Can I Take You Home With Me?

(written by Sunny)

While waiting for Lindsie's HER2 results there was still lots to get done. On Thursday, March 5th we met with Lindsie's radiation Oncologist, Dr. Kuhn. I don't know what I was expecting, but it sure as heck wasn't what walked in. This woman was at once high energy and soothing, confident and unassuming, efficient and warm, brilliant and totally accessible. She is this tiny, prim person with the vocabulary of an entire medical library and a quietly large personality. Suffice it to say Lindsie and I were in love. I could have listened to her talk all day. Thus the title of this post. I'm pretty sure Lindsie is getting up the nerve to ask her to move in any day now.

Anyway, I suppose you'd like to know what Dr. Kuhn actually said. Fine. We had learned from the official results of Lindsie's PET scan that there are tumors in multiple bone sites. Looking over the results the pain Lindsie had been experiencing in various places began to make sense. There are tumors in the spine, femurs, pelvis, sacrum, sternum, both scapulas, left clavicle, multiple ribs, and a few more sites. Some of these masses had been causing considerable pain for quite some time, especially in the spine, and radiation is the fastest way to shrink those tumors, thus reducing pain.

• The role of radiation in a case like Lindsies is twofold:
     - Palliative radiation, meaning it is used to reduce symptoms like pain
     - Protection of an elegant structure, meaning that if a mass begins to impinge on an organ, the spine, etc., radiation will be used to protect that structure.

Treatment
• The best course is to treat the worst two areas of pain initially. The more radiation given the greater the possibility of unwanted side effects, so we start with a minimal amount.
• In Lindsie's case the plan was to radiate an area of the spine and the right hip/upper femur
• Systemic treatment (chemo or hormone blockade) may reduce pain elsewhere as tumors begin to shrink.
• Radiation will be 2-3 times less powerful than what would be administered to the chest wall after surgery, meaning it's a comparatively small dose.
• A radiation simulation will be done before the first treatment to get Lindsie's protocol set up
• Each session will be 10-15 minutes
• 10-15 sessions will be administered

Side Effects
• 80% chance of pain reduction (Hooray!)
• Very low risk of this amount of radiation killing bone marrow
• Skin irritation will likely be minimal
• May loosen bowels
• Shouldn't cause any kind of sickness

Other
• Treatment won't be started until genetic testing results come back because of the possibility of the p-53 mutation (see glossary)
• More areas can be treated with radiation later if necessary

The meeting with Dr. Kuhn felt positive and promising. Lindsie was excited to have her simulation the following Monday (9th) afternoon and start radiation as early as that Tuesday (10th) along with the hormone blockade (if the HER2 results cooperated) that Wednesday (11th). It felt good to have a schedule in place and know the whole treatment plan was about to get set in motion. Plus, hanging out with Dr. Kuhn during appointments would probably be the best thing ever.

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Mardie

3/19/2015

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