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Tumors #2, different technique, the GammaKnife®

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Home Discovery, the Diagnoses Brain Surgery Recovery Begins MRI head scans Funeral Postponement Party Peripheral neuropathy
GammaKnife, tumor #2 Tumor #3, the lung Chemotherapy Blood test results Living after chemo, part 1 Living after chemo, part 2 Living after chemo, part 3 My cancer "cure"

Purpose: My purpose in making these pages is to help people. My hope is that seeing how brain surgery can go in the year 2009 will ease minds and give some hope and comfort. Radiation and chemo for the other tumors get closer.

This is the personal experience of David Luckenbach, diagnosed with brain and lung cancer in May 2009. A sailing instructor who smoked and drank, and almost died, saved by friends and angels and given another chance. Odd fellow I am, always ready to help other people, and neglected myself.

Tuesday, May 25
Time to start on the rest of the tumors, recovery from the brain surgery is winding down. Still have the staples in my head, but they come out Friday. This second day without steroids is better. I can still tell the steroids are there, but I'm better today than yesterday. Side effects are less, and a better temper. Some ear ringing, but it comes and goes, and not as loud. I don't like steroids.

Today we went to the Cancer Care Center of South Texas in north San Antonio, also known as CCCST. We were early so went by MRI Central again to get another CD of my first MRI, then had lunch and gave some sails to Charles. Turned out Charles and I both grew up in the same south Texas town, Alice, and even knew some of the same people.

CCCST is a good place, we got a favorable impression there. Not too fancy and nice people. First we met with Dr. Sharon Wilks, my new Oncologist, had an exam and a long informative conversation. She seems to know everything, and answered our questions well. She contacted Dr. Carlos Hernandez, as I looked like a good candidate for the GammaKnife®, a radiation machine we hope will kill the small tumor in my brain. Luckily he was on his way to CCCST and I would meet him later.

Then down the hall to see Dr. Hernandez. He is connected with the Gamma Knife®, and explained it and the CyberKnife, the similarities and differences and which one is good for what. He also explained another technique that irradiates the entire brain, which can have the advantage of killing small cancer cells, too small to find with a scan. Incredible technology, looks a bit like Star Trek equipment, or maybe after Star Trek.

He recommended the GammaKnife® because it can have greater accuracy, and I agreed. He phoned to get the MRI scan I had on May 13th, so I gave him the disk we had picked up that morning and saved him some time.

Basically, the treatment will go like this.

It takes a "morning" to do the procedure. In use for over 35 years, it's not new and has a long record. Useful for many ailments, and it comes with free parking. On arriving early, I'll be fitted with a titanium head frame so my head can be immobilized, and help plan and guide the treatment. Next comes a new scan to precisely locate the tumor, and I get a break while they prepare the treatment. Then I get a helmet too, with holes for the beams, which will intersect at the tumor, and hopefully kill it. Pretty fancy, no surgery this time and they say I might get a slight headache. Off with the gear and home I go. Sounds easy to me, although probably pretty boring.

Heading home, we went to MRI Central again to get another copy of the first MRI scan to replace the one we gave Dr. Hernandez, and saw only one wreck on the way out of town. We should know soon when I'm scheduled for the GammaKnife treatment, and Dr. Wilks is working on the lung cancer. We've made a new start.

Wednesday, May 26
I met Forrest in town and we started on moving our power line underground. I never liked the way the power line was. It was ok when the house was built, but later someone had added the carport under it, very much against code. A few days ago Forrest mentioned that it was illegal too, so it gained a high priority with me, an accident waiting to happen. The best solution seems to be to put it underground, which would also get it out of our big tree out back. All we did on Wednesday was go by the co-op to get started and pick up a new meter box, then to Home Depot to price the parts and wire needed.

Original routing of power line

Power line over roof

Thursday, May 27

Rose from the GammaKnife® center called, and we set up my orientation for June 9th, when I get to see the machine itself, and scheduled my procedure for June 11. On the 11th, I have to be at the GammaKnife® center at 5:30AM but should be home long before dark. They expect the GammaKnife® to take care of the small tumor in my brain, which is not in a good place to operate anyway. It doesn't sound a fun procedure, I think I'll be bored, I hope I remember to take a Sudoku book. Another day I can't eat after midnight, so I'm planning on a late supper! I didn't notice any steroid withdrawal symptoms at all, I'm starting to feel pretty normal, and I'm getting about 6 hours of sleep per night. I get to drive tomorrow!

Friday, May 29

We went by the hospital and picked up a disk of my CT scan, in case Dr. Wilks wants a look at it, but I'd like to put a picture of the lung tumor online also. Stopped at the Motel 6 to get a room for the GammaKnife® on June 11. I have to be there at 5:30AM, so we'll spend the night there and only have a block or two to get there. Much better than a 2 hour drive in the dark.

A week "off"
Saturday through Thursday I had no appointments, so life is pretty normal. The steroids continue to wear off, and I can finally feel pain again! Not much, just the scalp is a little sore where they put the points in the skull to hold my head fixed for the operation. I tire more easily and sleep much better, naps are more common since I try to stop when tired. I'm working on the website a lot, but it wears me out a bit sooner. I'm finally feeling like I had an operation and need some rest to recuperate, which is good.

