I suppose I’ll find many uses for the G.O. initials.  It has morphed for today.  I had my annual mammogram.  Short story: the radiologist doesn’t want to see me for 6-12 months (they are bowing to the opinion of the surgeon on that call).  That is good news for all intents and purposes.

Why Guarded Optimism?  Well, I’ve heard this before.  I still have dense tissue, so they are not the easiest things to read.  SO I went into the appointment just wanting a disc with my 2007, 2009 and 2010 images on it to take to Dr. Surgeon, breast specialist, when I go see her on July 1.  That was accomplished.  I was not nervous.  I didn’t loose sleep the night before.  I just went in like I was getting an x-ray on my ankle or something.  The very kind technologist knew my story.  I really appreciated that.  (My 10th grade spanish teacher would have said “PUNTO!”)  She asked if there was anything to screen on the left side.  I laughed and stuck out my chest like a prancing pony, very proud of the neat and very flat area where my left breast used to be.  Apparently some post mastectomy people have tissue left that is squishable.

So if you’ve never been to a mammogram it’s really something.  All the techs I’ve ever had have been really good at what they do.  Now there are markers on the press to line things up nicely for the digital imaging.  For some reason every time I go for mammograms, the woman before me got to have the BIG paddles.  They always get replaced with the smaller ones for me. 🙂

BTW: I saw a funny card that said something like “if women ruled the world” and it had a picture of a female doctor standing next to a mammogram machine.  The squisher was down at groin level and there was a man in a johnny trembling next to it. 

So here’s how it went:

Tech: Wow, you’re tall, let me raise the platform up a  bit.

Me: (I’m not really that tall, you know.) Yea, so I’ve been told.

Tech:  Position your feet facing the rig, relax your shoulder as I position your breast just right.  Can you lean in toward the machine (read: ‘squisher’)  a little more so I can get all the tissue and muscle?  Right arm up here, ok?  Can you square your shoulders and step your feet back a little so you are leaning in?  Turn your head, ok?  Here comes the scraaaaaaaape along your chest wall.  Sorry about that.  Just want to get as much as I can. 

Me: (leave the ribs out of it, ok?) Yea, I can appreciate that.  (ooooooowwwww!)

Tech:  I’ll just go back here and take the image…oh, why isn’t the machine taking the picture? Let me see.

Me: (the longest squish on record, I bet…it’s actually hard to breathe in this position) (I’m invisioning that I’m having the first mastectomy performed on the mammogram machine today… just cut off all circulation, sort of like what they do to little lamb cojones by tying them off and letting them drop…)

Tech: Are you ok? It’ll just be a sec.

Me: (straining) Yeh, sure, I can do this.  Gravity wasn’t doing a very good job at helping the migration of this thing, so this should help.

Tech: That was really funny.  There, it will release in a sec.

She pivots the machine so it can squish in a semi verticle position too.  The images were good. 

I am in what is called a ‘diagnostic’ catagory now for 5 years.  That means I get to wait while the radiologist grabs the hot potato and looks at the images for a diagnosis.  She came back in less than 5 minutes with the good news.  I had to wait longer to get the images on disc than the entire procedure.  THAT’s what I came for.  SO it sits on my bureau awaiting my trip on Thursday, next.  The reconnaissance mission continues.

I went to book club last night with women who have been among those at the head of the stampede and who have been flying with the angels.  My intention was just to say a quick hello, I hadn’t finished the book, and I’m kinda tired.  I left after an hour and a half. (a quick hello)  As I left there was cheering and chanting  (Ok, maybe not chanting but at least ONE was saying “30 seconds left…30 seconds left…”)  This group has held me and carried so much of this with and for me.

When someone says “You have done so well through this…” I look back and would agree.  I must say, however, that we had a matrix of support.  I’d just change that sentence to say “We have done so well through this…”  There will be plenty of time for me to reflect.  If you’re still reading along, there will be more soon.  As for this weekend, I’m going to enjoy A‘s birthday tomorrow, my twin brother’s birthday Saturday (OK, it’s my birthday too!) and Mother’s Day on Sunday.  There’s nothing like the feeling that this part of treatments will be over today and I have a weekend of celebrations.  Even if I just sit in the peace of my home.

