Monday, October 20, 2014

Friday, October 17, 2014

2k or 5k?

I'm behind again in terms of posting, but only because things have been busy in a good way. Here is the evidence of my 2k reception (to oncology and radiation) at Dartmouth-Hitchcock.
I'm including it because tomorrow is a big 5k day, the Head of the Charles, a 3 mile head race in Cambridge. I'm rowing again this year with my friend CB. Sometime last March, she did the calculation - 16 weeks for chemo, 6 and a half weeks of radiation, a little time for surgery, "you'll be ready for the Charles." And, she meant I would be rowing with her. At that time, and it still is, about being in the boat together. Over the spring and summer, it was good to think about it on some of the really tough days. Last year, we trained a lot and had a great race day, setting a new course record. This year, despite the surprise move to Hanover last month, we've still had a few rows together - not quite as many as last year - and still continued to train in our singles mainly, just not side by side. It should be a good run down the course. Steering, while still challenging with the buoy line and 7 bridges, should be less stressful since we have no crews in front of us. #poleposition

It's also the first race for my new team. We're in the Club 8+ on Saturday and the Championship 8+ on Sunday. It's exciting and nerve wracking all at the same time. I can't wait. Race day is always a good day. Green Means Go!

Lastly, since it's getting late, an updated photo at a friend's request. It shows my hair which has grown in to a good length, and I'm getting ready for tomorrow. Photo pinched from Anne. Not sure why my eyes are closed, but you get the gist. 2k or 5k? Why not both. 


Friday, October 3, 2014

Slide Control

This week went much better than last week in terms of mentally tolerating the daily radiation treatments. Getting and staying on one (and the right one) machine helped a lot - the initial set up and re-set up were over with so the visits were much shorter. On the first day there was music, I asked if we could keep it on and they said I could pick anything since they have Pandora. Now, as soon as I walk into the treatment room, I pick my music. Even though it will only be for about 4 songs, I have discovered this is my saving grace. One of the techs asked what I wanted to listen to, what was my favorite music. I said I didn't want to listen to my favorite music and then associate it with the treatment. Nora Jones was on the air when I walked in which seemed fine by me - at least it wasn't muzak, Country Western, or some angry 80s rock ballad or even worse heavy metal. Instead, it turns out I have selected Easy Listening (read that nice and slowly for full effect). Nora was followed by Frank Sinatra and that worked for me, too. The music is a nice distraction.

Anyway, here is the chain of events for anyone following along. The whole process takes roughly 90 minutes from my office in Alumni Gym, more on Mondays when I meet with my radiation oncologist. Walk to car, drive to hospital (park for free - score). Go down two flights to the radiation treatment center (room 2K is the radiation/oncology reception area - I kid you not). Swipe in at the bar code reader with my tag (left) and then wait to be called. A few minutes later, and some number of pages into the home decor magazine of the day, I get called to go to the gown changing area where I put on my non-drafty gown (arms through two sleeves then it wraps around from the back and it loops over my right arm, very nifty). Move into 2nd waiting area. Get called into the treatment room, remove the gown (these things will never wear out except from washing) and hop onto the treatment table where they place a bolster under my knees, the custom head pillow is already waiting (not soft at all, hard plastic), and I wedge up against a stop (like a seat but you are lying down) built into the table to keep me from sliding around. As I reach my arms up over my head to hold onto the handles to keep my them and me from moving, the techs remark my tattoos with a sharpie to better see the alignment marks. They use those marks to determine how much to pull on the sheet underneath me to slide me into position. Sometimes, they'll lift my arms to get them in the right place to align me as well. At that point, a red light shines onto me as part of the process. The reflection in the glass of the rotating X-ray disc above me shows an alien looking red patchwork of veins with very small spacing projected onto my bare chest. I can't think of the movie where I've seen this effect before, but it should come to me. On X-ray day, they take a few images at each of the three treatment stations and compare my alignment. This past Wednesday, they re-measured how far each of my sides is from a designated point to make sure I haven't changed in size. Finally, if it isn't an X-ray day, that's it - they leave the room and let me know it's time to start the treatment.

