Oncologist Appointment on Monday June 20th

I was pretty wiped out when I got home from my appointment on Monday, so that’s why I am just now updating you. Each appointment is usually about 2 hours long, from checking in to leaving, and depending on how I am feeling on that particular day, it can take a lot out of me. Below is an explanation of what happened during those two hours. 

When I check in, I fill out a short form with my name, arrival time, if I have been recently hospitalized and if I have changed my insurance. I give the staff my name, birth date, and the short form. The staff person goes into a drawer and pulls a file with two more forms for me to fill out, hands me a clipboard, and they put a hospital bracelet on me. I sit in the waiting room, which is almost always pretty full, so about 16 to 18 people, both patients, and caregivers. The first form is a general form asking about any recent side effects, hospital stays, surgeries, medications, allergies, and what questions I have for my doctor. The second form is a suicide form with a few questions about self-harm and caregiver abuse. It is sad that such a form exists, but it is a reality for cancer patients, especially older patients. I fill out both forms, keep the forms with me and return the clipboard to the check-in area. This process is done every time I have an appointment.

Next, I am called back to the lab area, where I hand the tech my completed and signed forms. They weigh me, take my temperature, blood pressure, and oxygen. The tech then asks me about my pain level and if I am constipated, both common issues while undergoing cancer treatment. Last, the tech draws two vials of blood, puts them in the machine for processing, and walks me to the exam room. To give you an idea of how big this office is, there are eight doctors and twelve exam rooms.

Everything is very efficient, so I rarely have to wait longer than five minutes before my Oncologist’s PA comes in and hands me the results of my blood panels. I see his PA almost every time I have an appointment, and every other time I am there, I see both my Oncologist and his PA. On Monday, the PA said that everything looks good considering the treatment plan I am on. My white and red blood cell counts are a little low, but nothing to be overly concerned about. My ANC is low again but not too low, so hopefully, it will stabilize as I continue my treatment.

The last part of my appointment is when I go back to the chemo treatment room to get my injections. This is generally the longest part of my appointment because the medicine for my injections isn’t ordered from the pharmacy (which is in-house) until my Oncologist or PA has seen me and approved for me to get my injections, which is determined by my blood panel results. Once my nurse gets the injections from the pharmacy, she warms them because the medication is so thick, so this adds on extra time for me to wait, but it is an important step. Once the injections are sufficiently warmed, I am taken into “The Shot Room,” and I am given my injections which take several minutes due to the amount of medication. I mentioned on Monday that I have a lot less pain and discomfort after my injections if they massage the area after taking the needle out. By massaging the site of the injection, they help the medication disperse quicker. My nurse thanked me for letting her know that info and said she would pass the word on to the other nurses. Patients are often scared to speak up about even a minor issue, and it doesn’t need to be that way. I have learned to be very open no matter how embarrassed I might be because I know that after coming to see my oncologist and his staff for over three years, they want me to be open, honest, and, most importantly, not to suffer in silence if something is causing me issues. So please remember, you are your best advocate when it comes to our healthcare system!

So what is next? I started back on iBrance on Monday after having a much easier time on the lower dose. On July 11th, I will have my PET scan to check the size of my tumors. Hopefully, they will be smaller, which means that the medications are working. On July 18th, I will go back to my oncologist’s office for my monthly appointment and get the results of my PET scan. My husband will go with me on the 18th but not on the 11th. Unfortunately, I am used to PET scans now, so he does not need to go with me.

Take care, everyone!

CT Guided Biopsy

A few days ago, I had a CT Guided Biopsy of my 8th rib on the left side, on my back. Everything went well; I am in a little bit of pain, but nothing that Tylenol can’t help. The doctor instructed me to rest for the rest of the day on Thursday, remove my bandage on Friday, and resume my normal activities.

After finishing my paperwork in the hospital registration office, I went to the lab to have my blood drawn for a few panels; among a few other things, they had to check my kidney function before doing the CT, and after that, I went to radiology to wait to be taken to the pre-op area.

Once my nurse was done prepping me for my procedure, my anesthesiologist came to get me and take me to the CT room. He explained that he would only give me enough medication to make me relaxed and a little sleepy but not entirely out. He said that if I did get sleepy not fight it and let myself fall asleep. I did fall asleep for some of the procedure, but I don’t think it was for very long because the process only took about 30 minutes.

