Breath-holding during radiotherapy?

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I think this might be a newer idea, but I went for my planning session this week, and they are having me take a deep breath, and hold for 20 seconds for the treatment. The therapist did explain the rationale, and it was to do with raising the rib cage away from the heart, thus making it easier to avoid irradiating the heart when treating the chest wall.

I should mention that I had a total mastectomy, involving some of the pectoral muscle, so part of the area over the heart is more or less skin and ribs! (I don’t think I have seen my ribs since I was about 8 years old!)

My concern is how well I shall manage the breath-holding if I am a bit anxious. I am somewhat worried about having the treatment anyway, mainly about the effect on shoulder ROM, and the development of lymphedema, as they are treating the axillary area. I had a couple of mosquito bites on my wrist about two weeks back and my hand swelled, which is not an uncommon reaction for me. The bites have subsided quite quickly on a cocktail of oral antihistamine and local steroid cream, but there is still a little swelling on the back of my hand. Does this mean lymphedema has set in? I do have an appointment at the lymphedema clinic next week anyway.

I also think that lying there, exposed as it were, is quite stressful in itself. I’m sure I will quickly settle down, doing it on a daily basis, but I must confess to a little anxiety about the whole caboodle, especially, as I say, the breath-holding part! I’m sure it will feel like I am going to burst by 20 seconds!

Oh, the other thing that was mentioned at my initial meeting with the rad onc was that they would do the treatment through some “artificial tissue” over my mastectomy site, which would help to concentrate the beam more superficially to protect the organs. There was no mention of thos on Monday. Has anybody had this??

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I’ve just done a quick Google, and it appears some centres use an Active Breathing Coordinator/Control (ABC) device to get a more accurate and repeated depth of inflation. While this makes total sense, I fear the sense of panic, or not being able to last for 20 seconds, might be exponentially increased!

Has anybody used one of these??

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I can understand your concern Morwenna. During rads I was told just to breathe away normally. They usually have a tv screen above your eyes with relaxing pictures and also music playing and I admit to feeling very relaxed on the table and thus my breathing was even and shallow. To have to hold your breath is obviously going to make you tense.
As for exposure - that worried me too. However the team were very sympathetic and exosed only the bits they had to covering everything else. I was lucky as I only had one breast done. I think it’s just the fear of the unknown and being completely out of control of the situation. I’m sure once you get started you won’t find it as awful as you fear. Hope so anyway. Good luck.
B

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Hi Morwenna. I asked just this question today! I was in for RAd no.4. Asked if I ought to try to hold my breath. They said no, the machine is programmed to take that into account. I had a radical not skin sparing MX so am worried about the Rads hitting something they shouldn’t.

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If you take a deep breath in, hold, and then very gently and slowly exhale would that work do you think? I do breathing exercises in yoga, if you slow your breath down for several breaths before the big hold it may help, and counting in your head too… So, breathe in for a count of two, hold for two, out for two. Pause. Breathe in for three, hold for three etc until your breathing is slower. You can do littlle tiny breaths with your rib cage expanded but just watch it doesn’t make you dizzy, and I think if you have blood pressure issues any sort of breath holding is a bad idea? Crikey they don’t half make things difficult do they…

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Hey Hun can I just say I has to do the same, it’s fine Hun it’s just to raise your rib cage etc. I had it over a month every day. They just speak thru a monitor 'breathe in and hold then breathe out. While you are lying there, there is a screen right in frontier of you and it shows where u have to breathe to. I was anxious also but it was fine, loads of moisturiser after every session anod I can assure you it’s a breeze to chemo. Good look lovely and if I can do it anyone can xxx

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It’s called breath hold radio and its when your heart an that’s in your way they don’t want to radio that part, hence the breathe hold. Hope this reassures you xx

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Morwenna, it was on our local news yesterday that there’s currently a trial underway at one of hospitals in Birmingham about breath holding for radiotherapy. They give you oxygen beforehand as it enables you to hold your breath for longer, the lady on television can hold her breathe for over 4 minutes now! They said it will help to target the radiotherapy to the site of the tumour bed and not the surrounding tissues.

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You only have to hold it for app 20 seconds and its fine honestly I should know I have been through it xx

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I’m sure it will be fine. I know I can do that easily. It just seems like every little thing I can find to worry about gets to me these days, and I didn’t sleep much last night. (Steroid buzz)

I was mainly interested to hear how other centres were doing it, and other folks experiences.

