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Dr. Raymond Mailhot presenting on Proton Therapy for Breast Cancer
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Nurses are the most trusted professionals in the United States according to the most recent Gallup survey.1,2 Eighty-five percent of respondents rated nurses as having very high or high “honesty and ethical standards.” In fact, nurses have ranked number one on the list since they were added to the survey in 1999. The bond between patient and nurse is undeniable and never more apparent than at UF Health Proton Therapy Institute.
May is the traditional time of year that we honor nurses as National Nurses Week is observed May 6-12. Our highly skilled nursing professionals include specialists in adult radiation oncology, pediatric radiation oncology and clinical research. As case managers, nurses are involved from day one in developing every patient’s care plan. They counsel patients on what to expect during treatment and beyond. They set patients at ease by providing knowledgeable answers and effective solutions to health concerns that may develop during or after the course of treatment. It is common for our nurses to go the extra mile to give patients that added bit of comfort, support or encouragement to keep on track with treatment for the best possible outcome. We thank all of our nurses for their commitment to excellence.
Stuart L. Klein
By Theresa Edwards Makrush
At just 20 months old, Noah Edgar of Colchester, England, is a happy, curious, busy toddler playing at the beach. Passersby may think he is in Jacksonville, Florida, with his family for vacation. They would be surprised to discover Noah is here for cancer treatment.
Last December, Noah had an eye infection. His parents Gemma and Rob took him to the doctor. After the infection was healed his doctor detected a tumor in the retina.
Retinoblastoma is an uncommon pediatric cancer of the eye. It begins in the retina, ocular tissue that lines the back of the eye, senses light and sends images to the brain. In the United States, retinoblastoma accounts for about 3 percent of cancers in children younger than 15 years – about 4 cases per million. Retinoblastoma is sometimes caused by an inherited gene mutation; when it occurs in both eyes, it is always the result of a gene mutation. It most often occurs before the age of two, with 95 percent of retinoblastoma diagnosed before the age of five. The tumor may affect one eye (about 75 percent of cases), or both eyes (25 percent of cases). The prognosis for retinoblastoma is good if the tumor is identified early. More than 90 percent of retinoblastomas that do not spread beyond the eye will be cured.
In Noah’s case, the tumor had become so large that it had detached his retina causing him to lose sight in the affected eye. It was decided his best chance for cure was to remove his eye surgically and follow it up with proton therapy and chemotherapy.
This news was a jolt to the family. “It’s the worst thing as a parent to hear that your child has cancer,” said Noah’s dad Rob. But the Edgars said they are confident in Noah’s prognosis after having surgery by the top specialists in England and now proton therapy at UF Health Proton Therapy Institute.
Proton therapy will deliver targeted radiation to the area where the tumor was removed in order to reduce the chance for recurrence. Because proton therapy does not penetrate beyond the treatment area, there is little chance of unnecessary radiation exposure to Noah’s remaining eye or brain allowing him to retain his sight and IQ.
Rob said that people should be aware of symptoms of retinoblastoma. If one of your child’s eyes look unusual in a flash photograph, it could indicate a tumor is present in the eye that is not reflecting light. The earlier a tumor is detected, the better. He recommends taking your child to an optician on a regular basis to have their eyes checked.
While they are in Florida, the Edgars are making the most of every day. It’s an attitude the couple chose when Gemma was treated for a brain tumor just months after Noah was born. “It’s hard, but we both have a positive outlook,” she said. Rob added, “Yes. There have been dark days and sad days. But we want to live for every day. Our other son Dylan is four years old and we try to carry on as normal.”
Most days after Noah’s proton therapy session, the family plays at the beach or the pool. One weekend they went to an amusement park in Orlando and to the Silver Springs State Park in Ocala, Florida. They have plans to visit Savannah, Georgia. “We try to have fun whenever we’re not in hospital,” said Gemma.
By Theresa Edwards Makrush
Each year the National Association of Veterans and Families (NAVF) honors companies and organizations that support the veteran community and honors a standout employee who exemplifies the true meaning of values taught by the military: sacrifice; passion for what they do; one who demonstrates the ability to improvise; adapt and overcome; and most importantly leadership characteristics in their daily work.
UF Health Proton Therapy Institute’s machinist Ray Lewis was selected as a 2016 Champion of Veterans honoree. He was honored at an awards banquet on May 6 at The University Club in Jacksonville.
One of the essential components of a proton therapy patient’s treatment is the creation of customized devices — compensators and apertures — that are made in the exact size and shape of the tumor area being treated. The aperture is milled out of solid brass and matches the width of the treatment area. The compensator is milled out of clear Lucite that matches the height of the treatment area. Stacked and attached to the end of the treatment nozzle during each treatment, these custom devices shape the proton beam as it passes from the proton beam line into the patient.
Ray Lewis is one of the people responsible for fabricating these devices. Ray joined the UF Health Proton Therapy Institute staff as one of its first employees, after retiring in 2005 from a 20-year career in the Navy. “I’m what you call a conventional machinist. Lathe, milling machines, shaping machines, boring mills, grinders. Typical machines you would find in a good size machine shop,” said Ray. He planned from the beginning to make this a job he could stay with until he retires from civilian work. “I love the job. I remember when I came in and did the interview I told Dr. Li [Zuefong Li, DSc, director of medical physics], like a lot of military people, I commit and stick with it.”
