Tag: therapy

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August PET Scan Results

I apologize for not writing a post sooner. Up until a week ago Monday, not much has been going on. All of my blood panels have been looking normal, well, for me anyway, with the typical rise and fall of my white and red blood counts and my ANC.

On July 10th after I went in for my regular monthly appointment with my oncologist I was feeling so good and energetic that I went home and worked out for the first time in ages. Now it is a month later and I am still working out and other than some intense fatigue last week, I have been feeling well and like I have completely recovered from the radiation treatments.

On July 31st, I had my PET Scan to see if the radiation treatments effectively treated the lesion on my rib in my back. I had the scan a month later than usual to give my body time to heal from radiation. I saw my medical oncologist on Monday this week for my regular appointment and to get the results of my PET Scan. The results are not the worst news, but not the best news either, but something in between, so I will do my best to explain what the results are and what they mean. {oddly enough, the doctor that read my scan and wrote the report is the wife of my medical oncologist}

As far as the lesion on my rib in my back is concerned, the report said that “there is increased sclerosis of the left eighth posterior rib with decreased FDG {fluorodeoxyglucose} uptake, SUV 2.0, previous SUV 4.2. Findings suggest favorable treatment response, with reported interval radiation therapy.” So, the lesion is still there, but its activity is less than half of what it was in the March PET scan. Increased sclerosis is a sclerotic lesion that is an unusual hardening or thickening of your bone. They can affect any bone and be benign or malignant. In general, they’re slow-growing.

I have never had any mention of my lungs until now. I have a “new ground-glass opacity in the posterior lower left lobe that measures 3.0 x 1.9cm and is adjacent to the left eighth rib metastasis. Given the interval development and radiation therapy, this is favored to reflect radiation pneumonitis/fibrosis.” Pneumonitis/fibrosis refers to the signs and symptoms of soft tissue injury resulting from radiation therapy. All soft tissues within the radiation field can be affected, including skin, connective tissue, muscles, nerves, and blood vessels. At this time, it is believed that this is just scarring from the radiation therapy, but my doctor will keep an eye on it. The activity SUV of this spot is 2.6, which is within the range of where my body runs, so hopefully, it will stay that way.

Now for one of the more serious findings from my PET scan. “Subtle new FDG avid lesions in the T8 spinous process, SUV is 2.1 and left S2 segment, SUV is 2.2; worrisome for new osseous metastases.” S2 is located at the level of the posterior superior iliac spine. S2 covers the back of the thighs. What does osseous metastasis mean? Bone metastasis occurs when cancer cells spread from their original site to a bone. Nearly all types of cancer can spread (metastasize) to the bones. But some types of cancer are particularly likely to spread to bone, including breast and prostate cancer. The good news with this finding is that the SUV in both areas is below where my body runs, so just as with the spot on my lung, they will keep a close eye on both sites and see if the activity increases.

The last finding in the report is “Increased FDG uptake within a left supraclavicular lymph node measuring 8 x 15mm. SUV 2.9, previously 2.2.” FDG uptake reflects the tissue glucose metabolism and is usually high in high-grade tumors and relatively low in low-grade tumors. Supraclavicular lymph nodes are lymph nodes found above the clavicle, which is where I had the first two small masses in my neck in February 2022. My understanding was that after my first month on iBrance, both tumors were dead and gone leaving a little bit of scar tissue behind, which I can’t even feel anymore. So this is another area that will be watched closely in the coming months.

I know that this was a lot of information and it certainly was not what I expected to see when my oncologist handed the report to me. We talked about possible changes in my treatment and that there are other drugs that he could put me on should my next PET scan show any increase in activity in the areas that we are watching. He would change my medication because an increase would indicate that iBrance and Faslodex are no longer working. He reminded me that eventually my body will adjust to the current medications and that we will have to make changes. For now I am continuing forward with iBrance and Faslodex until my next PET scan which will be in November.

I wish I had more positive news from this last scan but as I have said many times in the last 4 years, cancer is tricky and in my case it is aggressive, so my doctors and I have to be just as aggressive with my treatment. My oncologist says that cancer is very humbling, and that is so true. Cancer doesn’t care if you are rich or poor, the picture of health or sickly, young or old. If you ever feel a bump that wasn’t there before, you have pain that will not go away, you are constantly tired even with a lot of rest and good sleep or you just don’t feel right; please go see your doctor and find out what is going on. Your body talks to you, you just have to learn to listen.

