The Case of the Itching Underarm

I'm nearing the halfway point in my radiation treatments, and the irritation I was told to expect has begun to manifest itself. The sensation is something like what happens when a spot on your skin stays damp for an extended period of time - you start to chafe. The constant rubbing (due to the location of the tumor, under my arm), coupled with the effects of the radiation, causes an irritation near the top of my armpit, just about at the intersection of the underarm hair. This has led to a rash-like burning and itching. I guess this is what babies deal with when they have diaper rash, and I'm feeling a lot more sympathy for what the toddlers go through!

The treatment is straightforward and simple. I dust the affected area with cornstarch-based powder and use my favorite Body Shop Mango Body Butter. This keeps the area lubricated and absorbs excess moisture. I also have a prescription for Biafine, the standard radiation cream (topical emulsion, to be precise). I haven't ordered it yet, because the irritation really hasn't been too much of a bother to this point. I'll probably fill it next week, though, just to see if it works more effectively than Mango Body Butter, which does a pretty good job at relieving the itching.

I'll see my doctor (the radiation oncologist) tomorrow after treatment, which is the usual course of affairs for Wednesdays. At this juncture there's not that much to report. My energy is still very good, although the recent hot and muggy weather of the Memorial Day weekend found me wanting to just lay around inside. But all in all, things seem to be progressing smoothly, and every day brings me closer to the end of this phase of the journey and closer to the day I'll be rid of the big arm.

Eyes On the Prize

It's been a while since the last post, due to a combination of lack of new news, hectic schedule, and not feeling terribly well. The not feeling well part has nothing to do with the radiation, but more than likely has to do with high pollen counts and a slightly upset stomach. The stomach stuff has been floating around work the last week or so, and a little bit of it seems to have visited my intestinal tract.

The latest news is that my surgery has been scheduled for Tuesday, July 17, at 7:30 am. I've got my pre-op physical and (hopefully) final MRI with contrast on Wednesday, July 11. I have to say I'm ready to have the "lump of my life" residing outside of my body instead of inside of it. I'm just tired of carrying it around. The radiation treatments have become routine, and to this point haven't produced any noticeable fatigue. I see my radiation oncologist every Wednesday after treatment, so tomorrow I'll see her, which coincides with the end of two full weeks of radiation. I just keep telling myself - every day I get one day closer to being rid of this growth. I'm really looking forward to recuperating from the surgery and starting physical therapy. I just feel that I can get back to pretty close to full function after the surgery, even if it proves to be one of the harder things I'll do in my life. Bring it on - my eyes are on the greater prize of a cancer-free arm that does most of what my arm did before.

The folks, both patients and staff, at the Radiation Oncology center are a fun group. There's an unspoken bond between the patients who see each other 5 days a week, a family of hope and shared experience - everyone there lays on the same table and takes radiation in different parts of their bodies. Some are getting chemotherapy at the same time. All are positive and encourage everyone else with their demeanor. Everyone greets each other warmly, wants to know what's going on in your life, trades stories, recipes, whatever comes up in the course of the 10-15 minutes we're in each other's company. The staff join in the fun as they can with processing all the paperwork and managing appointments and dealing with the doctors. A very special confederacy.

Memorial Day weekend is approaching, so I get an extra day off from radiation on Monday the 28th. As I'm off from work as well, I guess it's a day to sleep in.

Can You Say Latissimus Dorsi ?

This morning I met my plastic (reconstructive) surgeon, Dr. Singh. Very tall, very nice, and armed with a credit card sized digital camera (an Exilim). It's most amusing, what with my photographic bent, but every doctor I've met from the Johns Hopkins team has felt a need to take my picture with a little digital camera. More precisely, they want to take a picture of the lump in my left arm, but I think I'm the only person who doesn't have a picture of my lump. Dr. Singh is the only one who has pictures with my radiation alignment marks showing, though, and he also took a shot from behind (rather like the position demonstrated by the friendly muscle mannequin above, except with my left arm held out parallel to the ground).

