New post Added to 8/30/08 - LIVE STRONG

New Post Added to 9/26/08 - Results of the Final Day of Radiation; The Power of a Survivor

A Father's Poem

My dad is not necessarily a man of many sentimental words,
but when he speaks from his heart, he never fails to say just the
right thing.

I have a chalk board in my kitchen that my mom & dad always leave
a note on at the end of each visit. He created this poem and gave me
these words when they were preparing to leave after New Years...


A Father's Poem
2 January 2009

The papers we burned at the end of '08
were things we wanted to eliminate

Bringing forward to the brand new Year
only good health, loving family and good cheer

As your curly hair grows out and your health rebounds
Remember that Mom & Dad are always around

Our love for you only grows and grows,
where it ends nobody knows.

Farewell 2008! Hello 2009!

I started this year with a cold, one whose germs touched many of my family members over the holidays but I m not complaining. As a matter of fact, I am happy to have a cold, for you see, starting off 2009 with a cold sure beats starting off 2008 with a breast cancer diagnosis. I have beat cancer's butt and I will undoubtedly easily kick this colds butt!

Reflecting on 2008...

As I look back on 2008 so many of the memories are cloudy and I really do wonder, "Where did 2008 go?" I suppose the year seems blurry due to chemo fog and the sheer exhaustion I felt most of the year because of my treatments. I suppose that's a good thing in many ways also. Still, I find it difficult to fathom that an entire year passed by and for the most part, the only memories I can recall are linked to my cancer treatments.

What I lost...

I can't help but think about just how much I lost due to the cancer that once claimed a small part of my body and such a large part of my life. I lost far more than just beautiful memory making opportunities, I literally and figuratively lost parts of myself. I lost 7 centimeters of my left breast. I lost a few sentinel lymph nodes and I lost ALL my hair. I lost my belief in myself that I am "Superwoman". I lost the idea that I could take care of myself. I lost a huge amount of pride, in more ways than I care to share. I lost some brain cells and memory function. I'm sure there's more that I lost, I just can't recall at the moment.

And what I gained...

I gained the wisdom that the amount of pride I had was unnecessary and unhealthy for any one person to carry around. I learned humility. I learned that it is ok for it to be all about me sometimes. I learned how to ask for help and how to accept it. I saw how good it makes the people who care about you feel to be able to comfort you in some way. I gained a sense of peace and a much needed balance.

I gained the priceless realization that I am much stronger than I ever thought I was and that I am much more positive than I ever realized. I learned that people think I am inspiring. That awes me and humbles me even more.

Life' Lessons...

Every bit of cutting, every single ounce of poisoning and every inch of burn ultimately left me with such beautiful rewards. Why would I possibly choose to reflect merely on just the ugly scars left behind? Instead, I choose to look ahead.

Had cancer not found me, caught me , grabbed hold of me and forced me to learn some of life's lessons in a mighty way, I may never have seen my reflection as I do now. In the end, I gained the realization that I am Super Woman, Wonder Woman, the Incredible Hulk, Mighty Mouse and Under Dog all combined in one mighty and magnificent package labelled ME! I learned that I am a Survivor and a Warrior.

I am relieved that 2008 is over but mostly, I am incredibly relieved and grateful that my cancer is gone and that 2009 started off belonging to me!

Cheers and here's to good health and happiness!

Ring of Fire; Radiation Burn

Fair warning - this may be a little too descriptive...the burn WAS repulsive...

Maybe I have been a night owl long before I or anyone else in my family realized it. I suppose I've also always been rather independent, believing I could do things all by myself.

I was 5 and my sisters had just snugly and safely tucked me in bed. Having me out of their hair they went downstairs to have some hot chocolate and watch television. Unbeknownst to them I snuck out of bed, quietly crept downstairs and into the kitchen where I discovered the pan of hot water on the stove. The handle was facing outward toward me, practically begging me to share in some hot chocolate, and with a little extra height I would gain by standing on my tippy-toes I was sure I would be able to reach the pan. Soon the mug I held in my left hand would contain my bedtime rendezvous treat - yummy hot chocolate. So I stretched, and I managed to reach the pan, but I barely had a grip and my little hand was strong enough to hold the heave pan of water. The result was hot water on my face and hand, rather than in the mug, I suffered from second and third degree burns on my entire face as well as my left hand.

