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!

Where is this new Tumor?

Terry called me this morning to tell me where this new tumor is located. She had called me Friday from her cell phone while I was at work and I got it wrong. It's not the stelium, it's the splenium! You know where that is, right? It's the back section of the corpus callosum, and it does look like a butterfly. Steve's small, 7 mm, tumor is located on the left lobe of the splenium, significantly far away from the first tumor. Steve's first, big tumor, was lower in the left parietal lobe near the speech area of the brain. This new one is up and to the right from there. What does a splenium do? What harm can it do to Steve? I've been trying to sort that out. As nearly as I can tell:

The diverse structural properties of the splenial fibers across brain areas suggest that they are involved in a variety of functions, while there are considerable variations between subjects, it implies a contribution of the splenium to plastic changes in the course of human development.  One such function is figure-ground segregation, which refers to the ability of the visual system to segment images of the external world into objects and background. 

Another source says, if you have a stroke which takes out the Whole splenium (a much bigger area than would affect Steve):
The resulting deficit will be pure alexia - i.e., the patient can write but cannot read (even what they have just written). Isn't that a crazy thought?

Last night, Steve took an anti-nausea pill 30 minutes before his 350mg Temodar chemotherapy pill, along with medicine for constipation prevention. So far he is feeling fine this morning. If we remember back to his prior experience with chemotherapy, usually the 3rd week was the worst out of every cycle when he had the most fatigue or nausea. We anticipate that will be the case this time, too.

Their dinner last night was wonderful and they said it was really great to see their friends.

Tumor Recurrence

2014 started off well. Steve wasn't on any unusual medication. He went to work. He hung out with his wife and kids and worked around the house. He had an MRI at the end of January which was uneventful and had his routine blood work and doctor's appointments. His latest MRI was done yesterday, as usual every other month, followed by an appointment with his oncologist, Dr. Hu.

The news we feared was delivered by Dr. Hu. Steve has a recurrence of his glioblastoma tumor. It is 7 millimeters in diameter and located somewhere deep in the brain. Terry said she had the doctor spell the location and told me the left stelium. Unfortunately, I can't find out where that is. Terry described it as, if you picture a butterfly, the tumor is located where the spine of the butterfly would be. So, maybe that makes it somewhere along the corpus callosum? near the ventricles? I'm not sure. Anyway, there will be no surgery on this tumor. The plan is to radiate it with what is called a gamma knife.

From Wikipedia:
 A Gamma Knife typically contains 201 cobalt-60 sources of approximately 30 curies (1.1 TBq), each placed in a circular array in a heavily shielded assembly. The device aims gamma radiation through a target point in the patient's brain. The patient wears a specialized helmet that is surgically fixed to the skull, so that the brain tumor remains stationary at the target point of the gamma rays. An ablative dose of radiation is thereby sent through the tumor in one treatment session, while surrounding brain tissues are relatively spared. The risks of gamma knife radiosurgery treatment are very low,^[29] and complications are related to the condition being treated.

The Gamma Knife (also known as the Leksell Gamma Knife) 

From the Cedars-Sinai website:  

Radiation distorts the DNA in cancer cells. The cells then lose their ability to reproduce. Conventional radiotherapy usually involves the delivery of large volumes of radiation, which may affect normal brain tissue as well as cancer tissue. Gamma Knife technology allows radiation to only touch very small tumors or lesions deep within the brain, leaving healthy brain cells alone. This treatment is safe, accurate and effective. There is no “knife” in Gamma Knife: because no incisions are made, it avoids the risks and complications associated with traditional surgery. The treatment is performed in one day and usually does not require an overnight stay in the hospital.

Steve is awaiting the date of his appointment to have this gamma knife radiation procedure. They expect it within the next week or two. In the meantime, Dr. Hu put Steve back on chemotherapy. Tonight he starts Temodar again, for the first time in five months. The dose will be higher, 350 mg, 5 days on, 23 days off, the same as before. They made sure he had his Zofran, anti-nausea medication ready to go, as well.

Right after the bombshell news of the new tumor happened, Steve had a work friend stop by at lunchtime without knowing about the new diagnosis. The distraction was welcome. Tonight they have good friends stopping by for dinner so they are cleaning house and cooking and looking forward to the visit. They like concentrating on their friends and family and not feeling ill. 

I'll try to post current information to you on this blog when I get it. I had stopped posting last year because there wasn't anything special to say…. Steve was just living life everyday with the addition of some extra appointments which were going well. I didn't think just posting lab work was informative to most of you. Let's hope this tumor treatment goes quickly and smoothly so I run out of things to say again soon.

A Good Year

Hi everyone!
It's been a while since I posted because there wasn't much news to report to you. Since I last posted a year ago, Steve has been doing quite well.

He continued his Temodar chemotherapy monthly with minimal side effects. April was his one year anniversary of taking monthly maintenance chemotherapy. He and Terry had a discussion with Dr. Hu and decided that, since Steve was doing well and his blood work looked good that they would continue at a lower dose of Temodar, just to provide some extra insurance against a recurrence. He had monthly blood draws, doctor's appointments and MRIs, all with good news afterwards. He was doing so well that, in October, Dr. Hu said he didn't need any more chemotherapy. Dr. Hu wanted to allow his body to fully recover it's strength and let his kidneys and blood work to get fully back to normal so he would be strong enough to fight the inevitable next tumor. October 2013 was his last Temodar dose. Then, blood work and routine appointments spread out from every month to every two months.

Throughout the year, he went to work and enjoyed his family. In July, the family traveled to Mendocino for my daughter's wedding.  This is one of my favorite pictures of Steve and Terry.

This is the Ravenscroft siblings, Greg, Lisa, Lesley and Steve at Katie and Nick's wedding.

Christmas was at Steve and Terry's home. They have been redecorating and fixing up the house and it was nice to see the improvements. We had a lots of busy fun with everyone around. Steve was healthy and kept busy with all of the activity.