Cancer log 118: It’s…

Cancer log 118: It's been almost three weeks since I did one of these -- having time to recover from chemo made for some quiet. I started feeling basically normal again about a month after chemo ended -- energy levels back up to normal, food tasted good again; I could eat spicy food. My head has the barest stubble on it, there's occasionally a strange and annoying taste in my mouth (when I'm *not* eating), and my hands and feet are still hyper-pigmented -- at yesterday's drawing class, someone said that I'd clearly been using a lot of charcoal. Hah! (Also, a month or so back, I was getting a pedicure, and the salon technician said I'd been walking around barefoot a lot, somewhat disapprovingly, and I quickly assured that in fact, that was just my skin, and please don't try to clean it off, because it would not go willingly.)

All of this recovery means I'm ready for tomorrow's surgery. More on that soon. Today at 3:30, I have a small procedure, but one that promises to be unpleasant -- they'll insert a needle into the areola to inject radioactive isotope. From the discussion boards online, about half the time, this feels basically like a hornet sting, which is bad enough, but the other half the time, women describe it as excruciating pain, similar to childbirth (which I got to skip, due to the whole c-section thing), or like having hot oil poured over your breast. Yay. The nurse told me to start the lidocaine cream three hours in advance, and slather more on every hour. That will help numb the surface, but won't do much for the deeper injection, or the dye itself, which apparently causes about ten minutes of burning.

I am actually more than a little freaked out about this, and I sort of wish the nurse hadn't emphasized the likelihood of it hurting, because usually I tend to gut these things out and take them in stride, but maybe I'm just tired of being poked and prodded, but I am stressed out enough that I sent an e-mail to my doctor last night (by way of the clinical trials nurse, who was nice enough to give me her e-mail) asking about whether a prescription for Xanax or something like it might be possible. I've actually never taken an anti-anxiety med, and if I have to just do my deep breathing and cope, I will, but on the other hand, why suffer if I don't have to?

Interestingly, in my research last night, I discovered two things -- one, that they used to worry that injecting lidocaine (numbing) along with the dye would dilute the results, but a 2009 study indicated that it didn't. So I'll at least be asking about that. Another study suggested that it actually was better not to do this as a separate procedure at all, that in fact, it could be done during the course of the surgery itself (when I'll be knocked out), without compromising the effectiveness. There was clearly some debate about that, and I wish I'd read the study a week or several ago, when I would've had time to discuss it with my surgical oncologist. At this point, I think it's likely too late to ask her to research and do a completely new process, especially since it involves coordinating with the radiation people at nuclear medicine, billing complexities, etc. and so on. But I might mention it to her to consider for her future patients, because boy, I'd be happier if I could just skip today's procedure entirely.

The purpose of all this, btw, is that they inject the radioactive dye today, and blue dye tomorrow during the procedure, and they travel through the breast to the lymph nodes. The surgeon looks to see which lymph nodes the dyes encounter first -- those are considered 'sentinel' lymph nodes, and the assumption is that if the cancer were going to spread, it would spread to those first. It used to be that they took out lots / all the lymph nodes (around 30), in the midst of a lumpectomy surgery, but that carries some serious risks, including the possibility of developing lymphedema, a long-term chronic and painful condition. So now they just take out one or two 'sentinel' nodes, to check if the cancer has spread there. (Almost certainly not, but I agree that we want to be sure.) And the dye lets them find those nodes.

I think that's the gist of it, based, admittedly on half an hour of stressed-out reading last night, so medical folks, please correct me if I got anything wrong here. As for me, I'm going to go teach my classes and try not to think about burning, excruciating areolar pain for the next few hours. Students are very distracting.