Memories of my burn are clouded, which I think is a good thing. My healing was nothing short of miraculous leaving no traces of scars. I thought that I would never again in my life be burned anything like that. I was wrong.

I knew the radiation would cause the treated area to burn but I was not prepared for just how badly my skin would be burned. After the first week of treatment my entire breast and armpit were burned. It was tolerable and could treated with Biafine, a prescription moisturizing cream. I had googled radiation burns and was frightened by some of the images I viewed. Bi-weekly I would ask the technicians if the burn would get much worse and each time I was asked I was reassured that it was probably as bad as it would get.

The final 5 treatments are called a "boost" where a higher radiation dosage is aimed specifically at the tumor site, rather than the entire breast and lymph node area. During this week my initial burn already started healing and the skin was turning tan. It had already become difficult for me to sleep at night due to discomfort and I wasn't able to lay on one side or on my stomach. I used a pillow as a support for the treated breast (left) and had not been able to wear a bra since end of week two. Still, all tolerable.

After my final treatment my skin continued to burn. The treated area was an approximate 3" circle and was very red and very painful. By day 5 it was showing signs of blisters. All within about a day I suddenly had multiple blisters which opped immediately leaving the skin raw and exposed. The Biafine would sting when I put it on and because of the openness of the would I wasn't able to rub it in very well. i would have to stand in front of a fan to help cool and dry me off. When the blisters popped they oozed a clear fluid and a few spots actually bled. The site remained like that for 2 full weeks.

My intent is not to scare anyone but to better prepare anyone who may have to face radiation. Granted, I was told that burns to the extent that mine were are not common, but they are also not unheard of.

It's been a few weeks now, 4 as a matter of fact and the burn has mostly healed. The raw spots scabbed over and have since fallen off. The breast area that received the boost is still pink and a little tender but at least it is back to the tolerable state.

Once as a kid and once as an adult, I think that's second and third degree burns about 2 times too many. :0(

Care Enough to Check Yourself

"People should be afraid of the cancer, not the mammogram." ~ Nancy Reagan

Trick or Treat

Boo!!! HA!HA!HA! How's that for a trick? Trick or Treat Day is coming and I haven't blogged in awhile so time for lots of ghosts - oops! I meant posts! ;0) I am so very honored that there are some people who check my blog quite regularly, so for those of you, I hope that you find my sudden burst in blogging and posting a treat! ;0)

I have also chronicled the many steps in my journey through the use of this blog and because of that I am going to "tweak" the post dates so that for the most part my comments will remain in chronological order.

The Pink Ribbon

The Pink Ribbon stands for friendships,
too many to count.
For strength no disease can ever surmount.
It celebrates grace in the shadow of pain,
Bringing us together in an unbreakable chain.
A symbol of hope and our goal, which is pure,
Never to rest until we find a cure.
(author unknown)

October is...

It's October and this month means very much to me for many reasons. First of all, it's breast Cancer Awareness Month. If you are reading this on my blog then you are already familiar with information regarding breast cancer in general and specifically my breast cancer. But don't let that be enough. Do something for the breasts, wether they be yours, a loved one's or all of them for that matter. Do a self breast exam, remind a loved one to do one, schedule yourself or a loved one for a mammogram if one hasn't been done in the past year, or donate to one of the many worthy causes. There is a reason for the need of an entire month being dedicated to breast cancer awareness.

This month is also very special to me because it is the first full month that I am entering with my cancer treatments completed. No more weekly or daily visits to Walter Reed. From this month forward every new day is a day entered without medical treatment and a day closer to better health and a full recovery. I heard Robin Roberts (cohost of Good Morning America and fellow breast cancer survivor) state, "this isn't like getting over the flu." She then repeated that statement over and over again, perhaps because what seems to be a simple statement isn't simple at all. In fact, it's actually quite complicated, involved and also very powerful. The statement doesn't need to be extreme for the disease or the impact to be. My body reminds each and every day in many ways that I am recovering from something that most definitely hasn't been the flu. But I am recovering and who could ask for more.

