Steve's a BleederHead

Steve says the gamma knife was very anti-climatic. There was no sound, no visuals. Totally painless. All he did was lie there until they let him out. They repositioned him once.

Afterwards, shortly after he returned to our prep room, they went to remove his halo. We were sent out of the room because most families don't do well seeing blood. However, Steve is a bit special. The nurse told us, as they removed one of the screws, blood spurt across the room. Steve said they got serious very quickly. By the time we saw him, he had this gorgeous compression bandage on his head. He had to wait for an hour before they let him leave. We were finished at 1:15, a little earlier than expected. Steve took 1 Keppra pill, for seizure prevention, 1 steroid, to help with swelling and then Tylenol for headache. 

Then we went out for lunch :)

At Bob's Big Boy. Steve still has his appetite. It's funny nobody looked twice at this man walking around with a bandage on his head.

Hi everyone!

More Photos: Entering the Gamma Knife Machine

This is what's happening now. It's 11:30 am and Steve is lying down on this machine. We are waiting for him to finish.

Steve with Dr. Hakimian and the PhD gamma knife technician looking at his set up.

Steve will lie down here. The procedure will take 45-50 minutes. There is music playing and they were discussing what  concerts they have seen.

Look at the size holes in the center of each green circle. This metal head piece was selected for Steve.

This head piece with red circles has larger holes and is used to deliver a different amount of radiation to other patients.

Part of the computer area where the doctor sits just outside the gamma knife  room. We can hear Steve talking and see two monitors showing the machine and Steve.

Today is Gamma Knife Day

I traveled down to Southern California to spend the day with Steve and Terry for Steve's Gamma Knife procedure. We left the house about 5:30 am and traveled down to Cedars-Sinai radiation center. We are  in the process of it right now. There is a lot of waiting time while the doctor's do their preparations. We just had breakfast. Steve had to wait until after this MRI to eat and it was hard to eat with the halo frame blocking his mouth.
These pictures were taken with PhotoBooth from my laptop. It looks like it reverses images so I hope you can decipher what's what.

This really says Cedars-Sinai Medical Center

Lesley and Terry in the waiting room while Steve has his halo attached.

Cool looking science fiction helmet. This was placed over the metal halo frame. They then used the black measurer and placed it in each hole along this plastic helmet and called out the distance to his scalp.

Here's a picture of the back of Steve's head and a bad picture of his nice nurse. The beverage area is right outside our door.

Screw sizes and Iodine swab used when the halo was placed.

Other pieces used by the doctor to measure where to place the halo. First, they used a topical anesthetic at 4 locations around Steve's head, then swabbed each area with iodine, then they injected local anesthetic at each screw site.

Isn't he handsome? Kind of like Iron Man or a Transformer or a Cyborg :)

Side Effects of Chemotherapy

Steve had to miss work today because of nausea and vomiting and an upset stomach. Terry had to go to work and both boys were at school so Steve was home alone part of the day. Terry brought him stomach medicine at lunch time and by dinnertime he was a bit better. He was able to keep some little food down. We hope he'll be better tomorrow.  It must be the higher dose of chemotherapy since this hit him harder than previous chemotherapy.

Poor boy :(

Planning for the Gamma Knife Procedure

Today Steve and Terry had appointments to prepare for the next step in dealing with this new tumor.

First, they met with Dr. Patil who was the neurosurgeon who removed Steve's big tumor just over two years ago. He coordinates Steve's care at Cedars-Sinai. He will be the one this time to place the halo on Steve's head with screws to the skull which prevents Steve's head from moving for the precision work of the radiation beams.

Then they met with the radiation oncologist, Dr. Hakimian.  They had met him before when Steve had radiation therapy and he directed Steve's previous radiation treatment, coordinating with the closer facility to home. This time, radiation will only last one session so it will occur at the Cedars facility. Dr. Hakimian had a Resident, Dr. Resnick who talked to them about what to expect.  He also said he had to look at Steve's MRI several times to find the tumor since it is so tiny. (Yay! tiny!). Steve's neurological exam came out perfectly fine. He has no deficits from this tumor. He doesn't have any vision problems and drives and reads the same as always.

 After the appointments, they felt better about the future. Every doctor was optimistic. They felt reassured by how often they heard "very small" or "tiny" or the gamma knife "should do the job" to stop the tumor. They liked their doctors and staff and they said the day was as pleasant as it could have been.

The plan will go something like this:

Prior to the procedure, Steve will start taking steroids to control swelling.

It will probably be on April 11th, a Friday, pending pre-authorization from the insurance company.

They will go to Cedars at 6:30 am and plan to stay until 2:00 pm.

First, Dr. Patil will attach the halo.

Then, Steve will be taken for an MRI with contrast and they will map the brain and make the final decisions on the radiation settings.

Steve will receive radiation from 201 sources (where did that number come from?) targeting the tumor site in the splenium. The gamma knife procedure will take between 15 minutes to 2 hours, but will likely  be on the shorter side since this new tumor is so small. The total radiation dose is expected to be larger than he received last time.

They remove the halo and Steve can go home.

Probable side effects are only headache lasting several days and that is from the pressure of the halo, not the actual radiation dose. There is a 5% chance of necrosis but steroids help prevent that (I'm not clear here about what is necrosing. Necrosis is a fancy word for dead tissue and I thought the tumor is supposed to necrose or die. Maybe this 5% chance is for surrounding healthy tissue dying? I guess we'll find out later if it becomes a problem.)  He is planning to be back at work on Monday.

In the meantime, tonight Steve takes his last of 5 chemotherapy pills for this round. So far, he is not feeling sick. Terry says his mood is good and all is as well as can be expected. The worst part is dealing with the insurance company and the pharmacy. Last Friday, Terry spent hours on the phone getting Steve's chemo pills shipped overnight. The company was going to take 5-8 days to process the order before shipping them. Ugh! Terry's really good at dealing with that. Tomorrow she plans to call the insurance company to expedite the pre-authrization process for the gamma knife procedure.  Way to go, Terry!