two small red dots. I think typically you would only have one red mark but we had to switch the size of the needle to a larger one because the node was so deep that the smaller needle couldn’t dig deep enough to reach it. There was visible bruising as the days progressed but nothing like the breast biopsy from last time. All in all this one was a piece of cake!

Scotty and I were ready to get this surgery under way and, fingers crossed, all the cancer out of my body. We got there on time and got prepped for surgery but much like the night before with the MRI we had a long delay. I was scheduled to go into surgery at 3:25. I actually made it into the operating room and scooted onto the table at 6:35. The approximate operating time was an hour and fifteen minutes but it took closer to three hours. There were not any complications, just needed extra time to be thorough I guess. Seems like the theme for this go round is waiting.

This time I was much calmer as I headed into surgery. Last time I was so scared I couldn’t stop the tears from falling. They eventually had to give me something to calm down. But Tuesdays I was chill. It could be that I am becoming numb to it or that God decided to help me calm down. I think it was a little of both. What helped even more was walking into the pre-op room and having this lady as my nurse!

When I saw Michelle I started to cry but I am so, so, so thankful that she was working that day. It made the waiting fun! Michelle and my kids are on the swim team together and all are around the same ages so we have become buds over the years. She was very sweet and told me that if it was weird she could reassign me to someone else but I think God knew I needed someone back there with me.

Since I was waiting so long I got to have everyone shuffle in and out to see me. If my surgery had started on time then my dad would have missed it because he went to the wrong hospital. Oh vey that man is crazy!

I ended up being the last surgery of the day for the hospital so by the time I was up every one was ready to go home. When I got into the operating room the team was pumped up and saying things like, “let’s get this show on the road so we can go home!” I looked around and said, “hey I know you all want to go home, me too, but see this hat, it’s pink because I have breast cancer and I really need you guys to take your time to get it out because this is not my first time dealing with it.” It might have killed the mood a bit but I know how important this surgery is. The nurses all said they knew that and they were going to take care of me. That was the last thing I remember till I woke up in recovery.

Waking up from the anesthetic this time I was really sick. There was no pain from the surgery but I was certain I was going to vomit. This had not happened in the past surgeries but I also would not put on the patch that is suppose to help with nausea. Last time I had that patch was when my eyes were dilating all funky and I couldn’t see (there is a blog post about it with pictures, not doing that again thank you). Also I had almost nothing to eat in 24 plus hours due to the MRI fasting and the surgery fasting. When we got home I made Scott give me one of my pills for vomiting and it kicked in before I heaved.

The doctor told Scotty and my mom that it went well. He was able to get out the cancerous nodes that were found from the scans and “a bunch more”. Hopefully we got them all. There were a few nerves that had to be damaged to get to them but not any major ones. Now we wait for me to heal and then pray that the radiation and stronger chemo treatments kill any remaining cancer cells this time.

Overall I feel okay. There is pain but it is tolerable. I also have the use of my opposite side which makes this seem like a piece of cake. I was able to give myself a partial shower so I don’t stink to high heaven in 105 degree heat. Also, I have to sleep sitting upright which means I am back to the chair. Seriously not a fan of sleeping in the chair, makes me feel helpless. I also have a drain again but that isn’t so bad because I kept all my mastectomy tank tops.

Yesterday I got back the results from the MRI and it came back clear. The doctors are pretty confident that the cancer is not anywhere else. However, I will continue to get scans now to check.

Scans done, check.

Surgery, check.

Up next radiation. I am awaiting a call from my radiation oncologist to get that appointment setup and learn more.

Now I am going to go nap.