Radiation Therapy for Breast Cancer

Once I was finished with chemotherapy, I had 6 weeks of radiation therapy to look forward to. By this time it was early December, and radiation therapy was a 5-day-a-week affair, some fifteen miles from where I live. I cannot drive in the dark; laser therapy for diabetic retinopathy has left me essentially night-blind. Luckily the cancer center was willing to schedule my appointments for near noon—the only daylight available this far north in the winter.

The first step is called simulation. This is when the technicians work out the exact position you need to be in for the radiation beams to have a maximum impact on the area from which the cancer was removed and a minimum impact anywhere else. They also mark key points on the breast with tiny tattoos. Laser beams on those tattoos eventually line up the radiation beams.

Door of the radiation room. The white is the edge of the door--and it has a lead core, so you can guess how heavy it is!

The tattoos were tiny—so tiny they were generally circled or otherwise marked with felt pens so the technicians could find them.

Probably the worst part of the procedure was that the position they wanted me in was lying down with both arms over my head. I had a frozen shoulder at one time—it’s still stiff—and lying for 15 minutes with my arms over my head, my hands clutching a rubber ring, was agonizing. The technicians generally had to help me lower my arms after the session was over. I could not move them.

Aside from that, the sessions were simply boring. Nothing much was visible, and I had to keep perfectly still while the machine rotated around me. Because of the intensity of the X-rays, the whole room was shielded and the technicians had to be out of the room while I was actually being irradiated. In fact, I recall that at one point they were having problems with the electric mechanism that opened and closed the thickly shielded doors. It was all they could do to open and close them manually.

Cancer radiation machine. The patient lies on the gurney on the front left which is then pushed under the white head, and the head then rotates around the table.

The worst problem was not the therapy itself, but the weather. January 2009 started out cold. The first ten days of the month not only had minimum temperatures below –40 F, the maximums were often below -40 as well. At those temperatures, both cars and power plant cooling ponds leave contrails. In built-up areas such as Fairbanks, those contrails flow together to create ice fog. In particular, there is a military power plant just north of the main road into Fairbanks from North Pole, where I live, that has caused several fatal accidents because of the ice fog it produces.

There is another way to drive into town, by making a long detour to the north around the base, and that is what I did for the first week of January, when I had daily appointments. Even then, the fog in town was so dense that I had a hard time seeing streetlights or telling exactly where I was, let alone seeing cars more than a couple of car-lengths ahead of me.

In mid-January the weather turned around and we suddenly had four days with highs well above freezing. A touch of relief? NOT. Our roads almost always have ice and snow over the asphalt or gravel in winter, and a midwinter warming just makes everything appallingly slippery.

The only side effect I had from the radiation therapy itself was the equivalent of a mild sunburn on the treated breast. My oncologist gave me some cream to treat this, but it was more a slight reddening than painful. Again, I kept up daily exercise throughout the therapy. I felt a little increase in energy after the chemo and radiation were over, but was not aware of fatigue during the treatments.

Am I cured? Less than three years after diagnosis, it’s impossible to be sure. I’ve had a mammogram and visits with both doctors in the last couple of weeks, and everything looks fine, thanks in large part to the fact that my primary care physician actually caught the cancer a couple of months before my regular annual mammogram was due. The early detection plus the exercise can probably get the credit for the relatively minor side effects I suffered. The cancer also pushed me into going ahead and publishing Homecoming.

And while my hair only thinned rather than falling out entirely during chemotherapy, it did come back in curly for a while. The photo of me, which was taken to go on the back of the book, was taken the summer after my treatments ended. Alas, my hair is now as straight as ever.

Breast Cancer 3: Mammograms.

I meant to cover radiation therapy this week, but I was tripped up by a blizzard. With 18 inches of fresh snow in the driveway, I couldn’t get out for the mammogram (X-ray of the breasts) scheduled Monday, and the radiation oncologist needed that before he saw me Thursday. I wound up getting the mammogram Friday, and have a new appointment with the radiation oncologist next Thursday. I hope I can get a photo of the radiation machine to use with the blog next week.

Business all over Fairbanks sponsor ice carvings as winter outdoor sculpture. The hospital imaging center has this skier, complete with goggles.

There are two types of mammograms: screening (to see if anything looks suspicious enough to look further) and diagnostic (once something else looks suspicious or worse.) Once you’ve been diagnosed with breast cancer, all the mammograms are diagnostic.

Three years ago, I got a diagnostic mammogram (which confirmed my doctor had indeed felt a lump), a biopsy (which involved shooting a sampler into my breast) to confirm that the lump was cancerous, and then surgery to remove the lump and the “sentinel node”—the lymph node most likely to be cancerous itself. If the sentinel node had been positive, all of the lymph nodes would have been removed. I was lucky; my sentinel node test was negative. But since I had chosen a lumpectomy rather than a full mastectomy, I had to follow chemotherapy up with radiation therapy.

Mammograms are uncomfortable but not really painful. Nipples and scars are marked with band-aid-like beads and tape with a metallized line. You stand next to the machine, your breast is squeezed between two plates, and when you are positioned to the technician’s liking you are told to hold you breath for a couple of seconds while the x-ray is taken. Generally they take one picture with the breast squeezed horizontally and one with it squeezed vertically. I think the most uncomfortable part of the process is getting my arms, chin, shoulders and ears out of the way and holding them there. I always finish a mammogram with a stiff neck.

They don’t have to develop film any more. The mammogram comes right up on a computer screen, and can be read at once. When I had mine done Friday, a couple of whitish areas showed up on the good breast, which led to a repeat of the X-rays with a different and smaller compressed area, and a few moments of worry on my part. Turned out to be calcium deposits that had been there all along. And this time I was told to come back next year, instead of 6 months from now.