Tuesday, June 9
Orientation for the GammaKnife®, 10AM. We met Beverly, who was very nice, and she showed us everything. It's in a special building with 18" or more lead walls. The GammaKnife® uses a Cobalt 60 source, which is strong and has a long half life, so one source will last for years. Because of the strength it requires 18" of shielding for storage in addition to the walls.

Click for larger picture This picture and explanation of the GammaKnife® is on the wall inside, very concise explanation telling about the procedure. This poster appears rather old, and the Elekta webite now says every day more than 100,000 patients receive diagnosis, treatment or follow-up with the help of a solution from the Elekta Group. If you click on the picture you'll see a larger version that's easier to read.

The GammaKnife® is made by Electa, a Swedish company founded in 1972 by the late Lars Leksell, Professor of Neurosurgery at the Karolinska Institute in Stockholm, Sweden, produces many health care solutions.

These are the "colanders", each has 201 holes and weighs 350 pounds, more lead. Each hole is about 3 inches long and all point at the same place in the center, where the "target tumor" will be placed. Since each hole is at a different angle, the radiation can only go through one hole at a time for each source. The machine can position the sources over a series of holes, with only the tumor getting a lethal dose of radiation. The rest of my head will get a dose, but nowhere near dangerous.

The GammaKnife® machine, with movable table and doors to let my head in. They'll install the colander with the size holes they want in the machine, and then my head and the frame gets positioned at the right place, with the helmet on over the frame. I didn't get to see the helmet, forgot all about it, darn.

The frame is on the far end of the table, not fully assembled. It's very adjustable, so it will fit any size head.

The set of fixation screws, with points that will barely reach my skull. They only use four, but they have different lengths for different size and shape heads. All the frame is titanium, so I can wear it in the MRI, the one I get right before the treatment.

The frame is on the far end of the table, not fully assembled. It's very adjustable, so it will fit any size head.

June 11
Dr. Wissinger, Dr. Hernadez, Beverly, Rose, Jim, and more, a great team that all arrived on schedule. I arrived at 5:30 AM, the nurses prepped me and hooked up tubes and wires to me. Then prepared the syringes and other tools and supplies for the procedure.
I examine the frame before getting to wear it. It felt about 5 pounds, and made of titanium and plastic so I could wear it in the MRI.

Dr. Wissinger, a neuro surgeon, fixed the frame to my head with the fixation screws. This was the part I wasn't looking forward to, but they did it with just the right amount of a "conscious anesthetic" and painkiller shots to the point locations. I didn't feel a thing, but even better I can't remember this part!

Fixed frame video, very short only 200KB.

Next was a trip to the MRI for a fresh MRI and a scan that shows the precise location of the tumor in relation to the frame. This scan not only looks for any missed tumors so they can be taken care of at the same time, but also provides the aiming for the Gamma Knife®, accurate to within 1/2 millimeter I heard, and now I think better than that.
After the MRI Dr. Hernandez and the team examined it and the aiming point found, the proper colander is attached to the GammaKnife® and my head frame in the proper place. I'm fixed in place and my head goes inside with 201 sources of Cobalt 60, one for each hole in the colander. All selected rays converge on the tumor, delivering a high dose of radiation to it, while a low dose to other parts of my head. I couldn't feel a thing, so this part was pretty boring.

We stopped at an HEB on the way to the Dr. Wilks office for my 12:20 PM appointment, had a bite to eat at the deli and bought some supplies for home. The whole procedure was pretty tame and boring, and didn't hurt a bit. Sure is a load off my mind, so to speak. I did have a headache Friday afternoon, but it wasn't bad and went away after one pain pill and a nap.

I had a follow up appointment with Dr. Hernandez one week later, June 18. I got a copy of the new MRI scan, you can see the small tumor below. I found out the tumor received about 1800 RADs in the procedure. The Electa company has three models of the Gamma Knife®, the new version called the Perfexion™.

This is tumor #2 or was when I got the MRI before the June 11 procedure, I put boxes around it. 13.9mm across, we'll do another MRI in about a month and see if the size has changed but more important see if it still has blood flow.

  

These pictures are where it was or is, scan taken July 15, 33 days later. The report said the tumor had shrunk from 14mm to 5mm, a very good sign. I can't find it in the first one, but maybe in the 2nd.

  

July 2
Went for my 6 week checkup with Dr. Bogaev. I showed him the June 11 MRI scan made for the Gamma Knife, and the place where he removed the big tumor looked good. He's taking over for Dr. Hernandez on watching the small tumor too. Dr. Hernandez is taking a better offer somewhere else in Texas. I'll see Dr. Bogaev again on July 23 after my July 15 follow up MRI.

July 15
To San Antonio again for a new MRI at the Methodist Hospital, they want to see what is left of the small tumor the Gamma Knife attacked. I had to get another disk to show the pictures above, and it was very hard to find tumor #2. The report said the tumor had shrunk from 14mm to 5 mm, much better than expected. Perhaps cleaning up my diet has helped.

July 23
Saw Dr. Bogaev on the 23rd and everything looks fine. We scheduled a follow up MRI scan in 3 months on October 21. Seems like we have tumor #2 under control.

Now we're focused on the chemo treatment, mainly for the one in the right lung, but at the same time to clean up any others. Since the first was surgically removed, and the second hopefully killed with radiation, we still don't know if the chemo drugs are the best to use on the rest. This takes more time, and progress and/or lack thereof is followed in the Chemotherapy Section

Next, Tumor #3, the lung

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