Just over a month ago I had my third and final dose of the taxing Tax. Docetaxel was pretty hardcore stuff; the first dose landed me in hospital with uncontrollable pain. Doses two and three were reduced to 80%. I was again unhappy with the dose reductions, in case they reduced the drug's efficacy, but kind of relieved in a way, as hopefully my risk for further complications brought on by this intense poison will also be reduced. Even with the dose reductions, I suffered some unpleasant side effects - feet that felt burnt, then peeled in sheets for weeks; twitching eyelids; yellowed and blackened fingernails; hypersensitivity to noise and light; impaired cognitive function and short-term memory problems and muscles that still ache as though I've done a heavy workout in the gym. But overall, four weeks on, I'm surprised and amazed by how good I feel. The human body's capacity for healing itself is absolutely incredible.
Yesterday, I was admitted to hospital for my surgery. I can proudly say that I was the first person at my hospital to have this particular surgery.
In February, my lymph node was biopsied and tested positive for cancer. Traditionally, this would automatically mean all my lymph nodes were removed along with the offending lump. Up to 70% of women who undergo this procedure - axillary node clearance - will go on to suffer problems with lymphoedema, frozen shoulder, cording and/or loss of sensation and strength in the affected arm. As an active woman, as a mother of young children, this procedure scared me almost as much as the cancer. Women end up permanently disabled. I cook, sew, garden, hammer nails into walls, move heavy furniture around, have cats and still carry my children in my arms; how was I to 'protect' my right hand and arm for the rest of my life? Something as seemingly innocent as a hangnail could trigger the dreaded lymphoedema.
Thankfully, I came across an article about a study that was published only last year. This practice-changing study found that for about 20% of women diagnosed with breast cancer (who have a small lump, positive but non-palpable lymph nodes, and who are likely to have further treatment such as radiotherapy to the armpit, endocrine therapy or chemotherapy) it was just as safe to NOT remove all the lymph nodes. In fact, in this particular study, the women who only had a sentinel node biopsy actually had a very slightly better prognosis. I took this study to my surgeon. He acknowledged it, but made it clear that the standard of care was still to perform a full node clearance on any node-positive patient.
After lengthy discussion, he offered me an alternative. I could do chemotherapy first and see if it 'cured' my enlarged node. If, by the end of my chemo treatments, the node looked normal on ultrasound scan, they might agree to perform a sentinel node biopsy rather than a full clearance.
The sentinel node biopsy seeks to identify the first lymph node the cancer cells might drain to, with the idea being that if that node is free of cancer, the other nodes also should be. The surgery is much less invasive and carries a far lower risk of morbidity.
I agreed to this deal. I thought if nothing else, having my chemo neo-adjuvantly (before surgery) would buy me a few more months with a healthy, non-compromised arm. It would give me time to finish the many DIY projects around the house, with the further benefit of being able to see if the chemo drugs were having any effect on my tumour. And it worked on both counts. I got to see my lump shrink by half, and after only two treatments my lymph nodes looked normal.
A week and a half ago I met again with the surgeon. I would be the first person at my hospital with a lymph node that tested positive to be offered the sentinel node biopsy.
It pays to be a stroppy patient.