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Recent Appointments

Soon after my last blog post, I went on vacation with my husband to celebrate our 19th anniversary, relax, and try to make more progress in my recovery from radiation. We had a wonderful trip, but it was unseasonably hot, so the heat affected me much more than usual because I was nowhere near 100% during our trip. So, when we arrived home, I wasn’t any further along in my recovery than before we left.

Martha Brae River in Jamaica

Two days after we returned from our trip, I had an appointment with my medical oncologist for my regular 30-day blood panels and injections. I was happy that my blood panels showed that my white and red blood cell counts had improved slightly and that my ANC was in the normal range for the first time in a while, recording at 1.7. My numbers did not match how I was feeling, but it showed me that I was making progress.

We discussed my next PET scan and when I should have it. Because I could have extra tissue where the tumor was located on my back, the tissue could look like the tumor is still there if we scan too early. I also had very intense radiation, so he did not want to expose me to more radiation so soon. So, we are delaying my scan by one month, meaning I will have it in early August vs. early July. It’s hard enough to wait every four months for my regular scan, but adding in a month makes it even more difficult, so I do my best to stay busy and not think about it.

Because of the timing of my trip, I went to my appointment a week late, so we discussed where I was in the month with my meds and what made sense as far as getting me back on track. Because my blood panels looked good, well, at least for me, they were good; my doctor decided I could wait and come in another six weeks. So my next appointment won’t be until July 10th. As usual, he reminded me that I could call at any time and come in to see him if I was having any issues.

My next appointment during the same week that we returned from our trip was a few days after seeing my medical oncologist when I saw my radiation oncologist. She looked at my back to see if I had any indications of skin irritation and at the location of my treatments for the same. My skin looked normal and clear, so that was good to hear. She couldn’t help but joke about the tan line on my back, saying everything looked great, especially my tan line.

I told her I still had some irritation in my esophagus when I drank liquids but that the pain from eating solid food was gone. She explained that my esophagus would take a while longer to heal and to take pain meds if needed, but I was definitely toward the end of feeling the discomfort. She asked when my next PET scan would be so we could see the results from the radiation treatments, and I let her know that it would not be until early August. I told her I would call her office once my PET scan is scheduled, which should be when I see my medical oncologist on July 10th. And with that, my appointment was over, and the only reason I would go back to see her would be if I needed radiation treatments again.

I am expecting things to be pretty quiet while I continue to recover and wait for my next appointment in July. I am feeling better as the weeks go by, and time has been flying by, which also helps quite a bit. I can’t believe it has already been seven weeks since I finished radiation. I was told that it could take up to six to eight weeks to recover, so I am near the end of that time frame now and feeling better with each passing day.

Once I am through my recovery, I hope to post more often and go back to not only updating about how I am doing but also passing on valuable information to everyone interested and especially to both cancer patients and their caregivers. I have found many articles that have helped me get through my challenges with stage 3c breast cancer in 2019 and, more recently, in 2022, stage 4 metastatic breast cancer. As always, thank you for being here, and take care!

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My Radiation Experience

I have been quiet recently, but I have been that way with everyone, not just the wonderful people who follow my blog. I emailed my family updating them on how I was doing, and my cousin said he was just about to ask me. I wrote back, and I told both he and my other family members the following, and I think this explains it as best as I can.

“It is hard to explain, but when I am having the difficulties I was having, and still am, with trying to recover from the treatments, it is hard to write about it. Everything with cancer is physical and mental, and at times, the mental is the most challenging part to deal with. When I got to my last three radiation treatments, I was in tears and telling my husband that “I didn’t want to do this anymore.” I went through the same thing when I got to number 12 of 16 chemotherapy infusions. It is so hard to see what the meds, treatments, infusions, etc…are doing to your body, yet you have little to no way of controlling anything. Sure, you can fight the side effects, but that is generally done with more medication, and sometimes, that’s the last thing I want.”

