Targeting Nerve Pain with Precision

Some people live every day in fear of a sudden attack of intense pain shooting up from their jaw and across their face. Often, they turn to a dentist because their symptoms mimic a toothache. They are unaware that the source of their pain is a nerve located millimeters from the brain stem that transmits sensations from the face to the brain and controls the muscles used for chewing.

Debbie Floyd experienced this debilitating pain and the loss of her teeth over a span of nearly 30 years. She finally found relief in the form of a very precise radiation procedure that is typically used to eradicate cancer.

“In my early 20s, I began experiencing severe pain in my jaw and my face,” said Debbie. “I thought it was related to my teeth so I went from dentist to dentist seeking relief. I would undergo root canals, but the pain always remained after each procedure.

“The next course of action included extracting teeth one at a time to determine which tooth was the source of the pain. Eventually, all of my teeth were extracted, replaced with dentures when I was 52, yet I still suffered from excruciating pain.”

A talented music teacher and performer on stage and in church, Debbie said the worst part was how the pain would take over her life. “It caused me to be agitated and irritable. I simply wanted to be left alone when the pain kicked in.

“As a result, I avoided socializing because I never knew when the pain would hit. At school, if the pain occurred while singing with the children I would have to stop and wait for it to subside before we continued.”

Debbie explained that anything could trigger the pain -- eating, talking, a puff of wind, brushing her hair or the water simply hitting her face in the shower could cause it to flare up. “I could sometimes go up to four or five weeks without the pain then it would return with a vengeance to the point that I could have an attack of pain every day for a month. The only time I did not feel the pain was when I was asleep.”

Debbie heard of trigeminal neuralgia during a conversation one day with someone whose spouse had experienced the same type of pain. “Once I started researching the condition, I immediately thought to myself ‘this is what is wrong with me.’”

Trigeminal neuralgia is a chronic pain condition that affects the fifth cranial nerve also known as the trigeminal. One of the most widely distributed nerves in the head, the condition causes extreme, sporadic, shock-like or sudden burning facial pain. The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle and lower portions of the face as well as the oral cavity to the brain.

Blood vessels pressing on the root of the trigeminal nerve are often the main cause of the condition. The pain can range from sudden, severe and stabbing to a more constant, aching, burning sensation. Attacks may increase over time and medication to control the pain can become less effective.

Debbie made an appointment with Neurosurgeon Dr. James Brennan to determine if she indeed suffered from trigeminal neuralgia. An MRI confirmed what Debbie had suspected. Treatment for the condition often begins with medication. Dr. Brennan prescribed Trileptal, a medication used to treat seizures, to control Debbie’s pain. After six months, Debbie returned to Dr. Brennan and told him that the medicine only worked if she took more than he prescribed -- sometimes as many as six pills.

Dr. Brennan suggested a procedure that could ablate or block the nerve. The procedure called stereotactic radiosurgery (SRS) uses computer imaging to direct highly focused beams of radiation at the site where the trigeminal nerve exits the brain stem. The treatment causes the slow formation of a lesion on the nerve that disrupts the transmission of sensory signals to the brain.

Dr. Brennan arranged for Debbie to meet with the SRS team at McLeod Radiation Oncology to begin the planning process for the procedure. “The radiation team of Dr. Rhett Spencer, Physicist Tobin Hyman and Karen Jones, the nurse navigator, explained everything to me and answered all of my questions.”

“The treatment for trigeminal neuralgia requires extreme precision and accuracy because we are targeting and irradiating a nerve located only three to four millimeters from the brain stem,” said Dr. Spencer.

The TrueBeam STx linear accelerator at McLeod is specifically designed for the delivery of stereotactic radiosurgery.

“The radiation is focused into a circular beam about the diameter of a pencil,” explained Tobin. “These eight to ten pencil beams move in an arc around the patient’s head and intersect at the same point in space, creating a high intensity area about the size of a pea. The radiation dose targets the nerve, effectively ablating it, and providing pain relief. The dose used to perform this procedure is approximately 40 times larger than the dose your typical radiation patient receives on a daily basis.”