The treatment is delivered through the X-ray machine which looks like a disc from my vantage point, maybe a couple of feet in diameter. It is on an arm which allows it to move in with nearly complete freedom of movement. It usually starts on my left near my elbow aimed at what seems perpendicular to my right breast and then there are a few zaps - I can hear the X-ray machine whirring when I am being radiated. After a those bursts, the disc rotates around me and to the right - next up, I believe, is the supraclavicular region. At this point, I can just see the edge of the disc in my peripheral vision. One or two more bursts, and the final rotation to my right occurs. I can't see where the machine stops because my head is turned up and to the left to keep my chin out of the action. The final two bursts are completed, and then the red light goes out signaling I am done and free to move - relief for my arms, and I can cover back up again with the gown. The total zapping time is about a minute or so and the time from first to last zap is about four minutes. Pro tip - make sure to wait till they remove the bolster and lower the table before disembarking or you'll make the techs nervous.

Then, I'm on my own again to head back to the gown area, apply some of the skin cream to the treated area, get dressed, and head out. Remembering which floor I parked on is the next major hurdle, and then I can drive away. It's that simple. The whole process (despite my whining) really is how my assistant coach would say much wow.

9 down, 24 to go.


Wednesday, September 24, 2014

Radiation Domination

Today marks day 2 of radiation therapy. 

All in all, a tough day. A dear and loved friend lost her dad early this morning. The side effects of his chemo became too much, but in the long run, how doesn't matter as much as the fact that he is gone. I'm thankful to have some hilarious and good, over the top memories of him - who else builds a pole vault pit in their backyard for fun, but my heart aches for her knowing what that kind of loss is like. It also, it almost goes without saying, cuts a little too close to the bone. 

Yesterday's first radiation visit, delayed from Monday due to a broken water pump, was literally painfully long. The lying still isn't bad. I actually don't mind that at all - it's a challenge I enjoy and can keep my mind on. I don't even have to hold my breath. It's not the molded headrest to keep my chin out of the works. It is as hard as a rock and if I hadn't been there for the taking of the (my) head impression, I'd wonder who sat in for me. It's hard, unforgiving, and has a ridge that digs into my scalp. But I've been told it's the right one - I asked. But wait, there's more. As I lie on the table with my head turned up and to the left, I have to keep my arms above my head. Therein lies the rub. The way my arms rest, particularly my right arm, it goes numb within seconds. The other one takes a few minutes. Today's shorter session was bearable with much counting and trying to focus on something else, anything but what was going on, but yesterday's session which included many x-rays and consultations and adjustments was excruciating both in duration and actual discomfort. I've been told that after today it won't take as long to set me up. I can only hope at this point. 

Adding insult to injury yesterday, I found out after my treatment that I am on a back up machine. Part of my plan in moving my treatment out of boston and waiting till now to begin was to ensure continuity - I would only be on one machine and only have one doctor. Toss that one out the window. Once the water pump situation is resolved, I'll be moved to the right machine. Finding out after the fact really irritated me. 

Not much positive to report here - a sore right neck, shoulder, and elbow, a tendency to numbness and aches after the contortions, and a general feeling of sadness as a result of the procedure. Lying on the table, naked from the waste up, feet strapped together, and arms stretched out over my head is a very exposed position physically and emotionally. Being blasted by a high dose x-ray has me asking is this really all they can do? Which leads down the rabbit hole of how bad is this if this process is part of the cure. And, finally, each session reminds me of this sickness. Even though these treatments are shorter than the all-day chemo infusions, which I would never want to go through again and would not wish on my worst enemy, at least I could distract myself. There is no distraction I've found when you're naked and exposed like this. Not yet, anyway. I find this part of the process quite depressing. Somehow, I have to reframe the focus, like I did with the chemo and its side effects, that this is going to make me better, that it is working, and it will all be worth it. It's like I tell my team on the tough practice days - you can choose to have a bad attitude or you can choose to have a good attitude. 

31 more sessions to go. I can do it. 

Monday, September 22, 2014

Pause drill

Quick update.

Radiation did not begin today as scheduled. I got a call this morning a couple of hours before I was supposed to show up. Coming, as it did, during a very densely packed HR new-employee orientation, I lost my perfect excuse to escape. As best I could understand, a water pump, possibly in the radiation machine (really?), was not working. I've been rescheduled for tomorrow at 5:00pm. In a fortunate turn of events, since that is normally smack in the middle of practice, tomorrow is an Ivy League Rest Day which enough on the team lobbied for. #sororityrush #earnedmytrustalready

Rapid fire update.

