Thursday, April 7, 2011

The lymphatic system and why I want to hang on to the nodes if possible; and medical establishment change management

Some of you may be wondering why I would endure a biopsy of my nodes just three days before my mastectomy.  Here's an article that explains how the lymphatic system works:

Importance of Lymphatic System

The "cliff notes" version is that breast cancer tends to spread to the nodes before going elsewhere in the body.  If those nodes are removed and they are all OK, it is now that much easier for rogue cancer cells to escape the "traps" set by the nodes.  Lymphedema is another serious side effect, and is particularly prevalent in women who undergo mastectomies with axillary node dissection.  It happens up to 10% of the time. 

The latest research indicates that full axillary dissection does not increase survival rates in women with tumors smaller than 5 cm, even if they have sentinel nodes that test positive for cancer.  Here's a nice summary of the findings:

Note the last sentence of this article:  "This study received considerable attention in the media and lay press, and I anticipate that patients will not only welcome the news, but also help drive change to avoid an additional surgical procedure which, for some, appears unnecessary."

I heard an interesting statistic yesterday from someone I know who is extremely knowledgeable about how the medical establishment manages "change" - it takes, on average, about 17 years for a change to work its way through and be wholeheartedly adopted by the medical community!

Here's an example of this that most of us have experienced.  If you have ever had a surgical procedure, you always get the "nothing to eat or drink after midnight" instructions, right?  No clarification, no exceptions, don't eat or drink.  Well guess what, the latest data says that 6-8 hours is plenty for solid food, and 2-4 hours is sufficient for clear liquids.  Anesthesiologists have been trying to get this message across for years; but telling everyone the same thing keeps it simple for staff, even if it's unnecessary.  My surgery is scheduled for 1:00 in the afternoon. I don't plan on getting up at 5:00 to eat so that I can meet the 8 hour rule.  But I will be up by 7:30 and I'm sure as he$$ having my morning cup of coffee, and any other clear liquids that will "float my boat" up until 9:00, with the complete approval of my anesthesiologist.

We all need to ask questions.  We can actually help drive change.



  1. Michelle, I found this on the diabetes blog, so I could read the latest. This all sounds so good.
    Thanks for explaining everything. It sure makes sense about the length of time to eat, and important for a diabetic, too. Good luck tomorrow.