Done!

As of Friday, I have finally officially finished with cancer treatments.

8 rounds of chemo,

2 boobs removed,

33 radiation treatments,

and a partridge in a pear tree.

I am tired and I'm happy it's over. Many people have asked what the next step is, so I figured I would address it here. At the bare minimum, my plastic surgeon wants to wait at least 3 months until I can have surgery to replace the tissue expanders with implants. I also still need to have the expanders filled a few more times before I'm ready for the exchange. We need to wait until my skin heals from radiation before that can happen - I would prefer the redness and peeling to be gone before I start stretching the skin, ya know? I also have to consider Phish. We're going to see their first concert in almost 5 years, and I can't enjoy myself if I'm sore, tired, or writhing in pain with C Dif. I'll be able to get the expanders filled in about a month, but the surgery will have to wait until after Phish.

Playing the Card

So, today was treatment 20 of 33. I'm almost two thirds of the way there!

It started as most days do, leaving the house at 8:15 and driving to the hospital. The techs were running a little late today, but all that means is that instead of getting on the table around 8:35, I was there at my scheduled 8:45 time. I met with The Zapper, as I do once a week. I got my coffee (today's flavor was Creme Brulee, which was yummy).

As I walked into the parking lot lobby where I validate my parking pass, I noticed that the automated machines were out of order. You see, normally I get a voucher at the radiation clinic. When I put the parking ticket into the machine, I use the voucher to validate the ticket so that I can leave. The machine cancels the voucher and returns both the ticket and the voucher. As you may remember from my last blog post, I save the vouchers and write the day on them and then line them up on my desk. Every day it's my way of telling myself that treatment is over for the day, work has begun, and I can live a normal life for the next 22 hours or so.

So, today the machine was out of order and I had to talk to a "real person" to get my parking pass validated. I knew this was trouble. As I walked up to the window, I asked the clerk if I could keep the voucher.

"No, I can't, because it isn't going to do you any good."

"Well, I know, but the machine usually gives it back and I save them."

"I can't give it back to you because you can't use it any more, it won't work."

"I KNOW..." and then I was upset. Instead of speaking logically, I knew that the best way for me to get my damn voucher was to play the card. Instead of fighting to stay composed, I let tears well up in my eyes a little...

"I come to radiation EVERY DAY and I save these vouchers to keep track of how many days I have left. These are IMPORTANT to ME."

And that took care of it. For about 5 seconds there I don't know if I made myself cry (which I SWEAR I have never done), or I just neglected to stop myself from crying. Either way, I got my damn voucher back, and now it's in its rightful place on my desk with "day 20" written on it.

Hello, Stranger!

[ducks as everyone reading this throws rotten tomatoes]

Okay, that's over.

Yes, yes, I know it's been quite sometime since I've posted. Quite frankly, not much has happened cancer-wise. Today was my 15th radiation treatment, and I have 18 more to go. I've been very busy at work (in a good way), and by the time I get home I haven't felt much like blogging.

I do like the routine of radiation. I get up in the morning, get ready, then head off to the hospital around 8:15. I take the same route (there's really only one way to get there), drive up to the 3rd floor of the parking garage (because there are more empty spaces up there) and park my car. I walk down the stairs, across the drive, and into the big revolving door. Head to Elevator B, Floor B, check in, then head for the changing room. I have to put on a hospital gown on top, but I get to keep everything else on. I grab my book (which I usually don't have time to read) and put everything else in the locker.

Then, if they're running early, the radiation techs are waiting for me and I head straight into Room 3. Otherwise, I'll sit in the waiting room for 5-10 minutes. Recently, I've been talking to another patient, but for awhile I was by myself in the morning. When I get into Room 3, I lie on the radiation table and then the leveling begins. It usually takes between 3-5 minutes for them to line up my body on the table using the tattoos and lasers. Once I'm where I belong, they leave the room and the zapping begins. That part lasts about another 5 minutes. Every other day I have a wet towel that they put on my skin that increases the dose to the area.

Then I leave, put my clothes back on, head up to the 1st floor and get a coffee. I put my parking ticket in a machine, along with a voucher I get for radiation, and then I'm on my merry way. I keep track of the parking tickets and write the day on them so I know how many treatments I've finished. They're all lined up on my desk at work:

So far, my skin is in pretty good shape. It's a little pink. It was worse last week, but I found that one of the creams I was using (recommended by the radiation clinic) was irritating my skin. It was pretty thick and goopy, so I think it wasn't letting my skin breath. I switched to something lighter, and my skin was visibly lighter about an hour after I put it on!

