We had a little confusion. The directions they gave Mom over the phone didn't quite jive the directions I googled off their website, but we finally made it to the Seay building at UT Southwestern and were greeted by the bright orange glass installation by Dale Chihuly. (See previous post.) A real treat! Mom and Dad had tried to see it when it had been installed but had been unable to find it then. Then it was past a very large David Bates painting and on to the doctor.
After check-in and vitals, we met first with nurses who took Mom's history and gave us a brief introduction to the process. Then we met with Dr. Timmerman and his team of resident oncologists. Everyone's manner was great. The attitude is realistic positivism. Their approach to attacking cancer is new and there is sense of ownership of the process.
What's new is the amount of lethal radiation Dr. T is able to focus on the tumor. Conventional radiation used a lower dose spread over a greater area. The problem was how to kill the tumor without killing a wide swatch of healthy tissue as well. The thinking was that radiation knocked the cancer back some and chemo and/or surgery would take out the rest. Sterotactical Radiation uses many low dose beams from many points of origin which converge and concentrate on a single point and deliver a much more powerful and lethal dose of radiation, doing major damage to the tumor. The Ghostbusters had it figured out. Crossing the streams is bad. Dr T crosses many, many streams.
The goal of the treatment is not to remove the tumor, but rather:
- "To terminate its growth pattern."
- "To shock it to prevent further reproduction of the cancer cells."
- "To castrate the tumor."
- "To pound the tumor with a potency that was never approached in older radiation therapies."
Sounds pretty good. There are some drawbacks with this focused treatment. With a tumor this size there is a good possibility (30-40%) that there are other cancer cells existing in Mom's lungs that are not yet detectable. We are doing nothing to prevent their growth. Frequently patients undergo chemotherapy along with this radiation to clean things up, but with Mom's kidney issues and general frailty, this is not a great option. The best thing is to keep our eyes open and catch and zap new growths as they appear.
Everyone was very emphatic about the lack of side effects at the time of treatment. Radiation is not quick. They don't see why someone who is driving can't drive themselves to and from treatment. "NO DOWNTIME, NO FATIGUE." was repeated.
HOWEVER, there is the possibility of long-term side effects, which affect about 15% of their patients. These are generally lung issues such as coughing, bone damage and pneumenitis, These are caused by collateral damage to the normal tissue. They 'burn' about a quarter-inch perimeter of healthy tissue around the tumor, to be sure they get the whole tumor. This healthy tissue might include ribs, airways, blood vessels, whatever is in the way. Such damage will start showing up 3-6 months after treatment. My guess is that the tricky thing will be discrimination between pneumenitis (inflammation treated with steroids) and pneumonia, especially with Mom and her COPD.
Dr T and his crew emphasized their availability and we were given plenty of business cards with direct numbers. Again everyone was very friendly and direct and quick to laugh and smile.
The process will involve 4 appointments.
The first is call "Simulation Day" or as Dr T. put it, "a day when we actually get to PRACTICE medicine." Unlike, say, surgeons. They will make a custom form fitting bed for Mom to use during treatments so her position will always be the same. They will plan the directions of the beams, based on imaging so they will know how to set up the equipment to attack the tumor. The treatments last about 25 minutes, so Mom will breathe and chest will move. To track it, she will get 4 pencil point tattoos that will be used to track her motion. The beams will then move accordingly. This appointment will be somewhat long and arduous.
Treatment will be in 3 sessions over a two week period. We need to allow about an hour for each appointment. Mom should be fine afterwards.
Scans will start about 3 months after treatment. Dr T says the first scan always looks great and everyone is thrilled. The second scan starts looking cloudy as scar tissue begins to slow and by 9 months the scan is a murky mess and people get worried. BUT he's supposed to be the best at reading them. That's why he is who he is.
Susan grilled him pretty hard over the side effects and collateral damage issues. They pulled Mom's image up and we saw the tumor. It's an ugly globulous thing and occupies a larger part of the upper lobe of her left lung than I had imagined. Google lung cancer images if you're interested in seeing some.
Overall, we were very satisfied with the appointment and the direction treatment is headed. The original Sonny Bryan's was right across the street and we left right at lunch time. Nothing like a good sliced beef sandwich to make you feel better. We got one to take to Dad.
Again, thanks, Dave. And Susan. And Dale. (And Sonny.)
ReplyDeleteI talked to Mother this morning and she echoed your attitude—very upbeat about the near future, reasonably upbeat about the more distant one. She seems especially pleased she will be able to manage going to treatments on her own, as she doesn't want "Dave to take any more days off on her account." Whatever. Just the realization of competence is healthy.
She said they worked Dad hard in his therapy yesterday and that after he finished his BBQ, he went straight to bed for the night. But the guy in charge of his therapy gave him big kudos for the day's work.
xxoomm