La Dolce Vita

Last month we rode in the LIVESTRONG challenge. Our kids, Kelden & Nick, myself and my sister, Michelle (who flew in from Phili) all did the 45 mile ride. We had a blast! The ride was great – steep hills, lots of curves and even a small creek crossing. We rode through the Austin country side and past people’s farms. There were over a 4500 participants and more than $3.8 million was raised to fund cancer research and education. It was really impressive to see such a turn-out and the volunteers were great. Thanks to everyone who contributed!

Kev is continuing with his chemo cycles – he finishes up his 9th cycle this week. There has been no discussion as to when these rounds will stop. I suspect that as long as he is showing some positive effects and no better option is available we will continue with the Nexavar and Abraxane. He gets scans at the end of this month – the typical MRI and CT but also this time a PET scan is scheduled. The MRI gives a good look at the brain. The CT is good for the torso – major organs. The PET (positron emission tomography) is a full body scan that acquires metabolic information based on the detection of radiation-tagged glucose. A PET scan can distinguish between living and dead tumors unlike MRI or CT which only confirms the presence of a mass. He doesn’t get PET scans very often – I think he’s only had 3 in the last 8 years. Probably because the cost is more than 10x that of a standard CT and the results would not really change the treatment protocol, given the limited choices. But now they want some info that they can't get from the CT/MRI.

A few weeks ago Kev and a few of his colleagues were rewarded by Boeing with a trip to Kennedy Space Center (KSC) to see the Space Shuttle STS-122/10A launch. Although he had seen landings (at Edward’s AFB), he had never seen a launch so this was definitely a great award. The launch went off on time with mostly clear skies and they had front row viewing near the VAB. (see picture). The following day he returned home to work the mission and was very closely involved in the repair to the torn solar array. A picture of Kev and some colleagues at work.

Apparently his MacGyver skills at keeping old lawnmowers/cars/houses running also work well for space hardware. He was part of a small team that designed and tested the "hinge stabilizer" (aka cuff-link) that resulted in the repaired P6 4B solar array. Here's a couple of entertaining links from Space.com: Terrific mission & How to Build a Cuff-Link.

Although the cancer is not going away, Kev’s health has improved greatly since August. He is completely off all pain meds and he is sleeping far better than he has in over a year. He appears to have healed completely from the hip replacement surgery. He still has a limp and walks with a cane, but otherwise no one could tell he was ever so sick. Even his hair has grown in enough to pass for a nearly normal 40-something!

Chemo continues with cycle 8

This weekend is the LIVESTRONG Challenge. Thanks to everyone who has donated. I’m starting to worry that our training wasn’t nearly aggressive enough. The 40-mile course is actually 45.54 miles with about 1100 ft of elevation gain. The posting explains: “Route distances will vary slightly for the LIVESTRONG Challenge Austin due to road limitations that compromise the LAF’s high safety standard. However, the constantly rolling Hill Country terrain coupled with heat, wind exposure and the infamous Texas chip and seal pavement makes the Austin course the most difficult in the series.” …hmm..nice – I definitely think the emphasis this weekend will be on “Challenge”.

Kevin is doing great. He is gaining weight – currently at 165 lbs. It’s hard to believe this past spring he was only 140 lbs. He is also regaining a lot of his strength and has even started doing a few little projects around the house. – Must be all the positive energy everyone is sending his way. He is in the 2nd week of cycle 8 with his chemo. Last month they tried to double his dose (cycle 7) and after a couple weeks some of the bad side effects came back on pretty strong, so they backed off. This time through they started him at 1.5x standard dose. His scans continue to show stabilization, but the hope is that we can actually get some regression of the tumors. The brain MRI was also positive (as in good news). The Stereotactic Radiosurgery seems to have helped since the MRI indicates necrosis in the frontal lobe tumor. We also discovered (from scans made the day of the radiosurgery) that just prior to the procedure, the tumor began to bleed quite a bit. But now the scans show a decreased amount of blood indicating it is being absorbed back into to the body.

Stereotactic Radiosurgery

Despite the name it does not actually involve any "surgery". Instead it uses a focused beam of high-dose radiation aimed directly at the tumor in the brain. Kevin had his procedure a week ago last Thursday, Aug 9th. Unfortunately they changed the plan late the night before and instead of checking in on Wed night they decided we should arrive at the hospital first thing on Thursday - 6:30 am. If there's one thing I'm learning through this journey it's to expect changes, but I still don't like it.

