My 7th radiation session was today and I have just 3 more to go. At last I feel I am getting the hang of this after a rough time last week. I count myself very lucky that I have not had to learn about pain management before now. (That’s nearly 7 relatively comfortable years – incredible!) My trusted oncology specialist was really helpful and reassuring, explaining the system at my appointment the other day. I’m sure the clear information helped me to feel much better!
There is background pain and incident pain, each requiring a different approach. It’s simple really, once you know.
Last week when I was struggling to cope, John helped me begin a diary of my medication doses and times. I didn’t want to lose track in my confusion. It turned out to be the right thing to do because when I showed Dr Shannon, she could use it to calculate what I actually need. I started on a strong slow-release morphine to ease my constantly sore hip and lower back. I also have an optional fast-acting booster (more morphine) to address the sharp incident pain at times when I have to move around or lie in my least favourite position – flat on my back. (Lying on the treatment table hurts the most. I can have a support under my knees and this helps a little.)
Dr Shannon drew a sketch of my hip and spine to show us where the tumour is digging into me, especially when my legs are straight. Today Dr Daly (radiation specialist) showed us pictures from the PET scan too, and we read the report that says the cancer is “invading” the psoas muscle and “eroding” the L3 vertebra. Scary! The proton beam fires at both sites to shrink the tumour, and hopefully my good tissue and bone will heal and regrow afterwards.
For each treatment I wear a paper dressing gown and lie on my back. Four technicians gently prod and tug till I’m positioned with my tattooed dots in the correct alignment. However, that’s not enough because my innards may have moved relative to the tattoos on my skin, so x-rays are used to show my bones and line up my torso. (See my previous post about planning and registration.)
Before my x-rays, the therapists run away to escape the radiation and they operate the apparatus from the control room. My task is to lie perfectly still (mindfulness is a wonderful tool) while huge machines whirr and lights flash.
Those machines each side of me (you can see in the photo) glide into place to make the x-rays. Next there’s a short wait (someone is doing sums) and there’s clunk-clunk as sections of the bed move under me. The x-ray equipment goes away and the round gantry (at the top in the photo) orbits the bed and stops in place. In that round face I can see an aperture which is specific for my treatment target.
At last everything is ready and a bright light shines during radiation taking only about 20 seconds or less. I can feel something, but it doesn’t really hurt until a couple of hours later. To produce intersecting beams the gantry changes angle and zaps me a second time. The team returns to my bedside to prepare me for treatment of the second tumour using the same procedure. The gantry takes a different aperture shape for irradiating the blob in my right pelvis, and it glides around to take aim twice. Altogether the session takes less than 30 minutes.
Radiation destroys DNA so cancer cells die and then my white blood cells swing into action, eating up the debris (apoptosis) and passing it through my kidneys. This will continue for months after my last session, but already it feels like the tumour in my right pelvis has shrunk. Hooray!
PS I have described the targeted radiation that I’m having and it’s quite different to radiation of a general zone, eg treatment for breast cancer designed to catch any rogue cells that survive after chemotherapy. The side effects are different too – no burnt skin for me.