Radiation - too close to heart - breath holding technique
I was planning on doing my radiation at the local hospital. After the CT scan, my radiation doctor said that she's concerned that it's too close to my heart. She recommended me to do the radiation at Mass Gen where I had my surgery.
I went to Mass Gen and did the CT scan/preparation. At one point they told me to take a deep breath as deep as possible and hold it while they measured how wide my lung can expand thus pushing out the heart. They said that there are other techniques they could use but they'll start with breath holding.
Has anyone experienced this? How would I know if my deepest breathing is deep enough to push the heart out of the way? Supposely, the tech can watch and see if the heart is out of the way. But how would I know?
Comments
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The tech and possibly the radiation oncologist can monitor you live time on the CT viewer, and give feedback to you on how you are doing. It's important not to get too tense on how you are doing as anxiety might cause you to breath more shallow and faster. If you're prone to anxiety, some pre-radiation Clonazepam ( a quick acting anxiety relieving drug) may help. Mass General is a great institution at which to have this done with dedicated modern radiation units, computers and team approach, and I should hope the techs/physicians will guide you through this time.
My best to you,
Tender
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Hey there! We seem to have the same diagnois and the same annoying heart set-up. My set-up is the 22d and first day is the 23--I'll be sure to post on the 22d to tell you what to expect.
I am doing my rads with the same set-up as you but on the west coast [Swedish in Seattle]. I did the first check-up on Monday but had to go back on Tuesday to do the breathing set-up. Not sure if its the same all over but I was given an tube with a mouthpiece to clench in my teeth. Then they put a clip on my nose. I had to breath normally and then breathe deeply as instructed while they did another CAT scan. What my rad onc said was that when you breathe deeply, your heart is moved back against your spine.
The biggest problem was that I took some deep breathes at the wrong time so we had to do it again.
It is scary to think about the risk of heart damage. My mother has been diagnoised with heart failure and while she is 81, its still scary because they don't know what caused it. The idea that there might be a risk down the road is nerve wracking. ...
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Thanks Tender for your reply! Thanks for the suggestion about the med. I think I should be okay but I'll keep it in mind just in case.
Hello 3monstmama - We really almost have the same schedule. My simulation is the 23rd and the first rad is 24th. From what you described, they did more on you than me. They didn't give me a mouthpiece nor did they clip my nose. I wouldn't mind if they did because that might help to make it secure.
My local doctor said that she didn't think that all doctors would mention this to their patients and most would just go ahead do the rad. But she really didn't want something happen to me 10 or 15 years from now. She even went as far as spoken to the doctor at MGH for me. Anyway, good luck to you on the 22rd and I'll wait for your post.
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I had rads after mastectomy on my left side so was concerned about this. They did the breath holding technique and supposedly didn't hit the heart. They are so precise with their measurements and I got x-rays each and every time I got rads to make sure placement was correct. I had a lot of faith in my rads oncologist and my techs were EXCELLENT. MGH is a great hospital and hopefully your experience will be a good one too. My rads were a year ago and I've had no problems other than an annoying cough which lasted about 3 months but then went away. Good luck and have faith - we've come a long way with technology and those machines are much more exact than they used to be. Having said that, you'll know if your techs are being thorough and will come to learn about all the quality control they will do each day before delivering the radiation...
Good luck to you,
Jackie
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Hi JacquelineG,
Thanks for sharing. Good to know that you had gone through it without problem. I am cuirous about the annoying cough. Was it caused by radiation?
Mei
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HI All,
Many of us with BC on the left side present heart issues. I had IMRT with breath holding. So far, no heart complications but who knows down the road. Just have to hope everyone is doing the best they can for you. I developed a tickle cough half way through rads that cleared up within a few weeks of the end of radiation. Cough was listed as a possible SE on the papers I signed but my rad onc never admitted there was a connection. I am sure there was.
I am fine now. No shortness of breath, no cough, NO CANCER I hope.
pam
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I just finished rads on my left breast and was put in prone position, as this supposedly lessened potential damage to heart. Does anyone know anymore about this? Does MGH use the prone postion?
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Hi bichonlvr03,
MGH did not use the prone position for me. Since my simulation is going to be next Tuesday, I will ask the doctor about it. Here I find another thread on this board about this topic:
http://community.breastcancer.org/forum/70/topic/720735
Hope this is helpful.
pj12345, I just read about IMRT. I actually don't know extactly what type of radiation they are going to use on me. I will have to ask next Tuesday. Thanks for your information!
Mei
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Does the amount of radiation total a person gets depend on their stage of cancer? For instance, a DCIS stage 0 would get less radiation total than someone with stage 3? Another question to ask next appt.
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I'm just a newbie to this. Have radiation appt in a week for set up, simulation and whatever else they do. Are estimating a 1.5 hr apt. What I'm wondering:
1. Are you cold being half naked during the radiation treatment?
Also, rad. onc at first discussion talked about the holding breath technnique to keep heart out of radiation field.
2. How long do you have to hold your breath? How many times do you do that in a treatment session? How long are the sessions?
I'm sure he will answer my questions when I go on the 29th, but meanwhile I'm searching for the answers.