Dr. Singh explained what he was going to be doing surgically to repair my arm after Dr. Weber removes the tumor, which in my case means removing the majority of my triceps. Once the tumor is removed, a latissimus dorsi muscle (see red area on muscle mannequin), with blood supply and nerves still attached, and a flap of skin will be lifted from my back and rotated into the place where my triceps used to reside. Then the latissimus muscle will be attached to the long bone of the arm (humerus) and will be positioned to approximate the triceps. Lastly, the skin will be sutured and my arm will have been reconstructed.

All told, the total time of my surgery will probably be somewhere around 6-8 hours. After the surgery, Dr. Singh tells me I can expect to be in the hospital for about a week. When I asked him how long it would take me to heal from the surgery, his reply was, "It'll be about two weeks before you feel like a human being again." I asked him if it would be possible to make the Cape May trip I take every year with my family (all 15-17 of us) if the surgery was done in mid-July, as the Cape May vacation starts August 4. His answer was that it may be possible, because Cape May was close enough to Baltimore that I could come back if there were any complications. I asked him if I'd be able to drive, and he said he doubted it, because I'd probably still be on painkillers. He then said that it might not be the best idea to go to Cape May, it might be a little soon in my convalescence. Bummer! But healing is more important, and Cape May isn't going anywhere anytime soon. Maybe next year.

Perhaps I'll try to get a copy of one of the pictures of my arm to post. Until then, you can practice spelling and pronouncing latissimus dorsi.

High Beams On

After a traffic tieup that made me 15 minutes late, I made it in for the first treatment. The staff was waiting for me, and I was obviously their last appointment of the day. All told, the treatment took about 10 minutes. Basically, it's just take off my shirt, lay on the table, get positioned in the mold, and then four quick (30 second) bursts of high-energy X-rays from four different angles. My total dosage of radiation is 200 rads (radiation units) per treatment, which is considered low level. Then it's sit up, toss the gown, put on my shirt and see you tomorrow.

They'll be changing my appointment time over the next few days as some earlier slots open up, meaning as other patients finish their course of radiation therapy. Tomorrow I'll be in at 4 pm, and Friday is supposed to be around 1 pm. On Monday, they'll move me up to 9 am, which is more preferable to me from a work standpoint. No more slugging my way through unpredictable rush hour traffic to make appointments, but rather doing a shorter dash from home in the morning on back roads, then heading off to work after rush hour is largely over.

So the first offensive move in the taming of this lump has occured. It feels good to be taking steps against it rather than waiting for the time to come to begin dealing with it. I'm far more comfortable being proactive and doing something to the tumor than I am waiting around for it to do more stuff to me. It's my turn behind the wheel, and I'm going to be driving with my high beams on, courtesy of the radiation staff.

X's Mark the Spots, Ceiling Tile Mazes

This afternoon's session was, per the radiation oncology staff, the longest one I'll have. The session lasted almost an hour and a quarter, instead of 30 minutes, for a number of reasons. They needed to get exact positioning measurements on my arm while it was in the mold (or casting) that they made 9 days ago. Because I have to have my arm palm up at a strange angle while in the mold, they had to position me off to one side of the table under the X-ray machine that will determine the positioning marks. I had to stick my right thumb in my belt loop to keep my right arm from dangling off the table. This makes me look like I'm preparing to do the children's song "I'm A Little Teapot", which I tell the staff. They laugh and decide for the duration of my radiation therapy they're going to call me "Little Teapot".

