Day two at Northwestern

I was up early, showered and shaved by 6:30 p.m.  I was surprised to find Tony & Cindy already up.  I was treated to a plant-based breakfast bowl and a cup of tea.  Tony is a cancer survivor, being given a cancer-free status last year.  Cindy is still battling hers, but doing well and looking healthy.  They have both adopted a plant-based diet, attributing it to their success in cancer recovery.  I get it.  I understand its benefits.  I think that I can embrace it in part, but having an occasional Spicy Deluxe Chicken sandwich will have to work into the program.

I was asked to report to the Northwestern Cancer Center at 8:45 a.m. to fill out some paperwork before my meeting with Dr. Ferris - Medical Oncology.  I was late.  I thought I knew exactly where the building was located, but it turned out that it was on the other side of the expressway.  I arrived at 9:00 a.m.  Lucky for me, the paperwork was the same that I had filled out the day before at the medical clinic where I had the MRI.

I filled out the paperwork in less than two minutes.  A nurse from Dr. Ferris office came to get me as I was handing in the clipboard.  Perfect timing.   

Medical Oncology handles the chemo part of treatment.  Dr. Ferris laid out her plan for chemo treatment.  I will receive a chemo dose once a week for seven weeks.  Seven smaller doses will be easier for me to handle with less side effects.  She is concerned about my tinnitus (ringing in my ears), since it is one of the main side effects of chemo.  Chemo could make it worse, possibly permanently. 

I finished up with Dr. Ferris and walked next door to the Northwestern Chicago Proton Center.

Another check-in process with the same paperwork, only this time, they took my picture for my new photo I.D. badge.  It's the "back stage pass" to the Proton Center.  You scan it when you arrive, and then at different locations around the building.  They need to make sure that they know where you are and that no one is wandering around the building.

First stop was CT Simulation.  This time, I was allowed to keep my pants and boots on, although I was asked to remove my signature black turtleneck.  Next, I was escorted to the CT lab.  The techs gave me a quick rundown on the process.  First, I am fitted with the mask, then they take a detailed CT of my head and neck while the mask is holding me perfectly still to the table.

The mask is a tight weaved plastic that is heated in an oven.  This particular style clamps under the head portion of the table.  The tech quickly applied it over my face, clamped it underneath, and began pressing it all around my head and neck to make a tight-fitting mask.  I had to lay perfectly still for ten minutes until the mask completely hardened.

The Eagle Scout in me had to ask myself the "be prepared" question... "Is there some kind of quick release on this mask, in the event that the room catches on fire, or some other type of disaster?"  I reached behind my head and felt the clamps.  I think I could get myself out if I needed to.  Let's hope I don't have to prove it.

The techs asked if I was comfortable, and ready to get started.  I'm as ready as I will ever be.  They set up the machine and left the room to monitor from the control room.  Realizing that I had my smartphone clipped to my belt, I snapped a selfie of me laying there with my cool new mask, before they started.  

This CT simulation is the first step in the planning sessions that lead to my proton radiation therapy.  Taken with the same mask that I will be wearing during proton therapy, the computer maps out the exact position of my bones, organs, blood vessels and soft tissues which include tumors.  The head and neck MRI's that I am having done will be spliced in to give my Radiation Oncologist an accurate picture of the cancer and it's location.  MRI's are better at imaging soft tissue which makes the tumors more visible.

The actual CT Sim took about an hour.  That was a pretty long time to be laying there unable to scratch the itch on my forehead.  Luckily, the actual radiation sessions only take about twenty minutes each.  I will be receiving radiation therapy everyday, Monday through Friday, for seven weeks.

Dr. Akthar - my Radiation Oncologist - came in to say hi when the CT Sim was finished.  We are right on track to get started in a couple of weeks.

Next stop is back to the medical clinic for my head MRI.  Same routine, scrub pants and a tee shirt, then off to the MRI lab.  This particular MRI lab is kept pretty chilly. I would guess about 55-60 deg.  After laying me on the table, they covered me with warm blankets, stuck plugs in my ears, and packed foam wedges around my head to keep it immobilized.

You may remember me saying that the neck MRI that I had yesterday took about forty-five minutes.  I suppose that it really didn't dawn on me that these are very high resolution images, unlike the ones I had before.  

The machine started, in the usual fashion, and I was left to the thoughts in my head. 

At first, the warm blankets gave me just the right amount of comfort that I fell asleep.   No telling how long I was out, since the only thing I could see was the blue plastic dot above my head that marked the center of the machine.  My guess, only a couple minutes.

I laid there as the machine went through its cycles of different tones, until finally, it stopped.  The techs came in and administered the contrast.  I asked how much longer.  They said about thirty more minutes.  Thirty minutes!  How long was that first session?  Fifty five minutes.  Now I am starting to understand why they didn't want to do it all in one session.  Not feeling so macho now, are you Joe?

About ten minutes into the scan, I became acutely aware that the foam block that was holding the left lower side of my head in position was starting to cut off the circulation in my ear.  It became more and more excruciating by the minute.  I began thinking to myself that I can't move or I will screw up the scan.  If I squeeze the panic ball this far into the game, they might have to start over.  I had to gut it out.

I've always had a high pain tolerance.  A couple of times, I had smashed and broken a finger early in the morning, and still finished the job before I went to the hospital.  Pain is not the problem.  My biggest concern, loss of bladder control.  There it is, I said it, know you know.  Maybe you didn't want to know that.  Sorry, now you do.  I don't think it is that uncommon for a guy my age.  One minute you're feeling fine, the next minute, you gotta go.  Too much information?

Now I'm laying there, concentrating on two issues - my bladder and the pain in my ear.  I've never been a multi-tasker so it was a no-brainer to err on the side of caution and devote my attention to the former.  Worst case, if I wet my pants, I'm wearing their scrubs.  With every change in tone of the machine, I prayed that it would be the last.  Then, finally, the machine stopped.  The techs came in and removed the head restraints.  I shot up from the table, exited the room to find a bathroom right across the hall.  

All in all, the head MRI took an hour and a half.  I hope I never have to do that again.

That was the last appointment.  I was finished and out the door at 3:30 p.m.  With a six hour drive ahead of me, I should be home in time for the evening news.  It's been a busy couple of days, but I am so glad that things are starting to move in the right direction.