First an IV catheter was placed in Kev's arm for fluids and meds. Next a metal ring-frame was installed on his head. It's held in place with screws in 4 places. Local anesthesia is used to numb the area just prior to inserting the screws. I was in the room with him as they were installing the ring frame, mid-way through the process, the neurosurgeon and nurse look at me and ask if I'm OK. As typical, these procedure are much worse for me than Kev. Luckily I had a chair in a corner and could lean against the wall. After the frame was on, Kevin commented that it felt like his head was in a vise - but of course - his head WAS in a vise.

Next contrast material gets injected in though the IV. This makes the tumor very visible on the CT scans. A cage-like grid is placed over the frame and the entire thing clamps to the table. The cage acts like a grid on a map and helps the Drs determine the exact location of the tumor. After the CT scan we went to a room and waited. During this time the radio-physicist maps the tumor location and determines the best strength and directions for the radiation. Then they actually make a dry-run to verify everything works as planned. This takes about 6 hours and Kevin slept the entire time. I spent the time in silence worrying about the past, present and future.

When the neurosurgeon and radio-physicists were finished they came and got us and took us over to the Radiation dept. Kevin goes on the table with the frame secured to hold his head in position and the high-dose radiation beam is aimed at the tumor from different angles. This takes about 45 mins. The frame is removed and we go back to our room to wait the required 2 hrs (for monitoring) before we can leave. After an hour drive, we made it back home by 7:00 pm.

Now we wait until his next MRI (Sep 25) to see if it was effective. In the mean-time we continue with the chemo-therapy.

Starting Cycle 6

Wow, it’s been over a month since our last post – time does fly sometimes. We’ve been pretty busy not only with the many Dr visits, but also with all the usual activities a family with two teenagers experiences. Kev recovered very well from his brain surgery although there seems to be some lingering numbness/tingling effects to his left arm. The neurosurgeon agrees that that could be from the surgery since the area of the brain he was working on controls the motor functions of his left arm/side. The very good news is that the pathology report post surgery did not find any cancerous cells in what was removed – the neurosurgeon was as surprised as us since all indications pointed to a reoccurrence.

Kev returned to his chemo schedule the week after surgery and has now finished up cycle 5. Scans last week showed stabilization and some regression of his remaining tumors. So he will continue with the chemo starting cycle 6 this weekend. Much of the usual side effects are still bothering him – the neuropathy in his feet was especially painful so he was given a new drug, Lyrica, to help with that – it’s working pretty well. The hair loss continues. Luckily, all the skin issues seem to be avoided this time.

He met with the radiologist who will be performing the radio-surgery on the tumor in his in frontal lobe next week (Aug 9). Apparently this time they want him to check in the night before and stay over. Since the procedure is scheduled to start at 6:00 am – this is beats an hour-long drive at 5:00.

Kev’s sleep patterns have been a mess for the past month – it wasn’t exactly normal before the brain surgery, but after it really went haywire. Immediately following the surgery Kev barely slept at all. He’d stay up until 4-5 am fall asleep for a couple hours and be up at 7-8. He seemed to have lot’s of energy and would get work complete in the middle of the night – he even finished up the plans for our garage rework/remodel. We suspected this was due to the steroid, Dexamethosone, he was taking to help with swelling reduction/healing. But it continued even after he discontinued use – up to a couple weeks ago. Then he started falling asleep at about 8 pm and sleeping easily until 10 am or when the kids would start making too much noise or needed a ride somewhere. Now he often naps at 3 pm, 7 pm and finally going to bed for the night at about 1 am.

His pharmaceutical menu now includes:
Nexavar (chemotherapy drug)
Abraxane (chemotherapy drug)
Hydrocodone, Oxycontin, Oxycodone & Actiq (his suite of narcotics for pain – his favorite being the Actiq lollipops)
Lyrica (neuropathy pain relief)
Keppra (anti-convulsant)
Ritalin ( to help stay awake/alert during the day)
Ambien (to help sleep at night)

Recovery

Kev was released from the hospital on Thursday (6/28) and has been feeling great! Seen here visiting with one of our chickens and enjoying the nice weather this weekend. The surgeon did a great job matching up the new scar with the old. I resisted the urge to ask if he re-used the same screws - $1068 ea (and we thought space hardware was expensive)!

Kev was working from home on Thursday and returned to the office today. He meets with the oncologist on Friday (7/6) and his pain management Dr on Tuesday (7/10). Then he goes back to the nuerologist in 3 weeks (7/24) to get his stitches removed.

