Author Topic: CyberKnife Journey at Stanford  (Read 28072 times)

rupert

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Re: CyberKnife Journey at Stanford
« Reply #60 on: October 22, 2018, 05:03:49 pm »
These tumors are very vascular.   After a radiation treatment there is damage to this vascular network.  The damage (tumor death) can be monitored by changes shown in the contrast dye on the MRI's.  As the blood vessels collapse the contrast dye doesn't flow as well through the tumor anymore.  That's not saying every MRI would need dye but,  after treatment using the dye periodically helps the doc see how the treatment is progressing.
« Last Edit: October 22, 2018, 08:56:15 pm by rupert »

Gtmochi

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Re: CyberKnife Journey at Stanford
« Reply #61 on: October 22, 2018, 09:29:08 pm »
Hi Freelander!

I am glad these posts are helpful.  Rupert is totally right! My doctors were saying the contrast is important in context of CK or any radiation treatment. Using it post-treatment reveals if the necrosis is increasing, decreasing, or has evolved into a dead/stopped tumor. I have read that when it is dead/stopped it can turn white again - a different sort of white, I expect, then a tumor that is still enhancing (I believe that is the word).  So, as Rupert stated, the contrast is helpful in monitoring the radiation's effect on the tumor post-radiation :).


« Last Edit: October 22, 2018, 09:32:35 pm by Gtmochi »
Diagnosis 2/15/18, 2.5 cm right side AN, hearing 100%
CK at Stanford, 4/23-4/25/18, Dr. Chang and Dr. Hancock
6 month MRI: No change, central necrosis
1 year MRI: some shrinking and necrosis

Freelander

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Re: CyberKnife Journey at Stanford
« Reply #62 on: October 23, 2018, 07:11:47 am »
Rupert and Gtmochi, your responses about the vascular system within the tumor being destroyed, hence, less flow and signal changes from the contrast MRI, sound reasonable.  At the same time, if the size of the tumor post-treatment remains the same or regresses, both of which can be detected without Gd, that may be sufficient evidence of tumor necrosis.   If a contrast MRI showed no discernable brightness or color change in the treated tumor, and no tumor growth, I wonder that the expert recommendation would be.   Hopefully, one safely crosses that bridge if encountered.  In my personal situation, the less Gd in my body the better.   Thanks for answering the question, and continue to give us the mid term post-treatment updates. 

notaclone13

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Re: CyberKnife Journey at Stanford
« Reply #63 on: October 23, 2018, 08:28:23 am »
The main objective of radiation treatment is to stop the AN from growing. If it actually shrinks the tumor, all the better. While seeing necrosis after radiation may be somewhat reassuring, it does not necessarily guarantee there won’t be future growth. I recall seeing at least one example on this forum where a tumor that showed a dark center after radiation ended up growing again. The radiation oncologists want the contrast agent no doubt to see how accurate the procedure has been at targeting the tumor. If they see a darkening, they know the radiation has hit the target and that is always a good thing to know. But in the long run, the only true indication that the radiation has been effective is that the tumor ceases to grow. That can be determined without contrast and in cases where kidney health is an issue, no doctor would argue against skipping the Gd.

gary.s

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Re: CyberKnife Journey at Stanford
« Reply #64 on: October 23, 2018, 11:33:00 am »
Hi Gtmochi,

I am really happy for you that the latest MRI results are positive and show necrosis of the tumor. You cannot ask for a better doctor appointment. Your reduction in hearing is a bummer, although you are more fortunate than most of us with 80% word recognition. Protect what you have left. The contrast issue is a real problem, so each of us has to find our direction and go with it. Since it is so soon post Cyber Knife, it seems to make sense to agree with the doctors and take MRI's with contrast. Maybe in the future as time goes on, contrast can be eliminated from the MRI's. So far so good Jessica.