Today they marked my skin for the "scar boosts" that they'll be doing at the tail end of the treatment. It involves 5 doses to the area around the incision. In order to plan for it, I got sharpie markings all over my chest. It looks like a kindergartner went a little crazy on my foob (faux boob).

Anyway, I'll be getting to sleep. It's a big day tomorrow!

1 Down, 32 To Go

Today was my first day of radiation. Pretty uneventful. My appointment was at 8:45 AM, and I was accompanied by my loving copilot, Rusty. We got to the center around 8:35, and I was out of there by 9:05. The process is very simple:

- Check in at the front desk.
- Go to a changing room and put hospital gown on, put clothes in locker.
- Wait in waiting room (which I didn't even have to do today because they were a bit ahead of schedule!)
- Go to radiation room, where techs darken my tattoos with a sharpie then position and level my body.
- Sit there for 10 minutes as the machine moves all around and makes funny noises.

Once a week, I have to meet with either the doctor (The Zapper) or her nurse practitioner. Today happened to be that day. So, although it took a half hour, it won't always take that long.

A couple of hours after radiation I was sitting at my desk at work and I felt a bit of a subcutaneous itch on my left side. This was pretty weird because I can't really feel much on the left side of my chest. I tried to touch it or itch it, but I couldn't get it. I ignored it and it finally went away which is good because there was really no way for me to effectively scratch it.

Right now, my skin feels fine, but they definitely stressed that I should be putting stuff on it before it feels burned, which makes sense. However, there are SO many restrictions. I can't use anything with metals (no aluminum, titanium, or zinc). This means most sunscreens. I can't use anything with fragrance. And I've also seen it suggested elsewhere that I should avoid products with alcohol. So, that basically eliminates just about everything, but they did give some sample tubes of things I should be using. One is called "Jean's Cream", developed by a cancer patient who used a homemade concoction during radiation. It uses mostly natural ingredients and it's supposed to work pretty well. It's not cheap, but only the best for my boobs, you know. There's also this really goopy Eucerin cream that I should use at night. Tonight will be my first night using it.

And that's about it. Here's hoping I sail right through radiation :-)

Radiation Tomorrow

Sorry, this will be a short post, but I figured it was better to have a few words than none at all. My radiation "dry run" went very well on Friday. I met with the nurse and she went over things I should use on my skin and things I should avoid. The main side effects I'll experience are tiredness and skin irritation. After a couple of weeks, I'll get a "sun burn", and it could result in blistering (but the idea is to take care of it *before* that happens).

Tomorrow is my first day of radiation at 8:45 in the morning. The appointment should only last about 15 minutes, and I will have to go 5 days a week for about 6 and a half weeks. Oh Joy! :-)

Career Woman

Back to work.

I went in on Monday for the first time in about a month. Ah, it was good to be back. So good, in fact, that I stayed for a looong day. I knew Rusty was going to bowling on Monday night, so there wasn't much of a reason for me to rush home. Plus, it's nice to spend some time off the couch. And I'm getting kind of sick of The Price is Right.

My manager/team lead at work is great. He's a little older than me, and he really likes beer. In fact, a lot of us at work like beer. Many people are appalled when I tell them this, but there's a pub nearby that we visit once every other week or so for lunch (and beer). The managers and even our director goes, too. At my last job my boss was a beer nazi at work. It was a different industry.

Anyway, to ease back into the week, my manager took me to lunch at the pub. Oh, it was so delicious. There was a yummy Belgian-style honey ale that is just the beer of my dreams. Aside from the beer, we also got to talk a lot about how to ease back in and feel more productive at work. It was a good lunch.

I've had no trouble with driving at all, and my muscles are feeling so good, and almost back to normal. I hope to start a post-mastectomy Pilates DVD soon. My Pilates instructor is getting it to me via a friend, so I don't have it, yet, but I'm excited about exercising again.

My dry-run for radiation is on Friday. The purpose of this appointment is to make sure that the radiation tattoos and the LAZERS line up so I'm in proper placement for the actual treatment. They'll also go over some of the skin problems I can expect and the products I can use to help.

One last thing... I realized I forgot to review the pathology report after surgery. The tumor was .8 centimeters and less around, and they got very good "clean margins" because they took so much tissue. Also, the skin that was removed was all clear. For the lymph nodes, they took 11. That number really surprised me because a lot of times I hear about 20 or so lymph nodes. Now, that could be because he only took the first "level" of nodes, or it could also be because I only had that many. Everyone has a different number of lymph nodes, and the radiation oncologist says that she likes to see anything over 10. Anyway, 3 of the 11 nodes were positive for cancer cells. Not too bad. We were really hoping for 0, but at least it wasn't 9 :-)

The pathology was a little disappointing, and I know my medical oncologist (Mr. Wizard) was also a little disappointed. It's possible that the amount of time between chemo and surgery accounted for some growth. It's also possible that it didn't shrink as much as we thought it did. Either way, it was still a good response, just not a great response. But really, .8 cm is pretty small.

