Thursday 4.10.2008 Radiation Marking

I showered this morning after a fairly restful night, comparatively. I am quite anxious about this appointment, the "planning session" for radiation treatments. I massaged my arm in the warm water, trying to get whatever it is to go away. It doesn't hurt like it did, but is that because I've become accustomed to the discomfort, has there been a change in sensation, or is it better/resolving?? I don't know. Sometimes I think that my arm has a "full" sensation, but visually I can't tell. I was hoping that my arm would be measured today, but it wasn't. I didn't have a nurse visit today; I was told I would see a nurse next visit. Ok.

Dan and I arrived at the Ingham Radiation Center for our 10:30 appointment. Daniel drops me at the door and goes off to park the car. The lady behind the window was different than I remember; the woman in front of me said she was here to see Dr. DeBiose, and the Window Lady told her to go on back. Huh? I have an appointment with Dr. at 10:30... Daniel joins me at the window, and the Window Lady tells the other woman to wait a moment--another staff person comes out and escorts the first woman back. Hm. Window Lady comes around the divider and escorts us down a hallway--there is a dividing wall maybe 5 foot tall that is topped with artificial greenery. This partial wall is creates the hallway from their reception/office area. The end of wall opens up into another waiting area, rimmed on 2 sides with upholstered metal waiting area type chairs. There is a table in the center of the room, a bit larger than a card table, with a jigsaw puzzle in progress. The pieces are brightly colored, and I see the lid of the box is stood on edge, and the picture is of tropical fish. (Interesting--as I am writing this, I have the thought that one of my co-pilots enjoyed puzzles, and would have liked that one. I had prayed before I left to help me be peaceful during this appointment. So Mom was there waiting for/with me??)

On another wall are 2 large doors, each marked "Change Room". Through another opening I can see a wall of lockers, each with its key on a springy wrist bracelet in the lock. Hm. Opposite us is a wall, half of which is covered with brown cabinet doors, and into the corner is a set-in counter that has an empty, turned off coffee pot, a basket that has "complimentary" written on the side, and some literature/handouts. I'll check that out later.

Daniel and I sit there a few minutes. Another, older, couple come in and sit down. The gentleman takes off his watch and glasses and hands them to his woman. Another moment later, a staff person comes out, greets him, and escorts him back.

A young woman comes out with a file in her hand. Stands there, looks at it for several seconds, then says "Katherine" with an accent such that I could hardly understand my own name. Oh, great, I'm thinking. My first time here, I'm scared to the edge, and here's someone who looks about as unsure as I feel. She tells me I need to put on a patient gown. Ok, I say, waiting for instruction. She turns to ask a staff person for a gown, and the staff person brings a gown, then checks in the dressing room. Oh, she says. Hoo Boy, I'm thinking. Anyway, I go in and put on a gown, and come out. I smile at her, trying to reassure her as well as myself. She leads Daniel and me back to the CT room. When we get into the room, a "real" staff person is there, doing what they do. She turns around and introduces herself as Adrienne, and introduces Hosna (?sp) as a student. She tells Hosna go ahead. Hosna goes into the introductory spiel, and after a couple of paragraphs, Adrienne steps in.

It seems I am having a CT scan to get started. I ask Adrienne about lying on my abdomen (remember the table with the "boob holes") and she said that while some facilities are doing that, it is still relatively new, still controversial, and better suited to larger breasted women. She looks at my chest, and accurately guesses that I am a B-C cup? Yes, I say, and she says that a smaller breast is actually better, because of the amount of energy (and then she said what the unit of measurement is) used for larger or denser areas can cause greater damage/unintended effects. Ok. Thanks, God, for smaller breasts. She asks Hosna to do something, and when she is away from us, Adrienne asks if it's ok for me to have a student. I tell her kind of, because I'm really nervous and anxious. She can be in there and learn, but I prefer that you (Adrienne) do all the stuff. She smiles, and says sure, not a problem.

Ok. Lets get positioned on this table. The CT machine is like a large ring, tire, doughnut, standing on edge, with a table going through it. There is a triangular shaped bar width-wise across the table at about upper thigh--Adrienne called it the buttstopper. Get your bottom up against that, and lean back, and place your head in this round shape. Well, let me tell you, it was about 52 degrees in that room, and my bare back against the cold metal table was having me looking for one of those hot flashes. A long one. One of the girls puts a bolster under my knees, (must have been Hosna) and Adrienne comes up to my left side of my head and helps me position my arms up and out to the side, and over my head. Well, you know with that left shoulder still being bum, we had to get that support piece where it would work (there are some angles that my shoulder will not move into). We had some difficulty adjusting the different pieces to my smaller-than-average (read petite) frame, but the girls finally decide that "this will work". It's important to get this positioning just so, Adrienne explained, because we're going to mark you, so that we can align the lasers and radiation accurately for each treatment. Ok, then, let me wiggle a little bit more, because I'm just not comfortable, and I don't think I want to replicate that every day. So, after a few more adjustments, they think we're good.

