Posts Tagged ‘IGAP flap’

“Enemy combatants this is your final warning, please evacuate. I repeat this is your final warning!”

Everyone loves a military cliché when it comes to cancer, so my secret mission for this blog post was to try to squeeze in as many as possible. I must stress that military clichés are reserved for people with the disease and there’ll be no bravery awards on my watch.

When I filled out my cancer return for 2012/2013 I wrongly assumed I’d repaid my karmic debt and my recent diagnosis proves that I still have plenty of credits in the bad-shit bank. My sense of normal has been severely warped in the past couple of years and I wonder if I’ve just resigned myself to life being shit, as it took the nice young doctor examining me before surgery to remind me how abnormal my life has become. His four words “you’ve been in the wars” were enough to unleash a torrent of tears.

war on cancer

Two weeks ago I had surgery – axillary clearance – to remove the lymph nodes from my right axilla: that’s the ‘armpit’, or ‘oxter‘ to you and I. In the war against renegade cells, the battleground of my body has been subjected to another assault. Unlike the sentinel node biopsy I had last year, this operation was much more invasive and they ripped out half my armpit. I think the NHS should scrap the latin and start using slang: “Aye we’re gonnae clear yer oxters” sounds much less intimidating than the militaristic “we’re going in for axillary clearance”.

As is the norm in my world, I thought I’d be fully recovered after a couple of days, however it’s taken me much longer to recover than I expected. You’d think my body would be hardened by previous battles but perhaps the relentless chemical and surgical assaults are starting to take their toll. They do a lot of rooting around to get to the nodes, nerves can be damaged, and tissue-fluid can build up in the axilla (armpit). This can result in a number of not very pleasant side effects. 

For the first couple of days, there was a definite rumble in the jungle of my armpit: I was mightily pissed off about having to go through surgery again, so it’s understandable that my armpit might want to communicate its discontent. By the end of the first week I was starting to resemble a human-bagpipe, and could have joined a ceilidh band with the ever-growing bulge and chorus emanating from my right oxter.

shrig-1112-400x215

An extreme reaction to axillary lymph node clearance

I’m surprised my body isn’t screaming, the damage that’s been inflicted in the last year: the FECin Chemotherapy; the now seemingly pointless Sentinel node biopsythe Mastectomy with bottom transplant; the skin-shedding Radiotherapy; the ‘let’s give the other one a bit of attention’ Mastopexy; and the bagpipe inducing Axillary lymph node clearance. That’s 4 operations, some heavy duty chemicals and a ton of radiation.

It’s not a competition, however I am considering starting a new Facebook game called “Disease Top Trumps”. Having been diagnosed with cancer twice in the last year, I do get slightly irritated when I read a Facebook status update that says “feeling rubbish today, sore throat 😦 “. It’s all relative and everyone’s entitled to a whinge, but from where I’m standing, anything that can be treated with paracetamol does not require a Facebook status update, and the next time I see one of these updates I’m going to find it hard not to play my cancer top trump: “I HAVE CANCER – WOULD YOU CARE TO SWAP?!” Or maybe I’ll just start doing tumour status updates: “Tumour feels bigger today, think it’s terminal 😦 ” and see what response I get.

I promise I will never give tumour status updates on Facebook, in fact I hope I never have to talk about this insidious disease ever again (at least not my cancer), because on Wednesday something incredible happened. Last week I had appointments, with both the surgical and oncology teams, to get the results from surgery and discuss the rest of my treatment plan. The results were irrelevant, I knew I was starting chemotherapy again in December, I just wanted a date, so that I could book a much needed holiday from the cancer that’s taken over my life for the last 18 months.

My apathy turned to shock, when I received the news, that of the 18 lymph nodes removed, only 1 was cancerous. The minimum requirement for treatment is 4 positive nodes and I only had 1, which means no further treatment, besides monthly injections of Goserelin (Zoladex).

You’re probably wondering how did this happen again? The answer is nobody knows. They can’t tell if the tumour was completely new, or if it stemmed from cells which migrated from the previous site. I had quite a large gap between finishing chemotherapy and having my mastectomy during my last course of treatment, so there’s every possibility that a few cells jumped ship when no-one was looking.