Post Op

The surgery went very well and Kev is recovering just fine. He is alert and talkative and is moving around pretty well. They have him taking potassium, magnesium, antacids, antibiotics, steroids and his usual anti-convulsants and Vicodin is doing a good job of controlling the pain. (No chemo drugs for the short term). He did get a couple doses of insulin because his blood-sugar levels were a bit high. This is a side effect of the meds (and is probably exacerbated by his present diet which consists entirely of fruit juice, puddings, jello and ice cream!). He should be off the IVs tomorrow (Wed) and be coming home on Th.
This time around Kev had the idea of getting his hair cut short before going in for the surgery and it looks like it was a good plan. Instead of shaving the entire right side of his head they only shaved a strip along the cut. Once all the bandages come off, we'll get a good picture.
Thanks for all the good thoughts and prayers!

Cycle 4, Week 3

Kev went in on Friday for his 3rd IV of Abraxane for this cycle. His blood counts were low so he had to go back on Sat for a shot of Neulasta. This helps "boost" his blood cell growth. Because of the sudden growth, this drug often causes bone pain, similar to growing pains that teenagers get. However it doesn't really bother Kev very much.

He also met with his Anesthesiologist (standard visit prior to surgery) on Friday. This is all becoming very "normal" to us now. The nurses in the pre-op recognize us on-site. The anesthesiologist knows the special "anti-nausea cocktail" Kev gets without us even having to mention it. I know which chairs in the waiting room are the most comfortable and what time the nurses come in with their "updates". I have even become accustomed to the 5am check-ins on surgery day. Everything is very predictable and in a sense that provides its own comfort. However we're fully aware that the only certainty is that nothing is certain. So when we were informed that we should check in on Monday at 10am instead of 5, it was a surprise that we gladly took. I hope that's the only surprise we get from this surgery.

Another Surgery

We met with the neurosurgeon on Tuesday and discussed the MRI. Since his last scan 2 months ago, there is a new small 6mm metastatic nodule in the right orbital surface of the frontal lobe. Additionally he pointed out that there is an increase in growth in the postsurgical cavity. The smallish markings that have been present since the surgery (and have been stable for the last year) were presumed to be "scarring", but this new and sudden growth is indicative of a recurrence.
He explained the new growth is in a fairly insignificant region of the brain. The left part of the orbital surface of the frontal lobe controls primarily "higher cognitive functions" and the right side is the "back-up" for the left side. It is highly unlikely for tumors in this region to cause any seizures or physical/mental impairments other than the effects it causes by getting larger and putting pressure on the brain in general. However the area where the recurrence is (right side frontal lobe) will most likely cause seizures (as we saw last year) and could affect control of left side of his body. So it was determined that Kev should have surgery to remove the recurrence (scheduled for June 25) and a month later will have stereotactic radiosurgery (which is a very precise delivery of radiation) on the new growth. If the stereotactic radiosurgery is not effective (determined by stabilization at 6 months post treatment) then a real surgery will be scheduled. It is felt that we have more time with the new growth to try a less intrusive procedure first, before resorting to "brain surgery".
Additionally, the neurosurgeon offered to remove a larger tumor (approx 3cm) in Kev's neck at the same time as the recurrence. It's not necessarily causing him any problems now but could present eating/breathing issues if it started to grow quickly.
Tomorrow (Friday) Kev get his 2nd weeks treatment of Abraxane as part of his 4th cycle.

Cycle 4 starts

A brief update:
Kev met with his oncologist on Friday and they decided to start a 4th cycle of Abraxane & Nexavar that day. The CT scans indicated, in general, a slight shrinkage in most tumors. (a more detailed report will follow). The new brain lesion was also discussed and it was agreed that Kev should meet with the neurosurgeon to discuss options. We have an appt with the neurosurgeon Tues.

LIVESTRONG CHALLENGE

On a more positive note, Kelden, Nick and I have decided to form a team and ride in the LIVESTRONG Challenge this October in honor of Kev.

The money raised funds the Lance Armstrong Foundation. LAF helps people with cancer focus on living. Their slogan - "We believe that unity is strength, knowledge is power and attitude is everything" pretty much sums it up. LAF has been a tremendous help to us providing both practical and inspirational information.

