All about radiation therapy.

I have about 11 treatments left. I am getting red and oddly spotted. However, I'm still feeling pretty comfortable. I've been busy with work and neglecting my blog, but it occurred to me that I hadn't written about the radiation yet.

So, let me walk you through this process. First of all, a lot of people have asked me if I've felt sick from the radiation. No. The reason is that they are not irradiating my stomach. (I don't know if you automatically feel sick if your stomach is the target field - it probably also depends on the dose you are getting.) I've been going for about 4 weeks now, and so far, I feel fine. I have experienced some tiredness, but as I've also been burning the midnight oil a little too much, I'm not sure the tiredness is related to the radiation. Mostly what I notice in terms of this is 1) sleepiness, which is different from fatigue and which suggests to me that I need to get more rest, and 2) moments of slight fatigue, where I might decide not to stop off at the grocery store on the way home because I don't have the energy for that. This usually occurs at the end of the day, and it's not much different from my usual energy level at the end of the day.

I'll tell you more about how my skin has reacted in a separate post. I want to tell you more about how they actually do this.

First, they make a mold for you to lie in when you're on the table getting the radiation therapy; this ensures that you are in exactly the same position each time. I had no idea that this was such an exact science, but it really is, so being in the exact same position each time is important. I had to lie back on what looked like a plastic pillowcase containing some of those little beads that are used in certain stuffed toys and pillows. I put both arms above my head and turned my head to the side, and then they filled the pillowcase with air and moved the beads around so that it formed a supportive mold. We played around with this until they found one that was comfortable, and then the mold hardened; each day, when I go in for my treatment, they pull my mold out from its shelf and put it on the table for me.

Second, they take an exhausting number of pictures - a CT scan and x-rays. I say "exhausting" because that's what it is - I was about 6 weeks out from surgery, so I still had not gotten back my full range of motion, and it was uncomfortable (not awful) to have my left arm in that position. I had to lie still for an hour, so they didn't start treatment until the next day. They take the pictures and scans so that they can be sure you are in - all together now - exactly the same position each time. They also gave me a dot tattoo on each side and on my chest, which are further used to line me up each day. I didn't know these were coming and felt a little violated by them, particularly the very visible one on my chest, which looks like someone was throwing Sharpies and happened to hit me.

I do what is called "gaited breathing," which means that I hold my breath during the actual radiation therapy. When my lungs expand, the chest wall moves away from my heart, which allows them to prevent my heart from being exposed to the radiation. There are four angles from which the machine delivers radiation; each time lasts from 12 - 35 seconds, depending on the angle (and the temperature - it was really hot and humid the day I had to hold my breath for 35 seconds). If I can't hold my breath, the machine will stop because I will move out of target range. It's pretty cool.

I lie on my back on the table, in my custom mold, with a cushion under my knees. The machine fascinates me - it revolves around me to get the different angles. The whole thing takes about 10-20 minutes as long as I am in the correct position and they don't need additional pictures. They do take x-rays, I think once a week, to ensure that I am in - guess what? - exactly the same position. Last week, I was off by 4 millimeters because my lungs had gotten stronger from all the breath holding and so they needed to adjust my position. That took about an hour. While it was more comfortable than the initial session of picture-taking, I did get a crick in my neck from being still for so long (they gave me a stretching break about halfway through).

Every other day, they use what I think is called a "bolus" - this is a packet of something that they lay across my chest that draws the radiation to the scar.

There is a little curtain that you can pull for privacy, and a gown you can put on and a towel you can cover yourself with (you have to remove clothing from the area that is being treated). I don't bother with any of these things. I think that this threw the therapists, at first, but what's the point? It seems like false modesty, though I appreciate that this is available for those patients who need/want it.

End of Part I.