Monday, April 20, 2009

Bone drugs may protect against radiation exposure

By Julie Steenhuysen – Sun Apr 19, 3:09 pm ET

CHICAGO (Reuters) – Drugs commonly used to strengthen bones to prevent osteoporosis may protect people exposed to radiation against developing leukemia, U.S. researchers said on Sunday.
They said two compounds in a class of drugs called bisphosphonates delayed and in some cases prevented mice exposed to high doses of radiation from developing leukemia, a common long-term side effect of radiation exposure.
Alexandra Miller, a scientist at the Armed Forces Radiobiology Research Institute in Bethesda, Maryland, has been studying ways to protect military personnel and astronauts from radiation exposure.
But she said the findings, which she presented at the American Association for Cancer Research in Denver, Colorado, could also help cancer patients treated with radiation who later develop leukemia as a side effect of their treatment.

The compounds Miller studied are bisphosphonates known as ethane-1-hydroxy-1, 1-bisphosphonate or EHBP, which Miller said is chemically similar to Procter & Gamble's osteoporosis drug Didronel or etidronate.
The other was an experimental drug called CAPBP, which Miller said is similar to Roche's Boniva or ibandronate.
She picked the drugs because of studies in humans that suggest bisphosphonates may help prevent cancer from spreading to the bone. They also have been shown to remove uranium from the body.
Miller exposed lab mice to radiation strong enough to cause leukemia. She injected some of the mice with one of the two compounds and waited.

Typically, mice exposed to radiation developed leukemia and died 92 to 110 days later.
"With the drug, the animals were developing leukemia too, but it took much longer, 150 to 170 days," Miller said in a telephone interview.

"The total number that actually developed leukemia was significantly lower with both of the drugs," she said.
She said all of the untreated animals developed leukemia after radiation exposure, but only about half did in the treated group.
"It was very significant. We didn't have any toxic effects with the drug treatment," she said.
Miller said many more studies would be needed before the drugs could be used in humans, but she thinks the compounds show promise as a way of addressing one of the most toxic side effects of radiation exposure.

Tuesday, April 14, 2009

Recovery from surgery on small intestine

It's now been 10 weeks since my surgery to remove 10 inches from my small intestine. As I look back on the recovery process a few things stand out:

1. I lost more weight than I expected (about 10 pounds total) and it took several weeks to steadily build up energy.
2. the worst part of the recovery was the first two weeks dealing with incision pain when I coughed ...
3. it took about 6 weeks before I could swing a golf club easily and attempt to play tennis.
4. it took about 8 weeks before I was able to play golf and tennis normally.
5. even in the past two weeks I still feel some incision discomfort but it's minor. The discomfort seems to move a bit and comes and goes although it's pretty mild at this point.
6. getting my full energy back has been a steady process. I was surprised how debilitating the surgery and 3 night stay in the hospital was on my energy level --- I remember walking 18 holes of golf after 3 weeks and was extremely tired afterward.
7. the digestive process and bowel movements from the first week on have been quite normal which has surprised me. I have been able to eat anything from the day I left the hospital. I did supplement my diet drinking Ensure "milk shakes" to take in more calories as I wanted to gain back the weight.

The incisions are still quite visible --- there are 3 small (1/2 inch) incisions that are still noticeably reddish, and about a 2 1/2 inch main incision above my belly button that is also reddish. I can feel a minor discomfort when pressing on them even now.

Saturday, February 14, 2009

Surgery to remove section of small intestine

On Feb 2nd I went in for surgery to remove an inflamed, infected section of my small intestine (about 10" was removed) -- the surgery was called a small bowel re-section. The problem had shown up a few days before in a Cat-scan indicating a perforation of the small intestine (jejunal loop area) had occurred leading to the body countering that with a mass of tissue accumulating. The source of the 5 stomach pains bouts was found.

So at 8:30 am, Monday Feb 2, surgery at the Stanford hospital was performed by Dr. Shelley Marks of PAMF. The surgery we were told went well and that led to 3 1/2 days of recovery at Stanford. The surgery was performed laprascopically, leaving three small incisions (about 1/2 inch each) and a larger (2 1/2 inch) incision above my belly button --- the larger incision was necessary in order to remove the mass of material and the small intestine intact.

My care was good, and the amount of pain was limited, only being acute if I coughed. As expected I was weak after the surgery and ended up losing about 10 pounds from the lighter eating prep period before and the surgery aftermath.

