Day 207 - Phase 3: Radiation!

I've made it to Phase 3! Hooray. It's one down and 27 more treatments to go. I had my first round of radiation and boy, was it a doozy.

So last Tuesday, I went to OHSU for my "mapping." That was an easy appointment. I thought it was going to be longer than what it was. The first stage was to get on a table and lie there very still with my hands over my head. It was nice that I actually had a handle to hold. I was worried that I had to put my hands up without any aid. Next, they stuck wedges under my triceps to help keep me comfortable. Once they had me in position, it was time to line me up. There were two laser beams (red) that they centered me on. One beam was going from one side of the room to the other side of the room (horizontal axis). The other beam was coming from the ceiling. Once they had me where they wanted me, Dr. Marquez came into the room and marked me up... the top, bottom and the sides. Next the techs mapped me by pushing me through a CT scanner. Thank goodness they didn't need a dye/contrast. The CT scan is used to map my organs and figure out the best angles for the radiation beams to hit the areas they need to hit and to avoid certain areas (more to come). Following the CT scan, the tech then tattooed me. Three little dots to mark the planes for the laser beams for true radiation. I have one on my upper chest on the left hand side and two on the front of my torso under my breasts. I can't see the ones on the bottom unless I look in the mirror. Ahhh, the trials and tribulations of having such huge knockers! Ha! Following the CT scan, I was done. I was given alcohol wipes to wipe away the permanent Sharpie pen marks. That's a handy thing to have to get those pesky marks off. After that, the resident came in and made me sign a disclosure and we went over the things that could happen from radiation: decreased lung capacity, heart issues, cancer from radiation, skin reddening, loss of hair under the arm, lymphedema... the list goes on. But the benefits far outweight the negatives.

Fast forward today. I got to my appointment at Radiation Oncology shortly after 12. My appointment was at 12.30 with Dr. Marquez's nurse to go over some stuff about what to avoid and what will be good. I didn't get in until about 1.20p! What is it with 12.30 appointments? Nevertheless, we finally got into the door and had a consultation with Nicole, the nurse. We went over what was going to happen today and what to expect in the next few weeks. I am still on track for 28 sessions. So nothing has changed with that... especially after seeing my recent PET scan. The first session will be the longest. We went over how to care for my skin. Apparently there is this herbal supplement/lotion/cream that Dr. Marquez is high on... it's called calendula. It's derived from a species of marigolds. Maybe I should grow some in my backyard and squeeze out the oils and apply it to my skin! Ha! She said that I should put it on the areas where I will be radiated. Apply it twice a day. We went over the fact that I may be fatigued from radiation. And then it was question time. I asked if I would be able to swim during the time that I get radiation. I have been seeing/reading so many different answers. Nicole said that it was okay for me to swim during radiation, as it will help me with keeping the skin and the muscles loose during treatment. She said that many women swim during radiation and then toward the end they stop because their skin is changing and getting more tight. Sweet! I can go swimming in Becky's pool... (here I come Becky!) She said that when I get out of the water to make sure that I apply my lotion and rehydrate the skin. Oh yes, she said that I should use mild soaps and then when I dry myself off, I should pat dry my skin. Reduce any sort of friction that could cause aggravation to the skin. She asked if I wear a bra. She suggested no underwire (I don't, too uncomfy) and that if it starts to irritate me, that I could take a sock and slip it under the band. Nothing like stuffing a bra! I also asked what will my skin look like and when will I start to see changes. She said in about 2-3 weeks, I will start seeing some changes - like a reddening of my skin. The changes will continue up to 4-6 weeks after the last treatment. Radiation is cummulative. Groovy. We'll see what happens. Oh yes, my diet can stay the same... however, I should stay away from antioxidant supplements.

Next up was the actual radiation where I got to sit on the bed and be radiated. So after speaking with Nicole, she showed me to the changing area. There are four changing rooms and each one has two lockers with keys. I changed into my gown. I got to wear my jewlery - all of it except for my necklace (which I wasn't wearing to begin with anyway). Next I was told to wait in the changing room wait area. It didn't take long before Rebecca rolled into the room. She's one of the team of four administering the radiation. She rolled in because she broke something in her foot. So she had a little scooter that she was using. She took me into the electronic room. She wanted to make sure that I knew who I was, when my birthday was and what sort of treatment they were performing today. I gave her all the right answers. I passed the test. Then she told me that the room had satellite radio. Sweet! I got to pick the music. I picked Top 40. It was hard to lie there and not move when all I really wanted to do was to groove and dance to the music. Anyway, I got to see a 3D version of my CT scan... with skin. Looked kind of frightening. It looked like one of those animated bodies you see on the news. Then it was on to the radiation room. There was a chair and a table where I set my purse and my locker key. Next I hopped onto the very hard table. There was a sheet lying over the table. Rebecca and another person, Linea, helped adjust me. They were matching up the three tattoos with the green laser beams. They told me not to move and that they would do all the moving. Finally they got me in the right spot. My arms were over my head and my head was positioned to the right side. The reason for me turning my head... they had to radiate the left side of my neck. They put the wedges under my arms and I continued to hold onto the handle bar. Then they raised the bed up and left the room

