About RADIATION...

Graham described it best afterwards, "They're probably so used to seeing people beaten down by time they see them that it was most likely refreshing for them to meet with us." Needless to say, we had a good time. I know, a bit bizarre, right? But at this point, with only one chemo treatment remaining, I'm like a kid anxious for Christmas. I'm just giddy as can be, wanting more than anything for all of this to be over with.

Questions that we wanted to know from my newest specialist, Dr. Evans, Radiation Oncologist: was his preference to have my implant exchange before or after radiation treatment; how long would I undergo radiation; how many days a week; how would I feel; any other side effects; any long term side effects; how would I know that it all worked; and most importantly, can I drink some alcohol?

After I gave the Nurse Practicioner, Larry, a former flight attendant, all of my history, I dressed into a gown and waited for Dr. Evans. The South African doc was a fresh dose of realism. While he examined me, he commented on what great work my previous surgeons had done. He commended me on the full movement of my right arm, where I had 24 lymph nodes removed. I dressed and he came back in to share what he knew.

The first thing he said was that I am doing everything perfectly, but that doing chemotherapy and radiation is just an insurance policy against removing and getting rid of any cancer that is possibly still present. Doing radiation increases my chance of survival by another 15%. I knew the reason for doing chemotheraphy was because of the cancer found in my lymph nodes near my breast. Since they're a part of the lymphatic system that travels through the entire body, the cytotoxins of chemo treatment would kill those little microscopic cancer cells that may have started growing elsewhere that we don't yet know about. Radiation treatment, because on the direct spot, will kill any other cancer that is directly in lymph node area that we already know about.

There are three reasons why to get radiation. The first is if there is a tumor larger than 5cm. My largest was 2.5cm, although I'm sure all 15 combined would be more than 5cm, that doesn't quite count. The second is if there are at least 4 cancerous lymph nodes found. I had 8. And third is if the margin is less than 2.5cm. (The margin is the distance between the tumor and the cut of the surgeon.) Mine was 1.4cm. So with 2 out of 3, I get radiation.

I'll receive radiation in 3 locations: the actual area where the cancerous lymph nodes were found and the areas on either side, below along my right side, and above, above my right breast below my clavicle. If I were having radiation directly on any organ, I would have worse side effects (i.e. I'd have stomach pains and digestive problems for radiation on my abdomen for ovarian cancer, or migraines for radiation for brain cancer). But because I'm not receiving it directly on an organ, my side effects will be as minimal as they could be for radiation. The worst that can happen is that due to the radiation on the lymph nodes at the top of my chest, there might be permanent scarring at the top of my right lung. So we'll have to keep an eye on it. But luckily since it's on my right side, it won't affect my heart at all and they'll actually shield and isolate that part of my chest. The most common side effect of radiation is fatigue, and is mostly due to the anxiety, depression or lack of activity. He said my fatigue level will be similar to my level after my nadir time (the halfway point between chemo treatments). So, I anticipate no fatigue at all.

The exterior side effect will be the effects of the skin itself. Because radiation is directly applied to the skin, there will be skin and tissue damage. I can't use any fragrant lotions, body washes, bath solutions or even deoderant. I can't take any hot baths or showers, only mildly lukewarm. However, I'll have to apply the suggested lotions (the nurses will give me all the details on my next visit) two to three times a day to prevent any redness and possibly blistering. The skin could change a darker color around where the radiation occurs, but will go away within the year. Note, how my skin changes with a sun tan makes no difference as to what will happen due to radiation. The area could also have some swelling and iritation so the more that I do preventative care, the better. I'll have to keep track of lymphodema, the swelling of my arm and hand because of the removed lymph nodes. And the hair loss only occurs on the area radiated, which means we'll see the hair come back under my left pit before my right. That'll be fun!

Dr. Evans' preference is to have radiation before the implant exchange surgery. Most women want to do the exchange surgery as soon as possible, simply because it's a bit uncomfortable having the tissue extenders in. I concur that they do feel somewhat disconnected from my body, hardened, and tender at times. But if I take the time out to do the chemo, then having the radiation soon afterwards, helps my insurance policy that much more. Also, radiation do sometimes shift or alter the implant, and do tissue damage under the skin. Some women would then have to go in and have a third surgery. But doing the implant exchange surgery after radiation, the plast surgeon could correct any tissue damage at that time. So even though I'll have to wait 3 months, the answer is, let's wait and take care of the cancer now.

