Radiation Treatment

I’ve gotten back to painting, started a new job and am now sitting in The Gambia Africa.  My new adventures have begun and I haven’t sat down to write about the adventure, or misadventure, of my cancer treatment yet.  I’d better put it down, even though it isn’t nearly as fun as what’s going on now.

It’s been about six months since my lumpectomy.  I flew to Frankfurt, settled in, had radiation treatment and started on the road to recovery.  That’s the nutshell, but doing all of this in Germany added a layer of stress, comedy and adventure that wouldn’t have been there otherwise.

I didn’t sleep on the plane flying over from the states.  The doctors told me not to take any sleep aids.  Since I’d just had surgery there was a danger of blood clots and I was supposed to get up every so often and move around.  Every time I drifted off to sleep I would wake suddenly because I was concerned about that, I was leaning on my incision or the guy next to me was snoring.  I was still going on nervous energy when I arrived in Frankfurt.  Bob was able to come into the baggage area to help me get my luggage through customs when I arrived.  But when we got to the apartment I collapsed in the recliner and slept there for several hours.  The danger with jet lag is that if you sleep during the day when you arrive, you may not sleep during the night.  Well, I did both.  It did take me a week to get over the jet lag completely.  I was sleepy during the day but I slept regular hours right away.

For the first month all we had was what we brought in our suitcases.  Our belongings would follow in three separate shipments.  The apartment was furnished and there was a “kit” with towels, sheets, pots and pans, silverware, a toaster and coffee maker and a few other conveniences.  None of them were very good quality but they were OK for getting by until our stuff came.  The place really looked like a bachelor pad when I arrived.  Bob had bought a huge TV and he had the recliner parked in front of it.  His friends had said that that wouldn’t last once I got there and they were right.  First thing I did when I had the energy was to rearrange the furniture. (A person’s got to put their mark on their home!)  When our "stuff" arrived, we set to work right away hanging art and putting pictures of our family around the apartment.  I brought my grandmothers china which hadn't seen the light of day in years.  The apartment came with a china cabinet and the china looks great in there.  I'm hoping to host some dinners and put the china to use.  Our apartment is big with three bedrooms and windows on three sides so it is light and airy.  We don't have any private outdoor space but there are big common areas where we keep our little patio table and chairs and a webber grill that a departing officer gave to us.  

There are rabbits living with us at the apartment complex.  They had bunnies about a month ago and there will be up to 20 bunnies on the lawn in front of our apartment at any one time.  The crows recently fledged, so one day there were several gawky young birds walking around the grounds, totally unafraid of humans.  Their mother sat on top of the apartment building squawking at me while I talked to her "kids".   Common blackbirds, like the four and twenty that were baked in a pie, are plentiful in our area. They are in the same family as robins, but there are no robins here so these guys are filling that niche for me.  Their babies fledged recently too and were afraid of people.  They were really noisy as they followed their parents around waiting for them to dig up worms and feed them.  It's pretty funny to see seemingly adult birds being fed by other adult birds.  

There were several options for radiation treatment in Frankfurt, and one of the best was three bus stops from our apartment.  St. Markus Hospital (Markus Krankenhaus) has a Breast Center (Brustzentrum) attached.  It’s really not as fun as it sounds.  They specialize in breast ailments especially breast cancer.  Bob went with me to the first appointment, as his German is better than mine at this point.  The doctor, a woman, said that she was afraid her English wasn’t good enough to talk about radiation treatment but it was better than some Americans’ English.  She explained the whole process, which was almost identical to what they would have done in the U.S.  I would start the following Monday.  Bob had to leave at that point to go to work.  The doctor walked me out to the receptionist’s desk and then said, “Oh, I really should examine your incision before you go.  Come on back to my office.”  I followed her back into her office where there was an exam table.  She closed the door and said, “OK, go ahead.”….  She meant, go ahead and take off my top… while she stood there in the room watching me.  Now, I’m not shy or modest, or at least I didn’t think I was, but I’m really accustomed to the tradition in the U.S. where the nurse takes you into the examining room, gives you a little gown and leaves you to undress in private.  The doctor then comes and gently taps on the door and asks if you’re ready.  While the doctor examines one breast, he or she makes sure that the other breast is draped.  Well, that’s just not how things are done in Germany.  There is no gown or drape.  So I half disrobed right there in front of the doctor.  I wasn’t even sitting on the exam table.  She looked at my incision while I stood there in her office and she discussed the angle of the radiation and because of the location of my scar.  She admired the lovely work done by my surgeon.  Thank you Dr. Smith!   I then got dressed again, in front of the doctor, and we said goodbye. 

