My Rads Consult/Simulation
Yesterday I had my consult with my RO and simulation. I learned - and Idk if this is normal, but it totally freaked me out - that they will be radiating lymph nodes in my chest and clavicle. I immediately start asking questions about the likelihood of truncal lymphedema. Lymphedema - permanent, all the time, chronic bullshit, not just, oh you might have some swelling during radiation, like the way they were trying to pass it off. I'm sorry, I'm a lawyer, and when I want to have a discussion, the discussion is getting steered. Let me ask the question again. But even now, I realize I didn't pin her down clearly on truncal lymphedema stuff because I wasn't prepared at all on that issue.
Come to find out, at the top cancer hospital in the country my RO hasn't had a patient who has come into rads with active LE.
My consent form described a potential side effect of radiation to be "arm swelling." I said, "Do you mean lymphedema here? Because lymphedema is not arm swelling. Lymphedema is a lifelong, chronic disease." She said yes, they were referring to lymphedema in the term arm swelling. I almost fell out of my freaking chair.
No one told me - and the hospital has a way to communicate how to prepare for procedures - to bring a camisole, or something to protect my sweater and my bra - from being damaged by the ink they were going to draw on me with until I got there. To top it all off, a ton of it was covered up with this tape, which immediately caused a skin reaction. Oh, I was sent home with markers and told to redraw it on myself. I took my shirt off last night and nearly passed out because I looked like a battle plan. I started ripping off all the tape. I wouldn't have been able to put lotion on because of all that tape crap. But then I read the information the nurse was supposed to have gone through thoroughly with me, and it said not to remove the tape because it might remove some skin with it. But I was supposed to keep moisturizing. But you've covered the entire area with this weird tape. I'm practically hyperventilating right now.
It's like every body image issue nightmare that I've been trying to deal with came rushing back all at once together. I am even MORE afraid now that after rads I'm going to wind up a scarred - and now she helped think of new ways, lymphedema - now not just in my arm, but EVERYWHERE - alien freak show.
I can opt out of radiating lymph node areas. Of course, I have to make the decision on my own, try to educate myself the best way I can and hope against hope that if I decide something against what the doctor says that I've done the right thing.
I used to think I was a strong person with a great attitude. Maybe I was. I hate letting something beat me, but I'm getting really close.
Comments
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Frill, you ARE a strong person, and there's nothing wrong with your attitude either--it's just that you're in an impossible situation trying to make medical decisions without the information you need or anyone to consult with that you trust to know the whole story. I am SOOO sorry you're facing this.
For goodness sake do whatever you have to do to tromp out the BC beast--LE is nasty, and yes, it's chronic, but with time and some help we really do get better at managing it. My LE is bilateral in both arms and trunk, so I sure understand your panic at not being able to pin down the answers you want. Please know that it won't always be this confusing and frightening--it gets better, honest!
In the meantime, we're all here for you. Chocolate helps too!
Gentle hugs,
Binney -
Frill, I know how tough this is. I went into surgery thinking that was gonna be it, and came out with the news that thanks to the positive lymph nodes and characteristics of my tumor, now I had to get chemo and rads. It took awhile to accept that. The RO told me that in times past, they would have gone back in and removed the rest of the nodes, but now they just radiate the heck outta them and consider it just as good, maybe even better. I knew removing them would be a huge risk for LE. Radiating them raises risk some, but nowhere near as much as removing them. So I was thankful for the rads.
Radiation was almost tougher than chemo in some ways. The daily grind does get old. But if I can do it, anyone can. Binney is right, just set your mind on exterminating any little invaders that might be lurking in there, and try not to worry about what may or may not happen. FWIW nobody told me beforehand about rads raising LE risk (found that out here) but I had no choice, it had to be done, so.....
I did end up getting truncal LE but it had nothing to do with the rads. It happened months later when an overly-enthusiastic PT gal thought she could "massage away" the cording.
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Hi, Frill. I agree about the wording on the consent form. "Arm swelling" is so misleading.
It is such an awful feeling when you have doubts and it seems like you are on a train and it is too late to get off. Maybe you can tell your medical team that you must see them right away if it is safe to wait a few days to start radiation. You need more information. Every aspect of bc treatment requires weighing the risks vs. benefits. And so often there is no choice that feels completely comfortable. What is your risk of possible radiation problems vs. risk of cancer recurrence without the recommended radiation? Radiating lymph nodes probably protects against distant recurrence (mets) as well as loco-regional recurrence. The Z0011 trail results are interesting to read in this regard; though I don't think you match the study population, it may still be informative.
If your skin is irritated or damaged right now, I would see about letting it heal before beginning rads. Radiation skin problems are not technically burns but a lack of regeneration. See the thread "A radiation oncologist weighs in..."
Regarding the markings, there are options and the techs need to work with you. As I recall, the big landing strip drawings are only needed for a few days. After that some institutions use tattoo dots and some only use small ink marks to line you up properly each session. They may not tell you that you have a choice but I think you do. I got three tattoo dots at first, but when they wanted to do more tattoos I negotiated to have marker instead, promising not to wash it off. I think I had tape circles over these but I'm not sure. Maybe tattoo dots would be a better option for you.
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