Two For The Price Of One

Even though I previously had two other gamma knife radio-surgeries, the treatment on January 30th was going to be different.  Dr. Kim (my radiation surgeon) would be addressing an entire tumor - rather than simply radiating the bed of a tumor that had already been resected.  Yet, because my recovery for the gamma knife at the end of August and beginning of December had gone fairly well, I was not apprehensive about this procedure.

In my mind, the recuperation for this latest gamma knife would be "easier".  This reasoning was based on the fact that the first and second gamma knives were proceeded by a craniotomy and this third gamma knife was not going to occur post-surgically.  Unlike when the knowledge gained during the recovery from my first neurosurgery made it difficult to contemplate a second one, the first two gamma knife experiences caused no sense of dread for the third one.  However, once again, my surmising turned out to be incorrect.

Several aspects of having the procedure remained the same - which was comforting.

• same location
• same check-in process
• same pre-op nurses (Connie & Marilyn)

A few facets had changed - which were non-impactful.

• different anesthesiologist
• different 2nd physicist
• different procedure nurse

One of the differences in the radiation routine was an improvement.  The adjustments previously made by hand screwing various arms to my head frame and removing them - which involved sliding me in and out of the machine, and sitting me up and laying me down repeatedly - was now done robotically inside the machine.

The biggest change to the modus operandi that did not bode well was when Dr. Mittal (my neurosurgeon) appeared after my stereotactic head frame had been attached and I was in the holding area waiting for the physicists to program the computer for my radiation treatment.  My gut reaction was:  "This is not good."

Dr. Mittal inquired if I was able to walk with my frame on and I indicated I could.  He invited us down the hall to "show us something".  It was the MRI from that morning that was done in preparation for my gamma knife.  He began by explaining that my smaller tumor (which we were going to leave to qualify me for the drug trial) had increased a few millimeters in the last two weeks and my larger tumor had increased several millimeters.  Fortunately, it was still feasible to radiate the exponentially larger tumor.

Hhmm - so what's the bad news I thought.  Well, it was that a third tumor (my fifth) had appeared   Even more disconcerting was the fact that it was not visible only two weeks previously from my regular monitoring MRI and it was already close to a centimeter in size.  Super.

The good news was that it was found quickly and more importantly, before my gamma knife procedure.  Therefore, I was going to have both the original large tumor and the new large tumor radiated together - two treated for the price of one.  Or at least two handled during the same procedure (as I am pretty certain our insurance will be billed accordingly).

In hindsight, having two pretty good sized tumors treated meant I had a much larger area of my brain radiated than in the past.  This explains why the recovery was much more difficult this time - although it wasn't anything I couldn't handle.  C.C. Scott said: "The human spirit is stronger than anything that can happen to it." and I agree.

While we were not thrilled by the latest development, it only served to underscore the need for me to begin taking Vemurafinib as quickly as possible.  Hopefully, this will happen sometime in the next week and this new "miracle" drug will be effective for me so I can KMA!