02 November 2006 1st Meeting Radiation Therapist

Once again, thanks Mom for you input on this!

On Thursday, Nov 2, I accompanied Dave to his appointment with Dr. Biral Amin, the radiation therapist. Again, a very impressive person – a young man, Indian?? But with no discernible accent. He was extremely personable, encouraging, understanding, explained things well.

Radiation is essentially high energy X-rays focused to a local spot. Radiation in combination with chemo has a synergistic effect, the combination of treatments being more effective than each one separately.

Side effects Dave will experience include sore mucosal membranes in the mouth and throat, possible difficulty in swallowing, dryness of the mouth, and altered taste sensations.

They will be using IMRT…..defined in one of the booklets we picked up as intensity-modulated radiotherapy, a recent advance that in some cases may spare normal tissues, including saliva glands. The doctors are able to adjust the radiation dose more precisely to the tumor.

He recommends that Dave be followed after treatment by an endocrinologist because of possible trauma (from the radiation) to the thyroid gland. This could be a life-long thing.

He prescribed Salagen, a drug to promote maximum salivary output, to be taken the three days immediately preceding radiation treatment. He requested an immediate “Pre-Radiation Exam” by Dave’s dentist (further explained in the pamphlets), and he was adamant that a feeding tube be inserted by a gastro-intestinal surgeon prior to beginning treatment. Reasoning for this is that it is easier to do that BEFORE treatment begins, and it is important that Dave’s nutritional level be kept at a high state, not allowed to suffer if and when his eating becomes difficult. He also explained that a chemo port, called a PICCline, will be inserted into a vein in the upper arm for chemo administration. (Dr. Atienza had explained this, also.) Both these tube insertions will be done in the hospital under anesthesia, but as an “in-and-out-in-one-day” procedure.

Dr. Amin said the radiation treatment would last 7 weeks, every day Monday thru Friday, about 20-25 minutes per session. At the first session (longer) ---or at the planning session???--- A plastic mesh mask will be fitted - the purpose of this is to help focus the X-ray beams, and to keep his head immobilized during the treatment.

Sequence of immediate future appts – Dental “pre radiation TX exam, GI dr. to insert feeding tube, Planning Session. Dr,s all to coordinate appts and treatment plan.