If you want to count down with us, I go in for my last booster at 1:00 EST.  We’ll start at 30…29…28…27…

So far so good.  I’m feeling like a pro going in for radiation.  The receptionist was working with someone and saw me enter and said “Hi P, go ahead on in.”  I saw the woman who gave me the tatoos who asked if the speakers that were just installed in the waiting area sounded ok.  When I was called into the radiation chamber she went on and on about my scarves.  Today’s scarf, in particular, matched my duds in a way that drew comments throughout the day.  (I think people were telling me that I don’t usually coordinate this way!)

Lying beneath the radiation machine, I felt like I was in a spaceship today.  They put a gel filled pad on me yesterday, I think it was called a bolus or something like that.  It went over the entire area to be radiated.  It is going to be used on me at certain intervals to change the depth of the radiation apparently.  I swear, the radiation staff should have roller skates on.  They swarm around me when I first get there, make sure the numbers and dots match, and are out of the room before you know it.  Back in for readjustments, back out, back in again.  They are so cordial, and yet so focused.

I went to leave, smelling like sesame oil, and the person at the desk handed me a beautiful bouquet of daffodils.  10 minutes, that’s all it took.  I headed back to town to get a new vacuum (ours kicked the bucket last week), stopped at work and heard from a loving friend about another case of invasive breast cancer, a friend of hers.  I immediately felt a calling to help in whatever way I can.  I know I’m still going through stuff, but I cannot overlook the help I’ve received from sisters-in-the-know.  Maybe I can return some of what has been and still is given to me and us at some point.  I picked A up from work, and headed home.

So far I’m not noticing much as far as reactions to the radiation.  I am putting aloe on in the AM and marinating myself in the PM with the chinese salve.  My next treatment is early tomorrow.  I’m looking forward to the weekend.

While I was waiting for our chinese take-out tonight the owner asked if I would like some tea.  What a nice thing.  I sat by the window along the river, warm tea cup between my hands, and watched the pouring rain as I thought about my experience today.

Before I left for work this morning, I took a picture of my scar and the area that is going to get radiation treatment.  I plan to take a picture each day to sort of  chronicle the affects on my skin.  Who knows if I’ll ever publish it, but it can’t hurt to get it recorded.

I checked in at the radiation department and as I practiced during the simulation and verification, headed to the dressing room, picked out a psychadelic johnny 🙂 and stuffed my shirts and jacket in the locker.  I replaced my doo rag with a baseball cap (the knot on the doo rag is uncomfortable when I’m lying down).  I waited by the window overlooking the fields, and watched the rain come down.  A radiation tech found me and took me into the now-familiar room.

Three women helped get me into position.  They already had my ‘cradle’ waiting for me – my arms fell into position easily.  They worked like quiet bees adjusting and aiming.  Someone said a number and someone else verified the same number (this is good) and they asked if I was comfortable.  I got to keep my pants and cowgirl boots on and I was complemented on my boots by several people.  “We ALWAYS notice people’s shoes in this job!”

Above me was this round disk like contraption, where the ratiation beams come from.  It has an aperture of sorts, it reminded me of the lense on an SLR camera.  It shuts and opens according to the shapes that are programmed into it.  I was draped very modestly today. 

When the radiation is turned on, the machine hums a bit.  Each exposure was very short, maybe 10 seconds in each position…or so it seemed.  After one exposure, the machine passed over to one side, the aperture readjusted, the hum and another readjustment by the team.  Sometimes the table I was on swiveled, sometimes the machine itself rotated to the other side or above me.  When it was above, I got that waffle iron feeling like I did during the mugga scan way back when. (I was the batter, remember??)  A few clicks, a few hums, a few adjustments and the staff came back in, ready to clear the way for the next contestant.  It took no more than 10 minutes, I’d say.

I was led to an exam room and met with the radiation oncologist for a quick visit.  Each week I will meet with him to go over questions, review the plan and look at my exposed skin.  I had him look at the ointment my herbalist gave me, and he said there was nothing that concerned him in the ingredients.  I told him it might stain my skin yellow and he laughed.

The “patient navigator” whom I met in chemotherapy popped her head in while I was waiting for the doctor.  She is so incredibly sweet and was just checking in.  She cheered when she saw my hair whisping out of the baseball cap.  My new schedule initially has me scheduled mostly in the early morning, but the scheduler was able to find me a 1:00 time slot for the majority of the treatments.  That’s good and will assure that I break my day in half as planned.