When I walked into the CT room, they had me lay on my stomach on the CT table. I was shocked to find out that the lesion is actually on my 8th rib on the left side of my back, not in the front, and it is very close to my spine, so that has me a bit concerned. The rib that I fractured some 18 years ago, that I was thinking was what was showing up in my scans, was a few ribs down from where the lesion is located, so it has nothing to do with the lesion at all. So with that said, I don’t know what to expect when I meet with my oncologist next Tuesday to get my biopsy results.

I have had many people ask me what I think of all of this, how I am feeling, and what my gut is telling me. I can’t help but see the similarities to the first time I went through cancer three years ago. With every appointment, things get worse and worse, more scans, more biopsies, etc. As before, I want to know what type of cancer I have to fight against, and I want to get started on whatever treatment plan my doctors and I agree on as soon as possible so I can get this over with and move on.

I am feeling OK so far. Even if the lesion on my rib is positive for cancer, it appears to be localized like the tumors in my neck, so it is not as aggressive as it was in 2019, and because of that, I have been feeling much better physically this time around so far. Mentally I am up and down; the stress is unreal because this is the moment as a cancer survivor that I have been fearful of, having to deal with recurrence.

Lastly, what is my gut telling me? I will be shocked if the lesion on my rib is negative for cancer. After reading the PET scan report and looking up a few medical terms that I had not seen before, I immediately thought that it would be a bad result once the biopsy results came in. I, of course, hope that I am wrong, and in a few days, I will know for sure.

Oncologist Appointment & PET Scan Results

I met with my oncologist this past Tuesday to discuss the results of my PET Scan. I was shocked to hear that I have two tumors in my neck, not just one. I found them early, so they are small, 0.9 x 0.5 cm and 0.5 x 0.5 cm. So small, under 1 cm, that they usually wouldn’t have done a biopsy on them, but I had already gone to my surgeon to have the initial ultrasound and biopsy done and had received the results already. I am happy that I took that initiative and went to see my surgeon as soon as I found the tumors so that I found out sooner rather than later that my cancer had returned.

The spot on my rib is still causing concern; it has been determined that it is a lesion that was not on my previous PET Scan in 4/2019. So with the fact that it was not on the last PET Scan and the combination of findings from the recent PET Scan, they are concerned that it is a solitary bone metastasis. My oncologist ended up ordering a biopsy of my rib after our discussion. So next Thursday, I am going to the hospital to have a biopsy of the lesion done. I will have both a local drug and anesthesia for the procedure. The procedure will take about an hour, and I will be in recovery for about 2 hours as they want to keep a close eye on me for bleeding and excessive pain. Unfortunately, I have to go through this biopsy to know if the lesion is cancer or not because it could change my treatment plan if it is positive for cancer, and I then have two different locations on my body with cancer.

Because I am having the biopsy done this coming week, I cannot continue planning with my radiation oncologist at this time. It is good that she now has the images she needed to determine my scope of treatment and if it is possible to treat the tumors in my neck, but the biopsy results could change everything. The lesion on my rib is on my 8th rib, right under my left breast, so as far as I know, it is located in the previous scope of treatment done in 2019/2020.

So my oncologist and I discussed what would happen if I couldn’t have radiation treatment. As far as my neck is concerned, he doesn’t want me to have to undergo surgery, but it is a possibility that I may have to go that route. When it comes to my rib, he didn’t want to speculate on it much. I asked him if it is common for there to be one tumor in one location when it comes to bone cancer, and he said it is unusual but not impossible.

Yesterday my husband remembered that I had pain in my rib several months ago. While we were discussing it, I remembered that I mentioned it to my surgeon when I saw him for a follow-up appointment in September. I pointed to the location of the pain and told him that I felt a bump there as well. When he felt the spot that was hurting me, he said, “that is your rib,” and I told him that I didn’t realize it was my rib because I had never been able to feel my rib so easily when I weighed much more than I do now. He asked if I remembered bumping into something or hurting it somehow, and I couldn’t recall doing anything like that. So I felt it yesterday, and when I pressed on it, it still hurt, and the bump was slightly more significant. So now that I remember that conversation with my surgeon, I am very anxious to get the biopsy done and meet with my oncologist to discuss the results and what will happen next.

I know this might not be common, but it seems that my body will cause me random pain, and then I find a tumor one to two weeks later. It has happened to me three times in a row, so I can say without a doubt that I will never, ever ignore any pain I might have in the future, especially if it is around my bones. My experiences are listed below; I don’t believe that this is a coincidence anymore.

