Radiation Cessation Elation

Almost precisely 24 hours ago (as I write this), I finished a course of 39 sessions of adjuvant radiation therapy (ART) for prostate cancer. [If you’re new to the Gazette — welcome! — you can get some additional context from this post.] I agreed to ART on the advice of my oncologist, although I had some doubts about the necessity of the treatment; this article from the Mayo Clinic provides some support for those doubts.

My course of treatment began on a Monday (March 3rd) and ended on a Friday (April 25th), and the interval between those dates was characterized by extremes in emotion and attitude. Was the experience worth the stress? We’ll know in a couple of months, but for now, here are some of the high/lowlights.

If nothing else, the experience was educational. Going in, I knew nothing about radiation therapy. For example, I had never heard the term “gray” applied to anything except color, so I was surprised to learn that it also is a measure of the dosage of radiation, abbreviated as Gy. The odd name is derived from the British physicist who pioneered measurements of radiation and it effects on tissue.

I also knew nothing about the linear accelerator that generates low-energy electrons, which slam into a tungsten plate and are then converted to photons that are manifest in the form of very high energy x-rays, nor how those particles of energy are targeted at where the cancer cells are assumed to reside. (I say assumed because unlike the easier-to-visualize situation where a specific tumor has been identified and can be targeted, my cancer is assumed to be in the general region of where the prostate once resided, prior to its surgical removal.)

And, finally, I came to understand that my version of ART was done only five days a week instead of daily so that the non-cancerous cells that might have collateral damage from the radiation would have a couple of days to repair themselves. Prostate cancer cells don’t have that same capability.

I spent quite a bit of time with Sara, my radiation therapist, and I peppered her, and Dr. Eberling, the radiation oncologist, with technical questions, and they were always patient and happy to answer them. Toward the end of the process, I asked Sara if I was annoying her with so many questions and she assured me that I wasn’t. She said that in her experience, there were two types of patients. One group was like me and wanted to dive into the details of what was going on. The other group went through the whole process and then at the very end asked something like, “now, what did you do to me, anyway?”

I’m not going to give a day-by-day account of the process, but I did compile a list of statistics and events that represent the aforementioned high and low points of the process. I hope you find at least a few of them interesting.

• Miles driven: 4,712 (includes the preliminary visits to Fredericksburg & Kerrville)
• Average hours/day required for treatment: ~2.5 (includes travel time)
• Total radiation received: ~80 Gy (grays) spread out over 39 treatments
• Actual total estimated time being radiated: ~2 hours (~3 minutes per day)
• # of treatment days missed due to equipment downtime: 1
• # of daily doses of Miralax: 65
• # of daily doses of Gas-X: ~120
• Bags of Lindt Lindor Sea Salt Milk Chocolate Truffles delivered to clinic staff: 7
• # of times we made a last minute stop at Walmart because I forgot the truffles: 1
• # of times I left my cell phone in a rest stop bathroom stall: 1
• # of times delayed by traffic – departure: 0
• # of times delayed by traffic – return home: 1
• # of encouraging cards, texts, visits, calls, etc: too many to count

That last one is perhaps the most important one. SO MANY people were backing me up and lifting me up, and I can’t possibly know how to sufficiently thank them. But I will single out my lovely bride as the absolute rock that supported me through every step. She refused to NOT come with me every day, even though the traffic and, frankly, my driving constantly had her on edge.

The other important outcome is that I gained a new sense of empathy for those who are enduring similar — and in more cases than not — much worse courses of treatment. I’ll be the first to admit that my treatment pales in intensity and stress compared to those who are going through chemotherapy or immunotherapy or even other types of radiation therapy. During the two months of my treatments, at least two of the people on my prayer list have passed away, and others are in dire situations or experiencing significant, life-altering side effects. Even among the other patients we met at the clinic during my treatments, there were those for whom this was a temporary stop on their way to more aggressive, intensive therapies at places like MD Anderson or Duke Cancer Centers. I pray regularly for God’s tender mercies and amazing grace to cover them and their families, and I do so with an understanding of the stakes that I only guessed at before.

As I implied at the beginning, this was simply another step in a journey. I have no idea whether or not the 39 days effectively eliminated the remaining cancer cells, nor will I have a clue for a couple of months. That’s when I’ll have the first post-treatment ultrasensitive PSA (uPSA) test, and that will — I hope — provide some clarity to what the next steps in the journey will look like. If you feel led to pray for us to have peace about that, we wouldn’t mind.

Final Notes: The Closing Ceremony

It’s not the Olympics, but as many of you know, there is a traditional ceremony attached to the end of a course of treatment for cancer, be it radiation, chemo, or other types. I’d like to share some photos of that, along with recognition of the team that helped me get through it. [All photos were taken by Debbie, who really should have been front and center in them.]

By the way, I should mention that they observe “casual Friday” at the clinic. The staff normally wears scrubs…in case you were wondering. But the smiles are pretty much always there.

I can’t imagine a nicer, friendlier, more encouraging team of people than the staff at the Friendship Lane Center for Cancer in Fredericksburg, Texas. Despite the 108-mile round trip drive, we never once second-guessed ourselves for choosing this clinic for treatment, even though it was outside the network occupied by all my other physicians (thankfully, it was still within my insurance network). I hope you never have to find out firsthand, but I stand by my recommendation.