09th Oct2011

Astrocytoma: 6 years in 8 MRI scans

by Dutchcloggie

So here they are: Jane’s MRI scans that show how this all went down. They can no longer find the scans they did first, in 2005 so the first view of the tumour is from 2006, a year after surgery. It is difficult to compare scans exactly as they have been taken by different machines, at different times and with different contrast substances. So when something lights up really bright in the picture, that does not always mean the tumour got a lot worse.

January 2006
Diffuse Astrocytoma MRI January 2006

There is a clear grey area on the left of the front (the MRI is mirrored so the left of the picture is the right of the brain). It is clearly visible that the tumour is diffuse. There are no clearly defined edges. It is not crossing the midline of the brain.

January 2007
Diffuse Astrocytoma MRI January 2007

Although some areas light up more, it is clear the shape & size of the tumour has not changed much since the last scan. Indeed, Jane is still happily living a normal life, forgetting about the tumour, free from any symptoms.  The difference in contrast can sometimes be as simple as it being a different machine (or me not using the exact same slide).

January 2008
Diffuse Astrocytoma MRI January 2008
A year later and the tumour is still roughly the same size. At this point. the doctors were discussing a possible tiny tiny change. However, the change was so small that some said there was no change at all. It is difficult to judge from the scan how big the actual tumour is and what is swollen healthy brain tissue.
October 2008
Diffuse Astrocytoma MRI October 2008

Now things have changed. Jane had been complaining of headaches and double vision. The tumour is clearly larger than previously. It is also obvious there is a lot more swelling and the tumour is pushing against the midline, bending it out of shape. This is called mass-effect. The tumour has invaded the Corpus Callosum and this means it is now inoperable. The swelling of healthy tissue is once again difficult to separate from tumour tissue. Based on this scan, Jane has radiotherapy.

July 2009
Anaplastic Astrocytoma MRI July 2009

After the radiotherapy, the tumour has shrunk a little in size. Unfortunately, as is very clear from the 3 bright spots, the radiotherapy has caused extensive brain necrosis (death of healthy brain tissue) and the bright spots are cysts filled with fluid, where brain used to be. Further more, the centre of the image shows the tumour has crossed the midline and has taken on the appearance of a much more aggressive tumour. It is now no longer a benign tumour but an Anaplastic Astrocytoma Grade III. In short: radiotherapy has not worked and caused brain damage. No cure is possible after this. Chemotherapy is started.

January 2010
Anaplastic Astrocytoma MRI January 2010

After 6 months of chemotherapy, the tumour has shrunk somewhat. It no longer presses on the midline of the brain. There is considerably less mass-effect. The grey area is smaller, although the cysts remain. They will not go away. This is a positive result compared to the previous scan and there is hope that the chemotherapy will continue to contain the tumour.

June 2010
Anaplastic Astrocytoma MRI June 2010

Very little change in the scan. Some slight change in the grey area but I can not tell if this is just because it is a different scan or if this means something. Although Jane’s symptoms are getting worse, the scan offers no proof of further progression. Just like there can be a tumour with no symptoms for a long time, it is possible to have symptoms longs before the scan shows any change.

September 2010
Anaplastic Astrocytoma September 2010

2 months later, the story is completely different. The chemotherapy is no longer working. The scan is not as clear as the previous ones but it is obvious that the tumour now stretches much further in to the brain. It has now reached the brain stem and affects both sides of the brain. There is no sure fire way to distinguish between diffuse tumour tissue and brain swelling but it is clear a larger area of the brain is now affected. Jane is admitted to the hospice and large doses of steroids help reduce the swelling. Symptoms improve for a few months.

A final scan is done in January 2011. I don’t have that scan (yet) but that scan shows more necrosis and new tumours in different parts of the brain.

So that is what it looks like. A relentless march towards death. It never really got much better, no matter what we tried. Looking at these scans makes me angry, it makes me sad. But it also gives me a strange sense of acceptance. It shows in very clear images that nobody could have done anything.

