A few nights ago, I watched a Downton Abbey episode. Mrs. Hughes, the housekeeper, found a lump in her breast. Mrs. Hughes was frightened, and she was anxious. Cancer was a word that drove a chilling fear into the heart of someone given the label as it does today. Mrs. Patmore, the cook and her friend, told her she needed to see the local doctor, Doctor Clarkson.
There was no health insurance. Medical services had to be paid up front. Wages were low. Treatments were slim. Radical mastectomies, not common today, were the only treatment. Radical mastectomies removed the breasts, the lymph glands and frequently the muscles underneath. The patient usually died anyway. ( In 1970 fifty per cent of women with breast cancer were still dying.) Mrs. Hughes had reason to be scared.
Dr. Clarkson drew fluid from Mrs. Hughes breast. He sent it off to the lab. There were no diagnostic tools like MRIs or CT scans to provide clues. They settled into wait.
She returned with Mrs. Patmore to learn the results from Dr. Clarkson. Mrs. Hughes had negative results. She could breathe. She could carry on with her busy life. She could be grateful.
My breast cancer was picked up by accident. My RA Doc ordered a chest CT scan and there it was. Something that shouldn’t be there. A biopsy was ordered to see what this something was. It was positive for malignancy. An MRI was ordered, and I was sent to a breast surgeon.
At the time I did not feel fearful or anxious. I was two weeks out from stage three thyroid cancer surgery. My RA was not under control. I was numb. I did as I was told. I walked through my days as a zombie. Fortunately, my cancer was in its early stage. Surgery, radiation, and an aromatase inhibitor was the treatment plan.
Although my breast cancer treatment has its own story, my cancer was squashed. I had more tools in my toolbox than Mrs. Hughes. I had insurance. I had diagnostic tests and I had a treatment that did not leave me a cripple. I am a lucky woman.
My third cancer was the most difficult for me to tolerate. The whole thing started when my RA doc wanted to follow-up a spot found in my uterus on a CT scan. I was going to start the biologic Actemra for my rheumatoid arthritis. I went to a gyn doc who scheduled a biopsy. She said it probably wasn’t a problem since I had no vaginal bleeding.
I had been scheduled to get the results several weeks out. I didn’t worry about it. Then her office called and rescheduled me for an earlier appointment. I went in. The doc told me it was cancer, and she would refer me to a cancer doctor. She said she didn’t know anything about this cancer. She left.
My son was driving. Back in the car I googled uterine serous cancer. That is how I found out that it was a rare cancer similar to ovarian cancer in its behavior. It was also caused by the Tamoxifen that I was on for breast cancer. I was stunned.
This was March and the beginning of a roller coaster ride that would last the rest of the year. How did I survive? I suppose I did it by being in a fog and doing as I was told. I didn’t think. I plodded. But at the same time, I had a deep worry about having the vaginal radiation. And I was right. It was overwhelmingly invasive.
It has been three years since I completed my treatment of robotic surgery, chemo, and vaginal radiation. And it hasn’t been until this year where I felt the trauma. I recently saw the CT scan that showed the 2 inch by 1.5 inch mass in my uterus. A malignancy. An invader.
I feel I was invaded, stripped clean, poisoned, and humiliated. That is how I feel about my treatment. Yes, I feel cured. So, I should feel grateful. I don’t.
This year, three years later, I worked through my feelings. I am done. However, I have a corner of my heart that has a little sad cloud that is here to stay.
I have had three entirely different cancers and three different radiation treatments all within four and a half years. I had to count that twice on my fingers to actually believe it.
My first set of radiation treatments was for breast cancer. It was this set of treatments that came back to haunt me this winter. But that is not my focus now. My treatments were at Kaseman’s MD Anderson. I went every day for three weeks at double dose instead of the usual six weeks. I had been reassured that the results were the same. I had to drive across town. It was like a field trip. I knew that once I got there, I could have a good cup of coffee. They had a Keurig coffee machine. It was a carrot for me, and it worked.
I would sign in. Change into a gown. Lock up my wallet. Then I would sit with other patients to wait my turn. This is the part that sticks with me. It was in this room that I listened to the stories of other patients. Someone told me that the only time anyone talked was when I was there. I am glad that they did talk with me.
My memory is about a willowy, woman in her forties, brown hair, a few freckles across her pale face. She had been a teacher. She had metastatic cancer and had been through a lot. Currently, she was being radiated for cancer in her leg. She said her friends told her that she should travel while she had time. She said she just wanted to stay home and see the people she knew. Then she made a statement. Something she had been considering. She sat there and said this is it. “No more. I’ve had enough.” She was done with any new treatment. She surprised me. She was young. Of course, she was right. She had taken all the treatments they had given her, but she was tired. No more energy. She was done.
When I think of cancer’s power, I think of her. She had done her best. She was exhausted and could do no more. It really wasn’t about fighting or winning. It was about staying alive. It was about staying alive until there was nothing left. Like she said, she was done. Cancer’s a tough one.
