The Continuing Adventures of Radioactive Man

If I was Radioactive Man a few weeks ago after the seed implants, today we would be seeing said superhero crawling along the ground as his life force got progressively lower and lower.  By my rough calculation, the Cesium-131 seeds are at about 5.5% of where their original strength.  And that's exactly where we should be about now.  So all is well, even if this means the death (or near death) of Radioactive Man. And I wanted to show the seeds here, and so I did some screen grabs of a video that one hospital site had about the brachytherapy (pronounced ... usually... like brake-e-therapy...).  So here they are, the first one on the left showing the seeds, the one on the right showing one of the needles used to put them in the prostate:

Of course, all this does is make way for a different version of the same story, only in this version the radiation will be coming from an external source, not one (or ones) I carry around inside me.  And getting prepared for that step was the reason for my latest visit to the radiation oncologist's office this week.
There was the usual preparatory sequence (aka enema) before a scan of the pelvic region.  It suddenly struck me as odd that the instructions (from the doctor's offices) have specifically stated that the enema should be done 2 hours before the appointment.  I have yet to find out *why* 2 hours (and not 3 or 1 ... or...)... All that meant that I had to get up at 5am to do the enema, because like a fool I had scheduled the appointment for 7am.  The big fun.  On all fronts.  Or backs.  Whatever.

I should stop and say something about where I am in the sequence of things.  I did the radioactive seed implants in December and they're winding down, so it'll be time to do the external beam therapy soon.  We're doing IMRT - intensity modulated radiation therapy - which is a form of external beam radiation.  The data from the scan today feeds directly into the planning stage.  Using the CT scan in concert with a computer program they build a map of where the beam should go and (equally important) what it should miss.  It's pretty cool, really... and after reading about it I'm pretty stoked about it. 

Which reminds me of the Simpsons version of Radioactive Man... for some reason... so here's a shot of the comic book action hero, Homer, as Radioactive Man.

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I arrived at the doctor's office just before 7, in the pouring rain.  There were no cars in the parking lot, but the doors opened so in I went.  I thought I'd be jetting right in for a CT scan, but no.  There were forms to fill out!  What was I thinking!  The nurse who was conducting this part of the appointment took me in an exam room ("so we can have some privacy," she
said, which was nice, but I didn't see anyone else there) and asked me some shocking questions. For example, "How do you learn?"  (Me: deadpan. thinking, WHAT?).  I still don't know how my answer to that affected the discussion, but what the hey?  It was fine.  I initialed and signed until I got to a rather scary blanket release statement that went like something like this:  "I agree that the doctor can do anything deemed necessary during this procedure or any other procedure, including, but not limited to taking my car for a joy ride while I'm unconscious."  Really.  Well, no, not really... but dang close.  I stopped and said to the nurse that I wasn't to wild about signing away the ability to have some say in my destiny.  Turned out she didn't like the statement either.  Or the one before it.  So... did that change anything?  Nope.  She also gave me a folder that contained a lot of information about the facility, the personnel, and some introductory information about prostate cancer and radiation therapy. I thought that it was a little late to be delivering this ... but it was good to get it.  Of course the radiation department is actually part of the larger hospital that my doctors are affiliated with, but I'm almost 5 months into this. Isn't it a bit late to be getting this?  The pamphlet on prostate cancer contains a lot of good information. Why can't this be a handout the doctors provide on the initial diagnosis (or before)? 

Well, OK... then I got a tour of the radiation oncology department, where I'll be a regular visitor in about 2 weeks.  Lockers, snacks, teas, hot + cold water... nice... and she explained the whole deal there about getting a gown and some pajama bottoms and where to change clothes and how they used a surveillance camera to see when you were ready.  No, the camera wasn't in the changing rooms.  So I put on the uniform, locked up my clothes... and waddled (how else do you walk in those clothes?) back to the exam room, where she hooked me up to a saline solution going into my right hand.  And then she told me we couldn't proceed because they couldn't administer the CT contrast dye without a doctor in the office, and the doctor had just called to say he had lost power at his house and was running late.  So... I read magazines.  You don't just reschedule these things.  And besides, I had the needle in already.

