What's up with radiation?

XLVI - I am a weapon of mass destruction...

I was scheduled for a short appointment to meet with the Radiation Oncologist so that I could learn more about radiation and what that would mean for my breast cancer. Like all new doctor's I was required to fill out massive paperwork and go over my medical history, as well as my entire family's medical history.

I carry a large paperwork binder that carries all of my records for my entire cancer treatment. It has all my many doctors and all of the copies of scans and paperwork organized by each one. It also carries a very important section of information I created, a written copy of my medical history and my family's history. It has all my surgery dates as well as my diagnosis & test dates. I have learned that I have had too much going on to remember it all in my head!

The Radiation Oncologist was very nice and informative. The process was pretty straightforward. I would return for a visit a few weeks after surgery. Based on the surgery's findings, I would definitely have my right breast (and a sliver of my right lung) radiated and possibly some of my lymph nodes (if found cancerous). I would then be scheduled for a detailed CT scan that would include marking the exact locations that I would be radiated. It would take up to two hours to complete the process and occur soon after the meeting appointment. At right around 3 to 4 weeks after surgery everything would be healed enough and radiation could begin.

Zap the boobie!

The actual radiation of the breast would be short, but I needed to schedule to be at the cancer center for around 1 hour every day, Monday-Friday for 7 weeks. Hope they do the zapping during school hours!!!

Of course, my breast would be manhandled by multiple people daily and I would be contorted and manipulated, but all for a good cause! The skin could and mostly likely would be affected. The first few weeks would probably cause nothing, but the last part of the treatment was often the worst. However, since it was being examined daily creams and lotions would be provided to help as much as possible. Of course, long term scarring of the tissue can occur. Which for those considering reconstruction, need to talk to the plastic surgeon about.

Fatigue often occurs, but it can be from radiation as well as all of the many things I have already done (chemo, surgery, etc) beforehand as well. And the long term side effects, like cancer, tends to be rare. Heck, chemo had the same side effect. Strange that the cures of cancer can also cause cancers?!?!

Find out more about radiation therapy here.

In my head...

No treatment seems like fun, but I hope and believe it will be easier that chemotherapy. Well, it will at least be different! I felt like I learned a lot about what I would be in for and found that the benefits of using radiation outweigh not using radiation, for me.

Episode Reference: 

Radiation prep & planning

Episode LVI: the smell of hospitals in winter

Enough time (2 weeks) had passed since my surgery, so last week I visited the Oncologist and Radiation Oncologist to talk about my next treatment. As expected it was radiation. I would be going for 7 weeks (35 treatments) and they planned to radiate my breast, some of my lungs, and expand the field to really get those lymph nodes too. But before I could begin I had to come back to get some preparation images so they could pinpoint the radiation.

Radiation Time

I arrived for my scheduled appointment and changed into two gowns. Soon after I was called back to a room that was similar to most imaging rooms I have been in now. However, the room I was in had more people in it. I could see multiple techs through an open window. There were other technicians coming in and out of my room. I then had to take off my gowns... hello everyone!!!

When I got on the table I laid back onto a blue body mold, which felt a lot like a beanbag. I put my arms above my head holding on to a handle that was strategically placed. Then I had to turn my head slightly to the left. After they were sure that I was in the right position that bean bag mold became vacuumed sealed into my now standard radiation pose! The mold would ensure I was in the same position every radiation treatment.

While the body mold was being formed around me, I was simultaneously being scanned. Multiple films were being taken of my breast, chest and underarm area. The scans were painless and in general only required me to remain still which I had to do anyway because of the mold.

Multiple nurses were walking in and out. Then came time to mark my body. The tech began drawing + & ---- on me in different locations. Two on my sides, near my lower rib cage. And two in the center of my chest, between the breasts and below. Also, multiple lines were blocking my future treatment area. The + signs were covered with small round tape to hopefully keep them in place until it was time to start radiation.

One of the radiation markers...

Of course it would not be humiliating enough to lie half naked being touched and marked on... no they would have to pull out a camera and take pictures from all angles. Really! I told them no Facebook posting of those pics unless they were properly Photoshoped. I was in the worst angle and some of the pictures were taken by just holding the camera up in the air. Who knows how horrible those were... except for the many people looking at them later!!!

Overall, the body molding process and images took maybe about 30 - 40 minutes, but at least it didn't require anything but my dignity which at that point was pretty much gone. If it was not gone yet, I am sure the daily radiation treatments would take it away!

