MEDICAL UPDATE: 4
Appointments completed this week:
Seed Marker Placement. Two step process: 1) Lidocaine injected as a local anesthesia 2) using ultrasound as guidance, a green SmartClip was inserted into the tumor. I got to watch both the needle with the numbing agent and the insertion of the SmartClip on the ultrasound screen!
Pre-op. Health history reviewed, vitals taken, ECG completed (normal except for my sinus bradycardia). Nurse practitioner reviewed the steps for surgery: 1) inject blue dye to identify sentinel lymph nodes 2) remove 1-5 sentinel lymph nodes 3) pathology/microscope examination to look for evidence of cancer in sentinel lymph nodes 4) removal of tumor 5) pathology/microscope examination of tumor to ensure clear margins.
Radiation Oncology Consult. Went to the Frauenshuh Cancer Center.. Nurse K. was pleasant, thoughtful and thorough. Doctor S. was kind, a good listener, and he answered all my questions:
Do I need radiation therapy (RT)?
Yes. It’s a package deal: if you choose a lumpectomy it is always paired with RT. Otherwise, you do a mastectomy. You would never just have a lumpectomy.
Is it an option to use a more directed, intensive radiation regimen? Can I limit my radiation exposure?
Maybe. Very few women are good candidates for partial breast radiation. It requires that something is left inside the tumor cavity as a “target”, which then has to be removed. Since I have lobular cancer, which has wispy tentacles, it is safer to undergo whole breast RT to ensure some rogue cancer cells weren’t missed. Dr. S. will look into whether I could be a candidate for this or not, but his strong recommendation is to move forward as planned.
Does my survival rate increase with RT?
Kind of. Five- and ten-year survivor rates are very good for someone like me, but RT is intended to prevent re-occurrence, not necessarily to increase my odds of surviving cancer. If I was 10-15 years older, we might skip RT but due to my “young” age (LOL) I will definitely want RT.
What does the treatment plan look like?
Dr. S. recommended 21 rounds of RT, one round per day. Sixteen will be whole breast; five additional will be targeted at the tumor cavity.
When would treatment take place?
Well, here’s where things changed from what I was told 🤦🏻♀️😩. Originally, I thought I would start RT 3-4 weeks post surgery. Dr. S. prefers to wait 6-8 weeks to provide ample time for me to recover. If RT is started too early, there can be other negative consequences. Since we hope to get back to Montana in May/June, I asked how long we could wait to begin RT. Dr. S. said we could wait to start until 12 weeks post surgery. We are considering this option.
What are the steps involved in RT?
Consult - done today.
Simulation, scheduled for April 14. This consists of an appointment with Dr. S., then an hour to take images (CT Scan), take photographs, and do measurements. Then, it takes 7-10 days to formulate a specific plan for RT.
Treatment, done daily, M-F, until all rounds are completed. So, roughly 4-5 weeks of RT. And there is special reserved parking for me! :D Sessions should only be a maximum of 20 minutes from the time I arrive until I leave, so pretty quick.
What are the side effects of RT?
Individuals will experience skin issues. Radiation is hard on tissue, so it’s important to use special lotions and wear clothes that don’t irritate or scratch skin.
Fatigue will start to be an issue after the first week and is cumulative, tapering off 2 weeks after completing RT.
Breast size and shape may be altered from RT, and it could take one year to stabilize. Plastic surgery can be an option later on if desired.
During RT, I have limits: No hot baths, no hot tubs, only lukewarm showers, no sun exposure.
Skin issues and fatigue should disappear within 30 days after completion of RT.
Surgery check in time of 10:55 am on Friday, March 17.
No food after midnight the night before, BUT….I can drink water, Gatorade or water with a Nuun (hydration) tablet until 8:45 am. I found Nuun tablets with caffeine, which the nurse approved, which should help alleviate a headache from not drinking coffee. Yay! 👏🏻
Surgery should commence around 1 pm, last an hour, then some time in recovery. Should be home by late afternoon.
General anesthesia may cause grogginess for up to a few days, but most women recover quickly from a lumpectomy.
Next steps:
Oncotype testing results will show up 1-2 weeks post surgery. The score I receive will help determine if I need chemotherapy or not. If so, that would happen prior to radiation therapy. Not crossing this bridge yet.
If cancer is detected in the sentinel lymph nodes, the plan could change. Lots of variables here.
Prayer requests:
For complete peace as I wait for surgery to start
For clear margins, for no cancer in the lymph nodes, and no serious side effects from anesthesia
For the medical staff to be focused, well-rested, a good team, careful and thorough
That I can continue to hold plans loosely and adapt as needed
For J., all the kids (A., A&M., K&K, V., M&R, J., M.), and my parents to feel peace and be well supported
For me to see opportunities to bless others and be a light
