Surgery

Had my dreaded surgery yesterday. Got up at 3:30 am to apply EMLA cream to my port. Was able to go back to sleep for 35 minutes before getting up again. Friend Sindhu picked me up at 5:00 am. Arrived at 5:30. Surgery was at the Cancer Center building which has an Ambulatory Surgery Center, not at the main hospital building.

They were able to use my port instead of my arm for an IV. 3:30 am is not an ideal time to apply EMLA cream. I must have applied it in the wrong location because the needle was very painful when it was inserted. They may have also used a larger needle. 

I was given Emend tablets for nausea and a Tylenol tablet pre-op.

The anesthesiologist stopped by and understood that I wanted no pain and no nausea. She said she would use a simple airway on me after she learned I have issues with acid reflux. I told her I wanted to count down from 10 before losing consciousness, but my last memory was being wheeled into OR and seeing an awful lot of people.

I don't know if it started on time, but my surgery was scheduled for 7:15 am. My first conscious memory post-op was at 10:40 am. I don't know what time surgery ended, but the surgeon estimated it would last 1.5 hours. 

I was so drowsy and kept falling asleep and also had nausea. It wasn't till 2:40 that I was alert enough to go home. I had to pee first, and discovered I have blue pee. The surgeon injected me with a blue dye to help locate my sentinel nodes. I still had nausea, but the nurse said I had already been given two doses of anti-nausea meds. They did send me home with a barf bag, crackers, ginger ale, and an alcohol swab to inhale.

Cousin Nancy gave me a ride home. We arrived at 3:45 pm. My friends George and Diane from Pismo Beach had arrived and were waiting for me at home. They're staying with me till Sunday. I spent the rest of the day with nausea and vomiting. I took one Tylenol capsule for pain and promptly threw it up. So I had no painkillers last night, but it wasn't too bad.

I took it easy this morning. Went downstairs for lunch. We went for a drive in the afternoon and bought some groceries at Trader Joe's. George made tacos for dinner. It was excellent. He used taco seasoning from Trader Joe's. I'll have to buy some later.

Not much pain today. I took one Tylenol this morning and took another tonight just in case. I'm wearing the same breast binder they put on me yesterday. My instructions say to wear a sports bra 24 hours a day for 7 days.

The only thing I know about my surgery was that 6 sentinel nodes were taken out. I thought there would be only 2 or 3. I didn't ask about the lumpectomy. I have two incisions, one on the lower right of the breast and another under my arm. I won't know the pathology results till my follow-up appointment on April 26.

Pre-op Procedures

The day did not start well. I woke up to news that my aunt wasn't doing well, and she died soon after. She was my mom's last remaining sibling. RIP Tita Med.

I had two pre-op procedures today. They're usually done the day of surgery, but because I'll be the first surgery of the day, the procedures were scheduled early to save time in the morning. Despite that, I still have to show up at 5:30 am tomorrow for surgery at 7:15.

The first procedure was to place a Savi Scout reflector in my breast. It's supposed to allow better accuracy in locating the tumor during surgery. In my case, because the tumor is gone, it's used to pinpoint the calcification that's left behind. The surgeon will then use a radar device to detect the reflector.

What I didn't know till I arrived for the procedure was that two reflectors would be placed to mark the edges of the calcification. There were two radiologists for the procedure. I think one doctor was training the other. 

A mammography machine was used for imaging. First my breast was compressed between two paddles. While it wasn't as bad as getting a mammogram, it was occasionally painful. I had warned the doctor before that my earlier breast biopsy was extremely painful. So I was given two shots of lidocaine. The first reflector was inserted, but the needle was left in my breast in case the reflector position needs adjustment. It hurt when the needle went deep, so I was given a third shot of lidocaine. Then the second reflector was inserted. Again it hurt, and I got a fourth shot of lidocaine.

Several images were taken while the two needles were sticking out of my breast. The position of one reflector had to be adjusted several times. Then the needles were finally removed. The whole procedure took about 35 minutes with my breast compressed the whole time. Brutal.

Next procedure was an injection of radioactive tracer to locate my sentinel lymph nodes during surgery. I was told the injection would feel like a bee sting, as if it's nothing. I've only been stung once in my life, and it was extremely painful and felt like an electric shock. Thank goodness for the four shots of lidocaine in my earlier appointment. I still felt the injection, but it wasn't as painful as it could have been.

The procedure took 20 minutes. I then had to kill time for 1 hour 40 minutes to allow the tracer to work its way to my lymph nodes. I was told to go for a walk to help the tracer. When I returned later for my imaging appointment, a gamma camera was used to detect the tracer. It didn't take long, maybe 15 minutes.

My breast started to feel sore on my drive home. Tylenol helped.

Second Covid Shot; Update on Side Effects

I got my second covid shot yesterday. The only side effect I've experienced so far is a sore arm. I forgot to bring my vaccination card, but it was no biggie. They gave me a new card and marked it for the second shot. Now I can get a free donut from Krispy Kreme. 🍩

This morning I got my every three weeks infusion. The pharmacy got my drugs ready early, and my infusion ended an hour earlier than usual. It took just a little over two hours.

Next stop was a covid test. It's required before I can have surgery. The test is so unpleasant. They insert the swab very deep into your nose. Even though the test is not painful, it's so awful that I'd rather get an injection. When I drove away from the drive-thru site, I pulled over for a while and cried. I think I got overwhelmed by everything that's going on. This was the first time I cried over my illness. It's been six months since I discovered my tumor. Not bad.

My last chemo session was on Feb. 22. My eyelashes and eyebrows started falling out after that. I didn't lose them all, and more fell out of one side than the other. I lost all the eyelashes on the right and a lot of the right eyebrow. But now new eyelashes are already growing out, and my eyebrows are starting to fill in. 

