Conversation with my doctor at MGH
Monday, 15 November 2004

	He wishes to have all pre-op and post-op images.   Two that
he does not have yet are the pre-op MRI/A images taken in Ithaca
and the balloon occlusion embolization images taken at NYHospital
26 October.   I have contacted Mark Bilsky's office to see if they
can arrange for these films ot get to MGH.

        I willalso need to see that he gets a copy of the images from
my upcoming CT-scan ofthe nefck, sceduled for 8 Dec at MSKCC.

        I will need to make an initial visit to MAss General for 1-2
days of tests and technical evaluation/measurements.  This will likely
be mid-December 2004.   The actual treatment plan will begin "early" in
2005, presumably right after New Year's, but dependent on the rest of
his schedule.   
        The treatments will be 20 minutes daily, 5 days a week, for
8-9 weeks.  The total dosage in 75-80 Gy.  I have not yet made the conversion
to rem, but it is a lot.  "This is what is needed for chordoma."   Is
is effectively a "life" dose, so we get one chance to elimate the malignancy
with radiation.  Any future re-appearance or metasteses will have to be 
dealt with by "surgery only".   All boundaries of the tumor volume will be
irradiated.

      The usual reaction to the 20 minute exposures is some skin irritation
and tiredness.   However, for the last three weeks swallowing will become a
challenge and it may near the end become painful to even swallow my own
saliva. [I did not ask at this point what one does for sustinance at this
point ... IV?  hospitalization?].
      Given that brachial nerves are involved there is a ~25% chance that I will
lose some arm function over the next year.  This is because healthy nerve cells
will have their DNA destroyed as well as chordoma cells; nerve cells replicate
infrequently, but when one tries to do so, it will be unable if its DNA has
been damaged and that nerve cell will die without being replaced.  According
to my nerve map, the possible affected motions assocoaited with C5/C6 include:
deltoid (raising arm), biceps (flexion of elbow), rotation of forearm
(supination), wrist extension and wrist rotation.