Monday, October 22, 2007

A Second Opinion

"In future, you will not be able to carry anything heavier than 5 kg...", said the nurse-counsellor as she brandished about a small plastic bottle which she had minutes ago informed me would be hanging from my armpit to allow for lymphatic drainage after the axillary clearance operation. I was SHELL-SHOCKED.... and my calm composure, carefully maintained during the earlier consultation with my first surgical oncologist, slowly disintegrated as tears started to bunch up in my eyes!

"Oh no... I won't be able to carry my baby niece and nephew anymore as they are already past 5-kg in weight... oh no... will I still be able to carry my SLR camera and go for photo-jaunts?... oh no... does that mean I won't be able to carry heavy pots and pans in the kitchen?", the potential consequences of losing my lymph nodes really came crashing down that afternoon.

When I first got my mammogram results back, I was sent by my company doctor to a government hospital (which I will not name here) where the surgical oncologist who examined me had recommended that I be admitted as soon as possible for surgery to remove the lump, and if tested to be cancerous then, to proceed immediately to remove the lymph nodes under my armpit on the side of my affected breast (known as an axillary clearance), which he explained was the standard operating procedure for breast cancer surgery. I had been prepared to do a lumpectomy to remove the lump but had not factored in the loss of my lymph nodes and the risk of lymphoedema (swelling of the arm) and other attendant risks of infection to the arm arising from the removal of the lymph nodes. I was bloody scared - in fact more scared of the axillary clearance than the lumpectomy!

Hubby insisted on a second opinion, and thankfully with C's help, we managed to get an appointment the very next day with Dr Zen (C's surgical oncologist). [Dr Zen is my nickname for my surgical oncologist, as he is the direct polar opposite of Doc Smiley being at all times very serious and reassuring in manner, explaining all the important stuff in his low and calming voice, hardly ever joking - very very zen-like!]

Dr Zen did a very thorough examination of my breasts, armpit and neck areas to check for any unusual lumps other than the one that I had felt. He recommended that a core-cut biopsy be done immediately on the day of consultation to confirm that the lump was indeed cancerous. Thereafter, he told me in a very serious manner that I had small breasts and that although I could get away with breast-conservation surgery - i.e. a lumpectomy (instead of a mastectomy - removal of the entire breast), it may distort the shape of my breast. Hold on a minute here... I may not have been a D-cup but I was definitely not an A-cup either... there and then I should have been instantly insulted, even hubby would not dare to call my breasts small... but somehow, Dr Zen managed to get away with that comment delivered in the gravest and calmest of tones!

What was more important though about this 2nd opinion was that Dr Zen had recommended that a sentinel node biopsy be done, a new technique which allows the surgeon to check whether the cancer cells have spread to the sentinel (guard) nodes before deciding on whether to do the axillary clearance of all the lymph nodes in the armpit. Premised on the fact that fluid from the breast first drains to a limited number of nodes in the armpit, any cancer cells which may have spread to the lymph nodes would get trapped first in the sentinel nodes, the procedure involved injecting some kind medicine (which contains a tiny amount of radioactivity and a blue dye) into the breast to track the path of drainage of the fluids from the breast to the armpit. During the surgery to remove the lump, Dr Zen would also remove the sentinel nodes and have them immediately examined for cancer cells. Only if the sentinel nodes had cancer cells would he proceed to do a complete axillary clearance to remove the lymph nodes under the armpit. For me, this was the Lord's answer to my prayers over the fears of the axillary clearance.

I was so anxious about my lymph nodes that my first two words uttered to hubby when I woke up after my surgery from my GA(general anaesthetic)-induced unconsciousness were "lymph nodes?". Total relief flooded through me when he gave me the all-clear - the cancer had not spread to the lymph nodes - all praise and glory be to the Lord for answering our prayers!

Immediately after my surgery, I ended up with a blue breast (due to the blue dye that was injected for the sentinel node biopsy) which was quite alien-looking but thankfully, the discoloration has reduced over the weeks - a small price to pay for going thru' this procedure.

Seeking that second opinion turned out to be such an important turning point in the course of treatment for my breast cancer that I cannot recommend enough to any one seeking medical treatment for any form of cancer to have a second or even third medical opinion, whether to get confirmation on the type of treatment recommended or to be aware of the alternative medical procedures available.

a taste of heaven

The above was my celebratory salad two weeks after my surgery - a green salad of fresh sweet figs, a couple slices of prosciutto (parma ham), shavings of parmesan cheese, and a light dressing of balsamic vinegar, dijon mustard and extra-virgin olive oil! A celebration of the fullness of life provided by the Lord!

As for Dr Zen's concern on the reduced size or potential distortion of my breast after surgery, I leave you with this light-hearted story (which a friend forwarded to me) (and no religious offence meant to any one):

"A man walked into the Lingerie Department of Macy's in New York City. He tells the saleslady, "I would like a Jewish bra for my wife, size 34B." With a quizzical look, the saleslady asked, "What kind of bra?"

He repeated "A Jewish bra. She said to tell you that she wanted a Jewish bra, and that you would know what she wanted." "Ah, now I remember," said the saleslady. "We don't get as many requests for them as we used to. Mostly our customers lately want the Catholic bra, the Salvation Army bra, or the Presbyterian bra."

Confused, and a little flustered, the man asked "So, what are the differences?"

The saleslady responded. "It is all really quite simple. The Catholic bra supports the masses. The Salvation Army lifts up the fallen, and the Presbyterian bra keeps them staunch and upright."

He mused on that information for a minute and said: "Hmmm. I know I'll regret asking, but what does the Jewish bra do?"

"A Jewish bra," she replied, "makes mountains out of molehills."

Looks like I need to find me a Jewish bra as well! :-P

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Blogger pfong said...

Wishing you a swift recover Cath. You are in my thoughts. Let me know if you feel like shooting, I can be your camera carrier :-)

10/23/2007 09:25:00 AM  
Blogger Mulhollands Falls said...

Hi Cath,

May I have the DR Zen's contact? would like to ask for a 2nd doc's feedback than just based on the government hospital one. you may email me at


10/23/2007 12:22:00 PM  
Blogger eatzycath said...

@paul - thanks for the offer, lolz may take u up on the camera carrier one day!

@joeyx - hang in there and stay positive - have just emailed you the contact for Dr Zen!

10/23/2007 08:01:00 PM  
Blogger boo_licious said...

Totally agree with you on the 2nd and 3rd opinions - I've seen so many cases (friends and families) where they realise you need to hear all viewpts as every doctor has their different way of approaching things. Even the doctors in Msia and Spore are varied in their opinion abt chemo treatments - here they seem to practise a very textbook approach i.e. less potent chemo mix while the Spore doctors are more aggressive.

Sorry, I can't help you carry those heavy items since I'm across the causeway but will give you my "invisible support". Go Cath Go! Beat this cancer away!

10/23/2007 09:36:00 PM  
Blogger eatzycath said...

@boo_licious - yes, it helps to get a 2nd opinion just to be sure and thanks for that invisible support!

10/28/2007 09:11:00 PM  
Blogger Camemberu said...

I've always loved the photos on your blog, and was very glad to see that you back blogging again. Stunned to read about your bout with cancer but you have been really brave and sunny coping with it! Gambatte! Will pray for you and recovery! Thanks for the wonderful, inspiring posts (and recipes too).

11/19/2007 09:10:00 PM  

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