Sunday, January 29, 2012

Radiation Treatments and Battling Depression

Note:  I started this blog last week and haven't been able to sum up the energy to finish it until now.  It will be a little long because a lot has happened.

On Tuesday, January 17, 2012, I had my first radiation treatment. I was not quite one month out from my double mastectomy. I thought radiation was going to be the easiest part of my journey. I met with the radiation oncologist and the staff made a "form" that I lay in so the radiation is directed where the cancer was found in my breast, in the area the cancerous lymph nodes were found, and to go up into my neck just past my collar bone.

I arrived on Tuesday at the scheduled time and the radiation (rad) tech met me at the front desk and escorted me to the radiation suite. Another tech was there and showed me the desk area where they would be watching me on monitors during my treatment. At that moment, I felt a lump in my throat and just nodded that I understood. Then they took me into a room that said "Linear Accelerator." It was the same room I'd been in days before to make the mold, but this time was different. This time I knew I would be receiving my first of 30 radiation treatments. Every day for the six weeks I have to say my name and date of birth and lay down on a table that is akin to the table one would lay on for a CT or MRI. Before the first rad treatment they needed to take some chest x-rays to make sure my heart wasn't located in a strange spot (so it doesn't get zapped). On the table, in the dark, I looked up at the machine, staying still, and I could see the reflection of my chest in the glass. I could see the six inch scar on my left side. It is still shocking and hard to look at so I focused instead on the Matrix-like green lasers that were shooting down at me from the ceiling. Again, the lump started in my throat and this time tears trickled down the sides of my face. I was surprised and embarrassedd to be so emotional at that point. Next, the rad tech came in and said the x-rays were fine and I was ready for my first treatment. It takes about five minutes.

Oh.....Last Friday, the radiation oncology nurse gave me three bottles of aloe vera gel and explained where I needed to apply the gel. She said by the end of this week I the areas being radiated will be pinkish and by the end of the 30 treatments I could have burns, blisters, and I hope not to go down that road...but I have extremely sensitive skin so it wouldn't surprise me if I did have problems with it. She asked me how I'm doing with all of this and I said my chief concern is fatigue and I just can't seem to get over it. She said "honey, it's going to take about a year, mainly because of the chemotherapy." That took my by surprise. A year. I hope not.

Mentally and physically I'm finding radiotherapy is not as easy as I thought it would be. I meet with the radiation oncologist every Monday. I was very thankful to have the opportunity to speak with him about my struggles. First off, I've lost five pounds, which normally would be a good thing, but they really don't want me losing weight right now. I can tell on the days I don't have any appetite I feel very sluggish so I'm doing my best to eat. Then, I told Dr. C of my fatigue and ultimately that I'm finding it hard to do anything at all. I sleep 12 hours a night and then as soon as I've had something to eat I want more sleep. I don't find much joy in anything.  I have dealt with depression for 20 years and this is much worse. He said he knew my Type AAA personality might have a problem with all of this the first time he met me. I am organized and I've been thrown a few surprises along the way I didn't anticipated.

I also asked him how much radiation I am receiving. He said a typical dental x-ray is about 60 rads (a dose) and the dose I'm receiving: 200 rads 5 days a week for 6 weeks.  That's a LOT!  No wonder my skin is pinking up. It helped me to understand that this is a bigger deal than I thought it would be. He also said he has seen other patients have a struggle during radiotherapy as well. People are more apt to be helpful and "there for you" when you've had surgery or are going through chemo and then stand back during radiotherapy "because it's not a big deal." He says that bothers him. It is a big deal and very hard on the body. But, the radiotherapy takes about 15 times in total and I wouldn't want to drag someone to a treatment session.  Michael has gone with me most days and has been very supportive.

Another thing I wasn't aware of is that it can take a toll on your bones. My sternum and ribs hurt terribly.  The sternum is a combination of recovering from the double mastectomy and radiation, but my lower ribs are probably just from radiation.  Ibuprofen just doesn't cut it some days. In some cases bones can crack or break.  Wow.

I have 21 treatment sessions to go.  Four weeks. I know I'll be looking back on it sooner than I expect. For now, I am trying to ensure better health by taking a better multi-vitamin, taking vitamin C, Fish Oil tablets with Omega 3's, Calcium, Vitamin D3, and my anti-depressant medication. I'm using a full-spectrum lamp because I'm not outside often and either is the sun. I did go on one walk this week to get some sun.  I walked around two blocks and it really hurt my sternum.  But I did it.  If I go to work for a few hours or to a couple of stores shopping, I am exhausted for the next 2-3 days.  I never expected that to be how this would work out!

As hard as it is to admit I am dealing with severe depression, I feel like I should be honest about it because there might be someone in a similar situation. I know I've been looking up information related to depression and breast cancer. And more information on radiotherapy. Tomorrow, I am going to meet another doctor to see if any adjustments can be made to my medications to get me through this very difficult time. And just talk about what I'm dealing with...and the other things that are affecting our family. Michael's bomb blast injuries, Conor leaving for Kuwait in May, Conor and Bonnie's baby on the way in June, and Olivia's struggles because our life has been so chaotic now since Michael's first deployment in 2005.  Ultimately, my counselor says I'm in survival mode and need to shift to self-care mode.  I'm working on that.

