From the category archives:

Radiation

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Finally, I am scheduled for radiation therapy or rather: Preparation for radiation. I meet with a technician to get my measurements set in a foam contour.  Actually, it turns out to be  nothing fancier than a plastic bag that she fills with warm liquid. I  then lie  down and my contours are set as the liquid firms up.  When I come for my therapy I will  lie down in exactly the same position every time.

The radiation oncology department has two waiting areas: one  for family or friends who accompany a patient. In this area there is an aquarium and a small reception desk, a few arm chairs.   It is almost empty.

A door with the sign: “Radiology Patients Only”  leads to another small, crowded waiting area. The ceiling is low and covered with acoustic tiles.  The chairs are the same type as in the outside waiting area.The magazines in the basket are out-dated and dog eared. Staff members, mostly women in blue scrubs, mill about, going in and out of side rooms, opening and closing doors, appearing or disappearing from behind curtains,  seemingly without purpose. Back against one wall is a blue drapery and behind it some cupboards above a low bench. That is where I am supposed to change into a cotton gown, property of the hospital, one size fits all — or nobody.

I also have a CAT scan which takes but a few minutes. I lie down on a narrow bed that slides in and out through a dough nut hole. I have no idea that I am receiving 6000 rads of radiation through out my whole my body. It is a  hundred times more radiation than a regular X-ray. Nobody explained the high level of radiation I would receive. Nobody told me why they need to have my cat scan although I recently had an MRI or why the MRI images would not be good enough.

Every day, Monday through Friday, for the next eight weeks, I will receive a prescribed dose of radiation to kill any cancer cells that may have been left. The therapy will cover my whole breast with some extra shock treatments concentrated on the breast area  where the tumor was (the tumor bed.)

A linear accelerator produces the treatment x-rays and this special  therapy to kill cancer cells is known as EBRT – external beam radiation therapy. (Without radiation, 40 percent of lumpectomy patients have a local recurrence of their breast cancer.)

The exact level of radiation will be set by Dr. Alpha and his medical dosimetrist. The actual radiation therapy treatments will be handled by his radiology technicians. I am told that I will be checked by Dr. Alpha, the radiation oncologist, every Monday.

I get to pick my time slot. I choose  2.15 PM Monday through Friday.  (Should I not be able to come one day, I can come twice the next day, as long as it is six hours between the treatments.) Finally, I get a parking pass, a yellow 8 x 11″ piece of paper with the words radiation oncology written in magic marker. It  is valid for the next eight weeks. When put on my dashboard, it allows me to park for free right outside the hospital entrance doors and to  avoid the crowded parking garage.

I am all set for my personal Chernobyl.

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Dr. Alpha, my new radiation oncologist, flips back and forth  in my pathology report. He seems annoyed. Not with me, but with the report. He pushes the reading glasses back on top of his head. “I don’t understand this,” he says. His tone bristles, but he looks kindly at me as he stabs his finger at at the bone of contention, my pathology report and the words “all other margins free of carcinoma.”

I am a bit embarrassed because in the margin I have scribbled: WTF.

“Oh no!” I hurry to explain everything, not  to defend Dr. Guru but  to sooth Dr. Alpha. I don’t want him to get more agitated and annoyed with Dr. Guru. I fish the Vanderbilt report out of my purse and show him  exhibit number one: Vanderbilt confirmed the first pathology report from my lumpectomy.

“Dr. Guru explained everything in his emails.” I tell Dr. Alpha. “I can send you copies. ”

Dr. Alpha does not seem convinced.

“Well, something is wrong.”

He starts to explain why my pathology report  is wrong, then abruptly stops himself.  He realizes that I can not process the meaning of his words so he draws a picture. “Here is the lateral margin,” he begins and goes on to explained how there has to be one. Then he goes back to the report, flips back and forth before he, frustrated, tosses the pages back on the table. Obviously, the answer he wants is not there.

“Either your pathology report is wrong or your surgeon is wrong,” he says firmly. Although he seems irritated with the report, a bit angry even, Dr. Alpha manages not to be the least bit unpleasant. “This is not right and I can not treat you like this. I read these reports all day long.  All day long. That is what I do for a living and I have seen everything.”

I am tempted to ask him about “everything,” but I guess that it would take an eternity and be way over my head anyway. Darn I wish I had paid more attention to science and not blown it off as “nerdy.”

“Forget Vanderbilt! They just confirm tissue cells. They don’t confirm margins,” he says and hands back the Vanderbilt result.

“Either the pathologist marked the slides wrong or the surgeon is wrong and has to redo it and give you a re-excision.” says Dr. Alpha.

“But that will take for ever? He is busy.”

“Not at all. He owes you. He will just have to get up a bit earlier in the morning. I am here till seven or eight at night. My colleague, Dr. E’s car never leaves here before 7.30 PM either.”

I mildly defend Dr. Guru. “I am sure he works that late too. In fact, some of his emails are sent late at night.”

“I will put in a call to him right now.”

“Good luck!”

“Let’s start with your pathologist then. Do you have her number?”

I scroll through my Blackberry while Dr. Alpha in a typical Type A fashion watches over my shoulder. “No, not that number, that’s not it. Oh, so you don’t have it,” he says while I am still scrolling. “Well, I will take care of it and I will call you by Friday. This will be cleared up by then, one way or the other. Either you have to have another surgery next week or we can start your radiation.”

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Visit with Radiation Oncologist

December 20, 2009

I leave Dr. Weary to meander through the bowels of the hospital until I end up in its basement.  “Radiation” reads one arrow pointing down yet another hallway.  Around that corner another door:  “Environmental Services.”
Toxic waste? Then I realize it is only a euphemism for the janitor’s office. Around the next corner from the janitor’s [...]

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Discovery: A Gene Not Responsive to Radiation

September 4, 2009

A cancer research team in Lund, Sweden has found a new a gene profile that can help oncologist better determine when lumpectomy followed by radiation may not be appropriate.
The newly discovered gene reveals whether or not a tumor will respond to radiation. Women who have tumors with this particular gene will in the future most [...]

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