August 10, 2018
I started my radiation treatments at the end of June. I had a week of treatment, then a week and change off before starting again while my oncologists and I figured out what to do about the new mediastinal node. The decision made was to re-start radiation this time combined with a radiosensitizing chemotherapy to make the cancer cells more susceptible to the radiation treatments. The new node also means an additional radiation plan that adds approximately 8-10 days to my existing treatment plan.
The first plan covers my whole right breast area, which includes my right armpit, down to about 2″ below my breast where my bra band rests, and across to about the middle of my chest and up just past my collarbone. The 2nd plan covers the middle of my chest and across to about the middle of my left breast up covers about an inch or so of the bottom of my throat. The way that it works, the plans are set up to go around healthy tissue like my heart and lungs. Between these two plans there are still small parts of my lungs that are getting treated, which can’t be helped. At the end, there is a third plan called a boost. It won’t cover quite as much area. It’s designed to to eliminate any residual cancerous cells within the breast, which would be in the place where the original tumor was removed and the affected lymph nodes – so for me, that’s my armpit, the one under my pec, and the ones in my mid-chest.
I have radiation treatments every day during the work week. I started out being on the schedule around 9 or 10. Now, I am usually the first one on the schedule in the morning. Mostly because I want it done and out of the way so that I can work uninterrupted for the rest of the day, and so that there’s nothing else competing for my attention so that I can get there on time. That piece of time management has always been a problem for me, but with chemo brain, it’s much worse.
I’ll be glad to have my days back so that I can be on the road with the rest of the commuters who understand traffic, and at be at work first thing in the morning instead of going to radiation, coming back home to do some meeting calls and get my burn cream on, and then get to the office around noon or later. It feels like a waste to be in the office for only a couple of hours, especially on days when the rest of my team is leaving the office between 2:00 and 3:00 to “beat” traffic, so I either end up staying later into the evening or leaving with them by 3:00.
When going to radiation in the morning, I can’t have any oils, perfumes or alcohol on my skin because it would intensify the burning to my skin, so I take my shower with the oil and fragrance free soaps and make sure that I’ve gotten last night’s cream off of my skin. I have designated bras for going to treatment and after treatment. The ones for going to treatment never touch any of the burn creams so I know I’m not carrying any oils with me. When I get home after treatment, I put the cream(s) on and change into one of the other bras that I will wear during the week, which help keep the burn cream in place while also keeping my clothes from chafing my much more sensitive skin.
When I get on the table, they line me up using lasers installed in the walls and the tattoos they gave me the first week. Once I’m lined up, they take some x-rays to verify my position is the same, and then the machine moves into position to start treatment. The x-rays are used to make sure my body’s in as close to the same position as possible each day. The machine reads these x-rays and re-positions the table before positioning to deliver the treatment.
When it’s ready to start the first actual treatment, the machine moves to just below my left shoulder. The aperture of the focuser reminded me of a calligraphy letter “H.” Considering that my last name also starts with “H,” I thought that kind of apropos. Then later, as it moves, it changes shapes. Sometimes just blobs, sometimes aliens, and sometimes it looks like an EKG line. I am not supposed to move my head during treatment, so I don’t get to watch it go all the way around to the other side. I can’t move around because it would mess with the measurements of the machine and I’d be radiating things that weren’t supposed to be treated, which would be bad in the long run. I can usually see the top of the machine when the focuser is over on my other side. It comes to rest down below my right shoulder under my back, and then starts the swing back to my left side. The rotation time takes about 70 seconds. Most days I can hold my breath all the way through the arc. Other days, I can feel my diaphragm or stomach muscles relax, and I have to take a new breath halfway or 3/4 of the way through. On the trip back it goes a lot slower when going past my left arm, and it mostly psyches me out so I have to take a breath to get it through to the finish. When it gets back to its starting position, the focuser rotates around and sets its aperture for the second plan. The whole process takes about 30 minutes from getting me in the right place to taking the x-rays to delivering the radiation.
It’s interesting to watch and think about how the machine moves and what kinds of intricate gearing are required to get it positioned each time. When it sets up for the x-rays, for example, there is a polished steel plate that is brought to my left side. I can hear the larger gears putting it into the right horizontal position, and at a certain point, it moves to a much smaller and precise (and quieter) gearing system to bring the plate closer to me. I can hear the whoosh and clicking sounds of the x-ray machine as it takes the images. Then, the x-ray head is brought around and over me, and the plate moves under. I can see reflections in the clear housings of the x-ray camera sometimes as it moves around. In the reflections, I can see how the lasers crisscross my body. There are flat panel monitors that show the changes to the coordinates for lining me up that I can sort of see, but can’t really read because of how my head is angled and where they are. Other days, the fact that I have cancer and am having to endure this every day for weeks on end makes me wonder how this got to be my life, what will be next after I’m able to get the next scan in 3 months, and what other side effects will pop up after radiation is done.
Before long, the machine is in position, the sound of the machine being ready to deliver the dosage comes on, and I know it’s time to take a breath and hold it. The tone reminds me of those days in band and orchestra when we tuned with the tuner. For those interested, it’s a concert F pitch. Kind of fitting considering I played Horn in F for so many years. LOL! When the tone stops, the treatment is done and I can breathe again.
When the machine moves, I can kind of watch it go around and see where it stops. When my diaphragm muscle relaxes, I can see the machine waver a bit, and I know I need to take a new breath. About 3/4 of the time, I get right in the zone and it starts again right away. The other 1/4, I usually have to let some air out to be in the right capacity zone. I am reminded of many days doing breathing exercises with the college band director before we’d start rehearsal.
Each plan takes about 5 minutes to run its course. The techs come back in between plans to reposition me for the next one. The settings aren’t drastically different between them. The machine projects a scale on my chest in centimeters. The techs line up one of my tattoos to this scale, the tattoos under my arms are lined up to the ones on the walls, and the machine head is positioned a certain distance from my skin before we start. The change in position is to move the table a few centimeters and reposition the machine head. At the end of treatment, I hear the tone stop, and the tech comes back in to move the table away from the machine so I can get up. The whole process takes about 30 minutes each day.
Once a week after treatment, I have an appointment with the Radiation Oncologist. She asks how I’m feeling, what my pain levels and areas are, and then takes a look at my skin. At about the 3-4 week mark, my skin started looking pinker. Now, I look like I have a healthy sunburn on most of my chest and part of my neck. It doesn’t really feel burnt other than there are a few spots that feel tight and it itches some. There is one spot by my collarbone that is probably going to blister up and open up. If it does, there is a special cream with silver in it that will help it to heal faster. In the meantime, the nurse gave me a sheet of Mepilex that I can cut into pieces for some of the more sensitive spots, like the one on my collarbone. In that case, it will also help keep my shirt from rubbing on the skin and irritating it more. The magic of Mepilex is that it’s a little thicker than a regular bandage, and the glue on it will stick to anything without causing skin damage. This means that I can put the cream on and the bandage will stay in place. It’s pretty cool stuff.
I tried to get some pictures and video of my treatment, but I wasn’t successful. If you want an idea of what it’s like to get radiation treatment, here’s a video that does pretty much capture how it was for me. This guy’s getting treated for some kind of brain tumor, so he’s got a head immobilizer where I have the breast board and while I *can* move my head, I’m supposed to lay perfectly still in the same position for the whole time. It’s only 5 minutes, so it’s usually not too difficult.