Most recently Cancer supporters here in TX united together to get a Cancer Bill successfully through the TX house and Senate which assures a public vote in Nov and offers Texans an opportunity to approve $3 billion in general obligation bonds that would provide $300 million a year for cancer research in Texas. This is especcially important for us since there currently is no cure or even a standard treatment for Malignant Melanoma. And there is a direct coorelation in cancer research between money and cures. All Kev's treatments now have the same goal - to keep the disease stabilized long enough for a cure to be found. Please join our team, or if you can not attend the Ride, please support the cause by donating to one of our team members. Links to join and to each members webpage can be found on the team page: http://austin07.livestrong.org/team_matterhorn

Join the fight - Take the Challenge!

MRI Results

Normally appts with the Neurologist these days are uneventful. He manages Kevs seizure activity and anti-convulsant meds. And since he has had no seizures since his brain surgery last August and his anti-convulsant meds hasn't changed since Dec (still taking 1000 mg Keppra twice daily) there is rarely anything to discuss when we meet. But today we had the new MRI results to look at since they weren't ready when we met with the Neurosurgeon on Tues. Unfortunately the results were not what we wanted to see. Kev has a new brain metastisis on his frontal lobe. It presently is only about 4mm and the Neurologist is not worried about new seizure activity since this part of the brain is not usually associated with seizures, but it does present other problems. For one, it pretty much disqulifies Kev from participating in any clinical trials for at least 6 months. In addtion, it's indicative the cancer is becoming more aggressive. Last time a brain metastisis appeared all other treatment stopped and the focus shifted to the brain. We meet with the oncologist on Friday and he is the one that will determine our next steps.

Tests

Today was a day of tests for Kev - MRI for the brain; CT Scan for chest, abdomen & pelvis; X-ray of chest; and blood draw. He also had an appt with the nuerosurgen to get his stitches removed in addition to a general check-up. Normally we get the MRI the day before meeting with nuerosurgeon so we can go over the results with him, but this time a scheduling glitch put both on the same day. However he does have an appt with his nuerologist on Wed so we get MRI results then. Friday is his appt with his oncologist and discuss which treatment options we should get started with.

Roman Holiday

Kev has really perked up this past week. It's been 3 weeks since he's had any chemo and most of the side effects are gone. His energy is back and even his facial hair is starting to grow. His meds are down to only the anti-convulsants and narcotics (pain killers). His next appointment is not until June 5 and since the kids get out of school Wednesday (5/23) we are going to escape reality and go to southern Italy for a couple weeks. This will be a very special trip for the four of us. Hopefully everything goes well.

Detour

Cycle 4 did not start on Wed and we are going to take a short respite of sorts. There are multiple reasons for this - Kev was wanting a break from the side effects that were worsening and his oncologist did not want him undergoing chemo if he was to have surgery. So he is chemo free until early June. There is however, a new twist. Since he was to have the tumor resection done, his oncologist mentioned a trial that NIH has been doing that Kev could qualify for. It's called Lymphodepletion Plus Adoptive Cell Transfer. It has two phases and basically goes like this: Phase I - the tumor that is removed will be used to grow T-cells (tumor fighting immune cells) in a lab. If the growth of the T-cells is successful, Kev gets to continue. Phase II begins with extracting stem cells from Kev's blood, then treating with chemothearpy to destroy his immune system. Then the specifically tailored T-cells will be infused back into his system. There is a lot more details , but for now we are waiting the 4-6 weeks to see if they can get his T-cells to grow.

Kev did have his surgery today (Friday). It went quite well. We arrived at pre-op at 5:30 am and left with one less tumor and 12 new stitches at 2:00 pm.

Cycle 3, Week 3

Now that we’re into the third month of this latest treatment, the accumulation of the chemo drugs are taking their toll. Kev is feeling pretty miserable most of the time. Although now that week 3 treatment is complete, he gets next week off from Abraxane and is hopeful that some of the discomfort will subsides. He is still taking the Nexavar daily but his Rx runs out the end of this week. He can’t get a new Rx until he sees his Dr. which isn’t scheduled until mid next week (2 May). This is probably just the usual kind of mistake that we often encounter which is resolved after a few phones and trip to the medical center. But this time Kev is not interested in trying to “fix” it. He is looking forward to not taking any chemo and even though at our last Dr. visit the plan was to continue through cycle 4, Kev is now talking about taking a month off. He thinks the side effects of the treatment is causing him more discomfort than the disease itself.

Cycle 3, Week 2

This past week has been difficult for Kev. His skin has been bothering him quite a bit – it’s peeling, itchy and his hands and feet are cracking near the joints which make it painful to bend his fingers & toes. Also the inside of his mouth is very tender so he can only eat soft, bland foods. In addition, he has been battling intestinal problems and diarrhea. This combined with a general lack of appetite does not help the whole weight gain objective.

