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Update and Surgery: Our last newsletter ended with preparing for L-A’s mastectomy surgery at Worcester Mediclinic (private hospital) on May 12th. She stayed in hospital for four days, until Saturday morning on May 16th. According to the hospital report, she had a single full mastectomy of the left breast, and nine lymph nodes in the left underarm area. The breast removal included everything to the chest wall, so reconstruction of the breast isn’t possible. However, Dr. Arnold Smith wanted to make sure that he would get all of the cancer out. Inflammatory cancer can taint and seed into any flesh it touches. Since cancer cells were previously up to the chest wall, and invading the lymph nodes, Dr. Smith wasn’t taking any chances.
When L-A initially asked the doctor if he got all the cancer, he had a worried look on his face and said that he really tried, but they won’t know for sure. The stats on this kind of cancer are not good. The chances are normally 40% survival over five years (he was afraid to share that, but this info is available online). However, L-A remains hopeful. We believe the still small voice of the Holy Spirit, who spoke directly into L-A’s heart twice last year. He said that her healing was in South Africa. The tissue was sent to the Pathcare Lab, who sent their report just over a week later. The surgeon rejoiced to share that the cancer was contained with excellent margins within the removed breast (rare for this kind of cancer), and there was no cancer whatsoever in the nine removed lymph nodes. Dr. Smith called this a miracle, three times, not something most surgeons in Canada would do!
L-A has had several follow-ups concerning drainage from the incision sites, removal of a suspicious (but benign) mole on her right leg, and to check the healing progress of both incision sites.
L-A was also given extra anaesthetic during the operation, which went on longer than the scheduled two hours. However other than the extra time, there were no abnormalities. The anaesthetic fee was twice the estimate, but since we had a very successful online fundraiser, we didn’t need to worry about covering the costs (what a relief!!)
No Hospital visitors allowed; - exccept those who work in MediClinic. Our friend Therden runs the ER in the hospital, so he was L-A’s sole visitor. He acted as go-between for care packages, drain bag and L-A’s favourite winter fruit: naartjies (like clementines). Therden visited L-A in the recovery room right after her surgery (where he proclaimed that L-A is an amazing cook). He visited again to pray with L-A, encourage her several times, and bring fruit. The last time he was to come, he couldn’t come in person, so he gave naartjies to Dr. Smith to give L-A. This prompted the sweetest discussion of how L-A and Tony befriended Therden (the attending nurse knew him also, so it was clear that Therden has a medical fan club).
Physiotherapy for arm to prevent lymphedema: L-A was assigned a physiotherapist named Bronwen while she was in hospital. She was given specific exercises to give increasing reach and mobility for her left arm, and to prevent lymphedema. This is a swelling of the arm that can be serious. However, there is no guarantee and L-A seems to be developing this anyway.
Swelling issue in upper arm and left side: L-A originally had two drains tubes and bottles for drainage from the incision sites. A surgical nurse removed the drainage tube from the breast and changed her bandages. She left the drains tube in L-A’s side, since it couldn’t be removed until the daily amount drained was under 50 ml. We bought a special drain bag to contain the drains bottle and tubes, so that they wouldn’t be in L-A’s way. However, there were times when L-A forgot she was attached. This resulted in the bag and bottle dragging behind L-A when she walked across the room. At first it was funny, as if the bag and contents would follow and say, “Forgot something?” Twice it was more serious, where the tubes were stuck behind a bedroom dresser, when L-A was in the bathroom, so it really tugged at L-A’s side. The second time was the clincher – L-A adjusted herself in her seat during an overseas Facebook Messenger call. So when L-A next went to the bathroom, the tubes were no longer attached. Now there was no way to drain her! It was Saturday night.
We went to MediClinic ER, and at first they were more concerned about Covid-19 than her problem. She gave the info and date/place of her negative test so it could be verified, and then she was allowed to enter. The ER doctor met her and told her that all they should do was bandage her. The only other option would be to take her back into theatre and re-insert the tube in a sterile process – expensive. So she was sent home with a little plastic baggie. Later, when L-A told Dr. Smith of this incident, he was upset that he wasn’t called, since he was on call that night. Then he joked that perhaps they were so concerned about the Covid-19 patients who were nearby, they just wanted to get her out of there. That wasn’t the first time she was moved away from a potential Coronavirus positive patient. It happened when she was still in hospital, so they actually moved her into a different room, since she is in a high-risk category.
