Meeting the Radiation Oncologist
Preface
A friend who works at the Rutgers Cancer Institute recommended Dr. Coral Omene for my medical oncologist's second opinion. There was some question about if she is in network or not (because she wasn't listed as a provider on the Cigna site), but I contacted my insurance directly, and she is, thankfully. I've got an appointment with her in early December to discuss the Oncotype test results. More on that toward the end of this diary entry.
This Morning's Appointment
I arrived 24 hours early for Dr. Desai. Turns out that I had written the appointment correctly in my datebook, but not on my wall calendar. (Have I mentioned that I really miss progesterone?) But, he and his staff kindly invited me to stay and accommodated me very quickly. Talk about a good first impression!
First, I met with a friendly nurse who went over all my records and talked with me about what to expect during the breast cancer radiation treatment. Some changes may be permanent, such as increased sensitivity to hot and cold temperatures (which also could decrease after 6 months or so) and hyperpigmentation (Lefty and the armpit may appear darker in color than Righty).
Because radiation not only kills cancer cells, it also kills healthy cells, I should expect some redness, dryness, itching, peeling, or blistering in the treatment area. Sam Cummis recommended Calendula for those side effects (and sent me three tubes of the helpful burn ointment, thanks again, Sam!). I can use it afterward, but I'm not allowed to apply any moisturizers 4 hours prior to the treatment.
I will not be able to wear any of my technical, synthetic, long underwear (which is what I tend to live in during winter) and will need to stick to loose-fitting cotton shirts for the length of my treatment and likely a month or so afterward. I'll likely return to wearing sports bras again, too. I'd bought a handful of flannel button down shirts prior to the surgery because I couldn't put things on over my head for a week, so they will come in handy. Will likely need to buy some loose, cotton long-sleeve t-shirts, though.
There may be changes in the breast tissue, as well. According to the handouts, "You may experience changes ... such as fullness and mild swelling; these changes will decrease over time. There also may be occasional warm sensations, tingling, or shooting pains; these sensations decrease slowly over time." Dr. McManus had told me early on that I'd likely experience the same discomfort I'd felt after the surgery, so I'll be taking Alleve once again.
Unfortunately, these effects and others (such as breast firmness or size changes) may last a year or longer.
The other aspect the nurse prepared me for was fatigue. I'll need to take frequent rests and pace my activities during treatment and afterward. Fatigue can last up to a year after radiation therapy ends. Some poor folks never recover their original energy levels after radiation. As long as I can (especially since I'm back to it, albeit slower than usual and at a much lower incline), I'll rise early and walk on the treadmill while it's dark out.
Once we schedule the treatment, I'll have a session that will last 30-45 minutes due to all the set up required. They will take a simulation, which involves a different type of CT machine than you typically use when getting a scan. Thereafter, each session will be 15 minutes (although it might actually take twice that to get the positioning correct), 5 days a week, for 4-6 weeks. Dr. Desai will meet with me each Monday to check on my condition.
Dr. Desai met with me and the nurse after she'd gone over all of the radiation facts and possible side effects. He spoke with me about my situation and performed a physical exam. I asked him if my seroma would delay the radiation, and he assured me that it would not. He'd read all my reports (since he's in the same system as Dr. McManus) and saw that she had aspirated it. It's much smaller now, but I'm still pretty sore in my armpit despite doing all the post-surgery exercises twice a day.
I asked Dr. Desai what he thought about the Oncotype test. He'd been interested in it, and we spoke about it for a few minutes. He brought up my long list of allergies and sensitivities, and I was glad to have been taken seriously about it. Sometimes, docs can brush over it like it's nothing, which makes me unlikely to continue working with them.
He agreed that the 3% difference between the recurrence rates of chemo vs. no chemo (but radiation and estrogen blocker) wasn't a lot. Although he was concerned about the cancer on the lymph node, my high Ki-67, and the grade of the tumor, he didn't think I'd need chemo, but was glad I had an appointment with Dr. Omene, whom he knows and respects. He also believed that she probably wouldn't recommend chemo either. I felt pretty relieved to hear all that and thanked him for his educated opinion. We ended the appointment with Dr. Desai asking me to call him after I meet with Dr. Omene to let him know my decision.
So, I have a little break between doctor's visits until I can go see Dr. McManus again about the armpit discomfort. There's also a small red bump by the end of the breast incision site. My theory is that since the other nylon suture ends haven't yet dropped off, this one ended up inside the incision, and it's causing the red bump. Just a theory, though, so I'll call Dr. McManus next week, after she's back from vacation.
Once again, thank you friends and family for all your support, calls, texts, messages, love, hugs, and gifts. I appreciate all the check-ins, positive vibes, and jokes. Hope everyone celebrating enjoys a happy and healthy holiday!
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