  • It's been over a week since I sliced open my boat on the submerged part of a tree on the Connecticut. Ugh. 
  • I shaved my legs for the first time in nearly 5 months. Slightly more pleasant than above.  #sharperblade
  • Max is nearly as excited when he sees a golf bag carrier as when he sees a deer. Or, a skunk. 
  • A week of DVW in the books!

Wednesday, September 10, 2014

Doctor-Doctor-Doctor

I returned safely from the Amsterdam and the racing on Labor Day. Results were, for the most part strong, though many of the athletes were affected by unfair conditions on the course. Even for an outdoor sport, it was a tough go watching so many athletes in a position of having so much out of their control despite the countless hours of training and devotion to technique. It was heartbreaking to watch whether you've been there competing at that level or not.

After my day of rest, it was time to dive into a series of doctor's appointments which would close the loop post-surgery and pre-radiation as well as set me up for the transfer of treatment to Dartmouth-Hitchcock. Tuesday, first up, MGH and my radiation oncologist. We went over my pathology report which had been updated in the form of "final report." Pre-chemo, I was originally diagnosed as T2 N0 where T indicates the size of the tumor (between 2 and 5cm) and N indicates what is found in the nodes (0 means none, clear). Following the chemo and surgery, I am now T1 (the tumor shrank to under 2cm) and N1 (one positive node). As planned, this indicates radiation therapy in my future - once a day for 6.5 weeks, Monday-Friday, or 33 treatments. What we discussed was where to have the treatment which boiled down to my right breast where the tumor was removed, under my right arm to get to the remaining lymph nodes, and above my right collar bone where the lymph nodes under my arm drain through. Short term side effects include hair loss at the site of radiation (not like chemo where I lost all my hair), skin issues (discoloration, loss of suppleness, burning, peeling, rash), and fatigue (mainly toward the last few weeks and likely less intense than with the chemo). Long term side effects could be lymphedema (swelling of my arm due to damage sustained by the lymph system) and brachial nerve damage (resulting in loss of control and strength in my arm), as well as an increased risk of skin cancer at the treatment site and other tumors/cancer in general. Both of the major long term side affects which could wind up affecting my arm are less for me because of my age, good health, and fitness/exercise. The best long term side effect is that overall, the radiation lowers my chance of recurrence of breast cancer by 30-40% such that I will have a less than 5% chance of recurrence over 25 years. That works for me!

The next day, Wednesday, early in Hanover, I met my radiation oncologist at D-H. We also went over my pathology report and agreed on the same treatment plan. This precipitated a radiation planning meeting for the following Monday. Afterward, it was great to then have a whole day in Hanover to get going on the transition to a new job in a new town, but at the end of the day, another 126 mile drive back to MA.

Thursday, day 3 of doctors, I met with my surgical oncologist at MGH to close the loop on the follow up team meeting - I had met with my medical oncologist right before going to Amsterdam but at that time the rest of my team was on (deserved) vacation. From my my surgical follow up, it was confirmed that the incisions were healing well and that the scars and puckering would continue to fade and smooth out. None of that bothers me and since nothing is terribly sore anymore and is healing well, I am very happy.

Time at home Friday-Sunday allowed for some socializing, some packing, some work from home, and some rowing before heading back to NH for Monday's early morning radiation planning meeting at D-H. Monday involved going over the treatment plan again and essentially staging a simulation. My radiation oncologist marked the treatment area with a sharpie and some indicator beads that would show up during the CAT scan. The three sites within this zone are basically my entire right breast, under my right arm where the lymph nodes are located, and the supracavicular nodes (think just above the really bony ridge of your collar bone). This would enable the team of nurses and technicians working with my doctor to line me up properly and plan for the correct dosage of radiation. It turns out, my surgeon placed (microscopic) clips where the tumor was removed which makes if very easy to see where I need treatment - these clips show up on this kind of imaging but are way too small to feel. After positioning me just so, I was marked, literally tattooed with 4 tiny dots - two on my sternum one each above and below my breast about 4" apart, and two others on my sides one each under each arm about 1/3 of the way above the lower sternum mark. They really look like small, dark freckles. One more trip in the CAT scan allowed them to adjust my chin out of the way. I'll have to look hard left for the treatment. Each treatment itself isn't very long, maybe a minute or so. And, just like an X-ray, I will not be able to feel the radiation therapy even though this amount of radiation kills fast dividing cells which is not at all like the lower amount you get at the dentist's office or to look at a broken bone - that amount does not kill your cells.

