Tag Archive | Dr. Figura

Graduated From One Doctor

I had my last appointment with Dr. Figura, my radiation oncologist, yesterday. It was just a short check-up. I got my vitals checked first. I never bother to get on my scale at home, because I know I’ll be weighed nearly every week at the Cancer Center. It looks like my weight might be dropping slightly instead of climbing slightly for a change. Then, it’s into the room to meet with the doctor.

A radiation check-up room

A radiation check-up room

Dr. Figura asked me how I was doing (fine), any pain (I’ve got a spot on my shoulder-blade that’s been hurting since radiation. If it gets worse, I’m supposed to let them know), any problems (no), and then into the gown:

The gown I chose was really long and ugly.

The gown I chose was really long and ugly.

Dr. Figura checked over the radiation site and confirmed there were no issues (you can’t even tell where the radiation was at this point) and I was done. It was a short enough appointment I would have felt a little cheated if I had paid my co-pay for the visit. The best news was I don’t have to go back and see him again. I can cross one doctor off my list. I’m pretty sure the other doctors will make sure I don’t miss him.

Time for a boost

I’ve finished my regular treatments and have started the boost treatments to the area immediately around my mastectomy scar. Even though I’m on the same machine, it’s still a lot of changes to the treatment. For one thing, I’ll be treated with electrons instead of X-rays. To do so, they add an additional piece to the radiation machine.

See the tube extending below the green light?

See the tube extending below the green light? The red laser is reflecting off the base of the extension.

At the base of the tube, a square of lead is clicked in place that has the cut-out of the treatment area.

One side of the treatment area

One side of the treatment area

To get the proper shape, a tech has to draw on a glass plate clicked into the base of the tube and trace the outline of the treatment area that’s been marked on my expander. The trick is, you can’t just look straight down and trace because the machine is in the way. Instead, you have to curve your hand in between the metal arms and draw with the shadow of the pen following the line on my skin. Very tricky.

Because of the curve of my expander, the physicist and radiologist have recommended feathering the treatment area, which just means they break it into two halves and rotate the machine to get the proper angle for each dose.

Rotation for treatment

Rotation for treatment

The whole device gets within inches of my expander. The techs traced the outline of the treatment area onto my skin from a template developed at the beginning of the treatment, and then line up the light projecting through the metal piece with the tracing. Unfortunately, they couldn’t get the cut-out to line up with the marks on my skin. It seems that my expander has shifted slightly, so they needed to recut the metal to match my new contours. It took the two techs, the physicist, and Dr. Figura about 15 minutes to come to that conclusion, with my lying there with my arm in the torture device arm-holder the entire time.

I had three options at that point – I could stick around while they made a new metal piece (nope, sorry, have to be somewhere at 9), I could come back later that afternoon (before 1:30? No? Then sorry, have to pick up my kids from a class), or I could add another treatment day where they just make up the one treatment. Seems like I have to go with option C. That means I’ll be ending next Tuesday instead of Monday. Even if it adds another day, I’m down to counting on one hand the number of days I have left.

Oh, the Itchiness

One week left of radiation, and that will be focused specifically on my scar area. That’s the good news. The bad news is that apparently, I’m allergic to radiation. That’s the explanation Dr. Figura gave me this morning during my weekly visit to explain why the skin in my treatment area is just completely covered in bumps.

A taste of what my skin looks like.

A taste of what my skin looks like.

It started Friday morning on the underside of my expander and has grown to include the entire treatment area, plus a little bleed into the surrounding skin and up my collar-bone. The worst of it is the whole area itches, pretty much constantly. Dr. Figura’s suggestion was to keep it moisturized, but it isn’t itching because it’s dry. If I don’t touch the area, it’s not too bad, but my clothes rub and once I start itching, it’s so hard to stop. Sometimes I put moisturizer on just so I have an excuse to rub the area.

Sadly, itchiness is much harder to treat than peeling skin, but Dr. Figura did mention he had some medication that may help. I’ll be asking the nurse about it tomorrow morning, you can be sure.

Half my doses are done!

I found out yesterday that it was the last day for my second set of radiation doses. I won’t be getting any more treatments to the area around my clavicle. That means I’m down to just two doses a day, both centered around my breast. I’m happy to be done with even part of my treatment.

I will admit the upper part of my expander has been irritated lately. Dr. Figura is pleased with how the skin looks, but even so it’s pink and sore and itchy. I almost wish it was warmer so I could not wear any clothes over the area. The advantage of it being winter is I can wear lots of layers and the size difference between the expander and my breast isn’t as noticeable. The disadvantage is there’s always something rubbing on my skin. I tried something different yesterday and wore a snug-fitting T-shirt under my warm clothes to hopefully decrease the rubbing. It seemed to help. The nurse suggested cortisol cream to help with the itching.

gollieI have been following the recommendation not to wear a bra so as to minimize further irritation to the area. That works as long as I’m not going out in public. Then I wear a bra because the size and height difference between the expander and my other breast is highly noticeable. The downward slant is what bothers me most. StatsGuy came up with nicknames for the pair of them – Bink and Gollie, after the book series by the same name with two friends of completely unequal size.

