Friday, March 24, 2006
My friends,
After I did the test patch, I did the whole thing, well half and half, but eventually the whole affected area. I’ve added this accumulation of the radiation posts:
I have not written since I started my treatments. My RO is irradiating the whole affected area, all at once. That means everything from my waist to my mid-thigh, with a shield (the technicians refer to it as the ‘jewel box’) covering my private areas. It’s a big area, and difficult to get it right, especially in only four positions/fields--1) anterior (front); 2) posterior (back); 3) right lateral and 4) left lateral. The groin is exposed in the front field, and the inner thighs and perineum are covered half in the anterior field, and half in the posterior. When in the posterior position, the technicians tape open my buttock cheeks, using the table as support (I ask the technicians . These two areas—the front and back—are done with the biggest field there is, the 25x25cm cone. Now, lest you think I have the frame of a pre-adolescent, it is effectively much bigger than 25x25, because they lower the table all the way down, going from the principal 100% field (which is the ‘SSD’ of 100) to an SSD of a little more than 140. Because this is a much bigger area, to keep the effective radiation at a constant, the physicists adjust by increasing the dose coming out of the linear accelerator. Thus, per square cm of Brad’s skin, let’s say, the dose is not diluted. Where the field borders meet are what are called match lines, which are drawn every day with a marker, as every day is a little different (how my leg is turned, how much the butt cheeks are taped open, etc.). The technicians try their best to not overlap, but if there is a little overlap, the constantly moving match line ensures that the overlap isn’t always in the same place.
We are following the blessed recipe passed on to us by Radiation Man, Rad Woman, EJ, and their radiation oncologists. That is, 20 treatments of 200cGy (200 rads) each, for a total of 4000. As part of this recipe, we use a 1cm bolus, which brings the most intense radiation (the ‘D-max’) up nearer to the skin surface. (For further technobabble about this particular facet, read on; otherwise go to the next paragraph.) Electron beam can be produced to penetrate to different depths beneath the skin, following the variable of MeV. Whatever the MeV value, divide by two for the effective depth in centimeters. So, at 6 MeV, the shallowest produced by this linear accelerator, just about all the radiation is absorbed by the 3cm of tissue closest to the skin surface. This is the strength we are working at, as did the prior patients. The 1cm bolus acts like 1cm worth of skin (it is the same atomic number as skin) and thus the resulting penetration of skin is only 2cm, which is the 4/5 inch that the others have spoken of. (For a great webpage on this that makes it easy to understand, click on my link for Electron beam technical info.)
Bolus is flexible in that it bends, but it does not contour to the shapes in our body. So on the front and back fields, the technicians use an old trick: instead of 1cm bolus, they use two thin hand towels, each folded once and soaked in water, to make a 1cm covering. This molds very well in the groin, around the leg, even between the butt cheeks! And it’s nice and warm in the sometimes chilly rad room.
I’m having about 25-30% of my whole body’s surface area irradiated. It’s a big deal. Generally, I’m a little tired and need lots of fluids to catch up with their depletion. Tomorrow will be my LAST DAY, Number 20 of 20 treatments. I’ve been keeping daily notes to give you guys, to understand the radiation timeline in more detail….
Session 1: There is itching immediately, which Dr. L says is not the skin tissue reacting yet, but the hair follicle itself getting irritated. I asked if I could take Benadryl to ease the itchiness (which threatened to keep me up all night), but he said that he would like to keep other treatment topical for now, and recommended pure kitchen cornstarch.
Sessions 2 and 3: More itching, more cornstarch.
Sessions 4, 5, 6: I start getting a general feeling of tiredness, accompanied by transient bouts of nausea. I don’t know if they were radiation related, because they stopped after this.
Sessions 7, 8: There is perceptible change in color on some parts of the skin.
Session 9: The first HS scar starts opening up—it looks like a scrape. It happens to be in the groin, which is not wholly by chance. For reasons I don’t fully understand, grooves like the groin and between the butt cheeks act as natural boluses. Also, there’s more friction in these areas, and the skin breaks down faster there. Also, the scar breaks down first because, as I’ve written previously, the scarred skin reacts more quickly and more strongly to the radiation, as we’ll later see.
Session 10: the skin all over starts to feel dry, a bit taut. This even though I have stopped doing my 2 or 3 a day alcohol swabbing, and have stopped using a drying soap. The color’s a tiny bit darker as well. I still put cornstarch to ease the itching, and take a couple of Benadryl before going to bed.
Session 11: The skin may feel dry, but no more alcohol + no acne soap = clogged pores, and the beginning of new lesions. Many of them, in fact. This reminded me of the old days, before I discovered the rubbing alcohol. Unfortunately, I cannot follow my old regimen during radiation, so that’s of no use! I’m still on antibiotics, and I may have to take Aleve to keep the inflammation down.
Session 12: There is noticeable hair loss. In fact, I have a new party trick, if I had such a party to show it off: the hair comes out in clumps—you don’t even have to pull on it. There is more irritation in the creases (groin, buttock). Itching is sometimes insanely excruciating.
Session 13, 14, 15: The pain increases as the creases start opening up. This is still mild pain—no need to take medications yet. In fact, things seem to be progressing all too slowly. While there is a difference in color and texture, it is so slight for 15 sessions.
Sessions 16-20: redness and irritation a bit, but pain comes after. Most hair out by now.
*I convinced my doctor to go another 4 days of treatment, for 24 total, and 4800rad. My skin was not getting dark enough, there was still too much hair on the skin, and I didn’t want to realize only later that we needed more. He went along with it. I know I’m going to pay in pain!
After last treatment, hair keeps falling, skin gets redder and more irritated, then starts hurting. The peak of pain is 7-10 days after end of treatments: at this point you really do need medication, and there are a couple days where sleeping is very difficult—it’s like a bad sunburn. You’re fatigued, you’re dehydrated, you feel like you’re abusing your body. But you’re actually helping it. really!
One month later, the skin is healing nicely. Everywhere, that is, except for these two symmetrical spots on the inner thighs where there was an overlap (stupidly) and that skin got twice the dose, and is probably going to be permanently damaged to some extent. DO NOT MAKE THIS MISTAKE! If it weren’t for that, I’d have all new skin by now, but healing is slow in those spots.
Three months later, I’ve gotten one lesion, an old one that decided to pop up and burn out. That’s it.
Six months later, nothing! Doing very well, fingers tightly crossed.
One year later, doing great. Only thing that pops up are two spots that were in flexural areas, and didn’t get enough dosage. Very small pimple-type lesions come up there, which is nothing, except on upper part of inner thigh which rub up against each other. I should at some point get touch-ups there. But other than that, looks great.
18 months later. Same thing—everything is great, except for those two spots. I keep waiting to see if something else pops up before I go back to touch up those spots, but nothing else does. I still haven’t made it back to the doctor, though, because the prospect of another 20+ treatments seems hard to fit into my once again busy life. But I must do it, just to complete the journey.
