Threw me for a loop - radiation?

Hi all,
I went to see Dr. Luke today to discuss my final pathology report from the surgery and the next steps in the treatment plan for me. I expected to discuss the fact that I'm going to be on Herceptin until next August, and that I'll need to go on Tamoxifen. I also expected to talk about lymphedema somewhat, but since they had such an extensive dissection of the nodes, I am at a higher risk for lymphedema than others that have had regular dissections. That was all fine, I mean, there are just some limitations for me in that regard. However, when he brought up the subject of radiation and suggested that I follow up with a radiation oncologist I was shocked, since in my discussions with Dr. Silverstein at USC he felt I did NOT need radiation and/or that it was doubtful that I would need it. Dr. Silverstein's view on this is that the general protocals for radiation oncology are that if there are 4 or more positive nodes, they radiate and if there are none, then they don't. It's a little iffy if they find 1-3 positive nodes. So, this is why Dr. Silverstein's view was as such. However, in discussing the pathology results with Dr. Luke (none of the 50 nodes removed were positive) he said he had a hard time stating that I didn't need it, yet stating that it is controversial since there isn't a lot of data on this for people in my situation and that a second opinion from a radiation oncologist (I'll see two or three is what I'm thinking) would be a good idea in this case. As for why Dr. Silverstein's opinion might be so different is that he is a surgeon, and Dr. Luke is a medical oncologist, so they are not specialists in radiation oncology just as Dr. Silverstein and radiation oncologists aren't specialists in chemotherapy. I'm just concerned, however, that when I do go to see a radiation oncologist they're going to recommend the radiation, just as if I were to see a surgeon before I saw a medical oncologist, they're going to recommend surgery because each professional believes in their approach to treatment of course. So, I can go and collect information and what data might be available, but I'll be honest, I'm just not sure I want to go through radiation unless there is a good reason to do it. I mean, if the tissue is fine, I don't want to damage it especially for the long term and have issues with the reconstruction becuase it will make the skin more leatehry and less elastic, etc. I just think that, mentally, I was not expecting to hear this from him, so when I did, it really threw me for a loop. I mean, I was ready to start focusing on recovery and moving on to the next phase of life, but now I feel like htat may be put on hold...Well, I'm back in fact finding mode, and have an appointment next Tuesday when I'm in LA to meet with a radiation oncologist at USC since I have to go there anyway to see Dr. Sherman and I have physical therapy in Pasadena later that day. I'll also follow up with Dr. Khanna here next Wednesday. I know that Dr. Khanna already feels that radiation is something that should take place, since that's what she said the first time I saw her. Now, once she knows the pathology, that may elicit a different response but I don't know. I will also probably see Dr. Massek (spelling?) because he is closer and it would be nice to not have to drive to Eisenhower every day if I do need to do radiation. It seems that it may just come down to a judgement call that I'll have to make and decide. Please pray that I have the wisdom to make a good decision. God has been so gracious and wonderful to guide me in every step of the way with the health professionals, and I look forward to how He is going to work this out. So, although it kind of threw me off a bit, I'm just going to investigate and collect information and then prayerfully decide. I just pray that God would show me his wisdom in this.
I also went to physical therapy locally today and, I have to say, it was quite different than the therapy sessions that I had been to in Pasadena. In fact, they call the therapy here Occupational. I'm not sure I understand the distinction but the session was different. The therapist spoke a lot about lymphedema and prevention of it (becuase once it occurs, there is no cure there is only management of it). She took several measurements of each arm to establish a baseline and also to detect any differences. My right arm is 1/2 -1 cm larger in circumference in some places but she didn't feel it was worrisome, which is reassuring. Also, the physical therapist in pasadena did actual work on my trigger points and massage to help the ligaments that are tight to loosen up. The therapist here did not do that. So, it was just different. Anyway she encouraged me to do the exercises three times a day, so I'll start to do that, and I'm sure I'll have to be diligent to fit them in, like make an appointment to do them at certain times. But hey, that's my full time job is rehab anyway...well at least until I find out about radiation....
Thanks for your prayers,
Julie