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!