Obviously I’m ecstatic that I don’t have to go through chemotherapy and radiotherapy again, but it’s scuppered my weight loss & hair removal plans. I’ve been fattening myself up in preparation for the chemotherapy I thought I’d be having. The chemotherapy diet is cancer’s best kept secret: ‘Feeling flabby? Watch the pounds melt away on the chemo-diet!’ I also expected to be as bald as a coot by xmas so I gave up on depilation: losing your eyebrows and lashes can make you look like an alien, however it means you don’t have to shave your legs for a whole 6 months. Perhaps if they emphasised these positive side effects of chemotherapy they might get more takers?

Alice

Dorothy and Alice contemplate the meaning of life

Those of you who know me well and who follow my blog will know that this recent recurrence has thrown my whole life into complete disarray, again. Friends and family have commented on how well I’ve coped with my recent diagnosis, but I’m a great believer in bottling things up & letting them out in inappropriate places. I’m joking, it’s actually really hard to contain your emotions when you think you’re going to die, and simple things like a trip to the supermarket are made even more stressful by the prospect of bumping into someone you know or bursting into tears at the checkout. You realise that the small-talk that people make in these environments is mostly just meaningless waffle. When people ask “how are you today?” they don’t want to know the truth and this for me is one of the most difficult parts of having cancer: it’s an exercise in people management. You’re continually thrown into situations where you have to predict and mop up other people’s emotions. Having the disease is stigmatising enough, but I’ve been in so many situations where I’ve lied because I can’t cope with other people’s reaction to my disease. It’s much easier to say “yeah I’ve got breast cancer but I’m feeling really positive and treatment is going really well” than to say “actually I’m beginning to question the meaning of my existence and wondering what I’ve got to live for”. It’s deep man, but it’s normal to ponder these questions when the grim reaper comes a knockin’.

I was ecstatic when they gave me the good news on Wednesday, however my elation has faded into quiet contemplation as I consider the enormity of what I’ve been through. I’ve survived cancer for a second time and I’m trying not to feel bitter about my recurrence, because if I do that, it means the cancer has won. I need time to lick my wounds and get my head around the fact that I’m not going to die before I start thinking about life again. I’ve earned my stripes, I’m hanging up my boots and I hope I never have to face this disease ever again.

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I’ve recently returned home after nearly a week in Ninewells hospital and I’ve realised that a trip to hospital is all about economics. There’s gain or loss with every visit. I came home with a new breast and a bit less padding on my right buttock.

In case you haven’t followed my previous posts I’ve been in hospital for a mastectomy with breast reconstruction. The procedure I’ve had is called an IGAP (Inferior Gluteal Artery Perforator) flap reconstruction. In simple terms they took a piece of my right buttock and inserted it where my right breast once was. It’s a bit like installing a new boiler, only with more pipework.

I am aware that I haven’t used the word mastectomy in earlier posts. For most, including myself, the word conjures up images of bald, breast-less women with big ugly scars. My worst fear was that I would become one of those women. Twenty years ago this would have been the case, however medical advances mean that I was able to have both my mastectomy and reconstruction at the same time.

Committing myself to major surgery wasn’t a decision I took lightly, however the alternatives were dire: an early demise or delayed reconstruction. I opted for the safest solution in terms of both my health and sanity. The risks of such a long operation are huge, however I had the 98.4% success rate of the breast reconstruction team on my side. Perhaps that’s why I felt so calm when I arrived in hospital last Monday.

The operation

My first afternoon in hospital was filled with pre-op assessments and chats with various medical people. I met with the plastic surgeon Mr M who listened to my bottom – a new experience for me – and covered me in blue pen in preparation for the operation. He is one of a handful of surgeons in the UK able to do this type of reconstruction, so I feel exceptionally lucky to live in an area and indeed a country where it’s both available and free. Big up the NHS!

The period between Monday night and Wednesday morning is all a bit of a blur. They let me out for a ‘last supper’ with family on Monday evening and when I returned to the hospital, I was offered me a pre-med to help me sleep. It must have worked because I have very little recollection of what happened on the morning of the operation. All I can remember is walking to theatre with the anaesthetist and being given a ‘gin and tonic’. The rest is history.

