Thursday, May 18, 2006

Emerging picture

Well, friends, the piecture is starting to emerge and it isn’t especially pretty. Swa the radiologist, Dr. Dajaba, this afternoon. She said the MRI from Tuesday night snows multiple spots in the interior of my brain—not the protective outer coating (the meninges, if I understood correctly(, but rather in the interior; she said to imagine them like raisins inside a raisin bagel. The biggest one is 2 centimeteres long, a bit less than an inch. The others are smaller, just a few millimeters. The catch is that she’[s sure there are more, but she has no way to know how many or where they are: the MRI can’t detect anything smaller than 3 millimeters. So the plan is to irradiate my entire brain. Theu will do this slowly and gengly, using a dosage about 2/3 of the usual daily doe, over two and a half weeks. Dr. Dajaba is confident that these leukemic cells will be extremely sensitive to the radiaition, and that she will be able to all of it without damage to any of my brain, so that Anna and I will be able to buy her dinner in Lebanon when this is all over (Anna wants to hear the music and go dancing in Beirut!(.

Tomorrow morning we’ll gi back to the Radiation Treatment Center. There they’ll make a mask of my head, covering it with some sort of breathing mesh substance Gore-tex, maybe?) that will dry in the shape of my head. This mask will be used during treatment each day to hold my head in place, ensuring that I don’t move around and that the radiation goes to the same targets each time. I think they’ll also draw circles and arrows on the mask (shades of Alice’s Restaurant!) to mark the spots. When it’s all over, we get to keep the mask as a souvenir.While all this is going on, they will also be doine what’s called intrathecal chemotherapy: yesterday’s lumbar puncture (spinal tap) revealed that there’s also leukemia in the spinal fluid—in fact, Mary Alma Welch, Dr. Giles’ Physician Assistant, told me on the phone late this morning that 85% of the cells in my spinal fluid are blast cells. The good news is that they have already started the intrathecal chemo—they “instilled” the first doe yesterday immediately after drawing fluid they needed for the various tests they run. We ran into Dr. Giles in the skywalk this afternoon, and he said he couldn’t say for sure yet how many intrathecal treatments would be needed, but he’s confident that the leukemia will respond.

Then we’ll be able to start the systemic chemo that will prepare the way for the bone marrow transplant. But it will be at least two and a half weeks before that can even start, since they have to finish both the radiation therapy and the intrathecal chemo before the systemic chemo can begin.

Dr. Dajaba says I will lome my hair. I hear everone saying, how will we tell the difference? So that doesn’t matter. But it was an excuse to buy a new hat—two new hats, in fact, including a great big-brimmed raffia hat from Madagascar. I also have several new shirts that Anna and I bought the other day before leaving Austin—I had decided that if I had to spend a long time in the hospital I could at least do in colorful clothes instead of those designer gowns opoen all the way donw the back… Only problem is that we didn’t bring enough socks and underwear for an extended outpatient experience! But that’s easy to fix.

--Time to feed Dillon, so I’ll stop for now and send this. It’s been a scary day. But the fact is that I’’m no sicker than I was 24 hours ago; I just know more about what’s wrong. And that’s a good thing; it means the doctors and others *including the physicists, as Dr. Dajaba said) are gaining more knowledge about what[s happening inside my body and how to deal with it. And, since they actually started the intrathecal chemo yesterday, I may even be a little better than I was yesterday. Here’s mud in your eye.

And, as always, thanks for all the calls and emails and prayers. I haven’t checked email in several days now (oh, the horror! The horror!) but I’m working on it.

Love to all from me and Anna and Dillon.

PS, 9:40 PM. We had a nice dinner again tonight, this time at an Italian place called Divino, on Alabama. Anna had duck breast with fresh cherries and wine reduction, and I had a grilled redfish. Delicious, and good for the spirit. Great eavesdripping, too—Anna called it my people-listening, to complement her love of people-watching. Whatever else is going on, so far there’s nothing wrong with my appetite or with the availability of things to satisfy it. More on Houston restaurants in future editions…


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