A little TMI

A few of the many things I won't miss about chemotherapy.

"Before cancer I just lived, now I LIVE STRONG" ~ Lance Armstrong

For years now I've seen people wearing those little yellow wrist bands that read "LIVESTRONG" . Until recently the most I knew was that it had to do with Lance Armstrong but I never really understood what it meant or what the whole LIVESTRONG challenge was about.

On August 24th, 2008, I, along with other team mates of Team Heather's Fellowship participated in the Philadelphia LIVESTRONG Challenge. This particular team was established by Heather and her boyfriend Aaron in 2006 when she was diagnosed with cancer. She passed away in 2007 at the very young age of 34.

As we well know, cancer touches nearly every person in some way or another. We walked in memory of Momma Wade, Kathy's mother, who also passed away in 2007 due to cancer. We walked in honor of Bill O'Neal, Will's father who was diagnosed with leukemia and after a long and brave battle beat its butt and has been in remission for 10 years. And we walked in my honor. I was still undergoing my radiation treatments.

Most of the team walked the 5K, however, Aaron, Will and Michael each bicycled 45 miles!!!

The Lance Armstrong Foundation unites people to fight cancer, believing that unity is strength, knowledge is power and attitude is everything. They are helping to make cancer a national , now global priority. They help people diagnosed with and affected by cancer face the challenges and changes that come with cancer.

I've participated in Walks before, specifically the Avon Walk for Breast Cancer, but this was different. The unity of all types cancer survivors and their loved ones was a power that is one to be reckoned with. Hopefully that is what it will take to find a cure.

Don't just live, LIVE STRONG!

Last Chemo Infusion (June 30th, 2008)

My medical oncologist, Dr. Mo on my last day of chemo treatment. Note that I was sure to include the word treatment after last day of chemo. The affects will be around for awhile. I have heard that it takes up to a year after treatment to return to your "normal" self, but since I was never quite "normal" prior to chemo we'll see how I do! ;0)

My doctor was fantastic, no, he was phenomenal. I've never had an oncologist before so I don't necessarily have anyone else to compare him to but I can tell you that if given a choice, I wouldn't have chose anyone else. Prayerfully I will never have to, but if asked by someone I love, I would recommend him in a heartbeat, as if my life depended upon him.

It startling to think that a doctor, especially in this particular field, holds the course and possibly the length and quality of your life within his hands and his mind. I immediately felt comfortable with Dr. Mo and as my treatment progressed and I saw him more often I simply kept liking him and completely trusting him more and more. When faced with the possibility of chemotherapy treatment, which wasn't originally in the plan, I asked him what he would recommend if I were his mother, sister, etc. Without hesitation he confidently replied that if I were his loved one he would highly recommend the chemotherapy. Throughout the course of chemo, as if i were an individual, not merely a patient and as if he truly cared about my outcome, more than just my diagnosis.

I am ever grateful to him for the care he has provided and continues to provide to me. I hope that he never loses his compassion and genuineness and he continue to give his patients hope and respect, as well as healing.

PICC Line

Peripherally inserted central catheter
From Wikipedia, the free encyclopedia

A peripherally inserted central catheter (PICC or PIC line) is a form of intravenous access that can be used for a prolonged period of time, e.g. for long chemotherapy regimens...First described in 1975,[1] it is an alternative to subclavian lines, internal jugular lines or femoral lines which have higher rates of infection.
A PICC is inserted in a peripheral vein, such as the cephalic vein, basilic vein, or brachial vein and then advanced through increasingly larger veins, toward the heart until the tip rests in the distal superior vena cava or cavo-atrial junction.
PICCs are usually inserted by radiologists, physician assistants, radiologist assistants, or certified registered nurses using ultrasound, chest radiographs and fluoroscopy to aid in their insertion and to confirm placement.

