First Dose (again)

(5/13/09)

Well, it turns out that Dr. J and I were thinking along similar lines. The tradeoffs were these:

- Do chemo first and risk the tumors growing and becoming too unwieldy for radiation to handle

- Do radiation to the lungs first and risk having disease pop up somewhere else in the body

Solution: do both at the same time!

But of course, so simple! So that's the plan right now, to wipe out the disease in the lungs and clear it out everywhere else, too, at the same time. We'll probably switch up the chemo drugs after radiation is done, too, so we can keep the cancer from becoming resistant. 

It sucks of course, but so far this treatment is looking a lot easier to handle. I have daily cytoxan by mouth for 28 days, and on days 1, 8, and 15, I get a 10-minute push (injection) of navelbine (vinorelbine). Hopefully aside from losing my hair, I won't have too many side effects. Starting Friday I'll go in for radiation therapy every day for 15-20 minutes for 10 days. The radiation will target both of my whole lungs with a larger dose going to the two nodules. 

Getting on a path to solving the problem always makes one feel better, although at this point I'm starting to get good at dealing with uncertainty. . . 

As a parting note for this post, I have to give a shout out to one of my personal heroes, Steve, who is battling Ewing's Sarcoma and just came out of a really rough couple of weeks. He and his wife Ann are such a strong, upbeat couple, and their positive strength is incredibly infectious. Steve, you're a freakin' champion!! Ann, you're incredible, too! 

Graduation from Radiation

(or "How I got sunburns on my butt") 2/13/08

Well, folks, 28 days came and went, much more quickly than I thought it would, thankfully. (Random aside: I wonder now where they came up with 28 days - I'm sure it's just a total calculated dose divided by the individual dose or something like that - but what about the obvious connection to the zombie movie 28 Days Later, its less-good successor, 28 Weeks Later, and the less well known and completely un-zombified Sandra Bullock movie, 28 Days? ... )

Anyhoo, I finished chemo cycle #4 last week and capped it off on Friday with my last radiation session (woohoo!!!). There wasn't too much ceremony surrounding the moment, but they did give me a spiffy certificate (as you can see in the picture). The rat is there to signify Chinese New Year (a gift from mom - can you tell which rat it is?) and how awesome this year will be compared to last :P. Apparently some people get dressed up in cap and gown on their last day, but I guess it didn't feel like that big a deal to me (plus I'd been in the hospital all week for cycle 4 of chemo anyhow - didn't have a whole lot of energy to put into it). It certainly feels like more of a big deal now that I don't have to go into the hospital every day and lie on a table for 15 minutes. Plus, I'm psyched to have these radiation burns on my bottom heal up (everyone get your inner chant on, "Heal! Heal! Heal!"), cuz they're painful and itchy and keep me up at night. I guess it's kinda like someone took a big magnifying glass while you were lying on your stomach at the nude beach and he/she aimed it in a nice concentrated 3x4 inch oval right on the midline. Then you get up two days later and it's all burned and raw and only in that spot and you say, "but I was only out there for 15 minutes!". And the evil maniacal laughter of the magnifying glass wielder echoes in the distance...

Actually, the magnifying glass looks a lot more like what's in the pictures below. About a week before I finished, I asked Lisa, one of the radiation techs whom I saw almost every day of those 28 days, to take a few pics for me:

Side view of me on the radiation table. As long as I wore loose-fitting pants with no metal, I didn't have to change into a gown every time, which was nice. The round thing above my pelvis is the gray cheese wheel I referred to in another post. The rectangular panel hovering below me is actually only there because they were taking some X-rays before starting the radiation. Usually that piece is retracted as the whole cheese wheel armature rotates around my body.

Onne, one of the other radiation techs, does something with fancy equipment. I never really saw this part, so I don't know what they would do out there. My impression is that everything is pretty automated, though.

They can monitor me from outside the room I'm in - gotta keep the radiation dose down for the techs!

A feet's eye view of me on the table - they have a mold to put the bottom parts of your legs into, so they can position you in the same spot every time. Also, there are lasers demarking a cross pattern onto the table, so they can use that, too. I also have little tattoos on my body for alignment...

I've been feeling pretty good after this last cycle, despite the burned bum and such - even managed to make it to campus twice this week and did a little bit of climbing yesterday. I've also been going to a "restorative yoga" class every once in a while (went on Monday). It's sponsored by the Stanford Cancer Center but is held at the Avalon Yoga Center in Palo Alto. It's more focused on relaxation and stretching, which is nice. Still having some painful BMs and other not-so-fun issues, but all and all, things are okay. It just gets a little boring on those days when I really don't feel so good and have to lie around the house all day.

K, til next post!