I woke from surgery sometime on Tuesday evening but it’s all really hazy after that. I drifted in and out of sleep. I had a midnight feast of toast and coffee. The whole nursing team were incredible but the nurse who looked after me on the first two nights was especially lovely. She fed me water through a straw when I couldn’t sit up. She cooled me down when I was too hot. The continual observations and monitoring of my new breast didn’t bother me in the slightest. The nursing was world-class and they just made me feel like I was in a really safe place.

I was bed-bound for most of Wednesday and Thursday, another new experience for me. I felt like a rat in a trap initially, however I soon became accustomed to the wires, needles and bags attached to me. Progress was steady over the course of the week. By Thursday I had taken my first baby-steps around the bed, by Friday I’d walked along the corridor and that same night the catheter and inflatable leg-socks were thankfully removed. My first catheter free trip to the bathroom was a big highlight of the week. Who’d have thought so much joy could be gained from a trip to the loo.

On Saturday, free of all my attachments, I enjoyed my first shower and ventured up to the hospital precinct, looking and feeling like I’d escaped from the asylum with my crew-cut, mismatched clothes and slippers.

The day after my operation I weirdly found myself listening to a discussion on Radio 4’s Women’s hour about breast cancer and reconstruction. It seems that breast reconstruction is a postcode lottery and many women are misinformed about their choices regarding surgery. I whinged in a previous post about my limited options for surgery, however these were due to my skinny frame and the radiotherapy I’m expected to have. Ninewells offers a multitude of possibilities when it comes to reconstruction (IGAPDIEP,TRAM & LD flaps among others) and after listening to this programme I feel really fortunate to have been given the choices I was.

What many women don’t realise is that you can elect to go anywhere you want for surgery regardless of where you live. New guidelines released by BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons) last week, aim to ensure that all breast cancer patients are well-informed about their choices regarding breast reconstruction and can expect to receive the best possible outcomes wherever they are treated (www.bapras.org.uk).

Post op

I was determined to look at my new breast from the start and I’d already seen it from my semi-reclined position, however it wasn’t until I showered on Saturday that I saw myself properly in the mirror. I was really happy with my old body and looking at my new self was quite a shock, so there were tears.

My new breast looks and feels strange although its early days. The scarring is minimal, as I’ve had a skin sparing mastectomy, so the only scar is around the nipple. Considering the limited amount of donor flesh available on my backside, the size and shape is really good. It will never be as good as the original but it’s a fine start.

Maggie’s really helped to prepare me for this as I think I would be in a complete state of shock if I hadn’t had the opportunity to see other women’s scars and to chat to them about the operation. My breast is still healing, so I just have to remind myself that this is just the start of the reconstruction process. Nipple reconstruction comes later, as will surgery to make my breasts more symmetrical: it’s a work in a progress.

Before surgery I was just as concerned about my bottom as my breast. I expected there would be a huge indentation in my buttock and although there is a massive scar, the shark sized bite I imagined is nowhere to be seen. Mr M mentioned that they can improve the symmetry on my buttocks but I doubt this will be necessary.

My body is recovering incredibly well from surgery although I do have to take it easy, something that I’m not very good at. I have to keep my leg as straight as possible for the next few weeks, to allow my bottom heal, which means I have adopted a peculiar gait. According to mum this is somewhere between The Hunchback of Notre Dame and Mrs Overall. I can’t bend, which means mum has to help me to put on my shoes and socks. I’m nearly there with the full reversion to childhood.

Mrs Overall in Acorn Antiques – she’s the one in the pinny

My breast is actually less painful than my bottom but this is probably because our bottoms are slightly more functional than our breasts. I did have plans to make use of my good breast, or ‘My Left Tit’ as I like to call it, to write this post, as I didn’t know if I’d have full use of my arms. Thankfully it hasn’t come to that, however my left foot has been giving me a hand. I’ll be typing out my next post with my big toe before you know it.

