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Archive for the tag “lymph nodes”

Breast cancer phase 3: Let’s get radiated!

StarfireNow that chemo and surgery are in the “done” pile, it’s time for radiation. What’s getting zapped? My right boob and the lymph nodes in my right armpit. The preparation for this has been sort of fascinating for a nerd like me. First, the radiation nurse educated me on what I can and cannot do while I’m getting radiation treatment. What sunk in is that I can’t use deodorant on the armpit that’s getting zapped. Ew, right? Well, she told me the tale of a non-compliant patient who insisted on using deodorant and his skin “sloughed off.” No pit stick. Check. The other thing is that I have to eat a ton (60-90 grams daily) of protein (Cue shit-eating grin from my husband. Nice try, Gunny) to rebuild the good cells that are going to be dying off from the rads. She said other stuff too. No antioxidants, go easy on green tea, no hot tubs or crazy hot baths/showers. I’ll see her each Friday so she can check on how I’m feeling and make sure there aren’t any early signs of lymphedema.

IMG_3622Next, Dr. Spiderman (the radiation oncologist) and…let’s call her Starfire (the radiation tech) gave me a CT scan while I lay on the table with my arms over my head. They made some measurements and put a sticker with a metal bit inside on each side of me and one in the middle. Then they scanned me and when they were happy with their work Starfire gave me a tiny black dot tattoo on each side.

IMG_3727These are so I can be lined up properly in the same spot each day so what needs radiating gets done and they don’t hit anything that could be dangerous (like my heart or lungs).

Starfire told me that the measurements she took, the CT scans, and Dr. Spiderman’s info about my particular cancer and his prescription for treatment would be handed off to a dosimetrist who would figure out the exact angle and dosage and all that. I’d never heard of such a person, so I looked it up and it’s actually pretty cool.

A week later I went back for more stuff. This time Starfire and another tech took me into the X-ray room to test out the program the dosimetrist had come up with. Make sure his calculations matched up with my human body. This was both super cool and slightly intimidating.

logansrun178As machinery rotated around me and red and green lines projected over my skin I couldn’t help thinking about the rogue laser surgery machine in Logan’s Run.

Goldfinger-laser-sceneOr Goldfinger‘s crotch laser. “Do you expect me to talk?” “No, Mr. Bond. I expect you to die.”

Both the disc-shaped thing and the cafeteria-tray thing that took turns rotating into position above me were slightly reflective, so I could see me and my boob and the red and green lines. Starfire popped in and out of the booth to draw on me. She also gave me one final black dot tattoo. My posture was that of a reclining nude, but with a Tron grid overlay. Weird. I didn’t have my phone, or I’d have captured it. Here’s sort of what it looked like:

This painting by Modigliani just sold for 170 million bucks.

This painting by Modigliani just sold for 170 million bucks.

And here’s what I looked like when they were done:IMG_3725

So, tomorrow the real zapping begins. The beams will only be on me for about 20 seconds. It will take longer to change into a hospital gown than to receive my treatment. I have a new parking pass and a special swipe card for checking in. Nurse Rad says the fatigue usually doesn’t hit for a couple of weeks, and comes not from the radiation itself but as a result of how hard your body must work to repair the cell damage. Sounds to me like the kind of pregnancy tired your body gets from building a human being. And I know I can deal with that. Actually, I feel like chemo set the bar for shit I can deal with. So I’m not afraid of radiation.

In general though, my level of anxiety is pretty ridiculous. I’ve worked myself into some sort of panphobic paralysis. I dread every phone call and email. I live in fear of a knock at the door. I went to see Spectre with Gunny and during the final third I become convinced that a man who had come in late to sit in the handicapped spot was going to pull out a weapon and slaughter us all. I had a vivid dream that I was in a cancer ward in New Orleans and the doctors discovered that I had a fatal case of akomi sarcoma. It was level 6 Hertz, which is really bad so I prepared to make goodbye videos for my children. At some point I realized I was dreaming and made myself remember the name of the new cancer, convinced this was a warning from my subconscious. So I Googled “akomi sarcoma” as soon as I woke up. Of course, it doesn’t exist.

On the more realistic (but barely) side of my anxiety, I am concerned about my liver. I’ve become super sensitive to acetaminophen (I vomit up large doses) and my appetite has tanked recently. There has been no end to the diarrhea situation aside from the two post-surgery Percocet weeks. So then I have this conversation with myself:

Me: I had a PET scan that showed nothing suspicious in my liver!