Prior to the procedure, Karen remained with Debbie as the team attached a frame to her head to keep her still during treatment. “I was awake during the procedure, but they gave me a medication so I would relax and keep still. After the procedure, they removed the frame and I returned home.”

Debbie was told not to expect immediate relief from the pain after the procedure because it can take up to six months for the pain to totally go away. “I had the procedure performed in November 2016, right before Thanksgiving. I started feeling much better in March,” said Debbie. “It has now been eight months since I’ve had any pain. I went from taking four pain pills a day to two, then only one, and I stopped taking it a few weeks ago.”

McLeod offers the only active linear accelerator (LINAC) based stereotactic radiosurgery program from the midlands to the coast. Since installation in October 2014, a total of 132 patients have received intracranial stereotactic radiosurgery. Of that total, 13 patients have undergone treatment for trigeminal neuralgia like Debbie.

“I was very pleased that McLeod offered the SRS procedure and I didn’t have to leave Florence to seek treatment,” added Debbie. “I honestly thought this pain was something I would have to live with for the rest of my life. I’m simply amazed that this treatment available at McLeod ended my years of suffering.”

Melanie Rollings

Forty-five year old Melanie Rollings, a dedicated McLeod Radiology Technologist, never dreamed she’d be the one in need of serious medical care. What began as severe, debilitating back pain quickly became a tough fight against cancer. After being referred to McLeod Regional Medical Center, Melanie underwent tests that showed metastatic cancer to the liver and spine that had started in her breast.

The diagnosis left Melanie shocked and scared, but an introduction to the highly-skilled McLeod Oncologist Dr. Sreenivas Rao changed all that. Dr. Rao began an aggressive chemotherapy program and customized treatment plan specifically designed to fight Melanie’s breast cancer. It was a complete success, and Melanie has been cancer-free for three years. Today, Melanie is grateful for the ability to do what she loves most - caring for others.

“Cancer will change your life,” says Melanie. “I experienced an amazing outcome, and, I could not have done it without God, Dr. Rao, and my family.”

The Hope Fund

Journey to Hope

John Braddy

Jocie Patterson

Jane Blum

Anne Kirby

Robby Roberson

Leslie Denton

Harry Cantey

Conni Singletary

Stephanie Benjamin

Leon Rogers

Carolyn Gary

Audrey Gilbert

Adriane Poston

Anne Elliott Kirby

By Tracy Stanton

Anne Kirby describes her radiation treatment for a brain tumor as “just a little blip in the road.” Thanks to advanced technology at McLeod and an excellent medical team, the tumor on Anne’s brain was destroyed in only one treatment.

In 2014, Anne suffered from severe back pain as a result of complex spinal issues. Having undergone surgery for this condition previously, Anne returned to Dr. James Brennan, a Neurosurgeon with Florence Neurosurgery and Spine, for treatment. Dr. Brennan determined that Anne needed additional surgery to alleviate her pain.

After a MRI before the procedure, Anne was surprised to hear from Dr. Brennan the day prior to the scheduled surgery. “Because a mass had been found on my kidney, he said he would be unable to perform my surgery. He immediately made an appointment for me to see a urologist the same day.”

After meeting with the urologist and undergoing further testing Anne learned that her left kidney needed to be removed because of the tumor’s size. A month after the kidney procedure, Anne finally underwent surgery for her back condition. Following the two operations, Anne sought the care of McLeod Oncologist Dr. Sreenivas Rao for treatment of the kidney cancer.

“Dr. Rao began running tests before I started on chemotherapy because an earlier scan also revealed there were small spots on my lungs. I had actually volunteered for a cancer research program at McLeod which involved additional detailed tests. That is when the spot on my brain was found.”

Dr. Rao sent Anne to Dr. Brennan to discuss removal of the brain tumor. Dr. Brennan explained to Anne that the tumor could be easily removed with the use of the new state-of-the-art radiation unit at McLeod.

Fortunately for Anne, she had the opportunity to receive the advanced services McLeod provides in its Center for Cancer Treatment and Research. The program includes a newly installed TrueBeam STx linear accelerator, which is specifically designed for the delivery of Stereotactic Radiosurgery (SRS) treatments. These treatments require extreme precision and accuracy to deliver large doses of radiation to the treatment site, reducing the amount of time during treatment and resulting in fewer treatments.

