From chemo to radiation

We met with the radiation oncologist today and had a very educational and positive discussion. Since I’ve been feeling so good, I started out by asking him to tell me again why I need radiation, hopeful that there’d be room for discussion. But he said that case history shows that without radiation, the probability of recurrence is 30% and with it it is 10%, which pretty well ended the discussion. Actually 10%, or 1 in 10, sounds a little high to me, and I’m generating new questions for the next meeting. Like “Is that with or without chemo?”

Criteria for determining the number and type of treatments in my radiation plan include the fact that I had positive lymph nodes (2) and that the tumor was close to my chest wall. They will radiate from my clavicle to ensure they get the lymph nodes there that were not specifically tested to below my breast, and from the midline of my chest to the midline of my side body. I will have 34 treatments in all: 25 whole breast photon treatments and 9 electron “boost” treatments of the tumor bed. Once we begin actual treatment, I’ll have radiation every day, Monday through Friday (excepting holiday), till completed.

I have my first radiation-related appointment on the 28th, when they will do a simulation or “sim” that includes temporary tattoos or “tats” and a CT scan to gather the data for a detailed radiation plan. I’m told that the tats (my first and only) are VERY small and barely show if you know they’re there. After the sim, it takes a week to a week and a half for development of the plan. I will then go in for my first radiation appointment, which will be a dry run (no radiation). I’ll get my permanent tats (like “real” tats, permanent for the rest of my life) and they’ll verify that the beams are properly aligned to get all the coverage they are looking for … and nothing more. Day 2 is the real start of the radiation. Side effects will probably include a burn akin to sunburn (at least over time). They will supply a lotion or cream to relieve the symptoms, and recommend loose, cotton clothing to avoid abrasion. I’m not supposed to go in a pool or the ocean during this period as the chemicals can further irritate the already irritated tissue. I can also expect a cumulative tiredness that might start to bother me around week 3 or 4.

I was impressed that my radiation oncologist offered “whole body” counsel. Rather than restarting my C and E supplements, he removed my remaining dietary supplement (fish oil) for the remainder of my treatment, but assuring me that a well-balanced, healthy diet will include all of the nutrients that I need. I’m afraid he wasn’t thinking chocolate or chardonnay. šŸ˜¦ He advised me to avoid manufactured foods and to lean to organic meat and eggs. (I hadn’t considered organic eggs, which he described as meat.) He prescribed “mindfulness-based stress reduction,” including 30 minutes of walking at least 6 days a week and other activities such as yoga, meditation, etc. He cited statistically relevant studies that showed a marked decrease in the frequency of recurrence among those that exercised and paid attention to reducing stress over those who do not. Quote of the day: “Every day, do something mindful.”

With the program that the doctor laid out and a calendar at hand, I believe I’ll probably start radiation around the 8th of June, which puts treatment #34 at around 24 July or shortly there after. I found my tumor on 6 September 2008 and will finish treatment and start hormone therapy by 1 August 2009. What a year!

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