Lisa's F-Cancer Blog

The radioactive seed insertion procedure is done! It involved a lot of waiting, especially for the doctor – whom everyone seemed to need. Staff interacting with me wore clear masks, but as is typical with the Communicator mask, it wasn’t always positioned correctly over their lips. “Can you pull that down a little more, please? A little more. More. Good.” Rinse, repeat.

The procedure started with an ultrasound to find the right area of concern, which was marked with, well, a marker. Then I got three shots of lidocaine. The needles themselves didn’t hurt so much as the lidocaine did going in – it burned. Then a needle with the radioactive seed was inserted. Now that was very unpleasant – it really burned.

Afterward, I had a couple of mammogram slides done so the radiologist could make sure the seed was in the right spot.

If for whatever reason I don’t have surgery tomorrow, I’m to call radiology as well as my surgeon, because the seed has to come out – and the only way that happens is with surgery. That seems ironic – if you can’t have the key surgery, you need surgery anyway? Would that even be possible? I hope never to find out!

During surgery, Dr. McAuliffe will use a handheld Geiger counter that finds radioactivity in order to see the right place in the tissue that needs to be removed. The seed (Iodine I-125) is of very low energy, and its placement is of little to no risk to me or anyone nearby. If you can’t tell, this is from the brochure I got.

I was told I’d get a call between 2-6 today informing me what time I’m to report tomorrow. Just like the cable guys… The call came just before 3. I have to be at Magee before the crack of dawn! That’s damn early, but at least it’s in the morning since I can’t eat after midnight.

I’ve been asked if I’m nervous. I’d say more than anything, I’m dreading waking up from the anesthesia (always weird), dealing with my historically poor reaction to anesthesia, the arm/hand restrictions, and going stir crazy over the next two weeks.

Whenever I’m in an operating room, it brings back memories of getting my tubes in as a kid, which I had to do many times. Back then, they put the mask over my face to knock me out, which never agreed with me. I remember at least one time they had to reschedule the procedure!

Now I don’t need tubes, and I’ll get the anesthesia through an IV with some anti-nausea medication. Progress!

Thanks for all the good wishes! I’ll see you on the flip side!

Today is the last day of my respite between chemo and surgery. My parents rented a place down south for two weeks; I joined for the second week to work remotely. After being inside my house for seven months, the change of scenery, warm weather, and being outside have been just what I needed. I still have lingering symptoms, but the fatigue seems to be improving.

Somehow I’m also the only one with a ton of bug bites. Maybe they somehow know my body is different…

Today I had to start using antibacterial wash that I was given in pre-op; I’m to use it until surgery. I was nervous that it would have a smell, but it wasn’t too bad.

Monday bright and early, I have bloodwork and then the seed insertion. Shit’s getting real.

Surgery is two weeks from today. I’m still waiting to find out when my seed insertion will be. I also need an ultrasound of my lymph nodes because the tech at the last ultrasound skipped that (probably assuming wrongly that I would be getting an MRI). Of course the only opening is at a UPMC hospital I haven’t visited yet because there’s no room at my normal hospitals.

And this morning I had my pre-op testing. I went to UPMC Montefiore, yet another hospital in the system, where it was a one-stop shop. It felt like I was in the Twilight Zone because the TV had on Fox “News” and all the clocks hadn’t been changed after Daylight Savings!

First my vitals were taken, and then I had an EKG. It literally took only two seconds! Then while I waited in the room for the doctor to come in, someone else entered. I explained I was deaf and needed to read her lips, so she pulled down her mask and said she was there to do a hearing screening. If I failed, they’d give me an amplifier. Obviously I didn’t need that! Why don’t they look at my chart, or is it even mentioned in there!?

When the resident came in, he had a clear mask – so at least they learned. He asked me screening questions and went over my medical history. He came back a little later with the doctor on duty, who told me that I’m a bit anemic. Could that possibly be contributing to my fatigue? COULD IT POSSIBLY???? I’m annoyed that when I brought up my fatigue last week, no one mentioned checking my iron levels or giving me some iron!

I got some iron tablets at the store after, and if my levels aren’t where they want them to be after checking my bloodwork, I might have to get iron via IV, which would get it in me faster.

The last stop was bloodwork. I then went home with a bag that has special body and face wash that I’m supposed to start using four days prior to surgery. I asked if it smelled, and the resident said he’s never used it. Well, I really hope it doesn’t smell!!!

This afternoon we met with the radiation oncologist, Dr. Torok. Before we actually met him, one of the nurses got my vitals (again) and took some history (again). I got a folder with key information and a bottle of aloe vera gel. She explained some of the radiation process and answered my questions and then had us watch several short, captioned videos about how it all goes down.

By the time the doctor came in, I only had a couple questions left. I like him and can tell I’ll be in good hands.

Assuming no evidence of cancer in the lymph nodes, the expected number of daily radiation sessions is about 20; this will be adapted based on the surgery. Radiation likely won’t start until 4-6 weeks after my surgery, unless my healing is going well and I’m ready earlier. Unfortunately, this means I’ll still be undergoing treatment on my 50th birthday! Wah!

When it gets closer to the start of this third phase, I’ll have a treatment planning CT where they’ll mark me up and create a plan based on this imaging. It’ll impact how I lay (lie?) on the table. It takes a week to get this plan ready. Then there’s a simulation or dry run visit, where I’ll be marked with a temporary tattoo and have x-rays done. They do everything but give me the radiation. If it goes well, then the next visit would be the start of treatment.

