80’S CANCER JAM OF THE DAY:
It’s been a long September. A touch of sepsis, a 10-day course of an antibiotic with a black box warning, a decision to end chemo early…yada yada. In spite of it all, I have bounced back once again to take on whatever comes next. Isn’t the human body simply amazing? It’s like a puppy that is continually scolded and kicked but returns time after time to lick your face.
It turns out that what comes next is the ultimate tan, otherwise known as radiation therapy. As I’ve shared before, I have some real concerns about becoming a human shish kebob, and yesterday was my day to annoy a new doctor, the radiation oncologist.
I first met him shortly after my diagnosis, and I remember being impressed with his unhurried, down-to-earth demeanor. Honestly, I don’t remember much else from that day; the shock was too great. So when he asked yesterday if I still had any “niggling concerns” from our first discussion, he didn’t know what he was getting himself into.
Hey, I gave him fair warning. I told him that I’m “that patient”, the one who does tons of research and never accepts any treatment at face value unless it absolutely makes sense to me. He didn’t flinch; I liked that. “Shoot”, he told me. So I pulled the pad with all my questions from my pocket.
Me: “I’m very concerned about irradiating my heart since the cancer was on the left side. I want to be able to run, and I don’t want to die of heart failure down the line.”
Dr. Rad: Pulling up my pre-op CT scan on his laptop. “Actually, you have a very favorable anatomy for radiation. Your heart is on the smaller side, and it sits a good distance back from the chest wall. We can get the beam almost down to zero before it reaches your heart.”
Me: “So your saying I have a small, cold heart.” (Dr. Rad chuckled) “Ok. But what about lymphedema? I’ve managed to keep that in check pretty well so far in spite of having 16 lymph nodes removed. If you go blasting my underarm area with radiation, couldn’t that get much worse?”
Dr. Rad: Reading my pathology report on the laptop. “It looks like we may be able to skip irradiating the area under the arm where the lymph nodes were.” He proceeded to draw a diagram of the likely area of radiation on the white board. “If we target this area, your risk of lymphedema will be about 10% assuming you don’t already have it. If we treat under the arm, the risk goes up considerably. Of course, if we skip that, there is a chance of recurrence in the underarm area.”
Me: “I guess the bigger question is how much gain in overall survival I can expect from doing this.”
Dr. Rad: Back to the trusty laptop. I half expected him to start pulling ferns and lamps out of there, like Mary Poppins with her carpet bag. “Let’s take a look at this study from 2007. It looked at women with estrogen positive, Her2 Negative tumors just like you. Your risk of recurrence in the chest area would go down from 35% to less than 5% with radiation. And your cancer was pretty close to the chest wall. We do not want a recurrence on the chest wall. Your overall survival over 10 years will improve by 10-15% with radiation.”
Me: Ok, I’m impressed. I like numbers and doctors who care enough to show them to me. “I’m with you so far. I like all that, but let me ask you this. You can only ever have radiation in this area once, correct?”
Dr. Rad: “With any degree of safety, yes.”
Me: “Why can’t I save this option until I need it? I may never have a recurrence. Just give me an MRI periodically to keep an eye on things, and we’ll pull out the electrons as soon as we see anything suspicious.”
Dr. Rad: “The problem with that is that we wouldn’t be able to see it early enough on MRI. You could probably feel it as soon as it would show up on imaging, and we don’t want it to get to that point. The bottom line is that I think we need to do a full court press here and do everything we can to keep it from recurring.”
Me: “Allright, I have one last question. I expect to get a fabulous new pair of boobs when all this is over, and I don’t want my skin to look like extra crispy KFC chicken.”
Dr. Rad: More chuckling. “Well, on the right side it doesn’t matter, but on the left side it may depend on how huge a boob we’re talking about. Everybody responds differently to radiation, so we won’t know how much the skin can stretch until it’s over. Start looking for a good plastic surgeon, and we’ll do everything we can to spare the skin. Now, do you have any more questions? Could there be any more?”
Me: “Oh, there can always be more. But I guess I’m good for now.”
Dr. Rad: “It’s no problem at all. You think, therefore you ask.”
So, we scheduled the planning session for next week, and the six weeks of daily radiation will commence on October 14. Am I thrilled with the idea? No. A voice in my head keeps telling me that a 35% chance of recurrence means a 65% chance of no recurrence. But I have to admit that the chest wall thing scares me. Since I had diffuse areas of cancer, with one type being only 1mm from the chest wall, it makes being a rebel somewhat dicier.
On a funny note, the nurse interrupted us in the middle of our one hour meeting to let Dr. Rad know that my ex-oncologist needed to speak to him for a minute. When he left the room, my husband and I smiled at each other. We made up our own version of that conversation.
Ex-Oncologist: “Oh my God, I just found out that Lisa is there. I’m telling you, get out while you can! Run! She’ll ask you all kinds of questions and expect real answers! Not only that, she’ll demand that you show compassion, even when don’t feel like it! And worst of all, she’ll call you out when you’re giving crappy care! You’re welcome, buddy.”
Dr. Rad: “Wow. I’m so grateful that you called. I’ll tell her we’re closing the practice and I’m moving to Afghanistan to treat underprivileged kids who can’t afford radiation. Thanks!”
Luckily, Dr. Rad did return. I guess he’s willing to take his chances:)