Radiotherapy - a patient’s perspective

A month ago I wrote about the experience of having my pre-radiotherapy ‘planning scan’ and the three little tattoos that came with it [My First Tattoo]. I have now nearly finished my radiotherapy and it is about time I wrote something about it [I should say at this point that this post is the first one that I am writing in response to a request - one of the radiographers that has been doing my radiotherapy saw last month’s post and liked it, and asked if I was writing anything about the experience of having the treatment].

Before you have radiotherapy the doctors decide what total dose of radiation they want you to have. This is then divided into a number of smaller doses, called fractions, to allow the non-cancerous cells to recover between the treatments. In my case it was decided that I would have a relatively small dose, so I am only having fifteen fractions, rather than twenty-five or even more, as some of the other patients I met were having. The radiotherapy department is only open Monday to Friday and so I have been going in to the hospital (James Cook University Hospital in Middlesbrough) every weekday since the middle of August and will have my last two fractions on Monday and Tuesday this week.

I had been warned that it might make me very tired and also result in other unpleasant symptoms such as soreness of the skin and damage to my oesophagus (my gullet) which would possibly make swallowing difficult. This last one was because of the location of my cancer - in the middle of my chest right next to my oesophagus. It wouldn't be the same for everyone having radiotherapy and there might well be different symptoms that other people get when the treatment is to different parts of their bodies. However, because I was having a relatively low dose I was told that I might not get any of these symptoms very badly.

On the first day of treatment, before the actual radiotherapy happened, my wife and I were brought into a room for a chat with one of the radiographers, and a radiography student, who told me again about the process and the possible side effects and answered any questions we had. Then, after a short wait I went through to the room where the machine is that would be used for all my treatments. A quick google search for ‘radiotherapy machine’ will show you that there are many different designs of machines but the one being used for my treatment looks almost identical to the one in the picture below (I was allowed to take a picture of 'my one' but I am not allowed to use that picture in social media or my blog).

 [photo from https://www.itnonline.com/content/renovated-uk-radiation-oncology-department-chooses-elekta-igrt-solutions]

Once in the room I got acquainted again with the ‘bean-bag body mould’ that they made for me when I had my planning scan. It was fastened to the bed and, once I had taken the clothes off my top half, I got onto the bed and wriggled until I fitted inside the mould, lying down with my arms stretched back horizontally above my head. Then they had to get me into exactly the right position, which is where the tattoos came into play. As I am lying down when they do this it is hard (impossible actually) for me to see what is going on, but what I think happens is that they use beams of light to get me lined up properly - all I can hear is various numbers being called out (e.g. “17.1, 69.3” and “I’m 2 millimetres supe on the head” or “4mm post on the patient”) and various other mysterious things of this sort. If I am slightly out of position they might ask me to shuffle up or down a couple of millimetres or else they might just push my body down slightly on one side (by the way - any radiographers reading this - you are all brilliant and all really lovely but it would really nice if you could somehow warm up your hands before this bit - brrr).

Once they have got me properly lined up, the machine springs to life and does a couple of turns around me (presumably to check that everything is okay) and then the radiotherapy staff all leave the room for about ten minutes while the machine executes a pre-programmed dance around my body. Until a couple of days ago I thought that it was different every time, but apparently it is exactly the same each time - but from my point of view some treatments seem longer than others.

While the treatment is going on I don’t feel anything - just as you don’t feel anything when you have an X-ray (and this is basically just an extra-strength X-ray), but as I have to lie completely still it can get a little uncomfortable and the urge to scratch my face or rub an itch on my nose can get almost unbearable. It is probably a good tool for meditation. The room that I have my treatment in has a large picture of Whitby harbour and abbey on the ceiling so I can distract myself by counting the windows on the buildings or focussing on one point on the abbey - I use different tricks each time. Also, there is usually some music playing so that can also be helpful - although once or twice the song has been something that I really want to tap my foot along with, and it has been hard to lie absolutely still. After about ten minutes the radiographers come back in and tell me that  can sit up. Then I get my shirt back on and go home until the next time. 

I have so far got off very lightly with the potential side-effects. I have been using moisturiser on the skin of my chest (but not as often as I was told I ought to) and I haven’t had any soreness or redness of the skin. Likewise, I have not noticed any difficulty swallowing that might indicate damage to my gullet. My wife thinks that I am a bit more tired since having the radiotherapy but I haven’t really noticed it and it’s certainly nothing like as bad as I was expecting it to be. As I am nearly at the end of the treatment I think I may get away with it altogether, but I have been warned that it might take me up to six weeks to get back to normal, so it is possible that I may get some of the side effects (and particularly the tiredness) after the treatment is finished.

My radiotherapy has been an additional precaution after the main treatment for my cancer, which was my chemotherapy (about which I intend to write more soon). As I understand it, I am having it just in case there are any stray cancerous cells still hanging around that the tumour might grow back from. As my haematology consultant explained it to me, with my kind of lymphoma the best chance of curing it is on the first go, and if it comes back it is likely to be much more problematic. The scan I had after the chemo had very positive results and I think that my cancer is now gone.