“This non-invasive treatment approach utilizes a set of multiple beams that intersect at a single point on the tumor. The radiation beam hits the tumor with a very high dose of radiation, but gives the brain just a low dose of radiation that it can tolerate. It literally is like taking a knife and cutting these tumors out without having to cut,” explained Dr. Brennan.

McLeod Radiation Oncologist Dr. Rhett Spencer has been treating patients at the hospital for 29 years. “Today, we have four dimensional CT scans and stereotactic MRIs to guide us in our treatment planning. Using these scans, we conform the radiation dose to the tumor target and verify the location and shape of the tumor during treatment. This linear accelerator also rotates in a 360 degree arc around the patient, delivering the radiation beam to any part of the body from virtually any angle. In addition, the treatment table is designed to move in six different directions, and the machine is equipped for image-based adjustments during treatment.”

Prior to treatment, a stereotactic protocol MRI is performed which involves double the contrast traditionally given, allowing the tumor to appear even more enhanced than it would on a conventional MRI.

“This means we are scanning the brain every millimeter not every five millimeters which is the standard with a conventional MRI so five times as many images through the brain are produced. As a result, we frequently find tumors that were not previously seen,” said Dr. Spencer.

Key to stereotactic radiosurgery is the planning required to map out the patient’s treatment. This involves a medical physicist who engineers the treatment plan and radiation dose required to precisely ablate the tumor while minimizing harm to healthy tissue around the lesion. Treatment is scheduled once the radiation oncologist and neurosurgeon approve the plan and ensure that everything is set to match up perfectly when the patient is on the table.

Karen Jones, the McLeod NeuroOncology Nurse Navigator, prepares patients like Anne for the day of treatment. She explains to them what to expect and answers any of their questions. Prior to the procedure, Karen remains with the patient as they are immobilized to keep their head from moving during treatment. This requires either a frame that is bolted to their head with four pins or the application of a special face mask.

“The mask was uncomfortable, but I did not have to be put to sleep or undergo surgery,” said Anne. “I did not feel anything during the procedure. When it was complete they removed the mask and I got up to leave. There was simply nothing to it. I walked out feeling the same way I did when I walked in. When I arrived home I rode around on my golf cart and watched my grandson pick up pine cones like I would on any other day.”

Anne added there was also no recovery time to deal with following the treatment -- which would not have been the case if she had required brain surgery

Anne has been among a total of 110 patients treated with intracranial stereotactic radiosurgery by the McLeod Neuro-Oncology Team since October 2014. This includes 13 patients suffering from trigeminal neuralgia, a painful nerve condition that requires the team to radiate a nerve located only four millimeters from the brain stem.

Karen says there are many other successful patient experiences like Anne’s. “Some patients with metastatic lesions that we have treated have other disease processes that affect their overall outcome, but we have achieved good success with the treatment of their brain tumor. For these patients, our goal is not only extension of life but to preserve quality of life.”

McLeod offers the only active linear accelerator (LINAC) based stereotactic radiosurgery program from the midlands to the coast. “The next closest comparable treatment program is the cancer center at Duke in North Carolina,” said Dr. Spencer. The hospital installed a second linear accelerator capable of performing stereotactic body radiation therapy in 2016.

“I am grateful that I did not have to go away to receive my treatment. I literally came down the road from my home to McLeod,” said Anne.

Since her procedure in April 2015, Anne has undergone four MRIs that have all been clear with no evidence of any new tumors.

Today, Anne reports that she is doing well. She married her high school classmate, Gerald Kirby, in July of 2016. The couple reconnected at their 50th high school reunion and are enjoying spending their golden years together.

Anne gives credit for her excellent outcome to God and the extraordinary care and services she receives from her medical team, especially Dr. Rao, Dr. Brennan and Dr. Spencer. She remains under Dr. Rao’s care for the treatment that is keeping the tiny tumors in her lungs from growing. Each day is another victory.

