Reconnaissance Fair

Today was my second pre-radiation appointment (the first, a week ago Friday). The initial appointment was a meet-and-greet with my radiation oncologist and her trusty resident sidekick. Today's was termed a "simulation", where they sculpted me into position for treatment. For the next ten days, the scientist eggheads are busy calculating how much nuking I can survive while still killing the little cancer guys. Then there's one more pre-appointment appointment, next Thursday, before I start radiation on August 11.

I will have 20 days of radiation, daily Monday through Friday, which works out to four weeks...finishing just in time for my epic September road trip. (More on that later.) Each appointment will be relatively quick, about 10-15 minutes of radiation plus prep time on either side (undressing, dressing, check-in, etc.). The real time-sucker is transportation...walking to the shuttle, riding the shuttle, walking from the hospital to the commuter train, commuter train to the East Bay, shuttle to work. They take appointments starting at 7 am, but they're first-come-first-serve, so while I'll try to schedule early mornings so I can get to work later if I need to, it's a bit of a crapshoot. I definitely won't be schlepping to work every day - my goal is a couple days a week, with remote logon from home always an option.

I won't glow, the radiation won't be contagious if you get too close, and most disappointingly, I won't be able to reheat food by holding it near my upper chest. But there is good news: while I'll need to keep my radiated areas covered, I can catch rays elsewhere on my body - no need to fill my closet with burkhas. And I won't have to choke down any medications before, during, or after the treatment. But a trip to the dentist is in order - they might end up nuking one or more of my salivary glands. As I well know from my dental office days, lack of saliva leads oh-so-rapidly to rampant gumline cavities. Hopefully gallons of tasty fluoride will stave off that possibility.

So enough with the preliminaries; let's get to today. Today I went to the basement of Mt. Zion, a much nicer UCSF facility, where all of my radiation treatments will take place. I stripped from the waist up, donned a monstrously large hospital gown and robe (basically a second layer of hospital gown put on opposite from the first one), and sat in increasingly colder rooms to await my simulation appointment.

First, I met the two radiation techs who laid me down on a long thin hard table, placed my legs on a cushioned, form-fitting knee lift, and had me scoot into a hard clear plastic neck lift. Very uncomfortable, and the rock-hard table didn't help. With my knees up and my neck corked around the plastic neckrest, my entire body weight rested on my coccyx, that small and entirely uncushioned tailbone. I stared up at a strange screen with a green laser outline of my head and shoulders on top of my shadowy, reflected form. A green laser cross-hair bisected my face. I felt like I was on the wrong end of range target practice.
The thin bench-like table slid back and forth under me as they checked my position. They kept stopping and torquing my torso left and right, nudging me this way and that to get me precisely positioned. It was quite uncomfortable, as I was strictly cautioned against moving in any way, so when they tweaked my spine one way and then the other, I could do nothing but throb in pain from the cricks in my neck and back.

Eventually they had me where they wanted me, and they stretched a warm, sticky, wet netting over my face and shoulders, locking it down around me and pressing it to my face. This was to create a mold which they will use to get me in just the right reproducible place every day for my treatments. The mask was more hole than string, but it still felt strange and claustrophobic as it dried to my skin. My doctor came in to argue for a more chin-lifted position (so as to better avoid those pesky salivary glands) and the techs pushed my head this way and that to try and meet her expectations. I wiggled into the perfect position for her, by using a much lower neck lift and tilting my head back, and it was reasonably comfortable as well, but the techs insisted on the higher neck lift - the smaller one (and the awkward position) resulted in a small gap twixt neck and lift. So we went back to the higher one and they snapped down the face mask - MUCH tighter than before. My chin and nose were being squeezed down through my face. I could barely move my lips and facial muscles to squeak out, "It's very tight!"

The techs sighed to each other, "Oh, we never should have removed the mask while it was still drying - it shrinks." "No, it's MUCH tighter!" I insisted. They frittered around for a few moments until finally one of the techs realized she'd put an extra layer underneath the neck lift, raising it even higher and thus tightening my face mask. Ahhhhh. Much better.

They marked up my face and sternum with permanent marker (which washed off later into a strange purple tinge), and then decorated my mask with masking tape and markers. You think a quick whiff of Sharpies smells bad, try marking them on your face...on a surface that stays right by your nose, with the chemicals lingering just below your nostrils. All of this created a nice box on my body for the radiation to zap.

That finished at last, I was passed next door for a CT scan. Much less involved than the one 10 days ago, this was simply to test the "box" and the positioning to make sure they'd zap what they intended. And other than the condescending CT tech who spoke very SLOWLY and LOUDLY to ensure I knew EXACTLY what she was SAYING and who figured dismissively that I either had to be a history buff (not quite) or a student (it's been over eight years since I was last in school, lady) to be reading a well-worn copy of Churchill's history of WWII while I waited for her, it was a rather pleasant visit, all things considered.

A few last notes. I took a post-chemo blood test last Wednesday, and although my radiation doctor was deeply disturbed by my low hemoglobin counts...my oncologist was excited. "No, that's a good number for her," he told my taken-aback radiologist. "They're going up."

And also today, I finally got the results of my post-chemo PET/CT scan taken a week ago Friday. With the important caveat that PET/CT only picks up cancer cells larger than a millimeter or two - and those little critters can be microscopic, hence the need for "clean-up" radiation - the scan showed me completely cancer-free.

Hooray for the chemo.