I still wish Roi (one of my Homecoming characters) was real.

Breast Cancer (Part 2)

As I mentioned last week, my primary concern was that my treatment for breast cancer had as little impact as possible on my diabetic control while having maximum effect on the cancer. I was well aware that chemotherapy would involve stress, and any kind of stress affects blood sugar. So when the oncologist gave me a choice of two types of chemotherapy drugs, I chose the milder but slower regime, 5-FU plus Methotrexate.

It was a mild regime in the sense of minimal side effects, but I had to get an infusion weekly for close to 5 months. And even with this regime I was warned that there was a good chance of nausea, losing my hair or anemia.

Luckily, I could get the infusions in Fairbanks, within driving distance of my home, and between the cancer center and VanTran I had a good chance of getting a ride if I got too sick to drive.

Remember I said that the diabetes actually helped me deal with the breast cancer diagnosis? It wasn’t all psychological. One of the things I have learned in my years of trying to keep my blood sugar under control is that I have to have regular exercise. I’m not much good at walking any more, but I have an exercise bike, a rowing machine and a treadmill all set up facing my television. About the only time I watch TV or a DVD without exercising at the same time is when my blood sugar is dangerously low.

I kept that up throughout the chemotherapy, with at least an hour a day of aerobic exercise. (I have an adult tricycle, too, but I didn’t ride that much the summer I was getting chemo.)

I honestly think that continuing to exercise throughout chemotherapy and radiation treatment had a lot to do with how few side effects I had. It may be that I was simply lucky, that I would have had few side effects from the chemo regardless. I can’t help but believe that some of my generally good health throughout the chemo was due to the fact that I continued regular exercise.

Having the rather large needles inserted into my hand was painful and annoying, especially as they always used the hand on the unoperated side, but I never had to have a shunt. Even my hair, while thinning, stayed on my head. I had to get blood tests before every session, and my white and red cell counts did get low enough I had to get some shots to build my blood back up, but I never really felt sick. I lost some weight I could well afford to lose, though unfortunately it didn’t stay off.

Most of the summer and early fall of 2008 I was driving to the cancer center every week for chemo. I did stretch the space between appointments once, to attend a family reunion. I’m glad I did, as it was my last chance to see two of my aunts, both then in their 90’s, who passed on a few months later.

I’ll talk next week about the radiation therapy.

Note—the Sunday blog would normally be about the genetics of the white splash gene in horses, but February 19 is Writing in the Dark, a writers’ conference held annually here in Fairbanks. Instead of the normal horse genetics, I’ll be blogging on the conference next Sunday. I’ll also encourage attendees to put samples of their writing at the conference up as comments. Our leader and inspiration will be Peggy Shumaker, our state writer laureate, and I’m really looking forward to it.

Breast Cancer (Part 1)

Fairbanks Cancer Center

A breast cancer diagnosis is a downer—no question about that! I think the doctor who had to give me the news that my biopsy was positive was expecting—well—hysteria? Horror at mutilation? Panic at the C-word?

I’ve lived with diabetes for more than 40 years. Of course I was unhappy at the diagnosis, but the prospect of losing a breast worried me far less than the prospect of losing my vision or legs, and I’d lived with both for years. As for fear of cancer, I was already aware that breast cancer, caught early, is one of the most treatable of cancers. And mine was caught early.

Yes, I was worried—I am still worried—about the possibility of recurrence, of metastasis. (I have a mammogram and a follow-up visit with the oncologist a week from now.) But the lump in my breast was caught early, in a regular visit to my doctor’s office. (As a diabetic on an insulin pump, Medicare requires that I see my doctor every three months.) After my doctor found the lump I had what would have been my annual mammogram a couple of months early. The mammogram led to a biopsy, which was positive. Surgery was indicated. (Not that I didn’t wish Roi’s Healing ability was real.)

Because my cancer had been caught early, I had a choice of mastectomy (removal of the affected breast) or lumpectomy followed by radiation therapy. Being lopsided didn’t bother me, but the possibility of surgery affecting the diabetes did. I chose right through to go for the options that might take longer, but would have minimal impact on the diabetes. For surgery, that meant a lumpectomy followed by radiation therapy.

I expected to be miserable after the surgery, but compared to a knee replacement a couple of years earlier it was a breeze. I don’t think I even used the pain prescriptions after the first day or two. I did have a drain, and that was the major annoyance connected with the surgery. I needed to raise my basal insulin for a few days, but aside from that my insulin pump kept my diabetes under control very nicely.

I think my main problem came from the fact that I had two oncologists, one for the radiation therapy and the other for chemotherapy, and they weren’t communicating very well. There was some question as to whether or not I needed chemotherapy, the genetic makeup of my tumor, and which should go first. They finally got it sorted out that chemotherapy should come first.

One thing I should say at this point. Fairbanks Memorial Hospital added a cancer center not too long before I was diagnosed. Before that, I would have needed to go to Anchorage, 350 miles of mountain roads away, for either chemotherapy or radiation therapy. As it was, my therapy was within driving distance of my home.

I’ll get into the post-operative therapy next week. For now, I’ll just say that the diagnosis really woke me up to my own mortality. It was the final push that determined me to go ahead with assisted self-publication for Homecoming. Maybe if I had really kept at it I could have found an agent or a publisher. Certainly the book has garnered some fine reviews and is currently a finalist in one contest. But the cancer diagnosis was the final push.

A few breast cancer links:
Breast Cancer Organization
National Institute of Health
Susan G. Koman Foundation
National Cancer Institute
National Breast Cancer Foundation
Breast Cancer Detection Center of Alaska
Fairbanks Cancer center