My PIC line was inserted just shortly after my first chemo infusion when I was admitted for Neutropenia. It was, for the most part, a painless process and really more fascinating that frightening. With the insertion of the picc line there is no more need for needles for the weekly blood draws, i.v. lines (saline was required often due to high pulse rate suspected from dehydration or simply due to chemo) or multiple attempts (3!) to find a good vein for chemo transfusion.

My picc line was removed on my last day of chemo by nurse Irene, part of my oncology team, as seen here in the photo (June 30th, 2008). Removal was completely pain free which I found equally as fascinating.

The picc line was one thing during chemo that I was grateful for.

The Cancer Connection

My first visit to the oncology department wasn't that all that long ago in terms of time but if based on experience it was a lifetime ago.

As I sat in the waiting room waiting to be called in by my oncologist I had no idea just how much my life was about to change. It began with my reaction to my first view of the treatment rooms and the patients lined up in the recliners receiving their chemo treatments (see post).

The experience of my first chemo treatment will never leave my memory, nor will it fade. I looked very much like the obvious new girl with my full head of thick hair. Chemotherapy isn't all that was given or received in these treatment rooms. Equally as potent was the advice and comfort dispensed from so many of the chemo veterans. Then before I knew it, without even realizing it, I too had become one of those veterans, baldly, proudly, strongly and lovingly passing along hope to those who started the process after me and those that needed it.

Although I had never experienced radiation treatments before, I knew that they would in no way compare to chemotherapy and I did not in any way feel frightened as I began the process. I am experienced in cancer, in surviving, in doing what you have to just to get through, whether it be a single treatment or a lifetime.

There is a bond that is shared among cancer patients/survivors. I have heard it referred to as "a club that no one wants membership in" but I think that phrase diminishes the true value of that bond. I have experienced it as a kinship in which you are naturally connected to someone at the deepest levels of their being; their hope, their fears, their mortality.

I have met co-survivors being treated for a multitude of cancers ranging from cervical, tongue, leukemia and of course fellow breast cancer patients. But we all share two things in common - cancer and survival.

I can't adequately capture in words the connection you feel when talking to a fellow patient/survivor and although I truly wish there weren't so many of us I am so grateful to each and every one that I have had the honor of crossing paths with.

"How are you?" Hmm...How am I?

With the completion of my chemo and the start of my radiation there is a lot of reason for celebration and excitement. Heck - I've even threw myself a party! I am thankful for many things. But when it comes to answering the question that has been posed to me countless times over the past several weeks, "How are you?", I'm not quite sure what the right, honest or best answer is. I haven't found a consistent or a complete answer yet.

I appear to be doing ok, or even pretty well. I'm feeling much better than I did while I was undergoing chemo. I feel more like myself every week, hopefully it will soon reach the point where I can say every single day I feel an improvement. But that is how I feel physically from the treatments. How do I feel regarding the disease of cancer? That's an entirely different story.

I feel scared. My prognosis is good but in all honesty, the cure for cancer does not exist. I don't have many fears. I'm not sure if that was me pre-cancer but I am certain that is me post-cancer. I can say without a shadow of a doubt that my greatest fear is recurrence. I try not to dwell on it but I must admit, not a day passes that it doesn't cross my mind. I try to rely on the reassurance that my completed course of chemotherapy would surely have killed any remaining cancer cells but yet can't help but question that thought process while I am currently facing 6 and 1/2 weeks of required radiation.

Each time I stand up my legs and feet ache so much so that I move as if I am a pregnant 85 year old woman. When I lay in bed and night and try to sleep the pain in my joints, particularly my hands, fingers, feet and knees make it difficult to rest. The mornings are by far the worst. After tossing and turning all night and my body temperature fluctuating between the cool air conditioner and the immeasurable hot flashes and night sweats I am so stiff and ache so much that getting out of bed and placing my feet on the floor is a chore I dread. I can deal with that though. But with each of those moments a thought, a worry races through my mind, is this normal? Is this the effects of chemo? Or could this be something more?