I was released Thursday afternoon, Feb 6, to continue recovery at home. The only pain I was feeling was from the incision and that was pretty mild, except when I coughed. Holding a pillow against my stomach helped a bit but it still would hurt. Gradually the incision pain has receded, all my bodily functions have returned to nearly normal until today, Feb 14, or 12 days after surgery.

Throughout this period of time I only took two vicadin (sp?) pills for pain and then a few days worth of Tylenol. No other pain meds since. In the hospital I only had morphine as low levels 3-4 times. I have felt fatigued which is normal throughout the time after the surgery. Hope to be back on the golf course within a couple of weeks and on the tennis court as well. Just need for the incision to be able to take the movements.

After a visit with Dr. Marks on Thursday, Feb 12, she said everything looked good and that full and final recovery would continue for a couple of months. Fully normal activities could be undertaken as I felt able to do so and the fatigue would go away soon. The best news was a call from PAMF indicating that there was no cancer. Hooray!

The official diagnosis is that I have diverticulitis of the small intestine (bowel). The removed section seemed to contain the only affected parts of my small intestine or colon (where it is quite common for people to have diverticula --- 50% of those over 60 have it). Turns out it is quite rare to have diverticulitis show up in the small bowel, or at least to have complications leading to a performation as I had. My surgeon thinks there may not be any reoccurrence as the tissue in both the small intestine around the removed section and in my colon looks quite good.

Wednesday, January 21, 2009

Prostate & stomach problem CT-Scan updates

Prostate PSA test -- My Jan 5, 2009 PSA test was .84 so that was a continuing decline from last time.

Recurring Stomach Problem -- Following a 5th episode of stomach pains that began around 9 pm Monday, Jan 19th, I had a CT Scan at PAMF on Tuesday, Jan 20, and it showed that there was a "focal area of marked abnormal appearance to the proximal jejunal loop in the left upper quadrant suspicious for possible mass ..." Dr. Matthews believes this is the cause of my recurring problems and I have a follow-up meeting with a general surgeon at PAMF, Dr. Marks on Friday, Jan 23 at 1:30.

Also, received an email response below from Dr. Hancock with his thoughts including referral to 3 Stanford GI surgeons:

Mr. Stevens,

Sorry to hear of the new problem. I have difficulty relating this to your radiation, given that the treatment fields were confined to the pelvis and well below the area where, I think, this is being described. Most radiation-induced tumors arise more than 15 years after exposure, and small bowel tumors have been extremely rare, even when radiation fields directly included the region. I looked back at the images from your MRI scan from December 2007 but could not identify any definite abnormality. Might be more useful to look with the new study side by side with the old to see precisely where the mass is located. It would be interesting to see how thearea with the current problem looked 13 months ago.

Jejunal problems are pretty rare. I usually think of tumors causing such masses. I would guess that the list of possibilities would include gastrointestinal stromal tumor, leiomyosarcoma of the jejunum, primary adenocarcinoma and lymphoma of the bowel. Abnormal masses in this area could also arise due to diverticulosis, lipoma (benign fatty tumor) and other benign or inflammatory causes.

There are some reports of jejunal masses being successfully removed by laparoscopy, which usually features less cutting and more rapid recovery than open surgery. I am not certain what the pros and cons of each approach might be--particularly if there is concern that there may be air outside of the bowel.

I don't know if Dr. Marks is a general surgeon or one who specializes in GI tumors. There are three GI oncologic surgeons here: Shelton, Welton, and Norton. Sounds like a law firm. I understand that Jeff Norton is usually the fellow who does most of the cases where GIST tumors are a possibility (GI stromal tumors). They, incidentally, are the rare tumors that put the drug Gleevec on the market because they have a unique genetic mutation (c-kit) that makes them quite responsive to Gleevec. Sometimes when tumors are a consideration, surgeons have evaluated the area first with an angiogram to determine the source of blood supply. This may not be necessary, since the area will be directly explored, anyway. It will be interesting to see what your surgeon(s) recommend.

First to figure out what this is, however. I would be happy to have a look at the CT if the PAMF folks want to ship it over on a CD.

Best, Steve

Steven L. Hancock, MD
Professor, Radiation Oncology
Stanford Cancer Center, CC-G-230
875 Blake Wilbur Drive
Stanford, CA 94305-5847