I get a little weekly devotional guide from a community called Imago Dei. This week the focus was on listening to God based on Isaiah 30:21 "Whether you turn to the right or to the left, your ears will hear a voice behind you, saying, "This is the way; walk in it." When we talk about listening for God we often think about the still small voice. The focus here though is on being ready to move and the promise that we will hear God's voice.
So I'm doing a fasting glucose blood draw along with other tests to get ready for Imfinzi treatment. Get up at O'dark hundred and head for the lab. Only to find that I'm half an hour early and while I wanted to be near the front of the line being first really wasn't what I expected. As I wait other people accumulate along the wall in the hallway. And the stories begin to emerge. Labour Day was the day before and along the line a lady mentioned that she hadn't been able to find an open lab. She had chemotherapy in a few minutes and was stressing out because her lab work hadn't been done. When the lab opened we all got our numbers to reflect our place in line. As I sat down I asked if she wanted mine so that she would be first. The look of gratitude was amaxing. Listening to the voice of God - what can I do to ease her stress? But the amazing thing to me was when the young man behind me reached over and handed me his ticket taking mine. He said "You were ahead of me. Take my ticket." I think everyone's day just got a little bit better.
My number is called. And I recognize the lab tech. In and out of the lab for a few months has some advantages. She looks at my tests and tells me that I'm going to need to lie down for thirty minutes. That is a new one to me. In order to get an accurate reading for one of the tests I have to be inactive. The cot in the corner has a use beyond a faint patient. I mentioned that I had had a mastectomy a few days before and that the surgeon had recommended a foot draw. She said it would depend on the technician but that it wouldn't be her doing the draw.
The actual blood draw comes along when the timer goes off marking thirty minutes. I asked the technician for the foot draw. She was game and prepped my foot. After getting two not very full vials with two different needle sticks and having five more vials to gather, I encouraged her just to use my arm. She found the vein without the tourniquet and finished in seconds as opposed the previous minutes. Wonderful.
The next day my meeting with my oncologist, Dr Johal went well. There were a few red flags though. The fasting sugar was high and my thyroid levels were a little high so he encouraged me to talk to my family physician. He ordered an A1C test and some additional thyroid tests. I had heard about A1C but never had one before.
Then it was my turn. I peppered him with my questions. What about a flu shot? Wait to see how I tolerate the Imfinzi. What about my 3 year follow-up for a colonoscopy? Let's wait on that. And the Vegegreen antioxidant that my sister sent me in a care package? Go ahead. (And it tastes great!) More seriously we talked about the side effects of the Imfinzi. Because it alters the way my immune system sees the cancer tumour, it can also see other organs as tumours and begins to attack them. Very low chances but they are there. Most of the treatment response is to slow down the treatment and to use corticosteroids to manage it. But we'll cross that bridge if we come to it.
With his blessing then I received my first Imfinzi treatment on Friday. It is being done at a private clinic under the auspices of the company providing the drug. For the first time in a long time I took an elevator up. I have been quite breathless these days. Lingering side effects from low red blood cell counts and blood loss from the surgery. It was a little different from the experience of chemotherapy. As this was my first face-to-face contact with Bayshore Infusion Clinic there was a lot of paperwork to be filled out. Another difference is that they monitor my temperature much more closely as this can be one of the early signs of a reaction. While mine rose slightly it wasn't enough to be a concern.
One of the challenges of mastectomies is lymphoedema. I had had a discussion both with the oncologist and the breast surgeon about needle sticks and blood pressure cuffs as these can both aggravate lymphoedema - the single largest potential side effect of my mastectomies. He set my mind at ease but agreed with the surgeon that these should be kept to a minimum. The nurse administering the drug was happy to accommodate me and my fear by minimizing the number of times she did blood pressure. Though she used a tourniquet she was quick and professional inserting the infusion needle.
Imfinzi is such a huge opportunity for me. And I was afraid that some last minute snafu would stop me from receiving it. Fears not realized. I have had the treatment and other than some loss of appetite and a wee bit of nausea I seem to have tolerated the treatment well. More prayer answered.
And so now my attention went back to the mastectomies. I have casually referred to drains. Those of you around patients with drains will know it is a big deal. Let me describe my drains. I had a chest binder to hold me and my incisions together. Hanging off the binder were four suction bulbs - think turkey baster bulbs. They were connected by 24 inches of tubing to the actual drains in my chest. Remember there are four of these apparatuses. I was quite self conscious about them because they were hard to cover up. Fondly I referred to it as my suicide vest.
On the Sunday after my surgery, Sandra and I met Yvette in the Peace Arch Park for lunch. The park allows us to meet without any of us actually having to cross the border. It's like a neutral zone for those of you not familiar with it. I was afraid that someone would see the red tubing and bulges and report me to customs. I had visions of burly gentlemen accosting me and escorting me to a safe place. Then having to explain all this. Fears not realized. We had a lovely visit and though I was winded from the walk through the park - it all worked out.
The measure for how soon the drains can come out is literally that - a measure. Each night I measured how much each drain had produced and recorded the amount. Not a job for the squeamish or faint of heart. Initially the amount (150mls) dropped quite fast but then it slowed down. The goal was 24mls in 24 hours. Somewhere I had read three to five days. The surgeon had told me seven to ten days. As time dragged on it became clear that it was going to be ten days. And ten days of making sure I didn't lie on things at night, of making sure the tubing didn't plug got to be a wee bit of a pain. Finally I hit the 24mls mark and trotted off to my family doctor to have them removed.
After a discussion about the risks of removing them prematurely, Dr Walter proceeded to take them out. Snip the stitch. Slide the drain tube from inside and slide and slide and slide. Somehow I had thought that the drain was four to six inches long. Not! It was like the magicians hanky coming out of his sleeve - the tubing seemed to never end. There was fourteen inches of tube. Times four. Little wonder my chest was a little uncomfortable! We then went on to discuss the rest of the lab results. My A1C level which measures my glucose levels over three months was on the low side of the normal range so no diabetes to worry about. And the thyroid levels will be checked again in six weeks to see if they have stabilized or continued to change.
At my meeting with my breast surgeon on Friday, she expressed amazement at the healing so far. I thanked her for nice clean scars. I have seen some pictures of real hack jobs and in comparison this is at the beautiful end of the spectrum. There was one small tumour in one of the lymph nodes on the right armpit so I will be having a discussion with my oncologist next week about that. She didn't think it would be surgery though more radiation is a possibility. The tamoxifen that I have been threatened with (lots of side effects so I have been a little resistant) is going to happen and probably sooner rather than later.
Through it all I have felt the hand of God working. Guiding surgeons' hands. Minimizing side effects from the new drug. Restoring my capacity to breathe fully. And that comes from your faithful prayers on my behalf. Thanks.