A Day at the Oncologists
Nov 19
Only two weeks after having found out that Fred had cancer, we met with our new radiation oncologist and our new medical oncologist (who prescribes the chemotherapy). Dr. SS is really impressive. He went over all the details about the radiation therapy that Fred will need to have. There is a nurse, Sandy, who works there and is also very impressive. I feel like we are in good hands with their team.
Fred will be having Intensity-Modulated Radiation Therapy (IMRT). This
type of treatment takes images from a CT scan and a PET scan and creates a virtual model of Fred. Then the radiation oncologist determines how much radiation goes to each part of Fred’s head and neck. This helps to preserve structures that are critical (brain, spinal cord), and those that are important (epiglottis, vocal cords, parotid gland) at the same time providing maximum cell death to the malignant cells. The pic at right is an example of what a simulated patient looks like. The purple areas are the areas that ret the most radiation. Fred will have one of these done as well.
There are going to be many side effects, some of which we knew about, and some of which were a surprise. One problem that is fairly easy thing to deal with is the fact that he will be in a mask during the radiation treatments. The pic at right is an example of such a mask. Each mask is fitted to the patient and is used only for him/her. The mask will keep Fred immobilized during radiation and
also to make sure the he is in the exact same position for each treatment. Once he is immobilized for the treatment, the linear accelerator will beam radiation most intensely to the tumor and lymph nodes, and little less intensely to the next most likely structures involved (other lymph nodes), and the least intensely to all the other areas between Fred’s ears and armpits. Having that mask on during the 30 to 40 minute treatment can cause claustrophobia, and I am anticipating that he will need some medication to reduce his anxiety. One of the good things about the mask is that he won't have to have the radiation marks on his face or neck like used to be done in the past.
Another of the easy things to deal with is the fact that Fred will lose his hair in the area that is radiated. He’ll have a funny hairline on his neck that will be about ear level. He’ll also lose his beard. The beard on the left side of his face may never grow back because that is where the tumor is and where the radiation will be the highest. Fred has already decided to shave his head if he loses his hair! He is worried about his beard, though. I am just glad that I love the way he looks with a goatee!
Fred’s skin will be affected early on. Dr. SS told us that radiation therapy is like getting a major sunburn every day for 35 days. By the end of the treatments, Fred’s skin will be burned from ears to armpits. He will develop blisters and weeping. We can handle that with hydrocortisone cream and aloe vera cream, but his skin will be painful nevertheless. The pic at right is an example of a radiation burn.
A very bad thing to deal with is the pain of the throat. Since the cells of the mouth and throat have a rapid pattern of replacement, they are often easily affected by radiation, making the mouth and throat very sore and painful. This leads to difficulty eating and swallowing, thus requiring a PEG tube for feedings and fluids. Narcotics are often used to decrease the pain because it is essential to continue swallowing, despite the pain. If patients stop swallowing, it can cause atrophy of the muscles and cause the patient to actually have to learn how to swallow and eat again!
Another really bad thing is that the major salivary glands are often affected. Dr. SS told us that Fred will probably lose his left parotid gland because it is directly in line with his tumor. His right parotid gland will also be affected during the radiation treatments causing a change in his oral moisture. This can cause the saliva to be reduced, too much, or different (thick and stringy, profuse and watery). There are medications that can be used, but mainly the patient just has to live with it. Fred will probably have less saliva permanently because of the loss of the left parotid gland.
Teeth can be permanently affected by the loss of saliva. Saliva reduces the bacteria in the mouth and so the lack can cause dental caries and cavities. Fred will have to see the dentist and have any dental work done prior to beginning radiation. He’ll also need to sleep with fluoride trays to keep his teeth healthy.
One of the saddest effects is the loss of taste. Dr. SS told us that Fred will definitely lose his sense of taste during radiation and it may be permanent. That will really change the quality of our lives since we love to go out to eat and it is hard to do so when you food doesn’t taste or doesn’t taste right. That makes me very sad.
After meeting with Dr. S, we then went over to the medical oncology side and met Dr. MS. She is also very impressive and carefully described what chemo to expect. She told us that he would be getting Cisplatin, which is an old chemo agent that I gave many years ago when I worked at LA County-USC Medical Center. She is going to use the highest dose possible for Fred. Of course, this has side effects as well.
One of the minor ones is that it can cause damage to the vein, so she likes patients to have an implanted port. The pic at right is an example of a port. That allows the chemo to be given without the potential damage. It also allows fluids, medications, and blood draws to be done without any additional needle sticks, an important fact to reduce pain and also to reduce the potential for infection.
Infection is a big threat because the Cisplatin kills all rapidly dividing cells, including the cells of the bone marrow. This leads to a lack of white blood cells, the cells that fight infection. Dr. MS will carefully watch Fred’s blood levels to make sure his cells are adequate before another dose of chemo is given.
One last problem is that Cisplatin can cause kidney damage. To reduce that impact, lots of intravenous fluids will be given to hydrate the kidney before and after the dose of Cisplatin is given. The port will help with the fluids as well. The pic at right is an example of what the port looks like when it is being accessed for use. When it is not used, it is under the skin and all you can feel is a bump.
By the end of this extremely long day of doctor’s visits, we were exhausted and drove home in a mental and physical fog. I can’t believe we have cancer in our lives. It is just not possible.
