Tuesday, August 10, 1999

Gamma Knife cases
reviewed using telemedicine

Article about treatment answers
Kauai pastor's prayers

By Helen Altonn


Specialists meeting weekly in Honolulu are reviewing complex brain tumor cases on Maui for possible Gamma Knife treatment.

And the patients don't have to leave home for the consultation.

Use of telemedicine is saving them the expense and stress of having to travel to Honolulu to see a neurosurgeon.

"What's fun is this is just beginning between St. Francis (Medical Center) and Maui Memorial (Hospital)," said Dr. Marcus Keep, St. Francis neurosurgeon. "We're looking to links with the Big Island, maybe Kauai, and American Samoa."

He said American Samoa has telemedicine capability and is "very positive about at least joining in to see what we're doing."

"We are here in the Pacific
and I feel we need to reach out and
join with other Pacific islands as much
as possible, especially in universal
things as health care."

Marcus Keep



"We are here in the Pacific and I feel we need to reach out and join with other Pacific islands as much as possible, especially in universal things as health care," Keep said.

Dr. Bobby Baker, Maui Memorial radiation oncologist and chief of staff, said, "I think telemedicine is finally showing some benefits."

Baker was among physicians taking a course at St. Francis on use of the Gamma Knife and is able to evaluate patients as possible candidates for the treatment.

But it wouldn't be practical for him to fly to Honolulu every week for a Gamma Knife Review Board meeting to present patients or to participate, Marcus said.

"We had the idea ... we have this amazing telemedicine technology made possible by the visionary and generous grant of the Weinberg Foundation to many of the hospitals."

So, telemedicine conferences were launched July 8 by the Gamma Knife Review Board, which meets at noon on Thursdays, Keep said.

More patients to be treated

Baker since has presented five cases to the board for recommendations. Of those, he said three are appropriate for Gamma Knife treatment.

"We see him on the video screen," Keep said. "He sees us on the video screen. He is able to digitize and transmit MRI images breathtakingly clear of patients that we can see on large screen monitors -- just like high-definition television."

Baker describes the patient's history and symptoms and the panel asks questions, Keep said. "It's just like a conversation with anyone else in the room. He answers us and asks questions."

Then the group, with Baker, decides if the patient is a candidate for Gamma Knife treatment now or in another month or not at all, Keep said.

The Gamma Knife Center of the Pacific opened at St. Francis last December. There actually is no knife, no cutting or no bloodshed.

It's a sphere-shaped cobalt radiation unit used for very small tumors and those close to the optic nerve or critical brain structure.

Baker said being able to present brain tumor cases to experts in Honolulu without patients having to fly there is "a great service because many of them don't feel well in the first place."

Patients also tend to develop close rapport with their physicians, he pointed out, and "they're scared and worried about going somewhere for sophisticated kind of treatment."

"The fact that I can accompany my patients to Honolulu for this treatment puts them at ease," he said.

The treatment requires a radiation oncologist and a neurosurgeon so he is able to work with the neurosurgeon to relieve the patient's anxieties, he said.

Instead of being away from home several days for consultation, a patient only needs to be gone one day for treatment, Baker said, predicting he'll be able to fly to Honolulu with some patients, do the Gamma Knife treatment and return the same day.

Even when Baker has no case to present, Keep said, "his input into cases presented here is just as valuable."

A bigger pool of doctors affords a better chance of recommending the best treatment, he said, "whether it is Gamma Knife now or later, whether it is surgery instead, or nothing at all."

Training continues

So far, 38 patients have been treated with the Gamma Knife. Keep has done 17 of the cases.

Doctors at nearly every major Oahu hospital have undergone Gamma Knife training at St. Francis and another training session will be held in February, Keep said. "We're doing our best to extend it out."

About 20 specialists participate in the telemedicine conference from Tripler Army Medical Center, Kuakini Medical Center, the Queen's Medical Center and Straub Clinic and Hospital, as well as St. Francis. Any interested doctor is welcome, Keep said.

Baker said St. Francis "has demonstrated a great deal of island friendliness" by allowing non-St. Francis physicians to use its equipment for their patients.

"St. Francis is sort of setting the pace for opening their doors to off-island physicians to participate in patient care," he said.

Special to the Star-Bulletin
The Rev. John Schmeling Jr. of Kilauea underwent
Gamma Knife treatment for a tumor in his brain.

Article about treatment
answers Kauai pastor’s

By Helen Altonn


A Kauai pastor was facing surgery for a brain tumor when he happened to see a Star-Bulletin article about Gamma Knife treatment to destroy such tumors.

"I had been praying for God to do something besides surgery," said the Rev. John Schmeling Jr., 51, of Kilauea, minister of the Lighthouse Christian Church.

He said a benign tumor was detected in his brain last September. "It was very slow growing but it was big, probably about the size of a golf ball, right behind my right eye."

His surgeon told him he would need surgery but they could probably only get 50 percent to 60 percent of the tumor, he said.

Then, when he was in Honolulu in December for a pastors' conference, he said, "this guy was passing out newspapers in the middle of the road. I never pick up one like that but my wife gave me 50 cents and I bought a paper."

It contained an article about St. Francis Medical Center's new Gamma Knife unit for treatment of certain brain tumors. "When I saw that article, I knew that was what I was to do," he said.

He said he took the article to his neurosurgeon, who said the tumor was too big for Gamma Knife treatment.

He said he waited several weeks, then called St. Francis neurosurgeon Marcus Keep. "He set up an appointment that very day. He said, 'Yeah, we can do it.' "

Schmeling had the treatment March 19. "It was a fun day," he said. "The nurse was giving me See's candy. We had a good time all day.

"The only thing that ever bothered me through the whole thing was when he (Keep) took the screws out. Putting them in was no big deal."

With Gamma Knife, a patient's head is fixed immobile in a frame with four screws going into the skin to hold it firm to the skull. The head then is placed within a colander-like helmet with 201 pinholes with cobalt-60 radiation beams that converge to attack a tumor or abnormal tissue.

Schmeling said he arrived at the hospital about 7 a.m. and was there until about midnight. "It took about eight to nine hours to figure out how to shoot the tumor."

Schmeling said he and his wife, Shannon, who was with him throughout the treatment, returned to their hotel room about 12:30 a.m. the next day, a Saturday. They returned home that day and he preached on Sunday, he said. His subject: "Death to a Tumor."

He returned for an MRI magnetic resonance imaging after three months. The tumor had shrunk "just a fraction," he said, "but they're like a chunk of balsa wood, real hard, real tight."

He said his regular doctor on Kauai is "just amazed" at the results of the treatment. "It's just been great and Dr. Keep calls you up to find out how you're doing."

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