I am recovering. Surgery was done on 13 December. It was a surgery to debride an abscess caused by necrotic breast tissue due to radiation. As I said before, it was day surgery at Presbyterian Rust Hospital in Rio Rancho. I have had several surgeries there and always feel safe and well cared for.
There was not much in the way of post op pain, so the start of my recovery was good. The scary part, especially with breast surgery, is when you take off the bandage for the first time to see what you have left. It is not like it is in the movies where you are seen lying in your hospital bed and the doctor gently removes your bandages. He looks at your wound in a reassuring manner and you feel that you will be okay. You are home. Alone. In your bathroom. You have a blue binder holding you in.
You also have the addition of a drain that must be managed. The drain is called a Jackson Pratt. It is a plastic bulb attached to a tube that goes to your wound. It had a pop up cap. My job was to empty it daily and record the bloody drainage. Next squeeze the bulb. Replace the cap and gentle suction would do its work. The tube is secure. I don’t have to worry about it falling out.
I take off the binder. I start to remove the dressing. I was told by the surgeon that my surgery would remove my nipple. I did understand the need. My cancer had been very close to it. Even so, it is a part of my body I have always had. I am being taken apart piece by piece. Mutilated.
I finish taking off the dressing. It looked like my breast had been held up and half had been loped off and then stitched up. I avoided looking at it after that.
The drain came out. I seemed fine. Then I saw an opening in my incision and as I leaned forward blood started leaking out in a good stream. Oh, dear. That was when the irrigations started. I was instructed to inject 10 cc saline with a blunt nose needle into the wound opening twice a day. This was starting to be discouraging.
I was worried that I was going to need a mastectomy and they would finish the job. No more breast.
One day I spiked a 102 temp. The second wound culture came back positive and I had developed a bad cellulitis. The irrigations continued. I was on a 10 day regimen of Keflex. Finally, I began to make progress. During all this I had gotten used to my new breast and became okay with it.
It is 5 January and irrigations continue. My breast looks much better and I feel like I am going to make it. This was difficult to go through. The surgeon put me to work. It was not easy for me to do but I did it and I think I am getting better because of it.
My surgery will be coming up soon. When I learned I would need it, I felt depressed. I had been going to the wound clinic once a week and I was irrigating and packing the wound twice a day for several weeks now. I thought these measures were working. They weren’t. I remember the doctor saying if I needed surgery that there would be little left. Another dip into depression. So, I continue the care and await the upcoming surgery.
I had breast cancer in October 2013. I had surgery and then a series of radiation treatments in 2014. The radiated tissue has become necrotic. A common occurrence that I didn’t know about. The dead tissue needs to be removed.
This surgery is considered a ‘day surgery’. I will go home the same day of the surgery. My son becomes the nurse. The cost of a nurse or nurses is eliminated when patients are sent home the same day of surgery. It is a big improvement on their profit.
I am fine. My body is battle scarred after three cancers already. I am also amazingly resilient. I will heal. I will adjust. And then I will carry on. We all do that. We have no choice.
Radiation of the breast can cause the tissue to become necrotic. I learned this a couple of weeks ago when I developed a foul smelling lesion on my right breast six years after radiation for breast cancer. The breast cancer surgeon knew instantly what it was. I had dead, rotting tissue in my right breast. The formation of necrotic tissue following radiation is a common occurrence. I was sent to a wound clinic.
A wound clinic manages wounds that are hard to heal. These nurses are the experts. They know everything there is to know about the care and healing of difficult wounds. My wound is about an inch in diameter and it is quite deep. Initially, it was foul smelling. It still is but not as bad.
I was given the equipment to treat my own wound. I irrigate the cavity with a blunt needled syringe loaded with Dakin’s solution, an antiseptic liquid. Then I insert gauze dampened with the solution and laced with Santyl and cover the wound with a dressing. The Santyl is a collagenase ointment which dissolves the necrotic tissue. It cost $95 with insurance. This is not for a weak stomach. But I am a nurse and have always been able to do what needs to be done. I do this treatment twice a day. Morning then again before bed.
I ran out of the Dakin’s, so I found a recipe online. It was provided by a doctor to save his patients money. This makes a good wound disinfectant. Boil four cups of tap water for fifteen minutes. Add ½ tsp baking soda and almost a tablespoon Clorox. Store in a clean glass jar for up to a year. Works great and beats paying $20 for a bottle.
My return visit to the Doc wasn’t encouraging especially after all my work. She said there is still too much dead tissue in my breast so I would need surgery. I would lose my nipple and my breast would be much smaller. Not quite a mastectomy but almost.
I have two weeks to get ready for the holidays and I have been instructed to carry on with the treatments until surgery. Joy. Joy.
My thyroid cancer was found quite by accident. I was having lung symptoms so my rheumatologist thought that I might be having problems with the methotrexate. She ordered a chest CT scan. It turned out that I wasn’t having lung problems I was having a different problem. I had a mass growing on my thyroid.
