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Friday, July 3, 2009

Treatment Plan (Medical Update) -- Radiation

The tumors are small, so I do not need surgery, thank God.

We will switch chemo treatments, most likely to Xeloda and Lapanitib. We are still awaiting approval from the health fund. In any case, we will not start a new round of chemo until we get the results from the PET scan that I am having this Tuesday.

The first round of treatment will be radiation.

On Sunday my oncologist called to tell me he made an appointment for me to begin radiation therapy on Tuesday.

Things were moving quickly!

I read up about radiation options (at BrainMetsBC.org) and liked the idea of stereotactic radiosurgery (SRS) (not really surgery, since they do not cut into your brain) -- they pinpoint the exact area of the tumor and bombard it with high doses of radiation. There are less side effects from SRS than from whole brain radiation (WBR), though WBR is often recommended in addition to SRS.

On Tuesday, the onco-radiologist who met with us (Moshe came with me), explained that I have too many tumors for any of SRS procedures (Gammaknife, Cyberknife, or Xknife). She patiently showed us the images of my brain, and pointed out the tumors. We counted 8 or 9 tumors.

She told me that, after consultation with the head of the department, they recommend WBR, for 20 treatments. I did not want WBR, and asked to speak with the head of the department.

Since I would need WBR, even if I also received STS, I went for the "simulation" while waiting for the department head to return to the department.

The "simulation" is where they set you up for radiation. There is a special machine they use to mark exactly where you will receive radiation. In my case, the set up included making a mask of my head to hold it in the same place and position.

I closed my eyes and the technician placed a warm mesh mold on my face and pulled it down over my head. I held my head still as the mold cooled and formed a hardened mold. I had purposely left my mouth open for easier breathing, but as the mold cooled it pulled my jaw closed so only a small opening was left. I worried that I would not be able to breath easily. The technician assured me that if I found it difficult to breath, the technicians could cut open the area of my mouth.

Then I left to wait for the department head.

There was another woman waiting already and then another couple joined us in the waiting area. Realizing that he might not know to call us in, I returned to the technician to ask how he would know that we were waiting for him. She told me she would let him know.

Good move!

We were the first ones called in.

The head of the department patiently and kindly explained to me, again, the reasons for recommending WBR, primarily because I had over 3 tumors. He also showed us the largest study comparing tumors treated with and without STS and read the summary to us: STS is dramatically effective when there is only one tumor. When there are 2-4 tumors, STS is still significantly effective. However, there is no evidence that STS improves recurrance or survival rates when there are more than 4 tumors.

He did not rule out the use of STS in the future, but certainly saw no benefit at this time. He is one of the top radio-oncologists and his position is consistent with the literature. He did not rush us and answered all our questions, even the ones we repeated from different angles.

I would begin WBR treatment on Thursday.

That first week, I would also receive radiation on Friday. Then I would receive radiation every day, Sunday through Thursday, for a total of four weeks (20 treatments).

Please daven (or send happy, healing thoughts) for RivkA bat Teirtzel.

With love and optimism,


Lynne said...

Glad things are moving along! Now you need to change your blog to CoffeeandChemoandRadiation.... just kidding. Let me know if you want me to come with you one day - I can always make time for you.


Baila said...

I'm glad things are moving quickly with this. Your medical team seems to be really good. Next up: good results (with G-d's help).

Rahel said...

Amen ve-amen. Are we still on later this month, or do we need to make a new date?

sparrow said...

Thank you for hopping over to NZ to visit my blog. I am thinking of you a lot today. Sending targeted prayers to those dastardly tumours:-) Big hugs.

Robin said...

Plans are good, they give direction to your fight, and you've got a top-notch team putting your plan together.

Holding you close in my thoughts my friend.

rutimizrachi said...

Everything seems back on track to me when you ask questions, get concrete answers, and build a plan. You go, Girl! May the miracle of the early discovery be part of a new and powerfully successful attack.

muse said...

The doctors seem on target.
B'ezrat Hashem!
Refuah Shleimah!!

Leora said...

RivkA, I liked the comment you wrote on Esser Agaroth's post on his terrorist attack memories. He was attacked externally; you are attacked internally - I can see the relationship. "Do not fear, My servant Ya'aqov."

Anonymous said...

I am glad the doctrs are reacting this quickly. Sending you my best wishes and praying for you.

Yehudit said...

Holding you in my thoughts and prayers, especially for the next few weeks to pass (g-d willing)as easily as possible, so you're quickly back to living your busy life, amazing us all with your spirit and energy.

Shelly said...

I keep rewriting my comment, not knowing what to say...
It seems like it was really a miracle it was discovered so early and b'ezrat Hashem that will make
an enormous difference.
You are the most alive person I know, using every minute you can, doing what you can for your children, your family and the world. Your zchuyot should stand for you.

Val said...

continuing to think of you. Glad things are moving quickly.

Daria said...

Sending you strength and courage as you go through this treatment...

Not Brisk said...

Refuah Shleymah

sparrow said...

Been thinking about you this evening and praying from the The Ends of the Earth.
Thanks for your good wishes for our anniversary.

Happy and Proud said...

Thinking of and praying for you.

Anonymous said...

Many many people are thinking of and praying for you and it sounds like you have and EXCELLENT and sensitive medical team.

Susan and Avi said...

RivkA, We are praying for you and thinking of you with lots of love and warmth. Continued hope and blessings to all of your family through all of this and may you keep carrying on with your courage, optimism and love,
Judy S. and family in Netanya

weese said...

my mom is on xeloda right now (she also does weekly gemzitabine (sp?)). she has secondary liver cancer. she is tolerating it fairly well. tho the doctor usually does 5 days on 2 or 3 off -they found she does better on a shorter schedule 3 on 4 i think is where she is at now.

Robert J. Avrech said...


The Avrech family is davening for you.

Dennis Pyritz, RN said...

Special invitation to all breast cancer bloggers. This month the Being Cancer Book Club is reading “The Adventures of Cancer Bitch” by S. L. Wisenberg, “witty and relentless, surprising and honest. Wisenberg has walked through the Valley of Cancer and she is willing to tell all; this is a cornucopia of breast cancer information as well as a very smart, funny read from an excellent writer."—Audrey Niffenegger, author, The Time Traveler’s Wife.
Book discussions are in Mondays’ posts. Take care, Dennis

rickismom said...

OK! Glad to see you are rarin' to go!

Shevy said...

Wow, RivkA, I've just been catching up as I took kind of a break after I lost 2 friends within about a week around the end of May/beginning of June.

It's hard to come back and see that you've been having a tough time.

I'm really glad that they're moving fast on this and that the dept head took the time to explain things so well to you. It sounds like they really have a good treatment plan in place.

And it seems to be so clearly an example of Hashgacha Pratit that this MRI that you "shouldn't have even had" would show you this at a far, far earlier stage than is usual.