The following Tuesday, Dr. Smith and his nurse Estelle drained L-A three times, and the liquid continued to be way more than 50 ml. The swelling refused to go down. A few days later L-A went in another time to see Dr. Smith’s colleague, Dr. Botha, while her surgeon was on holiday. Dr. Botha decided against drainage at this stage, feeling that the needles could cause more infection, and he could see fat invading into the area. He instead recommended area liposuction along with compression therapy. L-A asked him about manual lymph drainage, which had been recommended by her prosthetist Marzanne. Dr. Botha said that that therapy was more specific to the arm - but we will do more research on that - it may not be needed after liposuction. We asked for a quote. Meanwhile, L-A sleeps with a little pillow under her left arm that she’s nicknamed “Little Buddy.” This little pillow, and a soft prosthetic, were post-surgery gifts from her Cancer Care outreach.
Scare on the right breast: During all the recovery of the left side, L-A detected a lump in her right breast. She had Dr. Smith examine her, and he sent her later that afternoon to Worcester Radiology (across the street) for another mammogram and an ultrasound. The results were sent to the doctor with an all-clear. L-A was examined during the ultrasound, and she was told it was benign. It was a relief that the only non-Afrikaans word she heard exchanged between the radiologist and her supervisor was: “cyst.” Dr. Smith asked L-A to check the breast again in September for any progress.
Prosthetics: L-A had met with a prosthetics specialist, Marzanne Rensburg, while she was in between her oncologist consultation and Herceptin injection. She was fitted and given a card to look for prosthetic bra styles. Due to L-A’s size, many bras aren’t available, so Marzanne suggested “Safina,” which is pretty but comfortable. These bras have pockets inside the bra that contain the synthetic prosthetic, so it won’t fall out. We were given a well discounted price that includes the two consultations (the second on July 9th), one bra and the prosthetic. It is approximately $550 Cdn.
Herceptin injections: L-A had continued Herceptin injections every three weeks at CapeGate Oncology. Her next injection is on July 9th. There have been no further complications from the injections. L-A was having heart pain, which is one of the side effects, but after Sr. Marianna suggested L-A should journal when she was having pains, they stopped and are only occasional.
During the June 15th injection, L-A asked her nurse about compression tops. There aren’t any in Worcester, but Amazon may be the answer. For now, L-A is wearing a tight fit camisole that compresses both sides of her chest.
Ottawa Cancer Care: L-A has requested for the surgery, mammogram and surgical updates to be reported to Peter Dunn, who heads the admission to Ottawa Cancer Care at the Ottawa Hospital. They are to reach out to us very soon. It’s possible L-A may receive radiation therapy there, unless L-A’s oncologist wants it sooner. However, we likely won’t be back in Ottawa until October.
Recovery time from mastectomy: The info we have for mastectomy recovery ranges from 4-6 weeks (Google), 6-10 weeks (Dr. Smith) to three months/13 weeks (a Canadian nurse friend of ours). L-A is close to six weeks now, and we can say she is definitely a lot stronger than she was. But there is still a pain issue, and she needs to rest a lot, usually in afternoons. L-A was given another prescription round of medium strength oxynorm (oxycodone) for now by her favourite junior oncologist. Dr. Koetze was sympathetic to the pain issue, and assured her that this was temporary. Pain originates not only from the incision sites, but from both arms, due to the way that L-A has to sleep. Add to that the arthritic knees, for which L-A currently takes Lyrica, plus herbal remedies Piascledine and Curcumin.
We aren’t sure about the lymphedema issue (which L-A seems to have a mild case), but the liposuction may be the answer. L-A will see Dr. Smith on the 22nd for followup, so we will ask if he agrees with Dr. Botha’s recommendation.
For our praying friends, please keep L-A and Tony in prayer for L-A’s recovery, and journey through learning how to use a prosthetic, the liposuction procedure, and wisdom/direction for oncologist Hanlie du Toit over whether radiation therapy is needed in Cape Town or can wait until we are in Ottawa.
The last time we saw Dr. Hanlie du Toit, she was looking over my colouring book, since there was a buzz about it from the staff. While she didn’t buy it, her colleague Dr. Koetze and nurse Marianna bought copies. Well, Marianna is in the book. Here is Hanlie:
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