Thursday, August 02, 2007

Radiation Therapy Follies

The last few months have been a whirlwind of weird medical issues and elderly relative caretaking responsibilities. Oh, and there's also running the business and all that. I haven't posted in a very long time, but I've missed my blog.

Starting next week I begin radiation treatment for my little parotid tumor problem. Although the April surgery came back with a benign pleomorphic adenoma diagnosis, the fact is that without drastic measures I will have another - sixth - recurrence, and that each recurrence increases my chances of developing a malignancy.

Accordingly, I agreed to radiation treatment. On Tuesday I went to my radiation oncologist and was fitted with a mask. A large, rectangular, waxy, gauzy, heated thing was pressed down over my face as I lay on a CT Scan table and strapped down. As soon as it began to cool it started to stiffen. Not a painful experience but a bizarre feeling. For a fleeting moment I thought "I have to get out of here" as I considered ripping the damn thing off and fleeing. It passed, but I realized then that for the truly claustrophobic it has to be a miserable experience.

As the thing cooled they huddled next to me, drawing on it with a green marker and sticking marked pieces of masking tape in various spots on the mask. The two doctors worked companionably with each other, and it felt oddly like we were all involved in a grade school science project together with me as the test subject.

They told me they planned on using electron radiation primarily and hoped to avoid using photon radiation. To me radiation's just whatever is likely to make me glow in the dark, so I had to ask the difference. Well, it seems that electrons are delivered by a particle beam which can be tweaked and calibrated to a very subtle degree. They can be programmed to a great range of intensity and depth, and upon reaching their calculated depth they dissipate. Photons, on the other hand, are rays and keep going past the point of their original focus. They are necessary for deeper, more radical treatments. I asked if this is why Star Trek features photon torpedoes but no electron torpedoes. "Sure," replied one doctor.

After about 20 minutes the mask was removed and I was left with green marks down the left side of my face which came off readily with an alcohol wipe.

Today I went back for some tweaking and discussion of my case. The oncologist sat next to me with a wax slab upon which was a crudely drawn outline of my ear, and he snipped and shaped it to fit the ear, then traced it onto a lead sheet and cut that out. Again, he and the other doctor, his assistant, chatted companionably, exchanging little pointers and comments. "He's been with me for 23 years," he said of his assistant. "Since he was a kid." There was much happy talk about how well the ear shield turned out, with compliments all around from assistant and staff, and this I somehow found comforting. There is much to be said for making a patient feel as if she's participated in a joint effort rather than like a project to be worked on.

By Monday morning the shield will be coated with wax and I will wear it for each of my treatments. It feels strange but beats having stray electrons rattling down my ear canal and wrecking what's left of my hearing on that side. Given my history - five recurrences over 34 years, the oncologist told me that he was considering photon radiation of my lymph nodes. Ick. I'd much rather deal with the kinder, gentler electrons, but I'm not the expert.

The ear shield done it was time to take more measurements. Once more I ended up on a table, which was moved around and situated under a boxy looking machine so close it almost touched my face. The table moved smoothly and swiftly, like the beginning of an amusement park ride. Both doctors seemed inordinately pleased with the ease of their measuring and calibrating and more drawing on my face ensued. Then a tiny tattoo point was made on my temple and another on the scar directly in front of my ear. The one on my temple hurt and bled and made me wonder, not for the first time, why anyone would volunteer to be tattooed. The second one I hardly felt at all since the nerves are so deadened there from five separate surgeries over the same spot.

As I prepared to leave the office the oncologist told me he and my surgeon are going to present my case to a roundtable of doctors. It seems I'm a medical anomaly with my early onset of parotid tumors and my recurrent and never fully effective surgeries. Having hung out at the extremely useful Parotid Tumor Patients Forum online I know of situations a lot stranger and certainly more serious than mine, but that's a worldwide forum. I don't imagine they've seen that much of it on their little patch.

So there it is, the little problem that's been occupying so much of my time and attention these last few months. Now that it's getting underway maybe I can stop fretting over it and fret over more important stuff, like this stupid war and our equally stupid administration. Now there's a real problem.