During treatment, each session will take roughly 10-15 minutes, not including the time to get ready and positioned, etc. I think the total visit length is 30-45 minutes. Every Thursday I’ll see the doctor for a skin check; the topical treatment will adjust accordingly.

There are side effects, of course, like fatigue. But the doctor confirmed that radiation fatigue isn’t as bad as chemo fatigue. The skin might become irritated and/or burned. Everyone is different, but given my proclivity to weird/all side effects, I’m expecting ‘em all.

I won’t be able to read my Kindle during sessions, but I’ll be in the same boat as everyone else – no music is played like they do for MRIs. So it’ll just be 10-15 minutes alone with my thoughts every day!

They’ll try to schedule me for the same time every day. Parking is so easy and is super close to the building, so at least something will go smoothly.

As I was writing this up, my bloodwork from this morning came in. I do have anemia, but don’t know what threshold is used for the iron infusion. My liver numbers are still high, but have come down a lot since they were last checked, so the downward trend is good.

In general, my fatigue miiiight be getting a bit better, though it’s hard to tell because of Daylight Savings, and now this anemia! No change in taste buds; it can take up to two months! I’ve also been nauseous almost every day. Someone posted in one of my online breast cancer groups that they’re experiencing these same symptoms and their last chemo was four days before me. So I’m not an outlier…

After six+ months of inactivity, I did finally take a slow walk on the treadmill this past Saturday. And Sunday. And Monday. I’m going to try to do it every day or as often as I can so I can start building up my strength and energy. In just a few days I’ll be in warmer weather and will want to take advantage; here’s hoping I’ll be up for it!

My surgery is March 28! That was initially a tentative date, but now it’s official!

This news came after my surgical consult today. Dr. McAuliffe went over my recent scans. She clarified that we can’t compare the ultrasound to the mammogram, just a mammogram to mammogram and ultrasound to ultrasound. She said the tumor on the original mammogram was 4 cm, and on the last one, it was 1.0 cm, which is “really good.” On the ultrasound, it was 1.3 cm, and now it’s 0.4 cm, but that might be the clip that was placed during the biopsy.

There’s uncertainty as to whether my underarm was imaged. Sometimes radiologists skip this because they think the person is getting an MRI. I can’t get an MRI due to my cochlear implant. Dr. McAuliffe will contact the radiologist and find out whether they did it. If not, I’ll have to get this done, but it won’t hold up surgery.

“Shrinking cancer concentrically is really good,” Dr. McAuliffe said. It’s no guarantee that it won’t come back, but she still thinks breast conservation is the right approach. This is also known as a lumpectomy, or the medical term, partial mastectomy. The shape of my breast will depend on how much is taken out.

She will do a sentinel lymph node biopsy as well, which will be identified by dye. If there is cancer in the lymph nodes, I might need a second surgery.

I asked about the risk of lymphedema. She said there’s a 5% chance. It doesn’t really correlate to the number of nodes removed, but typically if there’s around five removed, they put patients into the lymphedema program. But the threshold number changes.

Shortly before surgery, I will get a second marker placed in my breast – a seed that has a drop of radioactive iodine. Dr. McAuliffe will use the detector sound to guide the incision and path to the tumor. She’ll remove a cube around the clip and seed. Then a mammogram will be done – “the only painless mammogram of your life.” If removal was centered, then surgery will be done. The surgery will include a separate cut under my arm, near the hair bearing area. Internal stitches will be used with glue over the cuts.

Then I’ll have to learn to live life with my left (non-dominant) hand for two weeks. That won’t be fun!

The nurse is trying to schedule my pre-op appointment for next week, in which I get bloodwork, an EKG, and a doctor to give me clearance for surgery. If I had it at Magee, it would be a one-stop shop, but they don’t have any openings. So she’s trying another hospital in the system. If that doesn’t work, I might have to have three separate appointments and get clearance from my PCP.

Following this appointment, I had a follow up appointment with Dr. Brufsky. Usually held the last day of chemo, he wasn’t in the office that day and said to just come after my surgical consult.

I complained about still not feeling well, about having overwhelming fatigue, and no taste bud improvement. Dr. Brufsky said to give it time as I had a lot of chemo. My hemoglobin is a bit low and my body’s been through a lot. “You made it, give yourself a break,” he said. If it’s still bad at six weeks, they’ll give me a boost.

Turns out I’m special in another way… only about 1% of people have liver issues from Keytruda, and I appear to be one of them. Dr. Brufsky said we’ll just stop the Keytruda. My extensive liver tests came back negative for everything, showing it’s not an immune response, which is good. The best part? My port will be removed during my surgery, which eliminates another procedure, and makes my life easier!

I had heard that typically Dr. Brufsky likes to leave the port in for at least six months after chemo, but maybe because I responded so well to chemo, he is feeling good about not needing it later on. At any rate, I’ll see him again after my surgery to discuss the pathology.

Tuesday is the radiation consult.

Onward!

Dear Body,

Today is probably a little confusing. For the first time in three months, you aren’t being injected with poisonous chemicals. This is not a fluke! Chemo is done with you. It’s an official break up. Why are there still repercussions? Why are you acting like you’re still in this relationship? It is time to let go and move on!

Sick and tired of waiting,

 Lisa