Splenic Irradiation Update: October 28, 2010

I am home, exhausted both physically and emotionally. I left home at 2 for my appointment with the radiation oncologist and did not leave there until after 5 then had dinner and went to the cancer support group and arrived home at 9.

What a compassionate, kind, educated man was the radiation oncologist. His training was completed at Mayo Clinic. Not only was his compassion amazing, he was very informative and helpful. He had reviewed almost a 5" binder of my records (and asked to keep it to finish his review). He had reviewed studies, etc. that I provided. He is in agreement that splenic irradiation is my best (and perhaps only) treatment option. I will have a planning CT tomorrow and then he will present the information to my insurance case manager. She is going to expedite the physician review, so we anticipate an answer by mid-week. November 8th is the target date to begin my radiation and I will go three times per week for 4-8 weeks, depending how well I tolerate it. 600 cGy is the goal we have for my cumulative dose of radiation.

After much discussion and debate, the radiation oncologist believes that I should begin with the 50 cGy fractions (versus the 25 cGy fractions). A fraction is a radiation dose/session. He said perhaps we will maintain that dose for a week but if I am tolerating it, we may continue. He will perform a CBC, CMP and uric acid check M-W-F on radiation days to watch for cytopenias (low platelets, neutrophils, hemoglobin) and indications of tumor lysis syndrome (possible with radiation as with chemo/immunotherapy). Tumor lysis syndrome can develop when the kill-off cancer cells is rapid and the kidneys cannot filter the killed cells and this can be fatal. Many people are able to take a medication to prevent it (Allopurinol) but I cannot take it because of my past drug reactions.

He said he would probably recommend anti-nausea medicines and I told him I have never taken them with chemo and would prefer to use my Sea-Bands and ginger. He agreed. He said he had no problem with my alternative treatments/supplements. Hurrah!

He said side effects could include nausea and fatigue but it will depend upon how low the spleen is when we begin radiation. He expects 1 month after completion of radiation for total recovery.

I had an interesting experience this evening - a God experience, I would say. Our daughter is a dietitian at the hospital where I will receive radiation. She was leading the Cancer Support Group tonight, so I attended. I asked myself why I was going because I have never gone to a cancer support group. Now I know why! The physicist (calculates radiation doses, etc.) came before the meeting and asked if anyone was going to begin radiation and he took me through all of the computer systems, the IMRT planning program, the equipment, etc. It was a helpful behind the scenes view of the radiation department. My daughter told him I was her Mom and asked him to take good care of me.

I shocked myself. When we went into the actual radiation room, my legs began shaking, my palms were sweaty and I felt like I was going to burst into tears. It was just a rush of emotion that I have never experienced except on the first day of chemo in 2002.

When the meeting was over, I went with my daughter to her office. The CEO and COO of the hospital were there and she introduced me to them.

I am a bit concerned - temperature was 99 today at their office. I had green drainage from sinuses and lungs today. They discontinued the Neupogen today because after 3 of the 5 injections, my ANC (Absolute Neutrophil Count - neutrophils fight infection) went from 500 to 10,000! Pretty good production for marrow operating on 2% without leukemia infiltration.

I am so exhausted but wanted to post my update. I have deposited all of this at the foot of the cross. I believe and am asking God if I am not to proceed with radiation that he use an insurance rejection to stop it. I will wait patiently.