Welcome to the machine...

Yes, the random mechanical noises of the Pink Floyd song were the first things out of my car stereo as I left the hospital parking deck after my initial radiation session. I kid you not.

So, what's radiation like? So far, painless. At the same time every day, I show up at an office in the hospital where I'm promptly escorted to the dressing room by one of the radiation therapists. I trade in my shirt and bra for a lovely hospital gown, and the therapist brings me to a desk that looks kind of like a television producer's console, but with a couple of monitors that show the inside of the therapy room. Two therapists ask me my birth date and compare me against a photo they took of me when I had my CT scan. As if I'd really trade this lovely experience with somebody else. 

Then we go into the treatment room, passing a foot-thick door that reminds me that I am going to get zapped with radioactivity. There's a big machine and a table with a special cradle on it. I lay on my belly, with my face in one of those massage table cradles and the affected breast hanging through a hole. Then the therapists turn down the lights, boost the table up and move me around to line me up for treatment, aligning the marks they made on my chest during the CT scan with laser beams that come from the walls. The first time around, I was tempted to tell them it was the weirdest massage I'd ever gotten, but as nice as these folks are, they don't seem to be very big on humor.

From there, they turn on the lights again and leave the room.    

A few moments later I hear what sounds like a computer printer working, an apt analogy given the registration marks they Sharpied onto my chest and back. Since I'm face down and can't move, I have no idea exactly what's happening when, but some of the noises are the actual radiation and others are the rotation of the big machine. Considering the size of the thing, the printer comparison worries me a little. I mean, what if it gets jammed? Given my past corporate experience with notoriously faulty multi-function printers, I'm a bit wary of a sound that indicates I could get gummed up and mangled like a wayward document. 

I kid, I kid. At no point am I actually inside the machine, let alone being run through a set of platens and rollers.

I haven't asked if I can video the treatments, but I found a great vlog that gives you some indication of what's going on. There's a lot of random stuff in it (this kick-ass woman was prepping for a triathlon during her treatment!) and she's face-up while I'm face-down, but the actual treatment starts around 3:50.

 

The treatments themselves don't take very long. Yesterday was my third one and the first that wasn't special in some way. Tuesday they were doing a bunch of adjustments because it was the first one in the series, plus I had to see the nurse for instruction on skin care for the area they're zapping. Wednesday they took an x-ray for the doctor because that's the day I see the doctor, and that's part of the drill. Anyway, from what I could tell yesterday, I get two big zaps that last about 10-15 seconds apiece, each from a different direction. It literally takes me longer to find a parking space in the deck when I get to the hospital. Come to think of it, finding a parking space is probably more stressful than the treatment.

As for other stuff, I was a bit annoyed the other day when the nurse told me I had to get weekly blood tests because I'd had chemo. I'm all for keeping ahead of potential problems, but it seemed a little excessive, given that my numbers have been improving and I'm checking in with my chemo doc every three weeks along with the Herceptin infusions. I don't like the idea of opening up a vein any more often than I have to, especially since they can't pull from the left arm anymore. Plus, it's a pain in the ass. The less time I have to spend in waiting rooms, the better.

Instead of debating it with the nurse, I asked the radiation doc when I saw her Wednesday. Armed with the lab report from last Monday's infusion, I stated my case, and she agreed we could forego the weeklies in favor of a test halfway through and at the end. 

Checkups and check ins

Throughout my treatment, I've kept my head by focusing only on the steps directly ahead of me. It's the best way to prevent myself from running away with all of the what-ifs.

Make it through all of the pre-surgical assessments? Biopsies? MRI? EKG? Nuclear stress test? Echocardiogram? Check, check, check, check, check.

Surgery? Check.

Recover from surgery? Check.

Chemo? Check x 6.

Blood tests to check for toxicity? Check x 18.

Recover from the assault of chemo? Working on it, and feeling good about my progress.

It wasn't till this week, though, that I was in the position to think about the long term implications of cancer. I was scheduled for a follow up ultrasound on my right breast. 

You might remember that back in June, my pre-surgical MRI had indicated a potential issue that didn't show up on the mammogram set that had confirmed the mass I'd felt on the other side. A follow-up ultrasound a few days later confirmed the need for a biopsy. To say I wasn't happy is an understatement. In fact, for the first time since my diagnosis, I was downright angry, and scared. I was being such a good camper about the left breast, doing everything I was told to do, keeping a positive outlook, and fate was potentially giving me a double whammy. Intellectually I know that there's no fairness when it comes to matters of health, but... it wasn't fair. I couldn't find a single bit of humor -- not even grim humor -- about this potential for a second cancer, and when I can't find a way to laugh about something, it's pretty bad.

Fortunately, in one of the few examples of really speedy action through this entire escapade, my surgeon was able to fit me in for a biopsy the very next day. Results came back benign a few days later, with a recommendation for a re-scan in six months. I made the appointment and put it out of my mind. Why think (translation: worry) about something so far down the line?

That brings me to this week. Monday I went in for my once-every-three-weeks blood test, Herceptin infusion and chat with the medical onco. All's good, but she scheduled me for one of the recommended periodic echocardiograms to make sure the Herceptin isn't mucking with my heart. Lucky me, I got an appointment scheduled for the next day, also the same morning as the ultrasound. One stop stressing! Unfortunately, my nurse navigator/breast buddy didn't stop by during my infusion - I wanted to ask whether I'd see her if the ultrasound brought good news. Given that my only prior experience there was that I'd need a biopsy, I wanted to be prepared for the sight of her. I personally like her a lot, but, well, there are just certain times when she's the last person I want to see.

