Tag Archives: radiotherapy

Radiotherapy planning

Posted in Bumpboobs, Radiotherapy Treatment, Treatment by

Welcome to the land of radiotherapy: Witness the waiting room filled with glossy magazines; revel at the sight of chocolate bars on sale behind the counter; marvel at the doors, whose signage warns of radiation; tremble at the nurses calling you in for consultation. And get your parking validated, too.

Yesterday Zsolt and I went in for a planning session. It was really quite simple, and surprisingly we didn’t wait in the waiting room for an hour. They called me in before I could settle with a magazine.

“Catherine Brunelle?”

“Here!”

And in we went. I was taken into the CT scanning room, and the nurse explained the process.

“I’m Karen, and that’s Louise, and Shelley, and Amy, and Tanya.”

“Hi! Hi. Hello! Hey.” (a chorus of hellos from the nurses – all so very friendly)

“We’ll be scanning you today and making marks on your body.”

Apparently I was to have a CT scan, but no injections or dyes were needed (thank goodness, my last CT scan I had to drink a litre of Koolaid dye in about thirty minutes. Ugh).  The doctor would come in and put marks on my chest (around the scar/breast area), they would then line me up, draw more lines, take the scan and give me some tattoos.

Here is how you are measured: They have you put your butt against this cushion and lay back into a head rest. The table is a table, no cushioning. Feet are placed against some plastic slider that keeps them steady. Arms are raised together over the body, then back above the head into some arm rests. There’s some strange medical bondage happening behind hospital doors, but all in the name of health management. It reminded me of old torchure devices, except everyone was smiling and happy, and I wasn’t uncomfortable, and there wasn’t any pain. So maybe a torture device isn’t the best description . . .

The doctor came in and wrote with green marker around my right chest area. All the while I stared at the ceiling. Finally it was time for the CT scan. This scan is designed to map out the dips and bumps of my chest wall, as well as measure where each type of tissue starts/ends (e.g. lung, rib, skin, etc.). Therefore, when I get my radiotherapy, the machine will account for those differences and change so that my lung gets less radiation than my skin. It’s a good thing.

The nurses taped little wires and buttons to my chest according to the doctor’s instructions.  Afterwards the nurses and doctors left the room and the machine began to whirr. Slowly I was slid back and forth through a giant grey doughnut (CT machine) and something in that doughnut spun around me – this, I later was told, was taking x-rays in a spiral motion. The CT scan lasted about five minutes.

Finally it was time for the tattoos! Ugh!  Three permanent tattoos are required for radiotherapy: one in the middle of  my chest, and two on either side of my body. They line you up on a laser grid and mark the places.

Here is how they administer the tattoo: a drop of ink is placed on the body. The nurse then makes a semi-deep prick of her needle into your skin, through the ink. That’s all. I guess the ink seeps in behind the needle and stays. I now have three tiny, dark dots across my body. They are too small to resemble moles, maybe small blackheads is a better description. Clogged pores.

It could have been worse.

And after all this, the nurses gave me my schedule for radiotherapy. Guess what? I don’t start for THREE WEEKS! How bizarre. I feel as though someone has extended my vacation.

Finally, cherry on the top of my day, I took my fist tamoxifen pill yesterday. This drug is designed to scoop up estrogen before cancer can take advantage, and it’s intended to be taken for five years. We’ll see.

One step at a time – and look no further. For the time being I have three weeks off, which sounds pretty freaking sweet to me.

And that, in a nutshell, was the radiotherapy planning session.

Dr Canada and the hug

Posted in After treatment, Bumpboobs, Canada, Chemotherapy, Treatment by

Today was a nice experience. Around new year I’d received a letter in the mail advising me of an appointment with Dr Canada on the 11th of January. The letter didn’t specify what this meeting was about, but it doesn’t take a genius to guess it was a follow up visit.

So this morning, way too early, Mom and I hop into the car and join the highway rush. Why does traffic slow down? What’s happening on the road that so many cars needs to clump together? Anyhow, we drove to the General.  Mom (Marcelle) had awoken me early for a shower with the idea that I ought to look good today – and she is right. I ought to have looked good, and despite my lack of hair,  puffy eyes (too sleep deprived from a certain younger brother who kept me awake while he had his midnight snack), and groggy expression, this morning’s effort paid off. With a bit of blush on the cheeks I looked . . . hmm . . . acceptable.

But wouldn’t you believe it – first thing Dr Canada says to me as he walks into the room (with me having been weighed and observed), “You look pretty today.”

Wonderful man.

Though honestly he is excellent and I consider myself lucky to have him as an oncologist. Both he and his assisting medical student checked my breast. Like my mother, he suggested my itchy nipple was due to hormonal changes – “keep it moisturized”  he suggested.

And then we got onto the topic of radiotherapy. I presented him with my options: 50 grey over five weeks, or 40 grey over three weeks, with grey being a measure of radiation. According to him, there’s little difference between the two. In some cases there is a worry about toxicity and the heart for 40 over three week, but because I’m having my therapy on the right side (away from the heart) it shouldn’t be a problem.

Little difference, but ultimately less radiation and a shorter time span . . . why wouldn’t I choose three weeks of radiotherapy over five? Maybe there  are reasons, but they’re not shouting out.

Which led my mother to ask, “are there any supplements she should take/avoid during radiotherapy?”  and Dr Canada suggested avoiding vitamin E during treatment, but deferred to my mom, saying that she was the expert in that area.