The suggested days of radiation are 28, so we're rounding to an even 30. I'll go in for a scan on 2/15, the week after my last chemo treatment, to get everything checked out and to get my temporary tattoos put on. These are markers that they place in order to ensure that each radiation treatment is on the exact spot each time. Then we'll start a couple of weeks afterwards. I'll go Monday through Friday, 5 days a week, for 6 weeks. The actual time of radiation is only 1-5 minutes, but the time to check in and get situated will be 30 minutes to an hour. Since the hospital is about a 30 minute walk from my office, I'm planning on biking to and from in order to eliminate the time taken out of my day.

So now, I see the light. By the end of April, I will have completed all my treatment. I can't tell you how happy this makes me. Graham and I left that office completely ecstatic. One more chemo, 30 days of radiation, and then life back to normal. It'll take about 3 months for all my hair to grow back (my eyebrows are finally disappearing, eyelashes are hanging on). And then a scan months afterwards to ensure that the cancer is all gone. The exchange surgery will be around August, one year after it all started.

But the blogging won't end there... I've still got to talk about:

The financial impact of cancer, even with insurance.
The food during chemotherapy.
The kindness of family and friends.
What cancer and chemo means to toddlers.
and much more.

Love you all.
Laurie

PS - I can drink, but in moderation. So I'm also counting down the days to have that glass of wine, sangria and mojito, but not all at the same time!

Before Chemo #5

I hope this finds each and everyone of you back comfortably in your own realities after the holidays. As I prepare for Chemo#5 tomorrow, consume all of my meds (steroids, zantac, and cinnamin chai tea, thanks to Heather Foley), get as many chores and tasks done before I'm knocked on my ass yet again - there were others that lived horrible realities through the holidays that I'd like to take a moment to pay their respects. The holidays are the worst time for tragedies to happen.  Maybe because it's supposed to be such a happy time, one of joy, and giving.  We all heard of the house fire in CT or the family shooting in TX. There were people who passed away over the holidays. I lost a woman I called a dear friend, to cancer. She fought it for many years, lived with it, saw it come and go. But you would have never known it by looking at her, however I'm sure the ones closest to her experienced every minute of it. And that's not an easy battle to fight either. Another friend by association, found out she's terminal. And I have a work associate terminal with another. I say these things not to make you feel guilty for having a good time through the holidays. Hell, I did. We all deserve it. I say it mostly because it's things like this - tragedy, death, cancer - that make as look at our own lives, remind ourselves what's most important to us.

I couldn't go through any of this without all of the love and support. I don't say this to expect more (although I'm not one to deny anyone giving me a lil' love=). Cancer comes in all forms, and it effects people in a number of different ways. Besides me, I'm sure you know a number of people that have fought it, are fighting, survived, died, or has had to care for a loved one going through it. So when I hear folks say that I look great (which thanks by the way) or amazed that I ride my bike (which I've only done twice throughout all of this), what you're not seeing are the days when I'm laid up in bed, having chestpains, moving so slow I feel what it'll be like to be elderly, so tired that I can't even lift my head, and feeling aches throughout my whole body I've never felt my entire life.

With that, I hope to truly document, with words and photos, what it's like, for me that is. I'll go out an about each day. I have to. Physically because my body needs the fresh air and the movement. Mentally because my brain needs something more than TV and electronics. So I'll do it early in the day while I have the energy. I'll try to nap, but it just doesn't work and somehow I feel worse afterwards. I'll go to sleep around 9pm, wake up around 6am. Will either read or check emails or play games, waiting for my eyelids to get heavy once again. And then sleep until about 8 or 9am. So it'll be the time at home that I'll focus on.

I have appointments early on Thursday and Friday. On Thursday, I have my first pelvic exam with my GYN since all of this began. It's something I'll talk about once I actually what know is going on with my reproductive organs. One, I need to deal with the outcome first. Two, I thought it best to have has few emails as I can openly mention menstrual cycles, periods, discharge - oops, guess this one is one of the few. Then I'll go to work for a bit before I return to the hospital to receive my Neulasta Immunity Booster shot, which ironically may be the cause of the extreme soreness in my neck and shoulders for the several days afterwards. I've found it odd the last two times that the nurse was surprised when I said that I'll take it in my arm. Does one have something to do with the other? What if I take it in my ass? Will my hips, thighs and ass hurt? Which one will be better? May ask you heads or tails the day of, so stay tuned.

On Friday, I have a site visit to review the location for Japan Day @ Central Park (yes, it's here already, and will actually be on Mother's Day - stay tuned)!  So after we're done, I may just spend the rest of the morning while I have the energy roaming through the Park. Again, great to live in New York.

Off to take my steriod pills, zantac, and colace. Then get some shut eye before I prepare to conquer the Red Devil.

Love you all.
Laurie