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Dry run today, over and done. I'm not sure why they really call it a dry run--yes it was in the room where I'll get my treatments and yes I lay down on the table but otherwise, it was just a bunch of xrays to check again on the positioning. I will say that doing it for real was easier than doing it when they did the mark-up---I didn't have to breathe exactly when they said but rather got a "when you are ready, breathe." Barring anything funky with my xrays, then we will be starting tomorrow, Tuesday at 8:15. . . .
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Patients can receive gated treatments meaning they hold their breath and regulate the amount or lung volume in the beam to spare tissue. Organ motion management is relatively common now. Also patients can be treated in the prone position to avoid heart and excessive lung.
The vendors have different ways to accomplish this. Varian has one way and Elekta/CMS another and the large academic centers might fine tune their options.
Harvard (MGH/Dana Farber) has a long history of excellence in the conservative management of breast disease. They still do.
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To all, Just finished IMRT (breath hold technique) in January for left breast...They would have me hold my breath 2 short times for set-up and 2 longer times about 15-25 seconds....Not hard to do, was very quick and easy, in and out of there in no time at all...I don't think you will need extra meds....I was told that this method displaced the heart and lungs from chest wall while moving the breast into the treatment field...Compared to others in my December Rads group here on this site, my se's were minimal, I had changed my diet to mostly whole foods, very little meat, more fish and I amazed my Rad doctor with having fewer problems than most of her patients....She even had me write out the plan I followed so she could pass it on to other patients...
My only problem was a day that a new tech was allowed to do my radiation when she was not familiar with my treatment.."That was a bad bad day, I almost jumped off the table not knowing that it was about 5 feet off the ground!!!"..Know your routine and question when it is done different!!!
Also I am at this time fighting my insurance company because the way these treatments were coded, I was charged an office visit charge for each....
beceen, my techs would put a warm blanket on me during treatments, it was a nice touch....
good luck till all, it goes faster than you think.....
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I appreciate the information. It always seen the unknown is so much scarier than the actual process. Not knowing if it was cancer when I was totally not expecting anything like that. ho family history, no suspicion, was much worse than after it was confirmed.
Warm blanket would be a lovely touch. They usually do that at my clinic/hospital, so hopefully they will do it for radiation treatments. I hate holding my breath though, so am dreading that part of it. They said they will do some kind of breathing test first, next Monday.
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beceen,
I was freezing all during rads. I wore long pants or long skirts and two pairs of socks. They laid blankets on me but not warm ones. I was so cold I shivered the whole time.
Also I had gating or breath holding. We "practiced" the day of my simulation and each breath hold was two or three seconds. They told you when to inhale and when to exhale. So the first day of real treatment I did not realize that I would be holding my breath 20-30 seconds. My brain had a lot of panicy thoughts that first 30 seconds :-) It turned out to be easy to do.
I found RT very stressful but got thru it fine. In fact it is a little hard to get used to ending it. You get to feeling like you are doing so much to fight your cancer when it is going on.
Good luck.
pam
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My radiation started today. I found that the treatment itself was much shorter than all the preparation and simulation.
Yesterday's simulation took about 40 minutes. After they finished they told me that they did a lot of "art work" on my chest and I could wash it off. Today the first part was for them to take x-ray pictures. That took about 20 minutes. Each time they say "Breathe In" I was to hold my breath until they say "Breathe" to release. This repeated many times sometimes I hold for 20 seconds and sometimes I hold for 2 seconds. During the hold, they would push a button to actually do something, a red light in the room will come on accompanied by a beeping sound. When they stop whatever they are doing the beep stops and the red light goes off. This is very helpful because I will definitely hold my breath for as long as that beep is on. During the actual treatment I only had to hold my breath for 20 seconds a couple of times, and a few seconds a few times. It's finished much faster than I thought.
I asked the tech how would they know how much radiation to give. She said that doctors write prescriptions just like prescriptions for medication. Based on each patient's situation, the doctor determines this prescription which tells the tech how to administer the radiation.
By the way, I was not cold in the room. I ware my long underwear, but I think the room temperature was reasonable. Sometimes doctor's office has temperature turned too low, it's crazy.
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Hello everyone. I am having my third radiation treatment this afternoon. So far so good no pain just a little soreness in the breast. I am happy that I found you all. I am 67 and live in AZ.
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Hello 2Cats! Welcome on board. Someone suggested to put on your lotion as soon as you come out of the radiation in the changing room. That's what I have been doing. It looks like we have the same schedule. Good luck to us :-)
Where in AZ do you live? I lived in Tucson for 12 years and loved it and still have many friends there.
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I am doing the breathing technique to audio" breath in, hold, two three, breathe out". Anyone else do this? Listening to that audio over and over and over is so stressful. It doesn't give a person a chance to concentrate on anything but why you are there. The first treatment of course was the worst as that lasted for 40 minutes and had to do that breathing audio the entire time. I literally did not know how I would make it through 32 more.
Today was my 7th and even they only last 5 minutes, but I still find it so difficult. When I drive home, I jump at the slightest unexpected noise. I thought things were going better until today. I'm just wondering if anyone else has done this particular breathing technique. And it is so cool in that room, you're half naked with chest just partially covered and that cool air blowing all the time. I do fine until I'm in position and then it's just hard to keep it together.
