Tuesday, November 23, 2010

Three's a Charm

I have started the preparation for the 3rd phase of my breast cancer treatment.

Five months of neoadjuvant chemo.  Check.

Bilateral mastectomy with partial axillary lymph node dissection.  Check.

5 1/2 weeks radiation.  Here we go kids.  Let's hope three's a charm to once and for all kick that bitch into a galaxy far far away.

I talked to Midge on the speakerphone while finishing up getting ready today for my appointment at the Cancer Center.  I was scheduled to receive a CT scan in order to plot where I'd be receiving the radiation, and have my radiation tattoos done.

I don't think Husband could have ever imagined that the future would deliver to him a wife with a Dennis the Menace cowlick on top of a short spiky head, scooped out deflated boobs, and tattoos.  Who'd a thunk it?

Sure was exciting this morning to brush my eyebrows.  They are almost completely back, and next week I think I'll go get them shaped up!  That is exciting.  My eyelashes are still tiny spiky things, but coming back as well.

The bad news?  The hair above my lip is coming in dark and feels coarse.  Oy vay.  Hormone thang I guess.  Don't even tell me I'll get through this whole thing, new boobs and body, only to have a mustache like Tom Selleck.

As I drove down the hill from my house, I passed the Marina, where my lab is located.  I thought about my lab lady and wanted to stop and say hi, but was running a little late.  I miss seeing her smile and getting her hugs, but not the pokes!  I don't think it was any coincidence she must have received the vibe, sending me a birthday wish from last night's post!  Hello Terry.  XOXO.  I think of you often!  You are part of my Angel network.

It was strange going in to the Cancer Center, checking in at a different desk, the Radiology section.  It wasn't long before I was called in and prepared to see Dr. Lotus, my radiation oncologist.  She has a very simple and natural beauty about her, and I'll bet she was an incredible student.  She is very competent and thorough.

She came into the exam room and warmly greeted me, and asked me to update her on how its been going since my last visit in early September.  I explained how my neuropathy and energy level seemed like it was getting better in the two weeks prior to surgery; I was swimming and regaining strength.

I told her the surgery knocked me on my ass, and most of the last month was extremely difficult trying to manage my pain and insomnia.  In the weeks after the surgery, I felt like I'd been hit by the recycling truck that comes to our neighborhood every Monday morning, shaking the house as it passes by.

It was not until I stopped taking the Vicodin and starting taking the Dilaudid that I was finally able to start sleeping, and in these last several days, I feel like my healing is finally kicking in.

I told her with all the pain, tenderness and immobility in the left arm, I was really worried about the effects of radiation.

Dr. Lotus asked if either The Good Witch or The Wizard had reviewed my pathology report after surgery.  Given that there was still some residual cancer prior to the surgery, she wondered if The Good Witch had discussed with me the possibility of a little additional chemo.

I about fell off the exam table.

"No, no she didn't."

"When did you last see her?"

"Um, just a week ago last Friday, the 12th.  No, she never mentioned that, and said I was ready to continue to radiation and she'd see me after the first of the year, unless I needed her before then."

"Ok, great, I guess she didn't feel it necessary."

I started breathing again.

Dr. Lotus outlined how things would go from here.  Today I would receive a CT scan so she could plot my treatment, as well as my radiation tattoos.  It would take her at least a week to plan my treatment, but she'd try to get us started by next Monday, although she couldn't make any promises.

She said she was referring me to a lymphedema therapist, which is a physical therapist for patients who have had lymph nodes removed.  She said I could start right away.  I was happy about that.  I'm worried about the lymphedema.  I know it's a condition that once it gets started can cause a lot of problems with swelling, pain and numbness in my arm.  I would probably go to the therapist a couple of times a week for three weeks or so, and as part of that, would learn lots of exercises and care for my left arm.

"I'd like to examine you now, so I'll step outside while you change into your exam gown" and she left the room.   I took off my hoodie, shirt and scarf.  I've been wearing my scarves around my neck lately, no longer wrapping my head in them.  My hair is coming in cute.  Still very very short.  I had the boys laughing the other day cause I have these tiny wisps of hair at the nape of my neck, and I showed the boys and said "Look guys, I almost have a pony tail."  "Right Mama."

Dr. Lotus came back into the room and examined me, lifting up each breast to look underneath.  She had me lay back on the exam table, and raise my arms above my head.  She poked and moved and examined my right arm.  Very little tenderness there.  She did the same for the left, and could tell it is tighter with significantly more discomfort there.

Dr. Lotus seemed pensive as she examined what was left of my breasts.  "I have not radiated a patient with a skin sparing that either was not already reconstructed or had tissue expanders in.  I'd like to consult with a  colleague of mine at MD Anderson who has a lot of experience with this, and have him concur on the treatment plan for you.  I'm hoping we can get this all wrapped up within a week, but with the holiday and all, it may take longer."

