Since it was my first time, I went a little early in case they needed time to process me as a new patient. They had sent me a packet of questionnaires about my medical history which I had filled out last night. I ended up having to wait for about 15 minutes, but it was okay. I was able to read a recent "People" magazine. I must be getting old, because I didn't recognize many of the "famous" people inside.
I was called back by a nurse who led me into an exam room. She was busy on the computer and told me to get into an exam robe. It wasn't a big deal, but at Kaiser, they leave the room while you do that. Her back was turned to me, and I'm not really shy anymore about things. Heck, I've even considered posting pictures of my scars on the blog!
She told me I got "Dr. S" and that I was lucky. I guess she likes him. She mentioned that he does a lot of the "nasty" cancers of the head and neck. I had mixed feelings about this praise. First off, does he know what he's doing when it comes to breast cancer? In a morbid kind of way, it helped to hear that I didn't have a "nasty" cancer. I mean, it sucks, thats for sure. But at least it could be worse.
Dr. S came in and I was a bit surprised to see a young guy. He's a small and thin guy of Indian descent, which I expected when I heard his name. Not that it matters. As long as he knows what he's doing. I was impressed when he started talking because it was clear that he had reviewed my case. Unlike Dr. P, he looked me right in the eyes as he talked. He even knew things about the pathology of my lymph nodes that I was unaware of. All of it made me a good candidate for radiation in his opinion. He wants to design a treatment plan that will radiate my chest, left armpit area, and left clavicle (where there are additional lymph nodes).
The bottom line is that doing radiation now will decrease the risk of the cancer recurring. When it recurs a second time, it usually is harder to treat. The theory is to go in now with all the guns blazing and do all we can so it does not come back. My treatment should take 6 1/2 weeks and begin in January 2011.
In my case, the biggest risk factor for recurrence is my age. I have 40-50 years on average to live, and the longer you live, the more chances for cancer coming as genes divide and mutate.
He spent a long time talking about short term and long term risks of radiation treatment. I should expect my skin to get red and burned. In fact, he wants it to happen so we know we are frying any cancer cells. ("Frying" was not his word, but that was what he meant). He suggested a calendula cream to treat that. Radiation treatment also has a tendency to make people tired. Because of the beams that will be coming at me from two different directions, a portion of my left lung is going to get zapped as well. This could cause some permanent scarring. That could impact my working out a little bit. He has had patients who were athletes and cannot run the times they used to. I'm not an athlete, but I do like to run. "Jog" may be a better word for what I do. They will be able to shield my heart and prevent it from damage from the beams. It also could weaken the ribs on my left side. If I were ever in an accident, those ribs would be more likely to break than those on the right side.
As I knew, my risk for lymphedema will increase. He said before radiation, I had about a 20-25% chance of it. Radiation will increase those risks by 10%. Both he and the nurse saw I was wearing my compression sleeve and were glad I was already being proactive about it. Hopefully wearing the sleeve constantly during the course of radiation will keep the lymphedma from happening. I'm also going to visit my physical therapist a couple weeks into it.
Overall, he was very confident that radiation would benefit me and it made me feel good about the treatment as well.
He did a brief physical exam and asked me if I was going to have reconstructive surgery. I did consult with a plastic surgeon back in July before my mastectomy. He said that if I had to have radiation, expanders and implants wouldn't be an option. At this point, I'm not interested in it. (I've been mulling over a blog post on the subject). I may change my mind in the future once I've got treatment behind me. Dr. S said I didn't have enough body fat to do a TRAM or LAT flap procedure. That is where they "borrow" tissue from your belly or back to re-form a breast. I was happy to hear that I didn't have enough fat to do that. It has nothing to do with reconstruction, but having lived overweight all of my adult life until about a year ago. I couldn't help but smile to hear that my plastic surgery options were limited because I was too skinny! He mentioned a procedure called a "DIEP flap" that they do at Kaiser up in Los Angeles. I may look into that later to see what that is all about. But for now, I'm focused on having that small little light at the end of the tunnel grow brighter.
The next step is a "mapping" appointment that will take about an hour. Its a lot like having an MRI in that you lay down in a tube in the "treatment position." For me, that is with my arms above my head. I'll be doing that 2 weeks after my LAST chemo on December 3rd. Daily radiation will start at the beginning of January.
- That the timing for my radiation appointments works out. I need to go every day, Monday through Friday. I'm not sure what time of day will be best for me considering my other obligations to shuttle kids around and take care of Jean-Marc. Luckily, the radiation office is near my mom's house. I have a feeling that I will be needing her to hang out with my little sidekick for a few minutes each day.
- Healing. That these last days of chemo be effective. I got a little freaked out today to hear about how the cancer was in my lymph nodes. Not that it was just there, but the way it was there and in at least one node had kind of broken out of the node itself. I tried to read my pathology report when I got home, but it took me back to June when I was freaked out about the cancer moving to other parts of my body. I just pray that this chemo disrupt any cancer that snuck out of the area.