Expert in that area! You know what that means? Mom was totally googled.

And yet he was quite cool about her alternative health background – not the least bit condescending or on edge. Instead he gave us his opinions about which supplements help, which to avoid, and which are rather unclear in their effectiveness. He also followed this up by suggesting I read some books on diet because while they may not be proven methods, they have sense behind them. “There are some well thought out ideas.”

AND then! So surprising – he gave me a hug and wished me luck. Seriously, no joking, we hugged. It was nice. Considering the heavy implication of our conversation, the reason for the visit, the fear I’d experienced last weekend, his hug was curative.

Medicine mixed with compassion, it’s the very best treatment. Today was a good visit, and it’s left me highly impressed.

Radiotherapy step one

Posted in Bumpboobs, Radiotherapy Treatment, Treatment by

As one door closes, another opens. This entrance is labelled ‘Radiotherapy’.

Zsolt and I went to the hospital level D last Wednesday, which is where all cancer related consultations take place. It has a large reception and waiting area. The walls are painted blue and orange and beige, the seats are coloured to match. There are piles of magazines because doctors never run on time, and a wait is inevitable. So far we’ve gone here three times. Once to meet my surgeon, once to meet my oncologist, and last Wednesday to meet the radiotherapist (radiologist?).

Eventually we were shown to a consultation room, and eventually the doctor appeared. I really enjoy meeting these men (they’ve all been men), because they are so incredibly confident in themselves. Whether they ooze charm, reserve, or whatever – they all know they know what they’re doing. And because they know it, I believe it.

In walks my radiologist and the first thing he says to me is, “Dr  So and So told me you’re Canadian! Where are you from?”

“Ottawa.”

“Ottawa! My wife and I skated down the Canal,” and he launches into a story about how while living in Toronto he and his wife took up skating with the aim of conquering the Rideau Canal.

Clearly this man has some people skills.

He then sat down and dove straight into the concept of ‘radiation’ and how we’re always exposed to radiation, and how we’ve been using it for a long time to treat illness, and how the process has become much better over the years so things are now at a point of low risk and better recovery. Etc.

Why radiotherapy? Because apparently, somewhat like chemotherapy, it stops cells from dividing. Fast growing cells possibly remaining in my breast/chest tissue (if missed during surgery) will be stopped dead. At least, that’s the idea.

He drew me a picture of a woman’s chest, and demonstrated which layers will be struck by the beam. Apparently they angle the beam so a minimal amount of lung is effected (though yes, my lung will get an unnecessary dose). However I may be a ‘candidate’ for a more precise form of radiotherapy that uses CT scanning to move the beam according to the bumps and dips of the body. (he mentioned this after examining my scar and chest area . . . so perhaps my theory of having an overly bumpy rib cage is correct, hmm). This CT scanning helps reduce the side effects.

And then he gave me a choice. There are two routes, 25 treatments or 15 treatments. If I were having reconstructive surgery then 25 would be better because the treatment is spread over time, which therefore protects the tissue more. But reconstruction won’t be happening. No thank you.

I cannot tell you the exact pros and cons of 15 vs 25 treatments. I cannot tell you because as he explained each option, my head went into a slight tailspin and my ability to focus stopped (interestingly the same happened to Zsolt). Maybe something was in the air, or maybe it was the force of this doctor’s personality. Who knows? All I remember is him saying “gold star treatment” for the 25 shot option. But frankly, I’m leaning toward 15, it’s an overall lower dose, despite being very similar to the 25, and gets things done more quickly. I think the real difference between these two is time and flexibility. 15 is faster, 25 is more flexible.

Anyhow, I’ll google it before deciding.

Here is another interesting bit of opinion. Dr Skates mentioned that much of radiotherapy is done to improve surgery results. He seemed quite confident in the skills of my surgeon (which is why my armpit, neck and shoulder areas won’t be getting radiotherapy), but suggested that some surgeons he’s worked with in the past  are less reliable, which means they need to shoot a larger area to cover up for any potentially missed bits of cancer.

Another good reason to find a surgeon with a strong reputation.

I get such a kick out of these doctors. These are men of power – and I suppose they are powerful; lives are held between their fingers. Maybe some people would also suggest they’re men of ego, but better ego than uncertainty or meekness or lack of experience.

Now that doesn’t mean I won’t double check their opinions, look around online, talk to other doctors and ultimately make my own decision . . .

Zsolt always says that I don’t believe him. He tells me one thing, I need to double check it. The other day I had him meet me at a restaurant because it was snowing outside. I was on the mobile phone with him saying, “I can’t get a ride because the road is covered with snow” (this is England, driving stops when it snows), and he’s on the other end of the phone saying, “But there’s no snow outside!” to which I reply, “yes, there is, I can see it from here – come and get me.”

He came and got me, but there wasn’t a snowflake on the ground. From the back of the restaurant where I looked out the window, the orange street lighting did look like snow. Really! But – no, he was right. This was one instance where I should have listened.

But the doctors realize we’ll look up everything they say. Dr Skates wrote down the two treatment options and told us there will be tons of information once we start typing into our computers. They know. And still, they are confident in their own expertise. I appreciate their confidence, because ultimately I rely on it.

That was radiotherapy step one. In January there will be a planning meeting, which will include tattooing my chest and possibly a CT scan.

As one door closes another will open. Chemo is almost done. Soon I’ll have a rest, and then it’s onward in the road to breast cancer recovery.

We are getting there.