Twenty-five thousand people work at UW Medicine. Twenty-five THOUSAND people and I feel like I need them all. “The Radiation Oncology Services at the University of Washington Medical Center provide comprehensive and personalized evaluation, consultation, planning, radiotherapy and follow-up for patients with a wide range of cancers.” Yup, right off their website. Who doesn’t want comprehensive and personalized evaluation, consultation and planning? Of course I do. But right now I just want the PLAN. I was really hoping that today, after treatment number nine, Dr. Tseng was going to give me ‘the plan”; the number of proton boost treatments at ProCure, how many photon treatments at UWMC, and the date I would be going home. I would get the plan, put it in my schedule, go back to SCCA house and write a really upbeat post about the great weekend I had with Olivia and Stella. Write about what a great city Seattle is, how wonderful the medical staff are, how supportive and awesome my friends, family and strangers are, how cool the tour of the Boeing plant was yesterday… I will write that post, but first I need to wrap my head around moving forward with much less certainty and without a firm plan.
Nothing in Seattle happens without coffee, so first I will talk to my new friends at Carabiner Coffee and get the caffeine and wisdom I need to come to terms with my new treatment scenario. While the ubiquity of Starbucks is truly amazing, the number and variety of independent and small chain coffee shops in Seattle is staggering. Some are trying to be the next Starbucks, some are offering quirky alternatives to it, and then there are these guys, right outside SCCA House in a van with a kayak on the roof. They make great coffee and are invariably upbeat, happy, and encouraging. I leave my visits with them feeling like all is right with the world. Their mission, “to keep people awake while livin the dream”, is hard to argue with. And they are very grounded. You need to be very comfortable in your own skin to live and work in about nine square feet.
Today’s treatment was efficient and easy, unlike Monday’s when the x-ray lens got stuck while I was on the table. We had to wait for an engineer to fix it while I tried to meditate. Everything breaks down at some point and it was great to see how quickly it was dealt with. Afterwards I met with Dr. Tseng. I was looking for “the plan”, and I guess I got a plan, just not the one that I wanted.
The issue is that we are not getting good coverage of my tumor site with proton radiation. The protons are being attenuated by the hardware in my spine and as a result we are getting a shadow, or “cold spot” immediately behind the rods. The hardware itself is being radiated fine but in order to compensate for the shadow they would need to radiate to an unacceptable dose for my bowels. We have been talking for weeks about adding some photon treatment to get good coverage over all of the potential cancer sites; however it now looks like we need to add anterior photon radiation as well – radiating through my front to get at the tumor site. This will give us even dosage that conforms to the target area. According to Dr. Tseng, this new strategy developed by the dosimitrists “looks really nice”. It should limit damage to my bowels (I’m all for that) but brings a whole bunch of other organs into play. Instead of a firm plan going forward we are going to go day by day, looking at dosage achieved both where we want it and where we don’t. UWMC has a linear accelerator and a cone beam CT, which allows for 3D imaging. This technology, which is not available at the ProCure site will allow Dr. Tseng and the dosimitrists to achieve very tight margins and get an accurate view of progress. When we get good overall coverage and sufficient dosage at the tumor site, I will come back to ProCure for a final round of proton blast to the hardware. It is a plan; of course, it’s just not as nice and neat as I wanted it to be.
It’s all good though. Between two guys in a VW van, 25,000 medical staff at UWMC, the flood of friends, family and strangers supporting me and the Marshawn Lynch baseball, we have this covered. It’s all good. Now I can go back to writing that happy post…