So, I have been working on recovering from 10 potent radiation treatments, and it has not been easy. This coming Wednesday will be three weeks since I had my last treatment. My radiation oncologist said that the radiation would continue to work for three weeks after treatment ends, so I hope to start feeling better later this week.

About halfway through my treatments, I started dealing with very severe fatigue. Even the simplest tasks would tire me, so I had to rest as much as possible. I asked one of the techs one day if my radiation dose was more potent than what I had in 2019, and she confirmed that it was. Generally, when you have 10 treatments vs. 25, the amount is more concentrated so that there are fewer treatments, two weeks vs. five weeks.

Along with the fatigue, I had some painful side effects. My whole body started hurting all of the time, and sometimes Extra Strength Tylenol was strong enough to ease the pain, and sometimes it was not. When it wasn’t strong enough, I had to break into my hoard of oxycodone I had left over from my surgeries, which seemed to help. I was also getting headaches, I was dizzy at times, and worst of all, I had pain when I ate.

My treatment was done from the front to the back, meaning that even though my tumor is on the 8th rib in my back, I was lying on my back for treatment. My tumor is also about one inch from my spine, so that is a big reason why I didn’t have surgery. I didn’t think about the tumor’s location with other body parts because I just wanted the tumor to die. 

My radiation oncologist told me that I might have pain when eating but that it would start towards the end of treatment and should stop pretty quickly once treatment was over. I asked her why, and she said my esophagus was close to the treatment area. I hadn’t thought about anything like that, so I was shocked. Sure enough, on the weekend before my last three treatments, I started having pain when eating. At first, it wasn’t too bad, but by the time I reached my last day of treatment, it was excruciating.

On the last Monday of my treatment, I had an appointment with my medical oncologist before my radiation treatment. He asked me many questions about how I was doing with the treatment and my side effects. He is an entirely different type of oncologist, so he is always curious to know how patients tolerate other types of treatment. When I explained my pain when I ate, he immediately asked me if I wanted to have him prescribe oxycodone. I have often read about patients needing pain medication and being denied because there is such a massive issue with addiction. I didn’t think for a second that my oncologist would tell me no because he knew that oxycodone scared me. So I now have more of that medication than I need because he always prescribes 90 pills, but it is helping me with the pain I have when I eat, and so far, just one a day has been enough.

On June 1st, I have a follow-up appointment with my radiation oncologist. She will chat with me to ensure I have no issues with my recovery. When I was discharged from my treatment, she told me it would take 3 to 6 weeks to recover from the radiation treatments. When I see her for my appointment, I will be at five weeks since my last treatment and hopefully feeling much better.

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Radiation Treatments 1 & 2

First, I want to let you know that I do not have any pain in the area where I have my radiation treatments. A lot of people assume that I have pain during and or after treatment and I do not. I do not have any burns or irritated skin either. According to my radiation oncologist I should not experience any of the above.

I received my schedule on Thursday when I went in for my first treatment and the final part of the SIMs appointment. My doctor had told me 10 to 14 treatments, so I was happy that she decided on 10. So my first treatment was a few days ago on Thursday, and my last treatment will be on April 26th. I go in every weekday, Monday through Friday, with weekends off.

Thursday was rough. It was a longer appointment because they had to x-ray me and finish plotting for the coordinates to set the machine for my treatments. I had to have both arms up over my head for that whole process which was almost an hour. By the time they were done, I was crying because the pain was so bad in my left arm. It felt like my arm was being ripped out of the socket. I tried so hard not to cry, but the pain was unbearable. I was so embarrassed, and I apologized to the techs; they were very kind and stayed with me and rubbed my back to try to get me to calm down. I don’t remember it hurting that much when I went through the same process in 2019, so I was shocked that the pain was that bad. Luckily the pain didn’t last long and went away about an hour after I got home.

On Friday, my arm hurt again because it went through so much on Thursday. It seems like they are taking longer to get everything set up once I am on the table. They are not only setting the machine for my coordinates, but they are also moving me around so the markers on my body line up as well. Luckily with all of the plotting out of the way, I only have my treatment when I go in now, nothing extra from here on out except a visit with my doctor each Monday.