The doctor (or one of them) arrived finally, so it was ok to get me down into the room for the CT scan.  Let me stop here to say that I've had CT scans on different parts of my body for as long as they've been making the machines... so I thought this was just another one.  No big deal, right?  You lie still, the machine hums, someone comes in and says they're going to push the dye in, there's a warm flush as the dye goes in, the machine hums again and you're done.  Aha!  Psyche!  They had a surprise for me this time.  The surprise was when Anthony (one of the tech's doing the scan) said something to the effect that they needed to put a little "plug" in my rectum to be able to tell where it was on the scan pictures.  But first, they asked me if I had done the prep (code for "did you do the enema?").  Well, yes, as a matter of fact, I did.  But this is a common question, so evidently not doing the prep step must be somewhat common. Amazing.  Anyway, I'm thinking this "plug" is going to be something small.  But nooooo... it's not.  While it's nowhere near the size of the Alien Probe they use for the prostate biopsy, it was rather long... and it took some time to get it in all the way.  Routine CT scan.  No way.

Before I could get on the table, though, Janice smiled and said, "I have to give you that test again... so, what is your full name?"  I tell her. "What is today's date?" I tell her.  "What part of your body are we working on today?"  I hesitate and say (with a question in my voice), "Uh, we're doing a CT scan on my pelvic area?"  That's good enough, evidently.  She smiles and says I can get on the table.

Anyway, there were some more differences with this scan.  They had me lift my legs and slid what looked like a sheet of foam insulation under my legs, from about the knees down to just past my feet.  Anthony explained that they were going to pump some air into this thing, mold it around me, and then suck the air out.  Then, when we start the radiation treatments, they'll use the mold to hold me in place.  So, I tried to relax and let them move me around like a hunk o'meat.  Well, they were nice and all, but that's what I felt like - a hunk of meat.  Mission accomplished, the air was sucked out of the thing (sorry, I have no idea what to call it), and the mold was made.  While they're doing all that, I looked off to my right and noticed a tool of some sort that looked like a prop from a science fiction movie from the 60's.  Twin cylinders poked out of the front of it, ending in  conical points from which some curly tubes hung.  It was menacing and mesmerizing at the same time.  I asked what it was.  Anthony explained it was the machine that would administer the dye when the time came to do that.
 
Anthony and Janice (not their real names) had finished the mold... ran the first bit of the CT scan, came in and reminded me that they were going to put the dye in now.  So, first I felt cold in my hand, and then warmth spread up my arm and across my chest.  That's normal (for me) with the iodine they use as the dye.  This time I also tasted metal in my mouth. Just a faint touch of metal... but definitely there.  The dye section of the test ran (a bit longer than the first part) and everyone leaves to go see how things turned out.  Then my doctor pokes his head around where I can see him, says, "Don't move. The shots came out perfectly! And hey... we can start the radiation a week early if you want.  (I say I think that's a good idea.)  Anyway, they'll be back in. Stay right there."  So, you know... I stayed right there. 

Anthony and Janice came back in, and there's some quiet discussion, and then they slide the table out a bit, and say they need to make some marks on me and that I should not move.  The table moves in very small increments, and then I feel them making some marks on me ... two marks on each hip bone and one on my stomach, about 2 inches below my belly button.  Then they slide the table out all the way, and Anthony says he's going to make these marks permanent... and he puts a bit of dye on me, and pricks me with a needle.  Yes... they're tattoos.  So now I have three tattoos... they look like small moles... one on each hip bone, and one in the middle.

We're done.  Anthony walks me down the hall and sets up a dry run for a week away, and I head out into the pouring rain... and head to work.

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Brief update on my bicycling activity: I'm riding the Bianchi hooked up to a stationary trainer in the garage. I knew this was boring, and thought (recently) that my experience as a competitive swimmer might help.  But this takes boring to a new height... and I can only take about 30 minutes on it.  Right now, that translates into about 10 miles, which isn't too bad, but it's nothing compared to actual riding. I'll work up to getting out on the road slowly. I'm looking into getting back in the pool as well.

As for emotional / mental state, I go through ups and downs... and like other cancer patients I know, sometimes I have to consciously choose not to think about some things because they're causing stress.