The masked woman

What a productive day this was against Lloyd!  I started off the day with a high-resolution MRI, which only took about 10 minutes.  The difference between this MRI and my MRI on Friday is that I was in a different machine that can take higher resolution images, down to the nearest 1 millimeter.  Wow!  That's impressive!  The Medical Physicist (let's call him Dr. Phys) needs this level of precision in the images so that he can design the radiation treatment exactly to the dimensions of Lloyd, the metastatic breast cancer tumor so rudely squatting in my brain. 

Later in the day I had to go back to the clinic to build my mask for the SRS treatment.  The purpose of the mask is to hold my head in place very snugly so that I don't move more than 1 millimeter during the SRS treatment.  Do you see the pattern, here?  This 1 millimeter of precision?  That's so that they minimize the damage to the non-Lloyd parts of my brain.  

The mask is made out of very hard plastic.  First, I had to lay down with my head between these blue brackets that were screwed to a board.  Then, they took strips of heated-up plastic and wrapped it around my face, including pushing it down over my eyeballs, all around my nose, and across my upper lip.  The rest of my mouth and chin were perfectly free.  They also had one piece of hot plastic to put around the back of my head, up by where my head is attached to my neck, but the rest of the back of the mask was not molded to my head.  Once they had the pieces in place to their satisfaction, they somehow snapped them into the blue brackets.  So I was penned to the table by my head, which was a bit of a weird feeling.  Fortunately the plastic is white, and a bit meshy, so I could see through it a little bit if I chose to open my eyes (but it was more comfy to keep my eyes closed and transport to somewhere else, I assure you).  

I had to lay perfectly still in the mask for 30 minutes while it cooled.  This was the hardest part because as the mask got harder, it became harder to swallow.  Swallowing while lying down is not very easy anyway, but then when you find that your nose is locked in place it turns out that your head bobs quite a bit when you swallow while lying down!  I then spent a good 15 of my 30 minutes first deciding on whether or not I should just let the drool pour out of the side of my mouth, and second planning for how I should deal with this on treatment day.  Would my mouth water less if I brushed my teeth at a strategic time before treatment, say, an hour before hand?  If I brush my teeth too proximal to treatment then the toothpaste residue will have a strong salivating effect.  I certainly will need to be sure not to eat right before treatment, as I blame proximal luncheon to maskmaking for my swallowing discovery today.  

After the mask cooled, they unbolted me from the brackets then sat me up with the mask around my head.  Whew, it was heavy!  Then they added a box over the entire the mask, which made the situation even heavier.  The purpose of the box is to add what I'll call gridlines for Dr. Phys.  At least, that's my interpretation of how he explained it to me.  The box goes on in a defined orientation and has lines in it that show up in the images, thus allowing Dr. Phys to be oriented in space relative to my head.  I suppose it's like helping him know that my tumor is at the 40 yard line, or 30 yard line, etc., rather than just being a tumor in an unmarked field.  With this box on my head, they laid me back down and bolted me to the blue brackets again.  Then--CT scan!  This was another high-resolution scan of my brain, and the entire mask-making process had conveniently taken place on a CT scanner table, so all they had to do was slide the table in and out of the tube a couple of times to get some shots of my head.  

I asked if I could take some photos, and they didn't mind.  So, without further ado, here's my mask:

Here's my mask, bolted to the table, photo taken from the left side of my body.  My forehead would be on the right, my chin coming out on the left of the photo past the blue bracket.  You can kinda see my nose near the blue brackets there on the upper left of the mask.   

This is looking down on the mask from above.  You can see the nose plate in the darker white, and the meshiness of the majority of the mask.  It's not too bad!  I'll get to keep it after treatment, then you can come check it out anytime.  The laser that you can see vertically in the picture is used to line up the patient for sliding into the CT scanner, which you can't see in the photo but is just north of the mask in the picture.  The black table below the mask slides a whole body into the tube.  Pretty amazing! 

Hopefully you can appreciate that although it's a little bit uncomfy (certainly not a pillow), it's really not that terrible.  Dr. Phys said he's claustrophobic and didn't know if he'd be able to do it!  I just blinked at him a couple of times and said I bet he could if he had a brain tumor.  You do what you gotta do, people!  Just close your eyes and breathe.  You've got this! 

So then while I was putting my snow gear back on to head home, Dr. Phys offered to show me my CT scan.  Clearly I snapped a photo of Lloyd for us.  

Here's a frame of my brain (my nose would be on the top of the circle, the back of my head at the bottom, my ears on the right and left).  Can you spot a slice of Lloyd?  Hint 1:  the black parts are normal; look for Lloyd as an irregularity in the gray parts.  Hint 2:  Lloyd looks spherical by this angle. 

Here I've drawn a yellow arrow to point out Lloyd.  I tried to circle Lloyd but that was less clear, so hopefully you find this to be a favorable notation.  If you can't see Lloyd, I apologize.  My goal is to get a picture of Lloyd from the High-res MRI.  I saw a hint of Lloyd via MRI last Friday, but I was too stunned by the news to snap a picture.  Lloyd looks VERY ugly and irregular by MRI.  

He said that he'll overlay these pictures with the high-res MRI from earlier in the day, to do the math and make the radiation plan.  He said it might take him a little bit longer than usual to make the radiation plan because Lloyd is not a good little sphere; Lloyd is irregularly shaped.  That's because Lloyd grew where he could make room, and clearly my brain didn't yield to his spherical desires!  Related to this, I asked Dr. Phys if Lloyd was tangled in brain tissue or growing more or less independently from the brain tissue.  Happily, his response was that Lloyd is independent, a true squatter.  Surrounded by brain, but not integrated.  This explains why they expect so little brain damage, but it was nonetheless good to hear.  

So, if Dr. Phys gets the math and mapping done, treatment will be on Monday, Jan. 8th, at noon or 4pm.  If Dr. Phys needs another day, it'll be Tuesday, and so on and so forth.  But odds are good that treatment will be early next week.  

Also, I shared with Dr. Phys that the tumor's name is Lloyd, and I needed him to do a good job of targeting Lloyd.  He complimented me for naming him and said that he'll do his very best at targeting Lloyd.  Welcome to the team, Dr. Phys!  

Last item of the day:  I might have realized how I subconsciously arrived at the name of Lloyd!  At the dinner table I was telling the girls about my adventures today, and I showed them the picture of my brain and pointed out Lloyd.  I hadn't shared with them before tonight that I'd named the tumor Lloyd.  My oldest daughter said, "Oh!  Lloyd!  Like the Masked Man in Land of Stories!"  The Land of Stories is a children's chapter book series that we've been reading aloud to the girls for awhile.  We're on book 6, they are very good books and I highly recommend them.  (I've actually only read half of the books because my spouse and I take turns reading, so I'm having faith that the even chapters are as good as the odd ones.)  ;)  Anyway, in a few of the books there is a villian called the Masked Man, and his name is Lloyd.  Spoiler alert:  the Masked Man totally gets defeated, killed in fact.  Sorry about the spoiler for anyone about to go and read the books, but I find it remarkably perfect that my subconscious chose the name of a masked villain for a brain tumor that requires a mask to defeat.  Thanks, Brain!  You're amazing!  Keep up the good work!   

I have no appointments tomorrow so I'm going to try for a somewhat normal day.  It'll probably take most of the day just to get my head out of the cancer clouds.  Wish me luck!