October 1st also marked a very significant milestone in my military career. I reenlisted for the last time which will effectively carry me to active duty retirement in 4 years and 4 months (February 1st, 2013!!!)

Happy October!!! Find a reason to celebrate and enjoy life! ;0)

How Radiation Affected My Vision

No, I don't see everything through a green glow.

It's now been nearly a week since I completed my radiation treatment and this first "down time" in 6 and 1/2 weeks has allowed me to reflect on the experience.

By first appearance, the radiation oncology waiting room looks to be a very plain, ordinary, and even dull place. But don't let this first impression fool. This is actually one of the most powerful places you will ever enter. It is hallowed ground where lives are lost or regained. Social standings, age, race, gender, rank are all meaningless and perhaps nearly invisible. This is a place where all who enter are equal. On any given day you can't swing a saline drip without hitting someone with some type of cancer. Other days the only place in America that may have more women who have had breast augmentation in some way is Hollywood.

I spent a portion of every day of the past 6 and 1/2 weeks in that waiting room. Some days my wait would be no longer 2 to 3 minutes. Other days I waited for 4 hours to receive my treatment due to equipment malfunctions. Everyone of those days I was greeted by Joe, the receptionist, who was a constant ray of sunshine in what otherwise may have been a dreary place. She was like our radiation cheerleader.

I've seen the heavy-eyed look of fatigue and heard the raspy, weak voices caused by radiation burns of the throat. I've seen patients walk in one day and have to be wheeled in the next. I've experienced the kindness of those who are strangers for merely minutes. I have seen patients start their treatment and I have seen patients finish their treatment. I've seen celebration and sadness, as I too shared in their victories and shortfalls. I've seen hope. I've seen love. I've seen life, unedited and raw. I've seen a type of equality amongst people that I have never experienced before.

There, in that radiation oncology waiting room, people faced the most devastating and difficult times of their lives but yet no one complained. No one was bitter, or angry or wallowing in self pity. For the most part, other than perhaps 2 people I briefly came in contact with, these cancer patients proved to be so much more than just a patient, or better yet a survivor. They too were warriors while all the while displaying tremendous positive attitudes. These were among the most amazing people I have ever had the honor of meeting.

And all of it, every detail of those 6 and 1/2 weeks amazes me.

Results of the Final Day of Radiation; The Power of a Survivor

After 34 treatments, one every day for the past 6 and 1/2 weeks this was my last day. The day didn't necessarily feel any different starting off or on my way to treatment. Not much was different once I arrived at the clinic, although I was beginning to feel some excited energy.

I changed into my gown, laid on the table and assumed the position as I had 33 times before. Once on the table I again, just as every other time, entered my zone. I was aware that Will was in the room taking photos to document this important part of my journey and I heard what to me were muffled voices between him and the technicians. They exited the room, the door closed, and my final dose of radiation began.

It was then, within those very seconds that the significance of this particular moment sank in and as it did, my tears began to flow. It was a sweet surrender. My treatments, my actual treatments for this cancer were over and I could now begin to rebuild and restrengthen my body and reclaim a big portion of my life.

My tears were unlike any I had shed before, but then again, everything about this journey has been a new experience and has touched the depths of my soul.

Within minutes my final radiation treatment was over.  Over!  But not my tears of joy and relief.

It's a tradition within Radiation Oncology to "ring the bell" when treatment is finally completed.   I walked up front to Jo's desk and vigorously rang the bell.   I hugged the staff that I had come to know and I cried even more.

As we drove home I knew that I wanted to capture everything about every ounce of emotion that was surging through my mind and body.   Words can not adequately express how I felt but I felt so strong, so powerful, and invincible.  Not immortal, but invincible, and that's what really matters.  I realized that day, within those moments, the accumulation of each and every moment leading up to that one, that I can do anything.  I can accomplish any task set before me, I can obtain any goal , and I can overcome any adversity that lay ahead of me. For the first time since my diagnosis, I felt the power of being a survivor.

When I got home, still feeling that power surging within me, I breathed into a decorative bottle and corked it, capturing the essence of the moment. Should I ever forget, get weak, disheartened or simply need a power boost, I will forever have that bottle. 

These boots are made for...

...kickin' some breast cancer booty! And I did! ;0) Here's to fighting like a girl and showing cancer just who the sissy is and who the boss is!!!