Teachable Moment
Here is information on depression from Fact Sheet on Depression Women's Health.Gov:
Not all people with depression have the same symptoms.  Some people might only have a few, others a lot.  How often the symptoms occur, and how long they last, is different for each person. Symptoms include:

  • Feeling sad, anxious, or "empty"
  • Feeling hopeless
  • Loss of interest in hobbies and activities that you once enjoyed
  • Decreased energy
  • Difficulty staying focused, remembering, making decisions
  • Sleeplessness, early morning awakening, or oversleeping and not wanting to get up
  • No desire to eat and weight loss or eating to "feel better" and weight gain
  • Thoughts of hurting yourself
  • Thoughts of death or suicide
  • Easily annoyed, bothered, or angered
  • Constant physical symptoms that do not get better with treatment, such as headaches, upset stomach and pain that doesn't go away
You can get help from:  
  • Family doctor
  • Counselor or social worker
  • Family services, social service agencies, or clergy
  • Employee Assistance Programs (EAP)
  • Psychologists and Physicians
There you have it.  Another bump in the marathon.  It's actually more like I've stopped running and am sleeping in a tent during the marathon while runners pass me by.  I'll get back on track and get running again, very soon.  

Wednesday, January 11, 2012

If Tears Could be Turned into Snow...

This past week has been quite difficult and my tears flowed freely.  Unbelievably, it's January 11th and we have very little snow in southeastern Idaho.  The other day it occurred to me if my tears could be converted to snowflakes the ski resorts in the area would be in great shape.  I'm not a skier (I've tried and am typically injured in some fashion, but I LOVE to drive in the snow and marvel at its beauty).  

My double mastectomy was three weeks ago.  I still have pain, which is normal.  I have been told it takes two months to completely heal.  No one told me how long it takes to heal emotionally from the surgery.  I still struggle with how I look.  Each incision is about 6 inches long.  Ghastly.  But, I remind myself continually it was to help save my life.  It didn't help when I took another fall last week at the Huntsman in SLC at my final post-op check up.  A nurse weighed me, took my vitals, and when I stood up, I just started to tip over and caught myself on the arms of the scale before I completely hit the ground.  I was mortified.  They wanted to put me into a wheelchair but I refused.  The next day I realized I caught myself with my ribs - and they are still sore as well.  

There are two lines of thought about my four falls.  One is the pain medication and the second is my balance has been significantly shifted because of the mastectomy.  Hmmm.  Thoughts to ponder while I am more careful walking stairs and stay away from scales.  

The final appointment brought good news.  There was NO CANCER found in the pathology done on the breast tissue.  The chemotherapy did its job!  I'm very happy with this news.  VERY!  

The surgeon did have to drain fluid (called a seroma) from under my right incision.  If not drained it can cause complications so I agreed to have it done.  Before I knew it he had a large needle with one end inserted into a bottle and the other end under my incision and I looked at my dear friend Jen and told her to breathe after seeing the look on her face!  She asked quickly, "what about something to numb the area?" and the surgeon said they had cut through all of my nerve endings so there shouldn't be any pain.  There really wasn't, until we were on our trip home and it was a little sore.  However, because of the fall and draining the seroma, it was very sore the next day.  I'm amazed at how concave the area is. For a time, I thought he had done a radical mastectomy on each side because my sternum sticks out so far now, but I can flex my pectoral muscles on each side.  Now, I know why I could never really see progress while weight lifting for my pecs, too much breast tissue covering them up.  Now is a different story, but I won't be weight lifting anytime soon.  I did walk a bit the other day and it was glorious. I cried the entire time, but it was a good cry.  

Yesterday I met with a counselor at the Cancer Center and hours later went back to met with the radiation oncologist.  I made the appointment with the counselor because I am overwhelmed with my emotions.  As I said, I still am in pain, I'm having a bit of insomnia because it is hard to get comfortable, forced early menopause is wreaking havoc on my system, and I'm still fearful of the unknown.  I spoke with the radiation oncologist in the afternoon about the paperwork that indicates there is a nodule in my lung.  He is going to speak to the chemotherapy oncologist about it and we'll keep an eye on that for a change in size.  So, while I'm thrilled there was no cancer found in the pathology following my mastectomy, I'm fearful it's still lurking around.  

These are all normal feelings.  The counselor and I also talked about EXPECTATIONS I have for myself and because it's the New Year, I made goals for myself.  He said I need to lower my expectations right now.  Not in an adverse way, but I've gone through so much in the past six months it's catching up to me mentally and emotionally and I'm not going to heal and recover if I don't learn how to relax and no expect so much out of myself.  Ugh.  I understand that and know I have to in order to recover - especially because I will be starting radiation next week.  

I have another appointment this morning to have a CAT scan of my chest and upper body so they can exactly determine where the targeted radiation will go.  They will also make a form for my body to lay on so I don't move at all during radiation and cause damage to my lung or heart.  And I'll  get a couple of skin markers (he doesn't like the word tattoo) to be the pinpoint area for the radiation.  He indicated it will of course be targeted to the area of my breast where I found the original cancer, the area where the cancerous lymph nodes were found, and then near my collarbone where the subclavicular lymph nodes are found.  I will go through 30 sessions over six weeks.  I will start on next Tuesday or Wednesday.  I'm not nervous about radiation at all.  After chemo and the double mastectomy it should be a breeze. 

Below is a song by Kerrie Roberts called "Keep Breathing," and I have listened to it non-stop over the last few days.  I think it's beautiful so I wanted to share it.  



One final note, I am heading back to work after my appointment at the Cancer Center.  I'm anxious and excited all at the same time.  I'm nervous about it because I'm so tired and sore, but it's time.  There is work to be done!  I'll do the best I can and build up over time and when I'm tired I'll head home to sleep.

Here is a quote from a book I purchased called "Be Happy."  It contains quotes from numerous authors.  Today, I like this one.  "How simple it is to see all the worry in the world cannot control the future. How simple it is to see that we can only be happy now, and that there will never be a time when it is not now."  ~Gerald Jampolsky