Pain in the Butt

(1/30/08)

Unbelievably, it's already 2008, and almost February for that matter. How time flies when you're having fun/getting radiation therapy every day. . . Okay, you'll have to excuse any cheeky humor that finds its way into this post. I've been reading David Sedaris' Naked, which is pretty much hilarious. He writes about his life in terms of these little vignettes - stories about hitchhiking across the country, going to summer camp, picking apples in Oregon - but he does it in such a way that makes everything just believable enough to buy into it, but just unbelievable enough to be in shock and awe at the situations he describes. Yes, I am coveting his writing talent.

Anyhow, here's the quick update: Today was day 21 of 28 days of radiation - just 7 more days to go!! So far so good - my neupogen shots have been keeping the WBCs (White Blood Cells) nice and happy, so we've been able to plow along with the radiation treatments. It's a bit of a pain to drive into campus every day, but I guess that's what I'd be doing anyway. The real pain in the butt is, well, this pain in the butt I've been having. I'll spare the gory details, but let's just say I have some sort of tear or cut or something that makes every BM (Bowel Movement) very painful. I've tried sitz baths, suppositories (reminds me of middle school, when we used to make off-color jokes about how Lee Harvey Oswald took a shot at JFK from the Texas School Book Suppository - not sure the joke really went much farther than that, because I'm not sure any of us really knew what a suppository was - except that it was supposed to be funny), lidocaine (numbing gel), lotions, but nothing seems to be making things heal up. Apparently this is just one of those things you have to wait out. Who knew simple bodily functions like pooing and peeing (see previous posts on Foley catheters and painful urination) could cause such trauma in one's life? Let that be a lesson to all you people out there, taking your pee and poo for granted. You'd better start appreciating the smooth workings of your respective urinary and gastrointestinal tracts, 'fore I come ov'r thar and whoop you with mah crotchety old man's cane. Jus' let me git outta this rockin' chair, first... (much exaggerated fist shaking ensues).

Happy New Year, Radiation Nation

(1/4/08)

Happy New Year Folks! I managed to survive the holidays without being completely under the weather. In fact, after my discovery of the drug-induced restlessness, my ability to feel like a normal person probably increased tenfold. We had a nice holiday, though it's the first Christmas (and birthday) I've spent in California, despite having lived here for so long. Something's not quite right about Christmas on the west coast - I can't really put my finger on it. Maybe it's the prevalence of non-deciduous trees that refuse to lose their leaves, maybe it's the lack of bone-chilling cold weather (though I admit it gets quite nippy 'round here). In any case, it was nice, but certainly not the same somehow.

It was also the first time my mom and her partner Dennis were in the same place as my dad and his new wife, and fortunately the universe did not implode. Everyone seemed to get along fine, at least in small doses, so no problems there. Of course the new camera was in full effect, although I did manage to reformat the memory card at one point, which lost a bunch of pics (not too many, though). Don't worry, I got plenty of crap for that, so no need for further crappage, okay? I'm only a PhD student in engineering - I'm not a rocket scientist, you know.

This week, I had the added joy of beginning my radiation therapy. They're using 3-D conformal radiation, which according Stanford's website includes "advanced immobilization." I can only assume this refers to the foam leg molds that I put my legs in when I lie down. It's probably some sort of space-aged foam that costs a billion dollars a cubic foot (or maybe $20 down at House of Foam). Well, to be fair, there are also all sorts of lasers being used to align my body in the right direction and place via these lovely cross-shaped tattoos on my hips (I'd show pictures, but they're a little too racy and rebellious to be displayed publicly.) The 3-D conformal part refers to how they are able to use pre-obtained CT scans to map out the location of radiation that conforms to the original tumor.

They're also using intensity modulated radiation therapy, more information about which I will conveniently leave it to the reader to peruse here.

For the patient, radiation entails lying on a bed with a big round gray cheese wheel floating above you. The round wheel is attached to the big rotating arm with its base toward the top of your head. After they line you up with the lasers and such, the cheese wheel is aimed at your pelvis and rotates around you for a designated set of zaps (14 for me, 2 each at 7 angles) while you lie there for about 10-15 minutes. It's really quicker than you'd imagine, except of course that you have to go back and do it 28 times (now only 24! Woohoo!).

The treatment itself can have some side effects - exhaustion, diarrhea (since it's aimed at the pelvis), bladder irritation, etc. Some people also get sunburn on the skin near where they radiate. Hopefully I won't have too much of any of this, but you never can tell. One thing I've noticed about these oncologists is that they will never tell you what will happen. Everything is individualized, and so you could or might not experience any or all side effects. I suppose in the end, like many things, the only way to know is to go through it. Kinda sucks, eh?