Wednesday, February 22, 2012

35% Complete

Yesterday was my tenth of twenty-eight radiation treatments.

Not much new to report.

The area being radiated is sore--but it's more like I've overdone it in a workout kind of sore as opposed to burned skin or sharp pains.  So, I'm trying to stretch the area a lot.

The other "side effect" that is already noticeable (though not awful) is that my esophagus is starting to feel tender.  It feels like heartburn, sort of.  It's not a big deal, except when I try to swallow my pills--one in particular is a horse pill and it's getting tough to swallow.  I met with Dr. Marquez yesterday who says to chug some Maalox and that could help, so off to the store for Maalox I went!

G may come to a radiation session one of these days.  If he does, I'll have him take some video of the machine in action...

No real fatigue yet, although I confess I did take a little power nap yesterday after the treatment which I don't normally do so maybe it's catching up to me?  We shall see....

Wednesday, February 15, 2012

6 Songs

It takes about 6 pop songs, from the time I'm brought into the radiation room until the time I am done getting zapped.  I realize that pop songs vary in length, and you have the occasional DJ talking in the middle of the songs...but no commercials on this particular Sirius/XM station so I've gotten to the point where I can pretty much count it off, assuming everything goes right:

1 Song = the time I'm on the table getting moved around, the bolus placed on my chest, etc.
1 Song = the time it takes to do the imaging, to make sure I'm on the table in the perfectly correct position
1 Song = the time it takes the team to review the imaging before starting the treatment
3 Songs = the time it takes to zap my tumor

I'm at the mercy of The Pulse satellite radio station as to how good those songs are, and it really does make a difference!!  I like PEPPY songs (even though I can't move around) because the slow ones bring me down.  "Moves Like Jagger" came on once and it was the happiest I've been with hands that were asleep, a sore spot on my head, and cold toes!

My skin is slightly pinker than it was when I started, but still not uncomfortably so.  My biggest complaint continues to be the ridiculous position I have to hold for those 6 songs.  This weekend, in fact, I woke up at 3:00 Sunday morning in excruciating pain--pinched nerve in my neck...the numbness and tingling radiated down my left arm and I could barely move.  That night and the following night I struggled to find a single position that was comfortable to sleep in, but I took an assist from my leftover surgery pain meds and have been sleeping well since then.  I talked to my doctor about it yesterday at our weekly check-in and she said I should try to keep that area nice and stretched...and she assured me that she'd refill my pain med prescription if I needed her to (hopefully I won't, but it's nice to know all I have to do is ask!!!!)

Today will be my 7th treatment; with 21 to go.  No "fatigue" yet but I didn't expect it this soon.  My appointments are now late afternoon instead of evening so I get to hang with O before bedtime.  And even though it's still annoying to have to go every weekday, it's just becoming part of the routine now...

Friday, February 10, 2012

All Night This Week...

Based on my schedule and request, my radiation treatments have been after work this week.  That means on Wednesday, Thursday, and tonight I miss the bedtime routine with O.  (Not to mention that on Tuesday, G and I attended an event to honor the Portland Police Bureau 2011 Retirees...so that will be four nights in a row...)

So far, not getting to kiss O goodnight has been the worst thing about radiation.  By far.

The skin is pinking up and I am slathering on the lotion to help keep things soothed.  I guess the silver lining there is that a lot of that area is still numb from the mastectomy / lymph node removal so it doesn't hurt as much as it might otherwise.

I was able to find a video of how the metal bars move during radiation!

Maybe that's only interesting to me, but it's the only entertainment while I'm laying there getting zapped!

Actually, youtube.com has lots of videos that show IMRT if you're really intrigued by the science of it all.

And I discovered another silver lining, because my head and / or neck aren't being treated, I'm not pinned to the table like this:




I saw this image the other day when I was looking for other pictures to describe my experience.  I talked to my treatment providers about it and they showed me how it works--yuck, yuck, yuck!  I would not like that at all (although the neck support in that picture looks nice...)

BUT in searching I also came across this photo, which makes me jealous--her arms look much more comfortable than mine are during radiation.  They fall asleep within minutes of my 20-30 minutes on the table.


Oh well, I guess you can't have EVERYTHING.
So, IN SUMMARY, THE BAD: pink skin, arms and hands that fall asleep, no O time; THE GOOD: skin is numb so it doesn't hurt, I really like the people who are providing my care.

Wednesday, February 8, 2012

One down, Twenty-Seven to Go

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!