Radiation in 3, 2, 1….

Radiation started today. Good news: my plan includes the smallest amount of radiation exposure and the shortest amount of time (only four weeks). The radiation amount is low because the pathology report shows cancer is gone, so this step is just a precaution since I opted for the lumpectomy and I still have breast tissue. Radiation will eliminate any minute traces that can’t be detected. (The length of time is based on a size measurement. I measured between four and six weeks. The radiation oncologist went with the lower end because of the GREAT pathology report.)

The appointment started with “radiation stimulation” (or “the sim”). Basically, instead of radiation, the machine was prepped to take images. The techs spent about 10 minutes positioning me, using the four tattoos as their guide. (A few weeks ago, I met with the team for CT imaging and the tattoos, which will help align me for each radiation session. The four tattoos – two on my sternum and one on either side near the bottom of my ribs – hurt more than the surgery. I was bruised for days – and each tat is really just a small, tiny dot made by applying a drop of ink and then jabbing my skin with a needle.)

Once my position was verified by the images, the radiation started. It took about four minutes to radiate five locations – lymph node area and the “cancer bed” from both the left and right sides plus the overall breast. The hardest part was staying completely still for the duration of the sim and radiation – about 30 minutes with my arms in “stirrups” above my head, my hips extended far to the right. Of course, when you’re told not to move, everything starts to itch – and you’re not allowed to scratch or your position will be compromised.

Following radiation and changing back into my clothes, I had radiation education with the nurse. Basically, we covered side effects and what to expect. My skin from collarbone to the sternum to the bottom of the right breast will appear a little more sunburned week-to-week (red, sunburn-like skin that will itch and may eventually start to “flake” toward the end of treatment). Fatigue is a side effect, but not like chemo fatigue. The nurse described it as wanting to take a nap or go to bed an hour earlier than normal. Physical activity will wear me out faster than normal. Big deal. There are longer-term effects, like the possibility of a secondary cancer in the area (less than one percent) and a life-long sun sensitivity in the radiated area (like it will burn before any other area of my body). Also, I have to use a special deodorant and apply a special lotion twice a day. No pools or lakes during treatment. Plus no underwire bras, so back to the surgical and sports bras for a month. Blah.

The biggest thing is radiation is every. damn. day. It doesn’t take long; most appointments will be 15 minutes or less. It doesn’t “hurt.” The side effects aren’t awful. But Monday through Friday, every day, for four weeks, is a lot of time spent at the cancer center. Ho hum.

I’m just going to focus on the positive: I have to wait six months after radiation for reconstruction on my left side (much needed because things are REALLY “off” right now – I’ll be wearing a lot of scarves to cover up the difference). Six months puts me at spring break, and I’m already on the surgeon’s schedule for early that week in March. New breasts done and healed by summer 2016! Woot!

Two weeks

I’m two weeks post-surgery today. I feel great – no pain and full range of motion on my right side – so much better than I thought I’d feel at this point.

In the last few weeks, I’ve had four doctor appointments, and one more scheduled for tomorrow. Thank goodness the cancer center is only a few miles away! The surgeon couldn’t believe I wasn’t in more discomfort or pain. The plastic surgeon checked all the incisions, removed my drain, ordered me to not lift more than 10 pounds (an increase from five pounds – yay!), avoid stress that would lead to high blood pressure or increased heart rate (easy with kids, right?!) and to wear a bra 24 hours a day (ugh). Also, I have to leave on a clear sticky surgical tape covering my incisions for another two weeks – because it’s so sticky, it’s full of little fuzz balls from towels and clothing. Yuck! The oncologist was giddy with the pathology results. He actually giggled at the success of the chemo and surgery. Of course, he’s also the one who proclaimed he loves “to kill cancer!” The oncologist said based on the pathology report and after I complete radiation, my odds of a reoccurrence would be “really, really, really low.” Woot!

