Part 9: A Very Localized Tan

Today was my dry run at the radiology oncology clinic. I had to grip two handles above my head while lying prone, which I can already tell is going to give me neck and shoulder spasms. The pandemic weight in my midsection rendered my breathing shallow and inadequate. The edge of the compartment jammed painfully against my ribcage. I couldn't get my head into a comfortable position. Lying flat on my face pressed the pillow too firmly against my eyelids. "Pillow" sounds comfortable, but this one is extremely firm, like a cushion used by ascetics or monks to mortify their flesh. My back and shoulder spasms also made twisting my head to lay it sideways painful.

I'm pretty sure at least one saint has been martyred in this position.

I visited a friend toward the end of Passover and helped her stow away her Passover dishes and pots on a high shelf. Reaching up to hand her some lids, I felt pain slice me right under my left breast.

The pain was sharp and unique; I went and checked my scars, and it was nowhere near any of them. Poking along my ribcage, I found a few small muscle knots at the junction of my chest and underboob. Muscle knots and trigger points are nothing new to me; they cover me like a cheetah’s spots. Another impact of PTSD on my body: when your muscles are constantly tensed up for fight or flight, eventually they stay in spasm.

But usually the trigger points sprout on my back, shoulders, legs, backside, and arms. Sometimes my feet. Breast knots were a novelty. I couldn’t find any corresponding sore spots under my right breast, so I figured the tension was the residue of surgery, two hours of my left arm stretched over my head. (I think that’s what happened, but I don’t remember the surgery. The anesthesiologist was correct when she said the askew mask wasn’t a problem.)

My friend gave me some CBD cream that didn’t help, so when I got home I applied arnica gel, a homeopathic remedy that’s good for sore muscles. When I attended my first radiation oncology appointment, I discovered a whole new muscle knot generator.

4/27/22

Subject: radiation therapy dress rehearsal

Today was my dry run at the radiology oncology clinic. It's in the basement of the cancer center. I'm not sure why I expected it to look like a basement, with cobwebs and slime dripping down the dank stone walls, but it looks pretty much like the other floors. Antiseptic, functional, meticulously arranged furniture. Hallways with exam rooms, procedure rooms, and offices. Bland rows of counters, cabinets, and exam tables.

I woke up with tension between my shoulder blades this morning. I tried to relax the muscles in the shower, but although I had ample hot water, the pressure wasn't sufficient to break up the knots. The day wasn't improved when I arrived at the center and sat in reception for 17 minutes before they had me go back up to the first floor to provide a urine sample. There is no way I could be pregnant, and only a Catholic doctor would consider it possible, but they made me pee in a cup anyway.

Back downstairs, I was asked to take off my shirt, bra, and earrings. They applied rows of stickers, of varying length, along my surgery scars and between my breasts. On my nipple and below my breast they stuck square stickers with little metal balls on them. My breast looked like a neomodern Christmas tree.

In a daring change of pace, I got to second base with a doctor and two radiology technicians, one of whom was male. I had to lie down on my stomach, on a table with an empty compartment on the left. The techs helped me position myself so that I dangled into the space, and made small adjustments by tugging the sheet I lay on. "Left. Pull her up. Now more right. Further up. A little back. That's it." I let the sheet take me where it would. She pushed my left breast into position while he dragged my right breast out of the way. It was friendly but impersonal, like handing a few dollars to a cheerful toll collector when you don't have EZ Pass. No eye contact, obviously; I couldn't see anything but the sheet. But they advised me every time they grabbed and moved my flesh.

I had to grip two handles above my head while lying prone, which I can already tell is going to give me neck and shoulder spasms. The pandemic weight in my midsection rendered my breathing shallow and inadequate. The edge of the compartment jammed painfully against my ribcage. I couldn't get my head into a comfortable position. Lying flat on my face pressed the pillow too firmly against my eyelids. "Pillow" sounds comfortable, but this one is extremely firm, like a cushion used by ascetics or monks to mortify their flesh. My back and shoulder spasms also made twisting my head to lay it sideways painful.

I'm pretty sure at least one saint has been martyred in this position.

As I lay crankily feeling the pillow compressing my eye, the techs drew on my body with Sharpie markers. Dots on my side, small of my back, and side boob. The doctor was supposed to inspect the artwork before they created tiny tattoos with needles and ink, but she was delayed. I was allowed to sit up, put my robe back on, and text my employee that I was going to be late. I asked her to please punt my 11 am appointment to the intern, who would be delighted with more client contact hours.

Right before the doctor arrived, they lay me down on my face again, slid and shifted me into place with the sheet, and carefully, clinically, impersonally moved the flesh of my right and left breasts. I smelled Dr. Flores come in—a light and floral scent. She gently touched each of the Sharpie marks and must have approved, because the techs told me the needles were coming.

I've really enjoyed the needle-free weeks since surgery, so I was dreading the tattoos. First they dabbed on several dots of something cool and viscous, like tempera paint. "Here's the ink," she said. "And more ink. More ink. Here's the last bit of the ink." I stiffened; I knew what came next.

"Try to lie as flat as possible," he said. "Okay, here we go with the needles. A little pinch..."

When you've been impaled with biopsy needles the size of pastry tubes, a tiny needle that doesn’t inject any burning lidocaine is actually not a big deal. A few more tiny pricks (title of my dating memoir?) and they were done. "You did so great!" she cried, sounding prouder than my mother when I graduated college.

"That wasn’t bad," I said, trying to sound weary and nonchalant.

