How Do You Bandage Your Underarm (and Still Use the Arm Attached To It)?

Last Wednesday (June 13) I had my last radiation treatment before surgery. Phase 1 is officially over, and the resting period before surgery (Phase 2) is upon me. Of course, things were going a bit too smoothly, so Week 5 of the radiation brought its own delights - skin problems. These were expected, they just hadn't manifested through Week 4, so I thought I might miss this part, even though it had been told to me that such a scenario was common.

Basically, the accumulation of high-energy X-rays finally caused the skin under my arm to burn and peel. So I have a kind of sunburned patch under my arm that is raw, which is annoying and sporadically painful. More of an nuisance than really problematic in the pain sense, but needing to be dealt with. The Biafine cream is fine, but the doctor decided to prescribe another cream, one which is used to treat burn victims and helps them grow new skin, as well as some other agents. The new cream is Silver Sulfadiazine.

Before the cream was available from my pharmacy (a 2-day wait), the prescription for my underarm was to put a kind of dressing over the area, called Xeroform, which is a yellow "gauze impregnated [their word, not mine] with 3% Xeroform (Bismuth Tribromophenate) in a petrolatum blend." Translated, this is a sticky yellow gauze that keeps the area moist and clean so that it can heal. Think gauze soaked in Vaseline with an anti-infective agent that's bright yellow. Then I covered the Xeroform with a non-adhesive dressing (called Telfa). Then I used tape to hold that in place while I made a kind of shoulder harness from the tape to go around my shoulder and hold the whole thing in place. I had to use two long strips of tape, one slightly longer than the other, and place the two strips with the sticky sides facing each other except for the ends. This allowed the part that went around my shoulder not to be stuck down on my shoulder, because removing that much tape from skin is not a pleasant experience. The sticky ends were taped to the back of the non-adhesive dressing and held it (mostly) in place. The whole apparatus was mostly a Rube Goldberg contraption, especially as the movement of the shoulder makes placing a bandage to stay put under your arm highly problematic. I did it for two days, and it took about 30 minutes each day to put the thing on. Needless to say, the fit was not overly comfortable.

When the Silver Sulfadiazine arrived, I was instructed to put it on the affected area with one half of a tongue depressor. This white cream is the consistency of cake frosting, so it feels rather like icing a cake a couple of times a day. But it stays in place without a bandage, so I've ditched the Xeroform, non-adhesive dressing and Elliott Ness shoulder holster tape job for just the Silver Sulfadiazine and Biafine creams. I don't wear my best shirts, and it's a lot more comfortable. It also seems to be working, as the Silver Sulfadiazine (an antibiotic that helps burned skin heal and regenerate) and Biafine combination has, over the past 5 days, lessened the annoying pain and begun the healing process of the skin. Also, not receiving radiation helps the process immensely.

All in all, things are going along just swell. I'm busy at work, getting ready to go to a conference for 3 days in DC, and just short of one month before the surgery. Perhaps I'll have fully regenerated skin under my arm before then - who knows. In the long run, the effects of the radiation on the tumor site seem to have done exactly what was hoped for, and now I'm getting my house (figuratively and literally) in order before going on to the next challenge.

No Red, But Skin So Soft

Although I've asked twice, there seems to be a scarcity of red markers in the radiation oncology building, so I'm stuck with turquoise. Not bad, but a little high contrast when wearing an orange or red t-shirt. It really doesn't matter that much, since I'll be done with the radiation in 3 more treatments ending Wednesday, June 13. After that, it's into my resting period until surgery on July 17.

I see my radiation oncologist every Wednesday, just to check in and see how things are going. The technicians take plain X-rays the day before I see her, so that she can see if things are going as planned. So far, I'm doing swimmingly. I haven't had any problems with excessive fatigue (except when I put in 10 busy hours at work disciplining kids, running Cub Scout programs, and dealing with an accident involving the bookmobile, all at the same time), which was one concern the doctors suggested I might have to deal with. I have developed some irritation under my left armpit, largely due to the loss of my armpit hair from the radiation. I've switched to the Biafine cream, and it works well. It is like having a type of sunburn, in that it's tender to the touch. As it's always resting on my side (unless I raise my arm, which I do frequently), it's hard to keep it from rubbing. Put in perspective, it's a minor annoyance.

The radiation oncologist was surprised at how good the rest of my irradiated skin looked. When I told her that I had finished 4 of my 5 weeks of treatment, she seemed surprised and said that in that case my skin looked extremely good. I figure that if I keep up with the cream, the underarm irritation will subside greatly by the time of the surgery.

And so I'm coming down the home stretch of Phase 1, as I've come to think of it. Three more days. Truthfully, I'll miss the people I've met at the treatment center - it's been a pleasant way to start my days. But Phase 2 (rest) looms, and then Phase 3, surgery. Phase 4 is rehabilitation, which will probably be the toughest part of the entire process. Mentally, I feel ready for all the phases - the only way out of them is by going through them, so bring them on and I'll deal with what I have to deal with. It could be kind of fun, and it certainly will be an experience I'll never forget!

Do You Have Anything in a Red?

As I come down the home stretch with my radiation treatments, the repetitiveness of the daily process leads me to look for less obvious items of interest. The one I'm particularly amused by these days is the ongoing change of colors used to mark my arm for proper alignment during treatment. These "registration marks" help the technicians to place my arm in exactly the same position repeatably, which is fairly crucial to getting a good result. To that end, when I had my fitting for my mold, the technicians spent a great deal of time making sure all the little details were taken care of, tweaking my position, cradling the mold while the foam inside set to the proper consistency, and taking CT scans to assure all was perfect. This procedure cost over $3000 (at least that's what the bill said - my portion came to a tad over $55, thankfully). They then marked my arm with (supposedly) permanent marker, which they covered with small, clear, plastic adhesive patches, so that when I had my simulation 9 days later the technicians would have no problem getting me in the same position. The color used that day was purple.

Within 4 days, the plastic patches began to "wiggle", as I've taken to calling it. From normal bodily movements and the usual wear and tear (like showering or high heat and humidity), the adhesive begins to get degraded, and the patches start to pucker up, which, of course, moves the position of the lines. In my case, 2 of the patches were in extreme danger of falling off completely the day before I was to take a 4 day trip. The fine folks at Greenspring re-patched me, but when I came in for my simulation on May 8, they began to relabel me - sort of a fine tuning of the previous marks.

Obviously out of purple markers, they redid a couple of my marks in black. Perhaps they were trying to simulate linear bruises, or they were ardent Ravens fans; whatever the reason, the results were two-toned. Over the course of my next 3 plus weeks of treatment, every one of the marks has had to be redrawn or touched up. At first there was consistency, with the purple marks morphing to black, so that about 10 days ago my marks were uniformly black. However, during the last ten days, the color choice has changed again, to turquoise this time. And the lines they've drawn are freehand and longer than before, so that an inch or so of extra turquoise shows beyond the patch-covered areas in some places. Fortunately, what is permanent on paper turns out to be extremely impermanent on my skin. Just part of the fun of the process. I have to say that I am in no way criticizing the performance of the technicians - we joke about the colors and they have not compromised my treatment at all. According to my doctor the setup and results are just fine. I think I might even miss these little marks when I finish my treatment cycle, which is soon (just 8 more radiation visits to reach my 25). But I'll see if I can squeeze in another color or two before I'm done.

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.

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.

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.