Deborah Mackey

By Jenna Falls Cox

Deborah Mackey moved from a small town in Duchess County, New York, to Little River, South Carolina, 14 years ago with her husband, Gene. A retired school bus driver, mother and grandmother, Deborah enjoys all that South Carolina has to offer. She and Gene love to take trips and experience the freedom that retirement life brings. Living life to the fullest, Deborah never thought that her happy, go free way of life would come to a halt.

“I had never really been sick,” said Deborah.“But, one day I knew something was not right because I was having some rectal bleeding. When the bleeding continued and grew worse, I went to see Dr. Trevor Poole with Southern Surgical Group.”

Dr. Poole recommended that Deborah undergo a colonoscopy to detect the source of the bleeding.

“We are big believers in colonoscopies,” said Deborah. “We had several friends who did not take preventative measures to prevent cancer, and they did not survive. My father also died of cancer at the age of 36 when I was 14 years old.”

Following the procedure, Dr. Poole contacted Deborah with the results of the colonoscopy.“I was hanging Halloween decorations through the house when Dr. Poole called. He told me that I had colon cancer, and I needed to come to the office so we could discuss a surgery plan. He added, ‘This cannot wait.’

“I remember thinking there must be a mistake. The news did not sink in at that moment. In a state of shock, I removed all the decorations because I was no longer in a cheerful mood. I went to bed that night and it finally dawned on me that Dr. Poole was talking about me. Me! Not the man next door, but me,” recalls Deborah.

On October 12, 2015, Deborah arrived at McLeod Seacoast for surgery. The operation lasted longer than anticipated.

“During surgery, Dr. Poole found that it was a more complex situation,” said Gene. “He determined that Deborah had ovarian cancer that had spread to the uterus and the colon.”Dr. Poole immediately called in Dr. Joycelyn Schindler of McLeod OB/GYN Seacoast to assist with the surgery and perform a hysterectomy on Deborah.

“When I came out of surgery I learned the cancer had spread,” said Deborah. “I was relieved that the hysterectomy was able to be done at the same time. However, my worry was not over yet. I had to wait for the results from the lymph node biopsy. Thankfully, Dr. Poole came in the next morning and told me that I was going to be okay. He always promised me that he would not let anything happen to me, and he kept his promise.”

After the surgery, Deborah stayed in the hospital for five days.“My recovery process was much easier than expected, and the nursing staff at McLeod Seacoast was excellent. My experience was the ‘Rolls Royce’ of care.”

The day Deborah left the hospital is one she will never forget.“It was an autumn day, and when I came out of the double doors of McLeod Seacoast I was in awe. The sun was glistening through the trees, and it made them sparkle so beautifully. I got out of the car in my driveway and just stood there taking in all the beauty around me. I said to myself, ‘Look, you still have everything.”

Following her recovery from surgery, Deborah had to undergo six months of chemotherapy. It did not take long for her to become very close with the Infusion Services staff at McLeod Seacoast.

“My nurses, Dana and Tonya, took such great care of me during my treatments,” said Deborah. “Every time my treatment was over, they gave me a big hug and told me they loved me. I cannot describe to you how uplifting my chemotherapy experience was. I actually liked to go in for treatments.”

Infusion Services at McLeod Seacoast began in May of 2015 with space for four patients to receive chemotherapy. During the past year, the need for infusion care has grown rapidly and this Fall the department is expanding to accommodate 11 patients at one time. The new wing in the Same Day Services suite has been designed to meet the needs of the growing community McLeod Seacoast serves and offers convenient access to infusion care.

“Our patients are like family to us,” said Dana Tyree, an Infusion Services nurse. “We get to know them on a personal level because we care for them over a long period of time. We share in their victories and become their support system in times of need.”

“Those nurses are a part of my family now,” said Deborah. “They made me strong. I visit with them when I come to the hospital even though I have completed my treatments.”

With treatment behind her, Deborah says she is growing stronger each day. She enjoys going to the recreation center, walking and taking day trips with Gene discovering all the charming small towns and area festivals along the coast. She also has more time now to spend with her children, Melissa, Nicole and William and her grandchildren, Gianna and Nicollette.

