Is it only two to go?!

Treatment number 42 is in the bag, only two remaining. The technicians were kind enough to take some pictures today just seconds prior receiving a treatment. Across my head you can see the laser lines that they use to begin the alignment prior to the beam starting. The black box is the CT scanner that they use to do the final alignment. This rotates 90 degrees each treatment as they shoot a shot from above and from the side to position the nozzle located on the left. This particular treatment was unique as the machine delivered about 7 "beeps" and then was silent for quite a while before it finished up. The key word there is FINISHED.

This will likely be the last post from Southern California. We returned the equipment today that gave us internet access at the apartment. We are posting from the library in Redlands, CA, a very nice facility with beautiful architecture. There are a number of "last times" this week as we get ready to head home. We will be going to the Tuesday night potluck for the last time and it is customary for the "graduates" to give a short speech.

There are four of the morning group that are finishing this week and we have all been plotting our trip home. One of them is from Woodinville,WA and they are going to take a slow pace along the Pacific Coast Highway for about a week. Others are stopping along the way to see the sights, however we have chosen the rapid deployment strategy and see how long we can drive in two consecutive days. We are ready to be home and hope to make the trip in two long days. The weather along the way has to cooperate, and so far it is looking good, but not great.

Thanks for the kind notes and thoughts you are sending our way. They mean a lot to us.

Clubhouse Turn

The week ended on a high note as treatment number 40 was completed right on schedule. The technical staff had worked very hard Thursday night to make all the necessary repairs. Everybody, patients and staff, seemed relieved to have the machine up and a weekend in sight. There are only 4 treatments remaining, if everything goes well we will be done Thursday morning. The side effects so far have been very mild, most noticeable are small round "sunburn" marks on both hips. They are not painful, but a gentle reminder that this is the homestretch as most patients don't see these until the last week. We have been going out to nice dinners with a number of patients that are finishing at the same time. These dinners are very festive as we are all glad to be going home. After we get home from dinner I do have some melancholy moments as these people have become good friends, I will miss the daily contact. They have led amazing lives, and more importantly have a forward looking outlook that is an inspiration for me.

We headed to Encinitas on Friday for the day with the family. Piper continues to grow before our eyes, the time we have spent with her and her parents have been one of the blessings of this adventure. Speaking of adventure, on our late evening drive back to Redlands we made a wrong turn and were headed to Mexico on I-15. We were listening to a book on tape, and I failed as the copilot as I had dozed off just as we were making the exit. I woke up a bit later and saw we were on a 6 lane highway, with another another 2 under construction. Through the post cat-nap fog we were able to turn around and make it home. We have decided that we are going to do a bit more pre-flight planning for the trip home. We have also decided that if we need me to be copilot that there will be a ban on the books on tape. Those babies put me down, and quickly.

We are beginning to pack and prepare for the trip home. We were able to cram everything in the car on the way down, I am not sure it will all fit, we may have to figure out what Brown can do for us.

Dang Power Supply

We are headed down the homestretch as treatment numbered 39 was completed today. The countdown has not been easy as equipment problems have caused chaos all week. The most serious was when the power supply was the problem on Tuesday which has seemed to cause computer and equipment problems the rest of the week. I have not missed a treatment, but have had to be patient to get them done. If the accelerator was a football team it would have been flagged for numerous false starts. Yesterday my original treatment time was 6:15 a.m. and the treatment finally occurred at 8:00 p.m. In the meantime, there were a number of attempts that were foiled at the last moment by equipment problems. Things have been so smooth that I had forgot how hard it can be when you struggle to get a treatment. The worst was watching some of the people in the waiting area trying to get their very first treatment. I tried to counsel them to be patient, but it seemed funny that I would try and tell anybody about the virtues of patience. Chaos reigned again this morning as my treatment was delayed, with false starts and offside penalties, for three hours. I also am taking a lot of good natured ribbing about the fact that I seem to be in the building when problems occur.