Gary
Mild symptoms on right side July 2014
CK April 16-20, 2018, Barrow Neurological Institute
9/2018 hearing aid Phonak Audeo B and Cros B

rupert

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Re: CyberKnife Journey at Stanford
« Reply #65 on: October 23, 2018, 08:26:42 pm »
Rupert and Gtmochi, your responses about the vascular system within the tumor being destroyed, hence, less flow and signal changes from the contrast MRI, sound reasonable.  At the same time, if the size of the tumor post-treatment remains the same or regresses, both of which can be detected without Gd, that may be sufficient evidence of tumor necrosis.   If a contrast MRI showed no discernable brightness or color change in the treated tumor, and no tumor growth, I wonder that the expert recommendation would be.   Hopefully, one safely crosses that bridge if encountered.  In my personal situation, the less Gd in my body the better.   Thanks for answering the question, and continue to give us the mid term post-treatment updates.

I think it's important to remember that surgeons like Dr. Chang are not just looking at some dark spots and measurements.  They have immense training and experience and their analysis is highly complicated.  How many people get to look at every slice of their MRI on a 6 foot screen?   There's just more to it than what we see with our untrained eyes.   I think most people handle the dye well and don't have problems.  of course if you have kidney issues that is a special case and something that should be discussed at length with you doctors.

Gtmochi

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Re: CyberKnife Journey at Stanford
« Reply #66 on: October 25, 2018, 08:54:20 pm »
@Gary - You are are right - it's important to stay focused on the positive! Everything being on track as far as the doctors are concerned is a very good thing. The hearing loss for sure is a drag, but somehow the test results put my mind at ease. Knowing is SO much better than not knowing and worrying and guessing what is happening! I am thinking that for now, in my personal case, the risk contrast presents is worth knowing what is happening within the AN.  Plus, it is what the doctors preferred for the time being. I am hoping that after a while the AN is stabilized/frozen and contrast is something that can be set aside.  :)

@Rupert - Yes! While we might have some knowledge, the doctors have spent a good part of their lives studying, operating, and working with these ANs - the perceive much more going on in an MRI than I ever could!  :)

@notaclone - It's true that necrosis does not always indicate a positive outcome, however, it is reassuring because, as you said,  it is evidence of the radiation hitting its mark. Also, according to Dr. Chang, necrosis is fairly common. This is one case where I am happy to track with the majority! Additionally, I have read that the necrosis can evolve to appear white on the MRI to indicate that the AN is no longer enhancing.  If this occurs in the future, I would like that to be evidenced in the MRI.  So in mu case, I'll stick to contrast for now, Of course it makes complete sense that in Freelander or anyone else at risk to the dye should not use contrast!  :)

I will for sure keep posting updates. When I began posting initially, I felt once a month for the first year would be helpful. I was so grateful to others before me for having done the same!
Diagnosis 2/15/18, 2.5 cm right side AN, hearing 100%
CK at Stanford, 4/23-4/25/18, Dr. Chang and Dr. Hancock
6 month MRI: No change, central necrosis
1 year MRI: some shrinking and necrosis

Gtmochi

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Re: CyberKnife Journey at Stanford
« Reply #67 on: November 30, 2018, 03:14:49 pm »
It's been just over 7 months since CyberKnife...and as far as symptoms go, things are pretty quiet. Tinnitus is still there (constant) but generally sticks to its usual noise level, which is usually pretty ignorable. Still some face sensation, but less than it has been, and it seems to restrict itself to the area near the bottom right corner of my face near the mouth or under the tongue. Sometimes it's not even noticeable. I have not had any dizziness (that I can tell) or fatigue (that I can attribute to the AN), and hearing seems about the same as it was when I was tested a month ago. Also, I have not really had any twitching - I hope I've left that well behind me! In any event, things at this time are about the same or slightly better!

If things continue as they have been, I'll wait a little longer between posts to update. Perhaps every two months instead of every month. At least until my 1 year MRI in April   :).

Wishing everyone good health and happy holidays,

Jessica
Diagnosis 2/15/18, 2.5 cm right side AN, hearing 100%
CK at Stanford, 4/23-4/25/18, Dr. Chang and Dr. Hancock
6 month MRI: No change, central necrosis
1 year MRI: some shrinking and necrosis

notaclone13

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Re: CyberKnife Journey at Stanford
« Reply #68 on: November 30, 2018, 03:46:02 pm »
This is great news Jessica.  Please do keep on posting because it is always good to hear about people that are doing well after radiosurgery.  I am happy to hear that you have not had any issues with dizziness and fatigue. Wishing you and yours a healthy and happy Holiday season.

gary.s

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Re: CyberKnife Journey at Stanford
« Reply #69 on: December 01, 2018, 01:00:47 pm »
Hi Gtmochi,

It sounds like you are doing fine and I am very happy for you. The symptoms you describe are tolerable, just have to ignore them and keep on moving forward. Stay healthy, happy and strong. As my doctor keeps telling me, "Just go live your life."

