Pre-op day....

We've spent many, many hours researching 'which hospital'. Even though the first meeting was with the Oxford NHS Trust, we are considering other hospitals. This is based on the NHS Choices website, where you can compare and review all the hospitals within a certain distance of your postcode. The fact that the Oxford Trust (Horton and the John Radcliffe constituents) performs axillary sampling, as opposed to sentinel lymph node (SLN) biopsies, is the main reason why we have done this. The difference between these two procedures, involves the number of lymph nodes removed from under the arm pit to detect if the nasty little cells have tried to make their way elsewhere. With axillary sampling they remove four of the lymph nodes from beneath the arm pit, with the SLN biopsy, they flush a blue dye around the tumour, when this reaches the lymph nodes the first one or two that colour are said to be the 'sentinel lymph nodes'. They then remove this or these lymph nodes for testing. The advantage of this is as follows, it is a less intrusive procedure, and secondly, there is much less chance of lymphoedema. Lymphoedema, put very simply, is caused by a back up of lymph fluid (the lymphatic system is cleaning system that runs alongside blood vessels). When we suffer a simple infection somewhere in our body, we experience increased blood flow to the area, thus we experience a higher flow of lymph fluid. This is the contributing factor of lymphoedema. When the lymph fluid starts to drain back through the lymph nodes to get to the lungs to be refreshed, there has to be an ample number of lymph nodes to cope with the flow. For example imagine a canal, a really wide one, that has 20 locks across it. They all open at once to let the build up of water behind them flow through. One day 4 of the locks simply won't open, the water behind the locks required the 20 to manage this flow when flooding (infection) occurs. When a flood (infection) does occur , the canal will fill up to the top of it's banks, and possibly into the fields surrounding it (the arm tissue, muscles and fat cells). This is how lymph nodes operate, they are the locks or turn styles that manage the flow back toward the lungs, where the lymph fluid is refreshed. This analogy may be rubbish, and confusing, as I just made it up now. If it is, Google it!
The JR Hospital only offers the removal of 4 nodes at present, as opposed to the sentinel lymph node biopsy, although in 3 months time they are bringing this procedure in (they already adopted it for melanoma patients), so we would like to chat with them about this.
On top of that you have the cases of MRSA and C DIF over the past 12 weeks, the JR hasn't managed to stay clean from MRSA, having experienced 4 cases within the past 3 months. Then you have how many Breast Lumpectomies, Mastectomies and Breast Conserving Ops they carry out each year, what the patients thought.... and it goes on... and on....
If Amanda decides she doesn't want the operation to be performed at The Horton Hospital in Banbury (we thought it was going to be in the JR but apparently not!), then there will be a delay in any operation, this is the only major downside to a change of hospital.

Neither of us really slept last night, I don't think Amanda slept at all! She is trying to grab a few Z's before the meeting at 12.30pm.

Anyway thanks for all the texts that have come through this morning we do appreciate it. You're not being ignored, she appreciates each and everyone.