One-Year Later

One year ago today I had surgery to remove breast cancer.  Six months ago was my last post. For almost six months I didn't have to think about a doctor's visit.  In January I quit my job to focus on my health.  In February I gave up my apartment so I do not have to keep that job.  In March I set off on a trip to cross off some bucket list items.  In late May I came back, and since I no longer have my apartment, I am bouncing around from place to place - essentially a nomad.  I stayed mostly in Virginia Beach though, as I had to start thinking about doctors' visits all over again.  

I no longer have health and dental insurance through work since I decided not to sign up for COBRA.  I signed up for dental insurance through the VA though.  It is a new plan, so I had to get a new dentist.  Due to insurance reasons, when you switch dentists, they will not do the cleaning on the same day as the initial exam even if you have seen a dentist within the past year.  This means switching dentists becomes a two visit ordeal.  Not to mention waits for some dental offices are many months, it will not be easy to get care elsewhere.  Another annoying reality of the American healthcare system.

I am also getting my healthcare through the VA.  Some initial visits are leading to additional follow-up visits, which is frustrating since I am tired of having to arrange my life around these doctors' visits.  Some of the visits are related to my breast cancer.  This past week I had an MRI and a follow-up with my oncologist and surgeon.  While it all went well, I just felt a like another patient they rush through.  I tell them of my concerns, but they can't do anything about it unless it is severe or something shows up on imaging.  Both doctors' visits were like 10 minutes or less.  It felt like a waste of time.  My surgeon mentioned for the first time though, something called costochondritis, an inflammation of the cartilage connecting your ribs to your breastbone (sternum). As of the moment it seems to be the likely cause of the mystery pain I mentioned in my last post.  There does not seem to be much I can do about it.

Going forward, I must continue Tamoxifen until October 2030.  I started getting side effects over the last few months such as missing periods, hot flashes, joint pain, depression and dry skin.  Most of the side effects come ago.  If I had to guess what triggers them, I would say it is stress, though I can't say for certain.  I suppose I should be grateful my side effects are tolerable, as many women do not tolerate theirs.  Yet, when I think about it, I am not happy at what the radiation treatment and the medication has done and is doing to me.  If I didn't do these treatments though and my breast cancer comes back or progresses, I am sure I would regret not doing them.  

My next follow-up will be in January with a mammogram and blood work for oncology, and another MRI in July.  

 

 

Radiation Fibrosis and Pain

 I have been mentioning pain in my last few posts, so let me summarize the types of pain I have been feeling in my breast and chest:

1. Scar tissue - This pain comes from the scar tissue at surgical sites.  Usually comes when working the muscles near the scars on my outer breasts.  Almost any upper body exercise I do utilize those muscles.  The manual therapy I have been getting hasn't softened the scar tissues as much as hoped.  It does not seem to be uncommon for internal scar tissue to take a long time to heal.  
2. Nerve pain - These are the shooting pains women tend to get after surgery.  Often they are from nerve damage.  I get them a lot in one place, but occasionally will get them elsewhere.  
3. Fibrosis - Over the last few weeks I have noticed that my skin and tissue in the radiated area has thickened and tightened.  Stretching my chest muscles feel like tissue is being torn apart.  
4. Mystery pain - There's an area about the size of my fist in my right chest wall, about 1 o'clock from the nipple.  It feels like someone hit me there with a baseball.  It is more constant than the other types of pain and I find it a little worrisome.  Given my scans were all clear though, the doctors cannot do anything about it.  The hope is it goes away.  

In this post I want to mention radiation fibrosis.  The radiologist never once uttered the word "fibrosis".  Not before treatment, and not even after I mentioned the pain I was having.  Googling tends to return very vague information and a lot of medical journal articles that I don't really discuss things in layman's terms.  What I did find helpful though, were the slew of YouTube videos that discuss radiation fibrosis and how to manage it.  I personally liked the radiation fibrosis videos on this channel: https://www.youtube.com/@breast-cancer-rehab. If you are getting radiation and are not familiar with radiation fibrosis, I would do some research.  I get the feeling radiologists don't like to discuss this with their patients because they don't want to scare them. 

In summary, radiation fibrosis leads to skin and tissue tightening from scarring.  In severe cases mobility can be severely be impacted.  It is important to stretch gently from the beginning to prevent the tissues from losing elasticity completely.  I think exercise also helps get blood flow through the area and promoting better healing.  At least I felt better when I could exercise more regularly than when I'm working.  Massages also help with lymphatic drainage and circulation.  

My case might be considered mild, but the pain is there everyday.  I don't have to take pain killers, but it is uncomfortable and mind my mind is on it often.  All I can do for now is continue with my exercises, stretching, and massages, and then hope that the pain gets better or goes away.  

First Mammogram After Surgery

I had my first mammogram since my surgery in July - almost exactly 6 months ago.  No evidence of malignancey.  I've had a lot of pain though, so they also did an ultrasound.  Nothing found there either except the scar tissue and some skin thickening from radiation.  While I had been worried about the pain, I did not think it was cancer so today's screenings only confirmed what I felt - that I'm cancer free as can be.  I say "as can be" only because there is potential for microscopic cancer cells to be somewhere in my body.  I'm not terribly worried about recurrence though.  I did everything the doctors told me to do, and I am still taking the hormone blocker that will starve any cancer cells left in my body.  What I'm worried more about right now is the damage the radiation did to me.  More on that in the next post.