Better Living Through Chemistry and Radiation

Today is the big day, start of treatment!  I am now officially under the influence of radiation and drugs -- so my writing may reflect that fact.  After carefully checking my person for ants, spiders, gila monsters, leeches, moths, snakes, crabs, praying manitses, octopi, blobs, and anything I may have picked up from outer space, I headed off to my first treatment. 

What?  You think I’m going to chance irradiating something that could turn giant and terrorize Central Florida?

The chemotherapy came first.  Chemo's job in my case is to make the MCC cells more radiosensitive, so it had to be in my system before any radiation could take place.  I find it ironic that at 18, I was hooked up to a dialysis machine to take poison out of me, and here I am 30 years later, going to be hooked up to a machine that will put poison into me.

The first order of business was connecting me up to the IV equipment through my week-old port.  It was still fairly sensitive but not nearly as sensitive as last week.  When the nurse put the needle in, it felt like any other needle stick I've had with the exception of feeling a definite "pop" as the needle pierced septum of the port.  I'm not trying to make anyone squeamish, just trying to let you know that in the long run, a port is a Good Thing and it doesn't hurt any more or less than a regular needle stick.

Each time I get chemo, I have to have labs beforehand so the doctors and nurses will have an idea of how my body is responding.  They're mainly interested in how my white blood cell (WBC) count is doing so that if it gets too low they can counteract it.  They're also keeping a close watch on my kidney function since I have a kidney transplant.  This is worth mentioning only because this time, the blood was drawn through the port - the dirty work had already been by the needle in the port, so no new sticks!

The next step was pre-medicating me with a couple of drugs, one to prevent nausea, and another similar to a steroid that would help prevent adverse reactions like swelling or rashes.  This took about 15 minutes to infuse and I didn't notice any side effects or unusual sensations other than feeling the cooler medication flowing into my warmer veins.  It's not painful, but can feel kind of creepy if you've never had an infusion before.  The nurse mentioned that the anti-nausea drug sometimes "makes people antsy, like they need to clean out the garage in the middle of the night."  Sounds more like "gumption" to me; if it makes me feel like getting onerous chores out of the way, I'll count it as a positive side effect.

After the pre-med, I was started on the main course -- carboplatin.  This is the drug that will make the radiation more effective and to a lesser extent, interrupt cell division of the MCC.  Once I was started and stabilized on the drip, I was booted out of the chemo department and sent over to radiology for my IMRT, pushing my IV stand ahead of me. One thing that struck me on the way over is how everyone moves out of your way when you're pushing IV bags and pumps around.

The IMRT was essentially the same as my Radiation Simulation, except shorter.  I took off my shirt and the mask that was previously made during Radiation Simulation was placed over my head and shoulders and bolted to the table.  The mask did it's job admirably by making my head and face completely immobile, even pressing down on my chest a little bit making me aware of my chest rising and falling as I breathed.  I'm not claustrophobic, but lying immobilized on a cold table in a chilly room, unable to speak, and aware of every breath can be stress inducing.

During the process of the radiation techs double checking the measurements made earlier, Tiffany, one of the radiation techs, kept up a running commentary about what was happening around me which was very comforting.  The radiation field placements are very finely tuned, down to the millimeter and took about 15 minutes.  There are machines now so precise that for chest and lung treatments, the radiation is timed to your breathing so that your lungs and chest are irradiated only at certain points of your respiration when they are at the same spot as your previous breath.  It's that precise.

The mask is so snug on my face that I can't even open my eyes fully and even then, what I see is the ceiling through plastic mesh.  It hightened other senses making me notice things I probably wouldn't have, such as how the pitch of the whirring motors sound like a major third, how the sound moved around me while the machine moved, the smell of the magic marker they used on the mask in order to calibrate the machine to my position, and a quick, sharp scent of ozone (I think) as the machine cranked up to produce radiation.

By the way, there are no radioactive materials in the machine.  The radiation is produced by a liniar accelerator (or "linac" as the pros know it) which is under complete control of the technician.  That's all I can tell you about it as we had only discovered four elements (chocolate, duct tape, WD-40, french fries) when I was in high school.

After the techs left the room for a second time the actual radiation treatment commenced.  It wasn't much different from the calibration a few minutes ago except that there were a few extra hums and the knowledge that this time, real live radiation was being aimed at my head.

Even though it's been explained to me a dozen times that radiation is colorless, oderless, tastless, invisible, and can't be felt, I knew I could feel pinpricks on my skin and a funny feeling inside my brain, the same way you know that your line in the grocery store is moving slower than the rest or that your computer hates you and erased your file right before you had a chance to save it.  At one point, I swear I saw a flash of blue light even though my eyes were closed.  Going to mention this tomorrow to see if my optic nerves are getting cooked.

After about 15 minutes of forced introspection, the techs came into the room to release me.  There was something special for the staff going on right after my treatment, so there was very little time to answer my questions and I was punted back (in a nice way!) to the chemo department again.  The carboplatin infusion had finished during RT so all that remained was to disconnect the IV and flush the port.  I was given an appointment for next week's infusion and presciptions for labs to be drawn for next time, and I was on my way.

Right after I got out the door I took stock of myself:  I hadn't thrown up, I was able to walk, I wasn't fatigued, and felt as "normal" as I had ever had.  I also had a disquieting feeling that there were cells in me that were rapidly dying at a much faster pace than normal and my insides were getting cluttered with dead cell detritus.  I didn't really feel any effects until about 20 minutes later driving home, a slightly nauseated feeling, but certainly not a dire feeling that I was about to blow grits.

As of now about seven hours after my first treatment, the only thing I've noticed is a slighty "wired" feeling that's unusual for me to have at this hour and a slight headache.  It feels like I've had too much coffee.  Funny thing though, the chemo nurse said it's the anti nausea medicene that can cause the jitters and give you insomnia; I may not be feeling anything from the chemo.  It could be from caffine withdrawal (only one cup today) or the fact that spring time (yes, spring starts in MARCH in Florida) causes all sorts of stuff to bloom that bothers my sinuses.

There's still tomorrow though.  It will be an interesting day.

(It's late, I'll fix the grammar and typos tomorrow.  Bear with me.)

Update 3/8/11:

Fix typos, introduce new ones, wordsmithing, more detail about RT.