Appointment 9 - Radiation Oncology Consult

There's nothing better than a good run. And not many thing are worse than a bad one. This morning started out so promising. I had a great night's sleep and was ready to begin my 7.5 mile run (twice around the lake) at 7:30 am. About 2 miles into it, my knees were bothering me a little. I stopped at home after the first lap to switch dogs and do a little stretching. It helped for about a mile. I still had 2.5 miles to go and could tell my old IT band issue was flaring up again. $&@(-/!!!!! I had to walk/run the last 2 miles and it took forever to get home. Six hours later, my legs are still bothering me, but now I can't take Advil in preparation for surgery next week. But worse, now the fear is back. For those who don't know, the IT (iliotibial) band is a band of connective tissue that starts at the ilium (hip bone) and attaches on the tibia, just below the outer knee. I have had problems with this particular part of my body for 4 years. It has resulted in me having to drop out of training for several running events, and even give up running altogether for almost a year. I could write a whole book on the doctor's visits I've had about my stupid knee, but I won't bore you with the details. I changed my gait last year, and have been relatively pain free since then. But now I don't know. Was this just a bad day, or a harbinger for things to come? Am I heading down that dark path path of injury again? The problem with IT band syndrome is you generally don't feel any pain until a mile or so into into a run. So there's no way to gauge how it's doing without starting a run and hoping and prying that the familiar twinge won't start up again.

I know now to take it easy at the first sign of trouble, so no running until the big Jami's Group of Losers 6K this Sunday. Then another week off next week to recover from surgery. This puts my training back a bit, but what are you going to do? Actually, if this were an Mitch Albon-type inspirational story, I would say that I have a new outlook on life and that I will only run for fun, without putting the pressure of a goal or race on me. But this is real life and I'm getting sick of my stupid connective tissue telling me I can't run a marathon, dammit!

Wow, it's only 9:30 am, and I've already written a page of drivel. Let's move on to my appointment...

I was late meeting my mom at North Memorial outpatient radiation therapy for my initial consultation, partly because my "run" took longer than planned, and partly because there is construction on the main road leading to the medical building. I noticed that the waiting room was stocked with cookies! I see some weight gain in my future... The nurse took us in and went over my recent history. Then she discussed the procedure and side effects. Basically, I would come in for a 2 hour planning session after my surgery. At that point, I would be measured and tattoed. During that appointment, I would have several x-rays taken as well as a chest CT scan (not for dianognosing anything, just for measuring). There would be 28 "regular" treatments (over 6 weeks), then 5 "boost" treatments, for a total of 33. That's 6 and 1/2 weeks of going in every weekday. The treatments only take 5 minutes and they try very hard to keep on schedule. The side effects of radiation tend to be a "sunburn" effect in the region, tenderness, changes the texture of the breast (which may be temporary), and fatigue. In addition, a tiny part of my lung and liver would be radiated, which theoretically could increase the risk of cancer in those organs. In addition, my ribs will be more prone to fracture during trauma.

Then Dr. Kosiak came in. A very nice guy with a colorful tie. We talked for over 30 minutes (maybe longer!). He discussed all of the options, including mastectomy, lumpectomy only, lumpectomy with radiation, lumpectomy with Tamoxofin, and lumpectomy with radiation and Tamoxifin. I have a very small tumor, and it does not appear to be aggressive. The only thing thing against me is my young age. He told of a group in California that has shown that in certain situations, surgery alone may be as good as with radiation, but nobody else has been able to replicate their results.

The stats in general are as follows: survival with lumpectomy alone is nearly 100%. However, recurrence with surgery alone is around 30%, with half being DCIS again, and half being invasive cancer. With surgery and radiation, the risk drops to 10-15%, again, with half being invasive cancer. So the invasive cancer risk drops from 15% with surgery alone to 8%  with surgery plus radiation.

The thing to keep in mind is that because my tumor is so small and not terribly aggressive, I may be one of the people who would have a very low recurrence rate (even less than 8%) even without radiation. The trouble is, the studies on this have not been completed. The other thing is, you can only radiate a breast once. If it does come back, I would need a mastectomy. So do I take my chances now, or later? Seriously, I'm asking this of you blog readers. Would you do the radiation? Feel free to answer as a comment. I asked the doc what he would do, and he kind of hedged a little, but leaned towards doing radiation, mostly because of my young age. I love being able to make choices about my treatment, but it does put a lot of responsibilty on me as well, don't you think?

Anyway, he also did a fairly complete exam on me, which was surprising. Too bad I can't use this exam as the pre-surgical exam that I have scheduled for Wednesday. This marks the 6th time my breasts have been "handled" since Feb. 28. Not that I'm counting.