Greetings from 19 Roscoe.

This last week was filled with many planning appointments, which included the two radiation simulations, and an appointment with Mike's oncologist.

The radiation appointments went well, and Mike is set to begin the process tomorrow. I was invited into the radiation room, so that I would have an idea of what his treatment entails. At the initial simulation appointment they made a mesh mold of Mike's glorious head. At the second appointment they had Mike lie on a large metal table, and then used the mesh mask to secure him into place. This allows them to target specific areas of the brain which will receive the radiation. It also stabilizes the patient so that there will be little to no movement during each session. Hats off to Mike for tolerating this confining situation. Once he is secured, the session should last only 5-10 minutes. Mike was told to expect to have increased fatigue as the treatments progress. He was also told that there may be an initial period where his symptoms of swelling and headaches may recur.

On Thursday Mike and I met with his neurological oncologist,Dr. Peak, at Kaiser in Redwood City, . This was a two hour appointment, where a very patient Dr. Peak answered all of our questions, and then in detail, went over the plan for chemotherapy and the trial medication. Earlier in the week I had dragged, okay, more like guided, Mike to a support group. This is a brain tumor support group that meets once a week. They usually have each participant share what they are going through, then offer support or information. Unfortunately, on the evening we attended they had a planned speaker, a neurological psychologist. The speaker was very informative, yet the topics raised played out like more of a "don't let this happen to you" scenario. We walked away with more concerns rather than any reassurances. Anyway, back to Dr. Peak. Dr. Peak gave Mike the much needed reassurance that he should come out of his treatment without any cognitive impairments. He then addressed the two options for treatment at this point.

The initial option is to proceed with the standard treatment recommendation, which is 6 weeks of radiation and chemotherapy. Chemotherapy is in the form of a pill, Temodar, which Mike would take daily for the initial 6 weeks, then continue for two weeks out of every month.

The second option is to proceed with standard treatment with the addition of the drug trial for Avastin. This is the option chosen by Mike. Avastin is an antibody that inhibits the blood supply to the tumor. It is administered intravenously every two weeks. Avastin is not a localized medication, meaning it works throughout the whole body, so we must be aware of any changes in Mike's health, as there are many significant side effects. Avastin has already proven to be very effective for colon and lung cancer, and is often utilized for brain tumors when a patient does not fully benefit from the standard radiation and chemotherapy treatment. In these cases Avastin has shown to inhibit tumor growth in 60% of patients. So the current trial is looking into the benefit of introducing Avastin earlier in one's treatment.

By joining the study Mike agrees to follow their protocol, have weekly blood analysis and meet with Dr. Peak every two weeks. Mike if free to withdraw from the study at anytime, and if he experiences any significant side effects, will be dropped from the study. After the 6 weeks of radiation/chemotherapy, they will follow up with a new MRI two weeks later. He will also then continue with the Temodar (chemotherapy) for the first 5 days of each month. If doing well, Mike can remain on the Temodar for 2 years, and remain on the Avastin indefinitely.

There you have it, more information about cancer treatment than anyone should have to know. My best to all of you. Please keep Mike in your thoughts and/or prayers.

Dan