How You Can Help the Cancer Patient Before the Surgery

• Help the woman obtain spiritual and / or traditional healing to help prepare her for the surgical procedures.

Linda B's editorial. We have found that it was very helpful to both the cancer patient and the family / loved ones to take part in a spiritual healing or cleansing ceremony prior to having the surgery. If such a ceremony requires several months preparation, ask the healer for a ceremony that can help prepare both the patient and the family for the surgery. Ideally, no more that two weeks passes between the time of the medical diagnosis and confirmation (i.e., biopsy) and the beginning of surgery. Once the patient and the family have had the healing or cleansing, the patient seems to approach the surgery in a much more positive perspective than prior to the ceremony. These patients also appear to be much stronger spiritually and more at ease or accepting of their current health situation. The ceremonies that require months of preparation should be postponed until the surgery and immediate follow-up care have been completed.

• Help the patient prepare questions that she and / or you would like to have answered about the surgery.

• If possible, have grandchildren and other children come over to visit with the woman the day before she goes to the hospital. Playing with the children and talking with the children has helped many of the women feel stronger about staying healthy so that they can continue to teach and enjoy the next generation. They approach the surgery with a strong drive to "get the surgery over" and get started with healing.

• If the hospital is several hours from the home, consider staying in a hotel the night prior to hospital check-in, especially if the patient is to check in very early in the morning (e.g., 6:30 a.m.). Money is usually as issue, so check with the American Cancer Society that is closest to the hospital, or a local hospice care center, or other facilities which may be available for the patient and loved one to stay during the surgery.

• For Native patients who have medical insurance: The patient has enough concerns to be considering as she approaches surgery. Someone needs to check with the health insurance agent and learn if there are any special requirements, restrictions or limitations related to her cancer treatment and follow-up care.

• Likewise, someone needs to check in with her employer and make certain that any emergency leave or other types of paperwork need to be completed so that her position is not filled during her medical leave.

Questions to Ask the Doctor Before the Breast Operation

• How long will the operation take?

• How should I expect to feel after my operation?

• Will I need blood transfusions during the operation and should I bank my own blood

• before going to the hospital?

• What will the scar look like? Please show me where it will be.

• Will I be in pain? What will you do for my pain?

• How long will I be in the hospital?

• Will I need special care at home after the surgery?

• When can I get back to my regular routine? Will I have to take any
• special precautions?

• What kind of exercises should I do?

• If I decide to have breast reconstruction, can it be done as part of this operation?

• If I decide not to have reconstruction, what other choices will I have?

(Printed with permission, Morra and Potts, Choices, Avon Books, 1994, p. 330.)

How You Can Help the Cancer Patient During the Surgery

• You can pray for the patient's rapid recovery to full health

• You need to take care of yourself and your family and get as much rest as possible. The length of the surgery may be a few hours to all day long.

Types of Operations

Partial mastectomy also called breast-conserving surgery, lumpectomy, or wide excision The lump in your breast is taken out, along with some of the normal breast tissue around it, to get clear margins. This is followed by radiation therapy to the part of the breast that remains. Survival rates are the same as with the modified radical mastectomy when cancer is treated in its early stages.

Advantages: If you are large-breasted, most of your breast is preserved. You have a better appearance than with a modified radical mastectomy. There is little possibility of loss of muscle strength.

Disadvantages: If you have small or medium-size breasts, you will have a noticeable change in your breast shape. You must undergo radiation treatments. If lymph nodes are not taken out, cancer may spread undetected.

Lymph node dissection also called axillary lymph node dissection Lymph nodes are taken out in the hollow of your armpit. Usually done at the same time as breast operation.

Advantages: Doctor can check to see if there is cancer in nodes.

Disadvantages: You have a risk of developing lymphedema.

Total or simple mastectomy Entire breast is removed.

Advantages: Your chest muscles are not taken out and there is little loss of arm strength. Breast reconstruction is easier.

Disadvantages: The breast is removed. This operation is not a common one today.

Modified radical mastectomy Entire breast, lining over chest muscles and lymph nodes under arm taken out. Usually only the smaller of the two chest muscles taken out. Survival rates are the same as with the partial mastectomy plus radiation therapy when cancer is treated in its early stages.

Advantages: Your chest muscles are not taken out. You can have breast reconstruction and you can plan it before your operation.

Disadvantages: Your breast is removed. You have a risk of developing lymphedema.

(Printed with permission, Morra and Potts, Choices, Avon Books, 1994, p. 322.)

How You Can Help the Cancer Patient After the Surgery

• Any surgery requires follow-up care. Talk with the providers, especially the oncology nurses and ask what you should do and how you should do it to help the patient recover from the surgery.

• All surgery involves some swelling, discoloration, and sanitary wound care. Have the hospital staff show you what to do and to watch you while you do it. It is one thing to watch a nurse cleanse a wound and quite a different process when you are the one do the cleansing. Let the nursing or other provider staff help you learn how to care for the patient.

