Breast Cancer and Needles

One of the most unpleasant things about having been diagnosed with cancer, besides the obvious, was the number of times I was poked with needles throughout the treatment period. First the blood tests, then the needle core biopsy, the vaccinations, the IVs, the self-injected Neupogen and then more blood tests.

The needle core biopsy was the least fun. The radiologist shot a hollow needle into the tumor at least six times from some type of needle gun (like a nail gun). Cores of tissue samples were extracted from the tumor to be sent to the lab for analysis. Even though the radiologist numbed the area first, it was still painful. In fact, it’s been over a year since the biopsy and my breast is still tender.

When the results of the biopsy came in surgery was immediately scheduled to remove the tumor, which meant more blood tests, a flu shot plus a pneumonia vaccine.

The day of surgery an IV needle was placed in my vein and another needle was used to inject a radioactive dye in my breast for the sentinel node biopsy. The hospital staff kept me supplied with warm blankets and gave me lots of attention. Just before surgery the nurse ran something through the IV to relax me. I felt pretty good by the time I was wheeled into the large white operating room.

After waking up in the recovery room I had to wait for a couple of hours until the anesthesia wore off before I was released. At home the next few days I experienced headaches from the anesthesia, but otherwise I felt great.

A couple of weeks later I was feeling very optimistic while I was waiting for the results of the biopsy. When my surgeon, Dr. Carmen Hudson, walked in with a serious look on her face and asked me if someone had accompanied me to my appointment, I knew something was up.

She first apologized for not getting a clear margin when she removed the tumor and informed me that I would need another operation that would involve removing my areola and nipple. I told her that it was only decorative anyway since I'm not planning to have any more children. She laughed and then got serious again. She said, "I'm so sorry. The biopsy revealed a microscopic amount of malignant cells in one of your lymph nodes."

“Does this mean that I’ll have to have chemotherapy?"

She said, "Yes, most likely." She told me that the standard course of action was to also remove the remaining underarm lymph nodes for further examination to make sure that they were cancer free. However, she said that she didn’t think it was necessary since the malignant cells in the sentinel node were microscopic in size and the other two nodes were cancer free.

In my research, I read that often times malignant cells found in the sentinel node, especially if microscopic, can travel there via the needle during a needle core biopsy. I also knew that chemotherapy was usually recommended if cancer traveled too far from its point of origin.

More blood tests, another IV, more needles.

This time, I requested a twilight anesthesia instead of a general because the general took too long to wear off. Dr. Hudson scheduled the "clean-up" surgery (her words) in Kaiser’s out-patient clinic at St. Vincent’s hospital, instead of the main operating room.

Similar surgery, but without the frills. My next pre-surgery room consisted of a bed with drapes on a track for privacy in a barracks-like room.

My nurse anesthetist was a short, stocky, very mature German woman who spoke with a thick accent. Earlier, Diane spotted her in the hallway pounding on a door saying, “Open ze door. I need drugs NOW!” We later figured that she was really a closet comedian, using her demeanor to entertain the patients.

After I was given something to relax me (another needle) my nurse anesthetist told me to walk to the operating room. When I asked, “Aren’t you going to wheel me in?” She said,“Nope, you can still valk, can’t you? So get goingk and HURRY. Ze docta est r-r-r-ready.” It was like a scene from a Frankenstein movie. I wondered if I had made the right decision and started to miss the all of the attention I got at the main hospital.

I walked to the operating room and climbed up onto the table. A nurse hooked me up to an IV and I slept through most of the surgery, only waking up once to comment on the beautiful butterflies flying around the operating room.

I woke up again in the recovery room, which was the same "room" I was in prior to surgery. As soon as my eyes opened Dr. Hudson released me and Diane drove me home.

A month later and a couple of days before my first chemotherapy treatment, I had more blood tests and the oncology nurse weighed me to determine the maximum amount of poison my body could handle.

The chemotherapy regimen my oncologist ordered for me was Dose Dense ACT. One of the greatest benefits of the Dose Dense ACT regimen is that it’s given over the course of four months instead of the usual six. This reduces the chances of side-effects, primarily cardiovascular damage. The dosage is given every two weeks rather than every three.

Since two weeks isn’t enough time for white blood cells to regenerate enough to be in the safe range, I had to give myself injections of Neupogen for several consecutive days beginning a few days after my chemotherapy treatment because it was during this time that my immune system was its lowest.

Before each chemotherapy treatment, I had to have a blood test to make sure that my white blood cell count was high enough to proceed with the chemotherapy.

The day of my first chemotherapy treatment I opted to have the chemo cocktail delivered via a vein on the back of my left hand rather than having a port installed in my chest. The ports can sometimes cause infections.

Minutes before my first chemotherapy treatment I was given steroids to help me tolerate the chemo drugs. It caused my legs to be restless and I couldn't lie still, so I was given another drug to counteract the first one.

The nurse found a good vein right away and inserted the IV needle. She set the chemo drip to enter my vein slowly so that it would be easy to stop, should I experience a bad reaction to the drugs. It went smoothly and so I scheduled another appointment.

Before they released me I was given some anti-nausea medication, which didn't help me keep down the rich sauce-laden French food that I ate following the chemotherapy treatment.

A few nights later I had to start the Neupogen injections and asked my sister, Diane, and son, Lance, to watch, to make sure that I did it correctly. I took the Neupogen out of the refrigerator 30 minutes prior to injecting the drug and filled a disposable syringe after the Neupogen warmed up. I pushed the air out of the syringe, sterilized my chosen entry site with alcohol and held my breath. Pinching the fatty skin between my thumb and fingers, I inserted the needle at a 45-degree angle, then slowly pushed the plunger of the syringe until the Neupogen disappeared.

The little fatty ring around my waist was my first point of entry... and second... and third, but when I began to worry about the possibility of hitting a vital organ, I switched to a new site... my not-so-fat thighs.

During my second chemotherapy treatment, I was assigned a different nurse. After two failed attempts to insert the IV needle properly and causing a vein to collapse, I asked for another nurse, which I continued to do for each of the remaining chemotherapy treatments.

During the Taxol stage of the chemo treatment, I came down with pneumonia, despite the vaccination, and had to have more blood tests, plus an x–ray of my chest, and a prescription for antibiotics. When the bottle of antibiotics was empty I had another blood test to make sure that my immune system was strong enough for more chemo.

I still can't stand the sight of a needle, but compared to chemotherapy, an occasional blood test is a piece of cake. The Neupogen injections were inconvenient but necessary to keep my white blood cell count up. I imagine that from now on needles will always be a part of my life (at least for routine blood tests), like it or not.