Fava beans and a nice chianti...

Yesterday was my radiation appointment. The radiation oncologists were both really nice and very, very thorough. They verbally went through my medical history, where I first noticed the lump, how I reacted to chemo. Luckily, I only have to have radiation for four weeks!! Not the 6-7 weeks they originally had thought I would need. I will be receiving an extremely low dose (3,000 r) compared to other cancer patients. Apparently, dual modality treatment (chemo and radiation combined) is extremely effective against my classic nodular sclerosing HL. The unfortunate part of this whole business, however, is the fact that my cancer was discovered a mere few inches away from my thyroid. For all of you non-doctor types out there reading, your thyroid is a gland that secretes important hormones (specifically triiodothyronine and thyroxine) needed for every day functions. It is located near the adam's apple in your neck. It's responsible for a crap-ton of important stuff such as cellular metabolism, maintaining body temperature, and properly storing and utilizing calcium. The radiation treatment necessary to prevent my cancer from coming back will pretty much decimate my thyroid gland and result in secondary hypothyroidism, making me dependent on daily oral medications that mimic the production of thyroid hormones. Hypothyroidism is responsible for a host of yuckie symptoms such as brittle hair and nails, dry skin, low energy, weight gain (as if the chemo and prednisone didn't already do that!), sensitive to cold, constipation, depression, fatigue, and joint/muscle pain.

Sounds like chemo ALLLLLL over again except for the rest of my life!

There may be a slight chance that my radiation, being so low-dose, will only cause sub-clinical hypothyroidism, but still...another thing I gotta worry about.

Anyway, after we talked about our plan, I was escorted into the simulation room. On the docket was a CAT scan, tattoos, and the creation of positioning mask for radiation. The nurse that was attending on me had a thick Southern accent and called me "darlin" every couple of sentences. She gave me a gown and asked me to undress from the waist up. They explained that they needed to do a CAT scan which would give the radiation oncologists a baseline of my body so they can determine the specific points inside my body where the radiation will be aimed. This needs to be as precise as possible so they can reduce the amount of healthy tissue damage (which puts me at risk for secondary cancers). The CAT scan takes a bunch of pictures in "slices"; kind of like cutting a birthday cake and being able to see all the layers of cake and frosting. They want to be able to see exactly where inside my tumors were so they can determine a good margin of error. Not only will they be radiating exactly where the structures are, but they will be doing a little around it, in case some stray cancer cells decided to wander outside of the premises.
So, I undressed and laid down on the CAT scan table. The nurses explained to me that in order to access the area under my neck, they had to tilt my head back. Tilting your head back that far is HARD, so they made me a special mesh mask that helps keep my head really still and in the perfect position. The mask making kit was a little like a warm, wet tennis racket... They heated up the mesh with hot water. Then the plastic mesh was pushed directly over my face and locked to the board underneath. It make me feel a little like Hannibal Lecter from Silence of the Lambs. Hello, Clarice...


The nurses pressed on the mesh to force it to conform to my facial features and turned on cold fans to help it harden. After the mask was formed, they took some tape and made some marks to help remind them of my positioning. They marked my arms and chest with a sharpie and completed the scan. Afterward, they removed the mask and took a sharp needle and gave me four freckle sized tattoos. These help align my body in the machine the same way each time. The little tattoos on my chest and between my breasts hurt like a bitch! My next appointment is in three weeks allowing me lots of time to start feeling normal again. It's not the actual treatment, but a simulation with the the actual radiation machine. They'll create these nifty foam blocks that will conform to the shape of my body and cover healthy parts of my body. Then they'll do a "dry run", which is essentially a practice session without radiation.

And all I have to do is lie there and go on a mental vacation! :)