Ring the Bell

Today was my last day of radiation therapy. There is a tradition of ringing a bell to celebrate the end of treatment. But a survey found that those who rang the bell had more distressful memories of their treatment than those who did not.

I didn't plan to ring the bell but wanted to see if the bell sounds good. I took the clapper and tapped it very lightly against the bell, expecting a soft metallic sound. But it rang so loudly! I tried to stop the ringing, but it turns out it's true that you can't unring a bell.

Radiation Boost

I'm into the sixth week of my radiation therapy. The final week is a radiation boost targeting the area where my tumor used to be. First they do imaging (one x-ray), then they aim the machine at my breast from two different directions for about 10 seconds each. Just like before, I have to take a deep breath and hold it for those 10 seconds.

This is what my skin looks like under my arm area.

I have grade 2 radiation dermatitis. That's a fancy term for radiation burn. Grading descriptions:

Grade 1 – Faint erythema or desquamation.
Grade 2 – Moderate to brisk erythema or patchy, moist desquamation confined to skin folds and creases. Moderate swelling.
Grade 3 – Confluent, moist desquamation greater than 1.5 cm diameter, which is not confined to the skin folds. Pitting edema (severe swelling).
Grade 4 – Skin necrosis or ulceration of full-thickness dermis (middle layer of skin).

The photo doesn't show the reddest areas. My chest was very red but is starting to fade now. The bottom part of my breast is very dark (hyperpigmentation). I could be back to grade 1 now. My skin is still peeling and itches occasionally but there is very little soreness. I couldn't sleep on my left side because it was painful. I haven't checked lately if it still hurts.

Today was treatment #29 out of 30. One more day left.

Balance Problems

Lately I've noticed some unexpected stumbling. When I tried checking my balance by standing on one foot and walking heel to toe, I was a bit unsteady. When I tried it with my eyes closed, I couldn't do it at all. I don't know if this balance issue is caused by my cancer treatments. It could simply be due to aging.

I had my physical therapy appointment yesterday and received exercises for both balance and osteoporosis. I've decided not to work on my frozen shoulder anymore. I still can't raise my arm from the side, and there's been no improvement at all since last year. Maybe my shoulder will spontaneously go back to normal by itself in another year or two.

Two Days Off

Yesterday I mentioned to one of the radiation therapists that the area under my arm has started hurting. She said the skin looks fine but asked if I wanted to see a nurse after my treatment. I said yes. 

I waited a while for the nurse and was surprised that it was Dr. Horst who came. She reassured me that my skin looks good but offered to let me take the next two days off from treatment. I accepted. It doesn't hurt that much, but I'm afraid the pain will get worse or I could end up with open sores. The area under my arm is also starting to look burnt. I can't sleep on my left side because then my breast starts hurting. I'm relieved to get a two-day break.

I got clarification about the darkening of the skin on my back. I thought radiation was going through my heart and lungs to reach my back, but I noticed later that it's only the upper part of my back above where my heart is that's getting dark. Dr. Horst said the lymph nodes above my breast are being radiated, and because I have a smaller body, the beam is going all the way to my back. It doesn't go through my heart and lungs.

Crosshairs

There are three crosshairs drawn on my chest with a Sharpie for alignment with the linear accelerator when I get my radiation treatment. The radiation techs place a clear sticker over the marks to protect them. But every week, usually on the weekend, at least one of the stickers falls off. It loses its stickiness from the water when I shower and the steroid cream and moisturizer I apply three times a day.

To redraw the the crosshair, the techs have to do an x-ray. I was concerned that I'm getting unnecessary x-rays every week. But I was told they have to do these x-rays anyway even if the sticker doesn't fall off. It's so that they can check that the crosshairs are still correct or something. Anyway, I'm no longer worried about the stickers coming off.

My irradiated skin has been red since Friday. Usually the redness goes away within hours of my treatment, but not anymore. The radiation oncologist and radiation techs said my skin looks good despite the redness. I get occasional itching and soreness and have to be more diligent about applying steroid cream and moisturizer.

Today's treatment was the end of the fourth week. Two more weeks to go. I hope my skin doesn't get worse.

Radiation Affecting My Back

Saw my radiation oncologist today before my treatment. I mentioned to her that my back was turning dark. I wanted reassurance that it's normal. I've been moisturizing not just my front but also my back because I had heard that radiation affects the back also. Scary to think that radiation goes through my chest, then my heart and my lungs to burn the other side.

My sister Kit asked why they don't use a lead apron to protect the rest of my body from radiation. At my dentist they always use a lead apron before doing x-rays. It's because the radiation treatment is more targeted compared to the x-rays done at the dentist. It's actually recommended now not to use a lead apron because it might cause more harm.

Kit also said that topical steroids like the ones I'm using can cause thinning of the skin. I didn't know that. Mometasone furoate and triamcinolone are both class III potent steroids. This article said not to use it for more than three months. I plan to use it for two months (6 weeks radiation plus 2 weeks post-treatment for delayed reactions) and should be good.

Six Weeks Radiation

Yesterday I was reviewing my radiation appointments. My last appointment is on July 27. That makes 6 weeks total. I thought I was having only 5 weeks of treatment, so I sent a message to my doctor's team asking for clarification. Looks like I misunderstood. I get 5 weeks of treatment to the left breast and axilla area. Then I get another week of treatment to the lumpectomy area only. So it's 6 weeks total. 🙁

Here's the doctor's note from an earlier visit:

With respect to radiation, we recommend treating L breast and axilla to a total dose of 50 Gy in 25 fractions over the course of 5 weeks using a 3D conformal radiotherapy technique. A boost of 10 Gy in 5 fractions to the lumpectomy bed will follow due to residual disease after chemotherapy, patient age, and perineural involvement pathologically.  

I thought the boost would be on the fifth week. The good news is I was able to get more of the mometasone steroid cream and can go back to applying it twice a day. My doctor doesn't expect me to get any significant skin changes other than darkened skin, but I feel better using the cream in addition to frequent moisturizing. I don't want radiation burns.

Yesterday's session was #14 out of 30.

Too Many Appointments

I've been having this many appointments every week:

5 daily radiation treatments
1 radiation oncologist visit
1 physical therapy
2 acupuncture treatments

That's 9 total. On my way to PT yesterday, I was thinking I'm tired of all these appointments. My physical therapist must have read my mind because she suggested coming every 2-3 weeks instead of every week. I readily agreed. She said what I need is time for my shoulder to get better. My next appointment is three weeks away.

I'm not convinced that acupuncture is helping that much, so I cancelled today's appointment and don't plan on returning.

I get Monday off for the 4th of July weekend. That leaves me 5 radiation appointments next week -- 4 treatments plus 1 doctor visit. But Friday is my next infusion. Three appointments for it -- blood draw, visit with oncology nurse, and infusion. I also get radiation in between, so that's 4 appointments on Friday and 8 total for the week.