I found my way back to the locker and applied the ointment on the exposed area.  Slowly I began daydreaming about chinese food and realized that I was starting to smell like sesame oil or something one might find in a chinese restaurant.  I went home and picked up E for guitar lessons.  It meant a lot to me that he remembered and asked me how radiation went.  While he was in his lesson, I went to the chinese restaurant and ordered some food to go.  I was sort of afraid that they might decide to put me in the wok if they smelled me,  so I kept my jacket zipped right to my chin.  Dinner was ready before my tea cup was empty.   Back at the ranch we celebrated each other’s day as we cracked open our take-out containers.  (A started her first ‘real’ job today…)

I’m 1/33 of the way into this part of the trail.  It wasn’t so bad today.  I felt fine, no immediate reactions.   My horse, she and I are well on our way with so many riders still on the trail with us.  I can hear the rain falling on the roof.  I might just go snuggle up in bed, one of my favorite things to do on a rainy evening.  I think I will use my aloe gel on the days that I go to work after radiation and save the chinese herbal ointment for the days when I head home.

I met with a radiation oncology nurse for radiation ed.  We reviewed most of what I’ve already gone over, and she gave me my schedule of 33 treatments.  They wanted me to start the day after, but I’ve planned 3 workshops and a trip to NY for before radiation begins, so they decided to push it to next Tuesday.  They don’t want me to miss two days with only two days under my belt.  If I were on day 20 and missed 2 days, apparently, that would be more allowable.  It was funny, as she looked at me with her coiff and gently made up eyes and said “you know there are free wigs available in the boutique…” and I gratefully declined, showing off my hair growth…She said “you do have a nice shape to your head and face and can pull (the scarf thing) off.”  She then told me about the 2 hour session available to go over make up tips and that I would even get to take some high-end products home free of charge.  I just raised my invisible eyebrows and smiled at her.  I’ve never been one to use many ‘products’.   This nurse respected that enough for us to get by during that part of the conversation.  I remember Mom asking me on my wedding day if I wanted just a little blush before the ceremony.  I was walking around the house with her wedding dress on and my birkenstocks.  I think she felt naked FOR me for a minute there…but as we walked up the isle, she and Pop on my arms, we were all aglow, some of us au naturale.

A diversion: I still am glad I chose not to wear a wig, and that I’m not making eyebrows where there are hardly any.  It’s all just NOT me to do that.  Everyone has to make their own choices here.   I feel proud that I can walk around with one side flat where a breast used to be without feeling self conscious most of the time.  It’s not that I want to be ‘in your face’ with my changes.  For me it is just about evolving with my body changes naturally, growing into my body.   If and when I decide I want to do something about whatever, I’ll do it.  I’m aware that I go over this ground from time to time as situations arise.  I’m glad that I can feel content enough in this area.  I have one of my favorite scarves on today and love the way it drapes over my shoulders.  My book group met yesterday and there were FOUR bottles of champagne among 8 of us…I think we left one bottle untapped…they helped me celebrate the last chemo, my hair growth, moving along on this trail.  I wore my cowgirl boots for the celebration.  They commented on how soft my hair is and rubbed my head as I purred and we laughed.  (we really did talk about our book too…really!)  They, among many others, help me more than they know.

I went into one of the two radiation rooms at the center.  It’s all state of the art, as the center just opened maybe a year or two ago.  They found my ‘cradle’, the mold / pillow that was made to fit my shoulders, head and arms above my head.  I settled into it and once again the drape was down to my lower ribs and my tatoos were aligned with the lasers.  The radiation machine can rotate around the whole ‘bed’ and catch me from all angles.  It seems that everything lined up well.  The ceiling tiles are black with holes in them, and the stars looked like they were shimmering.  It was very soothing.  The xrays were taken to identify my “boney structure”.  It looks like they will be positioning the rays from the sides, but I’ll know more Tuesday. 

About 3-4 weeks in, they will be doing something called a breast booster, where they use an existing template to fit my scar.  They will make a new one if there is not one already that fits the shape of my scar.  They will spend about 7 days or so concentrating rays right around that site.  I’ll keep you posted on that one too.  They want me to use aloe and/or hydrocortisone on the skin to ease the breakdown, and I will meet with the radiation oncologist weekly to monitor the skin reaction.  I’ve communicated with my hearbalist and she is recommending something called “Ching Wan Hun”, so I’m going to go with that.  I can use my aloe plant until the jar comes in.  I am to put something on the site, my neck to my sternum to the auxilla and way over around to my back two times a day.  They caution the use of vitamin C and E above certain amounts as they don’t want anything to prevent the affected cells (if there still are any) from breaking down.