While I was prone on the table, they slid me into the scanner for a CAT scan. It’s more open than an MRI tube, but since I was face down it felt almost as claustrophobic. I haven’t had a CAT scan in at least a decade, but it’s not as noisy as an MRI, although not quiet. You can take off your earrings and leave them on the nearby counter without worrying they’ll be sucked into the vortex.

After the CAT scan, they gave me a tube of homeopathic calendula cream to apply to the irradiated breast twice a day to prevent burns and dryness. Calendula is a flower in the marigold family; its petals, when dried, can help treat cuts and burns or inflammation from radiation therapy. The techs warned me to eschew underwire bras during the 15 days of radiation therapy (challenging, since almost all bras I own are underwire; I might need to order some) and I was done for the day.

I made it back to the office and learned that the client hadn't made it in yet. No harm, no foul. Next appointment is May 6. I'll update you next time about the actual radiation experience.

A week after the dry run, I received some disappointing news from Dr. Flores.

We are finalizing your breast radiation treatment planning and everything is going well, but due to the large size of the lumpectomy cavity relative to the breast size and the dose distribution generated after planning, it would be safer to give you the boost dose sequentially (5 fractions after the first 15) rather than simultaneously. Otherwise, a very large proportion of your breast would get a high radiation dose daily, and that may increase risk of inflammation and late scar formation.

Unfortunately that will extend your treatment course by 5 days, so instead of finishing on on Fri 5/27 you would finish on the Friday afterwards on June 3. I'm sorry for this inconvenience, but I would prefer to proceed in the safest way possible that gives the lowest risk of side effects.

If you have any questions, we can coordinate a phone call, let us know. Take care!

This was the first I had heard of my “lumpectomy cavity.” I thought my breast was pretty much the same shape after surgery as before, which impressed me because I knew they had to scoop out three bits of malignant or questionable tissue. Apparently the rest of my breast tissue did not expand to fill the void.

So there’s a hollow space in my breast now? I thought. What if it collapses, like a sinkhole? Will I have a divot then? Is it like Swiss cheese?

I didn’t even know how to research whether she was right. Most other specialists I’ve consulted during my long career as a trauma survivor with somatic symptoms—orthopedic surgeons, pain management specialists, gastroenterologists, rheumatologists, physiatrists, gynecologists, otolaryngologists—used language I could Google. There were articles I could read and understand about joint pain, irritable bowel syndrome, interstitial cystitis. I could question their treatment recommendations. But I’d never done any research into radiation therapy or read an article written for laypeople on that topic. This was uncharted territory. I still didn’t really know what I was getting into, even though I was tattooed and ready to roast.

But I could count.

Hi Dr. Flores—so that means 4 consecutive weeks instead of 3?

She confirmed I could count.

Yes, that is correct. A small gap between the first 15 and the last 5 is reasonable if needed to accommodate any schedule conflicts on your end, but we generally do it consecutively.

Again, I am sorry for the inconvenience but I want to minimize as much as I can the risk of late scar tissue.

I didn’t want late scar tissue any more than she did. But I was frustrated. I thought I’d scheduled all my remaining cancer appointments, and here was a whole new batch.

I'd rather just get it over with, so adding one more week makes the most sense. My workplace is supportive so that won't be an issue. Will I be able to get the morning appointment slots?

She was cautiously optimistic.

I have asked the schedulers to try their best. It may be just a bit later around 9-9:15am for that last week, but at least in the morning.

I updated my support network with excerpts from Dr. Flores’s messages, and concluded:

I am not at all sure what that means other than last week's uncomfortable session told them they need to take it easier on me. It would have been nice if the radiologists had gotten that memo before sticking me with all those needles. But fortunately I'm able to change my work schedule to accommodate another week of radiation. They are being incredibly supportive, which I appreciate, so I can't be too annoyed that I have five more days of radiation martyrdom.

My friend Jill sent me a link to the Susan G. Komen website that explained what a boost was. I still wondered how my breast created a cavity without collapsing. I groped and poked at the breast, thinking I’d feel a hollow and flexible sphere, like a balloon. There did seem to be an internal capsule beneath the scar that traced about 1/3 of my aureole. It felt like the hardened area I had noticed after the mammogram-guided biopsy, or the fibroadenoma in my right breast. I didn’t want to crush it and create a permanent dent, so I stopped poking.

I had to go in the Friday before the start of radiation therapy, and updated my followers on what happened.

5/5/22

On Friday I went in for X rays, with a travel pillow I was hoping I could put under my face, so my eye wouldn’t be squished and I'd be less uncomfortable. No such luck. They've already made their measurements and tattoos; they can't change anything. I wasn't lying down for long, but all day Saturday I had muscle spasms and tingling up and down my legs, and today isn't much better. I'm not sure if it's physical or psychosomatic, but it's uncomfortable. I just hope 4 weeks of lying on my face doesn't exacerbate it.

I still don't really know what to expect tomorrow, but I hope it's not worse than today. I ordered a small percussion massager, but it didn't work after 10 hours of charging so I had to send it back. I tried taking a long bath, but that caused a leak into the downstairs apartment, and it didn't make much of a difference anyway. Fortunately I have plenty of arnica gel, a homeopathic remedy that helps with muscle pain and problems. I'll probably need to order more before the 4 weeks of toasting are up.

#breastcancer #breastcancerawareness #breastcancercare #breastcancersurvivor #breastcancersupport #breastcancertreatment #breastcancerfighter #breastcancerwarrior #breastcancerresearch #1in8 #mammogram #biopsy #breasthealth

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