Myself: Yeah, seven months ago.

Me: I’ve had six rounds of chemo since then.

Myself: Which didn’t get all the cancer in my lymphnode!

Me: Yeah, but… Look, you’re just a freak. Stop.

So am I a hypochondriac now? Because every fucking twinge, bruise, ache, and brainfart makes me go “CANCER!”

Anyway. Here’s an update on my head. Look at all the hair!!!!!!

82 days since last chemo.

82 days since last chemo.

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Phase Two – Cut it out!

Wow it’s been a long time since I’ve posted anything. I’ve composed many many posts in my head which I intend to get to before long. Posts about my existential crises, about what I got wrong about cancer in my first few posts, the cancer books I’ve found most useful and entertaining, and a list of stuff I can do while I wait out radiation and grow some hair. But those posts are for another time. I want to stick to one subject today: breast surgery. I’m going to try to be pretty detailed while it’s fresh in mind and hopefully it will help people about to go through the same thing have a better idea of what to expect.

So, here goes: I checked in for my lumpectomy (also called “partial mastectomy”) at 7 a.m. The plan was that my daughter Callahan would come with me and my husband would stay home and get our daughter Allison off to school. Then Callahan would go to her college class in the afternoon and Gunny would pick my ass up after surgery was over. Of course none of this played out quite the way we planned. Allison had a minor meltdown in the morning. She was “Sad about that thing” (That thing being the cancer and the surgery and probably the disruption to her morning routine). Daddy asked her if she wanted to help get Mommy checked in at the hospital, if that would make her feel better. It would. So we took two cars to Overlake Outpatient Surgery.

Checked in! Hat by Kiki Lewis.

Checked in! Hat by Kiki Lewis.

I got checked in and the woman looked at the schedule and told us I’d probably be ready to go home around 4 or 4:30. Well, that threw a wrench in Plan A. Plan B was Callahan would return to the hospital after her math class got out at 3:30 so Gunny could pick Allison up from after-school chess club. I kissed Gunny and the baby goodbye and Callahan and I went in the back. I lay down in the bed and the nurses asked me about allergies and what medicine I was on etc. The only thing I’m on really is magnesium. I thought my supplement days were over when Dr. Captain America deemed my hemoglobin high enough for surgery. But I got an email from him last Friday telling me to double up on my magnesium dosage for a total of 1600 milligrams per day. Here’s the deal with magnesium: it makes you poop all the poop in the world. Which is probably why, even though my appetite is back and I’m as physically idle as ever, I haven’t gained a pound since my last round of chemo. It’s like bulimia of the butt. Honestly (and here I am describing shit to you, so what else could I be but honest?) I don’t think my body remembers how to manufacture regular poo. It’s like the enzymes or whatever is responsible for shit-creation are hanging out in my guts and some sushi or hamburger appears and one of ’em says “Food, huh? Uhhh what are we supposed to do with this?” and another one (maybe wearing a tiny construction hat) takes the tiny cigar out of his mouth and jerks a thumb towards my ass and mutters, “Ehhh, just liquefy it and shoot it out the back.”

Um. Anyway, the nurses set up an IV line in my hand and take my vitals and all that. I was tired and kinda punchy and suddenly so very grateful I hadn’t gone off the deep end and insisted we cut off my boobs. Surgery is weird and scary enough…at least I wasn’t saying farewell to those murderous twins. After a while of hanging out in that room, it was time for me to go to the Breast Center (where I had the original mammograms and Turdy (the breast tumor) and Turdy Jr. (the malignant lymph node) were discovered) to get some frickin’ wires put in to guide my surgeon Dr. Superman. I was kinda hoping it would be a fun reunion with Dr. Moviestar, but no such luck. I was hoping Callahan could come in the room with me, but they wouldn’t let her. Mainly because they’d just taken delivery of this massive new machine that looks–I shit you not–like a battle mech.

Get away from her, Turdy!

Get away from her, Turdy!

