American Bedu

There are many qualified doctors in Saudi Arabia and one should be confident of the care received in the Kingdom.  However today’s posting will be a bit more personal in that I will share my own experience in my battle against breast cancer and the doctor(s) who treated me.  Fortunately by being an employee of National Guard Health Affairs (NGHA) I am entitled to free care and treatment.  And in my view I believe that NGHA is one of the best health care facilities in the Kingdom.  During my battle with breast cancer I was fortunate to receive care and treatment from an incredible team.

Leading this team is Dr. Manal Al Zaid (Dr. Manal).  Dr. Manal is a Saudi and she specialized in oncology/breast cancer.  She was trained in Canada and the USA before returning to the Kingdom and practicing at NGHA.  This petite sprite woman has a no-nonsense approach and professional, competent manner.  She does not believe in speculation.  She is thorough in treating her patients and deals with the facts of individual cases.

In my case I was referred to her when I initially discovered a lump in my breast although after a mammogram and ultrasound other areas of the breast were of greater concern due to the configuration and clusters of suspicious cells.  Dr. Manal first had me undergo two differing types of biopsies, one of which she performed herself.  Concurrently she also informed me that the lump in my breast and tissue samples from the areas with the suspicious cells would need to be removed via a lumpectomy for further analysis.  A lumpectomy in my case was an outpatient procedure although it did involve my being put to sleep under anesthesia while Doctor Manal and her team performed the procedure.  The lumpectomy results in a small (less than two inch) incision on my breast and did not evade the nipple area at all.  Unfortunately the results of the pathology report which analyzed the tissue samples confirmed the findings of cancer which meant I had to undergo another surgery in an attempt to remove the cancer and cancerous cells.  Dr. Manal recommended that I have a mastectomy which is removal of the breast.

Prior to initiating the actions for the mastectomy I chose to obtain a second opinion from breast cancer specialist, Dr. Osama Al Malik.  Dr. Al Malik is a Saudi physician who is known throughout the Kingdom and GCC region for his expertise in breast cancer.  He is a practicing physician at King Faisal Specialist Hospital cancer center and also holds a private clinic through Kingdom Hospital.  Dr. Al Malik confirmed and concurred with Dr. Manal’s diagnosis.

At this juncture I needed to make some decisions in regards to the mastectomy.  Dr. Manal explained that she would perform a skin-saving mastectomy which meant the upper portion of the breast would be sliced and removed allowing her to get inside and remove all the cancerous tissue and cells.  Now my choices post-mastectomy were to either have an artificial prosthesis (artificial breast) which is removable and I could wear which gives the shape of a breast or I could choose two other options which involved breast reconstruction.  One option of breast reconstruction involved silicon gel implants to build up a shape of a breast again and the other, although also a major surgery, involved taking tissue and muscle from my stomach area and shaping and connecting it to my breast area, basically creating a new breast using my own skin and tissue.  I decided to opt for reconstruction using skin and tissue from my stomach area as I liked the idea of not having anything artificial and at the same time, a natural breast.  As a result, when I went for my mastectomy surgery, I did not have only a mastectomy but other procedures performed as well.

By choosing breast reconstruction this involved selecting a plastic surgeon.  Dr. Manal without hesitation told me I wanted Dr. Al Thunayan who is the head of plastic surgery at NGHA.  I had a consultation and examination with him and he made me feel immediately at ease.  Dr. Al Thunayan is a Saudi doctor dedicated to the specialty of plastic surgery.  He explained in detail to me what it would mean to use skin and tissue from my stomach area to reconstruct a breast.  Little did I know initially that by using the stomach area I would also get a free tummy tuck in the bargain!  Dr. Al Thunayan explained he would need to make an incision clear across my stomach area and remove equal amounts of skin and tissue so the area remained even.  This is also the same procedure for those who choose to get a tummy tuck.

So the team was now in place with Dr. Manal and Dr. Thunayan taking the lead.  They were each assisted by their own chosen colleagues.  The first procedure which was performed on me (after I was put to sleep by anesthesia) was injection of a radiation die which in turn provided Dr. Manal with a “road map” illuminating the lymph nodes of my body.  She chose to remove five lymph nodes from around the breast and armpit area for additional analysis to ensure these nodes were free from cancer cells.  After that procedure was performed she segued immediately into the mastectomy.  Once she finished the mastectomy, Dr. Al Thunayan and his team, who were also in the operating room, took over.  They performed the “tummy tuck” while simultaneously rebuilt my breast.  The day before my surgery Dr. Al Thunayan took precise measurements and made markings on my body which assisted him in rebuilding the breast to be identical in shape, size and contour to the existing breast.  The whole procedure(s) took six hours.

The first two days were the most difficult in recovery for me as I was pretty much immobile and unable to lift or raise my body by myself.  I have a high tolerance for pain but found myself feeling the effects of the anesthesia.  Anesthesia made my whole body feel groggy, heavy and nauseated.  By the second day it was very important for me to begin walking for very small periods and with assistance to overcome the effects of anesthesia and reduce the risk of blood clots from poor circulation.  I was checked upon several times a day by members of the plastic surgery team as well as from oncology.  Within seven days I was released from the hospital where I continue my recovery from home.

Prior to being released I was very nervous and apprehensive in waiting for the pathology results.  For if the cancer had entered the lymph nodes then it would mean continued treatments of radiation, chemotherapy or both.  I am sure you can all imagine my relief when I was told the pathology report was clean and no further treatment would be necessary.  Dr. Manal assured me she captured and removed all the cancer from the “infected” breast and took aggressive measures so that cancer could not spread from the bad breast to the clean breast.  While no further treatment will be necessary, I will have to take aggressive cancer-fighting drugs for at least the next two years as well as frequent checkups which will include mammograms.

I’m now on a six week at-home recovery with weekly visits either to the plastic surgery or oncology clinic.  Because of the surgery around the stomach area I must wear a binder or corsette like device 24/7 around my waist/stomach area for at least the next month.  This is to make sure the area remains tight and heals tight.  Due to the mastectomy I must wear a sport-bra for the next month 24/7 and will eventually be able to segue back to any bra of my choice and style.  While recovering I find that again due to some lingering effects of anesthesia I tire out more quickly but will slowly regain my full strength.  For the next several weeks I am not allowed to lift or carry items as my arm which is on the same side the lymph nodes were removed is now extra sore and sensitive.  I’m also instructed not to cook or clean.  (Thank goodness I am recovering in an area where housemaids are a typical part of the culture so I have a built in support mechanism).  As my stomach area heals it is typical to have some fluid drainage seep out.  When this first happened it frightened me a lot and resulted in a trip to the Emergency room due to the amount and flow of seepage.  Fortunately I was quickly stabilized and seem to be back on track now.

I have chosen to share such a personal post with you today to hopefully help allay concerns anyone might have on needing major surgery while in the Kingdom, highlight the professionalism and expertise of the Saudi doctors as well as help allay and inform any woman who may find herself in my shoes.  Breast cancer is not a closed closet disease which should not be discussed.  It is one of the most curable of cancers as long as detection and treatment is taken while it is in its early stages.  Annual mammograms are a must.

Filed under: gender, Health, Saudi Arabia