11/20/08 - MU - Ommaya Reservoir Surgery

Readers of my blog may remember an illustration of an Ommaya Reservoir that I posted (way) back on September 19th. At the time, I jokingly said to Laura, "At least I don't have one of those in my head..." Well, I soon will.


Ommaya Reservoir
I'm scheduled to have an Ommaya Reservoir implanted on 11/25, two days before Thanksgiving. It's actually brain surgery, to be performed by the same neurosurgeon that removed my brain tumor. The Reservoir itself is a small disk with a catheter (tube) that is going to extend through a hole in my skull into a ventricle (CSF-filled space) of my brain.

The Reservoir will be used to administer intrathecal chemotherapy, which is limited to my Cerebrospinal Fluid (CSF) which is in and surrounding your brain and spinal cord. My type of tumor (Medulloblastoma) usually only spreads to the linings of these cavities. Intrathecal chemotherapy should target any loose tumor cells that are in my CSF. Apparently, the CSF flows through your brain, down your spine, back up your spine, and then around your brain - one reason the "port" is at the top of my head.

The Ommaya Reservoir will remain in me unless it gets infected, or otherwise has some failure. It will reside between my skin and my skull. The hospital will shave the area (likely to be near the front of my head above my hairline on the right side) each time they have to access it. A hole will be drilled in my skull to route its catheter through my brain to the ventricle. On that, my nuerosurgeon said something like, "...you'll be asleep. Having someone drill through your skull while you're awake can be annoying..." Funny.

I will stay overnight in the hospital, so I should be home 11/26. Hopefully, I'll post an update here not long after that.

I guess the other option to administer intrathecal chemotherapy was a Spinal-Tap like injection as illustrated above. There were two reasons that won't work for me. First, my platelets were still only at 67,00 last week and they would like to see them at 100,000+ to do a tap (remember blood and CSF don't play nice, and platelets control your clotting). Second, the needle is inserted by the doctor's sense of feel, too far and your spinal cord could be contacted, potentially causing a lot of undesirable reactions. So, Ommaya, here I come.

11/18/08 - MU - Radiation Treatments

Radiation ended on November 6 for me. That day, I received my 22nd treatment. Prior to that, I got a treatment every business day (5 times a week). Luckily, the wait times were short (sometimes nil), and the radiation treatment itself only took about 10 minutes. The radiation machine apparently ran all day long, and it kept the radiation technicians very busy getting patients quickly in and out.

So, I'm going to describe one of the typical treatments in my own words. I'm sure there are more medically correct terms for some items, but I'll only use them if I know them. Hopefully, this account will be fairly correct...

I just went out on the web to search for pictures and websites, but one of the sites ended-up crashing my browser, so I'm not going to pursue that route any further. Besides the fact that it can be VERY time consuming. FYI, if you want any information beyond this posting, Wikipedia has a decent site.

When I first got to a radiation appointment I had to wait, but not usually very long. My appointment was at the end of the day, and only one patient followed me. Being there at the same time every day, you usually get to know the other patients with appointments near yours.

When it was my turn to get irradiated, I went into the radiation room, which was good-sized and had the radiation machine in the center. I was asked to lay on the table in front of the machine and secured by my custom-formed mask (see [Radiation Simulation]). Targets on my mask were aligned with some green lasers to get me pretty close to the ideal treatment location. The table I was attached to could move up, down, left, right, forward, and back to align the cross hairs. Once roughly positioned the technicians would leave the room to escape any stray radiation. Once they left, a very heavy automatic door would seal me in the room.


Targets on my mask (circled)
The radiation machine could rotate 360 degrees, and presumably by doing this along with the table movement, it could hit any target. Before treating me, it would first proceed to X-Ray me. Using this image, the software that controlled the machine and the table would adjust my position, so treatment was more accurate. Once fully aligned, the machine would proceed to treat me.

The radiation machine would rotate and "shoot" me with different strength radiation beams from different angles. Each one of these doses (angle, intensity) was called a field. Each day, I was treated (shot) from six different angles. The machine would rotate around me and stop to administer radiation beams, during which it made a buzzing noise. I couldn't feel anything. The below video is an experiment, there were no visible beams emitted from the radiation machine, unlike the lightning bolts I put in for effect... (I don't like the "video," but don't want to change it at the moment.)


Radiation photos
When the treatment was done, the technicians would come into the room and detach my mask. I would then get off of the table, and the appointment was complete.

11/16/08 - MU - Radiation Simulation

Radiation "Simulation" is an appointment to basically prepare and plan for radiation treatments. I didn't get all of the photos I wanted (the radiation techs/nurses were spared), but I will share some important ones.

The first part of the simulation is to make a custom-molded "mask." It is made from a type of plastic that becomes moldable when heated up. For that reason, the radiation technicians have me lay on a flat surface (the CT table - more on it later), soak the new, flat mask in some [very] warm water and then quickly put it down over my face. The briefly malleable plastic conforms to my features. I say features because the mask actually comes down to my upper chest. A tech pulled on the mask's nose, so I could breathe easier. It is shown below.


My radiation mask
The mask helps to accurately position me. It has 9 clips which lock to the table I am placed on (for the simulation, a CT (cat scan) table; for radiation treatments, the radiation table). Once clamped, it is very tight. The rest of my lower body has to be in an upright laying position on whatever table the mask is attached to.

Laser beams also help to position me. During the simulation, my body was aligned and pen marks (cross hairs) were drawn where the criss-crossed lasers intersected my body, as shown by the blue "+" signs in the photograph below. At the center of the plus signs located in the middle of my chest and stomach, I was also tattooed. This was done for when the pen marks washed away, a small "dot" tattoo was placed at the middle of those two plus signs. That way, in combination with the secured mask, the rest of my body could also be positioned by lining the tattoos back up with the laser beams.


Laser "targets"
Also visible in the image above is my "traditional" chemotherapy port. It is the small bump on the upper area of my right chest. It is basically a needle receptacle (rubberized dome) with a catheter (tube) that runs into my subclavicle vein. It is used to deliver chemo drugs or transfusions into my blood stream. It was surgically implanted after my brain tumor was removed and will stay in indefinitely unless there is a problem with it.

The cat scan was then used to image my entire spinal cord. If you aren't familiar with a cat scan, just imagine a popsicle stick be inserted into a doughnut hole. The popsicle stick is the table where I lay, and the doughtnut is the portion of the machine that surrounds me and takes "pictures." The table can move in and out of the hole. See the photo below. This scan relates the position of the mask and the laser beams to my spinal cord. The initial plan was to radiate my entire spinal cord, with a possible "boost" to the tumor area. After the initial simulation, my doctors decided to concentrate the radiation on the tumor, which is in my neck area. The tattoos weren't used to position my body, as the mask was enough to position me.


CT Scan machine
My next post will be about an actual radiation treatment, which includes more details and a movie of one...

11/16/08 - Quick Update

Oops! A month has passed since my last update! I wanted to generate some content (pictures and movies), and I didn't take those when I wanted to... Not that I haven't been doing other activities - the blog just took a backseat for a while.

My health is doing okay for right now (despite the tumor on my spinal cord). I finished my 22 radiation treatments last week. The main side effect was fatigue (tiredness). It did improve my leg numbness, which should continue to get better as the full radiation takes effect over the next few weeks. My next step will be having brain surgery on November 25th to implant an Ommaya Reservoir, followed by intrathecal chemotherapy for about eight months. I'm not sure how this style of chemotherapy might effect me since it's a different style that I received before.

More information about each of these treatments (and my health) will be posted here. Hindsight being 20/20, I'm now going to create posts about radiation treatment...