About seven feet tall, it has these arms that reach out on either side of you, and these plates that flatten your tits into flesh pancakes. There was a grid with markings and the doctor, after getting my boob squashed into the right position, took a surgical pen and marked my skin at position B-10. My response? “You sank my battleship!” Then she stuck lidocaine in my boob to numb it. That stung like a mo-fo. Then she followed that up with a teeny but hollow needle and threaded a single tiny wire through. One end was right on the metal clip Dr Moviestar had dropped in when he took the core biopsy of Turdy. The other end of the wire stuck out of my boob. I looked like a hedgehog with one lonely quill. The doctor liked that idea. She also loved the hat my friend Kiki made me. Being a knitter herself, she recognized quality work. I really wanted to get a picture of my boob wire, but by the time I was reunited with my phone, I’d been gauzed and taped up. We moved into an ultrasound room for the next part: locating the clip Dr Moviestar had put in Turdy Jr in my armpit. The doc had discussed this with Dr. Supe and he’d told her that if she couldn’t find the clip, no biggie, no wire, he’d find it with the radioactive tracer. Well, she couldn’t find the clip and guess what else she couldn’t find? Turdy Jr. That 4 cm asshole was GONE. I saw for myself on the screen.

Toodle-oo motherfucker!

Toodle-oo motherfucker!

I was feeling pretty good. The wire bit was over. They wheeled me back to outpatient surgery where I waited almost an hour for Nuclear Medicine to be ready for me. Callahan was exhausted and I felt guilty for wasting her time since it wasn’t looking like she was going to get to actually see anything cool. So…I sent her home to nap before class. Because I’m a dumbass. When Nuke Med was ready for me, it turns out she COULD have come with, and the tech, Gail, had trained at the exact same program at Bellevue College that Callahan is hoping to get into. AND Gail is friends with the director of the program. So I fucked that up and feel like a stupid, stupid asshole. So, remember me telling you that I was going to have a shot of radioactive tracer in my areola? And that the tracer would flow to my lymph nodes so that Dr. Supe, during surgery could run a Geiger counter over my armpit and see which nodes were cancery and take them out?

Wrong. First up, as the doctor told me, the tracer doesn’t go to the cancery bits like a moth to a flame. It shows which lympnodes are draining from the breast as opposed to another area. These little breast dumpsters are where the cancer would spread. Okay, now I know. The other wrong stuff? It wasn’t one shot…it was FOUR. Not in the areola, but at the perimeter, where the skin changes color from regular skin to nipply color. The placement, as the doctor put it, was three, six, nine and noon. It actually didn’t hurt that bad. Gail held my hand. When the shots were over they had me hold a heat pad to my boob and massage it so that the tracer flowed to the lymph nodes more quickly. I babbled about being radioactive or become SheHulk or an X-man. They were probably glad to get me out of there.

Damn you, cancer!

Damn you, cancer!

Back in my little room it was still 45 minutes before my surgery was scheduled. I dozed a bit and screwed around on Facebook via my phone. The anesthesiologist came in to introduce himself, the nurses hooked up the IV (fluids, antibiotics, and anti-nausea stuff). Then Doc Superman came in and after I flipped him a bit of shit about the one nuke shot actually being four. He went over what he was going to do: Take out the Turdy clip in my right boob plus a little bit of surrounding tissue, then Geiger my armpit and take out up to four lymph nodes. He initialed the right breast (so, you know, he got the correct boob), and said, “See you in there, kid.”

When I had the surgery to install my medi-port back in late April, I have no memory of the actual operating room. I think the anesthesiologist started me off in the wait-around room with a sedative and I was out of it by the time they moved me. But this time, I was totally alert. The OR was big and REALLY cold. Besides the anesthesiologist there were three nurses in scrubs and masks and I started to get a little nervous. It was REAL. Then I scootched off the gurney bed onto the operating table which is ridiculously narrow! Like skinnier than a dorm room bed. Probably 2/3 the size of a twin bed. Dr. Feelgood put a sedative in my IV and an oxygen mask over my mouth and nose and…

…woke up in the recovery room. Dr. Supe told me everything went great and he’d only had to take two lymph nodes! That’s really good because the more nodes that come out, the higher the risk of this super shitty (and often permanent) swelling and pain called lymphedema. Supe asks who’s picking me up and I say my daughter. Then I look at the clock and it’s only 2:00. Callahan’s about to go to class. So I tell him my husband. Supe has the number and gives him a call.

All done!

All done!

I move to a new room that has a recliner instead of a bed and the nurse gets me a Diet Coke and Saltines. (I hadn’t eaten or drunk anything since 10:30 pm the night before and I was HANGRY). I get my phone out of my stuff and post some updates to Facebook while the nurse calls in a Percocet prescription. After a while she goes to the waiting room to look for my husband. He’s not there. They ask me to call him and I do, obviously waking him up. Dr. Supe had just told him surgery went well, but didn’t mention that he needed to come get me. So he hauls ass to pick me up, feeling terrible though it was no fault of his!