Surprise!

I forgot to mention that today was my first appointment in over 6 months with my Radiation Oncologist, aka "The Zapper". They called me with the appointment about a month ago, so I kind of forgot about it, too. I was told that there would be four appointments before the first actual treatment, so I knew this would be more of a "meet and greet" session.

When we got there, I was reminded how much of a tedious process this is going to be. At this hospital, patients normally have to register every time they arrive. However, for radiation patients, you just register once at the beginning of each month. Luckily, the treatments are at a different campus of the hospital, which is approximately an 8 minute drive from my house (as opposed to the 10-12 minute drive to the other campus!). More importantly, it's directly on my way home from work. This is very convenient, since I'll need to be there 5 days a week for 6 and a half weeks.

So, anyway, we meet with The Zapper and she is very happy to see that I look a LOT better than she expected. She'd heard about an infection and more antibiotics (without realizing it was C-Diff, I believe)and was afraid that there would be infection at the expander site (but there is not). She also said she was impressed at how high I could lift my arms. We were SO happy to hear her say that. I want to make sure that I'm recovering well, and sometimes it's hard to get that kind of feedback.

One thing we weren't quite prepared for - she wants me to start right away. I didn't realize this, but they like to start radiation about 4 weeks after surgery. Well, this coming Wednesday is 3 weeks. Also, radiation involves "prep work" (which I'll describe later), and my body shape cannot drastically change in this time. This means that once the prep is done, we can no longer inflate the tissue expanders. Guess when she wanted to start prep work? Today! Those 4 preliminary appointments I talked about? Baloney. Or bologna.

I am very surprised that this is happening so soon, and I really wish we could have gotten that last fill in next week. When we talked to the plastic surgeon at our last appointment, we really thought we would be able to get at least one more fill in by the time radiation started. But what could I do? Obviously, the treatment is the most important thing we have to worry about.

Unfortunately, I'll be stuck with these small, unbalanced boobs for a few months. The worst part? I can't go shopping!!! Really, I can't justify buying clothes that I know aren't going to fit properly in another few months. On the other hand, I'll be happy to be done with treatment. Also, my incisions will have more time to heal before we start going to crazy with the inflation. And let's face it - anything worth doing is worth overdoing, so I've got a ways to go :-)

So, onto the prep work. Radiation is a very targeted, high-energy beam that is directed at certain areas where cancer is likely to fester or recur. This includes the lymph node area, mammary glands, the chest wall, etc. Just like chemo, it kills both healthy cells and cancer cells, so it's important to make sure it's pinpointed to the right area.

Today they did a CAT scan of my chest to view my anatomy to determine where the beams may be directed and where they could possibly hit organs or other good tissue that we want to avoid. It was pretty interesting - The Zapper spoke about how some patients have "perfect" anatomy, and some have not-so-desirable anatomy. So, if the heart is too close to the breast tissue, for example, it makes positioning the beam very difficult.

I had to lie with my arms above my head for about 30-40 minutes, so it's really good that my range of motion is restored. It strained a bit, but I wasn't terribly uncomfortable. The techs were very careful about positioning my body just so. They made small markings all over my body for the scan, and then after the calculations were done I got tattooed. Oh yes, you read that right. I was hoping for a big read heart that said "MOM", but instead they are tiny dots that are no bigger than the period at the end of a sentence. :-( First, it was the polka dots not covering my incisions, and now this. I never get my way.

Anyway, the tattoos are where the beam is going to enter my body, so they are a little more appropriate. I think there are four of them.

My next appointment is the "dry run" appointment, where they'll go over the kinds of things I'll need to manage side effects, and position my body for the treatment without actually administering treatment. That happens not on this Friday, but next Friday. Then, the following Tuesday is my first treatment.

And now for the beer countdown... 1 more day to go! I've fielded lots of questions about what my first beer is going to be. I joked with my dad that if this was him, it would be easy - a Miller Lite! But for a true beer connoisseur (sorry, Dad), how will I know today what beer I want tomorrow? I pretty much know that it will be one of two beers, but I just don't know which one at this point. You'll just have to read tomorrow to find out.

And the verdict is...

Today I had a half day of meetings with various specialists related to my care. There was the nurse practitioner (I'm going to call her the Energizer Bunny), the radiation oncologist (The Zapper), the behavioral therapist (Lady Frasier), the medical oncologist (Mr. Wizard), and the plastic surgeon (Tabouli McSteamy). Today was the day for them to meet me (ya know, put a face to the mammogram) and let me know what to expect for their particular course of treatment.

