On Wednesday this week (25th September) I will be having surgery.
First things first I have these lovely things to prepare myself for surgery with. One is a Nasal cream that I have to apply to the inside of my nose 4 times on Tuesday & again Wednesday morning. The other is a body & hair wash – I need to wash my body & hair on Tuesday night & then get up crazy early on Wednesday morning & wash my body again. This has nothing to do with Melanoma – this is a “cleansing of bugs program” and really it boils down to keeping MRSA out of Oxford hospitals.
At this point I will grumble quietly about the drying effect the wash on my skin & hair, the irritation of having to rub the cream into my nose when it is a delicate balance there anyway what with this cold I am trying to shift before Wednesday. Not to mention the fact that I have more than enough to do on the grooming front before Wednesday as it is….shave legs, paint toenails & fingernails…..
The Mr will curse as I crawl out of bed to do that chemical wash thingy at 5am in order to get to John Radcliffe Hospital for 7.30. I will then “check in” & get prepped for the first part of my day which is a procedure called a Lymphoscintigram at the Department of Nuclear Medicine.
During this procedure they inject a Radioactive Fluid into the middle of my back scar & leave it to move around the body & then the scan me to check the fluid has reached my Lymph Nodes.
About 4-5 hours later on the operating table they start by injecting a Blue Dye (once again to the middle of my back scar).They then watch as it moves around my lymphatic system & then identify (scan) which specific Lymph Nodes the blue dye has gone to – because the Radioactive Liquid at that point will be highlighted in Blue.
The Sentinel Node is effectively the first lymph node of a lymph node cluster than the Cancer may have travelled to. If my primary melanoma site were on my arm there would be little doubt that the Sentinel Node would be in my armpit – it wasn’t & so there may be one or more than 1 Sentinel Node that needs to be removed.
The body has as you can see quite a complex system of lymph nodes – the lymphatic system is effectively a bath channel containing a clear fluid called Lymph. The lymph fluid cleanses stray waste particles such as Viruses and Bacteria that have entered the body. If a foreign substance is detected it actives an immune response which is often detected by a swelling of Lymph Glands.
A person can have between 20 to 40 Lymph Nodes in the armpit area alone. The Surgeon will know which node to remove because it will now be Blue. So an incision will be made, the node removed & I will be stitched back up.
The Surgeon will then re-excise my back scar because he was not happy with what had been done & doesn’t believe that enough tissue has been removed. This will take some of the dyed blue tissue away – the dye remains in the body for up to 3 months!
I stay in overnight & then return home on Thursday to recover.
The Sentinel Node(s) is then cut into slices & tested over 10 – 14 days for signs of cancer (hopefully none). If there is any trace of Cancer I will have to go back in again for Lymph Node removal. If all is clear I can proceed to trial which is why this operation is being done at this late stage – to get me onto the drug trial.
There is a slight risk from the operation – as any performed under general. But specifically in terms of a Sentinel Lymph Node Biopsy (SLNB) there are some side effects ; Lymphedema (swelling of the limb associated with that Node), Seroma (a build up of fluid at that Node which would need to be drained), Numbness and difficulty moving – for most people unlucky enough to get these side effects, the impact dissipates after 2-3 months, although 5% do suffer permanent issues after a procedure as simple as SLNB.
So there you go. I found of most of this from my Surgeon & the handy leaflet I was given, but most of the information about SLNB is available online – this is a good link :

http://www.cancer.gov/cancertopics/factsheet/detection/sentinel-node-biopsy

I have been asked if I am taking advantage of this opportunity with a respected Plastic Surgeon….not yet….but it isn’t too late – he may well see my La La’s on the operating table and take pity…you never know…

…Fingers crossed people (for my proper surgery….not the La La’s!)!