We did hear back from the neurosurgeon and since he going to be out of the office on the 27th, we are now scheduled for May 4 for the head surgery.

Cycle 3, Week1

Well as you can see from the title that we have started another cycle of Abraxane & Nexavar.
The CT scans showed no new tumors and no significant growth in any of the existing tumors. This was interpreted as positive results. In addition there are a few tumors, neck & armpit that don't get scanned in the CT or MRI so the oncologists tracks these by physical measurements. The armpit tumor was greatly reduced, broken up and softer (from ~10 cm to ~6cm) so this was definitely a positive result. It was also discussed that after cycle 4 Kev would get a PET (Positron Emission Tomography) scan. This allows for a full body scan and can identify all his tumors. Plus it can differentiate between dying tumors and growing tumors. Kev has had a handful of PET scans. The first in 1999 soon after his metatastises were initially identified.
The oncologist also concurred to having the subcutaneous tumor removed from the back of his head. He suggested April 27 which would be at the end of Cycle 3. So we now just need to coordinate this back with the neurosurgeon.

Cycle 2, Week 4

No Abraxane this week, instead an MRI and consult with Kev's neurosurgeon. The results from the MRI were good - no metastases. Kev did ask about the tumor that is subcutaneous and on the back of his skull. It's been there over a year, and it has continued to grow even through the treatments. It is both bothersome, for sleeping, and troublesome in that we're concerned it may start growing into the bone. His neurosurgeon said he could easily remove it - day surgery. We just need to get the OK from Kev's oncologist.

CT scans planned for Tuesday and a meeting with the oncologist on Wed. As long as the CT scans indicate there is some positive effect, we should be continuing with the next cycle of Abraxane & Nexavar treatments.

Cycle 2, Week 3

Week 3 went well enough. Kev even worked in the yard this past weekend - a first in probably a year. No Abraxane this week, but instead this Wed we get an MRI (brain scans) - [fingers crossed...] A meeting with his neurosurgeon on Thursday will provide the results...
Next week we get CT scans (body) - more crossed fingers... & toes...

Cycle 2, Weeks 1 & 2

Last week Kev's appetite started to pick up, but still no weight gain. However by this week he had gained 4 lbs! The side effects are still manageable, but his hair is starting to fall out. He is not so fond of going through that again, but it obviously indicates the treatment is doing something to his body - let's just hope there are also some positive responses. Next Wednesday, the 21st, will be his last (3rd) abraxane treatment for this cycle and we will get scans shortly thereafter which will let us know how effective this has been.

Cycle 1, Week 4

It’s the end of week 4. This was an “off” week for the Abraxane, but Kev did receive boosters for red and white blood cell growth. And the oncologist gave him the “OK” for starting Cycle 2.

Cycle 1, Week 3

We are noticing some good side effects! Several of Kev's subcutaneous tumors are shrinking. The effect is small but noticeable. We don't know about the internal tumors until he gets a new CT scan, which will be after Cycle 2. It's great though that we can see (and feel) some results from these meds for all the discomforts he has to put up with. The fatigue and flue-like symptoms continue as does the sensitive tongue and cracking skin. Ibuprofen helps with mild fever aches & pains and he has a salt/baking soda mouth wash to help the tongue.

We had a regular follow-up appointment with the Orthopaedic surgeon. He took a new x-ray of the hip and said everything looks great. The artificial joint has not shifted and Kev has healed very well from the surgery. However despite his attempts to gain weight he is still losing - down another pound this week. Kev now weighs 135 and was put on an appetite "enhancer" - Megestrol.

Cycle 1, Week 2

Side effects are getting stronger. The palms of Kev's hands are cracking and his tongue is extremely sensitive. He is trying to eat soft bland foods. He lost about 10 lbs in Jan because of the side-effects of the radiation treatments so we have been trying to get him to gain weight, but when he weighed in this week he was another pound down.

Cycle 1, Week 1

Kev started his first cyle of Sorafenib/Paclitaxel on Wednesday. So far side-effects are minimal - mild flu-like symptoms.
And good news - our insurance company has agreed to cover the treatment!

Driving

Kev is now 6 months free of seizures and is therefore driving again - on a limited basis at least. It has been almost 1 year exactly since his first seizure and when he had to stop driving. He is very glad to be owner of his own schedule again.