The fourth appointment was with the lymph edema clinic – and a new doctor. Because lymph nodes were removed (only the three sentinel nodes), I’m at risk for lymph edema. After meeting with the lymph edema team, the thought of this condition scares me more than anything I’ve been through. The chance increases the more nodes are removed, and since I only had three removed, my risk is slight. But it’s a condition I’ll have to watch for – for the rest of my life. Any break in the skin (from a bug bite, needle stick, scratch), burn (including sunburn), “crushing” (like laying on the arm at night or having blood pressure taken on that side), or repetition (like up-and-down painting of a wall or the motion of cross country skiing) could cause a build up of protein within the cells that cannot be filtered out through the lymph system. This could result in swelling requiring compression sleeves and gloves, the need for lymph massage (not the relaxing kind of spa treatment I enjoy), or other treatments depending on the severity. It sucks.

But my biggest issue right now is figuring out what to do with the left breast. The right breast is amazing, but the left one… well, a friend summed it up by saying I’m my own before-and-after, at the same time. The left side is larger and lays lower on my chest – heck, it’s been exposed to gravity for 41 years so it sags a bit. When I look down, there’s a two-inch slope downward from my right breast to my left. It’s temporary – reconstruction has to wait until six months after radiation, and I thought it would be no big deal. But it is. I’ve scheduled a few appointments with bra fitters this week (what’s a few more appointments?!), but I don’t want to spend a ton of money (since it is a temporary condition). Worse case scenario, I’ll wear a LOT of scarves to cover my chest. Thank goodness I live in a climate where I can wear scarves from September until May! First world problems…

The kids have been great through all this, but they’re starting to get antsy, and, unfortunately, school doesn’t start until the end of the month. It hasn’t been the most fun summer – no road trips to the Gulf coast or weekend getaways this year. Everything has been dependent upon “how mom’s feeling.” Sure, they’ve been mini golfing and to the movies and fishing/camping (with my mom), but it hasn’t been our usual summer. I really need to think of a way to make next summer extra special…

Results are in…

Just a quick update:

The surgeon called today with the results of the pathology report. The cancer was completely removed from my breast, no cancer remaining. Lymph nodes were clear of cancer. Officially no detectable cancer remains. Woo-hoo!

(As a precaution and part of lumpectomy procedure, I’ll still need to complete 6 weeks of radiation to make sure there are no itty bitty particles hiding somewhere in there.)

Surgery recap and the morning after

Surgery day started at 6:30 a.m. My mom and Lauren drove me to the hospital and stayed with me through pre-op stuff.

Around 8, I was wheeled to the Radioactive Room to have nuclear isotopes injected in my breast. These isotopes would lead the surgeon to the main lymph nodes under my arm (the sentinel nodes). If the cancer spread, there would be signs in these nodes.

I was transferred to a narrow table and told to relax. The doctor came in and explained she would inject four needles into my breast, as close to the nipple as possible. I was told it would feel like bee stings. (But BEE STINGS – in my BREAST! Ouch!)

A nurse held my hand as the doctor injected the isotopes. The first two injections were like bee stings. The third, I didn’t even feel. The fourth, though, hurt like hell. The doctor explained that I would have imaging for about the next 40 minutes, and if the isotopes weren’t moving, she’d have to inject me again four times. If THAT didn’t work, there would be a Geiger counter in the operating room that the surgeon would use to identify the sentinel nodes. A Geiger counter?! How radioactive was I going to be?

Imaging wasn’t bad. Thirty minutes for the first images, seven for the second, and four for the third. The isotopes did not move. The doctor came back in for the second set of injections. All four hurt…major pain and not “bee-like” at all. A second set of images were taken, and the isotopes moved to where they needed to be. My underarm was marked where the main nodes were located, and I was sent to the mammography center.

In the mammogram room, I sat in a chair for the imaging. The point was to find the clips from the original biopsy and mark the clips with guide wires for the surgeon. After four attempts – three of which I was standing, the tumor located near the breast wall, and farther back than the other, was found.

“Are you very squeamish?” the doctor asked.

“Um, no, I don’t think so, but no one has ever approached my breast with a nine-inch needle before,” I said.

“Don’t pass out,” she said. Since she’d have to put the wire in with me standing (the only way we could “find” the tumor) passing out was a possibility.

“One, two, three,” the doctor said and passed a needle in my breast. I was prepared for pain, but felt almost nothing. About three inches of the wire was inside, about six inches left outside my body as a guide.