19th May2009

Keep it simple

by Dutchcloggie

Things are indeed getting better I feel. Maybe the fact that JD’s hair is now growing back in earnest makes me feel very hopeful of this all being over someday soon. I love touching the fuzzy hair on her head and stroking it. Last night we went to a rugby tournament that we both play in over the summer (Touch Rugby so no need to worry) and the girls in the team (who had not seen JD for a week or so) all said: Wow! Your hair is really growing back fast now. It made me smile. That is, until they started playing and I realised it will be a long time before JD will be back to the way she was before the radiotherapy treatment started. She looked confused and slow to react to what was happening on the pitch. But she said she was really enjoying herself so that was great. Maybe the tactical talk we had before the match helped her.

In touch rugby, there are only 6 players on the pitch and they have no specific task and decisions are made in a split second; exactly the thing JD is struggling with at the moment. So I suggested that instead of doing that, JD should be the only player with only 1 specific task on the pitch so she could focus on that one thing. So all the players on the team knew what JD would and wouldn’t do.

It seems that worked really well and JD played quite well. It still made me cry a little though.

We are getting her a free bus pass because last week her driving licence was revoked due to having had radiation to the brain and some focal minor seizures. It is the right decision but it made JD quite upset. The emotional impact of loss of independence is something that can not be underestimated. It is different if YOU make the choice not to drive. It is not nice when you are told you are unfit to drive.

But things are getting better. Slowly. But surely. The only thing to find now is: how far does the progress go and when will any permanent damage become obvious?

15th May2009

More hair!

by Dutchcloggie


Look at that! A lovely head of hair. It is growing back nicely. Far too slow for my liking as I am really excited about it and I want to see what it will look like when it has grown back fully!

I love stroking her head and the new fluffy hair. Radiotherapy can kiss my butt!

12th Apr2009

After the radiotherapy

by Dutchcloggie

We were warned about the side effects of radiotherapy to the brain. Tiredness, loss of short term memory, somnolence, loss of concentration. The oncologist tells you what to expect and you sit there and nod, thinking it will all work out in the end.

During the 6 weeks of treatment, JD did not really have any problems. She got tired and started losing her hair after 4 weeks. But no major problems. When the treatment was finished, we were told to expect the side effects to get a bit worse, until about 6 weeks after. And so we were not that alarmed when she started to get more and more forgetful. Nor when she was less and less able to concentrate. Or when she started to have problems with wetting herself in public. At the same time she was reducing the amount of steroids she was taking and headaches soon returned, indicating that things were not going all that well.

In the end, it was me who decided that things were not going well and were in fact getting worse than we were told to expect. Maybe selfish but I was no longer able to understand what was going on. AB would forget to do things she promised, she would not take me in to account in anything she did do (have dinner before I was home from work just because she felt hungry, make appointments with people on days that I already had something planned etc.) She also is unable to relate to her own emotions and is genuinely confused by questions that require a decision, be it a factual one or one based on emotions. She will give the answer you hand to her (‘You want red?’ Yes. ‘Or would you rather have blue?’ Yes, blue would be better.)

When asked why she says certain things or why she behaves in a particular way, she will look away, get distracted and (conveniently?) forget the question. This is all beyond frustrating for me and has brought me to the edge of reason with her at times.

I realise this is more my failure to deal with it than JD’s fault for being like this but either way, I struggle to deal with it. Some days I am able to just ignore it but on days that are perhaps stressful due to work etc, I might not be so patient and snap at JD. It makes me feel bad.

05th Jan2009

Radiotherapy today

by Dutchcloggie

A post by JD

I have my first treatment of radiotherapy today at 4:20pm. I have been waiting for this date for quite a while now and I just want it all to start properly. I’ve had all of the planning appointments and have had the mask made etc etc but have been waiting for today to come for about a month or so. Traveling to the hospital will be tough (as I can’t really drive at the moment – I’ll find a way) but there is good public transport. And I have some friends who have agreed to give me lifts and put me up for the night. What wonderful people! I’m not sure how much I’ll blog about it as I’m not big into diary-keeping/blogging/record-keeping but we’ll see. Speak late

11th Dec2008

Don’t ask, don’t tell

by Dutchcloggie

JD has, according to the Oncologist, a high likelihood of her tumour being a Grade II Astrocytoma. Inoperable because it has invaded the Corpus Callosum and there are signs of invasion of the Thalamus. This sounds really scary when they say words like ‘invaded’ and ‘inoperable’ but how bad is that really when it comes to daily life? I mean, the smallest sign of tumour is considered ‘invasion’ but that does not mean it is aggressively invading and growing, like an ivy plant growing up against the wall and eventually invading the wall of your house, pushing the bricks and mortar apart to get in.

