Today was our first visit with Dr. Nuke. Another DR we love for his clarity, directness, and empathy. (Why can’t Dr. Cutter borrow some bedside manner from the other three DRs on the cancer team?)
The deal: there are various “standard-of-care markers” for when and where one with breast cancer needs radiation. Venita needs radiation on the chest wall on her right side because the tumor in the right breast was an invasive cancer and over 5 cm. The radiation will continue up to the lymph nodes above her breastbone. She does not need radiation on the nodes in her axial (armpit) area because of the low finding of cancer there.
Dr. Nuke cannot fully evaluate the need for radiation on the left side until he sees the path report from that side's mastectomy. The path on the left breast biopsy didn’t “set off” any standard of care markers for radiation, but the mastectomy pathology might bring new information.
The staggered mastectomies/reconstructions add potential timing complications for administering radiation, but Dr. Nuke agrees with the need to get chemo into Venita ASAP because of the nature/size of her right breast tumor. If a need for left side radiation arises, he will “stagger” the radiation treatments.
The right side will get 28 treatments. That calculates to 5 days/week for about 6 weeks. It will of course be longer than that if the left side is involved on a staggered basis. Each treatment is about 15 minutes. There is an hour+-long, up-front evaluation session where they decide through CT scan where and how to nuke you.
We talked about possible side effects/complications of radiation. Of course we knew about the temporary “sunburns” in the irradiated tissue, and he mentioned fatigue. Dr. Nuke mentioned a few other things, said they were unlikely, so we didn’t even write them down (although Venita does remember permanent damage to the lung). Dr. Nuke said there is the possibility of some temporary arm swelling; as well as permanent arm swelling (something called arm edema), but said that arm edema with Venita was again unlikely. (We are completely unsure how related this arm edema is to lymphedema, but Dr. Nuke said it was something different!)
Dr. Nuke said long-term he expected Venita would unaffected by the radiation and should be back to normal within about a month after that treatment ends. Like Dr. Chemo (bless his heart), Dr. Nuke said he is talking about curing this cancer. Some stats he gave: without radiation—possibility of recurrence of breast cancer in the right chest wall ~40%. With radiation—7–10%. Venita’s odds of being a BC survivor—a little over 80%.
Dr. Nuke said Venita’s cancer presents itself as if it is genetically based (type, size, bilateral were factors he mentioned). However without family history, he is saying it is not genetic. The problem is Venita does not have real good history about breast cancer in her family, but we’ve talked about that before.
Dr. Nuke wants to start Venita on radiation therapy as soon as she is healed from the left breast mastectomy.
Dr. Nuke made a few accountant jokes--LIFO, FIFO, balance sheet, cash flow statement. Forgive him, he was trying to connect and we softly chuckled. He did also tell us a stupid DR joke. Wonder how many times he's told that joke.
Venita Shooting Herself
Mentioned yesterday that Venita was going to need a shot of Nulasta the day after each chemo treatment. Found out today (YEAHHHHH) that insurance allows her to get a scrip and shoot herself in the comfort of her own home.
OK, well there's shooting insulin into your cat and there's shooting yourself. Venita is thinking about having her nurse neighbor watch her practice shoot with sterile saline, just as the vet tech did did when V learned to shoot Max with insulin. The Nulasta comes preloaded in syringes. Venita hopes the syringes are short needles, small gauge!