Tag Archive | marking

Time for a boost

I’ve finished my regular treatments and have started the boost treatments to the area immediately around my mastectomy scar. Even though I’m on the same machine, it’s still a lot of changes to the treatment. For one thing, I’ll be treated with electrons instead of X-rays. To do so, they add an additional piece to the radiation machine.

See the tube extending below the green light?

See the tube extending below the green light? The red laser is reflecting off the base of the extension.

At the base of the tube, a square of lead is clicked in place that has the cut-out of the treatment area.

One side of the treatment area

One side of the treatment area

To get the proper shape, a tech has to draw on a glass plate clicked into the base of the tube and trace the outline of the treatment area that’s been marked on my expander. The trick is, you can’t just look straight down and trace because the machine is in the way. Instead, you have to curve your hand in between the metal arms and draw with the shadow of the pen following the line on my skin. Very tricky.

Because of the curve of my expander, the physicist and radiologist have recommended feathering the treatment area, which just means they break it into two halves and rotate the machine to get the proper angle for each dose.

Rotation for treatment

Rotation for treatment

The whole device gets within inches of my expander. The techs traced the outline of the treatment area onto my skin from a template developed at the beginning of the treatment, and then line up the light projecting through the metal piece with the tracing. Unfortunately, they couldn’t get the cut-out to line up with the marks on my skin. It seems that my expander has shifted slightly, so they needed to recut the metal to match my new contours. It took the two techs, the physicist, and Dr. Figura about 15 minutes to come to that conclusion, with my lying there with my arm in the torture device arm-holder the entire time.

I had three options at that point – I could stick around while they made a new metal piece (nope, sorry, have to be somewhere at 9), I could come back later that afternoon (before 1:30? No? Then sorry, have to pick up my kids from a class), or I could add another treatment day where they just make up the one treatment. Seems like I have to go with option C. That means I’ll be ending next Tuesday instead of Monday. Even if it adds another day, I’m down to counting on one hand the number of days I have left.

Halfway done!

Yesterday was the half-way point on my radiation treatment. On one hand, I’m excited to be halfway done. On the other, I can’t believe it’s only halfway. Side effects of the radiation are still pretty minimal, although I am noticing more dry skin and pinkness, especially on the expander.

I celebrated with another marking session, this one for the last five days of radiation that will target the area around my mastectomy scar with electron beams instead of X-rays. The techs slid in an additional device on the radiation machine that will bring the pattern specific to my scar closer to my body. They transferred marks from a template onto my skin (Sharpies, once again) and then from my skin to a clear plate in the device. They’ll use the clear plate to develop a mold and pour the lead alloy around it to make my radiation pattern.

Part of the action for the marking session was figuring out the specific angle to irradiate me, which involved spinning both the table I lay on and the radiation generator. This was all directed by an in-house physicist. I want to know how you get that job, but all I was able to get out of her was that she has a Masters in Physics. By the time we were done, I looked like I had a sock monkey mouth drawn on my expander.

No more stickers!

Right now I’m sitting in a Herceptin treatment that I almost forgot about. I didn’t put it on my calendar, but last night I realized it had been three weeks since the last treatment and three weeks until the next treatment, which is a strong indication that I had Herceptin today. Turns out I was correct. The excitement really came during my radiation treatment before Herceptin. I guess the last set of X-rays came out OK, because I got the stickers off and replaced by tattoos today. Here’s what my breastbone looked like with the stickers:

I had four other stickers - three under my arm and another on the top line.

I had four other stickers – three under my arm and another on the top line.

The top sticker was high enough that it showed with a low-necked shirt.

Here’s what the same spot looks like now:

There's two new freckles on my chest now.

There’s two new freckles on my chest now.

You can’t even tell which are the radiation marks and which are my natural freckles. The tattoos are in the center of the red marks caused by the removal of the stickers – teeny tiny and black. The stickers didn’t want to come off. They were like very sticky bandaids that left their goo behind. Luckily they have adhesive remover in their arsenal of toys. Yeah for no more stickers!

Marking session

I had a week of relative quietness, but things are on the move again. The Cancer Center called me Monday afternoon to see if I’d be available to do a marking session yesterday morning. Luckily, I have an awesome friend who was willing to take my kids with less than 24 hour notice so it was off to the Cancer Center once again.

This was my first time over on the radiation side of the Cancer Center. This was not a treatment. Instead, it was a marking session. That meant I would be in the machine that would be providing me treatment, instead of the CT scanner used for the first set of marks.

The radiation machine. The whole thing pivots. Notice the blue arm holder in the right hand corner for scale.

The radiation machine. The whole thing pivots. Notice the blue stirrups in the right hand corner for scale.

I had to lay down on a table (with a minimum of padding, I might add), tuck my left arm at my side, and put my right arm above my head.

The table.

The table.

No one is trusted to keep their arm still during the treatment, so you have to put it in stirrups.

The tortuous arm holder

The tortuous arm holder

Once I was in position, I was slid under the radiation machine for X-rays and measurements. This was the opportunity for the techs to refine the marks on my skin based on the doctor’s radiation plan. They projected a ruler onto my skin and read off numbers to each other, taking X-rays every once in a while. It took about a half an hour, and all I had to do was lay there, but by the end my shoulder was yelling at me to please move it. I’m just glad I have no pain from extending my arm over my head anymore, or I’m not sure how I would have made it through the full set of tests. I will admit, I did forget my Valium, so that may have helped. Even this morning, I could feel my shoulder muscle complaining just a bit.

I got a new set of marks and stickers – this time the techs used a green Sharpie.

The marks on my side and up through my armpit.

The marks on my side and up through my armpit.

After a few sessions, to make sure everything lines up the way it’s supposed to, I can get permanent marks instead of stickers. Tomorrow’s the big day when I start radiation. I think I’m ready for it, and not completely dreading the seven weeks of daily treatment anymore.