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Saturday, June 27, 2015

Cancer: Radiation

 Each day is a calendar square, each square empty except for my afternoon appointment written neatly in purple, the occasional lunch date added in black.  Dance classes are marked at the top of the day columns.  Nineteen carefully blocked days with 15 minutes extra noted every Thursday.  Thursday is the day I meet with the radiologist.

Is it a Space Pod?

Today’s Science Lesson: (there will be a quiz later, so listen up).  The Space Pod is the machine that effects radiation treatments.  Right, right, it isn’t really a Space Pod (in case you were in any doubt), or a Radiator or a Zapper (I’m just sayin’).  It’s a linear accelerator.  Electrons from an energy source shoot (accelerate) down a tube where they impact an angled metal plate.  98% split away as heat; the other 2% radiate photons (radiation) down the adjoining tube and spray them at my breast.  You can also send the un-split electrons down the tube.  Electrons kill cells really well, too, but they don’t penetrate very deeply and so don’t need a metal plate to catch them on the other side of their target.  Radiation hits any stray cancer cells that might have avoided surgery and damages their ability to repair themselves or to multiply.  It hits normal cells, too, but they are better able to repair themselves and so heal afterwards

The linear accelerator is HEAVY and so is located in the basement of the Cancer Care Center, but  there are faux skylights in the Rad room so it always seems airy and pleasant.  In fact the Rad area is about the most pleasant place on earth. The staff learns my name, respectfully Mrs. Simon and never Ann.  There’s never more than a few minutes wait for treatment.  The changing room (I remove my top and bra and put on a short hospital gown) and waiting room are quiet and comfortable.  There is hard candy in the outer office, but in the inner sanctum of the radiation anti-chamber, there are Dove chocolates.  All questions are answered.  Everyone strives to make me comfortable.  It’s like a spa -- well, almost. 

This skylight has dogwoods.  The other one has cherry blossoms.
  
When I’m called into the anti-chamber, the merest possibility of radiating some extraneous body part is prevented as they check my face against the picture taken during preparation.  (They promised not to put it on the Internet.)  While I eye the bowl of chocolates, I state my name and birth date and identify the left breast for treatment.  They’re thorough in all things so measurements and body placement are precise and are adjusted every week as needed. 

When I lay back on the oh-so-narrow table, the nurse and assistant help me remove my gown and drape it modestly over my right side.  I place my arms in the brackets.  If I like, the technicians wrap my arms in heated towels although I've declined since the temperature hit the high 80s.  The technician and nurse carefully align my tattoos with the sensors.  Once in position, I must not move.  I am an itchy, twitchy person, but they are strict!  They tape the funny black plastic box over the stickers on my tummy.  Everyone leaves the room (but me), and the gurney slides me  into the Radiator, er, linear accelerator.   

The space wings rotate around me and lock into position.  The square wing seen on your right swivels out of the way.  It can be used as a soft-tissue CAT scan.  The rounded wing on your left, is the one that will fry my cells.  It is angled so the rays travel through my breast and hit a metal plate beyond.  It has a rectangular screen with a smaller screen inset, and it if from there that the photons whoosh out.  

I hear a mechanical hum; the nurse’s voice through the speaker directs, “When you’re ready, inhale and hold your breath.”  Holding my breath pulls my heart millimeters out of the radiation beam.  If I exhale before directed, the sensors in the black box detect the movement, and the radiation automatically stops. The first zap is 21 seconds (not that I’m counting, but 21 seconds is a bit of time to hold your breath, I can tell you); the second discharge is seven.  The wings rotate to a new angle.  I hold for 12 seconds and then eight.  The gurney slides out of the Radiator.  Repeat once a day for 18 more weekdays.

2nd Treatment:   I can feel occasional sparks along the surgical lines where the nerves were cut.  They are trying to re-grow, but the radiation keeps killing them off.  The little twitches tell me the invisible, unsensed rays are working. 

6th Treatment:  My consultation with the doctor goes well.  My breast is sometimes sore, but there is as yet almost no reddening of the skin.  Depression hits on and off.  Today I probably feel down  because I slept badly last night.  I have been obsessing over the oncotype test which showed an 8% chance of metastasization years down the road.  This weighs on me.  For the first time I get why they call it the Life with Cancer Center.  I had thought it a horrible name, stressing that cancer would always be part of your life, but I am constantly aware that death shadows me. 

(Later that day)  I had lunch with my neighbor, a nurse and another breast cancer survivor.  She told me that breast cancer migrates to particular places.  They will regularly check liver and lungs.  Should the cancer metastasize, they will catch it early.  I feel the black cloud lifting.

9th Treatment:  It takes me five minutes to drive from my garage to the hospital parking lot, seven if the traffic’s bad.  How great is that?  I’m fine in the mornings and still happily flail my way through ballet class, but I've been pretty tired after the last couple of treatments.  I’m very tired of the whole cancer thing.  I’d like to do something else now, please.

11th Treatment:  Today the nurses attached a cone to the accelerator.  (Well, they called it a cone; it’s an open-sided box with a metal ring set in the side that points at you.) They positioned it a couple of inches from the lumpectomy site.  They drew a new target on me and put on a new sticker (new sticker, yay!) in preparation for my last three sessions.  These are called booster treatments and will consist of electrons (rather than photons) bombing right up against the lumpectomy site, the area of greatest risk.  (Remember how the linear accelerator works?  I told you there would be a quiz.)   Yesterday and today I have not been at all tired.

