Just a reminder folks, early detection is key. Get your mammograms!
Radiation Treatment Plan and Preliminary CT
Yesterday afternoon, I met with Dr. Desai, my radiation oncologist, to talk about risk, give consent, and map out the treatment plan. Afterward, I had a CT to help with the radiation setup and to confirm if the treatment plan would work for me. We discussed the possible side effects and what I could reasonably expect to experience. He also let me know about my positioning (face down) and why. I also received the first of 3 tiny tattoos on my left breast for radiation positioning.
The risks are typical for radiation treatment, which I've covered in earlier diary entries, so I won't repeat them here. He said I should expect more acute side effects because the treatment time would be compressed. Dr. Desai said he would be following the Canadian fractionation method, which accelerates the treatment time (3 weeks instead of 6) and increases the dosage of radiation. But, I'd need a CT to determine my precise measurements and see if there were too many "hot spots" in the breast to be treated this way.
There's a fair amount of scientific literature supporting the practice, especially for early-stage breast cancers with no positive lymph nodes. I have 1 positive node, but the amount of cancer in that node was 3 mm, so Dr. Desai thinks I'm a good candidate for this method of treatment. What is encouraging is that there were fewer side effects in women receiving treatment in this way than in the longer treatment schedule. I'm hoping that it holds true for me, as well (although with my sensitive skin, it might be an unrealistic expectation). What I'm most concerned about is the area under my breast and where my armpit is. Most issues occur where skin meets skin. I'll be applying the calendula ointment liberally and often after the treatment. Dr. Desai said the reason why they tell patients not to use anything prior to the treatment is that it increases the radiation exposure.
For the first two-thirds of the treatment schedule, I will be lying face down with my left breast hanging through a space in the table, rather than on my back. Dr. Desai explained that this would be done to prevent my heart, lungs, and other organs from experiencing increased exposure to the proton radiation. Later in the treatment, they'll switch it to electrons, and I'll be on my side so the machine will be closer to where my scar is and where the tumor was removed. The tech explained the second positioning to me after she completed the CT scan.
Prior to the technical part of the visit, I was asked to disrobe from the waist up. The tech placed stickers on my scar and nipple. Yep, my favorite -- adhesive on tender areas. At another point, while I was being scanned, she placed another sticker on my back that was supposed to stay on until I returned on Monday. It's already gone. My bra must have rubbed it off.
During the scan, I was positioned on the table in such a way that my neck was twisted toward the right, and resting on a cushion. My arms were over my head, with my hands gripping two vertical handles emerging from the table. The table was a bit dome shaped and only partially cushioned. It arched my back with no knee cushioning. The tech also put a round cushion under my ankles to lift my feet. No wonder Dr. Desai asked if I had any back troubles! I used to have some problems in my lower back, but it wasn't part of this discomfort.
The tilted neck twisting was uncomfortable and bothered me overnight. Worse, there is a metal bar covered by a minimal cushion that lies against the ribs under the breast. I will likely end up bruised in that area from lying on top of it for 15 minutes plus, 5 days a week. I also will be returning to my home yoga practice to deal with the twisting and uncomfortable positioning.
The tech said that everyone complains about the rib bar, but that they wouldn't be able to achieve a reproducible positioning if they tried to cushion it further. If everyone complains about it, why isn't it improved? Going through cancer treatment is tough enough, why can't some engineer develop a more comfortable radiation table experience?
Finally, after the CT scan, the tech gave me a tiny India ink dot of a tattoo on the side of my breast, below the midpoint of my scar by an inch. It didn't hurt while she did it, but I was a little sore afterward. Two more tattoos will be coming on Monday, when the radiation techs complete the set up and give me my first treatment.
It's clear that radiation is going to suck, but it's not going to suck as much as chemo. If I can tolerate the higher dosage for the 21 visits, it will be better than drawing it out for 6 weeks. The treatment will go into January because I'll miss two Fridays due to Christmas and New Years Cancer Center closures, but I'll probably need those breaks.
Thanks again for all your support, kind words and thoughts, prayers, and love. It means a great deal when folks take the time to comment.
No comments:
Post a Comment