Quiz time everyone! Inanna and I posed for two photographs for this rebus type quiz.

Ok, I will entertain the possibly that those are not actual photographs of us, or maybe just not recent ones, but I digress. The question of the day is what do you get when a girdle is preceded by a pelvis?

You get a pelvic girdle! And here is another actual picture of me (colorized for your edification):

That, my friends is the pelvic girdle. My actual one (ok, that is an artists rendering) has a tumor somewhere around where the word “Rectum” is in the picture. You see how the rectum becomes the butthole, in my case the tumor is pretty much a full surgeon’s finger length in from there.

When I am lying down on Truebeam’s table and having my radiation therapy, the machine circles my body. It projects its beam, aiming at the tumor, as it traverses left-to-right across this picture, then continues across my back, across the other side, and then across the front of my body to the start position. This gives it access to every side of the tumor, and the entire pelvic girdle.

Chemotherapy is delivered directly into my bloodstream 24 hours a day, 7 days a week. Since it is in my blood, it is bathing everything in my pelvic girdle (not to mention every other body part). 5-FU basically works by messing with the DNA of quickly reproducing cells.

5-fluorouracil (5-FU) is a chemotherapeutical agent used to treat cancers including breast and colorectal. Working as an antimetabolite to prevent cell proliferation, it primarily inhibits the enzyme thymidylate synthase blocking the thymidine formation required for DNA synthesis. Although having a relatively short half-life (< 30 mins) it readily enters the brain by passive diffusion.  ~NIH

The effects are drastic on proliferating cells, which need to replicate their DNA; but not so severe in quiescent cells, where thymidine is less essential.

And combined chemotherapy and radiation therapy …

The scientific rationale for the use of chemoradiation derives from the preclinical and clinical observations of synergistic interactions between radiotherapy and chemotherapy. When chemotherapy and radiotherapy are administered together, the chemotherapeutic agents can sensitize the cancer cells to the effects of ionizing radiation, leading to increased tumor-killing effects within the radiotherapy field. This, in turn, can improve local control of the primary tumor and, in some cancers, render surgical resection unnecessary. In other cases, patients with tumors that were initially considered unresectable are able to undergo curative interventions after completing chemoradiation. The chemotherapy component can address any potential micrometastatic disease that, without therapy, leads to an increased risk of distant recurrence. A large body of evidence exists that supports the use of chemoradiotherapy in gastrointestinal cancers. In fact, one of the first tumor types in which the superior efficacy of chemoradiation was described was anal cancer. Since then, chemoradiotherapy has been explored in other gastrointestinal malignancies with superior outcomes when compared with either radiation or chemotherapy alone. ~NIH

Besides shrinking and somewhat killing the tumor, what else is going on?

Looking at the pelvic girdle, it ain’t just holding my tumor. Let’s see … bladder, urethra, prostate, testes, penis, and whatever holds them all together. And we cannot forget skin, folds of skin, hair, and butthole (easier to write than “anus” for some weird reason). All of them getting chemoradiated to different degrees.

I am doing this voluntarily, although my choices are limited. As to what are the side effects that I am experiencing?

• As you know, my nuts hurt. And are quickly becoming ineffectual.
• I am queasy fairly often.
• Tired and not much stamina. Napping does not seem to help. It is not debilitating, but it is frustrating.
• All typical signals from my lower bowel are confused. I know when I need to go to the bathroom but I have no clue what will happen. All typical sensors telling me if it is just gas, or “poop” or even at times needing to urinate are all screwed up, hence I just sit and find out.
• Urinating hurts. It is not a true pain as when one has a urinary infection, it is a horrible bizarre feeling that just radiates from there to everywhere. Sort of like a 20 second low level electric shock that just goes through me. I know that sounds strange, or awful, and it is one of those things where I just grin and bear it.
• Skin rashes are common in the area of radiation, particularly in the folds of skin. That means between your cheeks, top inside of thigh where they meet the body, etc. Also, even though there are no folds, you can get the rash on your the butt where you sit. This is because the radiation machine hates you. I am lucky, so far I am keeping these mostly at bay. Mostly.
• And diarrhea is common. And we know how much fun that is. I am going to buy stock in Imodium. And Aquaphor.
• Luckily the mammalian penis is basically just blood vessels, vacuous space, and nerves. Nothing for chemo or radiation to attack with much gusto. (That is a way in polite company for me to say “Yes, my penis still works, thank you for asking.”) But that is moot because for whatever reason, sometimes, but not all times, that feeling I mention about urinating … well … um … occurs anytime any fluid is leaving my body via this modality. Let’s just say there is nothing as much fun as a game of Russian Ejaculatory Roulette.

All in all, my pelvic girdle is a mess, most things concerning it hurt, and they will into August. But I will have a nice sterile pelvic girdle with a smaller tumor and the potential to be cancer free after surgery (September) and more chemo.

I will tell you that the continual discomfort does remind me of that corset phase I went through in college …

With all due respect to MLK …

No more radiation! No more 24/7 chemotherapy! No more dangling catheters, no more pump, no more nurse’s dirty looks.

• Two – three weeks of continued side effects.
• Eight weeks until surgery.
• Just maybe this will be all over by next Valentine’s Day.

Lord knows I owe her my having a healthy rectum again.