Friday, June 13, 2014

Gracefully Moving Along

Long time, no writing here. Rest assured, that is only because my more typical life has come rushing in and I have been busy working my real job, tending our exuberant gardens, swirling away on the dance floor and well, just not thinking too much about breast cancer.
My recovery from surgery is complete, I have full range of motion & strength in my arms and mercifully, no lymphedema.  I seem to have sailed through chemo, and now, a month since my final infusion, am seeing a bit of hair returning to my head. Rapunzel I’m not, but baby steps in that department. Now if I could just figure out a way to keep the hair-free legs, we might have a marketable venture!
My next installment of treatment, radiation to the chest wall, began this week. I am now 3 treatments down, 25 to go! I attend every day, like one of the truly faithful, for about 5 ½ weeks; I have weekends & the 4th of July off. It's a bit Sisyphean, a whole additional piece to treatment and then the sheer every day-ness of it. Here's my favorite personal Sisyphean photograph, that's me at Ft.Defiance a few years back taking a break with a friend from my work on the Indian Reservation there.
Ft. Defiance, keepin' that rock at bay!
The rest of this writing goes into some detail about the radiation treatments. I enjoy demystifying medicine and articulating the experience. But if you are not interested in that, it could be filed with other missives under TMI. If that’s your feeling, skip to the last paragraphs under the *****.
Before beginning radiation I met with a number of experts, then my own radiation oncologist, and a gaggle of techie technicians and nurturing nurses. My RadOnc understands I am married to a geeky guy and that I too have strong interest in grasping the overarching goal of radiation (to prevent recurrence to the chest wall) but also to understand some of the more subtle aspects. She has explained in some mathematical and diagramatic detail, delineating just how much radiation each of my surrounding organs will receive over this time period, and how careful she is to insure these numbers stay low. The goal is the delivery of a total amount of radiation, parsed out over individual dosages. Interestingly, the anatomic shape of my upper chest wall allows for an angle of radiation which nearly spares the upper lobe of my right lung, an area that potentially could get a bit more radiation than anyone would like, keeping it safer from wayward radiation scatter. Who knew?
There are many ways to insure precision and like any sewing or carpentry project you’ve done, it’s all about measuring twice, cutting once. We’re not cutting here, so we can say measure twice, zap once. In the radiation room, there is a thin green line generated from a laser that runs along the ceiling above me. I now am the proud owner of several teensy tattoo dots on my chest area and there are computer generated maps of my body, both outside & in. Each of these tools helps create coordinates to line me up just-so each time I lay down on the movable metal table for treatment. The main goal is this: deliver the correct amount of radiation to the tissues in question while allowing for the least amount of radiation to my underlying and neighboring organs/bones like my lung, esophagus, trachea, ribs, spine & spinal cord. The team of technicians is patient and persnickety getting me set up and I appreciate their dedication to perfection. I understand that though there are guidelines and though there is physician preference, there are also many gray areas and some unknowns related to radiation; if we can control what we can, we should!
I lay on a crisp white sheet which overlays a long tray and they give little tugs to the sheet and nudges to the tray to get me perfectly aligned. Beneath me is a frame mold made during a dry run which also insures I am in the same position each day. My arms are stretched full length straight over my head and my neck is turned about 60 degrees to the left at a bit of a rakish angle, to pull my thyroid out of the radiation field. The big looming apparatus, which resembles an X-ray machine hovers quite close to my body. Inside its wide-open eye, I note an array of flaps, covers and levers, adjusted to decrease and increase the "rads" that come through, taking into account the particular contours of my body and position of my organs. The setup and computations are all done by computer but measurements are checked and rechecked, small rulers are pulled from lab jackets & are laid across my skin; I look a bit like a page from a dot to dot book, seems everyone has a thin black Sharpie in hand and takes liberty with dotting me up. No one is comfortable until everything is matched up, then I am good to go, the technicians scoot out of the room into the control area from which they deliver the treatment remotely.
There is a bit of a musical interlude, some whirring and whizzing, some high-pitched pings and then, voila!-- that dose is delivered. I have four areas being radiated each visit, so this process is repeated four times, with each one I am shifted a bit & realigned. I am to remain exceedingly still for the 40 or so minutes and to breath evenly, not deeply. Honestly, I am sort of fascinated by the whole process.  I love how the 3 or 4 women work in concert, choreographed to conserve motion and time, gracefully moving along the table past one another, each attending to a different detail. I make a lot of small talk, little jokes, pertinent questions, random observations and an ongoing sprinkling of thank yous to this dedicated staff. 
I love to remember everyone’s name and to be uber-friendly and encouraging to all the caregivers, from receptionists, nurse’s aids & doctors to technicians, phlebotomists and even the insurance person. It’s like another angle on mindfulness. Don’t get me wrong, I also advocate for myself, and get my needs met. Sometimes I wonder, how do people without medical backgrounds go through having a medical experience? You really have to be informed and know what’s going on… having another full time job!
When I am in the treatment room, I lay there and think all kinds of good thoughts like: "May these rads do away with any cancer cells that might be around, may the rest of my cells and tissues be safe and healthy; may I tolerate this treatment well." After I’m done with those basic thoughts, I move on to sending good vibes first to my amazing husband & of course the kids, and then to my ever widening, overlapping circles of friends and family, patients and students. This takes some time to go through my lists. I do not rush.
In lieu of the hospital Johnny, I wear a flowery sarong when I walk from the changing room to the treatment area. I am sporting  my babushke du jour into that quiet lead-lined treatment room, comfy pants & cozy socks. With the lights turned down low & covered by a warmed blanket on the areas not being treated, I could reframe this whole experience into some kind of newfangled spa treatment. Just need someone working my feet, some moisturizer to my face & cucumber slices on my eyelids!  Actually, I have never even been to a spa, so it’s true, my images here may be somewhat misinformed!
As the kind of doctor I am, I also know there is individual response, so I am doing everything in my power to get the optimal benefit from this treatment with the least amount of damage. I thought you might be interested to read a bit about the naturopathic adjunctive approaches I am using, which I will write about next week. Stay tuned!
 Lastly, I am thinking about the word radiation and some related words like: radical—believe me, I have been called worse. Radiate—this is my love coming at you from all angles and lastly, radiant. May we all be so, giving off positive thoughts, our best intentions.
Love & light,