RT starts in January and the Oncologist said: This will work. But will work for what? To stop the tumour growing further? For a while or for good? Is it a 99 certainty with these tumours that they will grow back eventually?

I kind of want to know if, in the end, this is going to be fatal. Even if it is in 10 or 15 years. I just do not want to have the idea that this can be cured completely only to then find out in a few years time that I was wrong in that belief. I know that it can be years after treatment before it comes back but none of the doctors have said anything about long term prognosis.

I wonder if long-term prognosis is a case of Don’t Ask, Don’t Tell. If we don’t ask them abut it, why should they say: “You do realise this will kill you in, on average, 15 years” for example.

Somehow I don’t want to know if this is fatal in the short term but I do want to know if, in the long term, this will be fatal.

Every time I think: if only I knew the answer to –insert question here–, I will feel better about things, more in control. And then we get the answer an a new question comes up and I think: If only I knew the answer to THIS question, I would have a better idea of how to handle this.

09th Dec2008

Always alert (or scared?)

by Dutchcloggie

JD has been preparing for the radio therapy which will start on January 5th. On the 23rd of December, she’s having her final planning appointment an then we are ready to go.

She has been on quite a high dosage of Dexamethasone for a few weeks now (8mg twice a day) and she is having side effects such as indigestion, feeling weak in the muscles, having a huge appetite and so on. She is definitely getting more round in the face but I actually find it kind of cute. It is unfair that the drugs she needs to take to reduce the swelling in her head simultaneously increase appetite and reduce your strength to exercise.

JD has not had a seizure since the very first one that announced the arrival of the tumour, almost 4 years ago now. And yet, I always remain vigilant for signs. Any unexpected twitch or rolling of eyes puts me on high alert. I guess I am never completely relaxed since she got ill. Whenever she is in a different room and silent for a bit, I call out to see if she’s still OK. She always is of course but it just makes me feel better. I used to cycle to work but I don’t anymore, in case something happens to JD and I have to rush home. Small things like that just change your habits.

Last night I had a proper scare through. Or rather JD had a scare. She got up off the sofa to get the paper from the bedroom (about 6 metres away). When she had not returned after a minute, I called to see if she found the paper. No response. I called again. No response. Still too lazy to get off the sofa, I called again. Or rather, I yelled quite loudly. No response.

Now I was worried. I walked to the bedroom and found JD lying on her back on the bed with pupils so big you could hardly see any of the colour of her eyes. I asked her if she was OK but she just stared at the ceiling and did not say much. I asked her what was up and she slowly managed to form a sentence, telling me she was ‘just having a little rest’. Obviously that is rather weird as she was just going to get the paper from the bedroom and come back to the living room. I was really worried at that point and thought she was about to have a seizure. She had that weird, vacant stare and disoriented speech.
After 2 minutes, she sat up and said she was fine. The whole thing had felt like some kind of headrush to her but different. She said when she got to the bedroom, she suddenly felt really tired and decided to lie down on the bed and then it was all a bit vague for a minute or two.

Weird. A bit scary that is. It might have been a headrush, nothing more than that but combined with the suddenly massive pupils, I felt it was a bit freaky. Maybe it has nothing to do with her brain tumour. Maybe it has everything to do with it. But I hate how the thing just changes your life in small ways. How you are simply a little less relaxed every time something happens.

27th Nov2008

Doctor Lecter comes to town

by Dutchcloggie


Yesterday JD went to hospital to have her mask fitted for the Radiotherapy. I took pictures, much to the amazement of the technicians. Well, I need to be able to explain to my family what is going on right?

Anyway, JD was positioned on a table and then they quickly placed some warm plastic mesh on her face which was then shaped and molded to fit her face. After about 5 minutes, the plastic was hard and taa-daa: a perfect cast of her face.

She was then taken for a CT scan with the mask on. That way, the Oncologist can map exactly the position of the tumour in relation to the mask. (Read more information about this on the website of Cancerbackup.org). He will put all the different scans (MRI, CT, PET) on top of each other to pinpoint the exact location of the tumour and then he marks out on the mask where exactly the radiation beams will need to be aimed during the radiotherapy treatment. Next month JD will go for a trial scan to check the oncologist has measured everything correctly.