• If shunts or plastic pipes remain in the wound to allow for drainage of fluid, you will need special training from the providers on how to care for such post-operative items in a sterile manner.

• You will need to help the patient get out of bed and walk and move. This is always important to help reduce the likelihood of pneumonia or other infections.

• Ask the provider how much, if at all, the patient is allowed to move her arm(s), especially if lymph nodes were removed. For some women, they are not to move the arm for several days following surgery. For others, they are to begin moving the arm on the day following surgery. This depends on when the incision was made and how long and how deep the cut.

• Bring a soft, small pillow to the home for the patient to keep her arm elevated (i.e., the arm that had the lymph nodes removed needs to be higher than the patient's heart). Talk with the provider about how to keep the arm from swelling (the arm that had lymph nodes removed).

• Watch the woman carefully for unusual swelling, pain, or fever. Infections can follow any surgery and must be cared for immediately.

• When driving the patient home, try to find a route with few potholes .... try to avoid road bumps and dips. The incisions are typically very tender and slight jarring can be very painful. For many roads on the reservation, it is not possible to find a paved, smooth road. Inform the doctor that the ride is likely to be rough and s/he may prescribe some additional pain medication to help her make the trip home.

• Some patients like to lie down for the drive home; others are anxious to see out the windows. Have the car / truck prepared for either need.

• If there are family members who tend to be noisy (e.g., small children), talk with the patient about if she would like to have them stay elsewhere for a few nights. Some patients feel the need for sound rest and do not want the children to see them acting so tired. They do not want little people to become worried. Other patients like the sound of young ones making noise, although it does disrupt their sleep. But their voices in play help the patients fight to recovery from the surgery and to heal so that they can play with the children too.

(there are) 7 of my lymph nodes that were removed and I kept thinking had I not waited long maybe, . . . they wouldn't have done that. But it's, it's to late now to even think that. And I really get scared thinking what if I had waited much longer. It would have been passed the lymph nodes and some place else. It's really scary to even think that. Gloria Suazo (Taos Pueblo)

• With providers' permission, you may begin to help the patient exercise. She typically is not to pick up anything more than one or two pounds for a few weeks, especially if many lymph nodes were removed. The types of exercise may include squeezing a wash cloth. She will probably be asked to try to raise and lower her arm for a specific number of repetitions (e.g., within a few days of surgery, the providers may want her to try to raise the arm 6" to 12" high with the elbow straight for five times ... and to do that every 2 hours .... the providers will have specific instructions).

• Try to find a way to make the exercises enjoyable. A group of survivors from Grand Rapids, Michigan took up fly fishing to help them recuperate from their lymph node removal and breast surgeries.

Linda B's Editorial. A "biopsy" and "lumpectomy" are not the same procedure. Many of our Indian patients have stated that they had a lumpectomy to identify the cancer, but these were typically "biopsies" to confirm the cancer diagnosis. A "lumpectomy" is a surgical procedure to remove the cancer cells and immediately surrounding tissue. A "lumpectomy" is sometimes called, "breast conserving" surgery.

I was very fortunate in many ways because I had a good friend of mine who just had gone through the same process ... so she gave me information and when I started comparing what the research reports were saying about mastectomy versus lumpectomy, I decided my chances were as good with lumpectomy as it is with mastectomy, so ... I asked to have the lumpectomy. I think I made an informed decision. Jennie Joe (Navajo)

But on the sixth day that I was in the hospital. I just got up, I felt good. I stripped my bed, I start putting all my stuff and getting all my flowers together. And the nurse comes in and says, "What are you doing?" I said "I'm ready to go home now", they said "you can't go home, you've got one more day, you need to stay one more day". And I'm like, oh man, so make my bed again, put everything back out. Trying to take my time, and figure out. . . . , so I go "Can I have popcorn or anything like this?". Then people started coming to see me, my relatives and I call them, the "prayer chain". All my aunts and uncles came and prayed and I felt real strong and positive and I was ready to go home. On the seventh day they said, well you better wait for the doctor to come around.

Well I have the doctor's beeper. I beeped him at 7:00 a.m. and I said, Dr. Little you need to release me now, I'm tired of stripping my bed and making it again. And he goes, "okay, we'll be by to see you and we'll let you go." They finally let me go home. My brother had put together a party with a picture of my son holding his head saying "Home Alone". There were balloons everywhere and I had my sister washing dishes, I have another one making beds. And I'm like, wow, this is cool, you know.

Cindy Thornton (Western Cherokee)

.And here when I got to the doctor he said, "Norma," he said, "we don't have to do a radical, we can do ... a "lumpectomy". And I said what does that mean? He said they'll take the cancerous, you know, cut most of the cancerous part out and then I'd ... either take radiation or chemo. And so I said, well you know that's fine, you know, .... I'd go for that .... cause half a breast is better than none at all.

Norma Staples (Mandan)