The Crown - How To (Scarf Wrapping)

I didn't often wear a scarf or hat and I never wore a wig while beautifully bald from chemo but on occasion when I did I was blessed enough to receive compliments on how I wore my scarf. Tying a scarf in a fashionable manner isn't as easy as you may think before the initial attempt so I searched online and found this "how to" which helped me. Hopefully someone else will find it useful also.
 
"This style of scarf-wrapping is named for the fact that it forms a fabric crown over the head. It is an elegant-looking wrap and is a good choice for bad hair days.
 
Scarf Style Needed: Rectangular (oblong) Scarf
 
Tying the Scarf:
      Drape the rectangular scarf over the head off-centered so that one end hangs much farther down the body than the other. Gather the ends of the scarf at the nape of the neck and cross them behind the head. Twist the longer end of the scarf to form a "rope" which should be laid along the front edge of the scarf approximately 1-2 inches from the edge (over the top of the head).
      Continue the twist around to meet the other, shorter, end of the scarf and knot the two ends together. The ends can be left loose to drape over or behind the shoulder, or may be guided along the back of the head and tucked under the scarf, out of sight. This is a terrific look for outdoor occasions or for anytime you want to create an exotic look and your hair won't cooperate."
 
 

The True Story of the Walter Reed Radiation Oncology Princess

My first few days of radiation were the worst - unbearable in fact. So much so that by Monday, after only having received 3 treatments, I requested to see the Radiation Oncologist and asked him what the chance of recurrence was if I chose not to continue with therapy. His answer was a startling 35% and he strongly encouraged me to continue with treatment.

Positioning of your body is critical during radiation. During your initial visit several "tattoos" similar to a mole are placed on your body to later assist the technicians with proper alignment. Your arm and head are placed in a mold which is then formed to fit snugly. Due to the location of my tumor I had to turn my head as far as possible to the right and remain in that position throughout each treatment.

Unbeknownst to me, or to the radiation team, the mold was pressing into a nerve at the base of my skull resulting in a stiff neck, severe headaches, nausea and vomiting. I threw up more during my first few days of radiation and that weekend then I did the entire time I was receiving chemotherapy. Radiation was supposed to be the easy part!

The cure was simple. A folded wash cloth was placed over the ridge in the mold where it was pressing against my nerve to alleviate the pressure. After 1 - 2 evenings of muscle relaxers and padding my mold, thankfully, all the symptoms resolved.

From then on Michelle, one of the radiation technicians, officially dubbed me "Princess", as in the old fairy tale by Hans Christian Andersen, "The Princess and the Pea". For the remaining 6 weeks I earned the right to that name requiring my "princess pillow" for each treatment.

Not the end, just the beginning. This Princess shall live happily ever after! ;0)

(written by me for inclusion in my Breast Cancer Warrior scrapbook)

Every Moment - Right Now

Every moment is a choice.

I'm learning so much from this journey
of medicine, faith and healing
but one lesson stands above all...

I’ve learned that every single moment,
I have a choice to make.

In every moment I can choose to worry about a future
I can nor predict,
or I can choose to revel in the blessings of my life as is.
I can choose to live in fear of something I can not control
or I can choose to control my attitude and my outlook.

Right now, I can love my family.
I can appreciate the love given to me.
Right now, I can see and I can feel.
I can breathe fresh air, smell the flowers,
and I can feel the rain on my skin.
Right now I can hear, speak and laugh.
I can hear the laughter of children
and I can laugh along with them.
I can tell those that I love
just how much they mean to me.
Right now I can enjoy the beauty of life,
and create memories.
I can support others
as well as be supported by others.
Right now, I have a wonderful medical team
and I can trust that they are taking care of me.
Right now, I have everything I need,
and in every moment I choose
to celebrate the blessings in my life.

Right now I am living well
and I choose to LIVE my life to the fullest.

(words of encouragement from me to me)

They told me nausea wasn't a side affect...

Laughter is still the best medicine! :0)

A little TMI

A few of the many things I won't miss about chemotherapy.

