| Radiotherapy Medication |
Morning
|
Afternoon
|
Evening
|
Notes
|
Granisetron 1mg
|
1
| 1h before TMZ |
||
Sildenafil 50mg
| |
1
|
1/2
|
With TMZ and Celebrex
|
Temozolomide 140mg
| |
1
| 1h before RT | |
Celebrex 200mg
| |
1
|
1
|
Anti inflammatory
|
Boswellia 400mg
|
3
|
4
|
4
| Anti inflammatory |
Valproic Acid 500mg
|
2
|
2
| ||
Metformin 1000mg
| | 1/2 | | Lowers blood glucose |
Omeprazole 20mg
|
1
|
1
| ||
Hidroxychloroquine 200mg
|
1
| |
1
| Not Chloroquine yet |
Curcumin 500mg
|
2
|
2
|
2
| Not Longvida yet |
Melatonin 5mg
| |
4
| ||
| Probiotic | |
1
| | |
| Multivitamin |
1
| | |
|
Alfacalcidol 0.5mcg
|
1
|
2
|
1
| |
Vitamin D 2000UI
|
1
| |
1
| |
Selenium 200mcg
|
1
| | | |
Sulforaphane 50mg
|
2
|
2
|
2
| |
Maitake 650mg
|
1
| |
1
| |
| THC vape |
1
|
1
| 30m before RT | |
CBD oil 10% drops
|
4
|
6
|
4
| 1h before RT |
Omega 3 2000mg
|
1
| |
1
| |
MCT oil tablespoon
|
1
| |
For ketosis
|
|
| Ketogenic diet & Intermittent Fasting | | |
First meal 3 PM (after RT)
|
|
| Wim Hof Method | | | | Breathing exercises |
| 3/31/18 | Presented with acute aphasia and vision loss, medevacked to Palmetto Richland hospital (Columbia, SC) tumor was discovered in left temporal lobe |
| MRI (missing report details) | |
| 4/2/2018 | TRANSPORTED TO MUSC, CHARLESTON, SC |
| 4/4/2018 | SUBTOTAL RESECTION OF LEFT TEMPORAL MASS performed at MUSC, Charleston, SC |
| 4/5/2018 | MRI BRAIN W/WO CONTRAST |
Status post subtotal resection of left temporal mass with residual enhancing
tumor along the medial margins of the resection cavity measuring approximately
2.4 x 3.3 cm. Additional enhancing satellite nodule along the posterior
inferior aspect of the resection cavity compatible with residual tumor.
Similar mass effect and partial effacement of the left lateral ventricle with 5
mm rightward midline shift. | |
| 4/6/2018 | NEUROPATHOLOGY REPORT - DIAGNOSIS: GLIOBLASTOMA MULTIFORME WHO GRADE IV |
(PARTIAL COMMENTS FROM REPORT DATED 4/6/2018)
Date Collected: 4/4/2018 15:05
Diagnosis
A. BRAIN, LABELED AS "TUMOR", RESECTION:
· GLIOBLASTOMA MULTIFORME, WHO GRADE IV
· IMMUNOHISTOCHEMICAL STAINS:
o IDH-1: NEGATIVE
o GFAP: POSITIVE
o SYNAPTOPHYSIN: NEGATIVE
o KI-67: PROLIFERATIVE INDEX OF 10 %
B. BRAIN, LABELED AS "TUMOR", RESECTION:
· GLIOBLASTOMA MULTIFORME, WHO GRADE IV | |
| 4/19/2018 | MRI FUNCTIONAL BRAIN |
| 4/20/2018 | MRI BRAIN LAB WITH CONTRAST |
| 4/20/2018 | Surgical Resection performed by Dr. Allan Friedman, Duke |
| Loss of right peripheral vision in both eyes post surgery | |
| 4/21/2018 | MRI BRAIN W/WO CONTRAST |
| FINDINGS: Postoperative changes of left temporal craniotomy with subjacent resection cavity within the left temporal lobe demonstrated. Surrounding increased signal on T2 weighted imaging is unchanged. There are blood products along the margins of the resection cavity. There are small areas of superimposed contrast enhancement along the posterior margin (series 12 image 90),medial margin (series 12 image 95), inferior margin (series 12 image 81), and superior margin (series 12 image 101). The areas of residual contrast enhancement are largely improved from intraoperative MRI. Trace extra-axial fluid and dural thickening at the craniotomy site. There are expected postoperative ischemic changes surrounding the margins of the resection cavity. Status post left temporal mass resection with foci of contrast enhancing tumor along the margins of the resection cavity. | |
| 5/17/2018 | Day 1 of 6 week Radiation/ Temozolomide therapy (MUSC, Charleston, SC) |
| 6/4/2018 | SEIZURE (occured 2 days after gradually stepping down Dexamethasone to 0mg/day) |
| - MRI & CT scan performed | |
| “Postsurgical changes of subtotal resection of left temporal mass with increased size of the resection cavity and likely increased local mass effect with entrapment of the temporal horn of the left lateral ventricle and slightly increased medialization of the left uncus. The component along the resection cavity demonstrating elevated CBV has decreased in size from prior studies. Overall, these findings are suggestive of evolving post-treatment related changes with persistent residual tumor.Stable 5 mm rightward midline shift.” | |
| - Increased dose of Keppra to 1g 2x day | |
| - Increased Dexamethasone to 6mg 2 x day (to gradually step back down) | |
| 6/8/2018 | MGMT GENE METHYLATION ASSAY - “GENE METHYLATION NOT DETECTED” |
| 6/8/2018 | PATHOLOGY - GENERAL/OTHER - “ NEGATIVE FOR IDH1 R132H MUTATION” |
| 6/27/2018 | Completed 6 weeks of Radiation/ Temozolomide treatment |
| 7/11/2018 | SEIZURE (occured 2 days after gradually stepping off dexamethasone) |
| - MRI & CT scan | |
| “ADDENDUM: Similar appearance of a linear area of incomplete filling in the posterior superior sagittal sinus. This has been present on multiple prior studies, including the patient's original outpatient imaging and may reflect an underlying dural reflection or potentially chronic sequela of remote partial filling defect. No occlusion of the sinus flow is seen. IMPRESSION: Posttreatment changes from subtotal resection of left temporal mass with persistent residual tumor and slightly decreased size of the resection cavity.Slightly increased vasogenic edema predominantly along the left insular region. Stable 5 mm rightward midline shift and early left uncal herniation. No acute infarction.” | |
| - Increased Keppra to 1500mg 2 x day | |
| - Increased Dexamethasone back to 6mg 2 x day | |
| 7/13/2018 | FOOT DROP IN LEFT FOOT (possible stroke during seizure, MRI of spine schedules for end of month) |
| 7/27/2018 | MRI BRAIN W/WO Contrast |
| “Extensive irregular enhancement of the resection cavity extending to the ependymal surface of the left lateral ventricle, appearing slightly increased in size. Significant increase in relative CBV within areas of enhancement and nonenhancing T2 hyperintensity. There has however been interval reduction of overall mass effect and rightward midline shift.” | |
| 8/1/2018 | DAY 1 METRONOMIC TEMOZOLOMIDE (100MG/DAY) |
| STARTED DISULFIRAM 250MG/DAY + COPPER 2MG/DAY |
