HAPPY THANKSGIVING

I have to say that this year we had an unusual Thanksgiving for us. Usually we gather with all the family around, play games, watch football, joke around and generally enjoy the aromas surrounding us as we enjoy being together. This year we are separated from family by being here in Loma Linda California and had to decide what we wanted to to do.

We have met several nice couples that we enjoy being around and decided we needed the whole scene as is our tradition so we started asking who was doing what, thinking that being far from home and families that we could just gather together for a fun day. It was amazing to us how many couples had family nearby and were planning to go home be with family . But we were determined to have a turkey and friends around so we invited two couples that we had just met and instantly liked. Well, they were already getting together and invited US to join THEM. Sounded good to us so we said yes.

Now, one couple was from Pennsylvania and the other from Washington. Well, the couple from Washington are Seventh Day Adventist so we knew we were in for a treat and looked forward to the all vegetarian meal. We got there around 2pm, helped put the food together and got ready to eat. Since they were RV'rs and there was 8 of us we set up a table outside and proceeded to load the table with food. We had a vegie loaf, 3 different salads, sweet potatoes, a crock pot full of mashed potatoes, gravy, a tray of nuts, vegies, rolls, coconut cream pie, pecan pie and pumpkin pie! Boy was that table full. The weather cooperated well as it was about 70 and partly sunny. We ate and told stories and talked about the sights to see in the area. It was a very nice day and we had a great time. We didn't leave until about 8pm. We have just met a lot of nice people here at Loma Linda and we all try to support each other.

(BUT, turkey is Thanksgiving and since we already bought our turkey we just cooked it in the morning before we met with them, knowing we would eat for a week on leftovers) In fact we had a full plate of leftovers for dinner tonight.

Steve carving our turkey in our kitchen

Steve's Progress and Doctor

Just an update on Steve's progress so far. Not too much to really tell yet, he has 4 treatments under his belt and 41 left to go. He receives a total of 45 treatments, 5 days a week. With time off for weekends and holidays he should be finished January 25, 2009. (Of course, that doesn't count delays because of breakdowns which happen maybe a couple times a month).

Steve's doctor is Dr. Ryan Grover. He looked 16 to me, (judge for yourself)but has plenty of education and experience. Dr. Grover completed his undergraduate education at Claremont Kckenna College, Claremont, California, being graduated with high honors. He subsequently attended the Keck School of Medicine, University of Southern California, Los Angeles, California, and was awarded his M.D. degree. He fulfilled his internship at the University of California, Orange, California, and his residency in radiation oncology at LLUMC. He supplemented his residency experience as an observer at the Department of Radiation Medicine, M.C. Anderson Cancer Center, Houston, Texas. Boy that sure kept him busy!

Dr. Grover holds memberships in several professional organizations, including the American College of Radiology, the American society for Therapeutic Radiology and Oncology (ASTRO), and the Los Angeles Radiological Society. He is a member of the Inland Empire chapter of MENSA - WOW!

Dr. Grover's research interests center around proton radiation therapy and radiation effects in tissue. He has a special interest in investigating radiation -sensitizing and radioprotective agents, including studies of agents that modify cell behavior.

He's just one of the many young bucks they have here along with the years and years of experience of those who were here before he was even thought of.

San Bernadino Symphony

We attended the San Bernardino Symphony the other night and I have to say that we were thrilled for the experience. We had never been to a symphony of this caliber before and thoroughly enjoyed ourselves.

Maestro Carlo Ponti Jr.

A little history about the San Bernardino Symphony; they are celebrating 80 years of bringing fine music to this region. It was founded in 1929 by Maestro James K. Guthrie, an internationally renowned conductor and community leader. The Orchestra, one of the oldest and most prestigious in the Inland Empire, is composed of some of Southern California's finest professional musicians.

The San Bernardino Symphony performs in the beautiful and historic California Theatre which was built in 1928. The magnificent performing arts venue we attended was designed specifically to accommodate orchestral performances. Will Rogers gave his last public performance at the California Theatre. Less than two months later, on August 15, 1935, Rogers perished in a plane crash in Alaska. In 1997, a large mural of Will Rogers was painted by Ken Twitchell on the east facade of the Theatre to commemorate the final performance of America's finest humorist.

