4 - Planning for Treatment

Planning for Treatment

So we go back to the chemo guy. He and the radiation guy have conferred. The regimen shall be six or seven weeks of radiation with chemo in the first and last weeks. That's it, that's the standard treatment for these things that "cures" the cancer almost all the time. Set to start a few weeks hence when the surgery has healed sufficiently.

Aside: doctors have an uncharacteristically practical definition of the word "cure." To be cured of something means, they say, "Whatever kills you, won't be this." It's a ritual. Two of them used the same words. It's a jarring idea, but, well, comforting when you think about it, if the percentage that they name is high.

The radiation sequence starts with a "simulation," which is an exercise to locate the radiation fields precisely within the body. They start with several dots tattooed onto the skin, left, right, and top, to be used later to position the body precisely on a table. Small lasers draw red lines up, down, and across, and the techs align the reference dots with the grid. Then they take X-rays from the top and sides, and the doctor draws on the films. "We want to illuminate *this* area but miss *that* organ" drawings. These are used to fashion large lead guides that shape the radiations beams during treatments. (Pictures attached.)

Surgery 2

The week before the chemo, it's back to the surgeon to get a port-a-cath. This is an injection port, a subcutaneous device through which drugs can be injected intravenously repeatedly without puncturing a vein every time. It's a small cylinder, mainly plastic or titanium, about an inch in diameter and an inch high, with a rubber top. It is placed under the skin in the shoulder, and a tube from it runs into a downstream vein, in this case the subclavian vein. Subclavian = under the clavicle, the collar bone. The top of the cylinder is a rubber membrane just under the skin. Push a special needle through the skin and the membrane, which is a lot easier than going into a vein, and squirt into the barrel of the cylinder. Anything injected into the port gets sucked into the vein.

This port is where the chemo goes in, several times. It can also be used to draw blood, too, theoretically. There is a one-way valve that normally prevents backflow into the port, but if one applies enough pressure (suction), it is possible to draw blood backwards through the port. However, this one seems to baffle all the nurses who try. They try to use this for the weekly blood work all through the treatment but never succeed.

Aside: the surgery to insert the port-a-cath is more, um, interesting than usual. As I awaken from the anesthesia, the doctor comes in, breathless, and says that he has to go back in because he forgot a little clip. Ten minutes later I am unconscious again and being sliced into again. I know this wasn't a hallucination because (1) they gave me two serial number identifier cards for the BardPort (brand name) in my chest, so parts were used from two separate units, and (2) the nurses remembered the incident when I went back to have the port removed months later. They thought it was funny. "I've never seen Dr. (name expurgated) move so fast."

Aside aside: This is mistake number two for this particular doctor.

Before the chemo and radiation treatments start, there is a CAT scan to establish a baseline. Torso, thigh to shoulder, takes only a few minutes, no sweat. Be sure to get a CD containing all the pictures. They will happily give you one if you request it in advance. Depending on the machine, you may need to adjust the contrast or gamma of the pictures, but any reasonable photo viewing application can help you with that. (Get the best zero-cost application from www.irfanview.com.) Some CDs now come with specialized applications for viewing the pictures, much better.