The Tab 7

Balance forward from The Tab 6: $292,947.97

4/14/11
Up to the Infusion Center for another dose of Herceptin.
.51 grams of Herceptin, a little larger dose, and hence a little pricier this time:
$9,894.00

Half a liter of saline
$24.00

Up to 1 hour in the infusion center
$810.00

Subtotal for Herceptin infustion:
$10,728.00
Running total:
$303,675.97

4/19/11
Blood work up before doing the prep work for radiation. Apparently all radiation oncology centers do a blood work-up before starting the treatments, to assess general health. Some centers then follow up every two weeks, or every month. Some do more blood work only if there’s a problem. UCSF doesn’t do any blood tests on me after I’m in the radiation merry-go-round.

This blood work seems slightly different than what is done before chemo and surgery. They take out the bilirubin test that measures liver and kidney function, and the prothrombin time test that measures how quickly my blood clots, and various enzyme tests.

CBC Auto, with platelet count
An automated count of various kinds of blood cells, red, white, platelets etc. This is considered more precise than “manual-counting”
$98.00

Sodium serum. How much sodium in my blood? Sodium is needed to regulate blood and body fluids, transmit nerve signals, keep the heart pumping and other vital things. As we all hear endlessly, of course, too much sodium isn’t a good thing.
$60.59

Potassium serum. How much potassium in my blood? Potassium also helps transmit nerve signals. It’s also key to kidney, muscle, and the digestive system function.
$58.47

Chloride serum. How much chloride in my blood? Chloride is a type of electrolyte, substances that help transmit nerve signals. Chloride works with other electrolytes such as potassium, sodium, and carbon dioxide (CO2) to help keep the proper balance of body fluids and maintain the body’s acid-base balance. An imbalance of chloride can be a tip off to sodium imbalances or kidney problems.
$58.47

Carbon dioxide. How much CO2 in my blood? CO2 is another electrolyte that is closely tied to kidney and liver function.
$61.65

Creatinine serum. The urea test is often done with creatinine test. The ratio between the two can identify problems like dehydration
$63.78

They add:
A test for Thyrotropin, TSH, thyroid stimulating hormone.
$209.41

And they add:
Quantitative whole blood glucose
$48.90

Outpatient Level 3 appointment
$139.00
This seems like quite a bargain price for a world-renowned radiation oncologist like Dr. Fowble.

Total for pre-radiation blood work and appointment:
$847.14

Running total:
$304,523.11

Next we move on to the radiation “simulation” session, where they figure out exactly how and where to aim the radiation beams to most effectively zap my cancer.

4/19/11
Simulation “complex.” If I was just getting radiation in one “plane,” the simulation would be “simple.” But Dr. Fowble decided that delivering radiation in three different fields or “planes” is the best for my case:
$2,530.00

Immobilz dev simpl
Can’t figure out what this is, I think it may have something to do with figuring out exactly where I lie on the treatment bed. It’s “simple” because I don’t lie in several planes, perhaps?
$532.00

CT Guide for treatment
They give me a CAT scan to get a detailed look at my anatomy so that the radiation beams miss my lungs and heart. I’m all for that! The CT tech is very chatty and tells me about the “old days” when they used to just have radioactive material like cobalt in a lead box and open it up to expose women’s breasts to it. That sounds almost medieval. She also explains all the weird white mesh impressions of other patients’ faces and torsos that are stacked or standing around the room. If you have to have radiation aimed at your head or neck, you need one of these mesh frames to make sure you’re the same position each time. Most people wouldn’t put up with tattoos on their noses or whatever! The frames look like empty orthopedic casts, ghostly, medical riffs on the buried clay army in Xi-an, China: Each mesh impression is different, individual. When I realize what they are, it feels a little like all these other people are gathered in the CT room with me and the tech. The interesting stories are free, but the CT is pricey:
$1,252.00

Simulation field 3-D
This is one of the the big advances in radiation oncology, the ability to plan and deliver doses of radiation in complex 3-D fields. Accordingly, it’s expensive:
$11,071.00

