Brain Exercise

After frenetic and wonderful holiday times with family and friends, we are settling in to routine around treatments.

Monday (January 6) I saw Dr. Sutherland (my neurosurgeon) and he gave us an encouraging opinion: I am obviously responding to treatment because I am clinically the same or better than when I left hospital.  If I was not responding to treatment I would be much clinically worse.

For the most part I am feeling ok.  While I rarely feel well, I rarely feel very unwell either.

Radiation treatment side effects start 2 – 3 weeks after initial treatment and are expected to gradually get worse until about 2 weeks after treatments finish.  I compare radiation treatment to sunburn (which is an effect of radiation exposure): Day 1 isn’t too bad, but days 2 – 4 can be nasty.

Radiation treatment causes some skin irritation and “patchy” hair loss, brain inflammation and swelling causes headache, nausea and fatigue.  I have minimal headache and nausea and minimal skin irritation, and I seem to have some patches of smooth scalp where hair is not growing.  Fatigue is my thing and I’m starting to understand the difference between “brain fatigue” which is helped by brain rest or a walk, and physical exhaustion which is helped by sleep (10 – 12 hours overnight and 1 – 3 hours of naps).  My “brain fatigue” comes after 20 – 30 minutes of brain activity: reading, writing, puzzles – then I feel like I can’t think.  I’m trying to balance brain rest (concussion research shows this is important in brain healing after injury) and brain exercise (which is important after brain injury to allow the plastic effect of neurons and connections to change to improve brain function).

Now I am going to get technical about how radiation and chemotherapy works, at least as my simple mind understands it.

Radiation (the kind I’m getting is focused photons) effects water to create radical ions which causes oxygenation damage to cells (mainly through DNA damage).  This is why they steer us away from taking anti-oxidants during treatment.  While anti-oxidants are quite helpful for preventing cell / DNA damage, cancer and slow aging in healthy people, it works against the radiation-induced damage, and can hinder its beneficial effects.  The improvement in radiation therapy over the years has been massive; they don’t just put you in a room with a pot of radium or cobalt any more.  Every RT machine is a mini linear accelerator that makes the radiation rays. Technicians can then target the tumor in 3D and avoid healthy tissues with tolerations of ~3mm.  Cool way more positive effects and minimal bad effects.

Temozolomide is a fairly new drug that I’m taking for chemotherapy.  It is a small molecule, that is absorbed well orally or IV, and also breachs the blood/brain barrier and is taken up into neural tissue.  It targets one of the proteins that cells use to help them repair DNA damage (gene specific stuff).  So it works well together with radiotherapy and is now first line treatment of gliomas.

While the research on temozolomide shows median survival increases to only 14 months from 12 months, the experience is new with this drug, and it seems to open a window for long term survival.

There is also some research on novel treatments involving viruses and vaccines.

All in the future is not bright, but neither is it dark.

Hal