Unfortunately, the strange position of my arm makes it very difficult to get the machine positioned correctly. After a couple of X-rays, the head technician, a nice man named Paul, comes back in and tells me that rather than take too many X-rays trying to get things right, they're going to walk me down the hall to the fluoroscope, which will give them the positioning data. So I parade down to the fluoroscope room, where it takes about 40 minutes to get everything set and the pictures taken. Periodically the team comes in and marks me with black markers that they cover with clear tape. They also mark my casting so that they can line me up exactly and quickly each time I come back. Then it was back to the X-ray room where they could take the necessary X-rays and fine tune the marks on my body and casting, which took about another 20-25 minutes. When this was done, I was set to start the actual radiation treatments, which begin tomorrow at 4:30 pm.

It's interesting walking into large rooms dominated by massive machines with tables attached to them, all the while knowing that these machines will shortly begin doing whatever it is they do to you. It feels a bit like being in a combination of a manufacturing shop and a sci-fi movie - steel tables, computer-controlled machinery that whirrs and buzzes and flashes and rotates, staff and technicians moving about calling out numbers, repositioning you remotely, while you just lay there and take it. They do have really great ceiling tiles, though. Several of them have complicated mazes drawn on them. As it was explained to me, people getting treated often have to lie on their backs for extended periods of time and get bored, so they've gotten the maze ceiling tiles so folks have something to occupy their minds while they're staring at the ceiling.

All in all, not a bad start. I have to give kudos to the staff at the radiation center, they were all great, funny, and obviously professionally adept at their jobs. They'll be with me for 25 sessions. Perhaps when I'm done I'll give them a teapot! I hope Paul, Marsha, Judy, and Tammy are ready to have some fun.

Beginnings - Let's Get It On!!

Hi, and welcome to my newly-created exercise in mass communication and full disclosure. I'm writing this post just before heading to my initial trip for radiation. Today is just to make sure everything is aligned correctly, and I get my permanent tattoos as well. The tattoos will make sure that they focus the radiation on just the right spot, and nothing else. Hence the title of this posting, "Beginnings - Let's Get It On!!" (apologies to Marvin Gaye)

With all the goings on relative to the fibrosarcoma in my arm, lots of my relatives and friends have been wanting news as to my condition, the progress of my treatment, etc. While it's been fun chatting on the phone with all of you these last few weeks, and I will continue to talk to you on the phone, I found myself wanting a more efficient and effective means of communicating with everyone. You can blame my dear sister Lora, the Rev. Chapman, for the creation of the blog (short for web log for those of you new to "blogging"), although she had no idea that she inspired this. Quite an indirect occurrence, springing from her habit of keeping a notebook of my medical journey.

When she went with me to Greenspring Station and her car broke down, I called her after my appointment, to fill her in on what transpired so that she could keep the notebook up to date. I was also spending a fair amount of time retelling my doctoral escapades to various family members, friends, and colleagues at work. Just this past week I was in Ocean City at a library conference, and I attended a seminar on blogging and podcasting (I may be podcasting to you sooner than you think!), and it clicked that starting a blog would be the ideal way to keep all concerned parties appraised simultaneously. Not only will the blog be a means for me to keep you posted on how my medical procedures are going, but it gives you the opportunity to send back comments, good wishes, and any other observations you feel fit to share. So it is interactive. And I figure that even after the surgery I can just fire up a laptop, sit back with a beer, and share the process with you.

A couple of ground rules for replies. First, no cursing (It's the librarian in me that had to say that)! Second, feel free to say whatever you want to say, it's all appreciated. Third, you'll be able to read and respond to what other visitors to the blog have said. Fourth, forgive me if every now and then I post another photograph of some bird or seashell or landscape or rock or something without a person in it, it's just what I do, okay? ;-)

So there you have it. Feel free to join in the experiment, the fun, and the opportunity of this, my blog about my cancer treatment journey and recovery. Make no mistake, I will recover from this, I'm in incredibly capable hands (God's, surgeons, physical therapists, plastic surgeons, bill collectors ;-) ) and surrounded my unbelievably caring people - you, my family and friends and co-workers. So come on in, sit a spell, and contribute to this blog, a little piece of virtual reality that I call Steve's Big Arm News.