memelaina | Mem and the Magic Dildo (Part One)

Keywords (bracytherapy vaginal_bracytherapy)

Okay, today I had my first session of radiation. Unless you are female and/or going through this yourself or with someone you love, this is probably going to be WAY, WAY too much information. I'm putting it behind a cut. Dad, you don't want to read this.

What I had was high-dose internal vaginal brachytherapy (brak-e-THER-uh-pee). I looked it all up on the web before hand and talked extensively to my doctor, so I had some idea what was going to happen, but it seemed to me that everything on the web was from a scientific, medical viewpoint and not from a personal viewpoint. So I decided that I would blog about it.

Last month I had a radical hysterectomy (uterus, tubes, and ovaries as well as two lymph node clusters) for endometrial cancer - that's cancer on the uterine wall. We had caught the cancer very early. Ladies, if you have ANY vaginal bleeding after menopause GO TO THE DOCTOR RIGHT AWAY. No one had ever told me that specifically, but I did. The surgery was successful and I was classed as a stage 1A cancer patient but my surgeon sent me on to a gynecological radiation oncologist. He suggested that I do three sessions of high-dose brachytherapy as a precaution against the cancer returning in my vagina. The statistics were compelling, the side effects seemed minor, my insurance would pay for it, and I agreed.

The doctor described the procedure and prescribed me three doses of Xanax - one to take before each session. I thought that this was mainly for nerves, but it turns out it has a significant effect on the ability to relax and stay in place without moving for about an hour and a half. Here's what happened from my viewpoint.

The major concern with my pre-procedure instructions seemed to be with me having some urine in my bladder, but not too much, and with having had a bowel movement within the last day. Neither of these things was an issue for me. I went to the bathroom when I got up at sixish and then had a cup of coffee. Everything was fine when I went to the hospital at 10am. Oh, they told me to bring warm socks, and I did, but I didn't use them. I imagine some people would be chilly, but I tend to be overly warm and was more than warm enough in the procedure rooms.

I came into the waiting room and signed in. A nurse came out to get me within a few minutes and stayed with me through the whole procedure. First she took me into a CT scan room and I removed my pants (no underwear yet, it still rubs on my healing incisions) and laid down at the very end of a long very hard table. The CT tech attached large, padded stirrups to the table that were like the ones on the operating table when I had my surgery. Not little stirrup cups for your feet, but big whole-leg holders. She set me up and the doctor came in and chatted with me while he did a pelvic exam and then used a needle through the speculum to insert a tiny gold bead in the very top of my vagina. He told me as he was doing this and I felt the littlest bit of pressure, but no pain.

Then the nurse and the tech disassembled the exam apparatus and had me stand up while they set up the CT scan bench. If you have never had a CT scan it's like a huge white donut (or kind of like the Star Gate on a room sized level) and you lay on a bench and the bench moves you automatically in and out of the donut to scan your innards. My attendants carefully put down a thick pad for me to lay on and helped me to get very comfortable with my legs raised and a bit to the side, and then braced into a somewhat more relaxed position with lots of pillows. They let me know that while and after the CT scan was being done I could not move at all. They gave me a little padded oval ring to hold in my hands against my chest. I could move my hands but couldn't significantly move my arms (couldn't stretch them over my head or lay them down at my sides) as that would change the position of my torso.

The doctor came back in and told me that he was going to insert the device (which, to everyone's amusement, I insisted on calling a magic dildo). He told me that there were several sizes, but that they always wanted to use the largest device possible because the larger the device the more evenly and specifically they could use the radioactive material to target a particular area. Since I've done three vaginal births, I'm pretty stretched out and he was able to use their largest cylinder. It was not uncomfortable, although as time moved on I felt the pressure more and more on my bladder and by the end really needed to pee.

Next was the CT scan. The purpose of this was to take pictures showing exactly where the various parts of the cylinder were in relation to the gold marker. This part took several minutes - maybe ten? - and I kept my eyes closed because I am fairly claustrophobic and don't like looking up and seeing myself in the donut hole. Probably the xanax helped with this as well. They moved me in and out through the CT scanner several times. When that was done, and the doctor knew exactly to the micrometer where everything was, my nurse, the CT tech, and another tech came in and moved me from the scanner bench onto a regular gurney using a slide board. I was told to just relax, not move, and not try to help. I weigh 260 some pounds, but they made the whole thing smooth as cream. Once on the gurney they were able to put up side bars (the CT bench doesn't have those) and I felt very secure. My nurse wheeled me down the hall to the radiation therapy room.

