Monday, May 4th, after four long months, Loraine’s battle against breast cancer is finally going into its next phase. With all that has transpired since her double mastectomy it seems like an eternity has passed. Hopefully we can put most all of this behind us once she has completed her course of radiation treatments. Of course, there will be regular monitoring for a recurrence over the next five years.

What are radiation treatments, and how do they help?

I find it amazing that a source of cancer for many is also a treatment protocol to kill cancer for others. Whoever came up with this concept was certainly thinking outside the box. Radiation therapy for breast cancer uses high-energy X-rays, protons or other particles to kill cancer cells. Rapidly growing cells, such as cancer cells, are more susceptible to the effects of radiation therapy than are normal cells.

Beside killing cancer cells, radiation is also utilized post surgery to help prevent recurrence. It can also be used to provide relief from pain and other symptoms of advanced breast cancer

Radiation therapy for breast cancer may be delivered in two ways:

• External radiation. A machine delivers radiation from outside your body to the breast. This is the most common type of radiation therapy used for breast cancer.
• Internal radiation (brachytherapy). After you have surgery to remove the tumor, your doctor temporarily places a radiation-delivery device in your breast near the tumor site. He or she then places a radioactive source into the device for short periods of time over the course of your treatment.

You need to know going into this battle that removal of the entire breast is usually not enough in itself to rid you of breast cancer. A mastectomy does not eliminate your risk of having a recurrence in the remaining tissues of the chest wall or lymph nodes. Therefore you need to be prepared for these treatments. Unless chemotherapy is planned, radiation therapy usually begins three to eight weeks after surgery . However, if chemotherapy is planned, radiation usually starts three to four weeks after chemotherapy is finished.  Loraine’s course of treatments will include one radiation treatment a day, five days a week over a span of six weeks. Spreading out the sessions helps healthy cells recover from radiation exposure while cancer cells die.

Will there be any side effects from the radiation?

Of course there can be side effects, we are talking about radiation right? Loraine was instructed to have an aloe vera gel to apply to her skin with the first treatment to mitigate the effects of burning of the skin, which would be similar to getting  a sunburn.

Side effects from radiation therapy will differ significantly depending on the type of treatment and which tissues are treated.  We are told, side effects tend to be most pronounced toward the end of the course of treatments. Once her treatments are complete, it could be several days or weeks before side effects clear up. I sure hope she does not experience prolonged effects, life has been hell already in battling the  staph infection that caused the four month delay in getting here.

Common side effects during treatment may include:

• Mild to moderate fatigue
• Skin irritation — such as itchiness, redness, peeling or blistering — similar to what you might experience with a sunburn
• Breast swelling
• Changes in skin sensation

Depending on which tissues are exposed, radiation therapy may cause or increase the risk of:

• Arm swelling (lymphedema) if the lymph nodes under the arm are treated
• Damage or complications leading to removal of an implant in women who have a mastectomy and undergo breast reconstruction with an implant
• Rib fracture or chest wall tenderness, rarely
• Inflamed lung tissue or heart damage, rarely
• Secondary cancers, such as bone or muscle cancers (sarcomas) or lung cancer, very rarely

Why has it taken so long to begin Loraine’s radiation treatments?

Before Loraine was healed from her double mastectomy, she had a very bad and deep staph infection settle in where her left breast had been. After three months of intensive treatments and thousands of dollars in additional medical bills later, we have finally whipped it with antibiotics and daily cleaning and dressing, and weekly doctor appointments at Saint Luke’s hospital’s wound care center. The wound from this infection was quite ghastly to say the least, and seeing it at it’s worse was not for the faint of heart. But, we got through this. To add insult to injury though, is Loraine’s physical therapy was put on an indefinite hold because of how serious the infection was. And then came the COVID-19 virus and the physical therapy center was shut down…

Post mastectomy physical therapy aids in the overall recovery process by focusing on regaining strength and increasing the range of motion for the shoulder and arm. Early intervention by a physical therapist can help women regain full function following mastectomy surgery, regardless of whether or not a woman has had reconstruction.  Because this rehabilitation therapy is a specialized protocol, it gets tailored to each patient’s specific needs.

Although I have a strong  working knowledge of physiology for strength training, I have no expertise in what is required, or good, for post mastectomy therapy. Size, location and the type of mastectomy are important considerations when choosing the type of therapy. Exercises to maintain shoulder range of motion and arm mobility are important in restoring strength and promoting good circulation. This is far beyond my scope of experience and I would be worried of either causing more harm, or just causing unnecessary pain with little to no positive results for her. Our bodies are meant to be in alignment.  When we live and move in non-optimal alignment, serious orthopedic injuries can occur.  Breast cancer survivors can often develop painful neck and shoulder impingement.  Physical therapy involves myofascial release which is a type of medical massage.  Focus is placed on gently releasing tension along thickenings of fascia and scar tissue.  Releasing this tension restores posture and alignment.  It also relieves knots and painful areas in all parts of the body. Loraine has been suffering quite a bit of pain as a result of not being able to get in for this necessary therapy.

If you’re being treated for breast cancer, it’s important to find a licensed massage therapist who has experience with breast cancer patients. Since many cancer centers are connected with programs offering massage therapy, ask your doctor for recommendations. If you are not trained in this, leave it to the experts.

• If you have had lymph nodes removed, the massage therapist should only use very light touch on your affected arm and the area around the underarm.
• If you have arm lymphedema, the massage therapist should avoid the affected arm and underarm areas completely. Traditional massage therapy can worsen lymphedema. A massage therapist who has experience with breast cancer patients may already know this, but it’s important to make sure he or she understands.
• If you have arm lymphedema, your arm and underarm area should be treated by a different kind of massage especially for lymphedema, called manual lymphatic drainage. Look for a physical, occupational, or massage therapist trained and certified in manual lymph drainage to treat your lymphedema.

Breast cancer sure throws you into a huge learning curve to say the least. There is so much we have learned, yet I wish we never had to in the first place. We knew that a double mastectomy would be painful, but we were not prepared for the pain which has come afterward. Loraine has been diligent in keeping up with her exercises the physical therapist has given her, but the  other therapy components which she has not been able to get to has lead to great suffering on her part. Loraine is a very tough woman who never complains about her aches and pains. It is heartbreaking at night to awaken to hear her crying in her sleep because of the pain she experiences as a result of not getting the myofascial release therapies. Usually after a surgery, pain subsides with time. In her case, the pain has become worse. She called me on the road the other morning in tears because it was hurting her so badly. I never felt so helpless in my life in not being able to bring her any comfort. Even if I had been home, I could not have made it better. Hopefully, now that she has healed, and the COVID-19 pandemic seems to have the curve flattening, maybe we can get back to the business of getting her better. Thank you to all who have kept us in your prayers and positive thoughts.

God bless and thank you for reading.