Audrey Tynan is a patient here at St James’s Hospital, with our Gynaecological Cancer and related services primarily, but she is now coping with the life-changing impact of lymphoedema with the additional issue of recurring cellulitis and the risk of sepsis. Audrey’s current condition can be traced back to necessary surgery she received, to treat cervical cancer in 2001.
At that time, Audrey had never been ill, so to receive a cancer diagnosis was a great shock and she was quickly entered into a treatment programme, which included radical hysterectomy and removal of lymph nodes, followed by chemotherapy and radiation therapy. Audrey made a great recovery and proceeded to get on with her life.
Seven years later, Audrey developed pain and swelling in her right leg and a CT scan and tests revealed a tumour on her para-aortic lymph node which required further surgery, chemo and radiation. This was a major open surgery. The type of surgery she had can now be done through keyhole which is great progress. The recovery from this surgery was a lot harder than her first surgery for cancer. She went through more chemotherapy and radiation for 6 weeks. It was during these weeks that she noticed a change in the size of her right leg and was in fact limping and in pain. Because there was so much going on with the therapy she was already getting she was hoping it was something that would pass. Unfortunately this was not to be the case. It was the start of chronic lymphoedema and in her case repeated episodes of cellulitis, which in many cases developed into sepsis and regular admissions through A& E for IV antibiotics.
Dr Noreen Gleeson, Consultant Gynaecological Oncologist at St. James’s Hospital explains “The current standard surgery, removing all the lymph nodes inside the pelvis interferes with the flow of fluid in the lymph circulation from the legs and genitalia. As a result, some women, like Audrey, develop very debilitating health problems like swelling of their legs or genitalia (lymphoedema) or recurring infection (lymphangitis), and even sepsis as a result of the complete removal of the lymph nodes.
With new technology, a new laparoscopic / key hole surgery device allows surgeons to be more selective in the removal of lymph nodes, through which cancer spreads, from the pelvis. Therefore, we are better able to target the ’correct’ nodes; those most likely to harbour the cancer cells. This results in women healing faster, spending less time in hospital, and less risk of developing long term disability. This is why I launched our appeal to support the purchase of this equipment”
For Audrey, lymphoedema has been entirely life changing. Her admissions to St James’s, via A & E are increasing, and last year she had between 8 and 9 infections and subsequent hospital admissions. She has to have a bag packed and ready for the hospital as she never knows when it will strike.
Audrey’s life is restricted by the lymphoedema, which she has to constantly manage. Lymphoedema causes exhaustion as it restricts the flow of fluids and impacts the filtering of the blood, leading to Audrey feeling breathless and tired, often carrying an additional 3 to 4L of fluid in her right leg. Apart from the physical change and having to select clothing and footwear to suit the size of one leg, there is the constant fear of infection and having to be rushed to A & E. Once the sepsis kicks in the deterioration is rapid and the key is IV antibiotics as quickly as possible. She carries a letter with her explaining her condition and how quickly it can progress and also the combination of antibiotics that have worked on her in past admissions. She also has to take an antibiotic every day to try and reduce the risk of infection.
Audrey is fortunate to have a part time job and understanding employers with flexible hours which allow her to attend her many hospital appointments. “Being able to go out and work, means that I have to make the huge effort to get up and out of the house, otherwise, to be honest, it would be a very easy option to stay in bed, with this condition. Some days I go into work, and I might have had a very bad episode the day or weekend before, but I force myself to make a greater effort as it is important for me to get on with life and have structure and purpose. Most of the time I am relieved if it’s a day off when I take sick as it is very important to me to not let my illness affect my job.”
For Audrey, these resulting complications from the essential surgery are in many ways, worse to cope with then the cancer itself. When she was being treated for cancer, she was on a defined pathway of treatment which she went through step by step. This is not the same experience for lymphoedema where there is no specific treatment pathway and limited resources available in relation to treatments such as deep massage. It is a complex condition which is not fully understood.
Audrey says – “I am speaking out about my condition, to raise awareness about the potential later side-effects of surgery and just how much difference this new equipment could make in detecting nodes that do not need to be removed. I understand fully that in my case there was no other option but to remove certain nodes but I don’t want other women to have to experience the reduction of quality of life that I am going through. Now that there is this new surgical equipment available, that offers women a much better quality of life post-surgery, I am giving my full support to this appeal and to the work of Dr Gleeson and her team who are doing tremendous work in fundraising to get this equipment. To me, it would make all the cancer surgery and treatment complete if my quality of life could be restored and unnecessary suffering avoided.”
The Gynaecology Team at St. James’s Hospital
Emer Casey Foundation Announces Donation of €60,000 to Gynae Cancer Care at St. James’s Hospital to celebrate World Ovarian Cancer Day
8TH May 2017: St. James’s Hospital and the Emer Casey Foundation today marked World Ovarian Cancer Day 2017, by celebrating the Emer Casey Foundation’s donation of €60,000 towards the purchase of much needed surgical equipment at the hospital.