Beam shaping, complex
This is deciding exactly how the beams of particles will be shaped. No more cobalt behind door number 3! Also expensive:
$5,160.00

Dose calculation:
Exactly how strong will those beams of particles be? How will the total dose be delivered?
$2,140.00

Running total:
$327,208.11

4/25/11
I return the following Monday for what they call a “dry run.” Apparently, since this is just putting me on the treatment bed, measuring the distance between my left breast and the linear accelerator etc., it’s considered “simple.”
Simulation simple
$1,378.00

Then we’re off and running for the next six weeks, Monday through Friday:
4/26/11
Complex 11-19 MV (Megavolts)
$924.00

4/27/11
Cont. Med. Physics. Support
I think this is when they take weekly images to make sure the beams are hitting the target as planned
$1,181.00

4/28/11
Complex 11-19 MV (Megavolts)
$924.00

4/29/11
Complex 11-19 MV (Megavolts)
$924.00

Running total:
$356,201.11

4/22/11
Yet another echocardiogram to make sure Herceptin isn’t damaging my heart overmuch
$945.00

Then on to the month of May radiation charges:
Two clinical treatment management charges at $1,562.00 each

Then radiation doses Monday through Friday at $924.00 each

Port films once a week to make sure the radiation is going where it’s suppose to go, at $235.00 each

Four charges, one a week, of “Continued Medical Physics Support,” I suppose this is when the films get reviewed by the medical physicists, at $1,181.00 for each review. Medical physicist must accurately measure the amount of radiation actually coming out of the linear accelerator.

And, on 5/20/11
Another beam shaping charge
$1,290.00
And, a dose calculation
$535.00

Subtotal for four weeks of radiation in the month of May:
$31,395.00

Running total:
$388,541.11

Then two more doses of Herceptin in the month of May, one on
5/5/11
$10,728.00
And another on 5/26/11
$10,728.00

RUNNING TOTAL, with still the last bit of radiation and some Herceptin bills to come:
$409,997.11

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About leftbreast

I have had breast cancer. I was diagnosed at 47, and am now 49. I have finished "active treatment," two surgeries, chemo, radiation, monoclonal antibodies. These days, I only take a drug to suppress my uptake of estrogen, since my tumor was highly reactive to that hormone. I have been married to my husband Pete for 21 years. I have a stepdaughter, Maureen, 30, and a daughter, Erin, 10. I've been a freelance magazine journalist for 20-plus years, covering everything from Chinese foreign policy to Catholic nuns to endangered species. I have had a great life. I have lived in Asia and all over the United States. I have spent nights with tree-sitters in Oregon and with astronomers at the Mauna Kea observatory in Hawaii. I've been to a cocktail party on the poopdeck of a British destroyer docked in Shanghai. I've taken the bus to Tibet, and tramped through the cloud forests of Panama with biologists. A magazine sent me on a raft trip down the Colorado through the Grand Canyon; another sent me to cooking school for a week. I have spent time with celebrities, presidents and heroin dealers. I love my work. I have a loving, supportive family and more friends than I probably deserve. I have had the space and time to camp, ski, cycle, garden, cook and spoil my pets (an Australian shepherd, a German shepherd and a tabby cat). If it all ended tomorrow, I would have to say that it has been a really, really good ride. When I was in thick of treatment, I was simply fighting for more time. Now, I'm trying to connect the experience of cancer with the rest of my life, with the time that's been won. I hope the cancer never comes back, but if it does, I'll be ready. That's what this blog is about.
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2 Responses to The Tab 7

  1. Connie says:

    I’m about to start on herceptin and I am at a loss as to how anyone can afford the treatment. Who pays for all this? I’ll meet with my Oncon this coming Tuesday and learn what the timeline will be, but at this time, I have no idea and it scares me to death. How often do you get infused with Herceptin?

    • leftbreast says:

      Connie, usually, you get Herceptin every three weeks for a year. Usually, your insurance pays. If not, I don’t know how people do it. Don’t be too scared, though, Herceptin has very few side effects.

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