After my treatment, I asked the nurse more about the oncotype test.  I didn't take notes, but I believe this is the gist:  stray cancer cells can be in our bodies.  They just float around suppressed by the immune system until or unless something triggers them to multiply.  More relief!  It’s a coulda, sorta, maybe scenario rather than a screaming you’re gonna die! scenario.  I no longer feel doomed.

12th Treatment:  The effects of radiation are cumulative, and I feel the burn.

13th Treatment:   While I’m in the Zapper, I think, hey, I’d like an end-of-treatment, sticker-off ritual.  I think of wearing gauzy scarves, skipping through a field of daisies a la Isadora Duncan, stripping off the stickers and strewing them to the wind.  I shout, "Sticker off!  Sticker off!" and move in slow motion.

15th Treatment:  My fatigue level is up and down.  This morning was the first time I did not finish dance class which was sad for me.   After class I had a phone call, and I would just like to say that my friends should put off having crises until I’m done with mine.  I mean, what’s up with that?!

17th Treatment:  I've been quite fatigued (as opposed to sleepy) for the past three days. Today, aha!, was the first of my Booster treatments.  They fitted the “cone” onto the Radiator, snugged it up close to my lumpectomy scar, and the big, dopey electrons dripped out.  (You know that’s a metaphor, right?  The electrons are tiny, they don’t drip, and if they did drip, they’d fall right on the floor since the cone is targeted from the side.)  Anyway, the important thing here is that it signals the beginning of the end.  I have the weekend to rest (except the Perfect Grandchildren and their attendants are coming to town, and my sister is having a big anniversary party and then brunch the next day), and then I’m in for my last two treatments.  The skin right under my nipple is really red and sore. I have gotten no further in creating a plausible sticker-off celebration. 


I’ve been tired all weekend.  Like really tired.  Like napping tired, and Inever nap!  I am tired of being tired, and now my lumpectomy site is stinging a lot.  I say Bleh! 

19th Treatment:  I was stoked all day because this is my LAST treatment!  Then driving to the hospital, I was a little sad, maybe because I will no longer be actively fighting the cancer.  Anyway, I was over it as soon as the treatment was over.  The nurse gave me a certificate of completion almost as if I’d actually done something!  I got instructions for follow-up care (continue the same breast care for a couple of weeks) and will make a follow-up appointment in two months. 

We grilled steaks tonight in celebration. My private celebration was in the bathroom (alas, no Isadora Duncan) as I unpeeled stickers and chortled, “Sticker off!  Sticker off!”  The newest sticker will have to wait a bit as tugging at it pulls the sore skin.  However, its day is coming.

Next week I enter the black hole of genetic counseling.  There seems to be very little to available about that in advance.  One quirky thing about it is that the genetic counselor got her masters degree at my old college.  What do you think of that?  She will probably test, and I hope they are able to take the blood right then.  It is so hard to go back and back and back some more.  Once they draw the blood, I guess, deducing from the oncotype test, it will take about 10 days to get results back.  We’ll see, or rather I’ll see and report back to you. 

Sticker off!

Sunday, June 7, 2015

Cancer: Preparing for Radiation (the simulation)

They TATTOO you!  Yes, tattoos.  And it hurts!  I asked for a kitty, but they only do dots.
Then they put stickers on your tummy.  It’s a three-year-old’s dream.  

You lie back on the CAT scanner gurney, hands secured in brackets overhead a la Fifty Shades of Gray.  When you are positioned just so, they draw arcane lines and dots on you with black and red magic markers. Who knew the preparations for radiation involved so much body art?    

After the radiologist approves the signs and symbols, the technician tattoos all-but-invisible guideline dots, one under each arm, one on the sternum.  How do people bear those beautiful tattoo sleeves?  Yikes! 

Next comes the black box which is positioned on the tummy stickers.  Of all the strange things that diagnosis and treatment entail, having a black plastic box taped to my belly is right up there.  Will I disappear inside the machine so they have to use the black box to find me?

The gurney slides into the CAT scan.  This time a nurse, rather than a robot, tells me when to breathe. She takes x-rays while I hold my breath, and some while I don’t.  The radiologist will analyze these to determine if holding my breath also pulls my heart out of the radiation beam.  That is worth knowing!  I breathe -- or not -- on command.  I do not move no matter how itchy the corner of my eye gets.  For once in my life, I am more than willing to be perfectly obedient. 

This appointment is called a radiation simulation. It’s not a simulation as far as I can tell, since the radiation does not take place in the CAT scan or even in the same room.  The process is rather a graphing and mechanical preparation.  The red rectangle they drew around my breast shows exactly where the x-rays will redden and burn.  There is no guessing, and there will be no stray radiation.

Once I’m up and dressed, I’m shown to an ordinary exam room where the nurse gives me “the talk.”  No, not that talk.  It is a talk about rules.  There are always rules once you are plugged into the medical world.  In this case, there are creams and powders and when to use each.  Vitamin C and Co-Q10 and high C multivitamins are prohibited during and for six weeks after treatment (antioxidants feed cancer cells).  I’m not permitted an underwire bra.  She says to wear a cami or a sports bra.  A cami?  She's kidding, right?  I’d expire from bouncing!  But, see, this is why god created catalogues.  

I discovered a soft, cotton bra which has both darts and front gatherings (lots of support) with a front clasp of four hooks and eyes.  I also learned that sports bras have come a long way since I last tried one. 

Stretched out, tested, prepped, and shopped.  I’ve cleared my calendar for the month.  I will back out of activities if I suffer the vaguely warned-about fatigue (which will also, you know, be a good excuse if I just don’t want to do something.)  I will show up five days a week for 19 treatments.  

I’m more than ready; I’m eager.  Nuke the damn cells; nuke 'em all!