Still Healing....

Since my last post, the chest pain got better after scaling back on exercise the chest area.  I haven't needed pain meds.  I still got the CT though, which showed couple of nodules in the right lung, but apparently they are two small to do anything about and I was told not to worry about it since I have no risk factors for lung cancer.  The surgeon also wanted to me to keep exercising my chest muscles since the scar tissues attached to them need to be stretched out. I also had my 3 months follow-up with the radiation oncologist and she also said I needed to stretch the chest muscles daily... possibly for the rest of my life.  Right now I still have the pain around the deep tissue scars near the surgical sites.  My radiated breast is also pretty tender, and when I stretch, it feels like tissues in my breast are tearing. It's worrying that my healing is going a lot slower than everyone expects.

On the bright side, my fatigue has improved.  I don't feel quite as tired these days and have been having more good days.  My boyfriend was sick for good part of December though, and I did at times feel like something was coming on, but by the next day I was feeling better.  I was really worried about getting sick since I got sick a lot this past year and a half, and each time it took weeks for me to recover.  I just really did not want to go through anything like that now after the year I had, and with the holidays and all.  

In late November and early December I did end up taking couple of FMLA days for my fatigue, but by end of the month I was putting in a full 40-hour week.  Although I managed, I did find it somewhat tiring, and I didn't like that it interfered with my workouts.  I still exercised 3-4 times a week, but not as much as I would have if I wasn't working.  I definitely felt a lot better when I wasn't working.  I had been thinking a lot about quitting my job to live life more the way I want to.  I was originally thinking of quitting in February or late January.  Now that I'm realizing how much better I feel on my days off, I'm now thinking about putting in my two weeks notice on Monday.  It's a scary thought, since I have a mammogram on January 7th and there's no guarantee I'll be in the clear.  Quitting now means I'll be paying $800+ a month for health insurance with no income, and I lose my short and long-term disability insurance.  I put in my 60-day notice to my landlord though, so I am also losing my home.  I don't want to stay in my expensive apartment too long if I am unemployed.  By March, I want to be free to go whereever.  I just hope my January scans don't mess up my plans.

Fatigue and Chest Pain

6 months since diagnosis...

4 months since surgery...

6 weeks since last radiation treatment...

4 weeks since starting Tamoxifen...

2.5 weeks back at work...

Towards the end of my medical leave I was starting to feel better and things were looking up.  Then I started working again and things took an abrupt turn for the worst.  If I had any fatigue when I wasn't working, it wasn't noticeable.  Since starting work though, I became much more fatigued.  Is it possible to be this tired from 8 hours at a desk job?  I can barely get through my work day and by the time I'm done I don't have energy for much else.  On the weekends after my long morning walks, I end up in bed for a few hours - too tired to do anything else.  There was at least one day where I had to take the day off of work.  There were many more days I wished I could rest.  

The fatigue was one thing, but I also started developing chest pains on the cancer side. This wasn't coming from the surgical sites.  It felt more muscular, in the chest wall.  It was isolated to the upper left quadrant of the right breast - not too far from the heart.  The pain was a dull ache that felt like pressure on my chest on one side.  It started about a month ago but it was mild then.  Now it is getting very uncomfortable and worrisome.  I reached out to all of my doctors.

The surgeon thought it was inflammation from the radiation.

Oncology suggested getting an EKG and going off of Tamoxifen for couple of weeks to see if it helps with the fatigue.

Radiation oncology didn't think it was radiation related.  Told me to take anti-inflammatories and rest more.

The PCP wants to let my cancer team handle this since it's probably related to the treatments.

I decided to take oncology's advice and stopped Tamoxifen yesterday.  Then I went to a walk-in facility and got an EKG, Tropnin (heart enzyme) test, and chest x-rays.  All were normal so thankfully it was not a heart issue.  It was getting to a point where I needed to have some relief, so I popped a few ibuprofens.  After some time, I started to feel better.  I was also sleeping pretty well until a smoke alarm started beeping due to low battery.  I had to get up and rip the alarm off the ceiling and pull the batteries out so it would shut up.  Then I couldn't get back to sleep.  But I digress.

Anyway, I will be popping ibuprofen for a while and cut back on my exercises.  On the 21st I have a CT scan so hopefully I'll have a better idea of what is going on then.  If I'm lucky I'll feel better by then, but it seems inflammation can take weeks or months to heal.  I really don't think I can go on like this for months.  

Back at Work...

Well, the inevitable happened and I am back at work as of this week.  There were some changes at work while I was gone, but nothing big so it was pretty easy to get back into.  The only problem was that I did not sleep well the first couple of nights.  I'm not quite sure why and whether the stress of being back at work caused it.  My goal at work now though is to not stress too much and take it a little easier.  There's no need for me to be an overachiever.  Unfortunately I do like a lot of what I do and I can sit at my desk for hours focused on work, even though I should be taking frequent breaks and moving my body.  I've also been having a hard time getting up in the mornings early enough to go to the gym, so I only made it once.  I did on another day leave work a little early because I needed some outdoor walk time at the garden.  I miss being able to go like I used to.  I still have a lot of appointments here and there tho so it's also a little tough to have to work those in.  Overall, it wasn't a bad first week.  Despite enjoying what I do though, I do prefer to be doing something else with my life.  I especially miss being more active.  Right now I don't have the energy to be as active as I want to be while working, but maybe in time.  I also miss the slower pace of life where I am not having to rush around to get things done, or to sleep in if I don't sleep well or am not feeling well.  Early retirement is still heavily on my mind.

