No Radiation

On Wednesday I had to drive to Houston to meet with my surgeon, Dr. Bedrosian. My appointment was at noon; I decided to drive down in the morning and drive home after my appointment, stopping at Mom’s house to drop off a book. The drive down was really wet and rainy. It took me almost 45 minutes to get out of Austin because of the weather. I finally settled into the 3 ½ hour drive, with the heavy rain making the drive miserable. Once I turned south at Brenham, about an hour north of the city, the rain stopped. At least I would not have to deal with Houston traffic and the rain. I found the hospital with no problem, I’ve been there so much that I must have some kind of internal homing device…maybe they implanted one along with my port. Who knows? This was my first visit to the hospital alone. It was fun eves dropping on to the conversation between the rednecks from North Zulch, TX and the volunteer who was every bit the bored River Oaks housewife. She was desperately trying to find something in common with these folks and failing miserably. It would have been depressing if they were looking for assistance, but I think they grasped the absurdity of the situation as well and were just being polite. On this visit I discovered that I have a stalker at the hospital, a spit stalker to be exact. Remember back in January, before I started chemo, I entered a study to see if they can diagnose cancer from spit? It was a long time ago and honestly I forgot about it as well until the research nurse appeared. They want four different spit samples taken during various times in your treatment. I got to chew unflavored gum and spit into a vial for five minutes. I don’t know why I like this study so much, and the best part is that I get to do it two more times. Never knowing when the spit stalker might appear and demand a sample. My meeting with Dr. Bedrosian was not that pleasant; I’m trying hard to think of a time when meeting with a surgeon would be under pleasant circumstances and not coming up with any. She has a new intern, a male intern, and the breast exam that he gave me was hilarious. He had me put my hands over my head and systematically went about trying to find my lump. When he failed to find anything in my left breast, he moved to my right breast. I could see from the look on his face that he was thoroughly confused. He then asked me, “In what breast is your mass located?” “The left one,” I told him. Onto the left breast again, “well I can’t feel anything. Are you sure?” “Yes, I’m sure.” Okay then. “Lay down with your hands over your head and let me try again.” At this point I mentioned that I had been on chemotherapy for 6 months, as if the hair didn’t give it away, and that Dr. Gonzales had been unable to detect a mass in my last appointment with her. “Oh. Sit up. I’ll get the doctor.” Poor guy. He was determined to find something. Dr. Bedrosian enters the room, proceeds to examine my breasts, turns to the intern and tells him, “We will probably get a good pathology report from this one.” Okay – cool. She then tells me that she has to take out all of my lymph nodes in my left arm. Not all, only the Stage I and II lymph nodes; basically all of them. Might as well be all of them. One of the things that I have really struggled with during this entire process is the possibility of getting lymphedema. She explains that they don’t have the ability yet to just remove one or two of the nodes if they tested positive before chemotherapy because there is no way of knowing which nodes have been sterilized by the treatments, and which nodes still harbor pesky cancer cells. But there is a study going on that I can be part of to help women later on not have all their lymph nodes removed. I’m still deciding about the study, but ultimately I know that I will say yes because it will help other women cope with this retched disease. And there is some noise on the lymphedema front; my plastic surgeon, Dr. Chang, is starting to see results with a new surgery to help reverse the effects. There is also some antidotal evidence that working out and staying at a health weight helps with prevention. Ultimately I may get lymphedema, but to worry about it now is silly. And if I get it I will deal with it then. She then tried again to convince me that I must have radiation therapy after surgery, even giving me a study “proving” the effectiveness. She let me know that if I decided to go through with radiation it would be another year before they could even consider reconstructive surgery, if they were able to do it at all. With facts in hand I promised her that I would at least consider the study, consider receiving radiation, and let Dr. Chang know of my plans at my appointment with him on Monday. I called Cody and we decided that I would look at the study when I got home but that he supported me in whatever decision I decided to make. I ended up running into Mom when I took her book over to her house. She commiserated with me on the lymph node removal and offered insight that I don’t have to do everything that the doctors tell me to do. “Screw them, do what you want. You’ve already done a hell of a lot.” I confessed that for the last six months I have felt like a prisoner. Unable to go about my life as I would like, always worrying about what people will think if they see my head and if I’m going to get some horrid disease. She confirmed and said that I saw the door of the prison starting to open, and just like that, slammed shut in my face by radiation. And with that I was off on my drive home. Time to sit and think about what to do.

The study is of approximately 600 women under age 35 at first diagnosis, with ER negative Stage II breast cancer from 1973 to 2006. It does not take into account any other type of therapy for cancer (chemotherapy would be one example); except mastectomy, vs. mastectomy with radiation, vs. lumpectomy with radiation. It does prove that over 250 months, approximately 20 years, that those who receive radiation after mastectomy have an improved survival rate of roughly 3% over the 20 year period. How many of those women received neoadjuvant or adjuvant chemotherapy? How have surgical techniques changed since the early 1970’s? How has breast cancer treatment itself changed since the early 1970’s?

I’m still not going to have radiation. If I get cancer again, I get cancer again. If I die from cancer, I die. I’ll deal with it, Cody will deal with it, and life will go on. So with that decided Cody poured me a glass of Prosecco and we celebrated.