We picked up the baby from school and when she saw me in Jeep she said “MOMMY!!!” We went home and I crawled in bed and Allison gave me this picture she drew for me.

This is me waking up after surgery. The nurse is clapping and apparently we're going to eat cake.

This is me waking up after surgery. The nurse is clapping and apparently we’re going to eat cake.

Gunny picked up my prescription and a Big Mac. It tasted like heaven.

IMG_3206So now I’ve got my Percocet with a Pinktober cap and my boobs are wrapped up in an Ace bandage.

IMG_3205I can take it off and shower on Saturday (48 hours after surgery), but can’t take a bath or swim for three weeks. It’s sore, but really not too painful. The only annoyance so far (besides the sweaty funk I’m sure is brewing inside the boob burrito) is I can’t sleep on my right side. This morning I peeked under the bandage at Turdy’s gravesite. It doesn’t look too bad! My armpit is kinda numb.

Kinda grody, but I still have two boobs!

Kinda grody, but I still have two boobs!

So what’s next? On Monday or Tuesday Dr. Supe will call with the pathology results. That’s when I will find out if there is any cancer left in me. I’m feeling optimistic and am fully expecting to hear that I am cancer-free. And then, friends, we are going to PARTY.

Lymph Nodes, PET Scans, and Lies

breast_stageIIb_large2I wanted to write this post last week, but was feeling too Percocet-y. And now I find that I am reluctant to put words to it. I don’t have any especially staggering news to report. As expected, the cancer has spread to my lymph nodes. Four of them, according to Buffy the Cancer Slayer. Which is a weird thing because if it was three lymph nodes, I’m safely still in Stage 2, albeit I get a slight bump from 2A to 2B.

With four bad nodes though, I may be upgraded to Stage 3. No one with any authority has re-staged my cancer, but I’ve spent quite a bit of time consulting my books and the almighty Internet. Honestly, the stage isn’t going to make a difference in my treatment (I don’t think) because we’re starting with the big guns (chemotherapy) in the first place. Will it be more likely that I have a mastectomy than a lumpectomy? I don’t know, honestly. I guess some of that will depend on what, if anything, shows up in my left boob, which hopefully will have an MRI-guided biopsy this week. And if we’re tracking the fucks I give, I have none to spare for my rack. The ladies served me well and I’m totally okay with being rid of them if it keeps me alive longer.

I’m rambling, I know. Here’s what’s gone down since my last post:

Two days post Mediport surgery.

Two days post Mediport surgery.

Thursday I had surgery to install the “power port” in my chest. I was given the choice between “twilight” anesthesia or “knock me the fuck out” anesthesia and I selected door number two. Boy was I glad I did, because a forty minute procedure ended up taking two hours. Apparently I have a very robust collarbone and so Dr. Boobcutter had to dig around quite a bit to find a good path to my vein. Anyway, I guess all went well. I went home that afternoon with an ice pack and a Percocet prescription and a sleepy head. For the next twelve hours I felt dopey and headachey and kinda barfy. And I’d only been home an hour before Buffy called to give me the word on my stupid lymph nodes.

Dr Cappuccino, my oncologist called just a little bit after that. He said that he and Buffy and Dr. Boobcutter had been conferring and they’d decided that I should push back chemo a few days so that we could get that MRI-guided biopsy on my left boob and a PET scan. He said that some other people were pushing for a bone scan as well, but he was on the fence on that and thought the PET would be enough to see what’s what. “Hang in there,” he said. “We’ll get you through this.”

That afternoon at school my daughter was crying on the playground so her friend Jasmine took her to the “recess lady” who, when my daughter sobbed “My mom has cancer!” took her to the school counselor. There she got some stickers and drew this picture.

It says "Cancer is 1,000 pieces of poops."

It says “Cancer is 1,000 pieces of poops.”

Is it weird that I didn’t get a call from the school? Is my kid high-maintenance? When she cried again that night “I wish you never had cancer!” I decided that I’m out of my depth on this one. I left a message with the oncology social worker to see if there is a support group or a therapist I should be sending her to.

Friday I spent most of the day in bed except for a trip back to the hospital for my baseline echocardiogram. The drugs in my chemo cocktail that target the HER2 antibodies are known to play a bit fast and loose with the left ventricle, so we needed to check mine out so we can track any damage (which is temporary in the majority of people). So of course, I’m sitting there thinking…every fucking thing they’ve checked (minus my DNA, which does NOT have the breast cancer gene!) has been bad news. So I’m like “does my heart look normal, ha ha?” And the tech of course isn’t able to make a diagnosis–only the doctor can do that. So that freaks me out and  I become the Liz Lemon of the echocardiogram. “Hey look, Gunny, I DO have a heart!” “Is that my aorta or the sarlacc pit?” Ba dum tish.

sarlacc-pit

Then all weekend I looked up stats about how that one extra node effects my prognosis. And I get shit like this.