"Before cancer I just lived, now I LIVE STRONG" ~ Lance Armstrong

For years now I've seen people wearing those little yellow wrist bands that read "LIVESTRONG" . Until recently the most I knew was that it had to do with Lance Armstrong but I never really understood what it meant or what the whole LIVESTRONG challenge was about.

On August 24th, 2008, I, along with other team mates of Team Heather's Fellowship participated in the Philadelphia LIVESTRONG Challenge. This particular team was established by Heather and her boyfriend Aaron in 2006 when she was diagnosed with cancer. She passed away in 2007 at the very young age of 34.

As we well know, cancer touches nearly every person in some way or another. We walked in memory of Momma Wade, Kathy's mother, who also passed away in 2007 due to cancer. We walked in honor of Bill O'Neal, Will's father who was diagnosed with leukemia and after a long and brave battle beat its butt and has been in remission for 10 years. And we walked in my honor. I was still undergoing my radiation treatments.

Most of the team walked the 5K, however, Aaron, Will and Michael each bicycled 45 miles!!!

The Lance Armstrong Foundation unites people to fight cancer, believing that unity is strength, knowledge is power and attitude is everything. They are helping to make cancer a national , now global priority. They help people diagnosed with and affected by cancer face the challenges and changes that come with cancer.

I've participated in Walks before, specifically the Avon Walk for Breast Cancer, but this was different. The unity of all types cancer survivors and their loved ones was a power that is one to be reckoned with. Hopefully that is what it will take to find a cure.

Don't just live, LIVE STRONG!

Last Chemo Infusion (June 30th, 2008)

My medical oncologist, Dr. Mo on my last day of chemo treatment. Note that I was sure to include the word treatment after last day of chemo. The affects will be around for awhile. I have heard that it takes up to a year after treatment to return to your "normal" self, but since I was never quite "normal" prior to chemo we'll see how I do! ;0)

My doctor was fantastic, no, he was phenomenal. I've never had an oncologist before so I don't necessarily have anyone else to compare him to but I can tell you that if given a choice, I wouldn't have chose anyone else. Prayerfully I will never have to, but if asked by someone I love, I would recommend him in a heartbeat, as if my life depended upon him.

It startling to think that a doctor, especially in this particular field, holds the course and possibly the length and quality of your life within his hands and his mind. I immediately felt comfortable with Dr. Mo and as my treatment progressed and I saw him more often I simply kept liking him and completely trusting him more and more. When faced with the possibility of chemotherapy treatment, which wasn't originally in the plan, I asked him what he would recommend if I were his mother, sister, etc. Without hesitation he confidently replied that if I were his loved one he would highly recommend the chemotherapy. Throughout the course of chemo, as if i were an individual, not merely a patient and as if he truly cared about my outcome, more than just my diagnosis.

I am ever grateful to him for the care he has provided and continues to provide to me. I hope that he never loses his compassion and genuineness and he continue to give his patients hope and respect, as well as healing.

PICC Line

Peripherally inserted central catheter
From Wikipedia, the free encyclopedia

A peripherally inserted central catheter (PICC or PIC line) is a form of intravenous access that can be used for a prolonged period of time, e.g. for long chemotherapy regimens...First described in 1975,[1] it is an alternative to subclavian lines, internal jugular lines or femoral lines which have higher rates of infection.
A PICC is inserted in a peripheral vein, such as the cephalic vein, basilic vein, or brachial vein and then advanced through increasingly larger veins, toward the heart until the tip rests in the distal superior vena cava or cavo-atrial junction.
PICCs are usually inserted by radiologists, physician assistants, radiologist assistants, or certified registered nurses using ultrasound, chest radiographs and fluoroscopy to aid in their insertion and to confirm placement.

My PIC line was inserted just shortly after my first chemo infusion when I was admitted for Neutropenia. It was, for the most part, a painless process and really more fascinating that frightening. With the insertion of the picc line there is no more need for needles for the weekly blood draws, i.v. lines (saline was required often due to high pulse rate suspected from dehydration or simply due to chemo) or multiple attempts (3!) to find a good vein for chemo transfusion.

My picc line was removed on my last day of chemo by nurse Irene, part of my oncology team, as seen here in the photo (June 30th, 2008). Removal was completely pain free which I found equally as fascinating.

The picc line was one thing during chemo that I was grateful for.

