On Tuesday, September 5, I went to the basement of the Cancer Center where the radiation oncology department is located. After checking in and waiting about a half-hour, I was taken to the radiation treatment room. I had to take off my shirt, which exposed all the drawn marker lines and stickers that protect them. These lines were placed in an initial CT scan visit, so that the radiation machine knows exactly which spot to target.
I sat on the table and scooted my butt into the rigid form that sorta holds me still (I’d lost about 6 pounds since it was made, so it was a bit of a loose fit). Then I laid down in the form, on top of a sheet. They used the sheet to lift and scoot me right and left until the green laser lines coming out of the radiation machine lined up with my marker lines and stickers. I had to keep my arms above my head for the duration of the session, which caused an ache in my bad right shoulder.
Normally there is a medieval sort of press they put on that pushes down on your abdomen and holds you still, but my HAI pump is in the middle of all that and it hurts to press on it, so I get to go all freestyle with it, and hold my breath instead, to remain still and keep my organs from moving around. I also had to fast for at least 3 hours, no food and only sips of water, so that my stomach would be relatively empty. Being the overachiever, I fasted for 14 hours from 11pm the night before to 1pm when the treatment was scheduled, which wasn’t much of a challenge.
Using breath holding, they get the alignment just right, using x-rays to visualize the liver and target tumor area, and the table would adjust up and down to get the aim just right, and after a while the radiation treatment started. It was about five or six sweeps of about 30 seconds, and I was able to hold my breath through each sweep, not too challenging except that you have to exhale nearly all your breath before holding it, so you don’t have full lungfuls of air. I spent my time relaxing so as to use less oxygen, and I was breathing quickly and deeply to get myself really well-oxygenated before each pass. Even though the breath-holding was not much of a challenge, the staff were impressed because it makes their job much easier to complete an entire pass in one go.
The machine makes whirring and clicking noises as it operates, (hopefully) zorching the liver tumor, while they play a bunch of relaxing unoffensive music like the Beatles, John Denver’s Country Roads, Fleetwood Mac, and the like. Country Roads was maybe a bit weird because it was used in the movie Alien: Covenant to lure a bunch of colonists to a planet full of Nasty. Instead of thinking about that, I thought about the super-long cross-country drives my family would take when we got stationed at a new military base every few years, and how in those days John Denver was like Phil Collins… their songs are always playing somewhere on the radio. So John Denver is forever etched on my mind as music of a hopeful anticipation of a new life somewhere else. And zorching a cancer tumor is definitely full of hopeful anticipation.
After the treatment was over I got a printed schedule of treatment times, where I learned we were doing five radiation treatments, one each day on Tuesday, Wednesday, Thursday, Friday, and the following Monday, all around 2pm.
I had a nice appointment with my radiation oncologist, who is a very friendly and positive person, and we discussed all the things I should be keenly aware of, that might indicate a problem with the radiation treatments.
Then we headed home, but I convinced my wife to take me to the Q Shack for some barbeque since I was starving. Barbeque is such wonderful comfort food. One of my favorite songs is Barbeque by Robert Earl Keen. It kind of says it all. I should add this song to my chemo playlist because I often crave it after treatments.
Unfortunately, filling my tummy with barbeque, green beans, and okra after a good dose of radiation did upset it a bit, but… worth it!
About halfway through my late lunch I started feeling super-super tired and when we got home I thought it would be a nice idea to have a lie-down for a couple of minutes. I woke up four hours later, nicely refreshed though still tired. I poked around the house for a few hours, went out to my secret lab and put my new paperwork through my handy Fujitsu scanner, and uploaded it to my Google drive in case I needed to refer to it from anywhere. I cleaned up my desk in my secret lab, though it will never be considered clean by anyone but me, there are stacks of things to work on and pay attention to. I realized I hadn’t paid all my bills yet, so got a start on that and then sharpened my wife’s favorite knife and stropped it until it had a decent kitchen-sharp edge.
