Welcome to my World: The SBRT Process, Revealed!

So, I'm all done with my radiation therapy, two days early - and not a moment too soon, because for whatever reason, it was making me supremely depressed. My oncologist mentioned once that radiation patients seem to experience depression at a higher level than other patients but he didn't have an explanation. I don't have an explanation, either, but I was a big disaster for the last four days. Just ask my husband, my mom, or my dad, all of whom were privvy to various temper tantrums and breakdowns. My kids also saw me weepy and taking to my bed, Victorian style. Not terribly proud of that, but to be honest, it was probably for the best to have me tucked away in the bedroom like an ailing great-granny. My poor kids - they're going to think motherhood consists of crying and sleeping. At least they seem to take it in stride - when I fell asleep on the couch yesterday for two hours, my 7 year old daughter, who was home sick with a fever, came over and covered me with a blanket. (Don't worry, my mom was there to watch her.) How sweet and kind is that? Sweet and kind enough to sort of break my heart, I'll tell you. But I digress.

Radiation is over two days early! How can this be? Well, I'll tell you. The two little lesions on my left lung were not able to be detected by the CT scan after the first day, so my surgeon decided not to keep radiating what looked like normal tissue. She's sensible like that. So instead of three sessions on that site, there was only the one. I did have three full sessions on the lesion on my upper right lung. Apparently that one was big enough that they could continue to see it on the scans. (And for anyone keeping track of my radiation exposure at home, you're reading that right - not only did I receive actual radiation therapy for four days in a row, but I also received CT scans immediately prior to each therapy session - and then of course there was another, more detailed scan a few weeks ago, that gave rise to this course of treatment. And I get a CT scan every 8 weeks right now, sometimes earlier. In other words, I'm basically like a walking tanning bed. On the upside, it makes reading in the dark much easier than it used to be.) 

I just wear this sign around my neck these days. It's hip. You'll see it in the spring 2015 collections, mark my words.

Anyway. Everything looked good after my last session, so the doctors don't think I need to follow up with chemo at this point. In other words, I'm free as a (irradiated) bird until my next CT scan, in October. Yippee! 

This therapy requires a fair amount of just laying around, so that gave me plenty of time to think. And mostly I kept thinking about how interesting the whole process really is - well, when I wasn't wondering if looking into the machine while it was doing its thing was going to make me go blind. (So far, I can still see, so I think the answer to that is no. Keep your fingers crossed for me on that one.) In case you didn't realize this, I'm the curious sort, so I ask a lot of questions. Usually, the medical staff is very kind and chatty and tells me everything I want to know.  This is why I adore my chemo nurses, because they put up with me asking a million questions about everything they're doing and why...and they even tolerate my reminding them to do certain things, because I'm neurotic. There was this one time that I had read an article how some guy died because he got 200 TIMES the amount of chemo he was supposed to receive! You can imagine how that morning went...And once again, digression. This might be the most scatter-brained blog post in the history of cancer blogs but just bear with me. 

This round of therapy was no exception to my curiosity, but it was harder to get the staff to talk to me, because I think the radiation specialists tend to be a bit on the introverted side (they don't interact with the patients all that much except to arrange them on the table and tell them not to move) - and also because they're not allowed in the room while any of the therapies are in session, since they don't want to get irradiated. But I managed to ask a bunch of questions, anyway. My first questions, back in February when I used this same approach for my liver recurrence, was how did the machine work and was it going to eat me alive? I mean, It's sort of an imposing looking piece of equipment:

Here's the table, all ready for me to jump on there and get my lesions blasted to tiny smithereens.

Check out the frickin' laser beams! Look at all of those parts! And it makes a vaguely scary buzzing noise while it's on for the radiation portion of the therapy, like a buzzsaw is coming for you combined with a high-pitched wail. Very calming. They reassured me that no, it could not eat me. The lasers were used to line me up. They stay on the entire time. Every session begins with a CT scan, as I said, that happens right there on the table. Those two pieces on the side come out and something else gets attached (I wasn't allowed to turn my head to look) and then all the pieces rotate around me quietly, taking a scan of my insides to make sure that the lesions are still in the same position they were in when they took the original scans - which were used by the physicists and other scientists to create my treatment plan. Then the doctor reviews the scans, they come back in, slide a few things around, and that thing that looks like a flat board on the left side of the machine is positioned over my face and the therapy begins and all the pieces rotate around me. It's not ON my face, just close, probably a hand's width or two away. The first set of sessions, I closed my eyes because that freaked me out. But I got braver this time. 

I got braver with my questions, too. My biggest question was, How do they make sure that the radiation is only targeted over my lesions, especially since they do all this while I'm breathing and stuff? The therapists told me that the radiation plate has these little fingers in it, that are calibrated by physicists (a practical job for physicists!) that move to only open up a tiny space for the radiation beam to shine on the exact right spot, and the plate rotates around my body. "You probably don't notice it while you're on the table," she said. Then, of course, that's all I could think about, and I spent the next three sessions staring intently at the radiation plate and watching the little arms inside skitter around, opening and closing, creating a focused but invisible beam of radiation. It was sort of soothing, really. The radiation beam plate is on the right side of the picture above. I also tried to take a close up of what it looked like so you can see the little fingers inside, but you can't really see it from my super sneaky picture I snapped:

That little rectangle is where all the radiation comes out. Inside it are the little tiny metallic clacking alien fingers.

I should also share with you that if I tired of watching the little fingers clack around (or lost sight of them, since it rotated around and underneath me) and I couldn't concentrate on my audiobook because of the buzzing noise or my superfun anxiety disorder, I still had options. Specifically, I could enjoy the beauty of cherry tree blossoms, right there in the comfort of my restrictive and uncomfortably chilly body-cast personalized cradle:

Ah, nothing takes your mind off radiation like cherry trees

I'm really not sure how cherry trees wound up on the ceiling of the radiation therapy room, and I don't know if they have the same pictures on every ceiling since I was always in room 4 (which was fine with me because my lucky number is four), but there you have it. 

All in all, the whole experience far surpasses the experience of actual surgery. Painless, short (I was on the table for about 15 minutes per session, except for the last one when the little fingers got stuck and they had to call an emergency physicist [!!!!] in to fix them), and no scars. All I had was some fatigue - okay, a LOT of fatigue, but perhaps I'm just lazy - and short-lived but very paralyzing depression. I'll take it. And I got to experience truly cutting-edge therapy, which is sort of exciting, in a nerdy and disturbing kind of way. 

So there you go. Your own personal peek inside the rarefied world of SBRT. I mean, you can't just take a tour of these places, even if you wanted to. They absolutely don't let you into the radiation therapy rooms unless you're actually having therapy, because there's all sorts of radiation everywhere, sneaking out of the rooms and slithering into your system, just itching to give you (wait for it) cancer. (Ah, well.) My husband wasn't even allowed to be there with me. So consider yourself lucky that I mustered up my inner Harriet the Spy and I snapped these photos of the most important stuff. I didn't want you to think it was all fun and games, just getting your body marked up with Sharpies and earning free teeny, tiny tattoos. (I mentioned those, right? They use them to help line your body up as well. About the size of a pencil point. I often see mine in the shower and start scrubbing at them, cursing my children for somehow getting pen on me before I remember what they are.) It's good times, I tell you. Good times!