Scans and Tests and MRIs, Oh My!
Once we met our oncologist, life became a blur of appointments, scans, pokes and prods to ensure everything checked out before chemotherapy started. First, a brain MRI, echocardiogram, and BRCA1 & BRCA2 (tumor suppressor genes that have an essential role in DNA repair and cell cycle control systems; mutations in these two genes increase the chance for cancer of the breast, ovaries and fallopian tubes, pancreas and prostate) test. I then met my new breast surgeon, who turned out to also be Korean. Hilarious! When I said my last name was Park, she said, "Well, it is either Park, Kim, or Lee." EXACTLY. I liked her already.
Next up was a breast MRI, CT scan and bone scan. I had also put in my anti-nausea prescription to be filled in time for chemo to start, and I even got a prescription for a cranial prosthesis (a.k.a. wig) and was actually excited to go wig shopping, because it would be an opportunity to have some fun with style in this not-so-fun situation! (My oncologist also advised that I go wig-shopping NOW while I had hair, so they could match my current color and style.)
It was hard to believe it had only been a week since I found out that I had cancer! Life seemed to now be divided into B.C. (Before Cancer) and A.C. On a whim, I had asked a friend for a ride to an early morning MRI. She was not able to do it, which I figured. However, she wrote me a few hours later and said, "I pulled a favor for you. My friend, who is a limo driver, will pick you up. You will be in good hands." However, given the ongoing costs of my pre-treatment (we haven't even gotten to the Main Event!), I warned her that I did not have any funds to contribute to the driver, and she said, "Don't worry about it. It is a way that I can help, and it is a way for him to give back." I shed tears of joy; my friends really amazed me during this time! When he picked us up, he informed us that his sister had breast cancer, had a mastectomy, and she was now doing great. We were sad to keep encountering so many people that had been impacted by breast cancer, but we were also encouraged to hear their stories of survival.
The MRI was challenging, since they had trouble finding a good vein and poked me repeatedly. I had a series of scans that also had to be done that morning, and after awhile, I just asked to come back so that I would not miss my next appointment. With band-aids on both arms, my boyfriend and I walked to the bus for the next appointment. On the way, everything finally hit me. I had not been able to mourn my diagnosis since it happened, because everything went into overdrive when I found out, and I was too busy to even think about it. I had a bit of a moment on the walk to the bus, or maybe all the poking and testing throughout the week had gotten to me, and I said to my boyfriend through tears, "It's been a hard week." He said he knew, because he had been right there with me, but we would be fine and had to get to the next appointment. No time for tears when you have more tests to finish before chemo starts! After a hug break (which always helps), we continued to the bus. Thankfully, he was there to keep me going with a hug and a smile.
Going into the CT scan, they asked me if I had any allergies (I didn't think so?) and, "Which flavor?" I wasn't sure what they were referring to, so I just said berry (I figured you can't go wrong with that). A very sweet, older couple was also sitting in the waiting room and asked which flavor I had chosen. I said berry, and the wife said, "He always has vanilla." They asked me if it was my first CT scan and assured me it would only take a few minutes. I overheard him saying, "I just don't want the cancer to come back," to which his wife sweetly said, "Don't say that!"
After I downed my berry barium smoothie (yum!), I went into the CT scan. It was over quickly, and everything seemed fine. However, when I went to the bathroom afterwards, my face felt hot and itchy. I saw the technician in the hall and asked if that was normal, and he was like, "No, you had a reaction to the contrast." Super! A nurse came in and gave me some Benadryl. She said if it didn't get better in a half hour, she would need to do an IV (more fun with needles). They put me in an infusion room so the nurse could keep an eye on me. She said the same thing happened to her, and her father asked what she had learned after her CT scan. She said, "I learned I am allergic to contrast!" I was given the all-clear and came back for my bone scan. The Benadryl may have been helpful, because I don't remember much else except going into the tube and coming out, so it turned out to be quite restful! He did tell me to stay really still. Mission accomplished!
Still no word on when my chemotherapy would actually start, I called my oncologist's office and learned there had been an insurance authorization holdup, so there was a delay. Seriously? I also learned the following details:
- Chemo would be every two weeks for two consecutive days.
- Day One would be a two to three hour session.
- Day Two would be a quick Neulasta (an injection that helps your risk of infection during chemo by boosting your white blood cells), 24 hours after the first session, and it would take around 15 minutes to administer.
- The oncologist did not order a port (a small disc made of plastic or metal, about the size of a quarter, that sits just under the skin; a soft thin tube called a catheter connects the port to a large vein, and your chemo meds are given through a special needle that fits into the port), because only eight sessions were planned. (I just had to drink LOTS of water before each session, so I didn't feel like a stuck pig again!)
I also scheduled a "wig talk" with my hairdresser and explained my situation. When I explained on the phone why I needed to meet her, the lady on the phone said, "Bless your little heart!" (I had been looking into a wig exchange program at a nearby church, but they called to let me know they no longer had that program.) If I was going to lose my hair, I planned to do it in style!