I then got to get dressed and meet with an education nurse. We discussed what radiation was and what would happen. Over the next two weeks my images and all previous scans would be gathered and reviewed. The doctor would review it and determine what areas should be treated. Then a team of Physicists would analyze it and make a definite plan. The doctor would then review the Physicist's plan and if any changes were needed they would re-review it. Once that was finished they would make a computerized plan and I would be given a card that had my individualized plan. Each day I arrived for treatment I would swipe my card and the computer and radiation machine would know exactly where to pinpoint my radiation.

In addition, I was told that the Moo cream (Udderly Smooth) and 100% Aloe Vera were fine to use, but that skin reddening does not happen for 2-3 weeks. If or when my skin got bad that I would be seeing the doctor every week and nurses were present daily. Also, I was warned about fatigue and to rest as needed. I was fatigued now!!!

Even though she was helpful, I was tired and ready to go. Ready not because it was taxing, but because I had the flu. Yes, I had found out the day before that I was contaminated with Flu A. I was on Tamiflu, but I was still feeling all the horrible side effects. While I did not have a fever I wore a mask just in case. I would hate to give the flu to any other cancer patient there and we all have horrible immune systems.

Back in bed with the flu...

In my head...

The flu stinks. The flu after surgery stinks. Even though I am exhausted and worn out, I am so glad that I got all my radiation planning done. I got it in before the end of the year and can hopefully start my treatment at the beginning of the new year. I am so glad that the year 2013 was almost over... I have so much to be looking forward to with 2014!!!

“Go back?" he thought. "No good at all! 

Go sideways? Impossible! 

Go forward? Only thing to do! On we go!" 

So up he got, and trotted along with his little sword held in front of him and 

one hand feeling the wall, and his heart all of a patter and a pitter.” 

- J.R.R. Tolkien, The Hobbit

Episode Reference: A Long December, Counting Crows song

New Year, New Start... 1st Radiation

Episode LVII: I fell into a ring of fire... and it burns, burns, burns

It was now a new year and I was ready to get the final treatment started. Ready to be completely cancer free!!! I went the Friday before treatment into the radiation office to get the last films before starting treatment. The location where I thought I was going to have treatment was changed and I was headed to a new center. While the center was closer, it was almost hidden in the basement level of the medical center. I think they were trying to hide the troublemakers there... like me!

I met the guys who were going to be manipulating and zapping me over the next seven weeks. They were funny, which was a bonus since I would be there daily. Of course I had to change into some hospital gowns and then remove them to get my final films. I got on the table and they measured and manipulated me until I was lined up properly and the machine took some pictures and then rotated around me to another angle and took some more pictures.

Not me or my guy techs, but an example of the machine...

Afterwards, I was given some new markings in a new color. Then they told me that I would not be able to start radiation until my insurance approved everything. Really? That should have been done weeks ago. As soon as I got home I was on the phone trying to figure out what went wrong. With all the holidays they were just behind. They promised it would be handled over the weekend, but my 8:40 radiation on Monday was not going to happen! Argh!!!

New color markings, now I have black & green...

Doctors, Doctors, & More Doctors...

My Monday was going to be packed even without the radiation treatment. I had an appointment with the Breast Surgeon where I was quickly checked out and given the we will see you in a six months because you will be up to your eyeballs with other people monitoring your breasts. Then I had to head to the Cardiologist to check on my pulse. Seems that it has continued to run high since chemotherapy... between 106-130. Another doctor, like I needed that?!?

A day of doctors... I got this!

After running an EKG the doctor decided that he would put me in a 24 hour monitor to see if my heart was getting any restful periods. Even though I am not worried, I was glad that we were looking carefully at all my symptoms (high pulse rate, swelling, and some occasional dizziness). However, it meant I would have to come back in tomorrow to get the monitor put on... seems I can't get away from doctors!

While in the doctor's office waiting, I got a call to let me know that my radiation was approved. Yeah! And they could squeeze me in after my appointment. Of course I was all for starting!!! I headed over to the treatment center and I got ready for my first radiation. I had brought my tote bag (with lotion) just in case they called. Being prepared can have its rewards.

At the radiation office, I changed into my gowns and once called made my way to the treatment room. I took off one of my gowns, got on the table, then removed my arms from the other gown and laid down into my mold. The guys positioned and moved me while we chatted. The sheet underneath me when moved made a gas like sounds, so I would just say "Excuse me" and we would laugh.

