First Radiation Treatment

I went in today for what I thought would be a "test run," but instead ended up getting my first radiation treatment. The IMRT treatment is very different from the two treatments I've had in the past. The setting up takes a lot longer and involves taking many pictures before delivering the actual radiation. Bascially I get placed on a mold of my upper body so that I can't move and they get the exact positioning (to the millimeter) everytime. I have to stay still without moving for about 30 minutes. It's a little difficult because my arms have to be crossed above my head and believe it or not after 30 minutes it can get quite uncomfortable. Once they're ready to shoot me with the treatment, an arm like machine rotates around my body and delivers radiation from six different angles. Each time the field being radiated changes to match exactly the tumor (or try to eliminate areas outside of the tumor). It's quite impressive and remarkable.

All Marked Up

Yesterday morning I had an appointment with radiology-oncology to have some x-rays done. Basically it was to see if the IMRT treatment that they put together matched the area that they want to target with radiation. My radiation doctor was satisfied with the results and he's ready to move forward. I also got all marked up with a sharpie pen, so I have the usual black cross marks on my chest and sides. I made the mistake of wearing a low shirt yesterday so when I went back to work in the afternoon I got quite the funny looks. I'm not sure what people thought of my black ink marks. This morning I will go back for a "dry run" and Monday I will start my treatment.

I will be receiving 14 days worth of treatment over the next three weeks. I was told that there are 7 different fields that they need to target and it takes about 5 minutes to set up for each field (the radiation itself is seconds long), so it's expected that each day will take about 30-45 minutes. I'm scheduled to go in at 4pm everyday, so I'll be going in to work extra early and leaving at 3:30pm and then working again from home in the evenings (not that I don't do that already). My boss was more than understanding and accommodating so I'm relieved about that. In fact, everyone at work has been beyond supportive of the whole situation. Again, I'm very fortunate to have ended up working with such a great group of people.

Yesterday afternoon I ended up getting a call back from UCSF. They wanted to have me come in for a consultation next Tuesday. I asked if the doctor wanted to see me regarding another possible treatment option, because I didn't want to waste my time going there, especially when I'm scheduled start treatment at Stanford on Monday. I was told that they couldn't offer anything better, he basically just wanted to go over the risks. I decided that it wasn't in my best interest to go up there considering that I've pretty much made my decision on moving forward with treatment.

This weekend will again be a busy one. We're getting our new stove delivered on Saturday and will be installing it on Sunday. The next step in the house remodeling will probably be re-doing some of the sheet rock. After that, probably removing old wallpaper, taking the cottage cheese off the ceilings, and painting.

Feeling Better

My mysterious rash finally went away after two doses of Benadryl. I still have some itching on the upper part of my body, but I don't think that's related to the rash from last weekend. When I saw my doctor this past week, she said I will probably have to take steroids the day before I have a scan to prevent this from happening again (if that was the cause).

My counts were good this week, except for being low on potassium and magnesium. I took a few supplements to give those a boost. I started back on my two week cycle of chemo on Wednesday night. I felt brave and decided not to take any anti-nausea medication with it, which ended up being a mistake. I woke up around 5am Thursday morning with major nausea. Fortunately I took some Zofran (anti-nausea drug) right away, fell back asleep, woke up an hour later, and was fine to go to work. I guess from now on I just have to take Zofran the first few days of treatment until my body gets used to it again.

My oncologist did not have the results of my PET/CT. Because it was done at Radiology-Oncology for treatment planning purposes, they don't relay the results to other doctors. I'll have to ask about the results when I go back to Radiology this Thursday. She also said a chest x-ray wasn't necessary, since obviously the PET/CT would show a lot more detail and she didn't think we would see results from the new chemo this quickly anyway.

The next step is for me to go back on Thursday for a final measurement. If all goes well, it would be possible for me to start radiation treatment on Friday. I still don't know how many weeks the treatment would be, I'm just hoping they'll be able to accommodate my work schedule. I'm still waiting to hear back from UCSF regarding a 2nd opinion. My guess is that if I don't hear from them by Thursday, I'll go with what Stanford has to offer.

Work continues to be incredibly busy as I'm sure many of you might have guessed since I no longer have time to email or log on to IM. The house has been keeping us busy on the weekends also. Last weekend we tore out the hardwood floor in the kitchen/dining room area and today we're looking into getting the gas line in for the new stove. We went to a few appliance places during the week to take a look at new stoves and I've already found my dream one. I can't wait until I can cook on a new stove, I'm sure nobody will be able to get me out of the kitchen :)

Allergic Reaction?

