Sunday, August 22, 2010

The Girl With Seven Tattoos

Now that surgery is behind me (whew!) it's time to turn our attention to the next step in my treatment - radiation.

A couple weeks ago I added yet another doctor to my repertoire when I met my radiation oncologist - Dr. Evans - for the first time.

After doing a physical exam, Dr. Evans sat down to talk to my parents and me.  He said he was already very familiar with my case, as he was present at the "tumor board" meeting where Dr. Sara had presented my situation after the two spots on my spine were discovered.  He told me that in the meeting Dr. Sara said that I was young, strong and motivated, and that he felt very strongly that these two spots to the spine should receive treatment, despite the fact that typically, a case like mine would not call for treatment to the bone.

The thing is, even though my bone scan came back negative, meaning it did not show evidence of active cancer cells, these tests are not foolproof and it doesn't mean that there are not still microscopic cells remaining even after the chemo.  Just as my PET scan before surgery did not detect any active cancer in my liver, but the pathology report following surgery did find microscopic cells, the same could very well be true with these two spots on my spine.  So we are not taking any chances and are going to blast those suckers with radiation to try to kill any cells that may possibly have survived chemo.

Of course, I will also need radiation to the breast, for the same reason.  I have always known I would need radiation, because radiation treatment is indicated in cases where the tumor is larger than 5 cm, which mine was.  And especially since my post-surgery pathology report found a fair amount of cancer still remaining along with positive lymph nodes, well it is all the more reason to blast the area with radiation too in order to kill any pesky cells that may have remained.

However, Dr. Evans said that the priority is to treat the spine first.  Unlike the breast radiation, in which I will have to go for treatment for about a half hour every day for 6-7 weeks, the radiation to the spine will take place in a total of 2-5 sessions, each of which will be about an hour or so in length.

The first spot will likely be treated in just one session, since it is not located near the spinal cord and therefore is safe to blast all at once.  However, the second spot is located much closer to the spinal cord, and so to be safe, treatment of this spot will probably take place in 2-4 sessions.

As far as side effects are concerned, Dr. Evans said that I will not feel anything during treatment - it is like getting an x-ray.  However, I may feel some fatigue as treatment goes on, and I may notice some scratchiness in my throat or lungs for a day or two after treatment.  Since one of the spots is located close to my spinal cord, there is also a very low risk (Dr. Evan said less than 1%) of paralysis.  But I am not really worried about this because the risk is so low.

I asked Dr. Evans what the "measurement of success" will be, i.e. how will we know if the radiation worked.  He said that I will have a PET scan following treatment, but because of the radiation itself can skew test results, we have to wait at least 3 months after treatment is complete before we can get an accurate reading.  Since my last PET scan did not show "active" cells, but rather two areas that appeared to have already been treated, between you and me I think we will know if the treatment worked when the cancer either doesn't come back or it does.

The first step in the treatment is to have a "treatment planning CT scan," which was scheduled for the day after my appointment with Dr. Evans.

Saturday, August 7, 2010

Who Likes Liver Anyway?

Has it really been three weeks since my last post?  Oops, I guess I have been neglecting my blog during my recovery, but better late than never, right?

The truth is, a lot has happened in the last three weeks, and while recovery is going well, my energy levels just haven't been back to normal yet and I haven't really had the necessary combination of time and concentration to sit down and write until now.

So where did we leave off?  Oh right, I was just about to go in for my second surgery, to have part of my liver removed. 

The night before my surgery, my parents and I once again stayed overnight at the Holiday Inn just a couple blocks from the hospital, because I was due to arrive for surgery at 6am Monday morning.

We reported to the 5th floor Ambulatory Surgery department right on time.  Soon they called me back into the pre-op area, which I am now pretty familiar with.  They took my vitals, asked me all the same pre-op questions as last time, and asked me to change into a gown.

Then my parents were called back and we waited just a short time before the anasthesiologist came by.  She took me directly back to the OR, giving me a shower cap to put on my head along the way, and then set me up on a gurney in the hall just outside the OR doors.

She mentioned that I was very young for this surgery and went through the general plan for anasthesia.  She said once we were in the OR she would give me something to relax me (she said she's a good bartender!) and then once it was time she would of course put me completely out.

Then, someone came by to insert my IV - and they got it on one try this time, thankfully!  I also saw Samantha, who is my plastic surgeon's PA and was there to do the first expansion in my tissue expander while I was under anasthesia.  And of course, Dr. Attiyeh came by as well to see me before surgery.

I didn't have to wait long before they were ready for me and once again, I walked into the OR, trying not to look around too much, and climbed up onto the operating table.

I don't really remember much after this.  I do remember the anasthesiologist saying that she was administering the drug that would help me relax and I thanked her for this.  She said "I told you I was a good bartender!" and I don't remember anything else after that.

The truth is, I don't really remember much about the rest of that day.  I only have vague flashes of being in the recovery room.  I remember my nurse had curly brown hair, but I don't remember her name or anything else.  I remember when she gave me the clicker that I could press to give myself a dose of the painkiller they had me on, but I was too out of it to understand the instructions.  Not that they were hard - I just had to press it when I felt like I needed it, but I could only press once every 8 minutes (well, I could press the button as many times as I wanted, but it would only actually give me a dose once every 8 minutes).  This method is called a PCA - patient controlled analgesia.

I wasn't too keen on the PCA because I couldn't stay awake long enough to give myself enough doses to kill the pain.  So I would click, fall asleep, wake up in pain, click, fall asleep, wake up in pain, etc.  I kind of wish they would have just put me on something that I didn't have to think about, but oh well.

Anyway, unlike last time I did not have to wait in the recovery room for several hours for a patient room to open up.  Before leaving the recovery room, I remember the nurse expressing a bit of concern that I hadn't been pressing my PCA... but I was not even "with it" enough to think about pressing the PCA at that point.

Once I was in my room I mostly just slept.  When I did wake up, I was in pain.  It felt like I had had the absolute worst ab workout you can possibly imagine.  The most annoying part was that I couldn't take a deep breath because it hurt too much.  So when I woke up, I would instictively try to take a deep breath, then get frustrated when I couldn't, and the only way to not feel the pain was to fall back asleep, so that is what I did.