This week has been a rollercoaster both physically and mentally, yet I feel surprisingly okay about it all. I’ve gained a breast, lost a bit of my right buttock and my arse is now quite literally staring me in the face. I’ve also acquired new addictions to white-toast and Game of Thrones. Of course the thing that has made the bad bits bearable is that I am now potentially cancer free, or at least very close.

I finished chemo nearly two weeks ago so I’m slowly getting back to health and moving on to the next stage of my treatment. It feels great to be finished chemo and be free of my Picc Line, however the next stage is full of it’s own little joys as I discovered on Monday morning, when I had my first appointment with the plastic surgeon.

After sizing up my breasts & my backside & drawing a rather comical sketch of my breasts, the surgeon gave me the low-down on surgery. I was given two options. The first is an implant combined with tissue/muscle flap from my back (Lattisimus Dorsi Flap). Option two is using tissue from elsewhere on my body. There wasn’t much fat on me before I started treatment, however the chemo induced nausea, combined with the 5:2 diet means that there’s now very little to spare. Apparently you can be too thin.

After ruling out my stomach as a donor site, he said he’d struggle to harvest enough tissue from my bottom, or at least not enough to make my breasts symmetrical. Unfortunately an implant isn’t a viable option, because the radiotherapy I’ll be having post-surgery will damage it. This leaves me with one not very satisfactory solution to the problem that is the cancer in my right breast.

I asked the surgeon what he thought was the best solution and he said he can’t make that decision, it’s up to me. I was left to go away and think about my one option and come back the following week to discuss it further with the specialist-nurse.

Mother and I were fairly traumatised after leaving the hospital on Monday morning, but luckily Maggie’s came to the rescue. I had a massage booked and I left mum in the care of the lovely folk at Maggie’s. After my massage, mum introduced me to a woman who’d recently had her operation and she was more than happy to show us her scars. All I can say is they weren’t all that bad. She had one massive scar across the crease line of her right buttock, but there wasn’t a big gaping dent as I’d imagined there’d be. Her breast was nipple-less (they do this later) but actually looked ok. The only scar was around the nipple. This was another of those serendipitous meetings I seem to keep having and it went a little way towards relieving the worries I have about surgery.

We went back on Friday and spent an hour chatting to the nurse about what will happen. The nurse talked us through everything from morphine to the moon-boots I’ll be wearing to stop DVT. It’s a long operation. I’ll be in theatre for 9-10 hours and for the first 48 hours, my breast will be continually monitored to check the new breast tissue is functioning. It could go wrong, although this is unlikely. They have a failure rate of 1.6%, so I hope I’ll be in the other 98.4%. It’s hard not to worry, but what choice do I have.

I’m going for the bum transplant because the only other option is to delay reconstruction, which I don’t want to do. Depending on the result of this operation, it’s likely that I’ll need further surgery at a later date. If they can’t harvest enough tissue from my buttock, they’ll either increase my new breast or reduce my healthy breast to match. I’m told that plastic surgeons are perfectionists so although it won’t be immediate, I will have an even pair eventually.

Mentally I’m not sure how you prepare for a big operation like this. I’ve been told my stay in hospital will be an emotional one. I’m losing a breast so I expect there will be tears. I’m happy with my body just the way it is, but it’s never going to look the same again and that’s hard to accept.

I’m having a minor operation next week to remove my sentinel lymph node. I’ve never been under the knife so I think this will be good preparation for the big op. This is likely to happen mid-November and I’m just waiting for the date to be confirmed.

At this point it’s hard to see the end of the road. I was hoping to have all my treatment finished by xmas but it looks like it will carry on into the New Year. I’ll be having radiotherapy after xmas then possibly more surgery after that.

I have roughly 3 weeks of freedom before my big operation so I want to squeeze in some fun before that. I also have hair growth to look forward to. I need to stop looking at my head but there’s definitely been a bit of growth. For the first time in my life I’m rather excited about having a five o’clock shadow on my head. I’m curious to know what colour it will be as I’m told it could come back a completely different colour and texture. Let’s hope I get poker straight blonde highlights. I haven’t had to shave my legs for 4 months, a small blessing, so I also have that to look forward to. Bring on the stubble.