I’ve never been a fan of tattoos. It is a modern fad/fashion that I’m sure a lot of people are going to regret in a few years’ time as they get fatter or thinner, and the skin wrinkles and the ink spreads into indecipherable Rorschach blots. When I were a lad, I stank of Brut 33, had platform shoes, flared trousers, porn-star moustache, and eventually a mullet. All of those fashion statements were temporary, and apart from the odd photo, not a trace of any of them remains.
I swore I’d never get a tattoo. Well, now I’ve got three. One on each hip, and one strategically placed between them. They’re only little dots, like a biro mark. These allow the radiologists to align you perfectly each time you have a treatment. It is important that they can triangulate it precisely so that the beam of radiation is targeted at the right place, and not just randomly burning up your abdomen.
They get you to lie down on the bed of the Linear Accelerator, or “Linac” as they are called for short (and which is basically a very complicated bloody huge x-ray machine), and do what they call “imaging”. This is where you realise that you must never lie to your radiologist – they can see right through you. Which is a good thing, as they can pinpoint your prostate with 3-D precision and focus the beam right on it.
The strategically placed tattoo gave me some insight into more general cosmetic treatments as well as a visit to the NHS tattoo parlour. They use a bit of tape to help them get the mark in just the right place – I couldn’t see from the angle I was lying at, but I think the laser lights up the spot, and they then ink over where the laser was shining. Anyway, I wasn’t expecting a Brazilian as part of the treatment! Well, not quite, in reality it was just a few hairs from across my lower belly, but it gives you an insight.
Out-patient radiotherapy treatments at our local hospital are normally only done on weekdays, Monday to Friday. The imaging happens at least once a week, as the abdomen varies from day to day depending on how full your bladder and bowels are. Diet becomes important, and suddenly you get health professionals giving you all sorts of unexpected advice that you wouldn’t imagine would come from them. Suddenly you shouldn’t eat green vegetables, or beans, or onions, or cauliflower, or drink lemonade or beer, or indeed consume anything that might make you fart. Instead you are encouraged to eat nice things like eggs, bananas, or marshmallows, and drink lemon barley water (although peach barley water is much nicer). So you cut down on fibre and fizzy drinks. Your bladder would also appreciate it if you ease up significantly on the caffeine
Red meat and red wine are out, but chicken or fish with white wine didn’t get a mention on the banned list, so there’s hope for a nicely naughty meal every now and again… It does make Friday nights special, because you get weekends off and can be as full of gas as you like on Saturdays and Sundays. Friday night is curry night, and Saturday is cheeseburger with onions at the football. Yeay!
To prepare you for a session, they bring you into a sub-waiting area (which isn’t a great deal different to a waiting area, just smaller), and get you to empty your bladder, then fill it up again. They expect you to drink roughly a pint of water inside 20 minutes. While you are doing that, you also have to take your shoes off and put your over-socks on. My over-socks were grey, which annoyed me as the red ones that other people got looked much nicer. Apparently it’s based on shoe size which colour you get. Anything from UK size 9 upwards turns out to be XXL, which came as a bit of a shock to me: I thought size 9 was pretty average. But that’s why mine were grey.
One of the other things they do at our local hospital is give you a car park voucher, which gives you cheaper parking, especially handy as you are often delayed due to the need for the Linac machines to be re-booted from a software glitch or power failure. It takes about an hour and a half to re-boot them, so the delays can be quite lengthy. All of my visits have been under four hours, and a straightforward “in and out” was often only about 35 minutes, but you can’t guarantee it. The actual treatment takes no more than three minutes once you are aligned on the bed and any imaging has been done. My treatment was two roughly 360-degree passes of just over a minute each (times 37 visits!).
You have an appointment time, but don’t let that fool you. As you might gather from the re-boot time, the machines are incredibly complex and known to be a little temperamental. On Thursday 25th October, my 28th session was scheduled for 5.00pm. At about 2.30pm I had a phone call saying that they were having great problems with the machines, and could I possibly come in at 8.10pm instead? Yes, no problem, I only live 15 minutes from the hospital, so it wasn’t really an issue. Then about an hour later I had another call, this time they wondered if I could make it for 7.15pm instead. Short of having an endless supply of Linacs, there’s nothing they can do to magic up a better arrangement, but at least they communicate with you.