Before the radiation started my white blood cell count, leukocytes, and platelet counts were shockingly low, so my oncologist prescribed 0.6ml of Udenyca in a subcutaneous injection syringe. This is a drug that promotes white blood cell production in your bone marrow (it did work), but at what cost?
Good heavens! After seeing the price tag on this drug I was so nervous at the idea of messing up the injection that I went up to the infusion clinic for coaching on how to do it right. They couldn’t administer it for some legal mumbo-jumbo reasons, even though they can pump me full of chemotherapy every couple of weeks, so I had to be sure I knew what I was doing. When I got home I asked my wife to do it, and figured if she didn’t know the cost she wouldn’t be nervous about it. We decided to put it in the fat behind my arm, because after my last surgery she injected the first shot of blood thinner into my abdomen. She did it just like that Mia Wallace adrenaline scene in Pulp Fiction:
This time, thankfully, it was one of the most painless and easiest shots ever. The side effects of this drug were awful though. They warned me I might have sore bones afterward. A day later, the bones above my knees were aching a lot, and it migrated to my arms, then my back, and I had a couple days of just feeling miserable. I sure hope I never have to take that drug again. But it did work, raising my white blood cell count above the minimum normal value as promised.
I had four more rounds of radiation just like the first. This time I drove myself there and back. Getting radiation treatments is so much easier than chemotherapy. The fatigue is much, much, much worse but I don’t feel dizzy or swoony afterwards, and I don’t have that unsteady baby-giraffe walk the atropine gives me. So it was fine. With the remainder of the treatments I drove myself to Whole Foods to get a little lunch off the hot bar. I had to hold any food or drink for 3-4 hours before the treatments, because if my stomach was full it would displace the liver just slightly and we might radiate the wrong area. So with each treatment I stopped eating around midnight the night before, and had a 14-hour fast going when I went in for radiation treatments. I was super hungry after I got out.
Then I would drive myself not to home, but to work, as I felt guilty being out for a few hours in the middle of the day, every day, for five days. And the first day, I slept for four hours afterward.
The fatigue with the remainder of the treatments was still weighing heavily on me, not as bad as the first day, but at the end of my work day I went home and got right in bed.
For my wife’s birthday we took a little overnight trip to Ocean Isle Beach. We got there really late and we were starving but apparently OIB folks like to turn in early, and all the restaurants were closed except there was a bar in Shallotte called the Wing & Fish Company. They were super friendly, fast, and the waitress was very accommodating of our low-carb diet. She suggested dishes and sides that would work well for us. We had a really pleasant dining experience there and will definitely return in the future!
I wanted to visit the NC Maritime Museum at Southport but it turns out it is closed on weekends — precisely when the tourists have the most need of it. That’s just silly. I’m going to have to take a day off to visit it next time. So we visited the local museum in Ocean Isle Beach, which was interesting and relaxing. It is the Museum of Coastal Carolina. It has the remains of a real shipwreck in one room… cool!
Then we went out on the beach and though I couldn’t do full immersion in the ocean because of my radiation marks and stickers, I waded out into the water which gave my feet a boost of lovely, healing relief! The FOLFOX chemotherapy rounds gave me pretty bad neuropathy in my feet and hands that gets a bit better when we hold off on chemotherapy, but it certainly doesn’t get better while I’m on FOLFIRI+Bev. The ocean is amazing though, when I am in the water everything feels perfectly neutral and I realize how irritating the neuropathy is the rest of the time. I have been taking 600mg per day of R-alpha lipoic acid and after months, I feel like it’s starting to have a positive effect, especially in my hands which get more of a daily workout.
We hurried back home because the next day our youngest child had the first day of his senior year in high school, and we wanted to visit my mother-in-law at the hospital after her knee replacement surgery.
So I tolerated the radiation treatments pretty well on the whole, and side effects were minimal. I will have a follow-up CT scan on October 26 to assess how the treatment worked. It takes a couple months for all the radiated cells to realize they have no workable DNA and to drop dead, so that’s the reason for the long wait.
In the next post I’ll talk about resuming Chemotherapy (#30!) on September 26.