Heck of a Way to Get a Tan

I am nothing if not sensitive to feedback from my followers, all 9 of you if you exclude me (the Sharps) and Andrea. And one comment that has returned from the field is that while the food part of the blog is entertaining, we have not heard all that much about radiation.

The good news in this regard is that the treatment, in Andrea's case, has been routine. This is nothing to complain about, and hardly minimizes the entire process of sitting through 30 sessions of being zapped. But this is not a story about dramatic experiences; rather, the process is almost eerily calm and ordered. This is not the case for all recipients of radiation treatment, which is something you discover when you share a changing room with patients destined for the four different machines at this particular facility at University of California, San Francisco.

Thanks to my daughter Rosie, I have become a reader of Wired magazine. Although they sometimes make me ill with their over-printed, over-inked, overly-glossy and glitzy style, I have to admit that there are some damn good writers covering some topics that don't see much light of day in other publications. The most recent issue had an article about cancer that in essence says the spending pyramid is inverted - - that is, 90 percent of money is spent on patients with Stage 3 or Stage 4 cancers, which are the two most advanced states. This is not surprising; as they point out, these are husbands, wives, mothers, fathers, sons and daughters - - loved ones, in deep peril. So no expense is spared. The point they bring forth is that if the spending was on early detection there would be few cases that progress to this difficult and expensive-to-deal-with degree.

Andrea is a prime example of the advantages of early detection. Thanks to the routine program at Kaiser Northern California, her relatively minuscule tumor was caught early, perhaps not has early as is technologically possible, but pretty close. So dealing with this tumor via lumpectomy, radiation and prescription drug therapy (Arimidex) is pretty cut and dried (ouch!) The therapy is not perfect; perhaps three to five percent of patients who undergo this protocol will have a recurrence in five years. Ninety-five percent or more will not. They will simply be cured by surgery, 30 treatments and five years of pill popping, one a day.

That does not mean that the treatment is inconsequential, and that it is not without its unique effects on the patient. For one thing, there are the nice gowns. You need to change into a gown before treatment, and you only undress and cover with a gown the section of you that needs treatment. Breast people get a bathrobe-style top that opens in the front. These are very soft, since they've been washed and sanitized many times, and provide a degree of comfort that offsets the coldness and starkness of lying on a highly adjustable metal table that can accommodate the myriad positions required to direct the radiation to the desired spot. Another strange source of comfort is the large circle in the ceiling of the treatment area. When the lights are off, it looks more or less like conventional acoustical tile. But when back-lit, someone has taken the trouble to put patterns of celestial constellations into it. It reminds Andrea of visiting the Planetarium in the Museum of Natural History as a child. The upper part of the machine rotates around you to pinpoint its action; in Andrea's case it then pivots to the other side and repeats the treatment. Radiation treatment is not a single therapy; different types (wavelengths) are used for various purposes. Five weeks of her treatment is with proton radiation. This is a penetrating emission, which is one reason all the positioning is so critical. You don't want to shoot it into parts of the body that don't need it, so it is directed more or less horizontally across the treatment area, from the side. At the end of the five weeks she will receive one week of electron radiation. This is directed right at the treatment area, but does not penetrate deeply at all.

The type of radiation you receive, the length of treatment and any concurrent therapies vary completely from patient to patient and by type of cancer. Each treatment, no matter how routine on the surface, is in fact custom-designed to the situation and physical being of each individual. Among those sharing the changing room one day was a woman needing radiation for the eye; obviously this is a whole different protocol than the breast, or than a prostate gland.

As you look up to the glass surface of the radiation source, childish stickers have been plastered around the metal surrounding the central glass cover. While these might be thought of as lame they provide a humanizing and slightly comic contrast to the sterile and frightening presence of this device looming over you.

Returning again to our patient, we are ever vigilant in looking out for symptoms of and reactions to treatment. Most commonly reported are sunburn of a sort, and fatigue, which build up as the weeks go by and sessions accumulate. So far, so good. Maybe a little redness on the skin, which is alleviated at least somewhat by the lotions provided by the facility. Still, it's a heck of a way to get a tan. This could very well get worse, but we are told that it goes away fairly promptly after the end of treatment. As for fatigue, it has not taken an undue toll so far, and in fact Andrea's energy has been notably high. On occasion Andrea has had some random sharp twinges in the treatment area. This too they say is routine, and is not at all constant.

So we have our fingers crossed and will hope for the best. If you don't see that much more about radiation treatment and instead quite a bit more about dining out, you'll know that all is well.