Thursday, April 8, 2010 – 10:30am – Good News! Shouts of praise! The pathology tests verified the tumor is what is called a germinoma (germ cell tumor). This is what the report says; DIAGNOSIS: Brain, pineal region, mass, biopsy: Germinoma.

Heidi & Kellee waiting for the final Pathology results.
Dr. Sh. came in the tiny little exam room first. We had previously met with her along with Dr. H. when Kellee was in the hospital after the biopsy. She told us the pathology tests did verify the tumor is a germinoma which is treatable with radiation. A short time later, we met with Dr. H., Dr. S. and D. Sh. Which meant there was 6 of us in the tiny exam room, it was standing room only. Dr. H. did most of the talking. He made a point of telling us he and Dr. S. had consulted and are in agreement with the course of treatment. (Which was a big relief, if you remember from a previous post we were concerned about the possibility of one doctor recommending one treatment and another a different course of action. Yesterday, Kellee had spoken with the scheduling nurse and he expressed our concern about the possibility of different options being presented and we think that may be why Dr. H. stressed their agreement in treatment plan.) Anyway, Dr. H. explained even though he was a chemo doctor and he normally would recommend chemo therapy and Dr S. being a radiation oncologist and he would recommend radiation, they agreed with this type of tumor the course of action will be radiation, (provided the MRI of the spine is clear). He said based on dose of radiation which will be given, the amount of side effects would be minimized, therefore he felt radiation is the way to go. I asked what is the grade of the tumor, is it malignant or benign? The doctor told us that is not quite finalized as to the “grade” of the tumor. However, being a germinoma, the treatment method would be the same. We will meet with Dr. S. later today after the MRI to go over the plan, etc.
Kellee endured another IV for the MRI which started late and lasted about 45 minutes, this gave Heidi & I enough time to go get something to eat and grab a sandwich for Kellee when the MRI was complete. We had got back to the MRI area and sat down in the waiting room and then Kellee was coming out looking for the key to the locker where he stored his clothes. We then booked it over to the Radiation Therapy area. (One note to add about at the MRI – When we first got there and they called Kellee’s name, we went back with him to the next waiting room where Kellee could change into a gown and robe, while Kellee went to a changing room, one of the nurses said to Heidi & I, “You have obviously done a good job of raising your son, because he is very polite and respectful.” That was nice to hear, every parent likes to think they are raising their kids well and to hear someone compliment your child for being well mannered is meaningful. Everyone knows it is probably more because of Heidi than Kent, but it is still a team effort!)
In Radiation Therapy, we met with Dr. S. and he told us the MRI of the spine did not reveal any mass in the spine. He showed us the MRI and he pointed out the spine and to our well-trained medical eyes, yes it did look clear. Dr. S. then went over the treatment plan again with us and it will be as follows: First there will be 21 units of radiation given to the head and spine with 1.5 units given each day. This will be 12-13 days. Next there will be 9 units of radiation given to the ventricles of the brain (1.5 units/day). Followed by 18 units focused on the pineal gland area (1.5 units/day). Each treatment will take between 20-30 minutes. On 4-19-2010 ia an appointment for something called “verification” which is basically a simulation of the radiation treatment to make sure everything is set and aligned properly. Treatment with then begin on 4-20-2010.
Now for a bit of Q &A (Sorry, most answers will not be too technical, otherwise Kent would not be able to understand them):
Why radiation to the brain and spine, isn’t the tumor in the brain and didn’t the MRI of the spine show no masses? Even though nothing detected in the spine, the doctor still recommends radiation of the spine, just in case some cells floated into the spinal fluid. Kind of a – let’s be safe rather than sorry treatment.
Why radiation to the ventricles, and what the heck is a ventricle anyway? The ventricles are fluid areas between parts of the brain. The ventricles are filled with fluid and act as shock absorbers for the brain. Radiation is done here for the same reason as on the spine. We don’t want any of those nasty little floaters to get away!
How will we know if the radiation is working? About half way through the treatment course, and MRI will be taken and the tumor should be noticeably smaller?
What if the tumor is not smaller then? We will cross that bridge when we get there!
Will Kellee be cured? The doctor stressed there are no guarantees, but there is an expected approximate 90% cure rate.
What will side effects be?
Short term side effects – nausea & ralphing (especially during the time the radiation is focused on the spine, but there is a prescription of meds to counter nausea), fatigue, dry mouth, redness & dryness to the skin, bloating, diarrhea, constipation. Hair loss – after about 2 – 3 weeks of treatment, the hair will be gone. (Kent wishes he could figure something out like that for the hair coming out of his ears and nose!) Hair will grow back and it should take less than the rumor of eight months we had heard. There is a chance o f decrease in blood count, particularly when the radiation is focused on the spine. So about once a week they will draw blood, (You are correct, Kellee made a face when he heard that, in case I haven’t mentioned it before, he does not really like needles.) If the blood count goes down they may have to stop treatment for a day or two.
What is ralphing? Vomiting, losing cookies.
Aren’t guys named Ralph upset about such name usage? Yes.
Long term side effects - Because the radiation doses will be what is considered fairly low and because Kellee is young the risk of the following are very low: Brain damage (dane bramage), other cancers (radiation induced in the treatment field), spinal cord damage, hormonal deficiency. One other side effect – fertility issues. Low sperm count specially usually for up to a year after treatment. They told Kellee not to be planning on having any kids during the same one year time frame. (There are other things to consideration I won’t go into here.)
Explaining all the side effects was part of the release/authorization form Kellee had to sign allowing the hospital to do the treatment.
Next the doctor said there is one more thing. (What you got to be kidding me!) He said since these type of tumors typically are found in the testicles, he recommends an ultra-sound of the boys (aka balls, gonads) just to be sure. Could we come back next week Wednesday for an Ultra-sound. Now this was a bit frustrating for a couple of reasons; 1. Why was he just bringing it up now? Shouldn’t this have been brought up earlier so we could have had planned it for today while we were in Iowa City anyway? 2. Kellee was none too excited about the prospects of such a test. We asked if they could possibly schedule it yet for today or how about on the morning of 4-19? Turns out neither would work, but they did write-up an order for it and said it can be done in Pella, if the Pella clinics have the ability to perform such a test. We will be checking into it tomorrow.
While there we filled out information for staying at Hope Lodge during the weeks of treatment. We are supposed to get a call from them telling us if they have room or not. Otherwise we do have some other options where people have contacted us who live in Iowa City and offered rooms.
Next Kellee had a CT scan and was fitted for an immobilization mask and body device to make sure he is always in the same position for each treatment to ensure precise delivery of the radiation beam at each treatment session.

Example of what the mask looks like
Thus ended our 4th Thursday in Iowa City since this all began on March 11. Kellee was kind of wiped out from the busy day and slept some on the way home. We picked up some pizza once we got to Pella as we didn’t feel like fixing anything.
Kellee’s attitude through this continues to amaze us (GOD IS GOOD!), those of you on Facebook go look at his take on the day – check out this link, you may need to copy and paste this link into your browser. http://www.facebook.com/profile.php?ref=profile&id=100000111840004#!/kelleevanhemert?v=app_2347471856&ref=nf