The Cancer Connection

My first visit to the oncology department wasn't that all that long ago in terms of time but if based on experience it was a lifetime ago.

As I sat in the waiting room waiting to be called in by my oncologist I had no idea just how much my life was about to change. It began with my reaction to my first view of the treatment rooms and the patients lined up in the recliners receiving their chemo treatments (see post).

The experience of my first chemo treatment will never leave my memory, nor will it fade. I looked very much like the obvious new girl with my full head of thick hair. Chemotherapy isn't all that was given or received in these treatment rooms. Equally as potent was the advice and comfort dispensed from so many of the chemo veterans. Then before I knew it, without even realizing it, I too had become one of those veterans, baldly, proudly, strongly and lovingly passing along hope to those who started the process after me and those that needed it.

Although I had never experienced radiation treatments before, I knew that they would in no way compare to chemotherapy and I did not in any way feel frightened as I began the process. I am experienced in cancer, in surviving, in doing what you have to just to get through, whether it be a single treatment or a lifetime.

There is a bond that is shared among cancer patients/survivors. I have heard it referred to as "a club that no one wants membership in" but I think that phrase diminishes the true value of that bond. I have experienced it as a kinship in which you are naturally connected to someone at the deepest levels of their being; their hope, their fears, their mortality.

I have met co-survivors being treated for a multitude of cancers ranging from cervical, tongue, leukemia and of course fellow breast cancer patients. But we all share two things in common - cancer and survival.

I can't adequately capture in words the connection you feel when talking to a fellow patient/survivor and although I truly wish there weren't so many of us I am so grateful to each and every one that I have had the honor of crossing paths with.

"How are you?" Hmm...How am I?

With the completion of my chemo and the start of my radiation there is a lot of reason for celebration and excitement. Heck - I've even threw myself a party! I am thankful for many things. But when it comes to answering the question that has been posed to me countless times over the past several weeks, "How are you?", I'm not quite sure what the right, honest or best answer is. I haven't found a consistent or a complete answer yet.

I appear to be doing ok, or even pretty well. I'm feeling much better than I did while I was undergoing chemo. I feel more like myself every week, hopefully it will soon reach the point where I can say every single day I feel an improvement. But that is how I feel physically from the treatments. How do I feel regarding the disease of cancer? That's an entirely different story.

I feel scared. My prognosis is good but in all honesty, the cure for cancer does not exist. I don't have many fears. I'm not sure if that was me pre-cancer but I am certain that is me post-cancer. I can say without a shadow of a doubt that my greatest fear is recurrence. I try not to dwell on it but I must admit, not a day passes that it doesn't cross my mind. I try to rely on the reassurance that my completed course of chemotherapy would surely have killed any remaining cancer cells but yet can't help but question that thought process while I am currently facing 6 and 1/2 weeks of required radiation.

Each time I stand up my legs and feet ache so much so that I move as if I am a pregnant 85 year old woman. When I lay in bed and night and try to sleep the pain in my joints, particularly my hands, fingers, feet and knees make it difficult to rest. The mornings are by far the worst. After tossing and turning all night and my body temperature fluctuating between the cool air conditioner and the immeasurable hot flashes and night sweats I am so stiff and ache so much that getting out of bed and placing my feet on the floor is a chore I dread. I can deal with that though. But with each of those moments a thought, a worry races through my mind, is this normal? Is this the effects of chemo? Or could this be something more?

I don't believe in living in fear, nor do I think that you should waste your moments worrying about things that have not and may not happen. The fear of my cancer returning though is a reality. My challenge will be to balance the fear with awareness and knowledge and find a sense of peace and comfort. I've learned so much about breast cancer and about myself on this journey and I have done well. I am sure that somehow, with this too I will do well.

Help!

"The radio is burning me and my eyebrashes have fallen out!"

Evidence that chemo brain is still in effect!

Word of the day - Bolus

Bolus, a flabby, rubbery material, is used in certain situations to “fool” the radiation beam so it will deposit the maximum dose on the skin surface instead of a fraction of an inch deeper, as it would otherwise. Therefore, a skin reaction is almost inevitable in this scenario. Bolus is usually incorporated into radiation therapy for skin cancers or when a surgical scar, such as a mastectomy scar, needs to receive a full dose of radiation therapy.

