October 2003

Dear family, friends, and colleagues,

I'm still recovering very well and continue to feel better every day. My weight is back to what it was before the surgery and I ride my stationary bicycle every day. I also exercise on a weight machine to get my muscles back into shape.

We met Dr. Goble, my radiation oncologist yesterday and saw Dr. Tripathy, my chemotherapy oncologist, again today. They have, in conjunction with Dr. Wood, my transplant surgeon, and cancer treatment specialists at the MD Anderson Cancer Center in Houston come up with a treatment plan to get rid of the cancer that was left behind after my transplant. Treatment will most probably start on Monday, October 6. It will entail 5 to 5½ weeks of radiation, 5 days a week. (The radiation exposure lasts only about a minute, and I can be in and out of the office in about 15 minutes.) In conjunction with the radiation I have to take a chemotherapy drug called Xeloda to make the treatment more effective. After a short break I will start 6 months of chemotherapy where I will receive one or two doses of chemotherapy drugs every three weeks. For the medically interested, they are planning to use a combination of Oxaliplatin and Gemcitabine, but it is not certain at this stage.

Tomorrow I will go in for a "marking session" where they will identify and mark the area they need to radiate. They will use a CAT scan to identify the target region (the center portion of my liver where the veins, arteries, and bile duct are connected) and then mark it using permanent markers and small tattoos (1 to 2 mm dots of ink under the skin). This will make sure that they focus the radiation exactly where it is needed and minimize the exposure of other organs (stomach, intestine, etc) to the radiation.

Of course, radiation and chemotherapy have side effects but my team is trying hard to minimize it. I can however, expect to feel tired and nauseated. However, I was tired and nauseated for about 8 months before my transplant so this will not be anything new. (It may be worse though, time will tell...) I took anti-nausea medicine before that worked really well, so I'm not too concerned about the nausea. Dr. Tripathy also suggested that I remain as active as possible to counteract the effects of tiredness. They also told me I should not lose my hair.

Although I know it is going to be tough, I am ready for it and hope to get through this while maintaining a positive attitude. I ordered a special T-shirt today that I will be wearing during the radiation therapy. Many of you know that I am a big Simpsons fan, so there was really only one choice: Radioactive Man!

Please continue to keep us in your prayers, and pray specifically that the treatment will be effective in getting rid of the cancer and that the side effects will be minimal. Also, please pray that Loela will remain strong and pain-free during this difficult time that lies ahead.

I will send out another update in a week or two.

Until then

Best regards, Roelof and Loela