Someday I’ll get the expander removed. I need to finish radiation first. Soon!

General discomfort

It’s three weeks into radiation, which is when side effects often start to appear. I’ve got nothing too bothersome going on, just some minor annoyances. I have one patch of dry skin high up on my chest. The location was really confusing me, since it’s not really even in the radiation area. Dr. Figura cleared up the confusion for me this morning, though, when he asked if it was where I had a sticker. That explains it exactly! It’s even a round patch of dry skin. I am faithfully slathering on moisturizer twice a day to the whole area, so hopefully the dry patch shrinks quickly and nothing else appears.

The other annoyance is the skin and muscle getting irradiated are tightening up. The physical therapist warned me this could happen, so I’ve been stretching the area whenever I think about it. It feel worst first thing in the morning, and I feel it mostly in my armpit.

I have been using my Swell Spot on a weekly basis. I think the radiation encourages the buildup of fluid around the expander and in my armpit. I don’t appreciate stretching my arm out in front of me and feeling the expander rub on the inside of my arm. It gets in the way when I drive as well. As I said, nothing too horrible, but definitely annoying.

Radiation routine

Radiation has quickly moved into a routine. Every day goes something like this:

  • I get to the Cancer Center
  • Scan my card and sit for a minute (I usually don’t even have time to check my email. I’ve stopped bringing my book, they’re so fast getting me in.)
  • Head back to my room
  • Lay on the table, with my arm in the horribly uncomfortable braces, and a pad under my knees. I keep waiting for my shoulder to stop hurting or my fingers to stop going numb. Hasn’t happened yet. On a good note, I have nailed the perfect place for my head.
  • The techs scootch me over a bit here and there so I line up perfectly
  • Four scans – one below, two on top, one farther below. The two from below need a wedge of metal in the X-ray machine to direct the radiation correctly, so the techs have to come in after the first scan and before the last scan
  • I’m out of there within 15 minutes

There are a couple of differences, depending on the day. On Monday, Wednesday, and Friday, I get a bolus of fake skin put over my chest for the first two treatments. This allows the radiation to target closer to the surface of my skin. Once a week I get X-rays to make sure everything’s still lining up. Once a week I see Dr. Figura, just to make sure there are no problems (none so far). I will occasionally get a dosimeter put on to make sure I’m getting the correct dosage.

All in all, a quick process on a daily basis. It just takes forever to be done with the whole treatment to be done.

Radiation simulation

After I picked up my lymphedema sleeves, it was off to the Cancer Center for the first step for radiation treatment – the simulation. I needed a CT scan of my body (called a simulation) so the radiologist (Dr. Figura) can develop a radiation setup that is specific to my morphology.

I like CTs much more than MRIs because they’re quiet and I didn’t even need an injection for this one. I had a choice of a couple of gown patterns and saw a new one:photo(11)

Not too bad, compared to many of the others I’ve had. Once I was gowned up, I went into the CT room. The tech had me lie down on the table, with my head resting on a flat, not-so-comfortable cushion and my arm held over my head. She added a wire sticker on my mastectomy scar so the scar’s location would show up on the scan. There was a series of lasers shining down from the ceiling that I was lined up with and sent into the CT. Five minutes later, I slid out of the CT machine, easy enough.

Even when the CT was over, I wasn’t quite done. The tech asked me to lie still on the table while she marked the laser lines on my body with blue Sharpie. Dr. Figura also came in and drew a series of marks on and around my scar. The plan is to get 28 treatments on my chest, and then five extra concentrated around the mastectomy scar. The tech had to transfer the Sharpie marks from my inflated breast onto tracing paper. At least she didn’t have to worry about the tissue squishing around while she drew since there’s no give on the expander at this point.

I got some special clear stickers placed over the marks on my chest and told to be very careful not to wash or pick them off. If it looks like any are going to come off, I have to go back to get the sticker replaced. Needless to say, I’ve been careful with them so far.

Notice some of the radiation guide marks.

Notice some of the radiation guide marks.

By the time I got off the table, my arm was killing me. My armpit didn’t really appreciate stretching like that, but the worst was the cramping in my shoulder muscles. I was told I’ll have one more marking session (with the opportunity to exchange the Sharpie/sticker combo for tiny tattoos) that will last a half an hour. The tech recommended some Tylenol to help with the pain, but I might use one of the Valium I have left instead.