Only two weeks after having found out that Fred had cancer, we met with our new radiation oncologist and our new medical oncologist (who prescribes the chemotherapy). Dr. SS is really impressive. He went over all the details about the radiation therapy that Fred will need to have. There is a nurse, Sandy, who works there and is also very impressive. I feel like we are in good hands with their team.
Fred will be having Intensity-Modulated Radiation Therapy (IMRT). This
type of treatment takes images from a CT scan and a PET scan and creates a virtual model of Fred. Then the radiation oncologist determines how much radiation goes to each part of Fred’s head and neck. This helps to preserve structures that are critical (brain, spinal cord), and those that are important (epiglottis, vocal cords, parotid gland) at the same time providing maximum cell death to the malignant cells. The pic at right is an example of what a simulated patient looks like. The purple areas are the areas that ret the most radiation. Fred will have one of these done as well.There are going to be many side effects, some of which we knew about, and some of which were a surprise. One problem that is fairly easy thing to deal with is the fact that he will be in a mask during the radiation treatments. The pic at right is an example of such a mask. Each mask is fitted to the patient and is used only for him/her. The mask will keep Fred immobilized during radiation and
also to make sure the he is in the exact same position for each treatment. Once he is immobilized for the treatment, the linear accelerator will beam radiation most intensely to the tumor and lymph nodes, and little less intensely to the next most likely structures involved (other lymph nodes), and the least intensely to all the other areas between Fred’s ears and armpits. Having that mask on during the 30 to 40 minute treatment can cause claustrophobia, and I am anticipating that he will need some medication to reduce his anxiety. One of the good things about the mask is that he won't have to have the radiation marks on his face or neck like used to be done in the past.Another of the easy things to deal with is the fact that Fred will lose his hair in the area that is radiated. He’ll have a funny hairline on his neck that will be about ear level. He’ll also lose his beard. The beard on the left side of his face may never grow back because that is where the tumor is and where the radiation will be the highest. Fred has already decided to shave his head if he loses his hair! He is worried about his beard, though. I am just glad that I love the way he looks with a goatee!
Fred’s skin will be affected early on. Dr. SS told us that radiation therapy is like getting a major sunburn every day for 35 days. By the end of the treatments, Fred’s skin will be burned from ears to armpits. He will develop blisters and weeping. We can handle that with hydrocortisone cream and aloe vera cream, but his skin will be painful nevertheless. The pic at right is an example of a radiation burn.
A very bad thing to deal with is the pain of the throat. Since the cells of the mouth and throat have a rapid pattern of replacement, they are often easily affected by radiation, making the mouth and throat very sore and painful. This leads to difficulty eating and swallowing, thus requiring a PEG tube for feedings and fluids. Narcotics are often used to decrease the pain because it is essential to continue swallowing, despite the pain. If patients stop swallowing, it can cause atrophy of the muscles and cause the patient to actually have to learn how to swallow and eat again!
Another really bad thing is that the major salivary glands are often affected. Dr. SS told us that Fred will probably lose his left parotid gland because it is directly in line with his tumor. His right parotid gland will also be affected during the radiation treatments causing a change in his oral moisture. This can cause the saliva to be reduced, too much, or different (thick and stringy, profuse and watery). There are medications that can be used, but mainly the patient just has to live with it. Fred will probably have less saliva permanently because of the loss of the left parotid gland.
Teeth can be permanently affected by the loss of saliva. Saliva reduces the bacteria in the mouth and so the lack can cause dental caries and cavities. Fred will have to see the dentist and have any dental work done prior to beginning radiation. He’ll also need to sleep with fluoride trays to keep his teeth healthy.
One of the saddest effects is the loss of taste. Dr. SS told us that Fred will definitely lose his sense of taste during radiation and it may be permanent. That will really change the quality of our lives since we love to go out to eat and it is hard to do so when you food doesn’t taste or doesn’t taste right. That makes me very sad.
After meeting with Dr. S, we then went over to the medical oncology side and met Dr. MS. She is also very impressive and carefully described what chemo to expect. She told us that he would be getting Cisplatin, which is an old chemo agent that I gave many years ago when I worked at LA County-USC Medical Center. She is going to use the highest dose possible for Fred. Of course, this has side effects as well.
One of the minor ones is that it can cause damage to the vein, so she likes patients to have an implanted port. The pic at right is an example of a port. That allows the chemo to be given without the potential damage. It also allows fluids, medications, and blood draws to be done without any additional needle sticks, an important fact to reduce pain and also to reduce the potential for infection.
Infection is a big threat because the Cisplatin kills all rapidly dividing cells, including the cells of the bone marrow. This leads to a lack of white blood cells, the cells that fight infection. Dr. MS will carefully watch Fred’s blood levels to make sure his cells are adequate before another dose of chemo is given.
One last problem is that Cisplatin can cause kidney damage. To reduce that impact, lots of intravenous fluids will be given to hydrate the kidney before and after the dose of Cisplatin is given. The port will help with the fluids as well. The pic at right is an example of what the port looks like when it is being accessed for use. When it is not used, it is under the skin and all you can feel is a bump.
By the end of this extremely long day of doctor’s visits, we were exhausted and drove home in a mental and physical fog. I can’t believe we have cancer in our lives. It is just not possible.
K
posted by Kathy @ 1:18 PM
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