Back to the symphony! Maestro Carlo Ponti Jr. is the Music Director and Conductor during this 80th season. Maestro Ponti is the son of Sophia Loren. Maestro Ponti began his studies at the Conductor's Institute in Hartford Connecticut under the direction of Maestro Harold Farberman. He has also privately studied with Maestros Zubin Mehta and Mehli Mehta, Maestro Andrey Boreyko and specialized at the Vienna Musikhochschule under Maestro L

Leopolde Hager and Karel Ancerl. Ponti's debut with the Russian National Orchestra in Moscow met with critical praise and led to his appointment in 2000 as the Russian National Orchestra's Associate Conductor. In 2001 Ponti was named Music Director and Principal conductor of the San Bernardino Symphony Orchestra in the United States, a position recently extended through 2015. Following his 2005 Italian debut with the Orchestra Del Maggio Musicale in Florence Maestro Ponti was chosen as recipient of Italy's prestigious "Premio Galileo" Award for exceptional musical achievement. Carlo Ponti is in great demand as guest conductor and has appeared with orchestras in France, Spain, Venezuela, Viena, Moscow and many, many others throughout the world.

We were told that they were going to have a pre-concert lecture and were invited to attend. We had no idea what to expect but were glad that we attended. San Bernardino Symphony pianist Michael Tacchia gave an informative lecture on the particular pieces that we were going to hear. It was interesting to learn the background of the the pieces and what to look for as the music was presented.

The program for the evening was as follows: Beethoven's "Leonore Overture no.3, op72b"; Mozart's "Piano Concerto no.27 in B-flat Major, K.595"; and Schumann's "Symphony no.2 in C Major, op.61". Each of these was broken up into different parts and we could easily distinguish as we listened carefully. Michal Tacchia taught us what to listen for and what it would mean to the piece of music.

Also on the program was Ms. Janina Failkowska who was a master on the piano in Mozart's piano concerto. We loved her apparel which consisted of black tux pants with a brightly flowered jacket. She was brilliant on the piano. As the program unfolded you could just close your eyes and let the music take you away to peaceful places.

It was a wonderful evening of musical delight as we learned, listened and felt all that was happening in the theater. Another piece of information we learned was the many ways the symphony is involved in the community. Third grade students in San Bernardino City Schools learn about a symphony orchestra and its instruments when docents visit each classroom. High school youth are introduced to the joys of classical music also. Their duties include ushering at the concerts and assisting with special Guild events.

Treatment Begins

On November 18 Steve received his first proton treatment. We found it fitting that on this day, his 63rd birthday, he would begin a new lease on his life. It began at 8:00am when he arrived at the reception area to check in. His appointment was a at 9:00am but they want you there 30 minutes early and he was anxious to get started. He had already had his "pod" made so all was ready.

The first thing you do upon arrival is drink 16 ounces of water about 20 minutes prior to the procedure in order to fill your bladder. This helps to stretch the bladder and lift it off the prostate and away from the target area of the proton beam. (Steve drank 20 oz just to be sure). When they called his name he went in and changed into this beautiful gown that even had air conditioning. Nothing but the best here!

Just one more glass!

Now unlike other types of radiation therapy that use x-rays to destroy cancer cells, proton therapy uses a beam of special particles called protons. Doctors can better aim and control the energy of proton beams onto the tumor, so there is less damage to the surrounding healthy tissues. This allows doctors to use a higher dose of radiation with proton therapy than with x-rays. This proton beam is precisely shaped in three dimensions and delivered to the prostate with extreme precision. For the radiation to be precisely targeted, you must be placed in the exact same position for each treatment. Customized devices, called pods, are built for each patient (body mold) to allow the proton radiation to conform, three-dimensionally, to the target site.

To back up just a little: On October 27th Steve climbed onto the pod which was lined with a soft fabric. The technician poured warm polyurethane between the PVC pod and the sheet on which he was lying. This produced a mold that conformed to his body and would keep him motionless while being treated. After a couple of days it sets and is all ready for you.

Steve in "his" pod

This might get a little more technical than even I feel comfortable with but this is such an important subject we can't just say "he lays down and they zap him with a proton beam". Prostate cancer is every man's dread and every man's future. So we want to accurately present this wonderful treatment properly.