The real thing then starts on January 5th.

The appointment itself wasn’t anything much. Quite technical. The oncologist answered some more of our questions and JD was pleased to report that the increased dose of steroids seems to be working well and her double vision and headaches have been reduced greatly.

Afterwards JD said that the whole experience left her feeling ‘cancery’. I suppose it hits home that this is cancer treatment. She said she has so far not seen herself as a cancer patient at all. Neither have I. I know a brain tumour is brain cancer but somehow it feels like a separate thing. Being surrounded by leaflets and brochures from the (excellent) MacMillan cancer charity makes you realise that in fact, it is a form of cancer.

It is all a bit strange because JD is not really feeling ill at all, especially with the steroids now controlling the swelling of the brain. In fact, the radiotherapy will make her more ill than the tumour ever has so far.

21st Nov2008

Radiotherapy, here we go

by Dutchcloggie

So we went to see the Oncologist a few days ago. And the news wasn’t as nice as we had hoped. JD is now having prolonged episodes of double vision, headaches and some dizziness. The doctor felt it was time to start treating the tumour. They prefer waiting with this as long as possible because radiotherapy might actually make a benign low-grade tumour turn in to a malignant high-grade one. But it is a small risk. However, it is one we need to take.

And so next week, we go back to the hospital where JD will be measured and fitted with a facial mask. On that mask, they will mark the exact spots where the radiation beams will be entering her head.

The word Cancer was used properly for the first time. Brain cancer. Sounds terrible. The word ‘inoperable’ was used as well. The tumour is in a place where they cannot cut it away. Basically the tumour is not a single lump but lots of little bits of tumour in an area that controls important brain functions.

The radio therapy can not remove or shrink the tumour but it can stop the growth. That would mean the healthy brain around the tumour will no longer be swollen. That will mean no more headaches and no more double vision. It would mean a pretty normal life. People have survived for decades after having this treatment. But we also know others have died. Most low grade tumours turn in to high grade in the end. The question is: how long before that happens? Especially since we already know it is inoperable, we are really hoping this early intervention with radiation will work.

It is a 6 week course. For 6 weeks, 5 days a week, JD has to go to a hospital an hour driving away from where we live for a 30 minute treatment session. With her double vision, she won’t be able to drive herself. So that will have to be me. My boss will be happy about that. Not.

Thankfully, we have great friends and there is already an offer for JD to stay overnight with a friend who lives near the hospital. Even if we can arrange it so that she can stay over with different friends a few nights a week, then I can drive her on other days.

I am already upset when I think of JD feeling ill and being scared. Because initially, her symptoms will just get worse instead of better. She will lose hair where the beams hit her head, she’ll feel ill, dizzy, headaches, more double vision, loss of appetite, loss of memory and concentration, tired and so on. And that is apart from the additional side effects from all the medication she will be taking. Steroids, anti-seizure drugs, and so on.

This whole tumour is unacceptable. It is just not good enough. She is NOT going to die of this. Not now, not in 10 years, not in 25 years. I WILL not accept that.

Tumour, are you listening? Bring it on you bastard! We’re coming to get you.

14th Nov2008

More pain in the head

by Dutchcloggie

Aarrggghhh! I know it is JD’s pain and not mine and that I shouldn’t complain but my God how annoying is this tumour!! I feel so powerless and unable to do anything useful.

On Wednesday, JD had yet another headache. In fact, she had a headache for a few days (ever since her course of Dexamethasone, a steroid that helps to reduce swelling of the brain) was finished. On Wednesday, it turned in to a proper headache that left her rolling around the bed in pain. By the time I went to bed, she had been like that for hours. We had tried Paracetamol, Ibuprofen and Codeine tablets but nothing really helped against the pain. She was throwing up and it was just heartbreaking to see.

In the end, I picked up the phone and called NHS Direct, a telephone service where nurses and doctors from the National Health Service give people medical advice 24/7. The idea is that if people call that for minor cases, then they don’t need to go to the ER or doctor, saving money and time.

I rang them to find out if there was anything stronger I could get JD for the headache. We live 2 minutes away from the hospital so if the answer had been yes, I would have taken her to Accident & Emergency to get he medication but I did not want to take her there and then be told there was nothing they could do for her. After all, it really was just a headache.