Everything was okay until the drive to the medical place on Tuesday morning. That's when I got a bit emotional. I can't even remember what song was playing on the radio, but the lyrics had added meaning. Something about mortality or some equally optimistic topic. I didn't break down in tears, but my eyes got a bit watery.

I wasn't worried about death as much as I didn't want to hear I'd have to go through this crap again. Another lumpectomy I can deal with, but chemo? No fucking way. And how would any potential new malignancy be managed in relation to my current treatment? And if it ended up being a stage 0 ductal carcinoma in situ (DCIS), would the docs want to be aggressive and yank it, or take the more conservative approach of checking back in six months, after I'm past radiation?

Before I could get too crazy, my frustratingly rational inner voice reminded me: nobody was going to be able to tell me anything before I got the ultrasound. Sometimes I really hate the fact that I stop myself before I really get raging.

One advantage of breast cancer: I got what suffices for frequent flyer perks in the imaging office. No forms to fill out, no wait in the cushy girls-only inner waiting room where everyone's wearing the same lovely mauve exam tunic. Right on time, the tech called my name and brought me directly to the exam room, where she gave me a moment to take off my shirt and bra and put on the tunic. 

I usually like to watch the screen during ultrasounds to see what the techs are looking at, but this time I didn't. The images aren't particularly clear, but the last time, I could see something unusual was there, and I got a bit worked up waiting for the news. I wanted none of that, and I didn't want to psych myself out. The tech was really great - after leaving the room for a few minutes to review the pictures, she returned and told me that everything looked okay. I'd get confirmation from my surgeon, but there didn't appear to be anything to worry about.  

Oh, happy day! Next step: the annual mammogram in May.

On my way out the door, I noticed my nurse navigator was in her office, so I stopped to say hi and share my good news. After congratulating me, she reminded me that this is my new normal. Staying healthy means vigilantly appearing at recommended intervals for tests that either confirm I'm cancer free or reveal something small we can nip in the bud. 

And, she observed, there's always the chance that my mind will do a number on me. Something totally unrelated could spawn neuroses that the cancer has returned, taken up residence somewhere else, you name it. It doesn't just happen to survivors; she told me she has moments where she's convinced that one of her own aches or pains is an early symptom of cancer. It's natural to feel that way - our neuroses can protect us as long as we get the issues checked out. I likened it to my experience with bedbugs: even after I'd eradicated them from my home, any little itch or bug bite brought fears they'd returned. 

The breast cancer survivors support group at the practice is a good place to talk about these things, she told me. These are folks who are a year out from diagnosis, and dealing with the aftermath. It sounds as if it might be a good thing for me, even though I've avoided going to the group with patients in active treatment.  

This is going to be a long haul, one that lasts for the rest of my life, hopefully many, many more years. The treatment may be the most intense part of the whole thing, but I'm coming to realize that it's just the first part. I have to get okay with the fact that I'll never be completely done with this.  

Feeling better

I'm feeling pretty good.

The weeks after chemo have been a slow but positive road toward health, such as it is.

My energy is coming back, and I've been taking advantage of the unusually warm weather to take some walks, go birding, whatnot. I was very happy to have enough vigor to thoroughly clean my bathroom and do some other tidying around the house. 

My insides seem to be healing up a bit. The hypersensitivity to certain odors is gone, so I'm no longer frustrated by the too-sweet fragrance of my laundry detergent. (Yes, can you imagine? Sometimes my clean clothes made me gag!) I've pretty much lost the weight I gained from the steroids I got with the chemo infusions, and my digestive and elimination systems are getting back to normal. You don't appreciate regular bowel movements until you don't have them! (Something tells me that some of you can relate.)

And yes, the hair is starting to come in. I can see some longer hairs (maybe 1/2 inch) flopping over among the buzzcut 1/4 inch bits. Some of the follicles from the shedded hair seem to be producing hairs, too; my hairline seems more prominent, and though skin is still clearly visible, my scalp looks more filled in. 

Yes, I know that the hair could come in different from what it was before. No, I can't tell whether it will be curly, gray, purple, what have you. If you've ever seen the scalp of someone with alopecia, you have an idea of what some of the longer hairs look like - kind of frail. However, not all of them are like that.

The other hairs? You know, the stuff you get with puberty? Still nothing, and I don't mind a bit. I can live without shaving a while longer.

The interregnum

Today's vocabulary word sponsored by... the break between chemo and radiation.

As I suspected would happen, I wasn't able to get radiation started before the holidays. I met with the radiation oncologist about 10 days before Christmas, and she promptly went on vacation. What is it with these doctors? First the surgeon went on vacay, then I had to wait to see my medical oncologist for the initial consult because she was off on a trip, and now the radiation oncologist? If I didn't know better, I'd think there was a conspiracy. Is there something in my chart that makes them think they need to retreat and prepare to deal with me?

I jest.

Anyway, on this round, we were at least able to make a little progress while the doc was away.  I met briefly with her covering doc, who supervised the techs on the next stage. They rolled me in and out of a CAT scan a few times to get measurements of the affected area and then drew a couple of Xs on me with a Sharpie marker so they can line me up properly the next time. I look at the marks as being like the register marks that commercial printers use to align colors on press. They have clear stickers over them so they don't fade out, but I still have to be careful in the shower so they don't peel off. Great.

Usually it takes seven to ten days for the doc to come up with the treatment plan and get things started, but given the holidays, I didn't hear from the hospital until two days ago. I go back in on Monday for more specific markings and a dry run, and the actual run of radiation starts on Tuesday.

Woo hoo.