This was my first cancer and I was in total denial that I might possibly have cancer. My patient doctor explained that the next step was a biopsy. I put the procedure off as long as I could. I was a working woman and I needed to work. Finally, the day arrived. In the x-ray department I was given a local anesthetic. Guided by ultrasound and a long needle, my doctor captured a number of samples from my thyroid. When the results came back, it was definitely cancer. It turned out to be stage three papillary carcinoma. It is not an overly aggressive cancer and it is slow growing. Lucky me.
My thyroid labs had always been normal. There was no large mass to demand attention. The cancer had been growing slowly over a long period of time. The cancer was also in my lymph glands. I would need surgery and then I would need radiation which is a story unto itself.
My endocrinologist said I would need an excellent surgeon. The surgery is delicate in two ways. The four parathyroid glands are in close proximity behind the thyroid gland. The surgeon must be careful not to remove or damage these glands when performing thyroid surgery. The parathyroid glands control the vital process of calcium metabolism. I was kept overnight to be sure there had been no damage to the parathyroids.
Also, the recurrent laryngeal nerves can be damaged during the surgery. The result of damage causes difficulty speaking. Yes, a skilled surgeon is a must for thyroid surgery. Fortunately, I had one.
I survived. My scar is barely noticeable. I will need to take a thyroid pill for the rest of my life as my body can no long make its own.
A week after the surgery I had a repeat follow up chest scan. Two things happened. First, the technician used an iodine dye as a contrast medium. It was contraindicated in a post op thyroidectomy patient. It was missed. Bottom line was my radiation treatment was postponed for six months.
The second thing that happed was bad news. This scan found another cancer. This time it was breast cancer.
I have survived three cancers, rheumatoid arthritis and a hip replacement. I expected that I would eventually have another cancer. The disease seemed to be written in my stars. However, I wasn’t expecting another complication from my breast cancer treatment.
My first complication was a rare uterine cancer called uterine papillary serous cancer. It is a side effect of being on tamoxifen. This cancer is aggressive and behaves similarly to ovarian cancer in that it is aggressive and can be deadly. It is never caught early. I was fortunate because it was picked up by my rheumatologist on a lower back MRI. So, I spent the entire 2018 with a biopsy, then major robotic surgery, followed by a summer of chemo, finished off with vaginal radiation for the holidays.
My complication was a breast abscess formed in necrotic fat tissue as a result of radiation for breast cancer.
Any surgery or radiation will cause scarring in the healthy tissue. I had a hard lump in my breast after surgery and radiation. I understood it to be scar tissue and I learned to live with it.
The softness of our breasts comes from fat tissue. It is this tissue that formed the scarring from radiation. Cancer doesn’t like radiation but neither does healthy breast tissue. It was this scarred tissue that became necrotic or dead. Fat necrosis is a long term complication from breast cancer radiation treatment. The necrotic tissue in my breast became abscessed. Breast abscess due to fat necrosis due to breast cancer radiation. Sounds awful.
My breast cancer surgeon recognized it instantly for what it was. I was sent to a wound care clinic. The nurses were also familiar with the condition. They said my breast looked more like a bad leg wound. It was a half inch lesion. They poked around inside (didn’t hurt). Much of the tissue was necrotic and also calcified.
I was given a prescription for Santyl which is an ointment that debrides the dead tissue. It dissolves the dead tissue to clean it out. It cost me $95. The going price is $250. The alternative is another surgery much like a mastectomy. I hope this works.
November 8, 2019
A grey fog has settled over the city. I can’t see the mountains. I can only see the neighborhood. The temperature is supposed to hit the sixties here in Albuquerque, but I doubt it. We need the sun to warm us up. Winter seems to have hit us suddenly. We turned from green to dull winter brown almost overnight. The quail block outside my bedroom window has been very busy. Lots of birds. Fat quail families making their regular visits. The squirrels have left the old tomato plant and are happily munching the quail block with the birds. I haven’t seen the chipmunks lately. Life in the backyard.
I enjoy winter here in Albuquerque. I enjoy my fireplace. Yesterday I had my afternoon coffee in a comfortable chair by the fire. I read another chapter or two from my current library book on my kindle. I am reading Ken Follett’s Pillars of the Earth. It is a seven hundred page book. The story draws you in and you feel the need to know what happens next. I keep reading. I have renewed this book once already and probably will need to do it again.
The lesion on my breast cancer scar is stable. I have an ointment for it, and I am taking an antibiotic for the three organisms growing on it. I visit the wound clinic in a few days. It should be an easy fix.
It has taken me a long time to recover from last year’s cancer treatment. Last year at this time I was receiving another radiation treatment for another part of my body. It was a follow up to a summer of chemotherapy. Glad I have the year’s recovery under my belt. I am stronger. I am doing a ten minute yoga routine every morning. It is good to have the energy for it and it is good to feel my muscles work.