Ruth and I had a chance this week to visit an Air Force museum near March Field. The museum was interesting as it had over 50 aircraft from WWI to present day. One exhibit detailed the exploits of a Thaddeus Lowe during the Civil War. He apparently was the first to use an aircraft, a balloon, to do reconnaissance during a battle. The exhibit described him as being hard headed, so I don't think he is related to our family.

We have begun to prepare for our trip home. There are about 5 of us that started just after Thanksgiving that will be completing next week. As much as I want to be home it will be difficult to say good-bye to some of these men as they have become good friends. It has been very enriching for me to spend time with them and I know the friendships will change as we all go home. It is clear that we do have a common bond that is strong as I have gotten calls from recent graduates to ask how I am doing and to offer encouragement.

Single Digits

Treatment number 35 was completed Friday, and it was a milestone as we only have nine to go. As one of my fellow patients said, " Single digits, must be nice". The week seemed to go really fast as the treatments were completed like clockwork. I gave up my early morning treatment slot for a patient that was finishing up on Thursday and it was interesting having a treatment in the middle of the day. Most of the other patients in the middle of the day are the newest arrivals, and they had a lot of questions for me because of my "senior class" status denoted by a red dot on my badge. There are so many things on your mind that first week and it made me appreciate how well my treatments have gone.

My fellow patients continue to be the richest part of this experience. One who finished treatments this week was a women that had a tumor wrapped around her spinal cord. I was amazed by her spirit and warmth throughout her treatment. Over 80% of the patients here are men being treated for prostate cancer. She attended all of the support group meetings and always seemed to have a smile on her face. I asked her if she got tired of these meetings listening to guys talk about their prostate. She answered that it wasn't about the content of the meetings, it was to be with people that understand what it is like to fight this disease. Her fight will be much harder than most of us but I think, and hope, she will win.

I also had a chance to talk to three former patients that were back in town for checkups. Two of them fly out in the winter, play some golf, and get a checkup. They were all doing very well which is good to hear. They took a lot of time to talk to a man that was in the waiting room considering this treatment. It seems like yesterday that I had all the same questions and insecurities regarding proton treatment; it's a difficult decision. At this point it feels like a really good decision for me.

I decided not to do the 1/2 marathon last weekend as my body, and my wife of 30 years, sent some pretty clear feedback that I needed to consider training for next year's race. Several people mentioned road work, along with the carbo loading might be in order. Peter and Karen participated along with 5,000 of their closest friends. They both said it was quite an experience as the race wound along the ocean in Carlsbad, CA. Peter and his friend Zeke also decided to do pushups at each mile marker, don't ask me why. I was proud of Karen as this was a longest race she had done. As you can see from the picture they received "participant" medals for their efforts.

P.S. Treatment 36 is completed, only 8 to go. A friend from Brewster, WA finished today and they are on the road home. They are great people and were fixtures for the morning gang and it was bittersweet to see them leave today.

Double 3's

Treatment 33 was accomplished today, things have been very smooth this week. I still have only very minor side effects so we are very happy at the position we are in as we head down the homestretch. I am gaining the dreaded reputation of being the one that somehow breaks the machine. Yesterday my gantry went down shortly after my treatment, the second time that has happened. It is all in good fun as my fellow patients are asking that I move my treatment to the last one of the day.

It is very interesting to be out and around so early in the morning. Most days I head out the door at 5:30 am in order to be at the hospital by 1/2 hour prior to the treatment. There are two things of interest that I have noticed this week. The first is that there are about 8 people who I call "commute sleepers". They arrive at the hospital parking lot about the same time as me, then lay their seats back and go to sleep. They have a difficult commute and they cannot count on being at work on time unless they leave very early. So they leave in time to miss the heavy traffic and catch some sleep before their shift. The second is that there are people here that apparently make a living by going through dumpsters. Ruth knew this was happening as we put out some unwanted items and she bet they would be gone by the morning. I lost the bet and was curious what was going on. Yesterday I saw a very new truck with custom sideboards parked at the dumpster. Four men were methodically going through the garbage and pulling out items that they must sell somewhere. These observations have made me appreciate even more my 3 minute commute in Wenatchee to a job with a great company.

