Notes on my Radiation Plaque Therapy (Brachytherapy)

 

One of the purposes in setting up this blog was to not only share my experience with my friends & family but also with others who may be facing a similar challenge. The following is written for all those audiences. I realize some of the material may not be of interest to all, but trust that each audience finds something of value.

Matthew Costello with Radiation ShieldFollowing are my comments about my initial Plaque Therapy surgery.

I haven’t verified this statistic, but I am told approximately 25 people a year in Virginia are treated for ocular melanoma. That makes it an unusual occurrence.

Anticipation

I was anxious anticipating the procedure. Radiation Plaque Therapy is a process where a disk about the size of a quarter is attached by sutures to your eye. It is a custom-made disk designed to point radioactive seeds at your specific tumor.

Just wrapping my brain around the idea that something would be sewn to my eye took quite a bit of trust. I was never quite clear where on the eye it would be attached. As it happened in my case, it was attached to the back of the eye as that renders less pain since there are fewer nerves back there.

Throughout this process, my best friend Holly, gave me rides and provided the hospitality of her rural home in Gordonsville. A quiet, renovated stationmaster’s house about 20 yards from the railroad tracks.

The surgery was set for 7:30 am which meant we had to be at the hospital at 5:30 am. Consequently I had to be up be up by 3:30 am to get prepared and take the 40 minute ride in to Charlottesville. Being as I am a night owl, not going to bed usually between midnght and 2 am, this was a challenge. As it turned out I only got about 3 hours sleep.

Pre-op

I remember the drive into Charlottesville in the still dark of morning.  We managed to make good time and Holly’s calm presence helped me to keep my anxiety in check.

Once we arrived we found our way to the Family Surgical Lounge around 5:40 am. Soon my name was called and we were guided to the second floor where I was instructed to change into a hospital gown and await the plethora of doctors, nurses & anesthetists I would see before going in to surgery.

Everyone was warm & friendly. It was clear they were looking out for me. The operating room nurse came to give me an overview of how the procedure would unfold.  Finally the anesthetist proceeded to give me a sedative and take me to the Operating Room around 7:40.

The Procedure

Though I was sedated with versed, I was conscious throughout the entire procedure.

Because I have bad back and a soft tissue hump in my cervical area, it’s difficult for me to lay flat without pain, so the first order of business was to get me transferred from the pre-op bed to the operating table get me somewhat comfy with extra pillows strategically placed under various body parts. I was told I was also receiving some medicine for muscle relaxation. Despite these best efforts, by the time the procedure was over, my back was locked and I was feeling my usual back pain.

Though I don’t recall the entire sequence of events, here are things I do remember. Because I was sedated with versed, which can cause lapses in memory, there is a margin of error to my report.

I was given a local anesthetic which they called a “block”. It is like a lydocaine shot a dentist would administer only this time in my cheek just below my left eye. The OR nurse had warned me that it might hurt and she would be there to hold my hand. She jokingly said I could squeeze it hard if I needed, but, if it was too hard and broke it, I would have to pay for it.

One of the effects of this anesthesia is it affects the nerves to the eye in such a way as to cause temporary blindness in that eye. Thankfully I would not have to see the instruments and hands as they worked on my eye.

The doctor rubbed iodine around my eye, cheek & brow then some sort of plastic sheet was laid over me with my head poking through a hole in it.

Then another plastic layer was draped over my face. I had been warned about this as it may trigger my claustrophobia. I was grateful to have the versed running through the IV and that there was a tube with oxygen running under the sheet as well.

This sheet also had an opening for my left eye allowing the doctors access for the procedure but my good eye was blocked.  Because of the big light above them in the operating room, I could make out blurred shadows from time to time.

Throughout the procedure I remember him asking me questions and talking back & forth at various moments. I also recall feeling his hands on my face and my brow and around the eye as he did his work.

A “dummy” version of the plaque was sutured to my eye. As far as I could tell this was a way to test how the plaque should fit and make necessary adjustments before applying the real plaque.

They removed the dummy and proceeded to apply the real disk.

The vision in my left eye was slowly coming back as they put the real thing on, I could see vague shadows, not too distinguishable, the big light above them causing a reflection on my eye.

I was aware that he was suturing and would use the ultrasound to confirm details. In the lower left hand corner of my eye I could feel a stinging like a stick poking it, the Doctor said that would improve by the next day.

By the end all plastic was removed and my eye fitted with a lead shield and taped. I transferred back to the bed with some difficulty because of my back.

Post-op

My memory of the exact return to recovery is blurry. Holly arrived in recovery after 9:30.

I remember the nurse giving me pain medication intravenously and I accepted his offer of nausea meds. When they kicked in, however, I began to feel that drugged sleepiness that can just take you over and I wanted to resist it.

Back to Holly’s

The nurse got me to Holly’s car and on the way home we got french fries. I exclaimed how terrific the fries were because I was sooooooo hungry -  best french fries ever!

I remember getting back home, into the house, being up for a bit, talking to Holly, then slept most of afternoon.

After my nap, the local anesthetics were beginning to really wear off and my eye ached as if someone had punched me in the face.  I made phone calls to friends & family. My appetite was good and I had ham with fresh organic vegetables for lunch.

Later my heavy lead shield kept slipping out of its nested position on my eye and the tape came loose. Holly did a masterful job of re-taping. Later that evening we ate polenta for dinner outside.

That day was marked with letting all the drugs wear off. I’m not one who likes to take pain meds . My pain threshold has been tested many times over my life. I think one of the worst pains I have ever felt was pain caused by photophobia from an iritis – it can only be described as the feeling of a dagger being driven back into your head. So the pain from this procedure, while being bad, wasn’t anywhere near as bad as that. This was more of an unrelenting ache. I found Tylenol by itself was enough to keep it to a bothersome distraction the first day or so except for my first nights sleep. The pain awakened me about 5 am. I took some more Tylenol and was able to get back to sleep in about an hour.

Subsequent Days

On rising the day following the procedure, my eye ached and there was pressure along with drainage in my left nostril which kept up for most of the day. All of this quieted as the day went on. The second night’s sleep was much easier though parts of the day I had some queasiness which I think was from something I ate and eventually passed.

In general I was able to watch TV, read a little, work on this account at my computer and take naps in between. Except for the facts I was functioning with one eye, had the persistent ache and there were irritating itches underneath the shield, I was interested in staying occupied.

Of course it’s not over yet and there are still the concerns: will the removal of the plaque be as smooth? What will the after effects of the radiation be? I’ve been advised that I’ll have double vision for a few weeks after the procedure because of the pressure on the eye from the plaque. Over the next few years the center of my vision in my left eye will become permanently blurred and I won’t be able to read with that eye.

As I write this I have less than 24 hours before the second surgery where they take the plaque off. Once that’s done it still takes a few months for the tumor to shrivel.

So far, the procedure wasn’t anywhere as bad as I feared. Of course it’s something I would have preferred to not have experienced. The reasons for the procedure are still of great concern. I really had no choice. One way or another, it seems some form of sacrifice is called for when cancer shows up.

I’m just so grateful that I have such great support and seem to be ahead in the fight.