My newest fashion accessory that I get to wear during radiation treatments. I don't get t keep it with me all day though like I do with the tats and the sharpee x's and o's.

Radiation Preparation

The following information has been extracted from various locations on the internet:

Treatment Planning
Before radiation treatments begin, you will go through a treatment planning process called "simulation". This is necessary to confirm that the treatment machine will treat the exact area requiring the radiation (called the treatment port). A map of the area on your body where the radiation is to be delivered, referred to as the treatment field(s), is created. A machine called a simulator, which is designed to mimic the movements and settings on the actual treatment machine (called a linear accelerator) that will be used to administer the radiation therapy to you, is used.
Throughout the process, X-ray films will be taken. The entire simulation takes one to two hours, but the actual time may vary slightly. Since you will be lying on a hard table under the simulator for most of this time, you may experience some pain or discomfort. Should this occur, tell the technician. Keep in mind that the time necessary to deliver the actual radiation therapy treatments is only minutes, not nearly as long as the time required for the simulation.
CT Simulation
In some situations, a special computerized tomographic (CT) scanner will be used along with simulation to help plan some radiation therapy treatments. In these instances, the CT scanning process will be performed in the Radiation Oncology Department several days prior to the simulation. Information from the CT scan is used to precisely locate the treatment fields. The CT scanner is specially designed to work with the other equipment in the Department, and is not a replacement for other diagnostic scans you may have received.
Tattoos
At the end of the simulation visit, it is necessary to put marks on you to outline the treatment field(s). These marks are in the form of very small tattoos, which are dots the size of a pinpoint or freckle, made using India ink. The process of tattooing causes some temporary discomfort. Generally, between 4 and 8 tattoo marks are placed, but sometimes more or less are necessary. In some treatment plans, a second set of tattoos may be necessary. While the tattoos are permanent, because of their very small size, they are not very noticeable. By using the tattoos, it will be possible for you to bathe or shower on a daily basis without worrying about removing these important marks that show where the radiation treatments are to be delivered. Also, if any additional radiation therapy is needed in the future, the tattoos serve as a permanent record of previous treatments. In very rare instances, tattoos will not be used.
Technical Planning Process
After simulation, details from the procedure are forwarded to medical radiation dosimetrists and medical physicists. These professionals perform highly technical calculations that will be used to set the treatment machine (linear accelerator).
Large alloy blocks may be placed inside the treatment machine to limit the amount of radiation delivered to your normal tissue in the treatment field. These blocks help decrease the development and/or severity of side effects caused by the treatments. Blocks are customized for each patient, in order to provide the best protection.
Set-Up
Several days after the simulation and after all calculations have been performed and custom blocks made, your treatment can begin.
Treatment machines (linear accelerators) resemble the simulator but are larger. You will be placed on the treatment table in the same position as you were on the simulator. Proper positioning usually takes 10 to 15 minutes. Once in place on the treatment table, a set of X-ray films will be taken. These films will be matched with the simulation films to ensure that the treatment is going to be delivered the same way as it was simulated. Occasionally, the match is not optimal. In these cases, adjustments will be made and will be checked by your attending physician. In rare cases, more adjustments are required and treatment may need to be postponed. Once the films and positioning are confirmed, a treatment will be delivered.
The actual administration of the radiation treatment usually takes only about 5 to 10 minutes. Factors that affect the total length of the treatment include the complexity of your treatment, the particular machine on which you are being treated and how quickly you can be positioned properly for treatment. On average, most patients spend a total of 20 to 30 minutes in the Department per day receiving their treatment.
On-Treatment Examinations
Once a week, repeat X-ray films will be taken to re-confirm proper positioning. These films will also be performed in most cases where there is a change in your treatment field or treatment plan. The X-rays taken during the course of radiation treatment are not used to help measure your progress or response to the radiation. Rather, they are only used to ensure that the position and treatment arrangement is appropriate.
You will also be examined at least once a week by your attending physician and resident. The examination day is generally on Thursday, just before or after your treatment is administered. These examinations are important because they give your physician the opportunity to evaluate your physical condition, answer any questions that you may have, and plan and coordinate future treatments.