Radiant (everything you ever wanted to know about me and radiation oncology)

Garth Williams - from Charlotte's Web
(one of Charlotte's words for Wilber is "Radiant")

The other day I went in to see my radiation oncologist.

For those of you not in cancer world, the oncologist breakdown is like this: solid tumor cancer treatment teams can involve both a medical oncologist and a radiation oncologist.  The medical oncologist is the one who takes care of the drug treatments and manages that care and all the follow-ups when care is done. The radiation oncologist plans and follows radiation therapy treatments.  But, not every cancer patient would benefit from radiation therapy, just like not every cancer patient needs chemo.

When I say "my oncologist" I'm generally talking about my medical oncologist, but, as I mentioned, I have a radiation oncologist, too.

My radiation oncologist is just the nicest woman. She's from Russia and starts conversations with phrases like, "well, my dear..." And, she clearly cares deeply about her patients.  If you've ever heard the phrase "salt of the earth," this is who that phrase was meant for.

And, she's not the only one in that office who's lovely.  The women at the front desk act like they've known you forever--and are happy about it.  My radiology oncologist's oncology nurse, who worked with me during my last radiation treatments to help keep tabs on my situation and give me solutions for my side effects (in 2012, mainly a nice red sunburn like skin reaction, which is common, but not, fortunately, the open wounds which sometimes follow), stopped by while I was waiting to go in this time to chat and see how I was doing.

And the radiation therapists (the professionals who run the machines to administer the radiation according to the radiation oncologist's treatment plan) treat me like a person (which, as you know, I am), with caring and respect and never any indication that I might really be just one more task on a long day's list of tasks (which, let's face it, I probably also am).

So, anyhow, the place is full of really nice people who seem to actually work in medicine because they want to help patients.  And a couple of days ago, all these really nice people agreed to shoot me full of radiation from multiple angles 5 days a week for 4 weeks.  And I agreed to let them.

Back in 2012, because I wasn't stage IV back then, the chemotherapy was intended to hunt down and kill any cancer that might have spread through my body and the radiation was in the areas where the known cancer had been (right upper chest and axial lymph nodes) to kill any cells that might have escaped the surgery and chemo.  The hope was that between them, the chemo and radiation therapy would cure me of cancer.

It was a good effort.

At this point, though, the horse is clearly out of the barn, so to speak, and the cancer has moved on to several unconnected spots on my bones, so radiation is no longer with "curative intent."  If they tried, they could probably get all the bone lesions they know about, but the assumption is that since my cancer has already shown that it's out of the breast and onto the bones, there are probably more cells lurking about that are too small to see but that would still grow into a problem (no worries, though, because medical oncology still has a plan to slow them down).  

But, even without radiation for a cure, they still do give radiation therapy to stage IV patients if the tumor is causing pain or other unpleasant symptoms and it's in a place that can safely be radiated. In those cases, they'll take care of it.

I have lesions on my pelvis, femur, rib, and a bone in my neck, but it's really only the ones in the pelvis/femur that are causing me any pain.  Those were the ones that lead us to investigate the pain and led to this diagnosis (the rib and cervical spine ones showed up on the PET-CT, but they weren't what we were in there to look at at them at the time, in fact, I wasn't even aware of them until I talked to my medical oncologist after the biopsy).

At first, I thought I wouldn't try to get the painful mets radiated.  I was doing ok with regular doses of simultaneous Tylenol and Advil and the occasional stronger drug in the evening and at night, at least as long as I rested it as much as possible and avoided shoes with heels, avoided moving it too far in any direction, avoided coming down hard on that leg for any reason, and walked carefully so as to gently roll through the limited range of motion each time I took a step, and only walk or otherwise put pressure on that leg when I really needed to.

I swear, that actually seemed like a pretty reasonable solution at the time.

But now I've decided to go on and let them help.

The hope is that, eventually, the hormone blockers would do enough to the cancer to let the bone heal and that should make the pain stop.  But, radiation therapy would also relieve the pain, and in a whole lot less time.

So, suddenly, after dealing with this hip pain getting more and more painful since Autumn, after taking pain killers for weeks, after being careful to move carefully or not move at all, getting this taken care of as soon as possible seemed like it was actually a very good idea. And, being able to take an actual walk outside when the weather turns spring-like and beautiful seems like a wonderful goal.

Before they give you the radiation they plan it carefully.  By the time I got there for this most recent appointment, my radiation oncologist had already studied my PET-CT images and knew the goal.  So I lay on a specialized CT table, my legs held by a customized form to keep me in the same position each time, and they took some more images, gave me 3 little tattoos to serve as guide marks (fun to think of myself as all tatted up, but in reality they're just three tiny black dots that look like freckles and match the other 3 tiny black dots from my first course of radiation), and sent me on my way with a check-in badge and a schedule of appointments.

Now they get to do the hard stuff, which is figuring how to angle the beams so they converge on the lesions and don't cross each other too much in other places (places like those pesky internal organs I like to keep in my lower torso).  Do you remember in "Ghostbusters" where Harold Ramis tells Bill Murray, "Don't cross the streams," and when Bill Murray's character asks why, the answer is, "It would be bad"?  Well, crossing too many radiation beams is kind of like that.

So, in about a week, they'll have things all mapped out and ready to go. I'll show up, lay on a table for about 20 minutes, keep doing that each weekday for 4 weeks, and the people in the know will slowly but surely force these lesions to leave me the heck alone.

Sounds like a plan to me.




*If you want more info on radiation therapy, I highly recommend the video at the bottom of the page here.  And, actually, the rest of the site, too.

*If you happen to have read Anne Tyler's Beginner's Goodbye, you may remember Dorothy was referred to as an "Oncology Radiologist." From the description of her job in the book, it's pretty clear she was actually a radiation oncologist.  A radiologist reads imaging studies (X-rays, CT scans, MRIs) and, although I couldn't rule it out entirely, I'm pretty sure "Oncology Radiologist" isn't really a job, at least not in the US.