The Sentinel Node Mapping

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I can finally type without too much discomfort, after the April 10th surgery, so I am going to begin with the first procedure, just prior to and at surgery.

The sentinel node mapping – the preparation for the sentinel node biopsy- the dye injection – was, for me, the worst of the two days of procedures, including the wire insertion and surgery.

The sentinel node biopsy means the removal of a couple of lymph nodes under the arm, on the side where the breast cancer has been found. It is an exam to find out if the cancer has spread. A radioactive substance is injected into the breast, and then the next day, the surgeon has a marker to help him find the location of the sentinel node and other lymph nodes, for removal.

The nurse navigator (and the brochure I was given) had explained that I must purchase Emla cream at a pharmacy, and apply it to the areola and just outside it, about an hour and a half before the injections would be done. Supposedly, this cream acts as a anesthetic so the procedure of injecting the radioactive dye will not be too painful. Perhaps my husband, who assisted me, did not apply it quite correctly but the results were not good.

The morning before the surgery day, I arrived at the radiology lab at the health center for my appointment, and I was brought to a small room. I changed to a short, upper body only nightie and laid down on a small cot.The radiologist came in with the nurse. She had told me that the injections would hurt, but not too bad. She said the pain was similar to a bee sting. Well, I am a rare one, as at age 59 I’ve never been stung, so I had no idea what might be coming. But I think  she was wrong!

When the first needle was inserted, I could feel it a bit, and I thought, “Oh, not too bad.”  But then came the ‘real’ injection, and oh my. After living through the birth of two children, one of which was about 16 hours, of mostly hard back labor, granted many years ago, I have never in my life had a pain like that. It hurt terribly. Not for long –  I had enough time to think, “Oh my, that really, really hurts. Oh my, I don’t think I can stand it. Oh it hurts. How long is it going to go on? Oh my. I don’t think I can stand it. It really hurts!” And then it stopped. Once more, the same thing. Then it was all over. I would not wish that pain on anyone. If you must have this procedure, be sure to find out how best to apply the Emla cream, if you are using it. If you have an option, of a local anesthetic, by all means, choose it!

I had to return to the radiology lab two hours later, for the scan. This is not pleasant, if you are claustrophobic, but at least it doesn’t hurt. The technician asked me to change to a nightgown, upper body only, and I had to lie down an a narrow cot. She asked if I was claustrophobic, and I told her, “A bit, so I am going to keep my eyes closed for this.” I could feel the bed moving forward, into the scanner area. Then some small whirring sounds. She was nice, explaining how the machine was going to take a picture, “Lie still for one minute” and then, “Lie still for five minutes.” After that, another technician came in, and using the photos just taken, he made marks with a pen on my underarm to show where the lymph nodes were located. This was painless. Then it was all done, and I could go home.

The following day would be the insertion of the wire at yet another health center, and then the surgery. More on that later.

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A Little More Time to Heal

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I have not been able to type much since the surgery on April 10. I am getting better, though, and it is easier with time. I will soon describe all the events of April 9 and 10, when I can type longer.

I have a follow up appointment with the surgeon on April 24 and at that time I will likely learn the results of the sentinel node biopsy.

Time for the Surgery

I have been in contact with both Gwen and Wendy, the co-ordinator and nurse and the appointment times are booked. On Tuesday morning at 10:30 am I must be at the hospital radiology for the mapping. I have assured both ladies that I have my EMLA cream ready. I just hope this local anesthetic means no pain that day! As I understand it, (I plan to read over all the information on Sunday morning, over coffee with my husband) there will be four needles filled with a radioactive dye that will flow into the sentinel lymph node and beyond.
On Tuesday afternoon, I have to call the hospital Admitting to find out what time the surgery will be done on Wednesday.
Nothing but clear fluids, soda, black coffee (yay!), black tea etc after midnight, to four hours before surgery.
On Wednesday morning, I have to be way across town, back at the women’s centre where the biopsy was done, at 8:30 am, to have a wire inserted, as a marker for the surgeon to find the tumor.
Then I must go directly to the hospital, to admitting. I will go to the Unit, where my husband can sit with me until I go into surgery. The staff will check my weight and blood pressure, and the anesthesiologist and surgeon will visit me.
There will be an IV. After surgery, I go to Recovery. From there, back to the Unit for one to two hours, and again my husband can be there. After that I will be coming home.

I have been told to be sure to “take your painkillers, even if you feel you don’t need them. Don’t wait for the pain to start. Get up and walk as the pills will make you constipated.” Oh well. I have bran cereal and should be fine, I hope! By then, I will just be glad to have all of this over with!

I hope there is nothing to see in the sentinel node. If there is, I am afraid of what that means. I understand it indicates the cancer has spread. Annual mammograms should have caught the cancer early enough, though, yes?

On another subject, my father-in-law phoned me the other day, after he found out about the cancer. In the old days, this man was gruff, snippy to his family, and drank all the time. A miserable man. Over the years he has had to quit drinking for health reasons. He has mellowed as he’s aged. He is a sweet old fellow now. I was so touched that he took the time to call me. My mother-in-law emails often and is close by, phone or Skype if I need her. My ‘oddball’ older sister is emailing to tell me she is praying for me.
I am blessed.

It’s a bit stressful, though, I find, as I tend to reassure all these people that the cancer has probably been caught early, and that after radiation I will likely be fine. But that is me, and my personality, not wanting others to worry.

Readers, wish me luck, pray if you like!