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)