The next part was about 45 minutes of waiting without moving. My marvelous nurse stood right beside me and engaged me in pleasant conversation. We talked about her children, my children, and how she'd spent some years with the military in Germany. She also showed me a very, very thin coil of wire. This, she said, was the non-radioactive wire they would use to insert through the machine into my magic dildo and be sure they got the placements correct. The real wire was just like it but had a tiny hole drilled in the end and a bit of radioactive material inserted and then soldered over.

Now folks, they had told me that they were going to use a cord to attach my magic dildo to a radiation machine and that the radioactive pellet would be automatically delivered and withdrawn while I was alone in the room. I envisioned a plastic tube like a big soda straw with little glowing rocks being pushed along it by some unknown force. 'twasn't NOTHIN' like that. If you imagine the thinnest possible piece of pencil lead that can be used in a mechanical pencil, and then break off a piece of it less that 1/8 of an inch long - well that might be three of four times the size of the 'pellet' that goes inside the tip of the tiny wire. The "cord" was about half the size of an HDMI cable (like for cable TV) and the cord attached to the end of the magic dildo and then the wire was pushed through the cord and into me with pinpoint precision. More than that. I think a pin like I use in sewing would be way bigger than the accuracy they were achieving.

So, when the doctor and the physicist (physicist!) had finally figured out my exact treatment plan and programmed the radiation computer the physicist came in with a Geiger counter and did a background radiation check. This part fascinated

lisajulie who wanted to know what exact readings they were getting and looking for, but I'm a different kind of geek and so not only didn't I ask, but I wouldn't have understood anyway. Then I was told to lie still and relax and everyone left the room. I was being monitored by cameras and there was an audio system as well. My nurse spoke to me encouragingly every few minutes giving me a countdown on the time (total treatment was twelve minutes) and making sure I was okay. The machine whirred and whizzed and clicked a bit as the wire and radioactive pellet moved into the magic dildo and then did a few minutes at one location and then moved a little and did a couple more minutes. There was no sensation whatsoever.

When it was done they all came back in the room and the physicist took another Geiger counter reading (she introduced herself but didn't talk much) and the doctor disconnected the cord and removed the magic dildo. I asked to see it. He seemed a little surprised and asked if I was sure. I told him I was and he held it up briefly before putting it in a basin that they laid between my lower legs and covered with the blanket. Then they wheeled me out to an exam room down the hall where my nurse used warm water to wash me up and dry me off. She had me sit up on the side of the gurney for a few minutes before standing to put my pants back on.

At that point I got to have a good look at the magic dildo. It was unglazed white ceramic with some lettering at the bottom that I assume described the size. It was slightly larger at the top than at the base and had a metal piece coming out the bottom end with a couple of attachy bits. Frankly, it looked more like a white corndog on a stick than anything else. It wasn't huge. Now I know there's a lot of supposed 'humor' about size but I'd say it was six to seven inches in length and maybe a little bigger around than when I make a circle of my thumb and forefinger. Ladies, I've been with guys larger than that - not many but a few. No reason to be scared about the size. It's a non-issue.

Since I was feeling fine, my nurse walked me back out to the waiting room. She asked me if I wanted to urinate, but I no longer had the need. So I sat for just a couple minutes with my husband while she copied my paperwork then she came back out, handed it to me, gave me a hug and told me I had done really well.

And it was over.

I have two more treatments, both of which should be shorter because the initial measurements and treatment plan are already complete. I'll write more to comment on those when they happen.

My basic reaction was that everyone involved was a warm, pleasant, caring individual. They made me feel like a person and not a specimen. They explained things carefully. They were very matter-of-fact about doing things and touching me in ways that usually have sexual overtones, but in this context simply did not. I felt throughout that everyone was taking it all quite seriously, but that their objectives were as much caring for ME as they were making sure everything was done exactly, perfectly, and precisely right. I felt both treated and treasured.

As side-effects, I had been told to expect frequent urination (which I've had), some diarrhea (which I have not), and to feel tired (I napped all afternoon and still feel tired and wrung out).

I sincerely hope that this narrative is useful to some other patients who are facing this therapy.