September 3rd, 2009:

Eileen and I went to see Dr. Barani at UCSF Mt. Parnassus on Tuesday afternoon. His task was to take a look at me and see if my pelvic tumor could be radiated to shrink it for better mobility and pain control. Since this was the first time he'd seen me, and since my last CT and MRI scans were taken in May, no one expected any major decisions to be made that day. Walking into the hospital, I had a couple of creepy moments as I recalled entering the same hospital for chemo many months prior. Especially, I remembered what it was like to stagger out of the hospital into Gaetano's car for my ride home, racked with nausea, dizziness, weakness, fatigue. Then I stepped through those memories and headed for Radiation Oncology.

The visit with Dr. Barani turned into Radiology 101: An Introductory Course. Basically, he told me about what to expect from treatment planning to the impact of radiation on specific parts of my body. Starting with the overall procedure, he said that the treatments would be strong rather than weak and they would be done quickly rather than extended out over several weeks. His initial sense was that I would get a treatment every day, five days a week, for three weeks. Fifteen treatments in total. By giving me higher doses, he would also risk greater toxicity.

As for impact to the various parts of my body, I could expect the following risks to the following places. Radiation burns the skin so my pelvic skin would be affected and treated with gel pads to ease the stinging. This would last during the treatment period and for two to four weeks after treatment. There are no expected long term effects. Lymph nodes hit by the radiation would be damaged and this would affect their ability to cleanse my right leg with lymphatic fluid which would create edema (watery swelling of the calf, ankle and foot due to poor circulation). An open question would be how much the lymph nodes and their circulatory passages could repair themselves, or not. During treatment the bladder would send me the message--it's time to pee!--more often. Worst case would be a short period of incontinence whose solution is: diapers. In conspiracy with the bladder, my prostate would send urgent, frequent messages about urinating. Again, worst case solution during the time of treatment might be a Foley catheter.

The biggest risk comes from possible damage to the large and small bowel and rectum. Depending on how much the tumor has penetrated the walls of the bowels and rectum, killing the tumor cells would potentially weaken the walls of my excretory system. This could be truly dangerous and might involve surgical repair. Of all the issues Dr. Barani raised, this possibility was the most frightening, damaging and risky.

What happens next? I've been scheduled for an MRI mid next week and CT scans for my pelvis and thigh will also be scheduled. Once we have the scans, Dr. Barani will be able to give a more informed assessment. Once I hear his evaluation, I'll be able to make a more informed decision about what to do. Of course, I'd like to walk for many more months. After my experience this week of not being able to hobble for a block on a couple of occasions, I am starting to face not reduced mobility, rather immobility. It's is a very difficult prospect. I turn away from it after every short, incredulous realization. But, this is how I absorb really big fears: a blip at a time. Back in the worst days of AIDS, we used to call it Terror Management.

Note: I happened to read the previous posting and was startled by the number of syntax errors. I spellcheck these drafts and review them prior to posting them. Was I on drugs? It annoyed me to see the number of typing mistakes that crept into the text, especially toward the end of the posting. Quality control never stops.