IT HAPPENED TO ME Brendan Glackenon the stereotactic radiotherapy he is receiving to treat two inoperable brain tumours
HOORS IN my head, bastards in my brain. Sorry to be rude, but we are about to treat aggression with aggression.
Two inoperable brain tumours, reduced some months earlier with radiotherapy, are to be attacked again, this time by a treatment known as stereotactic radiotherapy.
This is a technique used in the delivery of concentrated doses of radiation to small areas of the brain. I am hoping it will blast to Hell the aliens, the tumours - but of course that's not the way it works.
The more optimistic hope is that the treatment will further reduce the size of the offenders, which are small but lethal, like young children, except with no charm. They are now in situ almost two years, causing me utter frustration, to put it mildly, because of the relentless nature of cancer. Which is why I am determined on infanticide, so to speak. Die, you little f***ing monsters.
Once again I am in the tranquil and comforting surroundings of that oasis known as St Luke's Hospital in Rathgar, where I lie down on a treatment couch in the radiotherapy area.
The initial part of the treatment involves creating a careful mould of the teeth, using a sort of putty. When it hardens, the technician attaches a metal dental frame which has to be applied precisely and tightly. (Precision is a word I will hear quite often during the whole treatment).
There is absolutely no pain, just a modicum of discomfort. Then frame and mould are removed as one vertically from the face (easier said than done, sometimes) and the initial preparation for stereotactic radiotherapy is done. It has taken about half an hour.
A good time for a cup of tea and to admire the hospital's art collection. A couple of days later I return for the more high-tech part of the treatment.
Initially I was diagnosed with lung cancer two years ago (I never smoked) and this gave rise to two brain tumours. I was treated using radiotherapy and I was fortunate that not only were the side effects minimal, probably because of underlying good health and fitness, but the radiotherapy worked particularly well, reducing both brain tumours by small percentages. During and after initial treatment I enjoyed relatively good health, except for the old bugbear, fatigue. (The lung cancer is currently in remission).
However, despite three weeks in hospital, radiotherapy and chemotherapy, a long holiday and extended sick leave, I returned to work to find to my shock and disappointment that I was quite unable to rise to the demands of my job as parliamentary reporter.
When I was first recruited some five years ago, I was told pithily that speed and accuracy were the two essentials; as a result of illness, which was affecting my speech, reading and general comprehension much more than I had realised, I was now woefully inadequate in those areas.
And attempting to cope with the job for the first few days back, at the beginning of the new Dáil session in September, I experienced serious headaches.
The consultant oncologists under whom my excellent care was in St Vincent's and St Luke's decided on stereotactic radiotherapy.
So now I found myself ready for the second and final part of the treatment, where I am back in St Luke's under the good care of Anne Marie McArdle, clinical specialist in radiation therapy.
She explains more about stereotactic radiotherapy, which was originally developed in Scandinavia and is usually given as a boost treatment - just as it was in my case - either before or after a course of normal radiotherapy.
On average in Ireland, just two people are chosen weekly for the treatment, which is available only in St Luke's. It's not a lottery - the candidates are selected by the multidisciplinary team of doctors and oncologists having considered a variety of relevant medical factors.
I lie on to the Cat scan bed, and the dental frame with mould, personally tailored, so to speak, a couple of days earlier, is again fitted into my mouth. Above that is fitted another metal frame or helmet which has several hundred tiny holes in it to allow individual rays of radiation to target specific areas of the brain.
It may sound a little scary, but the experience is entirely pain-free.
Some people might find it claustrophobic, what with the tight restrictions of the metal frames, but sedation is on offer if asked for. Specially adapted linear accelerators are used, which work by producing beams of high energy X-rays which kill cancer cells (and healthy cells, which repair themselves).
Three of the radiation team - a specialist team on the day, including physicists, who measure the radiation doses - now check the equipment and plan and confirm the points of attack for the radiation.
This is a high-precision operation, with the radiation therapists confirming out loud the pre-selected points, and a computer is used to build up a three-dimensional picture of the area to be treated.
The team now leaves the room, and I hear only the by-now-familiar sound of the doors air-locking. And then silence. (On one occasion I was left listening to country music, possibly The Blanket on the Ground).
Through the window, by means of computer, five areas of the brain are treated by means of the linear accelerators or LinAcs, which rotate through a series of arcs from different angles. As the bed is moved, radiotherapy is delivered to a small volume of tissue.
The team returns and repeats the procedure with another five areas. All this took about 40 minutes.
The real benefit of the treatment is that a full week's precision radiation treatment is given in a single day.
I suffered no side effects or reaction that I knew. A couple of weeks later I met the consultant, and the news was good, in that the tumours were further reduced.
Unfortunately the headaches returned, so I have had to go back on steroids, which can create their own ongoing and serious problems. Nevertheless in terms of day-to-day living, I feel in relatively good health, though at the end of some days I feel as if I have been used as a sparring partner by Mike Tyson; and with the familiar "moonface" of those on steroid treatment, I look like a cross between a chipmunk, Oliver Hardy and an elderly orangutan.
Just as well as I am not vain . . . In the meantime I remain very grateful for the opportunity for undergoing the procedure, for the work of the brilliant professionals involved throughout a period of nearly two years, and for the ongoing care they have shown.
PS: A couple of years ago, Mike Tyson was defeated by an Irishman.
bglacken@ireland.com
• Useful contacts: www.cancer.ie (the Irish Cancer Society); www.cancer.org; www.rtanswers.org; www.cancerbackup.org.uk; St Luke's Institute of Cancer Research
• Readers who would like to talk about their own health experience, good or bad, can contact this column at healthsupplement@irish-times.ie