Radiation Therapy

Yesterday I had my 15th radiation treatment.  I am halfway through, definitely the easier half.  I confess I am writing this under duress.  I have just spent the last hour typing out a clear, seamless narrative of my recent experience – checked and edited.  I went to add a photo.  For some reason lately my blogging platform has been rejecting photos as being too large.  I tried to fix it, gave up, then hit my “Back” button. MY ENTIRE NEW POST HAD DISAPPEARED.

So here I go again.  Sometimes the post is better the second time around.  Always it is more tedious!  So 15 down, 15 to go.  Monday through Friday, radiation treatments have become my daily routine, my new normal.  The treatments themselves have become rather boring and decidedly undramatic.  Shouldn’t complain though.  Drama and cancer treatment is seldom a good thing.  It all started a few weeks ago, my second trip to the radiation department, this time for my simulation.  You say “sim” if you want to be cool.  Radiation departments are frequently housed in the basements of treatment centers.  The walls are lined with lead, the machinery is massive.  It’s heavy down there.

I am led back to the sim room.  This is where the simulation CT scanner lives.  I lie on the hard table.  The technicians bring over a large rectangular sheet of a treated cloth mesh that has just been prepared by heating to soften the fabric.  The whole thing is brought over my head and shoulders, then slowly brought down.  Technicians on either side push the warm fabric around the contours of my face.  It is snapped into place on the table itself.  This will become my mask, fashioned specifically to my head and shoulders.  It will ensure that my anatomy will be held in the same precise position and for each and every of the thirty treatments I am scheduled for.

A series of CT images are taken.  All of these are then examined in the planning room by a team consisting of my radiation oncologist, a physicist, and a dosimitrist (who calculates the dose, both the total dose and the 30 fractionated doses).  Radiation medicine is serious business.  The radiation beam has a specific target.  The official name for that target is my tumor bed, so-called since my actual tumor was removed some weeks ago my my surgeon.

My radiations beams are targeted but not quite so precise as say Cruise missiles are supposed to be.  There is always “collateral damage.”  This is due to the nature of radiation being delivered as a beam that is continuous.  On it way to my tumor bed in the area that used to contain my parotid gland, it first encounters several layers of skin and muscle.  It arrives at its target with optimal strength but then continues on, passing through structures in my throat and then out thru the other side of my face.  In my case five separate beams have been planned, each from a different angle, of a different intensity, and of a different duration.  If all goes as planned the maximum total dose will be delivered to the tumor bed, the area that might contain microscopic cancer cells that escaped the surgeon’s knife.

What does this collateral damage mean for me, the patient?  In my case it means a bad case of sunburn and an increasingly sore throat.  The first few weeks my face was increasingly red.  Now it is shifting towards more purplish tones.  Crusted areas have started to develop, especially around my suture lines.  Desquamation is the medical term.  Each morning I wake up to new blood stains on my pillowcase.  The skin on the right side of my face is tight and a little swollen, making my face a but asymmetrical.  The whole area is tender with occasional pangs in my ear and along suture lines.  So far the sore throat has not interfered with eating but my voice fails me at times,  dropping into a coarse, raspy whisper. My mouth is constantly dry despite an array of products from my dentist.  Fatigue is becoming an issue.  On Sunday and Tuesday I needed to take two naps each day, and that after nine or ten hours of sleep.  Spring around our house with all our gardens is not a good time to be dealing with treatment-related fatigue.

My appointment each day is at 2:40.  I drive downtown, valet park, take the elevator down to the basement, check in, get a cup of cold water, then head back to a waiting area.  In two to ten minutes (this seems to correlate somewhat to how interesting is the magazine I am reading) a technician carrying my mask comes to fetch me.  We go back to one of the two linear accelerator rooms.  A plate to receive my mask is attached to the head of the table.  The table is covered with a thin white sheet.  I lay down as technicians place a foam support under my knees, then fasten me down to the table with eight plastic clips.  SNAP, SNAP, SNAP…  Now I am literally pinned to the table.  I can blink but barely move my mouth to talk.  The technicians retreat to a room next door, closing behind them a seven by seven foot, 5 inch thick lead and steel door.  Remember those beams pass right through me and continue to bounce around the room.

It is right about now that my nose or ear or some other part of my face begins to itch, an itch I cannot scratch.  I know that the staff and see and hear me. Music is playing.  The first week I kept my eyes open and watched as the great machine rotated around my head, whirring, clicking and buzzing, and flashing red and green laser lights.  Lately I just close my eyes and let my mind wander off somewhere else, not from anxiety but rather from boredom.  SNAP, SNAP, SNAP…    It’s all over in about five minutes.

On Wednesdays I see a resident and then my doctor.  I am weighed, vitals signs are taken, and an assessment of the side effects is made.  This is the time to ask questions.  Last week I asked how the radiation might affect the vision in my right eye.  I completely lost vision in my left eye years ago after a shingles infection. We look over my treatment plan in color-coded CT sections of my head.  Maybe a 10% chance of cataract development in my good eye.  In a day or two the dietician will ambush me and chide me for a half pound weight loss.

And so it goes.  Not bad so far for cancer treatment.  Folks with head and neck cancers who also need concurrent chemotherapy have a much harder time.  So far just a bad sunburn and a slightly misshapen ear.  Hopefully my throat will not get so bad that I need a feeding tube placed in my abdomen.  Fighting the good fight.  This is what we do as cancer survivors.  I don’t mind the term cancer survivor because it is not so much about who I am as about where I have been.

Take care,

Dennis

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About Dennis Pyritz

Dennis W. Pyritz, RN, BA, BSN, has been a cancer nurse since 1987 and a cancer and bone marrow transplant survivor since 2004. In December 2001 he was diagnosed with t-cell prolymphocytic leukemia (T-PLL), a rare aggressive form of chronic lymphocytic leukemia (CLL). Dennis was treated with the then new monoclonal antibody, alemtuzumab (Campath) as this disease has a median survival of 7.5 months. He achieved a 26 month remission but relapsed in February 2004. He was retreated with Campath and went into a second remission. In August 2004 he underwent an allogeneic peripheral blood stem cell transplant with his brother, Mark, as donor. Dennis has remained in remission since - a near miracle. Throughout his career as cancer nurse and patient, Dennis has had the opportunity to speal to both lay and professional groups. Dennis has spoken on cancer topics and survival issues across the country as well as in the United Kingdom, Norway, Austria, Portugal, Honduras, Panama, Guatemala, Trinidad, United Arab Emirates, Jordan, Cyrpus, Israel, and India.

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