“Now that everything is over, I think about how it all happened. I see the faces of the people who cared for me, and I know I will never forget them. I am forever grateful to Dr. Poole and his staff and everyone at McLeod Seacoast. There is a lot of love in that hospital,” added Deborah.

 

Carolyn Bellamy

By Jenna Falls Cox

Carolyn Bellamy is known for her strength and positive outlook on life. Anyone she comes in contact with walks away a little happier. Carolyn has worked in Nutrition Services at McLeod Loris for 20 years. As part of the staff at McLeod Loris, she is accustomed to taking care of sick patients and their families, comforting them with kind words. This is what she likes most about her job. But, the day Carolyn learned she had Stage 2 breast cancer, she was the one who needed encouragement.

Carolyn’s journey began when she performed a self-examination on her left breast. “In my heart, I knew that something was not right,” said Carolyn. “When I performed the self exam, I noticed that my breast was swollen. I knew I needed to make an appointment to get it checked out.”

Carolyn made an appointment at McLeod Loris Primary Care to see Nurse Practitioner Wanda Grainger. “After a thorough examination and many questions, Wanda recommended that I get a mammogram. She noticed in my file that I was overdue,” said Carolyn. “She immediately called the Radiology Department at McLeod Loris and made me a same-day appointment for a mammogram. I could tell Wanda thought it was urgent that I get a mammogram that day.”

The mammogram results were abnormal, so an appointment was made for Carolyn to see McLeod Surgeon Dr. Amanda Turbeville the next day. After examining Carolyn, Dr. Turbeville ordered an ultrasound guided biopsy.

“When the biopsy results came back, Dr. Turbeville told me that I had a mass that was Stage 2 breast cancer,” explained Carolyn. “My oldest son, Neil, was with me when I received the news. He was trying to be strong for me, but I could tell he was upset. I did not panic when I found out. I knew the Lord had a plan.”

Carolyn was scheduled to have surgery the following week. Prior to surgery, she met with Dr. Turbeville for a pre-surgery consult. “Dr. Turbeville was very detailed during my consultation, and I appreciated it. She showed me on a diagram what was going to happen during surgery and where the mass was located in my breast. It made me feel better that she was direct and clear. She told me, ‘No worries, you are going to be okay.’ And, she was right.”

“Carolyn underwent breast conservation surgery which allows a woman to keep her breast,” said Dr. Turbeville. “As part of this surgery, a lumpectomy is performed, which is a procedure that involves selective removal of a tumor from the breast. This differs from a mastectomy, which involves the removal of the entire breast. A sentinel lymph node biopsy was also completed during surgery, where dye is injected into the breast. This precautionary procedure was performed to ensure the remaining lymph nodes did not need to be removed.”

Following Carolyn’s outpatient lumpectomy, she said her experience and results were excellent. “The same-day services staff was amazing,” said Carolyn. “They put me at ease, and I knew that God was guiding Dr. Turbeville and her team. I could not have asked for any better care.”

Carolyn was out of work three to four weeks after surgery. “I had very little pain after surgery. I followed Dr. Turbeville’s instructions on recuperating, but I was determined to get back to work quickly. Working at the hospital is therapy for me. Helping others is what got me through this experience,” explained Carolyn.

“Carolyn is such an optimistic person with a strong faith in God’s plan,” said Dr. Turbeville. “She accepted her diagnosis with grace and has fought through this journey with a smile on her face.”

Today, Carolyn continues receiving chemotherapy treatment at Coastal Cancer Center in Loris. “Dr. Emily Touloukian and the team there are amazing,” said Carolyn. “They worked around my schedule and made sure chemotherapy did not conflict with my everyday life.”

Carolyn now has time to get back to focusing on what is important in her life: God, family and friends. She is active in her church, where her husband, Elton, has been the pastor for 15 years. She also enjoys spending time with her threeyear-old grandson, Micah.

Ultimately, Carolyn’s faith and determination enabled her to survive this journey. “The Grace of God is what saved me and placed me in Dr. Turbeville’s hands. I lost my hair and my appetite, but I never lost faith. I want to be a witness for others facing this same journey that you can beat it. I also want to remind women that early detection is vital."

