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.