The radiotherapy staff that have been looking after me, and doing my weekly reviews with me, have all been great - very caring and gentle and willing to answer questions and I want to take this opportunity to say thanks so much to all of you.

More weeds and wildflowers - Yarrow and Sneezewort

             

Back in June I wrote a blog-post about a group of plants called Umbellifers  - the Carrot Family

(What is an Umbellifer? - and how to tell two of the commonest ones apart). In it I mentioned a couple of species which are sometimes mistaken for Umbellifers. One of these was Yarrow (Achillea millefolium), pictured above.

Even if you don't think you know Yarrow, if you live in the UK you will certainly have seen it - its feathery leaves and white, umbel-like flower heads are a very common sight in lawns, grass verges and weedy roadsides across the whole country. If you are a gardener you may be familiar with some of the cultivated varieties, including some pretty pink or yellow flowered forms.

Despite its appearance, Yarrow is actually in the daisy family (the Asteraceae, formerly known as the Compositae)  - if you look closely at the flower heads you can see that it is made up of lots of little 'daisies', but with white centres as well as white outer petals. Also, and perhaps surprisingly, each of these little 'daisies' is not actually a single flower, but a flower-head made up of several tiny flowers (or 'florets') - this is also true of daisies themselves and all the other members of the family, such as dandelions, thistles and sunflowers.

The first part of the scientific name of Yarrow - Achillea - is a reference to Achilles, the  character from Greek mythology, whose soldiers apparently used it to treat their wounds. The specific name - millefolium - means 'a thousand leaves' and refers to its feathery foliage. This is also reflected in one of the old names for the species, Milfoil.

Yarrow has a close relative in the genus Achillea, called Sneezewort (Achillea ptarmica). This is much less common in the UK than Yarrow and is usually found in damp grassland, although the plant in the photographs below was growing on an overgrown roadside verge in the North York Moors, and very close to some Yarrow, making it very easy to compare the two and look at the similarities and differences. The individual flower-heads look quite similar although they are bigger in Sneezewort and the way they are grouped together does not look so obviously 'umbel-like'. The leaves, on the other hand, are quite different, being long and thin with little teeth, rather than deeply divided and feathery.

  

My First Tattoo

Today, at the age of 48, I got my first tattoo. And my second and my third.

This surprising occurrence (to those who know me) took place at James Cook University Hospital, in Middlesbrough, after I went in to have the ‘Planning CT Scan’ two weeks prior to starting my radiotherapy.
First, a bit of background. If you’re reading my blog for the first time you might not know that in January I was diagnosed with B-cell Lymphoma, a type of blood cancer, and subsequently had five months of intensive chemotherapy treatment, necessitating me spending rather a lot of time as an in-patient in hospital (a new experience for me). The scan I had after the chemotherapy showed that I had had a ‘very excellent response’ to the treatment and that I was in ‘complete metabolic remission’ - meaning that the cancer had, to all intents and purposes, gone. However, just to be absolutely sure that there are no stray cells hanging around from which it might grow back, I have to have three weeks of radiotherapy treatment, starting on the 14th of August. 

And so, back to today’s scan and my tattoos. The scan is so that they know exactly where to target the x-rays (radiotherapy being basically a concentrated beam of high-energy x-rays (my radiographer friends might be able to correct me here)). Before I had the scan I had to lie on a bed with my hands clasped behind my head.  Underneath my top half was a weird sort of air-bag filled with little beads (like a bean-bag).  Four staff members, two on each side, pushed the ‘bean bag’ up against me while the air was being pumped out of it so that it formed a rigid shell around my torso, but I was still able to get in and out of it. The point of this was to make sure that I am lying in exactly the same position each time that I have the radiotherapy. Once that was done they used a black marker pen to draw some dots on my chest (one on either side and one in the middle) and then I had the scan. I have had several CT scans over the past few months and am getting quite used to it. This was one of the ones where they inject a special dye into my veins which will show up on the scan and it was over in a few minutes. 

After that came the great excitement of getting my first tattoos. They had told me in advance that I would be having these and I was looking forward to being properly ‘cool’ and ‘down with the youth’ for the first time in my life. So what have I got, permanently etched on my chest? An eagle and a couple of hearts perhaps? Or maybe three bees to commemorate the jokey name that I gave my ‘Bee-cell Lymphoma’ in the early days of my diagnosis? Sadly it was nothing so good as any of those - it is just three little dots so that they can make sure I am properly lined up when they zap me with high-energy x-rays in two weeks time. 

P.S. And to answer the question which I’m sure some of you are asking - it only hurt a tiny bit, and it felt just like it does when you have a blood test and they say ‘Sharp scratch’ before pricking you with the needle.