When I saw my onc doctor Tuesday he asked me how things were going and I just don't know why it is so difficult.
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beceen, what you describe is different than my experience. We must have different systems.
I am on the table lying on my back with what we call the scuba thing in my mouth with a tube that goes down and something that connects to a machine and a clamp on my nose. I breathe in and out through the scuba thing. When I take a really deep breathe, the machine "locks" while I hold my breathe. If I were to try to breathe out before the right time, it doesn't really go anywhere. Oh by the way, the radition machine I am on is called the precise but I'm not sure if thats the "name" or the hospital's name.
So the tech says take a deep breathe when you are ready, I take a deep breathe [and visualize my heart sliding out of range of the rays and think "ZapLand is good for me"], the machine goes zzzzzzzzzzzrrrrrrrrrrrrrrrrrrrrrr, like an annoying mosquito, then the tech says release or breathe. This repeats 3x in each position.
But there is no counting on my part. Hope this is useful.
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After rad #7, I had an inflammatory reaction to radiation resulting in pericarditis and a 5 day stay in the hospital. After a one week break from radiation, my heart block was enlarged and have had no problem since. Am now on mega anti inflammatories, being followed by a cardiologist, and am holding my breathe (both literally and figuratively) until this is done. Anyone else have this problem?
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Oh npgbold, I am sorry to hear this happened to you.
After my persistent questioning, I just found out from my unwilling-to-share-anything-doctor that with breath holding, my lung and heart still receive a small amount of radiation. But to them, the amount is "clinically insignificant". I was some what upset because even if it is clinically insignificant, I have the right to know and they should have told me up front.
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Npgbold I'm so sorry you hare having such a rough time. When is your last day? I hope things are smooth from here on out.
xiaomei I was aware of the clinically insignificant part re zapping. I seem to recall I was told that one part of my lung would probably be hit a little. I don't think they can completely avoid it but I definitely agree that you should have been told upfront.
for what its worth, when I lie on the table and take in my breathe, I try to visualize my heart sliding back in my chest towards my right arm/shoulder [its the best I can do on visualizing it away from the zaps]. So far, I haven't had any coughing or anything involving chest pain, just stupid red and, just this week, blisters. Today I will be having treatment 27. My boosts start on Monday.
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3monstmama Just got home from #22 - 6 more whole breast rads and 8 boosts to go....scheduled to finish on May 19...must say I am now getting VERY CLOSE monitoring from my rad onc. The SE is very rare....<5% - guess..... I was just lucky! However, everytime i get a twinge, i worry! On the bright side, my skin looks great (relatively speaking!)
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I'm a little confused about this. I'm having IMRT and was told that this new machine is so zoned and has blocks that protects your heart/lungs. They do not have me hold my breath. But I will ask about this again to clear up confusion. Maybe it depends on what "Type" of equipment each has and rather it's older or new, 3D or IMRT or ?
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I had IMRT on a Varian accellerator. I did the breath holding technique too. My tumor was in the outer upper quadrant of my left breast. I had a tickle cough during rads that cleared up right away. No heart stuff - yet - but that shows up years later. :-(
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A couple of you wrote that a "clinically insignificant" amount of your lung gets radiation. What exact amount is considered "clinically insignificant"? I am still in the simulation process pre-radiation and they are havng trouble with my radiation perscrip due to the amount of rad getting in my lung ...they say approximately 13%. Should this concern me? They say that amount is technically acceptable even in Mayo Clinic however, we are going to try another CT scan today on my tummy hoping gravity will allow a radx perscrip to not get so much of my lung. Anyone know the specifics about acceptable amount/limits of radx to the lung? Also has anyone else had success getting with their radx lying on their tummy?
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I have to admit, this issue is one of the most fear-inducing issues of my entire treatment plan.
I didn't have deep concerns about the lumpectomy (though I am still considering a bilateral when this is all over).
I didn't have deep concerns about all the potential side effects of the chemo, including the hair loss and all the other serious potential side effects.
But the idea of radiating and damaging my heart is making me almot paralyzed regarding my radition treatment plan.
My tumor was not only in my left breat, but it was fairly close to the center -- near the breastbone.
I think I may need some anti-anxiety drugs if I'm to even start these treatments.
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I was told that most of the issues with side effects come in places where they do not specialize in radiation linked to breast cancer or where they are not participating in studies. It also helps if you see a doctor who specializes in radiation treatment for people with breast cancer which is what I did.
I was also told that the odds of side effects from Zapping were FAR less than the odds of a reoccurance without Zapping.
You can get anti-anxiety drugs for zapping and if you are having a hard time, you should ask for them NOW. Anxiety is stress and stress interferes with healing. . . .
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Just to update, I have now finished all of my whole breast rads and am halfway thru my 8 boosts with no recurrence of the pericarditis. My rad onc told me he went throught 8 scenerios of my boost plan until he found the one that would protect my heart the most. So far, so good. Guess I was just one of the rare (un)lucky ones to have that particular SE. But it will all be over soon. Yippee!
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