Proton Therapy

Before sitting down to Thanksgiving dinner each year, my mom makes us all write down what we are thankful for.  Two years ago I wrote, “Good Health”.  I remember this because I was lightly chided for picking such a lame and obvious thing – like saying I’m thankful for oxygen or photosynthesis.  And though I was only a month removed from running my first marathon and in great shape, I was sincere in being thankful for it.

Last year, we celebrated Thanksgiving in North Carolina, and as a family we ran an 8k Turkey Trot in the morning for fun and to maybe optimistically offset the binge eating on the horizon.  And aside from a few cyclocross races I did the month before where I was out of breath but I didn’t think anything of it because it was a new sport for me and I didn’t know what I was doing or what to expect, that 8k was the first time where I noticed a slight shortness of breath when I exerted myself.  Not enough to raise any red flags at the time, and certainly not enough to even jokingly think there was a tumor growing in my chest (though there was by that point), but I remember running with Matt at a conversational pace and, well, having a hard time conversing.  Maybe we were pushing the pace faster than I thought, or I was slightly out of shape, but I was fairly in tune with my body and knew how it responded when exercising and I knew something was just enough off that I made a mental note of it.

After these past 8 months, I don’t think anybody is going to question the importance I put on health.  This year, I’m thankful for science.  Because without medical science I literally would not be here to type this now.

So let me tell you some more about science.  Particularly Proton Therapy.  I’ve had 8 treatments at the proton therapy center in Warrenville so far (12 more to go).  Here’s how they typically go:

This is what the treatment room looks like:There is a custom back mold that was made for me when I got my initial planning scan done that rests on the bed and makes sure I’m in the same position each time.  It’s like a giant bean bag that had all of the air vacuumed out of it which made the beans retain their shape.  For my treatments, the beams of protons are directed from above me, not from the side like in the photo above.  The protons get there from a cyclotron and a bunch of magnets and vacuum tubes that look something like this behind the scenes:Lasers shine on my body and after making a few general adjustments so that the tattoos on my skin line up with the lasers, I get my custom molded mesh mask placed over my face and locked into place so that I stay reeeaaaalllly still.  The picture below isn’t my mask, but it’s the same idea and covers my neck because that’s part of the area where I get a dose of protons.Once I’m locked down, I get a couple X-rays taken to figure out my exact position in relation to the machine and how it compares to my original scan.  A few measurements based on those films are made, the table I’m laying on is moved slightly to correct, and more X-rays are taken to confirm the new position.  Repeat as necessary.

Once I’m in position, a large brass aperture shaped to my specific treatment area is loaded into the nozzle at the end of the machine.  It looks sort of like so:Only mine has a widely different opening in the middle.  In front of that brass disk, there’s a big plastic compensator that covers it and is carved out to different depths to control how much energy the beam of protons has in certain areas as it hits my body.  The biggest advantage of proton therapy over traditional photon therapy is that protons penetrate to a certain depth and then stop and dissipate all their energy, sparing the health tissue behind it, reducing the possible nasty side effects.

The actual beam of protons are then fired for about a minute.  Yes, it’s silent, and no, it doesn’t hurt.  In fact, I can’t feel a thing.  And then a different aperture and compensator are installed, I’m moved to a slightly different position, and everything is repeated again.  In total, I have 6 different combinations of beam shapes and positions that cumulatively add up to deliver the required doses in the necessary areas, but I only get 3 different ones on one day, and the other set of 3 every other day.  The whole process each day takes about 45 minutes from when I walk in the treatment room.  From my actual treatment plan, here’s where all the radiation is focused (front view):3D view (yellow tube in back is my spinal cord for reference):

It’s mostly concentrated around all the scar tissue right behind my breast bone, and then it splits at the top and goes up each side of my neck, sparing the esophagus in the middle.

The side effects are pretty minimal.  So far I have a skin rash in the treatment area that looks like a sunburn, and a perpetual sore throat.  I have a special ointment to alleviate the redness, but I’m told it’ll continue to get worse no matter what.  At least it doesn’t itch or throb or hurt like a sunburn on anything.  In another week or so, I should start to feel pretty fatigued, but that should be the extent of it.

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