My hair is also starting to grow out. It's still quite short, less than 1/8", but it's long enough to make my scalp look dark.

Other improvements: 

• My skin is not so dry anymore. I'm not shedding skin all over the place like I used to.
• I've gained weight. My appetite is back, food tastes good again, and I'm eating way more than I should. This morning I weighed 105 at my appointment.
• My fatigue went away about 10 days after my last chemo. It disappeared as quickly as it appeared. I thought it would go away gradually, but no.
• I've had a runny nose since my first chemo. I've gone through several boxes of tissues. Sometimes I'd be blowing my nose nonstop for several minutes. My nose was bloody too. It finally stopped a month after my chemo ended.

What hasn't gone away is the off-and-on diarrhea. It's a side effect of Perjeta. I'm afraid I'll be experiencing diarrhea till December. My potassium was low again this morning. I was given 40 mEq of potassium. It was in powder form this time, orange flavor and very salty. I was given apple juice to mix it with. I'm glad they didn't give me the humongous tablets that I had trouble swallowing.

Tomorrow I have two pre-op procedures scheduled. Surgery is on Wednesday. I was stressing out over the procedures and surgery. Now that I've got my questions answered, I'm feeling more calm. I just wish it hadn't taken such a long time to get them answered.

Surgery Rescheduled

I had a video call Monday with an anesthesiology nurse. I made it clear to her that I don't want pain, and I don't want nausea. When I asked her about getting a nerve block, she said they don't do it at the South Bay location where I was scheduled to have surgery. It's a smaller cancer center in San Jose.

A few hours later I had an office visit with my surgeon and asked about getting a nerve block. She thinks it's not necessary. This may be true for some patients, but I know it's offered as an option at other hospitals for the same procedures I'm getting. Regardless, it's not offered at the South Bay center.

My surgeon wanted me to have a wire-guided localization to mark the breast area to be excised. But her nurse mentioned a newer technology called Savi Scout. From what I've read, it may or may not be more accurate, and it may or may not improve the odds of getting clear margins. It does have the advantage of not getting accidentally dislodged. It also eliminates having an uncomfortable wire sticking out of the breast for possibly hours before surgery begins. I asked my surgeon if I could switch to Savi Scout, and she agreed.

Then I asked about Lumicell. It's an imaging system that highlights tumor margins. Like Savi Scout, it improves the chance of getting clear margins. If I don't get clear margins, I will need a second surgery, and I absolutely do not want to undergo surgery again. 

It's not clear to me if I'm a candidate for Lumicell. But the surgeon said I can't have it because it's done only at the Palo Alto location. At this point she stated that because I wanted the surgery on April 6, it limits me to the South Bay location. I told her that wasn't true, that I didn't request April 6. She abruptly left, presumable to find the coordinator and reschedule my surgery. I later found out from her nurse that she prefers the Palo Alto location because it's a bigger facility with more resources.

My new surgery is date is April 14. This works out better for me because I have my second covid shot scheduled for April 11 and my next infusion for April 12. On April 13 I'll have two pre-op procedures, the Savi Scout and radioactive tracer. I will also need another very unpleasant covid test.

Another plus is that the new date gives me more time to visit with my sister and nephew who are in town to visit my dad. They won't be out of quarantine till Friday and will fly back on April 10. With my original surgery date, I would have had only three days to see them.

Surgery Second Opinion

I had a video call on Wednesday with Dr. Wong at UCSF. She recommended lumpectomy and sentinel lymph node biopsy followed by radiation. No surprises there. I was already resigned to having surgery and let Stanford know. My surgery is scheduled for April 6. 

Monday was my sixth infusion of Herceptin and Perjeta. I will get 18 infusions total.

Radiologist + Vaccine

Had a video call Wednesday with a radiologist, Dr. Salem. Most of the time was spent with the resident radiologist, Dr. Wang. The recommendation will likely be 3-5 weeks of daily radiation depending on the pathology after surgery. I will have another appointment two weeks after surgery.

I became eligible for the covid vaccine on Monday. Because of the vaccine shortage, I could not find appointments Monday and Tuesday. On Wednesday I tried looking in San Francisco and managed to get an appointment today at Moscone.

My friend Dhez joined me on the drive to SF. I didn't mind the company because driving in SF, especially downtown, stresses me out. Parking in the garage was also stressful because the parking spaces were so narrow. I drove past several available spaces till I could find one that was a bit roomier next to a partial wall.

There were hundreds of people at Moscone, but they were pretty good about keeping their distance, and the process went smoothly. The vaccine was from Pfizer. I had to sit down for 15 minutes after my shot in case of adverse reactions. From the time I entered till the time I left the building was 35 minutes.

Dhez and I ordered lunch to go and ate it at a nearby park. It was a nice and sunny day. There were lots of people out and about in SF. Too many, in fact, considering there's a pandemic. Most folks wore masks, but not all.

My arm is sore. My second shot is due in three weeks, on April 11.

Muscle Pain

The fatigue caused by my chemo is pretty much gone. I can walk up the stairs without trouble. But I noticed pain in my thighs and also in my arms. It was puzzling since I haven't been working out. I finally looked it up. Muscle pain can be a side effect of Perjeta. Either that or I have covid.

The pain is not too bad. It hurts only when I move. I try not to move.

I saw the surgeon again last Monday. She's recommending a lumpectomy. She will also have to do a sentinel lymph node biopsy. That means I will have two incisions. 

If I don't have clear margins, meaning if pathology finds cancer cells around the rim of the tissue that's removed during surgery, I will need a second surgery, and it might have to be a mastectomy. I don't want a second surgery. I don't even want a first surgery.

I managed to get an appointment at UCSF on March 24 for a second opinion. The doctor I wanted to see is not available till late April, so I settled for another doctor who trained under her.