The last two weeks, radiation consult

whoaaaaa so it's been over 2 weeks... lots happening non-medically speaking...

I had a great 4th- went to a BBQ and watched the fireworks from a balcony in Fremont. They were choreographed by a DJ set blasting out of an old-school boom box. Also complete with Michael Jackson hits in remembrance. Later that night we saw an awesome funk band and danced the night away...

I spent most of the last few weeks house sitting for a friend in an apartment a little south of downtown. I was feeding their dog (who had a mohawk) and taking advantage of living in an urban environment with a pool and hot tub on the roof of the apartment complex. Basically this meant that I spend a good portion of the day dozing off or reading Harry Potter in the sun with an occasional dip in the pool. Not a bad way to pass the time, eh?

Last week I had two visitors all the way from Australia, something which I had been looking forward to for awhile. I had met one of the guys in the train station while traveling in Barcelona, and ended up taking the train with he and his friend to Pamplona for San Fermin (running of the bulls). We had crazy fun times there, and then I ended up meeting back up with him in London, where I stayed with him for almost a month. When I came back to the states, he came and visited me in St Louis, and we have kept in touch on and off throughout the years. He and his brother had now decided to stop in Seattle to visit during their US tour. It was great to see him again as it had been 7yrs since we had last talked face-to-face. I had a great time, showing them around Seattle to all my favorite places- it was like seven years hadn't gone by! Anyways, it was great to get to see him again and catch up- I am definitely planning a trip to Australia as soon as I graduate!

Since my last post I have also started clinicals again. I am at a family practice with two nurse practitioners at least once a week. So far it's been tough because I feel out of practice with examinations, diagnoses, etc. I don't know how long it will take to get these skills back but it is frustrating. Fortunately my preceptor is supportive and a great teacher. The problem is that her patients are so complex- way beyond my level. A guy came in the other day with a history of stroke, diabetes, asthma, and high cholesterol, and he was complaining of a constant severe headache and blood stools. That's quite a workup I did! The clinic still uses paper charts and his was like 2 inches thick! All of the patients seem to have at least 3 chronic conditions which are still in the process of stabilizing. At least I am seeing a lot of interesting cases- we just sent a lady to the ER today for possible Stevens-Johnsons syndrome- a really rare medication reaction...

Ok so back to the medical:
So I had my appointment with the radiation therapist last week. He was this nice, really straight forward guy. He also had a student with him who didn't seem to know anything. Wow I know how that feels.. Anyways, he started by explaining the role that radiation may have in my case. Basically, radiation is not the standard therapy for women with ovarian cancer. Usually they have surgery to remove the ovaries, uterus, and fallopian tubes, followed by 6 cycles of chemotherapy. pretty much what I had minus the hysterectomy. However, because I have the weird, one-in-a-million, super-aggressive and chemo-resistant clear cell type, he recommends that my treatment be a little more aggressive to be sure to rid my body of all the remaining cells. He basically gave me two options: 1.) 5 weeks of radiation to my pelvis or 2.) 9-12 months of low-dose chemotherapy. Hmmm let me think about that one. Chemo for an entire year? HELL NO! It would only be one of the drugs I was on, Taxotere, but it would still have all the regular side effects: increasing nausea, loss of my now baby-fine head of hair, incapacitating fatigue, numbness and tingling of my fingers and toes that within a year could affect my grasp and ability to write, walk, etc, murder of my red and white blood cells and platelets (making me more anemic that I already am). I can't imagine feeling shitty for an entire year- and because it was low-dose I would be getting it more frequently, meaning my side effects would increase over time.. In any case, my immediate thought was FUCK THAT so I asked the doc a little more about the radiation. He said that each session would be about 40 minutes and take place at the clinic M-F. The radiation would be aimed in an upside-down Y shape, so that it would hit my pelvic and inguinal lymph nodes. The side effects were different for everyone, but the most common with radiation to that particular area were fatigue, nausea, and diarrhea. At this point I made very clear how much nausea, how much diarrhea, etc and he said that maybe it would be 2-3 episodes of diarrhea a day and that the nausea could vary- in any case the symptoms don't usually show up until the 3rd week and get progressively worse as you approach the end. He then went through the more serious side effects, which he assured me were rare. Because the radiation was aimed at part of my intestines, it could damage the tissue and cause strictures and places where bowel could no longer pass through- causing obstruction and resultant surgery. I could also have skin damage, although this was unlikely as the beams would be aimed well below the skin. Secondary malignancies was another big one, as the radiation may actually cause other types of cancers later in life. Finally, he brought up the one that concerned me the most at this time- infertility.

As much as my oncologist doesn't agree with my decision to keep my uterus, I would still like to try to one day give birth. Therefore, I was very interested in whether or not radiation could affect the functioning of my uterus, thus affecting my ability to carry a child. Well the Dr. told me that with radiation there is always a possibility. He said that he has known several women who had carried their babies to term after pelvic irradiation. He also recognized that there would be a significant risk of damaging the blood vessels which supplied the uterus, as they are interwoven with the lymph nodes that would be targeted. He then cited several techniques where they could tuck the ovaries behind the uterus as to preserve fertility. As he said this of course I got upset, because I had no ovaries to protect (thinking again about my healthy left ovary that was removed). He assured me that he would do his best to prevent damage to my uterus, and that a detailed CT scan would be used to map out the exact placement of the beams so that they would spare as much healthy tissue as possible. He also reminded me that chemotherapy (or option #2) would best preserve my uterus. He then told me that he would make me an appointment for my detailed CT scan and mapping procedure, and in the meantime I could think over my decision. I told him that it was fine and that I would most likely go ahead with the radiation.

So there it is- I have made my decision to start radiation and am scheduled to have my CT scan tomorrow. I will most likely start my first treatments this week. I did snap a little when the receptionist called me to make the appointment- she said that before I came in for the CT scan that the MD wanted me to get a pregnancy test. When she said it I started to get really angry and asked why, as there is no way I could be pregnant. She said that as long as I could verify to her that I was really sure I couldn't be pregnant that it would be fine. I told her that I was really sure that I had no ovaries and that shut her up for a minute. I know she was just doing her job but I was angry at the doctor for obviously not taking the time to read my chart and the results of my surgery. How can you be a gynecological radiation therapist and not know the status of your patient's ovaries? Idiot. I bet it was the med student who ordered the test... Anyways, I was insulted and did not need that little reminder of my infertility. And I should be able to refuse a test if I want to. This just reminds me of the two weeks before surgery when the various doctors made me do a total of 4 pregnancy tests, including one the morning of surgery...

That's all for now.. Oregon Country Fair experiences to follow...