At first the idea of putting radiation off for a week was NOT what I wanted to do in my ‘keep on truckin’ mode, but I planned this trip to see my mom  when I was feeling well and before treatments began.  This was before I knew they were going to plan them right after the verification.  Seeing Mom is more important to me.  It’s been too long.  During our last conversation I let her know about the upcoming radiation, and that I was feeling really good.  I reminded her about my fuzzy head and she said:

 “Oh, did I know you lost your hair?” 

“Yea, Mom, do you remember that I came down at Christmas time?  You asked why I was wearing so many hats…”

“Oh yea, this brain of mine is for the birds.  Honey, you have made my day, my week, my year by telling me you are coming down.”

How could I pass up a visit with that angel-mom?

Yesterday was the simulation.  I went and had my vitals taken, met briefly with the radiation oncologist and then was lead to the radiation area of the cancer center.  You know, they make cool colors for cell phones, for cloth diaper wraps for babies, for paper cups, dog collars, even fruit loops, but never have I seen a cool johnny.  I went into the CT scan room and they had me lie on the table and put my head on this pillow of sorts.  I positioned my arms over my head and they basically sucked the air out of the pillow so that it formed to my form.  I was told to turn my head to the right to avoid creases on the left side of my neck which they said could add to the skin issues I would inevitably experience. The radiation oncologist came in and drew on my chest using the scar at times as a guide.  The other 2 staff put some stickers on me which are designed to show up on the scan.  The johnny was draped back over me. 

They sent me into the tube for the first run.  I was asked not to move (but I didn’t have to hold my breath like in the diagnostic scans I had last fall), and they went out for a period of time which seemed long as I was lying there with my arms above my head.  Eventually they came back out and checked things out to verify that they’d marked the correct areas.  If targets had feelings, this must be what it feels like when someone sights-in a rifle.  Or maybe I felt more like the subject in a petrie dish.  Or perhaps both.  When they were happy with the alignment, they put a small dot of ink where all the lines intersected and pricked me with a pin to create a freckle-like tattoo.  I think there are two on my left side and one on my right.  These marks and the pillow form will be what they use to line me up each time.  One of the staff had two such tatoos put on her hand to show patients.  Even though they are really small, I was struck by the dedication she must have to do that for our benefit.  This appointment took about an hour total.

As they were marking me up I felt fairly vulnerable.  I was expecting to have my left side exposed, but most of me was exposed as they worked to line things up.  I chose not to get heated blankets in what was a fairly chilly room because if I had a hot flash I’d have a hard time not moving.   I had to leave my head turned to the right the whole time.  I tend to prefer female providers, but I do ok with males.  Fortunately there was one of each this day.  They were good about draping whenever they could.  They were extremely kind and respectful.  If someone had come with me, I’m not sure how much of that they would have been permitted to attend. 

Radiation is something we all are encouraged to avoid whenever possible, and here I was signing a consent allowing exposure to radiation for 33 treatments.  That’s 6 ½ weeks.  We took the plunge at the start of all this to follow the recommended protocol whenever possible.   I kept reminding myself about those who have been in clinical trials to help come up with the cocktails and the formulas that have informed my treatment.  I wouldn’t say I have had second thoughts about our treatment choices.  It is what it is, but it’s truthful to say that I don’t like this.  Here again is something I have to do all by myself.  People can come with me, staff can support me, but everyone exits the room when the beams fly except me.  At this point in my treatments, I am feeling the most normal I have felt since September.  My life activities are getting back to normal.  I’m working most of the time.  I’m getting more active.  This just doesn’t fit with entering the cancer center and taking that familiar pose under the scan machine.

Now that I’ve written it out and had time to think about it, I am able to think of the questions I could not articulate when the radiation oncologist and I were sitting together in the exam room.  I’ve written them down for my next visit.

As I was leaving we identified some preferred times to schedule me for the treatments. First thing in the AM appointments are the most popular so I’ll have to queue up for my turn.  I asked for early afternoon appointments  until the earlier appointments are available, so that I can just do it on my way home from work.  This will give me a definite cut off time each day and will most likely assure that I do as I say and head on home.

The next appointment is in one week and is called a Verification where they put me back in position to do a dry run of sorts.  At that time they will take x rays .  I will also have the port-a-cath flushed, which is something that is recommended once a month if it is not being accessed regularly, in order to avoid clotting.