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MLA Full: "Let's Try Radiation Therapy!" YouTube, uploaded by vlogbrothers, 28 July 2023,
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Not my favorite thing I've ever done!

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Good morning John.

So my hospital, strangely enough, has a secret special entrance at the bottom of the parking garage just for cancer patients. The first time I arrived at this door and I read this little sign, I was like, "Oh shoot, we're gonna have to find some other way into the hospital." So yeah, it takes a little while to absorb the whole cancer patient thing. Doesn't really seem like that's you at first. But they do, once you're in there, hit you with a lot of signage at every opportunity to drive home the situation. Also, I feel like most hospital waiting rooms don't have this many tissues. Like, I feel bad for not crying when I'm in here.

John, today was my very first radiation therapy appointment, which was weird and I want to tell you about it. So just a quick recap: I started this all out with chemotherapy which killed so much of my cancer that they can no longer find it inside of me, which is great. But, they do think that it is likely that I still have what they call "microscopic disease" and it's probably centered in the area of my body where my lymph nodes were previously very swollen. We have a high-resolution picture of that from when I was for first diagnosed, and so the idea is to aim a beam of radiation at just that area of my body where my lymph nodes used to be swollen. And thus to just, like, explode whatever cancer cells are still in there because cancer cells are more susceptible to radiation than regular cells. Now, that doesn't mean that this isn't also gonna screw up some of my regular cells, it will just hurt the cancer cells worse.

Now I gotta say radiation therapy is a little weird. The whole idea is that you're gonna go lay down in front of a particle accelerator that's gonna shoot high-energy photons into you at, like, a rate that is somewhat comparable to what people who worked on the Fukushima Plant after it melted down received. It's enough radiation that if you got it to your whole body and all at once, rather than, like, spread out over several weeks the way that they do it, you would die. Like, you would die immediately and terribly. But they don't give it to you all at once, and they don't give it to your whole body so you don't die which is awesome. As I always say, not dying from radiation poisoning is amazing.

So yeah, it seems like it'd be a pretty intense experience, but it's not. It's entirely silent and you feel nothing. You lay there for eight minutes and then you go get McDonald's. Now, the thing itself is very cool. It moves around and it shoots from several different angles and the idea is that it can hit the diseased area like from this angle and then from this angle and then from this angle, and that means that the place where all those things are intersecting is getting a super high dose. Like, the cross gets the high dose but the finger parts get like half doses. And you do that five times and then where all the beams are meeting get five times the dose and all the other places get like one-fifth the dose of the middle. But also, in order to shape the beam so that's it's the exact size of, like, where my lymph node inflammation used to be. There's this adaptive shutter thing that, like, changes shape and it, like, almost looks alive.

It's very cool to see in person, but unlike the animation I just showed you, the radiation is invisible so it doesn't look or feel like anything. It's super bizarre because you know it's this big thing, but I like chemotherapy which like has a feeling. This is, like, nothing, which doesn't mean that it's not like a big deal and it's not dangerous. It turns out I'm a good candidate for radiation therapy. One because where my cancer was means they can hit it with a bunch of beams without hitting my heart. They're gonna hit like a little bit of my lung but not with a lot of dose and so that's not as much of a concern. And also it's because I'm kinda old. Like, if I was seven-years old, I'd have 80 years to potentially get a secondary cancer from my radiation therapy. But I'm 43, so I only got like half that time to develop a secondary cancer which means my chances of developing a secondary cancer are lower. Like, this is the math they have to do because treating cancer isn't really about getting the chances of cure as high as possible, it's getting the chances of cure as high as possible while also getting the chances of severe side effects from the treatment as low as possible. And those side effects are really significant. They could be, like, heart failure, like straight heart failure, where you have to either get a heart transplant or die. They can be secondary cancers that are more dangerous than the one that I currently have. You can get a pulmonary embolism. You can get a stroke. These aren't side effects that are annoying, they're are side effects that can kill you.

So cancer treatment, like a lot of things, is not so much about decisions as it is about trade-offs. Now, do I love the fact that we could be doing more to prevent relapse but we aren't because there's all these other things to consider? No, but, like, that's the situation we are in. So I laid there for eight minutes and then I went and got McDonald's and then I was on the wrong side of town so I DoorDashed boba to my house. And then judging from the receipt that I received, I got Dakota's sushi, and I assume that Dakota got my boba, so Dakota, I hope that you enjoy my boba because I am enjoying your sushi. 'Cause look, you gotta take what life gives you and life gave me cancer and Dakota's sushi.

John, I'll see you on Tuesday.