Radiation Prep: More to Look Forward To

Yesterday I went to the radiation oncology clinic to prepare for radiation therapy for breast cancer.

To set the scene: I had my last chemo infusion two weeks before, and am still having side effects from that, as well as symptoms from a sinus infection and side effects from the antibiotic I’ve been taking for over 15 days. The intervening two weeks were a welcome respite from seeing any medical personnel whatsoever, but, as I drove to the clinic, I found that it wasn’t enough: the mere thought of having to resume treatment, of any kind, made me sad and tired.

I didn’t know much about what to expect from radiation, except that it should be not nearly as bad as chemo, except maybe for the fatigue. “…radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.”

I soon learned that “not as bad as chemo” could be a very relative thing. The radiation nurse explained what I have to look forward to: something like a bad sunburn (on the right breast, the one being treated), increasing in severity over the course of the treatment and continuing for some weeks afterwards. “Bad” as in: possibly even blistering. It’s true that some women don’t react that badly to radiation, but I’m likely to be on the unhappy end of the spectrum because (from breastcancer.org):

“your skin might have a more dramatic reaction to radiation, covering more of the breast area. This is more likely to occur if:

  • Your complexion is fair and you’re susceptible to sunburn.
  • You have large breasts.
  • You are receiving radiation after mastectomy, and the treatment is designed to give a high dose to the skin.
  • You’ve had recent chemotherapy.”

Three out of four… I’m screwed.

And, for my large breasts in particular, it gets worse.

I wrote a long time ago about the difficulties of fitting bras. For me, this became both easier and harder when I moved back to the US. Harder because I gained and then lost a lot of weight, then, with the onset of menopause, began gaining breast size for no reason I could ever figure out. I now wear a size 34G bra.

For those don’t know much about bra sizing, this means that my ribcage right beneath my breasts is 34” around (this is the band size), while the breasts themselves are 5-6” larger – this means a cup size of G (or could be DDD, DDDD, E, F, or H, depending on the manufacturer).

Most women who have this much breast tissue are also larger around the ribcage; it’s not hard to find a 40G bra, for example. But 34G is very hard indeed – there are few styles available, and they are hard to find (I go to Nordstrom’s, which also has staff who are very good at fitting bras – that’s the easier part).

Most of the bras made for large breasts have underwires: U-shaped pieces of metal that run under and up the sides of each breast. (Yes, actual metal – they set off the metal detectors in airports.) The ones that don’t have wires have broad, tight bands of elastic. Sports bras are more likely to be soft, but also plaster the breasts down to keep them from bouncing during exercise. Neither of these is a good option:

  • A large breast has a deep fold under it, which of course gets sweaty no matter what I wear or don’t.
  • Now imagine severe sunburn in that area, which usually never sees sun.
  • Now imagine that skin becoming possibly blistered, with extra irritation from sweat, chafing, and heat. (I’m having hot flashes, too, which mean I get sweaty more often!)
  • Now imagine wearing a piece of metal tight or elastic against that for hours (yes, there’s cloth over it, but…).

The nurse told me not to wear underwires throughout treatment, until the skin has recovered afterwards. I could have worked that out for myself. But what the hell is my alternative?

The standard advice on the cancer forums is to wear a 100% cotton bra, with a front closure, a size larger than you normally wear. Guess what? THERE IS NO SUCH THING IN MY SIZE. Those kinds of bras come in what I call “fucking stupid sizing” – S, M, L, XL, 2XL, where large cup size assumes also large band size. If I get a band that fits my ribcage, my cups will overflow severely. If I get a cup size large enough, the band will be so loose that my boobs will fall out the bottom. I have some like this that I wear for minimal support and comfort at home, but I would not be comfortable wearing them (physically or psychologically) in public.

Going braless is not an option. Large breasts are heavy, especially mine (dense breast tissue, remember?). They need support, and hurt without it.

Most of this flashed through my mind as the nurse was explaining other radiation side effects, like fatigue (yeah, that happens, too – no one knows exactly why).

Then she gave me a form to fill out, a new requirement for hospitals to measure improvement of patient “distress,” instead of their previous measurements of sheer physical pain. I think I scared her: I was pretty damned distressed by the time I filled out the form. She recommended a local cancer support center, and the clinic’s social worker (this was part of the standard info packet anyway).

Other fun things about radiation include that I shouldn’t swim or sunbathe throughout. Fortunately, I’m not much of a swimmer anymore, and mostly actively avoid sun; I had enough of bad sunburns in childhood.