First was the Energizer Bunny. I think she's going to be my go-to throughout a lot of this. She gave me some tips on losing my hair (shave it once it starts to come out so that I don't have to deal with a clogged shower drain on a real bad day), she offered to speak to my boss if I thought he would give me a hard time (he won't), and she also informed me that it would be okay to continue with regular massage treatments (yay!). The Energizer Bunny is also a fellow Wait Watcher - she has lost 70 pounds to date! (good for her - I've only lost about 15 on WW so far - but something tells me I had a bit less to lose).

Next was The Zapper. It took her a little bit to get up to speed with my case, but she informed me that I do, indeed, need radiation therapy. Not much to say about this because it will be a few months before she comes into the picture. One interesting thing I learned is that aside from the armpit lymph nodes that you normally think about there are some in the neck area, too. She will zap these just in case any cancer has spread here because it won't be possible for my surgeon to hit that area. Another interesting thing I learned is that whatever is left of my boob will be tan.

Onto Lady Frasier. This consult was kind of useless for me. Let me summarize - I am doing about as well as can be expected considering I have cancer. End of story. When I heard "behavioral medicine" I was hoping I'd hear about complementary treatments (like yoga, massage, etc) or certain exercises I should do. Instead, it was more about how I was doing and coping. I'm sure there are plenty of other people that don't have as good of a support system as I do, but I'm doing just fine, thank you.

Then, Mr. Wizard. I call him this because he was pretty unanimated until we started talking about some of the more technical aspects of his work. He described how the pituitary gland sends signals (oscillating signals, in fact) to the ovaries to activate them. There is a pharmacological way to neutralize these signals and basically "deactivate" the ovaries (thereby causing them to stop producing estrogen) without permanently removing them. Yay! This got him really excited when he explained it to us. This is important to me because my cancer is estrogen-receptive (meaning estrogen makes it grow) and also although I have zero interest in having children right now this is something I may change my mind about in the future (as a woman, I reserve the right to change my mind about anything and everything :-). As a sidenote, my cancer is also progesterone-receptive, but we don't yet have the results regarding HER-2 NEU (I'm really pulling for that one!). My final question to him was that when we decided to do chemo (which, at that point, was looking to be pretty soon) would it be possible not to schedule it this coming Monday? You see, I have tickets to the Red Sox game that day (Marathon Monday/Patriots Day - I really can't miss this). He was totally sympathetic because he has tickets to Wednesday's game!

Next, the plastic surgeon. I call him Tabouli McSteamy because he was Egyptian and you know that plastic surgeon on Grey's Anatomy, "McSteamy" (can't wait 'till that show starts up again). He was kind of weird. He kept looking at Rusty when he talked about my boobs (might be cultural, I don't know). I didn't really make a connection with him like I did with the other doctors, but he did explain things fairly well. Unfortunately, there are so many different options that may or may not come into play depending on what kind of surgery I have. At this point, I could have a lumpectomy (where they remove the tumor and some surrounding flesh), a single mastectomy (whole boob), or a double mastectomy (you guessed it - both boobs). Clearly, that has entirely different ramifications on the plastic surgeon's job. We decided that as my surgery gets closer, we'll meet with him again at his office where we can see pictures of the different options and actually feel the different implants. Sadly, some amount of disfigurement seems inevitable. It seems small in comparison to dying of cancer, but I've got to look at this every day for the rest of my life. This is one of those things I'll have to come to terms with. Fortunately, the "verdict" means I'll have some time to do that.

So what exactly is the verdict? Well, next week I will begin chemotherapy and that will last approximately 2 months. Treatments will be once every two weeks (or, once a week every two weeks, as Mom would say :-). During this time, they will be closely monitoring how my cancer responds to the chemo. After that, I will have a bit of time off and then I will have surgery. What kind of surgery I have depends on the size of the remaining tumor as well as the results of the genetic test (if I have the BRCA mutation, they will want to be more aggressive... i.e. take more boob). There is something like an 80% chance that I have the BRCA mutation but I think, if there's a .5% chance that a 27 year-old could have breast cancer and I have breast cancer... that 20% is looking damn good. After surgery I will undergo radiation (Mon-Fri for 6 weeks I think), and then it's on to reconstruction.

Well, that's about all I've got for today. You all have to stop commenting on the bitch post. I'm beginning to regret writing that. ;-)

Oh and BTW, you can all be as opinionated as you please (including you, Mom!). I shouldn't be the only one that gets a free pass on that stuff.