Adrienne goes into a teaching mode with Hosna; they are on each side of me with their marking pens. At this point, I look over at Daniel, who smiles and nods at me. The girls do their thing, and I am getting marker marks on me. They place some type of lightly adhesive metallic strips in strategic positions--one was along the incision on the breast, and the others might have been where they made the marks on the sides. I raised my head to look at what they were doing, but was reprimanded and told to hold still. I told her I was trying to see what it looked like. Nope, you have to keep your head still. Hm. Ok. (How am I going to write about it if I can't see it??)

They are done with the marks and markers, and call Dr. DeBiose overhead to come into the CT room. A few moments later, he does.

He approaches me, shakes my hand, asks me how I'm doing. I tell him I'm nervous and anxious, not knowing anything about radiation treatments and all. He smiles, and is very kind, reassuring me that all will be well, that each of the staff are very good, they'll take what time we need to take, and that it's really a very simple process. (Sure, I'm thinking, you're back isn't stuck to this table like a tongue on an ice cube tray...) He goes on to tell me some more technical stuff while he's clinically looking at my exposed upper body, checking the markings with my anatomy, touching the outer edges of the breast tissue and explaining the angle of the radiation, looking to make sure the laser lights on the machine are lined up on the markings correctly, etc. He says it looks good, and that they are all going out of the room while the machine does the CT scan. Adrienne adds that it might be about 3 minutes.

I am alone in the cool room, placed onto the equipment in such a way that I'm afraid to breathe. I had been taking big breaths during the setting up, to try to calm myself, and I don't know if the machine is doing it's thing or not. After what seems like 20 minutes, but was probably only 2, the machine makes a low whirring noise, that steadily rises in volume and pitch. It reminded me of an airplane engine firing up. I took a breath, let it out, and said here we go Lord. The table started moving, and I went back and forth through the ring several times. I lost count after 4. The table stopped and the machine wound down, the sped up again, and I moved back and forth a few more times again. The table pushed back out, and machine turned off, and they all came back in.

We're done with that, they said, and Dr. asked when my last chemo treatment was. I told him March 19-20. He said, ok, lets start you April 24. Ok, I said. I'm thinking, good, that gives my arm and breast more time to heal..

Adrienne tells me not to move, and gets the stuff to make the marks permanent. She tells me it's India Ink, and she'll use a large needle and poke once. She starts on the right side. Ok, poke--(Ow, that one hurt, like a wasp burn/sting). Then to my cleavage. That didn't hurt quite as much. Then the left side. I hardly felt that one. I breathed out. Permanently marked, no going back. Adrienne asks Hosna to get the camera to document the placement of the marks, and Adrienne takes the pictures.

They dab at the ink a little, then say we're done. Hosna shows me back to the change room. She turns away, and as I'm going in, Adrienne catches up and says the card was not in the camera, and would I mind if she comes in, too, and takes pics again. Sure, not a problem.

Adrienne takes the pictures she needs for the chart, and I take adantage of the one-on-one opportunity. I ask a few more questions to clarify some things, like what about the fatigue, and the skin care. She says of course people get tired, the body is working hard to repair the damage being done by the radiation. And using aloe gel and/or aquaphor ointment should be enough for the skin care. The nurses will talk with you next visit and tell you more about your care. Ok, thanks, I say. I have dressed while she's been talking to me, and we leave the change room.

Mary, one of the nurses, has my chart now, and leads Daniel and me to an exam room to wait for Dr., as I haven't signed the consent yet. He comes in right behind us. We end up having casual conversation, I ask him if I could see the images we just did. Sure, he says, and we go back over to the CT room. At the computer, he pulls up my images, and we go through the series. My films look good, he says. Dr. Sanchez left lots of clips in both of the surgical beds. I was surprised, I don't think that was mentioned in the operative report. Anyway, he prints out a copy of the image for me, and shows me the angle of the beam for the treatment. Cool, thanks. We go back to the room. He sees Dan's current Golf Digest mag that I had put in our Appointment Bag, and they start talking golf. For about 20 minutes. I have been chilled, and I realize that my body temp has come up to normal while standing there. I know the room temp hasn't changed--I recognised the hot flash. Funny.

The guys finish up, I sign the consent, and we leave. It is 12:30.

Somewhere near the end of the process in the CT room, Adrienne talks about appointment times. I tell her they will need to vary, she tells me I have to plug in to one time throughout the 6 week treatment period. I'm thinking that's not going to work well for me. Dr wants to start treatment Thursday April 24, and Friday, then every weekday for the 6 weeks. I'm thinking that gives me some time to figure out what works best for me, for us at home, and us at work. Especially work. I am having a hard time with "leaving the team" in a bind for staff. It's no fun to work short handed, and it's no fun to pick up extra hours, either. And it's no fun having these treatments. I'll do what I need to do for myself, and I feel bad about stepping away from my job responsibilities.

We got home about 1. I breathed a lot, and reflected on what just happened. It all went well, I suppose. I fixed lunch and ate, then took the pictures before cleaning off the marking pen from my skin.


These pics show the left side. The incisions show pretty good, too, and X marks the spot for the tattoo.



Right side, and right side tattoo.


Front view. There is a mark in the center, with a tattoo there, too.


So, that was my day. I cleaned off the marker with ointment, and I have the three "blackheads" left.

Thank you for reading, for keeping me in your thoughts and prayers. I sure needed them today, and I was breathing in all I could. Love to you all.