12/09/08 - Intrathecal Chemotherapy #1

The other day, my flow study was successful. The following day, Thursday 12/04/08, I had my first of ten doses of intrathecal chemotherapy (depocyte). As I mentioned before, intrathecal chemotherapy is administered via my Ommaya Reservoir directly to my cerebrospinal fluid (CSF).


Cleaning the Reservoir area
Since the CSF is in a relatively small area in the brain and spine, some must be drawn out to make room for the chemo drug. The picture below shows this. Another bonus to this techniques is that the extra CSF can be examined for disease spread under a microscope.


Removing some CSF
Admitting the intrathecal chemotherapy is a relatively short process. For one thing, it is a relatively small amount of drug. I will get this dose every two weeks for two months, and then once per month for six months. The drug is supposed to eliminate any cancerous cells in my CSF.


Intrathecal chemotherapy via Ommaya Reservoir
My doctors will decide if the disease has spread outside of my CSF (likely via MRIs), and may also administer traditional chemotherapy along with the intrathecal type.

12/05/08 - Ommaya Flow Study

A new experience... My flow study, technically known as a cisternogram, was performed last Tuesday and Wednesday. Thursday was an optional day if the previous two days weren't successful in their results - they were. So, the flow study appointment for Thursday was canceled, but an appointment to receive my first dose of intrathecal chemotherapy was scheduled in its place. That will be a separate post...


Diagram of Gamma camera (Click to enlarge)
Back to the flow study, which was done by Moffit's Nuclear Medicine group. They injected my Ommaya Reservoir (once, at the beginning of the test) with a radioactive dye (indium 111), and then used a sophisticated piece of equipment, called a gamma camera, to track it. They did this immediately, six hours later, and 24 hours later. They had enough data from these images to determine that the flow study was successful, so a 48 hour appointment wasn't necessary, and it was canceled.


A gamma camera Similar to the one used on me
The output of the camera is not what you might think. Since it is only sensitive to radiation, the images are scattered "dots" on a plain background, although you can make out my brain and spine. When the tech was taking the image, it was white spots on a black background. It could also take up to five minutes for a proper exposure. In the outputs shown below (which I was surprised to get) the images are inverted - black dots on a white background.


Gamma camera images of my flow study
The doctors got these results and decided that the flow study was successful. What all they looked at to determine this, I don't know...

12/02/08 - Quick MU

Laura and I left for Moffitt this morning at 7:30AM and got back home at almost 6PM. Long day, although we were able to get away from the hospital to have some lunch. So, I'm going to keep this post short, and hopefully follow it up with some longer ones in the next several days. I had three appointments... Two Flow Study ones, and one meeting with my neuro-oncologist and his Physician's Assistant (PA).

Anyhow, I was able to clarify some of my previous "self-diagnoses," and everything is going as planned. The potential other brain tumor is still a question, but the doctors explained more about what it could be, and if it is something harmful, they will address it in time. Of course, they gave me more details about my treatment plan.

Tomorrow, I have an appointment to have the staples from the top of my head removed. I also have another Flow Study appointment, but I should be home earlier in the afternoon than today.

12/01/08 - MU - MRIs Self-Diagnosis

I stayed overnight after my Ommaya Reservoir implantation. Since I was already in the hospital, I had MRIs done the morning after the surgery. As always, I was able to request a copy of these MRIs on CD-ROM. I haven't heard what any doctors have to say yet, but here is my self-diagnosis, along with the new scans.



MRIs of spinal tumor (Click to enlarge)
My scans from 9/09/08 clearly show the tumor in my spinal cord. The ones done last week on 11/26/08 only show a few remnants. It appears that the radiation treatments did their job and "zapped" it. Hopefully, my doctors will say the same...

I mentioned in my post titled "10/01/08..." that there may be another brain tumor. My doctors had varying opinions about the area, and it was not treated during Radiation. In the same area now, there is an anomaly on my MRI. I'm going to point this out to them (if they miss it), and ask them what they think it is. Anyhow, here are the MRI scans of it...



Potential Brain Tumor? (Click to enlarge)
Since processing these images, and as a result looking at them more closely, I do have more concern about this area...

Another thing... Why are the MRIs shown in groups of two images side-by-side? One image is with contrast, the other is without. "Contrast" is actually a drug that is administered intravenously, and then similar MRI images are taken again. Contrast sometimes helps the doctors see things better. The images above show the scan with contrast on the left. To see if an MRI has a contrast agent, the scan itself will say C: MAGNEVIST.

11/30/08 - MU - Ommaya Flow Study

Now that my Ommaya Reservoir is implanted, my doctors will conduct a "Flow Study" to see if it is functioning properly. I have three appointments in the coming week where this will hopefully be accomplished. Once done, I'd imagine that it won't be long until I receive intrathecal chemotherapy (mostly confined to my cerebrospinal fluid (CSF)).

The Flow Study will be performed by injecting a dye (radioactive?) into my Reservoir and seeing if it circulates down my spine and up around my brain. Presumably, the time to do this will be measured to determine a Flow Rate. When this is an acceptable value, then I'll likely make an appointment to receive intrathecal chemotherapy. There is a "filter" called the blood/brain barrier which will prevent most of this drug from entering my bloodstream.

Tuesday, I have an appointment early in the morning and late in the afternoon. In between, I hope to see my neuro oncologist, to see how things are going. He's apparently booked-up on Tuesday, so I don't have an official appointment... On Wednesday of this week, I have an appointment to get my staples removed from my scalp from my operation.

11/30/08 - MU - Ommaya Surgery Unwrapped

I had my Ommaya Reservoir surgery last Tuesday. On Saturday (11/29), I was told (previously) to remove the bandage. No wonder my head hurt... I was didn't expect to see such an extensive wound. I'm going to try to post it's picture in a way that it's hidden from people that may be more squeamish, but it's really not that bad.


Ommaya Reservoir (click to show unbandaged view)
So now I will describe it. Again, not that bad, but don't read this further if you don't want to. The incision to implant the Ommaya Reservoir was "C" shaped. It is held closed by 15 staples. I was surprised to see dried blood on the incision and staples. I guess I thought it would be cleaner...

Today (Sunday), I can wash it!