Pain in my lower neck, to shoulder, to the shoulder blade = breast cancer

Pain from my outer ear, up the side of my head, to the top of my head = breast cancer in the lymph nodes in my neck

Pain in the 8th rib under my breast = most likely more cancer, not sure of the type due to location

I will update again next Thursday, depending on how much pain I am in, or Friday about my biopsy. Thank you for being here!

Radiation Oncologist Appointment

A few days ago, I had an appointment with my radiation oncologist. I hadn’t seen her in over two years, so it was nice to see her, but I wish it had been under different circumstances. After we caught up on where we had been, I was finally able to show her the pictures from our vow renewal ceremony, so that was nice, and what we had been doing; we discussed my cancer.

Unfortunately, since the CT of my neck came back clear, she has to wait for the results from my PET scan. She needs to see the exact size and location of the tumor to figure out if she can treat me or not. If there is even the slightest part of the tumor in my previous treatment area, she can’t put me through radiation. I didn’t know that you couldn’t radiate the same area more than once, so we must have clear images to compare from 2019/2020 to today. My PET scan is tomorrow, Friday, and I am going back to my oncologist next Tuesday for the results.

So after my initial appointment, my doctor asked if I could come back in an hour to do some plotting with the tech. I didn’t need to be anywhere, so I said I could come back, no problem. When I came back, they took me to the CT room, measured a few coordinates, and went ahead and marked me with stickers in case I could have radiation soon. When I laid down on the table, my doctor came over and felt where the tumor was, and she said, ” it seems like it is very superficial; that might be why the CT scan didn’t see it.” I hadn’t thought of that being the reason for the clear CT, but it makes sense.

Next, they had me put both arms over my head, which is the position I will have to be in for the radiation treatments. It has been almost three years since my first surgery in April 2019, and it still hurts to have my arms up over my head for any length of time. I have gained a lot of mobility back since that first surgery but not 100%. Because of the pain I am in when in that position, they will make molds for me to rest my arms in so the pain and pressure will be decreased, making me more comfortable. When I put my arms up, my doctor felt the tumor again and said it had dropped slightly in location, taking it closer to the area where I had radiation before; this is not good if I want radiation to be the primary treatment to get rid of the tumor.

So, now we are waiting for my PET scan and the results. What will happen if I can’t have radiation? I am guessing that I will have to have surgery to remove the tumor, but after that, I am not sure. I will be asking my oncologist about that when I see him on Tuesday next week.

Scan Results & My Treatment Plan

So I guess if there can be any good news that goes along with having cancer again, that would be the good news I received today.

There is a spot on one of my ribs in the nuclear medicine bone scan. I am confident that it is from when I fractured my rib ages ago. We need to be sure that it is from my fracture and not more cancer, so I have a PET scan scheduled for next Friday. Something odd is that the CT of my neck came back clear, yet that is where the tumor is located; the CT couldn’t find the tumor that I can feel, crazy! My other CT came back clear, so the cancer is isolated to my neck. I will have to go through radiation, so I have an appointment with my radiation oncologist next Tuesday. She will determine how much radiation I need and if I will need surgery after radiation.

After radiation, I will be put on a new inhibitor because the one I have been on for the last two years didn’t work other than possibly keeping the new cancer from spreading. I will also be going through chemotherapy again, but this time, it will be in pill form, not by infusion, and for at least two years. But the good news is that I will not lose my hair while on the chemotherapy drug.

As far as my diagnosis, I have the same cancer I had before, invasive ductal carcinoma, breast cancer stage 3c. Because the tumor is nearby where the cancer was in 2019/2020, in the lymph nodes in my neck, and it has not spread to my organs, it is still considered breast cancer. Oddly enough, the tumor is on the same side of my body this time as well.

All in all, I am very relieved! I will update you after my next appointment.

I Have Cancer, Again

I received my biopsy results yesterday, and they were positive for cancer. My oncologist’s office called me in the morning and scheduled an appointment right away for today to discuss our next steps.

I was hoping that my oncologist could tell me what type of cancer I have today, but we do not have those results back yet, so I will hopefully know in a few more days. There are a couple of possibilities as far as my treatment goes, but I won’t have a definite plan until scans are done, and the results are back.

On Monday, I will be going to the hospital for a bone scan-nuclear medicine, CT neck with contrast, and CT C/A/P with contrast {ct scan of chest, abdomen, and pelvis.} If there is cancer anywhere besides my neck, we will know for sure once the scans are completed and analyzed.

On Friday next week, I will meet with my oncologist to review the scan results and my treatment plan. I do know that I will most likely have radiation therapy on my neck; anything beyond that will be determined during my appointment.

More to come…

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