I’m tired of being that friend, you know the one, who always has a never-ending problem that needs to be talked about and sympathised with. Which is why I toyed with the idea of not saying anything at all. To friends, family and also here. Then I took a few days (and sleepless nights) and thought about the first 10 months of this journey, and how I carried on pretending as if nothing was happening. It has been liberating to some extent being able to share the process in this way, and I also think it’s helpful for me to have everything logged in one place. So that I can keep track. Is that weird?

The nitty gritty is that, I thought I would have the lung surgery and carry on with immunotherapy without any new dramas, at least for a few months. Technically speaking, there is no new drama. As a prerequisite to my lung resection back in November, the team asked for a liver MRI (MRI imaging being much more detailed for the liver than CT.) I haven’t had a liver MRI for a few years, and the surgeons wanted to be sure that the 3 nodules in my lungs were the only areas of melanoma in my body – which is what my CT scans had been showing from the start. The liver is one of the organs with the highest blood flow, and therefore it is usually a place cancer cells like to set up shop. My liver MRI in September showed tiny abnormalities. Next stop a PET scan, detailed in a previous post. This came back totally clear, and so lung surgery was given the green light.

Dr F being Dr F wanted to be thorough as always, and referred me to the liver MDT (multi disciplinary team). So a whole lot of liver specialists sat round a table and analysed my scans all the way back to the beginning of time. They asked for another liver MRI to compare with the September one, which I had done just before Christmas. The results showed absolutely nothing had changed in 3 months, and when they looked back through CT scans from the past year or so they can see these tiny abnormalities present. They haven’t changed in all that time, which has led to some disagreement between professionals as to what they are!

As a metastatic melanoma patient, anything odd must be presumed melanoma – it would be silly to think otherwise actually. But melanoma also spreads and grows like crazy if untreated – especially in the liver. So the fact that the PET was clear and the abnormalities haven’t changed leaves a question mark to some extent.

A few days after the scan was reported I was phoned by a liver surgeon asking me to come into the Heath Hospital (rife with COVID) 4 days after Christmas. At this point I knew they were considering surgery (again), as something I have learned throughout the pandemic is that if anything whatsoever can be done over the phone, that is most definitely the preference over physically bringing you in to the hospital. The only time you enter a hospital at the moment is for a medical procedure that cannot be done elsewhere. What I didn’t expect was that I would be having 2 pre-operative assessments and consent to 2 surgeries in the next 6 weeks.

This may be my way of coping, but I am looking at this whole thing as a positive. Dr F tells me that he has referred many patients for surgery in the past and he often gets a flat no. He says that they really wouldn’t be offering me surgery at this time unless they truly thought it was worthwhile. Mr K is the lead Consultant Liver Surgeon in Wales, and wants to do a liver resection – basically the same as what happened with the lungs, but this time not through key hole but open surgery. He also wants to take a lot more of my liver than they did the lungs – 45% cue horrified face. However, BIG however actually, is that the liver is the only organ in the body that fully regenerates. And it only takes a couple of months, which is why it is obviously better to get any abnormality out whether it is melanoma or not. Mr K explained, the reasons why he wants to operate are 1. Because it is the only site of potential disease, therefore post surgery I would be rendered disease free. 2. If it is melanoma, which Mr K thinks it probably is, then actually immunotherapy is working for me as it hasn’t changed in a very long time. Therefore getting rid of it, helps my immune system to continue doing what it’s doing, and more efficiently perhaps.

The first operation is called a staging laparotomy – booked in for 13^th January. This is a protocol before the liver resection, and keyhole surgery where they put a tiny camera in to your abdomen to check the liver surface and make absolutely sure that there isn’t any other spread within the abdominal cavity. It is still under general anaesthetic, but a day case so I will only stay in hospital for one night before the operation and then go home straight afterwards.

If I pass that test, then the liver resection is considered major surgery as with the lung resection, and I will stay in hospital for a week or so. I’ll have a(nother) nice scar, this time following the curve of my ribs on the right side. Honestly, there will be nothing left of me by the time they are finished! But I feel very lucky that all my scars seem to be minimal, and in really discreet places. To be honest, I don’t mind either way, but there is something to be said for scars that could quite frankly have come from anything. This one I have decided is going to be a shark bite, from surfing a sick wave in Australia! (I’m not a surfer, nor am I allowed anywhere near Australia at the moment.)

Another specialty to explore and learn about (Hepatology), more tissue samples to analyse in a laboratory (always good for science, and for future treatments), another stint in hospital whilst the country is in lockdown – so really not missing out on much… all things I keep telling myself in order to keep spirits high. Which truthfully they are. I have nervous moments, and nights where I wake up and can’t get back to sleep with my mind running in overdrive, but overall I’m really doing ok. I trust the professionals, and I feel forever grateful for the highest quality of care that I’m receiving.