Last night I started itching all over my upper back, neck, arms, and face. At first I thought it was just one of the symptoms of my disease, but then this morning the itching was worse and I started getting red blotches/welts all over. I called Stanford around noon and they suggested that I either go to the ER or go into the infussion center as a "sick call." Because it's the weekend, they don't have many doctor's on staff so I would have to wait a while to see a doctor. Fortunately I only waited about an hour before seeing the doctor on call. She thinks I had some type of allergic reaction, because of the way my skin looked. It may have been from the contrast that was used for my PET/CT scan. Although I've never had a reaction to the contrast before, it's not unlikely to eventually develop one. They gave me some Benadryl through IV (which knocked me out right away) and I'm supposed to take some more through the weekend to hopefully clear up the rash.

I was pretty upset about the whole ordeal considering that Saturday's are my only days to do anything fun. We've dedicated Sunday's to working on the house and I'm so exhausted from the long hours at work to do anything on weeknights.

PET, CT's, & Tattoo's

I spent all of yesterday morning/early afternoon at Stanford.

First, I had to go to medical records to try and retrieve numerous amounts of past treatment records so that I can get a 2nd opinion appointment scheduled at UCSF. UCSF has a great radiology oncology deparment just like Stanford. Because of the risks involved with doing a 3rd round of radiation I thought it would be wise to get a 2nd opinion. I'm hoping that they will be able to see me this coming week.

After that I went to have my PET/CT done. All went well with those and the radiology technician even said we could use my old tattoo's so I didn't have to get any new ones. I'm scheduled to go back in two weeks for a "test run." It takes them two weeks to configure the IMRT treatment that I will be having. If the "test run" goes well, then I may be able to start treatment the following day. The treatments would be every day, so it will be quite the challenge coordinating them with my work schedule.

This Wednesday I will see my doctor again. I will be getting a chest x-ray to make sure that my tumor is not growing out of control.

Work still continues to be as busy as ever. I've come to the realization that it will probably never slow down and I just have to get used the VERY fast paced environment at Oracle.

Things with the house are slowly moving along. Chris and I are hoping to go take a look at some floor places this weekend. We finally got our new dryer delivered last Sunday and I'm shocked at being able to dry a load of laundry in under an hour!

Radiation Consultation

This morning I went to Stanford to meet with the radiation specialist that has done my two previous raditation treatments, Dr. Kapp. He reminds me of the scientist guy from "Back to the Future," so I always get a kick out of seeing him. Him and his fellow went over my history (since the last time I saw him) and did a physical check-up. Unfortunately the computer systems were down at Stanford this morning, so they weren't able to take a look at my past PET/CT scans. Of course that was the most crucial part since they need to see the exact location of my tumor growth to determine if further radiation can be done.

Dr. Kapp did mention a radiation treatment option that could be possible. It's called IMRT (Intensity-Modulated Radiation Therapy). Below is a short overview view of it:

Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that utilizes computer-controlled x-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. The radiation dose is designed to conform to the three-dimensional (3-D) shape of the tumor by modulating—or controlling—the intensity of the radiation beam to focus a higher radiation dose to the tumor while minimizing radiation exposure to surrounding normal tissues. Treatment is carefully planned by using 3-D computed tomography (CT) images of the patient in conjunction with computerized dose calculations to determine the dose intensity pattern that will best conform to the tumor shape. Typically, combinations of several intensity-modulated fields coming from different beam directions produce a custom tailored radiation dose that maximizes tumor dose while also protecting adjacent normal tissues. (http://www.radiologyinfo.org/content/therapy/imrt.htm#how)

He still has to take a look at my scan and see how close my tumor is to the spinal cord. The biggest risks in my case (because of the location of my tumor) are permanent damage to the spinal cord (causing paralysis), damage to the heart, lungs, esophagus, and other surrounding organs, pneumonitis, and mucusitis. These were the same risks the second time I had radiation, but now they are increased with a possible third round.

So the next step is for me to have a PET/CT within the next week or so to evaluate the exact size/location of my growth. At that point Dr. Kapp will decide whether we can do further treatment (it would be much less than what I've had in the past). If we can move forward, I will go in for measuring and tatooing (yet again), and I could start treatment as early as a month from now. I would probably be able to remain on the Procarbazine chemo that I'm taking now since the side effects are so minor.

I guess I can say that today's appointment went better than expected. I definitely thought the immediate answer was going to be "no way, no more radiation." IMRT has only been around at Stanford for the past six months, so it's a very new treatment option and one that I'm VERY grateful for. This just goes to show how new options are becoming available all the time and there's always more and more hope for people battling these terrible diseases.