IMG_1716

Five year survivalWhat do I believe? Who do I trust? Am I being alarmist? Probably. But there’s enough concern to look at the rest of my body for more cancer.

So last night my son was over for dinner, milkshakes and Game of Thrones. And when the show was over and he was getting ready to leave we were chatting and I tell him chemo now is going to start on May 5 [insert joke about tequila in the IV for Cinco de Mayo] and he laughs and I follow with “Of course, that’s because they found more cancer and I have to get a PET scan har har.” And Allison, who is clinging to her brother’s leg like a tick–and who I apparently failed to notice–says “They found more cancer?”

“No,” I said. “No, I was just kidding.”

What stage of cancer involves lying to your kids?

Fear – The Real F-Bomb

Normally, I would wait until I know more before making this post. But, this–the waiting, the not-knowing–is a large portion of this cancer dance. So, today, I went to the radiologist to do ultrasound-guided biopsies of stuff that showed up on my breast MRI a couple weeks ago.lymph-nodes1

No biggie, I thought. I’ve done this before. I know what to expect. And I even had a prediction (left boob was a false alarm and lymph node in right armpit would probably be cancery). Here’s what I didn’t expect: it wasn’t one node they were looking at it was, according to two different techs “a handful” or “three or four.” Can you fucking count? I realize that techs usually can’t tell you anything because they aren’t supposed to make a diagnosis, but JEEZ. Is it five? Is it three?

Okay, so they’re looking at more than one node. I can deal with that. But here’s where it got freaky. One of the lymph nodes under my arm is GINORMOUS. It’s 4.4 cm. That is almost twice the size of Turdy the Tumor. Or at least his size when we did this ultrasound jazz back in early March.

Son of Turdy

Son of Turdy

Dr Movie Star comes in to do the biopsy. We talked about Burt Reynolds and that cheesy killer bees movie that culminated in the Super Dome.

Was he going to stick a needle in all the suspicious nodes?
No, just the big one.
If the biopsy comes back cancerous, is it a tumor in my lymph node?
No, it would be a malignant lymph node.
Since this blob is bigger than the one in my boob is it possible that the cancer started there and moved to my boob?
It’s not impossible, but it’s not probable. It usually starts in the breast and moves to the lymph nodes.

Okay, so he did the biopsy and I got to look at the little wormy core samples that he’ll send to the pathologist. They don’t look evil.

My left boob thing? Dr. Movie Star couldn’t find it. Hooray, said I. Well, that means we’ll need to do an MRI-guided biopsy instead. Boo, said I. He also mentions that if the biopsy comes back bad (and I am fairly confident that is the case, because it’s extremely common for cancer to spread to nearby nodes) they will probably do a PET scan or CT scan to see if cancer is anywhere else in my body. This is when I saw the Eternal Footman hold my coat and snicker. And in short, I was afraid.Prufrock

So yeah. I know I’m supposed to be all positive happy snappy blah blah bullshit, (and Oh! You should have seen my performance today. I was in full-on Trixie Mode. Cracking jokes, making small talk, calling everyone by name and telling Dr. Movie Star his techs should all get raises. Aren’t I a firecracker? Don’t I just have the BEST attitude, bless my little heart.)

Meanwhile, all I can think about is worst case scenarios. The cancer is everywhere. Every fucking where. I’m going to die. They’re going to do a bunch of scans and they’ll change my stage from 2A to 4, which as Dr. Boobcutter put it, is “game over.”

Bright side, bright side, bright side.

1. I’m starting chemo in six days. It’s going to work on killing cancer wherever it may be.
2. I don’t have any symptoms (but what about those headaches? Or how my back always hurts? Shut UP.)
3. I have an awesome medical team that is proactive and sympathetic.
4. I have health insurance. Yes, they may be slow, but Tricare has approved every single thing my doctors have ordered.
That’s all I can think of as far as the cancer. The other bright sides? It’s sunny today. I have two episodes of Mad Men waiting for me to watch. All three of my kids are healthy. I have amazing friends and family. I have this blog: a place to dump my fears and anxieties. The internet is forever and this blog may be my legacy.

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