The first treatment takes the longest. It was awful. I am not going to lie. The first thing they do is take x-rays and scans of your body. Then they take those "today" scans and overlay them from the CT scan which actually has your internal organs. They want to make sure the computer and whatnot is all set up correctly so they are maximizing the radiation field, but minimizing the radiation to parts they don't want to hit (lung and heart). This was the hardest part because my hands were up in the air and my left hand and arm started to hurt from being in that position for so long. My arm started to get numb. Finally the techs came in and said that they were done doing all the mapping and they would start my first dose of radiation. Dr. Marquez was in the room while they were fine tuning the mapping. They scared the living daylights out of me. I jumped on the table. I asked them if I could move my hand at all. They said I could move my fingers, but not my hand. Dan ended up taping my hand to the handle that way I could relax my arm. It helped... a little, but my arm still hurt. He even said that my arm was ice cold. Um, yep! He started to tape up the right hand, but I said that that one was fine. Then they left and I had 10 minutes of radiation. They started with my supraclavicular area (side effect of radiation, a sore throat because the beams are going to hit my esophagus) and then from there, I don't know. The radiation doesn't take very long... it's all the prep. So after the first round, the techs came in and marked up my skin with permanent pen AGAIN... marking the field of radiation. They marked up my neck, under my arm and down the center of my chest. Once they did that, they put on this thing called a "bolus." It reminds me of ballistic gel. What I found out is that the radiation beams reach their maximum output at a certain depth. By putting the bolus over my body, it acts like a "skin thickener." I need the radiation to hit the skin, not a 1.5cm into my body. If the radiation goes through my normal skin, it will hit anything at maximum input of 1.5cm. Interesting. And the bolus they gave me is MINE. After the last session of radiation which was to the chest itself, the techs came in and took pictures of the markings they made with a camera (as in a little digital one). They have to document the field of radiation. Then I was able to get out of the compromising position they put me in. They promised me that next time it will be much faster.

As for the radiation machine. It's huge. It's open. What they have is me on a table lying flat. By my head is the actual machine that gives me the dosing. It's shaped like a C with me in the middle. The arm then rotates around me, so I never have to move. It looks similar to this.

If you keep your eyes open, you can see there are these little keys inside the plate and they move and I think that's what directs the radiation beams. Interesting, eh?

Next I was told to get dressed and then wait to go and see Dr. Marquez. Every Tuesday I will be meeting with her after radiation. We will discuss how I am feeling and what's going on with my skin. It took awhile for Dr. Marquez to come in, but when she did, she came in with a smile. Made me happy that I decided to go with her. She said that I lined up perfectly. I said that I had been practicing. She said that normally with people they shift a little bit, but I was just perfect. Beautiful... I did something right! ha! She asked me if I had any questions. I asked her if she felt any need for me to get a higher dose of radiation than she planned. She said that I looked fine and that her initial dosages for me was fine. My dosage is 5040 centigray (cGy). That's the total amount of radiation I will get over the course of 28 treatments... so 180 cGy's a day. She pulled up my chart and said that I didn't have any cancer and that this is preventative. Dr. Marquez had mentioned that she would do higher radiation if there was still cancer present in the node in my neck. But since there wasn't there was no need to worry about it. We talked about the PET scan... she said that I had some brown fat which is nothing in my neck. Then we talked about under the arm where I had some uptake, but that's normal after a surgery. Then we went into talking about the very mild uptake in my mid chest (anterior mediastinum). She didn't worry about it. She said that there was no correlation between that and the CT scan that was done at the same time. There's no tumor and there's no concern. Then proceeded to go into what exactly is 'mild' and "very mild"... does that mean cool? So it was all subjective.

The coolest part of the whole day is that she showed me my treatment plan. I got to see the images that were taken of my body. She showed me the quadrants they are radiating: the neck, the breast, under the arm and the area right next to that. Then she showed me the histogram which shows what organs were getting the most radiation. The most was my skin. Dr. Marquez then showed me that they were working really hard to avoid my heart and the aortic valve to my heart. They did a good job with that. However, the lung... they are hitting about 40% of that and when all is said and done, I will have about a 30% decrease in lung capacity. But on the up note, they won't have to do anything to my right lung. I'd rather be alive huffing and puffing than dead. I will most likely start to notice the decrease in capacity about a year from now. So I told her, now's the time to run that marathon. :) She said it's in October. God love her! We discussed the fact that she's radiatiating the nodes in the middle of my chest so I don't come down with inflammatory nodes. That would be a bad breast cancer. Get it all now. Oh yes, during the planning session, she said that she almost had to deflate one of my breasts. She said about 100cc's. I said, "Oh no, I worked so hard for these - all the sweat and tears!" But she talked with Dr. Thaker and they put their heads together so I didn't have to deflate. I didn't realize that the other boob would get in the way of the radiation beams. Goes to show you how much I preplan. So they figured out a way so the rad beams can get where they need to go AND I save my boob. So now I don't see her for another week.

Tomorrow my appointment is at 1p and should last 15-20 minutes. My last appointment is Friday, Sept. 14. Hopefully they will be more on time. I am now on a quest to find calendula. Wish me luck!

P.S. I know that Steve was there with me in that radiation room today.