Part 7: Radiation Treatment: Pain, blisters and pigmentation…OUCH!

Yes, they told me that there might be some side effects from the radiation therapy and that it would be a “cumulative” effect.  That means after each treatment the potential side effects could increase – like blistering on my skin that feels like a horrible sunburn at the beach for too many days under the scorching sun without sunscreen.  And tenderness that hurts to the touch on my breast so it’s hard to give a real hug and increased pigmentation on my entire breast and left underarm.  I also experienced fatigue and slight nausea.  This usually became worse towards the end of each week as more radiation doses had been done.  The weekends gave me some much needed reprieve and I was grateful for that.

As I send out this blog, I will have completed my entire course of radiation – 21 days, 16 of regular therapy and 5 days of “boost” to the cavity where tumor was.  Every weekday morning, Monday through Friday, at 8:00 am, I went to the radiation therapy center for my treatments before heading to my office.

So happy that they are now done!   Time to celebrate – especially since this coincides with the 4th of July – Independence Day for everyone, including my left breast!  Free from radiation, poking, prodding, and excising.  I truly admire all of the women who have endured this therapy, sometimes for much longer, and commend them.  Even more significant kudos go to those women who endured chemotherapy for their cancers.

 

 

What’s the good news about completing radiation therapy?   All of these symptoms will regress.  The pigmentation will take the longest to subside, but the breast tenderness, blistering and fatigue should improve within a week or so.  Did I say I wasn’t the best patient?  That doctors, in general, make the worst patients?  That I really don’t like pain?  Yes, this radiation treatment has also been an educational journey.  In the beginning, I was feeling pretty good – I can do this, right?  But when week 3 started, it was a different scenario.

Let me remind you why I chose to even undergo this treatment.  My radiation oncologist told me that by undergoing this preventative therapy, the risk of recurrence, would be reduced from 10-15% at 5 years to 5% at 5 years.  I felt that this was worth the risks and benefits, given the risks/side effects were temporary and reversible as described above.

Now is when my story perhaps changes compared to others on this journey.  Usually after a patient completes radiation therapy for Stage 1 Breast Cancer she follows up with her medical oncologist and starts treatment with an aromatase inhibitor.  Ok – let’s give some background on what I’m talking about.

With breast cancers, there are receptors on the tumor cells which try to increase blood flow so they can enlarge, potentially invading the lymph nodes and other tissues (like liver, bone and brain).  When the tumor has spread to these organs, it has metastasized.  In general, chemotherapy is used for aggressive tumors or later stage tumors.  Many times, additional medications are recommended called aromatase inhibitors (AI), also known as arimidex and aromasin.  In premenopausal women, tamoxifen is used .  Aromatase inhibitors decrease the amount of circulating estrogen and block any conversion of testosterone to estrogen by the aromatase enzyme.  The goal is to have very little to no estrogen circulating in the bloodstream to reduce the risk of recurrence.

As you know, in my case, the tumor was Stage 1, small size (8 mm), negative margins, negative lymph nodes and no evidence of metastases-   All very favorable factors.

Let’s go back to the exam room with my medical oncologist.  She told me that by doing the AI treatment, I would reduce my risk of recurrence by  50%!  Wow, 50% – that sounded  like a lot.  But then I started computing what that would mean in my situation.  The risk after my 4 weeks of radiation decreased from 10-15% to 5% at 5 years.  By taking the AI, I would go from 5% risk to 2.5% risk of recurrence.  By putting these numbers in perspective, as well as being a specialist in women’s health, I needed the make the best decision for myself.

Imagine the quizzical expression on her face when I calmly declined the AI treatment.   As with anything in life, we choose medications, procedures and treatments options based on our individual risks and benefits as well as the best information available.   Ultimately, the decision is ours to make.  The quizzical expression then turned to a concerned one when I told her that I was not only going to decline the AI treatment but that I also going to continue with my bio-identical hormone therapy.

Why would I do that?  Every day, I see women suffering from the symptoms of peri-menopause and menopause.  Menopause occurs when a woman no longer has a menstrual cycle for 12 consecutive months, leading to a precipitous decline in estrogen and progesterone.  Women can experience this transition in many different ways.  Some women sail through menopause without one hot flash or night sweat while others can’t focus, lose their train of thought, become irritable and depressed and even potentially lose intimacy due to painful sex /lack of libido.   Those women experiencing the latter usually come through my office door for much needed help.

My 10-minute monologue started with the above and continued with the desire to maintain brain function, receive heart disease benefit from hormones, keep my vaginal tissues from drying up and stabilize my moods.  I did try to go off my hormones in early February when the abnormal pathology report came back.   Let me tell you – it wasn’t pretty.  I couldn’t think and my brain was in a deep fog.  I found myself repeating questions, trying to remember details like names and numbers which had seemingly evaporated from my memory bank and feeling depressed.  I realized that I couldn’t run a practice, much less live my life, in that state.  The thought of going off my hormones and then adding an aromatase  inhibitor  which would lead to even lower levels of estrogen wasn’t the right option for me.  I realized that it would decrease my risk of recurrence but at what expense?

In no way do I mean to offend any women who have chosen to pursue this treatment.  There are times that this is definitely the best decision.  It comes down to each individual woman having an honest discussion with her physician regarding the risks and benefits, with her specific tumor markers, stage, etc.   For me, the negative risks/side effects of going on AI therapy didn’t outweigh the benefits.  I will say that my oncologist and breast surgeon were both happy to hear that I would use the lowest, effective dose of hormone therapy that worked for me.  Of course, they still think that I’m stubborn but they understand my reasoning.

So, there you have it.  This 4th of July is especially meaningful for me – for it celebrates the completion of my treatments and a new beginning of health and wellness.

May this 4th of July be a celebration for you!  For freedom to choose what is best for our health and the liberty to make such decisions.

In health and happiness,

Dr Diana Hoppe OBGYN in encinitas, CA. signature- hormones, menopause, weight loss, pap smear, total women's health care

 

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