The Next Phase

A little over a week ago (1/24) we met with Kev's Oncologist. He offered us the chance to get into a clinical trial that Kev had wanted to do last summer so we jumped at it. First new scans had to be performed, so appointments were set up for later that night and the following day. The brain MRI had to come back clean otherwise he wouldn't qualify. And an appt was scheduled for us to meet with the clinical trials Dr the following week (1/31).

However, when we came back for the appt with the trials Dr, we were informed that the next available opening was in four weeks. Although his brain MRI was clean, the CT scans indicated a lot of new growth so it was decided that we did not want to wait and opted for plan B, which used one of the same drugs from the trial. Plan B consists of taking an oral med, Nexavar(Sorafenib) along with an IV drug Abraxane(Paclitaxel). (The trial was Nexavar with an experimental drug CCI-779)

Nexavar targets two separate enzymes that regulate the cell cycle. It targets both the RAF/MEK/ERK signaling pathway to inhibit cell proliferation and the VEGFR-2/PDGFR-ß signaling cascade to inhibit tumor angiogenesis. In common language that means it supresses the formation of cells and new blood vessels.

Abraxane kills cancer cells by affecting its ability to stop cell division. It works by damaging the RNA or DNA that tells the cells how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce apoptosis (cell suicide).

Treatment is scheduled to begin on Wed 2/7.

Radiation- behind the scenes

Step 1: (upper left) Kev climbs into his custom made "seat".

Step 2: (upper right) The alignment begins...The table adjusts in two axis. It can raise/lower to set for correct depth and it can move in/out. Adjustments left/right are made by the tech pushing/pulling on the “seat”. A red laser light (barely visible in pics) is used as an alignment guide for left/right and in/out adjustments. Real-time x-rays are used for depth alignment. There is a bank of monitors on the wall used for visual displays. These settings are saved.

Step 3: (lower left) The emitter rotates.

Step 4: (lower left) Depth settings are now made for the underneath zapping operation. The program is “run” with a 15 second delay – enough time for everyone (except Kev) to evacuate the room through a 3-foot thick door. The techs monitor everything from a different room with computer displays.

Radiation

In early December it was decided that Kev would undergo radiation treatment on his pelvic region. It's assumed that the surgery did not remove 100% of the cancer in the bone so the radiation is used to attack any residual. And since the surgeon was not able to get to the groin tumor, this would also be included in the focal area. [The radiation injures the genetic material (DNA) in the nucleus of the cell. It will either destroy the cell or alter its metabolism which effects its ability to function normally.]

We met with the Radiologist on the 5th and she had his 'simulation' scheduled for the next day. Although there were a page full of side effects, she explained the ones most applicable to Kev would be localized burning (not unlike a sunburn), intestinal discomfort, muscle aches and sterilization. Kev always teased about having a late-life, unplanned, love-child after K&N went college. But with one consenting signature we said farewell to Freegift Pehr.

The 'simulation' consisted of having a custom fit mold made to hold his mid-section in the same place day after day and temporary tattoos applied to the newly shaved areas. The first treatment was Dec 11 and continued daily for two weeks, ending on the 22nd. Kev would lay on the table sung in his form fitting mold. The tattoos were used to align his body with the machine, maintaining repeatability on the focal area. Real-time x-rays were used to verify proper depth. It really was quite an impressive set-up. He'd first get zapped from underneath and then the machine would rotate and zap him from the top-side. He was getting 300 centigrays/day for a total exposure of 3000 centigrays. The whole process only took about half of an hour, but add in an hour drive (min) each way and wait time and it quickly became difficult to juggle the kids' schedules and Kev's schedule. A big thanks to Dave and Dan who helped out with transportation on days I had conflicts.

We met with Dr. A, the radiologist, on Wednesdays to discuss side effects. At the first visit Kev didn't have any noticeable side effects, but she explained they are often delayed since they correspond to dosage accumulation. She recommended 600mg ibruprofen for muscular discomfort and gave Kev some Aquaphor lotion for the burns. By Friday he was using both. On the following Wed we discussed the muscle soreness and the burned/sensitive skin. He had no intestinal problems -- yet. The treatment concluded on Friday, Dec 22, with a ceremonial ringing of the bell (K, N & I were all there to applaud) and total accumulation of 3000 centigrays radiation exposure. Dr. A (who btw looked barely old enough to be out of high school much less medical school) explained the following week would bring the worse side effects and Kev should expect to feel "poopy". I wondered if she meant literally or figuratively - she meant both and was right.