I’m sure when I return on Monday for treatment #3, I won’t have any more issues with pain. I will try to keep my movement as limited as I can in my left arm over the weekend. The excessive pain I am experiencing is only in my left arm and that is because I had 18 lymph nodes removed from under my left arm during my cancer removal surgery in April 2019. I realize that it has been four years since that surgery but when there are that many lymph nodes removed there are multiple nerves that are cut and disconnected, so at least in my case, I have never regained full mobility and I am still numb in the upper part of my arm over to half of my breast. I have learned to live with the numbness over the years. I can feel pressure but that is all, so it took awhile for me to be able to find the right pressure to shave under my arm and not cut myself. In my opinion it is a small price to pay for my surgeon saving my life and me being alive today.

As always, thank you for being here and supporting me. 💕

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B12 Shots


When I saw my regular doctor last Wednesday, we had some time to sit and chat, which was nice. This doctor prescribes my diabetes meds and keeps track of my general health. Today he took some blood to check my A1c and to run a panel for cholesterol, liver, kidneys, etc., things that my oncologist doesn’t look at every month.

We discussed my fatigue and depression, and he suggested I get B12 shots. He told me to look it up online when I got home, and if it is something that I want to do, to call my oncologist and ask if I can have B12 shots while on iBrance and Faslodex. I have been suffering for months, so I am willing to try anything to feel better and not so disconnected from myself.

There is an overwhelming amount of information about B12 online. Some of the data is favorable, and some is not, depending on your general health and reason for taking B12. My doctor has had very positive results with his patients who are suffering from both fatigue and depression like I am. B12 shots will not interfere with iBrance or Faslodex, so I decided to go ahead and try them, hoping to improve my overall well-being. Today I had my first shot, and I will have four more over the next month.

A healthy intake of B-12, whether in a normal diet, through a supplement, or via injection, can help a cancer patient recover. It can also help reduce the risk of cancers in healthy people. In most cases, the body only absorbs the amount of B-12 it needs and naturally discards the rest.

I will keep you updated on my results over the next few weeks.

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2nd PET Scan and Information About PET Scans

I had my second PET scan on Friday since starting iBrance and Faslodex. I wasn’t nervous about the scan; that part is relatively easy; it’s the uncertainty and having to wait to see my oncologist for the results that is the most difficult part. I also deal with pain during my scan because ever since my first surgery in April 2019, I have had pain when raising my arms over my head, which can become very uncomfortable when I have to stay still in that position for more than a few minutes.

Unfortunately, PET Scans are not as quick and easy as getting X-rays. From checking in to registering, going through the scan process to leaving, I was there for 3 hours. I go alone to the appointments because my husband can’t go back with me while I am being scanned, so it doesn’t make sense for him to be there. He goes with me to my oncologist appointment after my scan, so he will be with me when I get my results. I never know what to expect, so it is comforting to have him with me, no matter what the results turn out to be.

Until I faced breast cancer in 2019, I had never had surgery, a biopsy, a CT Scan, a Bone Scan – Nuclear Medicine, or a PET Scan. I have learned so much in the last three years and eight months about things I wish I had never had to experience. I share as much information as I can with my readers because I want you to not only understand what I have been through and what I am going through now as a stage 4 metastatic breast cancer patient but also to help those who are going through the same journey. It is terrifying when you don’t know what to expect, and you are overwhelmed with information. I try to make it a little easier for those interested in getting the information needed to help themselves through whatever they may be facing or helping a friend or loved one through a difficult time.

What is a PET Scan?

A positron emission tomography (PET) scan is an imaging test that can help reveal the metabolic or biochemical function of your tissues and organs. The PET scan uses a radioactive drug (tracer) to show both normal and abnormal metabolic activity. A PET scan can often detect the abnormal metabolism of the tracer in diseases before the disease shows up on other imaging tests, such as computerized tomography (CT) and magnetic resonance imaging (MRI).

The tracer is most often injected into a vein within your hand or arm. The tracer will then collect into areas of your body that have higher levels of metabolic or biochemical activity, which often pinpoints the location of the disease.

Why it’s done

A PET scan is an effective way to help identify a variety of conditions, including cancer, heart disease and brain disorders. Your doctor can use this information to help diagnose, monitor or treat your condition.

