Blogging in B Minor

I had an MRI on Thursday which was 30 days post-gamma knife. As you might recall, a second tumor appeared 30 days ago and I immediately was scheduled for gamma knife which was a great way to address the problem. I really prayed for was that the original tumor resection site was stable and that the Gamma knife treatment directed at the new tumor would essentially destroy most of the tumor tissue. Of course the risk continues to be centered around motor function, left-side weakness and seizures.

First, here is an image of the scan (click for a larger view):

The yellow arrow represents the original tumor. The report indicates that this is stable which is great news. The red arrows point to the new tumor location and as you can see it is now hollow to spare you the medical jargon. The only possible issue that is something to potentially be dealt with in the future is scar tissue from the recent Gamma knife procedure. Sometimes Gamma knife can result in what’s called necrosis, or scar tissue. This can irritate areas of the brain and result in brain swelling. If frequent headaches result, sometimes surgery is necessary but I am far away from anything like that, so all in all this procedure went well and I am very happy with the scan.

Moving forward the plan is going to be pretty aggressive. I have three doses of DCVax left.  We’re going to administer those over the next six weeks, two weeks apart. After the first two doses I’m going to start back up on avastin.  I will likely go back onVP-16 which has obviously done the job over the last 30 days in stabilizing the original tumor. I’ll also continue taking Valcyte. I am like a drugstore cowboy! I have an entire cabinet in the kitchen dedicated to my medications. It’s unbelievable.

Today is good. I’ve been very tired due to family and friends being in town the last three weeks so this weekend is the weekend to relax and catch up with things around the house.

Thanks to everyone for all your prayers around this latest MRI. They really mean a lot to us.

God bless

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First off, here’s a freaky image!  I want to be this next Halloween!  This look at brain anatomy  is somewhere on my blog but I thought it would be worthwhile to include it in another post.

This really explains the delicacy of the primary motor cortex which is exactly where the two tumors I have are located. The original tumor that was first discovered in January 2007 has primarily affected the area at the top – functions such as the arm, trunk and foot. The second tumor that was just discovered several weeks ago has significantly affected my hand and arm which makes sense if you look at this on MRI.

This diagram is blown out into other diagrams. For example you can find a diagram that just focuses on the face. It’s amazing.

In terms of Gamma knife, the swelling in my forehead has subsided.  It basically drops down from your forehead to your eyes and then into your cheeks.  At one point it was just above my eyebrows and Rachael said I looked like a Vulcan!  I did! It was like a huge ridge that went from one side of my face to the other.  My good looks were just starting though. Next, it dropped into my eyes and I look like I got punched out in a bar. Woo hoo! A cancer patient brawing in bars.  I walked out into the family room one morning and my son Aidan looked at me and said “you look different dad – have you looked in the mirror?”  Nice.    Alas, it’s gone

I’ve had the normal nausea associated with taking VP 16 but Zofran really helps with that. Still a bit fatigued but that is much better. Over the weekend I was pretty tired but I expected to be.  Tomorrow I’ll be going in to me with my neuro oncologist followed by another Avastin infusion.  I’ll go in for physical therapy.

With the fun stuff, we are looking at a number of options for get-aways. A few local options such as Carmel, Monterey, and other destinations on California’s central coast are convenient. We’re planning a trip right now with Aidan but were not sure where. It’s a trip that will be just for the three of us since Keegan is two and Rachael, Aidan and I have never done this before. There’s a cool safari trip that we can do overnight - you take a jeep trip through a large open area – giraffes bow down and you can touch them and there are a lot of other animals.  Then you can stay overnight in a cabin that has netting and canvas so you can hear the animals at night.  I will take lots of pictures.

God bless

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A very quick post and some pics regarding today’s Gamma Knife surgery.  First, everthing went perfectly and it was successfully completed today.  A long day it was.  We were there at 7:30am and left at 2:00pm. I will get into more details later about the process (this is #2 for me) I thought it would be helpful for some to see pictures of the actual prep involved in Gamma Knife - the prep consumes most of time. 

Warning for the squeamish – some of these pics may not be for you.  After all, they are screwing a device to my head to render it immobile while receiving high dose precision radiation from the machine:

More to come later but wanted to quickly thank everyone for all the prayers.