We had a great weekend, the picture today is of the sunset at Swami's Beach in Encinitas, CA. There was an unusually low tide at sunset so we went for a stroll along the tidepools as the sun was setting. It was a beautiful sunset and you can see from the picture I enjoyed the company.

Words you don't want to hear while in the "pod"

This has been an interesting week, with 30 treatments complete. My treatment protocol was modified beginning with #29 to make the exposure slightly smaller. All of the physical equipment was ready for the changover but there is a data file with the new protocol that would not load on the gantry computer. They had hoped to have it fixed by 9:30 a.m. so I went back to the apartment and had some breakfast. When I got back at 9:00 they called me back at 9:10 for my treatment and got me all set in the pod and then one of the technicians said, "Uh Renaldo, I hit the big red system interrupt button." Let me tell you, these are words you don't want to hear when you're laying there in a very uncomfortable position. They tried to restart the gantry but it took too long and I had to get out of the pod without being treated. About an hour passed before my third and successful try for treatment #29 was completed. This is something I hope doesn't happen again. This morning's treatment went off without a hitch so we should be back on the right road.

We had friends of ours from Wenatchee over for dinner Wednesday night. Their son is at Loma Linda after receiving a liver transplant. Their son came near to death as a result of a toxic reaction to Tylenol. They were recovering from the emotional shock as they had been told over the weekend that their son was likely not going to make it through the weekend. Against all odds a perfect donor liver was found in Ohio and the transplant saved his life. He remains in critical condition, however when we were having dinner the surgeon called to say that a number of vital organs were showing unexpected recovery. We also got to see the look on our friends face as they got to speak briefly with their son over the phone. They have shown courage and heart that I cannot properly describe. The father shared a story of sitting in a conference room while the medical specialists discussed whether their son would live or die. I can't think of a darker day for a parent but yet they persevered and felt that their son had been given a new life. They have a great attitude and stamina and they will need both as their son recovers and adjusts to his new life.

One element of this liver transplant drama was that the son did not have health insurance. The surgeons and hospital administrators made a very difficult decision to do the transplant. At the end of the meeting there was a simple mission statement by the lead surgeon, "save his life". In a world of managed care, HMO's, and more business like approach to medicine these people made a purely humanitarian decision to make the attempt to save his life. It is likely a hospital foundation will fund a portion of the costs, estimated to be in excess of $2 million. I was awestruck by the generosity of Loma Linda Hospital. It forces one to think about your own individual committment to those in need. I have put a picture today of the hospital grounds so that when I look back at this post some day it will help me remember their committed generosity.

This has been a week of shock, reflection, and difficult treatments. However, the sun is shining today and we are headed to San Diego to spend time with our entire family and celebrate a birthday. I am determined to savor every moment of their health and vitality, even if it means I can barely walk into treatment on Monday. My mind is saying I want to do the half marathon tomorrow with the kids, but my wife and my body are giving a little different feedback. Maybe I will join the pasta feed and see how it goes from there.

Thanks again for the kind notes, encouragement to update the blog, and the well wishes. They mean a lot to Ruth and I.

Proton Accelerator Tour

Treatments 23, 24, and 25 are complete, all rather smoothly. This was a week where a large number of patients were finishing their treatments so there was quite a shuffle in the schedules but mine has remained the same. Doesn't appear to be a lot of demand for the 6:15 am treatment slot.