Cancer

PET scan combined with CT scan

Cancer cells show up as bright spots on PET scans because they have a higher metabolic rate than do normal cells. PET scans may be useful in:

  • Detecting cancer
  • Revealing whether your cancer has spread
  • Checking whether a cancer treatment is working
  • Finding a cancer recurrence

PET scans must be interpreted carefully because noncancerous conditions can look like cancer, and some cancers do not appear on PET scans. Many types of solid tumors can be detected by PET-CT and PET-MRI scans, including:

  • Brain
  • Breast
  • Cervical
  • Colorectal
  • Esophageal
  • Head and neck
  • Lung
  • Lymphatic system
  • Pancreatic
  • Prostate
  • Skin
  • Thyroid

Heart disease

PET scan image of the heart

PET scans can reveal areas of decreased blood flow in the heart. This information can help you and your doctor decide, for example, whether you might benefit from a procedure to open clogged heart arteries (angioplasty) or coronary artery bypass surgery.

Brain disorders

PET scans of the brain for Alzheimer's disease

PET scans can be used to evaluate certain brain disorders, such as tumors, Alzheimer’s disease and seizures.

Risks

For your PET scan, a radioactive drug (tracer) will be injected into a vein. Because the amount of radiation you’re exposed to in the tracer is small, the risk of negative effects from the radiation is low. But the tracer might:

  • Expose your unborn baby to radiation if you are pregnant
  • Expose your child to radiation if you are breastfeeding
  • Cause an allergic reaction, although this is rare

Talk with your doctor about the benefits and risks of a PET scan.

How you prepare

Tell your doctor:

  • If you’ve ever had a bad allergic reaction
  • If you’ve been sick recently or you have another medical condition, such as diabetes
  • If you’re taking any medications, vitamins or herbal supplements
  • If you’re pregnant or you think you might be pregnant
  • If you’re breastfeeding
  • If you’re afraid of enclosed spaces (claustrophobic)

Your doctor will give you detailed instructions on how to prepare for your scan. A general rule is to avoid strenuous exercise for a couple of days before the scan and to only drink water after midnight before the day of the scan.

What you can expect

The PET-CT or PET-MRI scanner is a large machine that looks a little like a giant doughnut standing upright, similar to CT or MRI scanners.

From start to finish, the procedure takes about two hours to complete and typically does not require an overnight hospital stay. When you arrive for your scan, you may be asked to:

  • Change into a hospital gown
  • Empty your bladder

A member of your health care team injects the radioactive drug (tracer) into a vein in your arm or hand. You may briefly feel a cold sensation moving up your arm. You rest and remain silent in a reclining chair for 30 to 60 minutes while the tracer is absorbed by your body.

During the procedure

When you are ready, you lie on a narrow, padded table that slides into the part of the scanner that looks like a doughnut hole. During the scan you must be very still so that the images aren’t blurred. It takes about 30 minutes to complete a PET-CT scan and 45 minutes for a PET-MRI scan. The machine makes buzzing and clicking sounds.

The test is painless. If you’re afraid of enclosed spaces, you may feel some anxiety while in the scanner. Be sure to tell the nurse or technologist about any anxiety causing you discomfort. He or she may give you a drug to help you relax.

After the procedure

After the test you can carry on with your day as usual, unless your doctor tells you otherwise. You’ll need to drink plenty of fluids to help flush the tracer from your body.

Results

A doctor specially trained to interpret scan images (radiologist) will report the findings to your doctor.

The radiologist may compare your PET images with images from other tests you’ve undergone recently, such as MRI or CT. Or the PET images may be combined to provide more detail about your condition.

I hope this explanation of PET scans helps you to understand what is involved and what cancer patients go through as a regular part of their care. Depending on the type of cancer and the treatment plan, most cancer patients are scanned every three to six months. I am scanned every four months because my cancer, in both 2019 and currently, has proven to be aggressive, so my oncologist feels that every three months is too often, but every six months is too long between scans, making both him and me nervous.

I will post again once I have my results, but in the meantime, if you have any questions, don’t hesitate to get in touch with me. Thank you for being here! 💕

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