Then I went on to the actual prep part of the visit. This meant stripping to the waist and putting on a hospital gown, then waiting in a waiting room as I will for actual visits. The worst part of that was the TV. Ten minutes’ exposure to the tripe that is daytime television is ten minutes too much.

The technician came and escorted me back to the radiation area. The preparation was to figure out how to aim the linear accelerator they’ll be pointing at my breast. I had to lie on a table with a CT scanner, my right arm over my head, supported/held in padded open cuffs at the upper arm and wrist. As I soon discovered, these were not comfortable: the one at the upper arm was pinching a nerve such that my hand started going numb.

I lay there for 25-30 minutes while the technician aligned me on the table, put stickers on me to mark the surgery scar, my nipple, and other spots whose logic I did not understand, then ran me through the scanner, and had the oncologist come and check her work. Then, after a brief break for me to move my arm, she put me back in position, and tattooed five dots on and around my breast (one is centered on my sternum). I now know that it is extremely unlikely I will ever willingly get a tattoo; even that small experience of it was unpleasant, and I will not welcome any more needles into my life than I already have to.

Now I have another two weeks or so “off” while a form is made, I’m not sure whether that is to support the breast in a specific position, or to mask other parts of me that they don’t want to hit with radiation. Frankly, after all that, I wasn’t in a mood to ask any more questions.

After the form is ready, I’ll go back for a simulation: a dress rehearsal of radiation treatment, without the actual radiation. In the meantime, the radiation oncologist will be preparing a treatment plan with specific dates and doses to be administered. As with chemo, I will see him once a week during treatment to monitor and try to manage side effects. At least this presumably will not involve needles for blood tests (though I’ll also be having a follow-up visit with the oncologist during this time to check cell counts etc., and I’ll have to have the port flushed with heparin once a month so I don’t get blood clots in it).

I spent a lot of the rest of the day crying. I’m so tired of being a cancer patient, tired in general, and utterly distraught at the idea of having any more pain and problems with my breasts. It’s hard enough to deal with them under normal circumstances. There would have been a certain relief in getting a double mastectomy and just having done with them.

my breast cancer story (thus far)

Fitting Bras

Men, you have no idea how important it is to have a bra fit well. (I suppose there might be something analogous in male attire, but probably not something that most of you have to wear every day.) Well, I’m here to tell you: it’s critical. It is extremely hard to get bras to fit right, and a constant, nagging discomfort when they don’t. Perhaps that’s why a lot of women I know hate to shop for bras. We know we’re going to spend hours rifling through racks and trying things on (when every trip in and out of the fitting room means getting undressed and redressed completely), and still go home with something that doesn’t quite work. Shopping with friends can take the edge off by making the whole situation very funny: you find the most ridiculous bras you can and try them on for each other, laughing uproariously and wondering who the hell would ever wear that for real.

One difficulty in buying bras is that they don’t all fit the same way, even within a given size. Just like clothing, bras come in different styles, and some styles work better with your body shape than others. If, like me, you wear an unusual size, finding anything at all in that size can be tricky.

There used to exist a cadre of women who actually knew how to fit bras, and worked in department stores sharing this knowledge with the benighted masses. They could tell you exactly what was wrong with each bra you tried on, and, after you’d rejected half a dozen, would trot out to the racks and instantly, unerringly, lay their hands on the item that would fit.

Macy’s used to have them, but the Macy’s ladies appear to have gone the way of the dodo. So I now know of only one place on earth where buying bras is relatively painless: Lady Grace. I just realized looking at their website that it’s actually a chain, with locations in Massachusetts, New Hampshire, and Maine. I’ve only been to the store in Brookline. When I first started going there, thanks to a friend, around fifteen years ago, their fitters were the classic little old ladies. Now they’re young ladies, but, thank God, the wisdom has been passed on. On my recent visit to Boston, I spent an hour and a half in Lady Grace, departing with seven new bras, and a whole new world of comfort.

There’s one difficulty that a single visit can’t resolve. Many breasts are not the same size all month. Water retention before our periods makes them swell (and become tender – no touchy!), so a bra that fits well the first week of our cycle won’t later on. So, yes, there is a reason why we need about two dozen bras in service in any given month.