The following Monday I went to my first appointment, which was over in the Hospital proper.  The nurse, a man, showed me to a little room (a booth really) with a door on either end.  He explained something, in German, and after asking him to repeat himself and repeating what he said, I gathered that I was to take my top off and go through the other door.  That’s what I expected.  Alone in the booth, I disrobed again and reached for the gown.  No gown.  There I stood in this little booth half naked looking at the door.  I didn’t know what was on the other side but I was pretty sure there was a young man!  Maybe he’ll knock and tell me to come out.  Or not.  So I opened the door a crack and peeked into the next room.  There was a big CAT scan machine… “Hallo?” I said in my best German.  No one answered.  I peeked around the door further.  There was no one in the room.  I peeked further.  There, almost behind the opened door, was a window into the tech’s room.  The young man and a couple of young women, all in white, were messing with the controls in that room.  I was standing with my half naked body hidden behind the door, my head peeking around so that I could see them.  In my halting German I asked if I should come out into the room… naked.  “Yes” was the answer.  They were, or they acted, unaware of my embarrassment and went about the business of getting me situated on the CAT scan table and positioned properly.  They did a scan to see the “marker” that had been place in my breast at the former location of the tumor.  They marked my breast and chest with sharpies and covered the marks with waterproof tape that would stay on me throughout my treatment.  Between my embarrassment and the fact that they were touching my rib cage with cool fingers and pointed markers, tickling me, I started to giggle. My German is OK but I just didn’t know how to explain all of that.  They didn’t really know what to make of me but I came away from it knowing that "kitzlig" means ticklish in German.

My radiation started on that Wednesday in the Brustzentrum.  I was to start showing up each weekday at 7:10 am.  I was instructed to bring slippers and a hand towel.  They explained why… in German, so I only got part of it.  They don’t want me to wear shoes on the radiation table.  I didn’t get the part about the towel but figured that it was their concession to my modesty.  Wednesday morning I caught the #34 bus at 6:58 am.  I showed up in the radiation waiting room with my flipflops and a hand towel.  I was shown in to one of three booths like the dressing room on Monday. I was to strip to the waist and put my flipflops on and wait to be called.  Once again, there I was, in the little booth, half naked armed with a towel that was about 12” long and about 8” wide.  They called my name and I held my little towel up in front of my breasts and walked into the radiation room.   The same young man was there.  He gave me a funny smile, reached out and took my towel from me and laid it on the table.  “Please, lay down here with your feet there and your head there.” He said.  I could have laughed again but was able to control it this time.  The towel was so that they could move me around on the table without any friction to put me into position.  They were able to bring the mountain to Mohammed.  I became unembarrassed by walking out of my little booth topless.  I just can’t wait to go to the gynecologist in Germany!

Other new German words I came away with are “haut” and “jucken”  which mean “skin” and “to itch”.  I had an allergic reaction to the waterproof tape and my whole chest broke out in an itchy rash. “Strahlentherapie” means “radiation therapy” and the little dressing booths are “kabinen”.  I learned that Germans aren’t comfortable talking to strangers on the street or bus and avoid making eye contact, but if you are sitting in a doctors’ waiting room you are like family.  Germans are, of course, very efficient and I never had to actually wait in the waiting room except once when there was a problem with the machine and there were about eight of us waiting.  We ended up exchanging email addresses.

I frequently found myself feeling overwhelmed by all of the events of my life and feeling very tired as a result.  At some point the fatigue was more about the radiation than the emotional stress.  Some people don’t have that reaction but it really did a number on me.  I became so fatigued that simply going to radiation in the morning, coming home and having breakfast would wipe me out for several of hours.  I tried to get out and walk every day but eventually it didn’t seem worth how awful I would feel.  Thank heavens for my I-pad, because I read and read and read and had all of the books in the world at my fingertips.  I finished up radiation on the 14^th of May, the day before my Birthday!  What a birthday present!  I figured I’d be feeling pretty normal within a week or so.  Hah!  Then I read that you need at least a day of recovery for every day of treatment.  Well, that would mean 6 to 7 weeks for me, which was pretty much the case.  I still have some lingering effects more than 8 weeks later but I’m feeling so much better than I have since my surgery that I’m elated by my energy.

My follow up is that I am to get a mammogram every six months now and my doctor in the US prescribed Tamoxifen, which, in effect, blocks all estrogen in your body.  I haven’t started it yet and am very hesitant.  The side effects can be really annoying (like hot flashes) and really bad (like having a stroke) and I haven’t decided if the risk reduction is big enough to make it worth it.  I was going to start but Bob was asked to do a TDY (I really don’t know what that stands for) which is a temporary assignment, in The Gambia.  We had to get Yellow fever shots and take an antibiotic against Malaria.  Tamoxifen renders the antibiotic useless so I’ve postponed the decision until I’m finished with the prescription.

I have had so much going on since I finished radiation, but that is for another blog entry, which will be soon.