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PaulB Offline OP
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Thanks, I do all that, and rinse with aloe Vera juice, coconut oil too, and use biotene mouth wash, toothpaste, after each meal, gum, but returned my water pic since it hurt too much, even on low. Radiation just wreaked havoc on my teeth, in a short period, but what was probably worse was the chemo, which caused worse dry mouth, mucocitis, infection, and other side effects, than radiation, and was in ICU for two months, and no oral care was done, and for a god four months after that. I just remember them using the sponge brushes, suction machine, once in a while, and couldn't even drink water or have ice in my mouth nor cold get out of bed without two nurses, a Hoyer lift. The teeth, if you call it that now, are beyond repair, and past the gum lines, down to the roots, and there is no between the teeth.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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Hey Paul,

Finagle your way to arrange a visit with the Wizard. Maybe you will be the one to pull the curtain like Toto. Still a question in my mind is how the analysis and strategy is developed for each treatment plan. How much input does the RO have, is the dosimetrist there to just carry out the orders from the RO, how collaborative is the process, and the Grand Wizard (medical physicist) - how much do they get their hands dirty in individual cases rather than managing the facility's equipment and processes, etc.?

I never really had the chance to get all my questions answered at the time and at some point did not really care, just wanted to get past the rads.


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Jul 2012
Posts: 3,267
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PaulB Offline OP
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Don,

The gantry Proton machine is huge, and proton equipment is a city block long, so we'll call that Emerald City lol. Seems this RO was out of the loop, as far as knowing when the treatment plan would be completed, and said it takes three weeks. It probably didn't help I had 18 PET/CT, CT and MRI's discs to give them, and determining dosage from prior radiation. From what I know, the RO has to approve all treatments plans, and is overall in charge. The RO knows the formula the physicist or dosimetrist it's uses, but hear a computer does it now, at least for IMRT. After I saw my RO, different from Proton, last year, he said, now the difficult part of his job begins, treatment planning. He isn't taking orders from no one, and calls all the shots, pleasant enough guy though, and is the Physician in Chief for their 5 hospitals, Chairman of Radiation oncology, Co-director for Head and Neck Cancer, so can't see the physicist being above him. I still would like to meet the Wizard, kind of like, where's Waldo in the picture.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jan 2013
Posts: 1,291
Likes: 1
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Here you go. I posted this on my journal site. It covers the roles and relationships between the radiation oncology professionals. You are probably signed up but if not, register and I'll get you access. You need to register to see the contents.
http://beatdown.cognacom.com/content/radiation-oncology-dosimetrist-and-physicist


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Jul 2012
Posts: 3,267
Likes: 1
PaulB Offline OP
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My oncologist wants me to see the cardiologist before chemo, carboplatin, treatment, whenever that is, and still no word on radiation yet, so I doubt it's next week. I'll even be fine if they say I can't have anymore radiation, and roll with the dices. I have a doctor appointment on Tuesday. My blood pressure was one day 179/93 and then 153/100, which is high for me, normally 130/80, and heart has been racing.

Thanks Don, good account of your Tx, and read the different roles.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jan 2013
Posts: 1,291
Likes: 1
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[quote]read the different roles[/quote]I did go back and reread that doc and it was still unclear how they are organized.
Quick google found this how Vassar Brothers Medical is organized:

The staffing of the four centers is managed centrally and assignments of personnel to clinics remain relatively static. This strategy affords stability and continuity in the practice of each center combined with the significant advantages of built-in peer review and cross-coverage as well as centralized administrative control.

The physics division of the group comprises six full-time licensed Medical Physicists, including one Chief of Physics, plus two Medical Physics Residents. All four centers are served by a single physician group that currently comprises six ABR-certified Radiation Oncologists; all of them are credentialed at all sites. The Dosimetry section, which also reports to the Chief of Medical Physics, comprises five CMDs including one Chief Dosimetrist. The therapists report to three site supervisors, one is responsible for FROC and PROC, another for VBMC, and the other for UROC. All of the above are involved in some capacity as rotation supervisors or teachers in the Medical Physics residency.

The Chief Medical Physicist, whose base office is at Vassar, serves as Director of the Physics Residency program. Those duties are part of the job description, and are a key element of the recruitment process if/when the position is filled.


Found this this too about specifics of job of dosimetrist

Last edited by donfoo; 12-14-2013 03:36 PM.

Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Jul 2012
Posts: 3,267
Likes: 1
PaulB Offline OP
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Seems like I will finally start radiation on January 6th. The radiation center called me today that my treatment plan is completed, and wanted me to start tomorrow night at 8pm lol. First I have to see if my driver is available for transportation, which I'm paying $75 a day for, and have to contact my oncologist when I can start chemo. Then the scheduler said Sunday night at 7:30PM lol, but agreed after the New Year. No sense ruining my holidays at this point, and having missed days from the holiday closings, probably having to be made up on Sundays.

Contacted my oncologist's office, and will start carboplatin on January 8th, and once a week thereafter. They have to get copies of my EKG from my cardiologist visit yesterday, and I have an echocardiogram on the 30th, a stress test in February, but was given an all clear to start chemo anytime.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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Posts: 945
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Posts: 945
Hi, Paul
I'm glad the schedule is set. I don't know if missed sessions are as bad with the proton therapy as they are with IMRT, but scheduling so you can go straight through without holidays getting in the way sounds sensible to me.
Maria


CG to husband - SCC Tonsil T1N2M0 HPV+ Never Smoker
First symptoms 7/2010, DX 12/2010
TX 40 IRMT (1.8 gy) + 10 Cetuximab
PET Scans 6/2011 + 3/2012 clear, 5 year physical exam clear; chest CT's clear of cancer. On thyroid pills. Life is good.
Joined: Jul 2012
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PaulB Offline OP
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Thanks Maria. Planned breaks are another story maybe, just like weekends, but yes, I would rather go straight through. I would think Proton is the same as far as tumor kill, cancer regeneration or repopulation, as IMRT.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






Joined: Jan 2013
Posts: 1,291
Likes: 1
Patient Advocate (1000+ posts)
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Joined: Jan 2013
Posts: 1,291
Likes: 1
That machine must be expensive. Treatment slots on Friday and Sunday nights! They are paying mucho overtime for the techs. I'd be signing up for Sunday nights for 2x plus I suspect. :-)

At least you have things pretty settled now and your time window for treatments. Enjoy the holidays! don


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
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