Before I begin a retelling of yesterday's adventure, I wanted to show you the room where my "simulation" took place last week--
That's where I laid last week to be measured and scanned, scanned and measured, tattooed and so on...
Yesterday, I checked in at 12:30 and first met with Dr. Marquez's nurse. She took me through what a typical radiation day looks like: check in at the front desk, head to the "sub-waiting area" where I will put my belongings in a locker and change into a robe (it's
almost like a spa) and wait for my Radiation Team Members to come get me for my fun. I learned that any lotion with CALENDULA as a primary ingredient will be my best friend, and that I should use it from day one even though my skin won't hurt at first. Basically, I'm to act as though the area being radiated has a horrible sunburn--no super hot water, blot with towels to dry, etc etc etc.
So off to the sub-waiting area I went, changing into my robe. Each radiation machine has its own team of therapists, so I met a few of mine yesterday. Here is a picture of what the machine looks like:
I lay down on the table there and it can move as well as the machine around me. The only thing missing from this picture is the bars that I have to hold onto with my hands so that my arms stay lifted up. Also, they put a little wedge underneath my knees for comfort (
spa!).
I should mention here that the type of radiation I'm getting is called "Intensity-Modulated Radiation Therapy" or "IMRT" for short. Here is a brief description of how it works:
Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that utilizes computer-controlled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. IMRT allows for the radiation dose to conform more precisely to the three-dimensional (3-D) shape of the tumor by modulating—or controlling—the intensity of the radiation beam in multiple small volumes. IMRT also allows higher radiation doses to be focused to regions within the tumor while minimizing the dose to surrounding normal critical structures. Treatment is carefully planned by using 3-D computed tomography (CT) or magnetic resonance (MRI) images of the patient in conjunction with computerized dose calculations to determine the dose intensity pattern that will best conform to the tumor shape. Typically, combinations of multiple intensity-modulated fields coming from different beam directions produce a custom tailored radiation dose that maximizes tumor dose while also minimizing the dose to adjacent normal tissues.
Because the ratio of normal tissue dose to tumor dose is reduced to a minimum with the IMRT approach, higher and more effective radiation doses can safely be delivered to tumors with fewer side effects compared with conventional radiotherapy techniques. IMRT also has the potential to reduce treatment toxicity, even when doses are not increased. Due to its complexity, IMRT does require slightly longer daily treatment times and additional planning and safety checks before the patient can start the treatment than conventional radiotherapy.
Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells, thus shrinking or eliminating tumors.
Yesterday was a longer session because it was my first on the machine and adjustments get made. They also lay a bolus across the side of my body being treated. It looks like this:
The round part at the top of the machine in the photo above moves around and there are little metal bars inside of that that adjust themselves...Here is a picture. I wish I could find a video because it's actually kind of cool to watch:
There is no pain from the radiation (unless you count my arms falling asleep and / or my head hurting because it has to be turned to the right to avoid severe esophageal burns...) during the treatment itself. Of course, the skin burning and hardening could eventually be uncomfortable, but only time will tell on that. It doesn't hurt today.
Finally, I met with Dr. Marquez after the treatment. I will meet with her each Tuesday after my treatments. She told me planning my treatment was difficult because of the spread of the area that needed to be covered. She was happy to report that my heart will not get much radiation, but disappointed to report that 35% of my left lung will get radiated. She has had two other patients similar to me, and both have experienced shortness of breath, etc, for about a year after treatment. She expressed concern that it could affect my ability to argue for long periods of time in court....but I'm sure most judges and defense attorneys will be thrilled that I'll have to learn to be more succinct! Not shockingly,
Greg was also not distressed to hear the news of my potentially having to speak less and in shorter sentences.
The lung radiation also increases my risk of lung cancer, but she said that's really only a concern if I smoke or am exposed to second-hand smoke so...SMOKERS: you're now going to have to quit. HAM I'm looking at you! (I love you!!!)
They were able to schedule my treatments around my schedule. I printed out 8 weeks from my work calendar, and highlighted the things I had to go to, and they worked around everything. It was great. (And, I think one of the team members in particular felt at that point we were kindred-highlighting-nerd-spirits!)
The only thing about this that is worse than chemo (so far) is that it is
EVERY FREAKING DAY. The reality of that set in yesterday. EVERY DAY I have to drive up the hill for this treatment, find parking, take the elevator, check in, change my clothes, lay on a cold hard table for 20-30 minutes....E V E R Y D A Y. That is just so unexciting to me. BUT: now that it's started, I'm that much closer to being done so there's the silver lining!