I don't believe in living in fear, nor do I think that you should waste your moments worrying about things that have not and may not happen. The fear of my cancer returning though is a reality. My challenge will be to balance the fear with awareness and knowledge and find a sense of peace and comfort. I've learned so much about breast cancer and about myself on this journey and I have done well. I am sure that somehow, with this too I will do well.

Help!

"The radio is burning me and my eyebrashes have fallen out!"

Evidence that chemo brain is still in effect!

Word of the day - Bolus

Bolus, a flabby, rubbery material, is used in certain situations to “fool” the radiation beam so it will deposit the maximum dose on the skin surface instead of a fraction of an inch deeper, as it would otherwise. Therefore, a skin reaction is almost inevitable in this scenario. Bolus is usually incorporated into radiation therapy for skin cancers or when a surgical scar, such as a mastectomy scar, needs to receive a full dose of radiation therapy.

My newest fashion accessory that I get to wear during radiation treatments. I don't get t keep it with me all day though like I do with the tats and the sharpee x's and o's.

Radiation Preparation

The following information has been extracted from various locations on the internet:

Treatment Planning
Before radiation treatments begin, you will go through a treatment planning process called "simulation". This is necessary to confirm that the treatment machine will treat the exact area requiring the radiation (called the treatment port). A map of the area on your body where the radiation is to be delivered, referred to as the treatment field(s), is created. A machine called a simulator, which is designed to mimic the movements and settings on the actual treatment machine (called a linear accelerator) that will be used to administer the radiation therapy to you, is used.
Throughout the process, X-ray films will be taken. The entire simulation takes one to two hours, but the actual time may vary slightly. Since you will be lying on a hard table under the simulator for most of this time, you may experience some pain or discomfort. Should this occur, tell the technician. Keep in mind that the time necessary to deliver the actual radiation therapy treatments is only minutes, not nearly as long as the time required for the simulation.
CT Simulation
In some situations, a special computerized tomographic (CT) scanner will be used along with simulation to help plan some radiation therapy treatments. In these instances, the CT scanning process will be performed in the Radiation Oncology Department several days prior to the simulation. Information from the CT scan is used to precisely locate the treatment fields. The CT scanner is specially designed to work with the other equipment in the Department, and is not a replacement for other diagnostic scans you may have received.
Tattoos
At the end of the simulation visit, it is necessary to put marks on you to outline the treatment field(s). These marks are in the form of very small tattoos, which are dots the size of a pinpoint or freckle, made using India ink. The process of tattooing causes some temporary discomfort. Generally, between 4 and 8 tattoo marks are placed, but sometimes more or less are necessary. In some treatment plans, a second set of tattoos may be necessary. While the tattoos are permanent, because of their very small size, they are not very noticeable. By using the tattoos, it will be possible for you to bathe or shower on a daily basis without worrying about removing these important marks that show where the radiation treatments are to be delivered. Also, if any additional radiation therapy is needed in the future, the tattoos serve as a permanent record of previous treatments. In very rare instances, tattoos will not be used.
Technical Planning Process
After simulation, details from the procedure are forwarded to medical radiation dosimetrists and medical physicists. These professionals perform highly technical calculations that will be used to set the treatment machine (linear accelerator).
Large alloy blocks may be placed inside the treatment machine to limit the amount of radiation delivered to your normal tissue in the treatment field. These blocks help decrease the development and/or severity of side effects caused by the treatments. Blocks are customized for each patient, in order to provide the best protection.
Set-Up
Several days after the simulation and after all calculations have been performed and custom blocks made, your treatment can begin.
Treatment machines (linear accelerators) resemble the simulator but are larger. You will be placed on the treatment table in the same position as you were on the simulator. Proper positioning usually takes 10 to 15 minutes. Once in place on the treatment table, a set of X-ray films will be taken. These films will be matched with the simulation films to ensure that the treatment is going to be delivered the same way as it was simulated. Occasionally, the match is not optimal. In these cases, adjustments will be made and will be checked by your attending physician. In rare cases, more adjustments are required and treatment may need to be postponed. Once the films and positioning are confirmed, a treatment will be delivered.
The actual administration of the radiation treatment usually takes only about 5 to 10 minutes. Factors that affect the total length of the treatment include the complexity of your treatment, the particular machine on which you are being treated and how quickly you can be positioned properly for treatment. On average, most patients spend a total of 20 to 30 minutes in the Department per day receiving their treatment.
On-Treatment Examinations
Once a week, repeat X-ray films will be taken to re-confirm proper positioning. These films will also be performed in most cases where there is a change in your treatment field or treatment plan. The X-rays taken during the course of radiation treatment are not used to help measure your progress or response to the radiation. Rather, they are only used to ensure that the position and treatment arrangement is appropriate.
You will also be examined at least once a week by your attending physician and resident. The examination day is generally on Thursday, just before or after your treatment is administered. These examinations are important because they give your physician the opportunity to evaluate your physical condition, answer any questions that you may have, and plan and coordinate future treatments.