A.V. Thompson

By Tracy Stanton

At 79-nine-years old, A.V. Thompson is a busy man. He tends to the cows on his farm in Cades, South Carolina, and manages the 70 properties he leases. In addition, he still “piddles” around the garage he built on the farm for his mechanic business. It appears nothing can slow him down -- not even a diagnosis of lung cancer.

Calling himself a “Jack of all trades and a master of none,” A.V. worked in a number of fields while raising his family. “I started off working at Wellman Coleman Company in Lake City, then I went to a building supply business,” said A.V.“I was not happy in that work so I began doing mechanic work. After my dad had a heart attack, I went back and took over the family farm.”

While managing the farm, A.V. also spent time in the dairy business with his father-in-law. He continued to work as a mechanic, and went into the insurance business. Eventually, he settled down on his farm and built a garage for his mechanic business

Today, he tends to his cows and sells the livestock. He also builds trailers and erects fences.

It was not unusual for a boy growing up in the south to begin smoking at a young age. A.V. started the habit at 12 years of age, during a time when generations of families smoked, explained Gayle, A.V.’s wife of 55 years.

“I never thought about cancer when I was smoking,” said A.V.“People would say ‘A.V. you better quit smoking’ but I wasn’t worried about dying from cancer. It never crossed my mind.”

However, in the fall of 2015, A.V. began noticing that he felt chronically tired. “I would give out faster and need to take a break.”

A.V. made an appointment to see his family physician of 30 years, Dr. Albert Mims in Lake City. “Dr. Mims always said I amazed him because I was in my 70’s and I would not quit smoking or slow down.”

Dr. Mims examined A.V. and they discussed his recent symptoms. “Dr. Mims then told me that he wanted to send me for a lung screening at McLeod.”

Established in 2014, the McLeod Lung Cancer Screening Program involves undergoing a low-dose CT scan. It is recommended for people between 55 and 80 years of age who have smoked one pack of cigarettes per day for 30 years or two packs per day for 15 years.

“I had been following the medical literature about screening with low-dose CT scans for people at higher risk of developing lung cancer,” said Dr. Mims. “When McLeod started their program, I began to review charts on eligible patients. A.V. was an ideal candidate for the screening.”

“When Dr. Mims received the results of the scans, there was a spot on my left lung. He said we would not know if it was cancer until they did a biopsy. He then sent me to see Dr. Jona.”

McLeod Pulmonologist Dr. Vinod Jona explained that A.V.’s CT scan showed a nodule of 11 millimeters in size. “Based on his history of smoking and the size and the shape of the pulmonary nodule, we knew it was very suspicious for cancer.

“Shared decision making is one of the nine essential components of lung cancer screening. After discussing all the risks and benefits, I referred A.V. to McLeod Cardiothoracic Surgeon Dr. Carey Huber for thoracic surgery evaluation and possible resection of the lung nodule.”

“Using video assisted thoracoscopy, we biopsied the nodule and confirmed that A.V. had lung cancer,” said Dr. Huber. “I performed a lobectomy and removed the upper half section of his left lung. His lymph nodes were negative, and the pathology indicated the cancer was a stage one."

“Lung cancer is curable when it is detected early like in A.V.’s case. At stages three and four, the cure rates are dismal,” explained Dr. Huber. “The lung cancer screening program is by far the biggest advancement in lung cancer treatment in 20 years. We can now detect small, early stage, potentially curable lung tumors. I compare the use of low-dose CT scans for lung cancer to the strides we have seen in breast cancer detection with mammograms.”

Since A.V.’s cancer was caught early, he did not require chemotherapy or radiation treatment. “I came home and I have been doing alright. When they told me it was cancer, I said, ‘well it is what it is,’ and that is how I took it from there on out.”

Following the diagnosis, A.V. quit smoking and says he does not miss it. Besides a lingering cough that Dr. Jona told him may occur because of the scar tissue in his lungs, A.V. reports that he is doing well.

While he was in the hospital, A.V. also learned he was the first person diagnosed with lung cancer since the screening program began at McLeod.

“God bless the screening,” said A.V. “I’m happy Dr. Mims sent me for the screening. I believe that saved my life and I will forever be thankful to him, Dr. Jona and Dr. Huber.”