I will begin treatment on September 22 and my last day should be November 5. I would be starting a week sooner, but decided to wait out for my doctor's return from the annual American Society for Radiation Oncology Conference Targeting Cancer (I think I have that right).

Finally, I became especially aware of the time frame of all of this when I got a call from my old mammogram provider reminding me of my 6 month check up. (I won't be going since my next one is scheduled at MGH 6 months from now. Sometimes, it is hard to believe this all began 6 months ago, that it is over 2 months since my last chemo, and that I am feeling as good as I am today. Beyond that, life is the general craziness that ensues at the beginning of every new school year as the returning students come back to campus and the new ones arrive for the first time. Throw a somewhat bossy/needy dog into the mix, two brand new coaches, a first practice in only a few days and you've hit the nail on the head on the level of the excitement going on around me.


Sunday, August 24, 2014

Amsterdam, The Netherlands

Three and a half weeks past surgery, almost a full 7 weeks post-chemo, and 11 days since my last post and I am doing well. The follow up with my medical oncologist was uneventful. The pathology report showed clean margins on the tumor which measured a little over 1cm in the biggest dimension. There was a micromatastasis in the first sentinel lymph node but it is no cause for concern. Any others were likely zapped by the chemo which is what it was meant to do. Both of those results mean no more surgery and no more chemo. Onto radiation!

In the meantime, since my last post, a lot has been happening. The CPET went well, as well as could be expected especially if you are a rower who has ever done a VO2 max test. The technician set up the erg for me and we picked a 12' piece with shifts each 2' to step up the watts in a linear fashion. I made it a little over 30sec into the final shift, and from the data it looked like I had definitely peaked and plateaued (good for providing the desired information). If I heard correctly, I was on the order of 165% of my predicted (age/height/weight) capacity. I'll have to look up what it was 15 years ago, but only when I'm feeling particularly secure, I think. While the technology may have improved to measure and record data, the actual test wasn't any easier to do. With a plugged nose and having to breath in and out of a tube held to your head with a neoprene mask, not to mention more than a half dozen or electrodes, it was quite the set up. Sorry, no photo. I remembered too late. I'm not as fit, understandably, as I was before the cancer treatment, but the outcome of the erg piece honestly wasn't as grim as I had anticipated. 

My hair is definitely growing back now. The peach fuzzy hair I shaved off has been replaced by about 3mm of normal looking, dark hair on my scalp. On top of that, just as I was down to the last eyelash on each eyelid, the barest fringe of eyelashes became noticeable. At roughly the same time, the light hair on my face returned. I no longer feel weirdly naked and exposed. And, last but not least, my eyebrows have just started to grow, too - they look faintly colored in, but are more and more noticeable every day. Eyebrows certainly add or convey a lot of expression that is notable more for its absence. Still waiting on some nose hair to fill in and help with the filtering system, but this is an excellent start, for sure. It only continues to get better from here on. 

Post surgery, I have also resumed rowing and running - the week off following surgery was tough without exercise but definitely the right thing to do since I was physically tired and needed to protect the surgical sites, and I'm glad I toed the line. This week, in Amsterdam at the World Championships, I've been able to bike (in the gym or following practices along the race course, a fun but frightening peloton), run, and erg with some regularity which is nice. It certainly helps to have a physical release at these kinds of events. I'm tired at times, sure, but mostly that is a combination of jetlag, cellular recovery, and being a hardworking coach. 

I do have some really big new in the plus column for a change. I have a new job - I know, I'm dropping the bomb late in the post. I am now the Head Coach of Dartmouth Women's Rowing. Bet you didn't see that coming. Neither did I. But when I got a call about the position mid-July I thought why not explore the possibility. It turns out  liked what I saw on my interview, but tried to think practically about it being a viable option. Then, after what seemed like too long of a time to get a good phone call, it came in the form of an offer, and I said yes! Now, when I get back to the US, I will have two major tasks in front of me. Arranging for radiation to be moved to Hanover (that shift is actually underway) and getting up to speed seriously fast with Dartmouth - a new assistant coach, learning more on who my new team is, and finding a place to live among other tasks. 

Until then, back to the racing, writing some emails, and more when I get home.