Radiation 822 (more 411 than you ever wanted!)

How Radiation Works
Radiation therapy — also called radiotherapy — is a highly targeted, highly effective local treatment recommended in conjunction with a lumpectomy to destroy cancer cells in the breast that may stick around after surgery. Radiation therapy may be externally or internally delivered, both on an outpatient basis. The most common radiation treatment for breast cancer is external radiation therapy. It uses a large machine to direct a beam of radiation at the cancer site from outside the body and focuses high-energy rays to the entire breast from a machine called a linear accelerator to damage cancer cells. These high-energy beams, which are invisible to the human eye, damage a cell’s DNA, the material that cells use to divide. After the first course of treatment, a “boost” dose of radiation is given in the same area of the breast where the tumor was removed. The most common type is given externally (as in the first course), and may last from 1 to 2 weeks.

Over time, the radiation damages cells that are in the path of its beam — normal cells as well as cancer cells. But radiation affects cancer cells more than normal cells. Cancer cells are very busy growing and multiplying — 2 activities that can be slowed or stopped by radiation damage. And because cancer cells are less organized than healthy cells, it's harder for them to repair the damage done by radiation. So cancer cells are more easily destroyed by radiation, while healthy, normal cells are better able to repair themselves and survive the treatment.
A typical course of treatment is 5 days a week for 5 to 7 weeks. The treatment takes a few minutes each day.

Why Radiation is Necessary
Radiation is an important and often necessary form of anti-cancer therapy because it is able to reduce the risk of recurrence after surgery. Although it's quite possible that all the cancer was removed through surgery, breast cancer surgery cannot guarantee that every last cancer cell has been removed from your body. Individual cancer cells are too small to be felt or seen during surgery or detected by testing. Any cells that remain after surgery can grow and eventually form a new lump or show up as an abnormality on a test such as a mammogram.

Research has shown that people who are treated with radiation after lumpectomy are more likely to live longer, and remain cancer-free longer, than those who don't get radiation. In one large study, women who didn't get radiation after lumpectomy were shown to have a 60% greater risk of the cancer coming back in the same breast. Other research has shown that even women with very small cancers (1 centimeter or smaller) benefit from radiation after lumpectomy.

Radiation Oncology Team
Women having radiation therapy do not go through it alone. They have a whole team of people working with them to make sure they get the best treatment. This team may include:

• a radiation oncologist — to plan the treatment using radiation therapy;
• a radiation physicist — to make sure the machine delivers the right amount of radiation;
• a radiation therapist — to run the radiation therapy machine;
• a dosimetrist — to figure out how much radiation and how many treatments are needed;
• a radiation therapy nurse — to help manage side effects and provide information about the treatment;
• other team members may include a dietitian, physical therapist or social worker.