When I got there for what was now my 7.15pm appointment, the radiologists were clearly not happy with the whole scenario. We (there were five of us in the waiting area at this time) could either wait until at earliest 8.00pm or rearrange for another day. They offered me Saturday at 12.15pm instead. I was happy to agree because I didn’t want to drag the treatment out, especially as we had already arranged an end-of-treatment jolly for the evening of my 37th session. So I went in on the Saturday, and was actually in and out within 25 minutes, which was a record for me!
I digress: the car-park voucher, remember that? Because I drove in every time, I had to use the car park. I’m not sure I like the message on the exit gate from the main car park at our hospital. Once the machine has read your number plate and checked you have paid, it reads “Thank you”, followed by “Have a nice day”. And if you think about it, “have a nice day” isn’t even a pleasantry, it’s an instruction. What a sensitive thing to have a car park control point saying at a hospital. They clearly didn’t think of why people might park there in the first place. “I have to tell you you’ve got cancer. Have a nice day.” “Sorry to tell you your father/mother/partner has just died. Have a nice day.” “Your child is in intensive care. Have a nice day.” Please dear reader, do me a favour, and don’t ever say “have a nice day” to anyone you even remotely like.
The actual radiotherapy started on 17th September, and turned out to be a mostly painless experience. I say mostly because they get you to fill your bladder before you go in and lay on the bed. Any delay, and the urge to go, or at very least to cross your legs, gets stronger and stronger. That can be really uncomfortable, exacerbated because of course your mind is focused on staying as still as possible so that the radiation beam is hitting the target, and not some other delicate part of your anatomy by mistake.
When you lie down on the bed, with your shirt pulled up to your belly button and your underpants lowered below the buttocks, they get you to lift your knees to your chest to flatten your spine onto the bed. They can ask for me to “raise them to your chest” all they like, but actually I’ve not been able to do that since nineteen-eighty-something, so in a spirit of compromise it seems that a reasonable approximation will do. Then they elevate the bed so that you are up close to the big round x-ray delivery machine (the radiation head). Then two radiologists push me shove you into precise position, to ensure that the laser beams are lighting up on your tattoos. You’re not allowed to help them, just lie there and let them shove you into place. Only on a very few occasions did one or other of the radiologists have cold hands, so it’s usually fine.
For the first fortnight I wondered if they had put me on a placebo machine, as it didn’t seem to have any effect at all. Nothing seemed to change, and apart from holding in a full bladder, there was no sign of discomfort. At my weekly reviews I picked up some useful tips like using cornflour instead of talcum powder to help reduce the nappy rash effect of the sweats, as well as reassurance about the overall programme. Commercial talcum powder is made from talc, a mineral form of clay made up mainly of the elements magnesium, silicon, and oxygen, and having that mix powder-puffed around your groin wouldn’t help with their precise targeting of the x-rays.
Then at the beginning of week three my bowels decided to inform me that it wasn’t a placebo machine after all. Diarrhoea with a slime of blood in it. From then on I had to be aware of the impact on my bowels, and eventually worked out that for me a regime of one loperamide capsule every other day was ideal. Although the treatment is surreptitiously invasive, I think the susceptibility to diarrhoea isn’t helped by a combination of cutting down on the fibre as well as the collateral damage the radiotherapy can inflict. Other people I spoke to needed more help managing it, others less.
Of course as I’d had piles for about 30 years, that was an existing weak point. They became quite active as well in week three, which meant that I couldn’t really monitor any blood coming from inside. Good old Preparation H gel helped manage that. The haemorrhoids playing up meant that I couldn’t be certain whether my passing blood may have been a one-off. However the piles cleared up within a few days and there has been no sign of blood since then, so it seems to have been a short-lived problem for me. When I sat on the loo it did still feel as if I’d been living on a diet of nothing but scotch bonnet chillies for a while.
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