The precision of the proton beam requires equal precision in planning and delivery. This is done in two steps: (1) a three-dimensional reconstruction of the prostate or tumor and its relationship to surrounding structures. The three-dimensional information is obtained by performing CT scans - in about 20 minutes they take ninety-eight or so pictures in the prostate region . These pictures are used to produce a three dimensional "hologram" of the prostate which the oncologists, physicists and dosimetrists use to plan his treatment. This information is also used to construct two custom-made focusing devices called an aperture and a bolus, which are used together to conform the proton beam to the precise target area. (2) a reproducible treatment position that minimizes movement errors. (Steve's pod as described earlier)

Bolus used to shape proton beam

So, yesterday Steve climbed into his pod and let the technicians do their thing. With laser beams as guides, his was moved to a position within half a centimeter of the calculated optimal position. To make the position more precise, the radiation therapy technologist obtains several low-power diagnostic digital images. Distances from various bone landmarks to the isocenter are measured on these daily images. These are compared to identical measurements made on computer-generated films based on the planning CT scan. Usually it is necessary to move the patient a few millimeters to make the position conform exactly to the prescribed treatment. Now his specially created aperture and bolus, mentioned above, were loaded into the beam line. Each of these devices are identified by a bar code, which must be scanned by a laser scanner (similar to those at a supermarket). A match must be made before the computer will permit a treatment to begin.

The proton journey to the prostate begins! It is really complicated and hard to follow so I am going to try and write it in simple english and still do it justice. The protons are sent through a vacuum tube within a pre-accelerator which boosts their energy to two million electron volts. They travel around a synchrotron about 10 million times per second which also increases it energy to between 70 to 250 million electron volts. The voltage achieved is enough to place them at any depth within the patients body.

Model of accelorator facility

The treatment rooms have gantries which are wheels 35 feet in diameter and weigh approximately 90 tons, which revolve around the patient to direct the beam precisely to where it is needed. From Steve's perspective, however, all that is visible is a revolving, cone-shaped aiming device. Each treatment room has a guidance system to direct and monitor the beam until it enters the patient in precisely the location and shape that the doctors have predetermined.

Final alignment of delivery device

The entire proton facility is controlled by computers that are equipped with safety measures to ensure that patients receive proton radiation treatments as prescribed. They also have cameras and microphones if the patients need the technicians at any time. The entire process takes about 3 minutes in the pod. What a wonder of technology!!!

Now we will settle into a routine that works around his treatment times which vary from day to day. Yesterday was 9am, today was 12 noon and tomorrow is 9pm. I know, it's crazy, don't ask me who there scheduler is!

November 15, 2008 Summary

You wouldn't believe how long it has taken to try and set up this blog. Today has been week 2 at trying. I think we did it finally!

In summary of the past 3 weeks here, Steve had his doctors consultation, his CT and made is pod in which he lays to get his radiation treatments. Due to the influx of patients coming here our start date changed from November 4 to November 18, which happens to be Steve's birthday. What a great way to start a new life!

Loma Linda University Medical Center

We arrived on October 26th to a temporary house. Since then it took us a week to set up house after which we decided to visit the area since we had time. So far we have visited the San Diego Temple, the Los Angeles Temple, Lake Arrowhead, and Palm Springs. Last night, the 14th, we went to "Thanksharing" at the Seventh Day Adventist Church which is a community-wide worship service celbrating God's goodness, admission with non-perishable food items. It was a great musical night!. Tonight we will go the the San Bernadino Symphony (free bec of LLUM) with Carlo Ponti Jr. as the conductor. We are looking forward to another great night.

On a regular basis we have a Tuesday potluck support get together, a Wednesday night Radiation Medicine Support Group with Dr. Lynn Martell leading the evening and a regular Thursday night restaurant tour featuring a different eating establishment each week. Of course we also have the great workout club, Drayson Center, we go to 3-4 times a week. We hope to get into better shape.

The goal here is to make the person whole; physically, emotionally, mentally and spiritually. Everyone here is great. We haven't met anyone who wasn't nice and helpful. It's a great atmosphere for healing.

Los Angeles Temple