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Yesterday I had an MRI in the morning that was scheduled as a 30 day follow-up to my last MRI. The image to the left is the result. The yellow arrow represents the existing tumor cavity left over from my second surgery. The red arrow represents a new tumor that was found during the study. There’s no way to understand the grade of the second tumor based solely on MRI but presumably it’s also GBM and originated from the initial tumor. These tumors are infiltrative by nature and grow like weeds so you can stamp one area out but they have fingers and can pop up somewhere else. So much for my first day of being retired!

I always remember, there is nothing that can happen at this point that we can’t handle and there is always a solution that we can pursue. It’s never easy but we find our way. So once again, the wheels of medicine are often running. The first thought here is Gamma Knife and that is what we are going to do. It’s scheduled for Thursday morning. I have a meeting with my neurosurgeon tomorrow just to discuss the game plan and any deficits/risks of the process. The second tumor appears to be on the motor strip as well but in the specific area that controls my left hand. I had a seizure on Sunday morning and it was a little different than previous seizures in that my left hand was pulled into a fist and I started pumping my fist repeatedly. This correlates with the location of the new lesion.  I had Gamma Knife in 3/08 so this will be #2

As I have more information I’ll post it here. Thanks for all the prayers and support.

God bless,

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The gamma knife surgery is behind us and was successful – at least based on the plan that was established.  The MRI that was conducted first thing in the morning showed no growth which was great news!  That of course allowed us to proceed with the plan.

This is the only pic I could get (a cell phone pic at that).  This is the frame that was screwed into my head that stays on through the entire process – from MRI through the end of the Gamma Knife procedure.  It not only serves to keep your head perfectly still and provide the surgeons with precise measurements for the procedure, but it also allows you to feel like you have voluntarily placed your head into some type of crude torture device, or vice, which is truly awesome. 

Not to scare anyone, they provide a nice dose of local anaesthetic (my head is still numb as I write this) and give you ativan before they break out the Allen Wrench set.  They have a great tool kit there.  But, as with any other procedure, infusion, surgery, etc. I have been through during this trial, I try to never lose sight of why I am doing these things.

So, I have quite a nice headache, some holes that will heal but the results will not truly be known for 1-2 months.  Based on the plan, however, it looks good.  There are some risks moving forward – increased risk of seizure, radiation necrosis, and some other issues but this is the best course.  The vaccine will be started next week and finally we will be on the plan I have been chasing for months.

I will continue to put updates out here of course.  Time for rest…

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Very quick post – my Gamma Knife procedure has been moved up to this Thursday – the 12th.  Everything is being accelerated because the DCVax vaccine will be ready for my use next week (perhaps Tuesday).  The entire team agrees that performing Gamma Knife and then utilizing the vaccine is the right course of action which makes a lot of sense.  So, today I had a quick consult with my neuro-surgeon who is on the gamma team.  Wednesday I’ll meet with a neuro-radiologist and Thursday we’ll get it done.

A lot more to come I’m sure….

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Quick Post:  This is very preliminary but the Tumor Board met and approved me as a candidate for Gamma Knife surgery.  This is pretty cutting edge technology.  There are a lot of risks associated with this given the location of my tumor/recurrence including motor deficits and other deficits but there are also pros, the primary being in simple terms sterilizing the cancer tissue so it hopefully doesn’t grow so we can use other treatment modalities.  I’ll have this done at Sutter as I have all of my treatment.  The Sutter Neuroscience Institute is a top notch brain tumor center and I would recommend it to anyone seeking treatment for a primary brain tumor.

It looks like something out of science fiction but here is a great photo showing the convergence of 201 beams of computer-guided radiation on a tumor through a specialized “helmet” that keeps the patients head stationary.  Here are a few photos:

And here is a cross-section diagram that depicts the process graphically:

We’ll learn a lot more in the coming days.  I’m a bit tired of discussing the vaccine.  It’s there – the goal would be to use Gamma Knife then perhaps the vaccine but most likely we’d start with Avastin after Gamma Knife after some time passes to assess the surgery.  What’s great about the Gamma Knife process is it’s nearly an out-patient endeavor.

More to come.  Lots to discuss, absorb and decisions to make.

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