Thanks all :slight_smile:

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Morwenna - your last question about the “artificial tissue” - I think this may be a bolus. I had one for rads over my Mx site and was told it is to concentrate the rads where needed and not to go straight through to my organs. More important when you have had Mx and there is only a thin layer of skin and tissue to target. The only way I can desrcibe is a kind of small rug they lay over your chest. Mine was a square with a metal guaze of some kind inside, wrapped in layers of wax and covered in plastic. It was relatively heavy and cold, but in no way painful or unpleasant. I do think it raises your risk of skin burning, as the rads are more concentrated on your skin. Which is what you want really after a Mx; a good blast to the scar. So make sure you slap on the cream and ask for extra help (different creams/dressings) if your skin does suffer too much.

Rads have been done for decades without breath holding. It does sound like a good idea to me actually, but If you can’t manage it, just tell them and they will do it the old fashioned way.

Good Luck, x

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Thanks Cressida,
That sounds like what the radiation oncologist described, but no mention was made of it at my RT sim session. Oh well, what will be will be.

I only have skin over part of my ribs as the BS had to take some of the muscle for clear margins. I haven’t seen my ribs for some years before that! :wink:

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Hi

im about to start rads and have been offered the breath holding trial at the QE hospital. Ive agreed so i’ll let you know how it goes.
Apparently it really helps with the long term side effects. x
QD

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I’ve had to do quite long breath holding for cyberknife preparation (inserting the gold seeds)- I don’t know how it compares to the procedure for conventional rads. One thing I would say is make sure they give you time to adjust your breathing between each go - the radiologist was rushing me so that I had only just released the breath when he was asking me to hold it again. I asked him to allow me 3 or 4 breaths between each hold and that made it a lot easier.

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Hi
I am being treated this way at St Lukes. Have to wear goggleswith a little screen and take a deep breath and hold whilst machine does it’s stuff! I was really worried about it all, but after 9 days i’m used to it now…adn very glad they are trying to miss my heart! :slight_smile:

Good luck xx

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Hi girls
i am on no 13 of 15 breath hold rads. My lesion was in my left breast, and it was explained to me that raising the rib cage away from vital organs ie heart/ lungs is less likely to cause any long term damage. I did practice holding my breath for as long as possible prior to my treatment. It has been successful, and I have had no problems holding my breath for the required time.
unfortunately, I caught a cold after the first three sessions, and became very congested. Thought it would cause me problems, but aside from some gurgling, I have managed. Had to take a dose of lintus to ease the congestion, but it has been ok.
needless to say, I am very tired now, almost at the end, and very sore. Skin s still holding up, but my breast looks a bit like a red traffic cone! The last two afternoons I have come home and slept for three hours!
wishing you all the best possible outcomes for this horrible cancer journey, and am so grateful that we have this site where we can share experiences and give some hope and comfort to each other.
Jenny

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Hi Morwena. Lovely to hear from you. I can’t offer advise on rads as not started yet but surely its a breeze compared to chemo and you’ve been there, done that, got the T shirt!! Good luck. I hope all goes well. Xx
Emma
p.s how you getting on with your prosthesis now? X

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I finished the last treatment today, and breath-holding turned out to be no bother at all, except one therapist who kept saying a bit more, a bit more, a bit more, until finally I said, “I CAN’T! I’M FULL!!” and told her she must have drawn the lines in the wrong place! I was half laughing, but also a little bit pi**ed at her to be honest. Normally it was very easy, and sometimes I was told not to breathe so deep!

I have no breast on that side, so they used a bolus and warned me that it makes skin reaction more likely, but I’m just a bit red, and was told it looks really good for this stage, although expected to get worse for the next week or two.

As for fatigue, … I actually hiked up a mountain on Sunday - to the Plain of Six Glaciers above Lake Louise, Alberta, Canada. So I’m feeling pretty pleased with myself (OK, I was a couch potato for the last two days, and my feet still hurt!) :smiley:

But … I’m all done !!! :smiley:

PS, I’ve not actually worn my prosthesis since starting rads, and have no intention of doing so until I’m completely healed. I’m making do with my softee, and that’s only for as short a time as I can manage. I’m looking forward to getting an appointment with a plastics surgeon, as I still hate being one-sided.

I told my GP I was thinking of having a prophylactic right Mx, and bilat diep reconstruction, and rather to my surprise he totally approved. Then he spoiled the moment by telling me another patient of his had a prophylactic mastectomy on her “good” breast and it was found to be “riddled with cancer”! Thanks Doc, so tactful!!!
I almost find him amusing, he is so crass at times, but it has occurred to me that the vast majority of my left breast cancer was microscopic and did not show up on imaging, so who knows, right???

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Bumping this thread up for Jobi.