Once in position, they left the room and I waited. Not for long. Some beeping sounds were made and the lens of the machine would move, then more beeping sounds were made and the lens altered again. That repeated itself multiple times until the radiation for that direction was complete. Then the machine would slowly revolve around my body and repeat the same process from a different angle.

Examples of how radiation was zapped through my breast 

and the area that gets radiated!

That was all radiation was, some noise and I was zapped. Afterwards in the changing room I put an ample amount of Udderly Smooth cream on and placed a rolled up t-shirt under my breast. It was going to be the first day of not wearing a bra for the remainder of my treatment... I was slightly (or more than slightly) uncomfortable about the idea of being bra-less. However, the nurse educator had mentioned that the area under the breast was usually damaged the worst due to the moisture/sweating there. By rolling up a soft t-shirt or material it would help decrease the moisture and skin-to-skin contact. I was all for preventing potential problems!

My tote was now a way to countdown my treatments!

After a few hours at home my chest began to feel hot. As I was casually watching tv I felt that I was slightly sunburned. Then I thought to myself, you are being crazy. I reached into my shirt and my skin felt hot... really hot. I peeked into my shirt and saw that I was red. I was shocked. I was really shocked because I was told I would not begin to turn red until the 2nd or 3rd week of treatment. I was red and sore... and I was even more glad that I had the Aloe Vera in the house already.

Only hours after and I am turning pink!?!?!

In my head...

I cannot believe my skin turned pink only hours after treatment. I know I always have to do things ahead of schedule, but I only hope that it's not a sign of things to come. Being unusual should not always mean that I do things unusually!

However, I know that I can endure and I know that I will get through whatever radiation brings. I have to, so I will. Now I just need to make the best of the week and get my the all clear from the Cardiologist, which I am sure I will get after my 24 hour monitoring. The idea of dealing with multiple doctors throughout the week is not appealing, even if necessary!!!

“Strength does not come from physical capacity. It comes from an indomitable will.” 

- Mahatma Gandhi

Episode Reference: Ring of Fire, Johnny Cash song

Radiation Week 1

Episode LVIII: [Fire] is a mystery...

What a week... my first week of radiation treatment was done! I went every morning after taking the kids to school and got my zap on. Each day was something new this week... yet the radiation process had a similar routine:

1. Use awesome radiation card to register myself into the office. The card was credit card size, but had a bar code that was programmed to contain all my radiation information. It essentially told the machine, hey she's here and this is her zap plan... like I said cool.

2. Change into hospital gowns. I would take off my clothes and put them into my Rad Bag and change into two gowns.

3. Use awesome radiation card again before entering treatment room. That card is really cool. I guess they want to make sure it was me before it zaps me!

4. Hop onto the zapping table. I would remove my gowns and place my head and upper body into my body mold. While laying down on the slab my knees were supported and my feet were looped together so that I would not move.

5. Boob in a box. The techs would move me around and adjust my body until I was in the perfect position. A bunch of numbers and grid will be lit on my body, including lasers that match up to my marks/tattoos. The techs will often call out numbers and move the table until I was just right and my boob is in the radiation zapping box.

6. ZAP. ZAP. ZAP. Everyone leaves the room and the radiation begins. The radiation machine emits radiation in different ways, as the box changes shape throughout the treatment. Then it rotates and goes from a different angle.

7. Run away! I wait until the lower the table (cause I am high up) before I flee. I also put lotion on my breast and change back into my clothes before I actually leave. I am naked enough and in front of enough people right now.

Essentially, I am in the office for 20-30 minutes, except for doctor day. That day I have to hang around and get my skin examined, so it takes longer. Overall, the actual radiation time takes only minutes and only required me to stay completely still... a difficult task for me...

Radiation, Heart Monitors, & Tattoos... oh my!

On my second day of radiation, I had to continue to stay still after treatment so they could put the tattoos on my body. They were put on the second day so that they could make sure the marks were in the correct space. I opted for the tattoos because that way I would not have to wear tape and deal with multiple manipulating of my breasts because the markings may have moved. I was more sure of my decision because my first tape markings moved from showering and daily wear and tear, so why not get 3 tiny tattoos.

My first tattoo ever! A tiny dot . 

Obviously, I wanted some punishment, so after getting radiation, films, & tattooed I headed to the heart center for a 24 hour heart monitor. So, here I go again... time for some heart monitors too...

