The Radiation Oncology (RadOnc) people, God bless 'em, have a lot of checks and balances in place to make sure they don't radiate the wrong thing. The tough part is getting the patient in the exact same position every time he gets on the table. This is somewhat easier when you are radiating a lung or an abdomen. This is much more difficult with me, since the main target is very close to my shoulder - a movable joint.
One of the "checks" is those little tattoos on my body. You line these up with certain lasers, and make sure I'm in the same general position each time. But the RadOnc people also take x-rays to verify that the "blast zone" - for lack of a better term - is the same each time. All of this stuff is originally worked out in the "plan." The "plan" (their term, not mine) is constructed based on my original CT scan, my PET scans, and original x-rays. Based on all this stuff, the doctors, techs, physicists, etc., set up a "plan" that is very precise. But the precision allows for very targeted radiation therapy with minimal collateral damage.
However, the precise plan means that I must be in a precise position each and every time they radiate. The issue, apparently, is that my clavicle is in the "blast zone" on the plan, but the techs are having a difficult time getting it into the "blast zone" during treatments (without screwing up other things). So this issue has led to "x-ray -> move Nick -> x-ray -> move Nick -> x-ray -> move Nick" over and over again, to the tune of like 13 x-rays in two days.
So this morning, we were doing the x-ray/move Nick dance when apparently the machine got all x-rayed out and broke. The techs were getting frustrated with the whole dance as well, so they decided, along with doctors, to essentially re-do everything - go back, do another CT scan, work out a new plan, and repeat the process. This would have meant no treatment today, no treatment Sunday, a new plan on Monday along with no treatment, and no treatment until a new plan was worked out. Could have added a whole week to treatment, which...just not good. And not what I needed right now.
But the RadOnc people did a lot for me today, which was awesome. In short, they decided to make a giant mold of my upper body:
Bad picture at the moment - I'll get a better one on Sunday - but the mold is the pink thing. They pour some chemical goo (the technical term) into the mold, have me lay down on my back in it, and the goo forms to my body, hardens, and keeps me stable. Then, they ran another CT scan with me in a new position in the new mold, and essentially re-did what they did before. Which, unfortunately, included new tattoos (I'm up to 5 now. As a bald guy with 5 tattoos, I think I should change my lifestyle. Unfortunately, Four Loko is now banned, which is what I believe I'm supposed to drink if I'm a bald guy with 5 tattoos. Instead, I'll have to settle for watching UFC fights and drinking King Cobras).
This took until 12:30 or so. But then a bit of good news: the techs said they could treat me in the afternoon under the old plan if I could be back at 1:15. So I ran upstairs to the Little Caesars and grabbed some lunch (side note: If you are a hospital, and you are trying to cure people of cancer, don't put a Little Caesars inside. That stuff has to be at least as carcinogenic as Marlboro Reds). I made it back down to the RadOnc lair by 1:15, where they put me in the other treatment room (which is significantly better than the treatment room I was originally in), and started the process again:
See those blue things there? Those are for the patient's arms. In plan #1, my arms were up above my head. This led to the clavicle problems. In the giant mold, my arms are going to be down at my sides. This is why I needed to be re-tattooed.
So while I managed to make one radiation session last about as long as chemo, it was significantly less painful. Plus, I understand why all of this stuff is being done, and I appreciate the reason. The attending RadOnc doc, Dr. Robbins, was with me for a period of time and did a good job of explaining everything. That's all I really ask for - just let me know what the hell is going on. Sometimes it's about asking the right questions, sometimes it's about having the right people. And Henry Ford has a lot of the right people.
So the good news is that there won't be any delay in my treatment. I'll hop into the new mold on Sunday, and we'll keep right on going. This is much better than getting a CT scan on Monday and waiting for a new plan to be drawn up. Everything in both plans will be the same - they're radiating the same area - it's just that the different position will change all the angles. So that's what needs to be figured out.
All for now. More when I have more to say and time to say it.
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