Bra Straps

What is it with the visible bra straps these days? There’s something in my upbringing, American or Asian, I dunno, that tells me that only sluts let their bra straps show. I could never wear spaghetti-strap tops or dresses because I absolutely need to wear a bra, and there’d be no way to hide its straps. (Yes, there are strapless bras, I have one because of a bridesmaid’s dress I had to wear once, but it’s practically a corset – doesn’t exactly fit with the carefree look one is trying to create with spaghetti straps.)

But lately I see girls and women letting the straps of their bras – and sometimes backs and fronts! – just hang out of whatever they’re wearing. I can’t help but think it looks trashy. Not to mention, in some cases, REALLY stupid (yes, even on Sarah Jessica Parker in Sex & the City). Honey, that backless black halter top with the white bra entirely visible from the back? Not workin’ for ya.

In Italy there are bras with transparent plastic shoulder straps which are supposed to resolve this problem, but it just doesn’t work. No matter how transparent, the straps are clearly not skin, especially when they’re digging into the shoulder. You might fool the eye at a distance, but that’s not really the point, is it?

So my advice to my daughter has been: enjoy the braless look while you still can, and give it up when it’s time to.

More on Bras

August 20, 2003

(Another of those articles that generated responses!)

A woman friend forwarded this to me: “A good friend is like a good bra: hard to find, very comfortable, supportive, holds you up when you are down, and always close to the heart.”

Buying bras in less-developed countries was very difficult back in the 1970s-80s. Sally Kibblewhite, who was my English teacher at Woodstock, wrote me: “The thought of you going off with seven bras reminded me of the selection I had when we set off for India, because we had been advised that bazaar bras were not ideal. I had washed them and they were drying in the sitting room of David’s brother’s house. He never forgot this vision of many pastel-coloured bras dangling from the clothes horse, and regularly asked me how my bras were going.”

I wish someone had thought to warn me about the less-than-idealness of bras in India. When we left the US for Bangladesh, my breasts weren’t large enough to worry about wearing bras, and none of us thought ahead to the time when they might be (my then-stepmother rarely wore a bra herself, being an uninhibited flower-child type, and small-breasted). By the time I got to boarding school at Woodstock 18 months later, I needed a bra. Being socially naive, I didn’t realize this until I took a dip in a cold river (wearing a T-shirt) during our 9th grade class hike, exciting much comment. Then my family had to scramble to get hold of some bras somehow. In India in those days, all bras were made the same way, of heavy cotton, with the cups sewn in a spiral to maximize pointiness – not what a blushing adolescent wants for her first bra, even if there had been any small enough to fit. We had to get my stepmother’s parents to mail me some “training” bras from Pittsburgh. (My dad’s running joke was that training bras are to train the boys how to undo them.)

Re. fitting bras in more modern times and places, Mike Looijmans suggests:

“Bring your (boy)friend and have him run up and down the aisle with bras. That saves you from having to undress and dress multiple times. He’ll have a chance to peek at half-dressed women (if all’s right, he’ll mostly be looking at you) in need of bras. Also, at the end of the afternoon, he’ll have a good idea of what size you are, so that if he wants to give you something naughty to wear, it’ll at least be somewhere near the right size.”

He adds: “I don’t think I’d take two women shopping for bras together seriously… While the two of you were doing that girlish giggling in the dressing room I’d probably be holding out a cupped hand and asking the kind lady in the shop for “about this size…” 😉 ”

In regards to my rant about today’s “anything shows” attitude, Mike and a few others pointed out that a décolleté lined with lace can look very classy instead of slutty. For the older generations (which doesn’t include Mike), back in the day when there was less flesh in general view, a mere glimpse of lingerie could be very exciting. Mike points out a solution for the straps problem: “My girlfriend has a bra that ends in two spaghetti straps on either side. If worn under something with a spaghetti strap, there’ll be a total of three straps on each shoulder, and that looks like it’s meant to be so. (strapless isn’t an option for her either).” My daughter has now found some bras like this, and they do look great. However, Benetton doesn’t have sizes to fit me!

Yesterday in the supermarket we saw another non-solution: a woman was wearing a low-backed sundress, so that the back of her bra was completely in view (and the front wasn’t entirely covered, either). I am not offended by total nudity (though I might find it surprising at the supermarket), but that, to me, just looked completely trashy. (She must have been a tourist. The ladies of Lecco often dress even more elegantly than the Milanese.)

Mike gets the final word on this one: “Now we’re on that topic anyway, am I the only guy who thinks a [full] bathing suit looks much sexier than a bikini?”