Physical Therapy Sessions 1 & 2

The first couple sessions of physical therapy was pretty nice.  Unlike other treatments that harm your body, this one only helps heal.  Both of my breasts get a massage and cupping (something like a miniature version of ones they do on backs) for a total of 40 minutes to help break down the scar tissues.  There's also a little massaging of the lymphatic system to help drain fluids.  The first session was quite gentle and the therapist was careful to back off when there was pain.  In the second session it was a different therapist and she worked the scars a little harder.  When I winced in pain she acknowledged it with "I know, I know" like she was soothing a child, but didn't really ease up too much.  It was tolerable though, and I'm really looking forward to getting these scar tissues broken down.  I have one or two appointments a week for the next 4-6 weeks so looking forward to seeing some improvements.

Physical Therapy Consult

Three and a half month out of surgery but the internal scar tissues haven't improved (at least to the extent I can tell) and there is still pain when I lift weights or do anything that stretches the scar tissues.  The surgeon sent a referral to a physical therapist to see if they can help.  The initial consult appointment was today.  

The physical therapist examined my scars and tested my range of motion.  My range of motion is mostly fine.  I've been doing some tai chi and qi gong here and there so that likely helped.  But to address the pain and a bit of swelling on the left, the recommendation was getting massages in the area to help with breaking down scar tissue and lymphatic drainage.  It seems on the left, the scar tissue may be blocking that drainage, and thus preventing the swelling from going down.  I was given snippets of textured foams that I could insert into my bra that would help massage the scar tissue when I move my arms.  I was also able to schedule some appointments to get the area massaged professionally.  They would also teach me how to do it so I can do it on my own as well.  I was looking forward to getting a break from doctors' appointments, but I really want the scar tissue to heal and pain to go away sooner rather than later.  Hopefully these physical therapy appointments will help.

Radiation Follow-up & Debrief

Almost 4 weeks out since my last radiation treatment, the skin is doing much better compared to few weeks ago.  Much of the pain is now gone, and there's just the occasional irritation that feels like a band-aid being peeled off in places, particularly in the back where the skin got exposed to the sun because I wasn't made aware the treatment area would extend so far back.  There's is still discoloration of the entire treatment area, with the worst of it being under the arms.  It could take years for the skin to return to normal, or may never return to how it was before treatment. In any case, the radiation area isn't bothering me as much now and I am having more good days mentally and physically.  I still had a follow-up scheduled though so I went.

Today's appointment was supposed to be a skin check after getting burns from radiation treatment.  My usual nurse was out sick though so I spoke to someone who didn't seem to specialize in breast radiation.  She didn't actually check my skin, and I didn't really feel like waiting around for a doctor since I felt like my skin is getting better.  The main take away from the debrief I also got was that I need to minimize sun exposure to treated area by using sunscreen SPF 50+ for life.  Good thing I am not a beach person, but I am going to have to be careful being outdoors in tank tops and such.  Yeah, it is a little thing, but there are many of these "little" things and also many big things as a result of going through cancer treatment.  

Aside from the sunscreen warning, I was told I can start using deodorant if it doesn't irritate my skin.  I can also swim and take hot baths eight weeks after last treatment if I'm healing ok.  

The usual process for most folks is to do a telehealth call with the provider a month after the last treatment.  The nurse suggested I go ahead and schedule that call even though I was here today, in case additional questions come up. The doctor still owes me some help in removing the radiation tattoos so I'll bring that up on the call next week.

3-Months Surgical Follow-up

It's been just over three months since my bilateral lumpectomies and there is still pain at the surgical sites on both breasts from scar tissue, or fat necrosis as the surgeon called it.  I am still not climbing or running due to surgical pain, and I'm not swimming due to radiation.  The pain is almost daily, though not all day long. It's worse when I do weight training but hurts even when I don't. The surgeon ordered an ultrasound prior to the follow-up and confirmed that there were no fluid build up that could be drained or other issues.  Although I do seem to be taking longer to heal than expected, she did not think the size of the scar tissue was bad.  She will refer me to a physical therapist at the cancer center to see if I can qualify for a vest that will massage my breasts, which will help break down the scar tissues faster.

My next follow-up with the surgeon is in January.  We will do a mammogram first and then discuss results in that appointment.  If my breasts still hurt in three months, I have the option to postpone the mammogram. I'll likely tough it out and just do it though since I could use more peace of mind.  

I had a few other questions for her, and she listened and answered everything patiently without any attempt to rush me like some of my other doctors do at times.  While I'm sad about the continued pain, I'm happy with how the appointment went.