Gary
Mild symptoms on right side July 2014
CK April 16-20, 2018, Barrow Neurological Institute
9/2018 hearing aid Phonak Audeo B and Cros B

SP

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Re: CyberKnife Journey at Stanford
« Reply #70 on: December 01, 2018, 02:10:18 pm »
Hi Jessica,

It's good to hear from you and that you are doing well.
Your descriptions of "ignorable" and "not even noticeable" are joyous words to describe any AN symptoms.

best of health and happiness with each forward step,

Stella  :)

My AN Story – Sydney to Stanford CK
2.3 x 2.2  June 2022@7yrs
2.9 x 2.9  May 2020@5yrs
2.9 cm  Mar 2019@4yrs
2.9 cm  Aug 2018@3yrs
3.1 cm  Aug 2017@2yrs
3.2 cm  Aug 2016@1yr
3.2x3.0x2.5cm AN; CK Aug 2015

Gtmochi

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Re: CyberKnife Journey at Stanford
« Reply #71 on: December 09, 2018, 05:43:24 pm »
Hi everyone! Thank you all for your positivity and support! I am sorry I did not reply sooner - you know how the holidays are ;-). I so appreciate your reassurance and support, and count myself very lucky  to have come across this forum and connected with such kind people.

Notaclone13, I will definitely keep posting! A happy holiday season to you and yours as well :)

Gary, the advice your doctor gives you is so great, and important to remember. 

Stella, You are very right! They are quite joyous indeed :)

Wishing you all lots of health and happiness as the holiday season is winding up  and the year is winding down :).

Jessica
Diagnosis 2/15/18, 2.5 cm right side AN, hearing 100%
CK at Stanford, 4/23-4/25/18, Dr. Chang and Dr. Hancock
6 month MRI: No change, central necrosis
1 year MRI: some shrinking and necrosis

Gtmochi

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Re: CyberKnife Journey at Stanford
« Reply #72 on: January 24, 2019, 07:26:16 pm »
9 months have gone by since CyberKnife at Stanford, and things appear to be holding steady.

Tinnitus is still around, but currently seems to be less. It went through a period in which it became more insistent, but now, to my relief, it has died down a bit. I’d say the tinnitus is, relatively speaking,  the most bothersome of my symptoms. It also happens to be what brought me to the ENT in the first place!

There’s still some facial tingling - it’s mostly just in the right corner of my mouth, a little on my right tongue and occasionally at my temple/hairline adjacent to my R ear. Sometimes it’s not even there. I love when it is not there.

There is intermittent ear fullness. Sometimes I'm aware of it, sometimes I'm not. Either I am used to it, or it's actually improving. No way to know for sure!

The hearing loss seems to be the same from when I was last tested. That’s been not amazing, but I work from home, and so do not have to deal with the challenges of a noisy workplace that many face. Mostly it’s just irritating. When I do run into issues, I tell whomever I am interacting with  that my right ear is not great at doing its job, and that if I look clueless or don’t respond, chances are I did not catch what was said.  When I go out, I try to position myself in the best spot, and if the ambient noise makes it hard to understand, I chat with those nearest to me.  I’ve not yet got a hearing aid - but I plan to!

Thus far, I am truly fortunate to have not had any real balance or vertigo problems to speak of - I still ride horses 4-5x a week, go to the gym, do yoga to stretch at night. For Christmas, I got a Bosu ball. I get on that when my Apple Watch informs me that it is time to stand up, or on the phone - ha!

While this advice is not applicable for everyone - so many with AN’s are struck with awful balance issues - my two PT friends (one of which works with those with vestibular issues) told me it’s best to “lean in” when challenged. So, for example, if you feel a bit dizzy when you turn, do it again (carefully! With help if needed!). Basically make yourself do the uncomfortable - within safety and reason, of course. I’ve not needed vestibular therapy, but I think it would be huge for anyone with dizziness or balance issues. When I shattered my finger (twice in 6 months!) and then had 3 (!) surgeries, I went to PT. I could have found the exercises online, but being with a professional made me feel safer and in a program tailored to my specific issue. I had such PTSD about hurting my hand I was too scared to do anything with it, and it was quite reassuring to have someone guide me through exercises.  I am very glad for those sessions, and that my insurance covered them.