You might remember me mentioning MD Anderson in my blog before, it's one of the top cancer treatments centers in the country, and many of the large studies involving breast cancer patients come out of there.

Dr. Lotus instructed me to keep my gown on, and gather my things, and the technician would come in and take me to the patient waiting room, and then down the hall where the CT scan would be performed.  "See you there in a minute."

The cheerful technician arrived and lead me the short walk to the patient waiting room.  It's like a large lounge with a TV, cabinet lockers, dressing rooms, and a restroom.  This is where patients scheduled for radiation wait their turn.  It was a large comfortable room, and one wall was all windows with a view out to a nice garden.  I placed my things in a cabinet, and locked it.

We headed back down the hall, I had my key, and turned into the large room with the CT scanner.  It looks like a super sized doughnut, with a large moving platform in front it.  I knew the drill.

I removed jewelry and hopped onto the table and the technician helped make me as comfortable as you can be laying on a hard metal surface that is more like a tray than a bed.  She tucked me in with warm blankets and I had to position my arms above my head and hold on to two handlebars, one in each hand.

It wasn't long before Dr. Lotus came in, opened my gown, and was lifting and moving Itsy around.  I could tell my case was a real logistical challenge for them.  After she and the technician tried to maneuver my breast around for awhile, she said she'd like to call in her colleague at the office, the dosimetrist, and have him give his opinion as well.

From what I understand at this point, the radiation is administered as a field.  The radiation oncologist and dosimetrist (as in master of the dose) do their geometry to determine the size and shape of the field, as well as the dosage.

I know I through them all for a loop today, as what normally would take about an hour to set up a patient in the perfect position for treatment took over three hours with me.  The problem?  How to get that flat boob to stand straight up, with protective materials placed all around it where they do not want the radiation to penetrate.  With a full mastectomy, the patient has a completely flat chest, and so it is very easy to lay things down on a flat surface.  With a regular breast, it can stand up more on its own and they can position things around it.  My odd shaped boob with lots of wrinkling in the skin made for a real challenge for them.

They needed to come up with a solution for positioning me in such a way that could be duplicated exactly every single time I come for treatment.  They would solve one problem then another would arise, and at one point, Dr. Lotus thought it might be better for me to go home, let them think about the puzzle so to speak, and then I'd come back tomorrow.  They tried a couple more things, and started to get somewhere.

I ended up with a concoction of bubble wrap, metal mesh, tape, and stretchable bandaging across my chest taped down to the platform I was laying on.  I looked as if I had some kind of MacGyver contraption on the left side of my chest.

Finally, after three hours of laying on that platform, most of the time with my arms over my head, they were able to arrive at a solution they were all happy with.  They photographed it and had the other technicians come in and see what they had done so that everyone would know the special arrangements for moi!

Once they got me all positioned, the technician gave me more warm blankets and wrapped me up like a papoose.  They all left the room, and I had to hold very still as I moved back and forth through the CT scanner.

It was an exhausting day for me, and my arm was stretched to its limits today.  I sure felt like a guinea pig!  It's a little scary when you are a FIRST for people, just like for my surgeon.  I was his first skin sparing that was not immediately reconstructed.  Now I was the FIRST set up like this at the Radiation Center.

The last prep for the day was my tattoos.  Dr. Lotus marked tiny dots on me; two on each side of me a few inches down from my armpit, and two on my chest.  One on the chest is directly between my boobs, the other is slightly higher and towards the left.  The technician said "Ok this is going to pinch and sting a bit.  Are you ready?"

Uh huh, I shook my head yes.  She injected the small amount of black dye into the two spots on my chest, then under the right arm.  It was quick but a sharp sting.  Then she did the one under my left arm.  Didn't feel it, still completely numb there.  I have four dots now, and officially tattooed.  They will use the dots to line me up with lasers, similar to the ones you shoot to get a straight line to hang pictures on the wall.  Made me think about my job and how we use one of those lasers to shoot a line down the banquette to make sure all the tables are in a perfect straight line.  Never thought somebody would be shooting one of those across me.

Over the next few days, Dr. Lotus will do her homework to come up with the plan for me, will consult with her colleague, and next Monday after the holiday, I will return for a simulation.  If all goes well, I will start my radiation the next day.

28 sessions, daily, Monday through Friday, taking me through the end of the year and into January.

I am in the third and final stretch of cancer treatment that started in May.  If you include my reconstruction and recovery from that, this whole process will take about 15 months.

Did you know gestation for an elephant Mama is 22 months?  She gets a big wrinkly baby out of it.

I'm hoping to lose these wrinkly babies, and birth the new me.

Cancer free.

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