Evidence of his level of commitment started from day one. Ray recalled, “I started on the seventh of August and the following week was when they were going to treat the first patient. When I started and we were doing orientation in the Tower [a separate building from the proton therapy institute], they called me out of the orientation to fabricate the device for the first patient.” He willingly left orientation and made the devices that would be used to treat the first patient on August 14, 2006. From that point forward he has milled countless devices for hundreds of patients.
During his nine years at the institute, Ray has gained the admiration and respect of everyone he works with. He has been nominated for the UFHPTI Shining Star Award, a peer-recognition program at the institute for employees who exemplify excellence.
Jeff Rexford is the site manager for IBA, the manufacturer of the proton therapy equipment. Jeff and his team are responsible for running and maintaining the proton therapy system. Jeff said, “I have known Ray since I first began working for IBA in January of 2007. In that time I have had the pleasure of working closely with him on many technical projects. Ray has taken his position to something much higher than a normal machinist’s position. He has shown great inventiveness and dedication to improve many aspects of the machining process. Ray’s dedication and professional expertise has driven a few important improvements to the development of patient plans. It is with Ray’s knowledge that we will also increase the efficiency of the in-house fabrication, and reduce the outsourcing of patient specific devices.”
The chief dosimetrist Debbie Louis oversees the department that uses computers to design and program the treatment plans. These are then transferred to the machine shop to create the devices.
Debbie said, “Ray is always willing to adjust his work schedule to accommodate clinic needs, even at the last minute and always with a smile. If he says he can get something done, you can be sure it will be done. Ray is a pleasure to work with and a real asset to UF Health Proton Therapy Institute and our patients.”
As the senior-level machinist, he is often called upon to make the more complex patient-specific devices. Even on his days off and vacation days, Ray willingly comes in to help if needed. Holly Mostoller is the human resources director and recalled one such occasion. “On August 8, 2014 in the early morning Dr. Hunter was in need of having new apertures made for an eye patient. The machinist on duty that day did not start until later in the afternoon and Ray was on vacation. I was unable to reach the on-duty machinist first and then reluctantly called Ray to see if he would be willing to come in to quickly produce the equipment for Dr. Hunter so the patient could start treatment right away. Ray gladly agreed and came right in and completed the process allowing the patient to start. All on his last day of vacation and right before the weekend. Ray is a very dedicated employee who helped out in a time of need when it was not required of him."
Ray’s military service spanned a period that included several significant historic events. He remembers in 1991 transporting and loading ammo on submarines to support Operation Desert Storm. He was at Guantanamo Bay when the mass migration from Cuba and Haiti in 1994 occurred and the whole base was covered in tents and camps as people sought asylum in the U.S. In 2001 he volunteered to do a second tour at Guantanamo in support of Operation Enduring Freedom. An old friend of his had returned there working at the brig and he needed some people to help. So Ray volunteered and served as Assistant Brig Officer in Charge, including a six-month stint as Officer in Charge while waiting for a replacement due to personnel retirement. He stayed there until 2005 when he retired as a Petty Officer First Class after 20 years of Navy service.
Ray settled down in Jacksonville, where he had purchased a home while he was stationed at Mayport (1998-2001). During his time in Guantanamo Bay, he formed many close friendships, people who have also retired from the Navy and settled in Jacksonville. His best friend still lives in Guantanamo, a Cuban exile and his wife who live on the base. His best friend has cancer, and Ray helps by sending essential medical supplies. “I’m always anxious when I take the medicine to the base for shipment. I worry about missing the transport. He needs it to keep alive,” Ray said.
It’s the ultimate care package from a man who always goes above and beyond the call of duty.
The Men’s Garden Club of Jacksonville is putting its green thumb to work for the good of patients having radiation treatment for cancer. Several aloe vera plants are nestled in the tropical garden located in the main lobby below the staircase for patients to take home with them. Check with your medical team to see if this natural balm is right for you. Then help yourself to an aloe plant.
The sap of the aloe plant is easy to use. Simply snap off a leaf and squeeze to extract the gel-like fluid onto the affected skin. The most common benefit is a cooling or soothing sensation that eases discomfort from minor burns.
Here are some tips for tending your aloe plant:
Unless you live in an area with a very mild climate, it's best to leave your aloe plant in the pot and place it near a window that gets a lot of sun. Aloe vera is a succulent, and as such, stores a large quantity of water within its leaves and root system.
During the winter months, the plant will become somewhat dormant, and utilize very little moisture. During this period watering should be minimal. Allow the soil to become completely dry before giving the plant a cup or two of water, just enough to moisten the soil.
During the summer months, the soil should be completely soaked, but then be allowed to dry again before re-watering. Aloes have a shallow, spreading root system so when it is time to repot choose a wide planter, rather than a deep one. Use a planter with a drainage hole, or provide a 1-2 inch layer of gravel in the bottom of the pot to ensure adequate drainage. Use a good commercial potting mix with extra perlite, granite grit, or coarse sand added. You may also use a packaged 'cacti mix' soil.
Aloe vera plants are propagated by removing the offsets which are produced around the base of mature plants, when they are a couple inches tall (or larger).
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The Precision Newsletter is an electronic-only publication that is distributed by email. Each issue is sent monthly to patients, alumni patients and friends of the University of Florida Health Proton Therapy Institute. As the official newsletter of the Institute, the content is compiled and prepared by our communications representative and approved by the editor Stuart Klein, executive director of UF Health Proton Therapy Institute. Special bulletin newsletters may occasionally be prepared when timely topics and new developments in proton therapy occur. If you would like to send a Letter to the Editor, please click here.
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