Next, I had to get a last-minute dental exam and cleaning. (Many survivors advised me to visit the dentist prior to chemo to identify existing or potential oral infection, so that it can be controlled before chemo begins. If you have to have any dental work done during chemo, you risk getting an infection from the bacteria in your mouth. Also, during chemo, you will not produce as much saliva, so oral health would be extremely important.)
I was worried I would have cavities that may need to be filled pre-chemo, and then when would I be able to do that amongst all the appointments? How would I time them when my cycles were up? I also am not always the most diligent flosser, so I was hoping for no additional work. The dentist gave me a good cleaning and said I will have to really stay on top of brushing, flossing, and keeping my mouth moist during chemo, since I won't be producing as much saliva and may get mouth sores, which is a common chemo side effect. As I was waiting for my teeth to be cleaned, Angelina Jolie was smiling at me from the People magazine issue about her recent wedding. I noticed her new boobs looked quite perky, so I took this as a good sign that gave me hope! (Since discovering she carried a faulty copy of the BRCA1 gene, and given her mother had died from ovarian cancer, she recently had a double mastectomy/reconstruction.)
The dentist said thankfully, there were no cavities. He gave me a goodie bag and a recommendation for a homemade, non-alcohol mouthwash during chemo. And no skipping brushing and flossing!
Since we had a little time before the next appointment (a rarity in those days), we enjoyed our unexpected free time, went for lunch (I enjoyed a milk boba tea while I could, as I would probably have to give it up soon), and window-shopped at the local mall. Since it was Breast Cancer Awareness Month, everything was pink, felt positive and was like a warm hug all-around.
We then headed to the hospital to meet my radiation oncologist (part three of my "Treatment Trilogy"). I just hoped that we would feel comfortable with her, since that was important to us with all of my doctors. She said she felt like she already knew me, since she had already spoken with my oncologist and breast surgeon. (My oncologist had wanted me to meet all of my treatment doctors involved at the beginning, so they could feel the original tumor.) She did a physical exam and said the tumor felt mobile, so it was probably not attached to my chest wall. She felt it would respond well to chemo. Finally, some good news during all of this!
She also informed me that my brain MRI came back fine, meaning no cancer there! What a relief! She also said she spoke often to my doctors and would check in with me frequently, especially after chemo and surgery, to check the progress of the tumor. She answered all of our questions, and I now had a good feeling about "Team Rachel!" Most especially, I liked that they communicated with each other often.
We learned the radiation therapy would begin about six weeks after the surgery and would be every weekday for six weeks. It would be a quick procedure, but it would mean daily trips to the hospital. As we were leaving, I said to my boyfriend, "This will eventually be our new home!" Wow, we had a long road ahead. Hard to believe we were just going about our lives two weeks ago, but life is a surprising ride, and you just have to strap in and hang on.
It would be awhile before I received the results of the BRCA1 & BRCA2 test (I did the salivary one, where I swished mouthwash around in my mouth and then sent it to the lab). Having a BRCA1 or BRCA2 mutation meant a higher risk of developing breast cancer and ovarian cancer, in which case, a bilateral mastectomy (DAMN, could I keep at least one boob I came with?!) would be recommended, along with a prophylactic bilateral salpingo-oophorectomy (also called a BSO, this is the removal of the fallopian tubes and ovaries to prevent ovarian and fallopian tubal cancer). I just tried not to think about it too much until I had to...one week at a time, and that week, I was about to start chemotherapy. I was just trying to take it one treatment at a time, one day at a time. That's all I could do.
We had to go back to finish the breast MRI that was not able to be done previously since they couldn't find a good vein before, and of course, we had more appointments. This time, I drank LOTS OF water beforehand, and thankfully, they were successful on the first poke! (Although I was being stuck daily like a pin cushion, I still hated looking when they did it.)
During the MRI, the technician gave me something to squeeze, in case I needed assistance. I was determined to not use it and power through. What I had hoped would be a fairly seamless and uneventful procedure turned out otherwise. Towards the end, when they injected contrast, I felt something running down my arm. The technician stopped and came in. When I happened to look over, blood was running down my arm. Why did I look?? He fixed the IV (again, I wasn't looking) but then informed me since the procedure is timed, we would have to redo the part with the contrast. NOT. FUN.
If you have never had the pleasure of being on a breast MRI table, you have to lay face down. There is a place for your boobs to go into and a nice, hard, not-so-comfortable bar between them. Imagine the joy of pressing your body weight into this for 30 minutes, and then being told you have to do some of it again while blood runs down your arm. Awesome! Who invented that table anyways??? I bet it was a man!
That was the last of my "pre-game" activities ordered by my oncologist. After my final MRI was over, I had a vertical imprint in my chest and a bandage on my arm. However, I can proudly say I never squeezed for help...