The nurse on the phone was fantastic. She was friendly, helpful, caring and understood that I was anxious to get SOMETHING, anything, to help JD feel better. She decided it would be best for a doctor to call me back to discuss it. And so I gave my phone number and within 15 minutes, a doctor called me back. He said he would like to see JD at the hospital. So I bundled her in the car for the 2 minute ride and off we went.

The doctor was friendly and managed to make me feel smug too! He said it was rare to meet a patient with a partner who knew every single detail of the treatment (I know all dates, medications, dosages and whatever else you can know about JD’s condition). This surprised me because I would have thought everyone wold know all details about your partner’s illness.

Anyway, he looked at her and offered her to be admitted overnight (it was already 1.30am by then) so that they could give her stronger pain killers. The other alternative was to give her a new course of Dexamethasone right away as that would immediately start reducing the swelling of her brain and thus take away some of the pressure inside her head. JD chose to go home instead with the tablets.

They seemed to help because she finally managed to fall asleep around 3am. In the morning, we went to the GP who gave her a new course of Dexamethasone for the next 25 days.

It is now Friday and the headaches are still there. On a scale of 1 to 10, she rates it as 7 or 8 today. That sucks. That really sucks. I hate the fucking tumour. It may not even be related to that bloody thing. She might just have developed migraines. Now that would be really shitty.

JD was supposed to go to Germany with the fencing team for a tournament. She’s at home now, deciding the headaches were too severe.

Oh, and to top it off, the boiler is broken and we have no heating & no hot water.

06th Nov2008

A little less scared

by Dutchcloggie

I just spoke to the ‘Cancer Nurse’ from the hospital about JD having to see the oncologist. (I lied and said I WAS JD or else they wouldn’t speak to me. I am so naughty:-) He had her file in front of him and said: “You only have to see the oncologist because the PET scan was ordered through his office. It does not indicate any kind of treatment is required. it may be but, looking at her files, the PET showed it is still a low-grade glioma with very little growth. Chances are he only wants to discuss possible treatment options for the future and check you with more frequent PET scans than has so far been the case. That is good news”

Wow. I guess that is good news indeed. Can someone please tell the hospital that just sending appointments to see Oncologists is really scary if you don’t know why you are supposed to be seeing an oncologist?????

Anyway, long live the Cancer Backup nurse! Feeling a lot less scared about the appointment now.

04th Nov2008

I changed my mind

by Dutchcloggie

I’m scared.

04th Oct2008

To the Clinical Oncologist

by Dutchcloggie

There are moments when I just don’t know what to think. JD had her PET scan 2 weeks ago to learn more about her tumour. We have not heard anything about a report or result of the scan. However, yesterday we got a letter saying an appointment has been made with the Clinical Oncologist in 2 weeks’ time.

What does that mean in relation to the PET scan? That they have decided treatment is the way forward? A Clinical Oncologist treats cancer with chemotherapy and radiation so I assume JD is not just going for a nice chat but to actually discuss some form of treatment. It would be nice to have had a call or letter from the doctor, explaining the result of the PET scan and what the next steps are going to be. Now we are just assuming we know what will happen.

I am angry as I want to know what to feel. JD seems to be afraid of the whole brain, cancer, tumour, dying thing. I am not (yet?) too scared about the tumour itself as I trust the doctor when he said it is still quite small but that he simply likes to get rid of it before it can maybe cause trouble in the future. Me, I am just scared about the treatment JD will get. Radiation? Chemotherapy? It just brings up pictures of really sick people. I don’t want JD to feel like a piece of crap. I don’t want to have to see my wife in pain and discomfort. I feel bad enough when she has a headache.

It is important that we keep talking to each other. JD has a tendency to try and make things go away by ignoring them for a while. I on the other hand feel a need to know as much as possible about what is going on so that I can ‘decide’ on how I feel. That sounds calculated but I mean that for me it is important to be able to put things in some kind of perspective. Is this tumour one of those that kills people in a few years? Is it one that is just a nuisance but which can be ‘controlled’ with treatment or surgery, even if it can not be removed completely? How scared should I be, how life shattering is this tumour? I feel like I am dangling in space with nothing to hold on to for security. There is no frame of reference to use as a yardstick.

Maybe it has to do with a need to be in control. I am sure a psychologist will have a theory about it.