I am all hooked up and marked up... a hot mess!

Keeping tabs on me...

After 24 hours, I returned the heart monitors and continued on with my week. The monitors were going to keep track of my heart and my heart rate. Fortunately I was not going to need medicine to help with my high pulse rate. The doctor let me know that I had enough time during my sleep where my heart was able to rest. While the numbers were higher than they would like, I escaped the need for more regular doctors and medicine. If my heart rate did not go down a year after chemotherapy then I would have to go back in to get checked and possibly take heart medicine. However, for now I can leave it alone!

Last treatment this week!

With the first week over, I completed 5 individual treatments. Each day of treatment I drew a radiation symbol on my clothing bag, my Rad Bag, as a fun way to keep a countdown.

1 Week & 5 Zaps Down...

Even though I was defying the odds and burned slightly on the first day, I continued to keep getting red throughout the week. I was definitely using the Udderly Smooth, aka Moo cream, and Aloe Vera. Hopefully, I will maintain only this level of red and irritation, as it is manageable.

Looking pretty red after only a week!!!

In my head...

I was glad to have a week down. I was even more glad to get a few days off from radiation. Those weekend days were really needed. I was surprised at how red I had gotten (since I was told that it would be weeks before I would notice) and at how tired I was from treatment.

I was fatigued... really fatigued...

With so many more weeks (6) to go, I was using my sense of humor to get through the discomfort. And to be honest it was really like a bad sunburn. Unfortunately, it is on my boob... and seat belts, clothing, and anything touching it was sensitive.

“Show me a man with a tattoo and I'll show you a man with an interesting past.” 

- Jack London

Episode Reference:   “What is it about fire that's so lovely? 

No matter what age we are, what draws us to it?...

The thing man wanted to invent, but never did...

If you let it go on, it'd burn our lifetimes out. 

What is fire? It is a mystery. 

Scientists give us gobbledygook about friction and molecules. 

But they don't really know. 

Its real beauty is that it destroys responsibility and consequences.”

- from Fahrenheit 451 by Ray Bradbury 

Radiation Week 2

Episode LIX: It's Friday I'm in LOVE...

So another week down... another 5 zaps... 10 total radiation treatments!!!

2 weeks & 10 zaps down...

I have continued to have the same skin discomforts, but enjoy the good conversations with technicians and other fellow radiation patients. However, I am one of the young ones getting breast cancer radiation in or around my scheduled time. I keep saying to myself that my youthful energy is an asset!!!

Smiling through my treatments... go week 2!

I spent much of the week just going back and forth to treatment... following a pattern. I get kids to school, shower quickly, and drive to the treatment center. I go through my radiation routine and head home. Usually, I begin to get tired - especially by mid-week!!! So, then (if I have nothing planned) I embrace my exhaustion and nap...

Exhaustion = Nap time

By the end of the week, I was starting to peel. It was like a slight sunburn peel where a light layer of skin was ready to come off. When I took a shower on Thursday and Friday mornings the skin on my breast would turn white and was gently removed when I dried off. And by drying off I mean patting dry, the idea of rubbing was a not something I would consider and was even warned would be a bad idea. On Thursday, I even had a little extra skin get stuck to my tank top and peel off into my shirt... Yuck!

Dark tank top showed a combination of skin and dried aloe.

I finished another week of treatment with only mild to moderately irritated skin and some slight peeling. And the peeling (since it was light) actually made me feel slightly better. And now I was excited it was Friday, because I got my weekend pass from treatment!

Looking slightly pink after peeling on week 2!

In my head...

I am still refusing to wear a bra. I have had too many warnings that bra = disaster. So, I am slowly getting used to going into public all free-swinging. However, I always keep a rolled up, soft, cotton rag under my breast to prevent skin-to-skin contact. I was told that I should burn badly there due to having larger breasts. So, I am trying to prevent that and it seems to be working.

I am glad to be maintaining my redness and not progressing too much. I am so glad that I was able to have one of my friends along with me on a couple of visits where we got to eat and hang out. I was also provided an amazing meal by another friend, which really helped since cooking has become something less desirable to do as the week progresses. And for some reason my family wants to eat in the evening?!?!?

Let them eat cake...

“There is nothing in the world so irresistibly contagious as laughter and good humor.” 

- Charles Dickens, A Christmas Carol

Episode Reference: Friday I'm in Love, The Cure song