What to Expect

What to Expect at Your First Visit

Your first visit either as an out-patient or an in-patient will consist of a Consultation with Dr. Menache. If an out-patient, you should arrive about 15 minutes prior to your appointment time to fill out the dreaded paperwork. 

When your name is called, you will be brought to the vital signs room where your blood pressure, pulse, heart rate and weight will be taken. From there you will then proceed to the consultation/exam room. You first will watch a short 10 minute film about radiation therapy. Following this, the radiation therapy nurse will come in and ask you questions about your health history and other questions that are important to your particular diagnosis. Please be sure to bring your medicine bottles with you. The radiation oncology nurse is a very important person during your treatments. He or she will be involved with any issues you may encounter during your treatment and beyond.

Next, you will be seen by the Radiation Oncologist, Dr. Menache. He will also ask you questions, some of which may have been asked by the nurse as well. He will also go over all your tests to date and answer questions you may have. If you have questions, it is good to have them written down so you don’t forget any.

A full examination will then be performed with particular attention to the area being treated. Depending on the site of treatment you may be asked to change into an examination gown.  

Following the examination and once you are dressed again, Dr. Menache will go over your plan of treatment. Treatment, if indicated may consist of: radiation alone, radiation at the same time as chemotherapy or following one another. Prior to starting radiation, more tests such as a PET scan may be ordered to complete your workup.

The Doctor will also go over the expected common side effects of treatment as they relate to your diagnosis, area of, and length of treatment. This is a good time to ask questions! The nurse will then return with a consent for treatment form prepared by Dr. Menache and he or she will then go over it with you. The radiation oncology nurse has a wealth of information and experience and can answer most questions or concerns that you may have or forgot to ask the doctor. They are particularly knowledgeable in regards to skincare and the prevention of skin reactions. He/She will then give you an appointment to come back for simulation or treatment marking. This is usually within one week of your first visit date. In over 90% of cases, you will not receive treatment on your consultation day. Simulation and or treatment may be delayed due to insurance authorization.

Simulation Day
Your return visit will be to have your mapping or simulation performed. This is a CAT scan-based procedure and will not hurt. The machine will not touch you nor come particularly close to your face.  You will lie on the table with either your arms at your sides or above your head. A special custom-made cast or mold will be fabricated to fit your body. The purpose of this is that we need you to be in the same position every day with no movement during simulation and treatment. We will make you as comfortable as possible without compromising your treatment. Diagnosis in the head and neck region will require a mask to be made to hold your head in the same position every day. This mask is very easy to make and is full of holes so that you can see and breathe easily. If you are very claustrophobic please take an extra anti-anxiety pill before you arrive.  

Once the scan has been performed the special radiation simulation therapist will draw some lines on your skin with a sharpy pen and cover them with sticky clear dots to prevent them from coming off. The simulation therapist is also a treating therapist and can answer questions you may have about your actual treatments. Before you leave, the simulation therapist will go over how to take care of your setup marks and give you an appointment for your actual first treatment with radiation. The simulation procedure usually takes about an hour from the time you are brought into the room and are ready to leave. If you are experiencing a lot of pain prior to coming or have trouble laying on a hard CAT scan table please be sure to bring with you an extra pain pill or two to help ease your discomfort. 

First day of Treatment
Since you came for simulation, a lot of hands and eyes have touched your chart in preparation for this day. This includes Dr. Menache, the dosimetrist, and the physicist. They all work together to plan your actual treatment and how it will be administered. You will lie down on the treatment table in the cast or mask made for you in simulation. The radiation therapist or treating therapists will then align you up with the marks placed during simulation and then make the shifts needed to move you into the final position determined by the planning team. X-rays or a CAT scan will then be performed on the actual treatment machine to make sure that everything is correct.

Once the films have been approved by the physician and he has checked the setup in the room, the therapist will draw new treatment marks on your skin or mask. The therapists will then leave the room and start your actual treatment. You will not feel anything nor will it hurt when the machine is turned on. You will hear a buzzing noise. Your actual beam on time will not vary from day to day but will be the same every day.  The therapists will be able to see and hear you through the video system. At least once a week x-rays will be taken to make sure that everything is still lining up correctly. In some cases where internal body movements are expected, you may get a CAT scan every day. The first day of treatment usually lasts about 20-30 minutes and then after that, it is about 15 minutes more or less each day. In general, treatments are given every day but some treatment regimens are given two to three times per week. 

During Treatment
Once a week you will visit with Dr. Menache so he can assess your progress, detect any potential problems or answer any questions you may have. These are usually very short visits of about 5 minutes or less but are very important to your overall treatment plan.  You will also see the radiation nurse as well.  Depending on your situation you may also see the dietitian, the lymphedema specialist, or the social worker. While Wednesdays are set aside for your “on-treatment visit” you may ask to see the nurse or Dr. any day of the week. Your therapist can also answer many questions as they are very knowledgeable about your radiation treatments.

This outline is a guide. Your actual journey may be different in some ways but will include all the steps outlined above. Your treatments will be customized to fit YOUR diagnosis and situation. Dr. Menache will work side by side with your Surgeon, Medical Oncologist, and other health care professionals to formulate a plan tailored especially for you.