The second tumor was easier to find and mark, although I was worried about the mammogram panels (the part that squeezes you) hitting the first guidewire and pushing it through my breast. When the second needle/guidewire was placed, the nurses put both under a Styrofoam cup and taped the cup to my chest. This was to “protect” the needles from movement before I was taken to surgery.

I had almost two hours before surgery, so I was taken back to my room. B was there, and having him close while I’d be in surgery made me feel better.

Surgery was about four and a half hours. The first thing I was told when I woke up was that the lymph nodes were clear – meaning no signs of cancer! Both the breast surgeon and plastic surgeon said the procedures went great, no surprises. A few hours after surgery, I was discharged and B drove me home.

Today, I’m aware, but not in much pain, on the areas of incision (a small one in the side of my breast – where the surgeon removed the tumors, a larger one under my breast and one around my areola – both part of phase one of reconstruction, and one on my side past my arm – holding a drain for any fluid build up). I’m in a surgical bra for the next seven days, only able to remove it for showering or washing it.

I know the breast is swollen, but from what I can see, I’m quite pleased. The size (compensating for the swelling) and shape are fantastic. It makes the left breast look kind of sad and floppy (reconstruction on that side won’t happen until next spring).

Overall, I slept great last night, and I feel really good today. So good, in fact, that I’m under the very watchful eyes of my mom and kids to make sure I do NOTHING today, even though I feel like I could do stuff. (They’re okay with me typing, but not lifting my computer…) I’m on restrictions for the next four weeks – primarily no lifting more than FIVE pounds, and limiting activities that increase heart rate and blood pressure. Those are going to be hard rules to follow, if I continue feeling this good.

Fingers crossed for a quick and easy recovery.

I’ve been Sharpie’d

Surgery’s tomorrow.

I feel comfortable in my decisions. I fully trust my medical team. B will be there for me tomorrow. I feel pretty good going into the day. I just need to get through the surgery to keep on track with the treatment plan (radiation next, then reconstruction).

Today was filled with doctor appointments and pre-surgery stuff. In between the stuff relating to my surgery, Ethan had a cardiologist appointment in the afternoon. He was born with a bicuspid aortic valve, and he’s monitored every few years to make sure the valve isn’t leaking. Good news: he’s good to go for another two years.

My big appointment today was the “marking” visit with the plastic surgeon. I figured there’d be a couple of lines, like where the incision would be, but…

This was a “no pomp and circumstance” kind of appointment. Just right to the point. Change into a gown. Doc in the room right away carrying a large bin of Sharpies.

He sat on a chair, face level with my breasts and started with a thick black marker making a vertical line directly down the middle of my chest – collarbone to half way to the belly button. Then the underboob, both sides. He lifted my breast, made the line, tracing the natural curve, then dropped the breast. Flop! I’m not as perky as I was 20 years ago, but I’ve never felt so “floppy” in my life.

Next a bullseye sort of pattern on the right side. Four rings from mid-breast to nipple. He drew another vertical line from collarbone to the center of my right breast. And a vertical line from the nipple to the outside of the breast.

The doc then switched Sharpies. He picked up a red one and drew a two-inch line in between the lines making the bullseye. “This is where the surgeon can make her incision,” he said. “There’s plenty of room to work within the length of this line.”

A few more lines completed the design, then he unwrapped a sterile, orange-capped marker. With surgical scissors, he pulled out the felt tip of the marker and used the tip to retrace all the black and red lines. He labeled a few things, then we were off to the photography room again.

Seeing the image of the lines on the computer screen next to the images taken during my last appointment was weird. I hadn’t realized just how many lines he drew, and how some of them were already “running” ink across my skin.

I was ushered back to the exam room, told to change back into my clothes, and waited for the nurse to conduct the patient education session.

We talked drain maintenance, pain meds, bra requirements (24-hours a day for the surgical bra until my follow-up visit) and physical restrictions (lifting nothing over 10 pounds and not engaging in any activity that will raise my blood pressure for a month).

I had two pre-op calls to clarify my medical records and reiterate restrictions before surgery. Now I wait for 6:30 a.m., when I need to be at the hospital. Whew!