The thing I have noticed about my symptoms overall is that they are capricious - receding so much and for such a long period that I take it as a sign things are going swimmingly. Then they come back to visit and I get a bit down, wondering  if maybe the stupid thing is waking up. This despite evidence to the contrary - I’ve read growth and symptoms are not really linked. That worry is fleeting, though - the further out I get from CK, the more able I am to move on and keep living the dream (ha!).

That emotional aspect - the toll this whole process has taken - is perhaps the most difficult. I am not the same person I was before diagnosis - I (along with all of you) have been through, and are going through, something. Kind of like any traumatic event (job loss, divorce, what have you), it has left its mark. But also in positive ways - understanding and frame of reference when people around me find themselves dealing with a scary diagnosis enables me to be even more empathetic. I’ve always been a happy person, but I appreciate every single moment in my life more. The AN has also given me an injection of motivation. I find myself even more focused and fierce about achieving goals - I’ve been reminded that life is short. That I have been the lucky recipient of a non-deathly diagnosis, and that the outcome of its treatment thus far has been barely life-altering (so grateful for that, too).  I do honor and mourn that I’ve got an AN. That it’s made me have weird face feelings and is taking my right hearing (here’s to hoping some sticks around for the duration), as well as something of an emotional burden in terms of the CK"s efficacy. All of that is not amazing, but man... am I grateful that last February 15 I wasn’t diagnosed with something so much worse.  I am grateful to be able to look toward the future and know it unfurls before me with a story as yet unwritten.

My next MRI and hearing tests are scheduled for the end of April - I am looking forward to seeing what-all is happening in that noggin of mine. I am hoping and praying for continued positive results.

Once again, I seem to have written a novel. So, if you’ve made it this far, I apologize and thank you!  I’ll update again in 2 months, and then of course after my 1 year MRI. Fingers crossed :).

Wishing health and positive outcomes to all!
Jessica
« Last Edit: January 24, 2019, 08:42:59 pm by Gtmochi »
Diagnosis 2/15/18, 2.5 cm right side AN, hearing 100%
CK at Stanford, 4/23-4/25/18, Dr. Chang and Dr. Hancock
6 month MRI: No change, central necrosis
1 year MRI: some shrinking and necrosis

SP

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Re: CyberKnife Journey at Stanford
« Reply #73 on: January 26, 2019, 07:11:57 pm »
Hi Jessica !

Yes I made to the end  ;D. I think its inspiring and maybe (?) a bit cathartic to get thoughts and feelings out by writing. What you wrote resonates a lot with me on many levels.  Thank you for sharing where you are at and for keeping the optimistic perspective on this journey. It reminds me to do the same when things get a bit tough.
I am hoping and praying with you for continued positive results in April and beyond.

moving forward with hope for the good things,

Stella
My AN Story – Sydney to Stanford CK
2.3 x 2.2  June 2022@7yrs
2.9 x 2.9  May 2020@5yrs
2.9 cm  Mar 2019@4yrs
2.9 cm  Aug 2018@3yrs
3.1 cm  Aug 2017@2yrs
3.2 cm  Aug 2016@1yr
3.2x3.0x2.5cm AN; CK Aug 2015

gary.s

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Re: CyberKnife Journey at Stanford
« Reply #74 on: January 27, 2019, 06:07:49 pm »
Hi Jessica,

I also made it to the end of your post. Your words really ring true with the way I feel emotionally and physically. I know we are a week apart in our CK radiation experience, so our symptoms and anxieties are running parallel to each other. We hit the nine month mark together, and I am also grateful that things are going as well as they could for both of us. Just have to keep dealing with things as they come up, and give them time to fade away. Hopefully our tumors are also fading away. Be well,

Gary
Mild symptoms on right side July 2014
CK April 16-20, 2018, Barrow Neurological Institute
9/2018 hearing aid Phonak Audeo B and Cros B