Saturday was the Accelerator tour which they give once a month. This was our first chance to see the tour as they did not have one in December because of the holidays. To say the least it was an amazing sight, the mechanical equipment that supports the treatment was some of the most complicated I have seen. It was crammed into a relatively small space, about the size of a basketball court. There was high pressure piping, vacuum lines, huge magnets, and large power supply cabinets. The power supply cabinets were very similar to the control cabinets at a power plant, except that the power was coming in rather than going out. From the equipment tags it looked like there was about 5MW of load for the magnets that accelerate the protons alone so my guess that the total load for the hospital complex is 15 to 20 MW total. Their load must be a power managers nightmare because it pulses every 4 seconds with about 3 MW of load to jump start the protons which must be very hard on the electrical equipment. The craftmanship of the piping, wiring, and piping was very good, it was all clearly tagged with safety devices and operating instructions. They quoted a goal of 98% availability, which is very aggressive considering the kind of specialized equipment they maintain. The technicians did a good job of explaining the equipment if you have an engineering background. For instance, they described the amount of protons in a typical treatment as 7.6 x 10 ^23 . The guy next to me asked how much was that and I answered, " a lot" and he was satisfied. They mentioned that most of the outages are caused by computer hardware and software issues, with actual mechanical equipment failures being rather rare.

Ruth enjoyed the tour as she teaches technology, it was fun for to hear what advances technology will make in the future in positioning of the patient. It will basically become much more automated, and they hope to be able to treat roughly double the amount of patients. My first thought is that they would have to make significant improvements in soft infrastructure such as waiting rooms, dressing rooms and patient communication if they wanted to come anywhere close to that goal. For some reason they haven't asked me about my thoughts on this.

The bottom photo today is of the pipe that carries, accelerates, and shapes the proton beam for Gantry 3, my little home for 30 minutes or so every day. I can hear various sounds coming from the "back room" as they prepare for treatment so it was fun for me to see the equipment. The top picture is of the area that they strip off the proton from a hydrogen molecule and dump in to the accelerator pipe.

I am still working on my theme statement for 2006. More on that later.

Mean, Median or Mode ?

Not really any of these terms, but the halfway point, numero 22, was accomplished today. After refreshing my memory on the terms I am pretty sure none of the above apply. For some reason today I felt like the little boy that didn't want to go to school. Fortunately nobody wanted to listen to my "stomach ache" story so I trudged into the hospital. As usual, the techs and fellow patients were very cheery so my mood improved after finishing the treatment. On the way out from my weekly clinic appointment there was a 4 year old patient whose dad was bringing her in for treatment. He was also in a wheelchair as he had broken his leg. Let's just say that whatever had caused my "stomach ache" had been replaced with a much clearer perspective.

Our New Year's Eve started early as we went to a local British pub and listened to a bagpipe band. For some reason a lot of the patrons were crying, so Ruth and I joined in. Not sure what that was all about because I didn't recognize the tunes, except for "Auld lang syne". My guess is some of the tunes must be melancholy. We then went to a small party at another complex where a lot of proton patients live. It is a "retirement" home and we finally found a crowd where we can be the last to leave. It was fun, the fellow patients are a great group of people.

We had heavy rain and high winds this weekend, the pictures are of palm frawns that obstructed the road when we where driving yesterday. Ruth coined the term "palm frawn drifts" but somehow it doesn't roll of the tongue like "snow drifts". The other picture is of the sunset outside our unit, we have really nice landscaping in this complex and there was quite a bit of damage by the storm. It rained heavily on the Rose Parade, first time in 51 years. There was more than a little weather whining going on, not by us as we saw the freezing rain forecast for Wenatchee. We did not lose power at all during the storm, but our football viewing was interrupted for a couple of hours. It is important to carbo load during these outages as you never know if the power might go out.

We spent Saturday with the Ligotti's in Encinitas. Piper was very entertaining, her verbal skills are improving every time we see her. She gets very excited when we drive up and it warms your heart. She is a character, we love our time with her.

I am reading one of Lance Armstrong's book and a theme for 2006 is developing. I am thinking of replacing new year resolutions with a more flexible theme, further thoughts on this tomorrow.