Gamma knife only hope

“Kostia, I never had such a feeling as when I met you. You are an extraordinary person with a big heart. I wish you the best of luck in your life.”

“Dear Kostia, you are a good student, friend, and classmate. You are a pleasant person to talk to. I wish you the best health, the greatest happiness, and the purest love.”

These are some of the wishes that the classmates of 15-year-old Kostiantyn Berezovsky inscribed in his yearbook. To continue learning about life, Kostiantyn has had to experience many hardships and fight the whole world.

IN ONE MONTH THE BOY GREW BY SEVEN CENTIMETERS

Eight years ago Natalia and Serhii Berezovsky noticed a delay in their son’s physical development: he stopped growing.

“A local endocrinologist referred us to the Institute of Endocrinology in Kyiv,” says Natalia. “They made the correct diagnosis only on the third attempt. The doctor suspected a tumor as a possible cause of the developmental delay. After the diagnosis was made, within days Kostia was operated on at the Orlov Pediatric Clinic of the Institute of Neurosurgery.”

“The surgery was performed by means of a craniotomy,” says Serhii, who is also a doctor by profession. “This is a very traumatic kind of surgery. The tumor was located in the region of the so- called Turkish saddle (pituitary fossa above the hypophysis) where all the cerebral nerves converge. During the operation they had to cut the nerves responsible for the sense of smell. Kostia learned about this only after the operation. He had a benign tumor, but if just one cell had been left after its removal, it would have started to grow quickly again. Since the operation our son has malfunctions of the endocrine system; he has developed diabetes insipidus. (He is constantly thirsty but his body won’t absorb liquids.) That is why he has to take hormones. The tumor affected his growth. One month after the surgery he grew by seven centimeters.

In October of 2000 Kostia had to undergo another operation. This time a different technique was used: the tumor was accessed through the nose with the use of special medical instruments. This technique has been used only on adults, so the parents had to request the neurosurgeon to use it on their son. Kostia is the first child to undergo this type of surgery. In Ukraine there is only one neurosurgeon, Dr. Oleksandr Huk, who uses this technique.

“We read in a newspaper about the gamma knife, which eventually became our last hope for curing our son,” says Natalia. “We started searching for more information on the Internet and learned that there is a Gamma Knife Center in Moscow. We e-mailed them our son’s case history and pictures, and asked about possible treatment. Their reply was that our case was very difficult; they could not say anything without examining the child, and because of their limited experience they needed to consult specialists from other countries. In Moscow this kind of surgery costs $7,000.”

“Our last resort was a gamma- knife session in the Czech Republic. But one session of radiosurgery, which is a kind of operation, costs И10,000. Our family did not have the money-we spent all our savings on the previous treatments.”

“The Czech Gamma Knife center has developed a positive reputation since its opening 15 years ago,” continues Natalia. “For Czechs and Slovaks these sessions are free but not for CIS citizens. But a Czech program offers free treatment to 10 Ukrainian children every year. Expenses are covered by a charitable organization called Charter-77. We were very fortunate that our son was accepted by this program.”

THE MOST PAINFUL PART IS STABILIZING THE HEAD

Kostia and his mother arrived in the Czech Republic on the appointed day. The first thing they noticed was the friendliness of the people, the respect shown to patients by the medical staff, and the comfortable conditions for both parents and children.

“In the elevator we heard people greeting each other as they entered and saying good-bye as they left. The same rules of etiquette apply to cafes, shops, and all public institutions. Of course, no one replies to greetings but these are the norms of etiquette there,” says Natalia, describing her genuine astonishment at the time.

“While their children are undergoing treatment in the clinic, parents stay at a nearby guest house that they pay for out of their own pocket,” Kostia’s mother continues. “That is where I met a woman who was born in Chernihiv oblast like me. We talked in Ukrainian, our mother tongue, and spoke Russian with the Czechs.”

“A gamma knife session is not surgical intervention: invisible beta rays are aimed at the head. The most painful part of the session is when they placed my head in a special frame to prevent it from moving. People may think this sounds very easy: you just lie in a hospital bed. But my whole body went numb and my eyes were glazed over. After the procedure I slept for a long time,” says Kostia.

“Every ward has a stereo system and a bathroom with a shower, whereas in the Institute of Neurosurgery in Kyiv there is only one bathroom per floor,” says Kostia comparing the conditions. “There are only two beds in a room, each equipped with a convenient wall- mounted and string-operated light. Next to every patient’s bed there’s a conveniently located bell button for calling the orderly and a phone you can use to call any country in the world. There is also a round-the-clock oxygen-supply system available for use at any time of the day. The bathrooms have special railings for weak patients. The food is delivered in a special hermetically sealed container-always fresh and hot.”

“During the gamma knife session they turn on the music selected by the patient. Kostia picked classical music-Tchaikovsky,” Natalia adds. “All the doctors were surprised by his choice. In a room next door doctors were watching him on computer monitors and I was able to do the same. You could talk during the session, so the doctors knew how my son was feeling directly from him.”

“During the first operation part of my hypophysis was damaged, so I have to take hormones all the time. This led to malfunctions in the functioning of the hypophysis, adrenal glands, and thyroid. If the tumor had been removed with a gamma knife, this could have been avoided,” says Kostia.

I asked him how a 15-year-old teenager knows these terms. The explanation was simple: Kostia dreams of becoming a doctor and spends a lot of time researching interesting facts like this on the Internet. Recently he enrolled in a distance-learning school to improve his knowledge of biology.

BITTER REALITY

The ordeal seems to be over. But for the rest of his life Kostia has to take hormones to make his endocrine glands function properly. This is the bitter consequence of what he has gone through.

After his treatment at the Czech center Kostia is finally able to attend school on a regular basis. Because of his disease, for the past five years a teacher has come to his home to give him lessons. His childhood was spent in a small room at home and in hospital wards.

After talking with this youngster, you gain a new appreciation of all the things that life gives you; you want to learn undiscovered things about the world and strive for spiritual growth.

I am certain that in 10 years’ time Kostia will be a good doctor. And I know for a fact that to this young man patients will not be just part of his work. All of them will be part of his big, kind heart.

The Berezovskys are grateful to the students and teachers of Gymnasium No. 21 in Lutsk, the staff of Music School No. 3, Yaroslava Mozhasky of Autotsentr Zakhid, Serhii Martyniak of Pan Kurchak, and everyone who helped them in their difficult time.

FACT FILE

More than 1,500 adults and children die of painful brain tumors every year in Ukraine. This statistic is not complete because many people with this disorder are not registered at hospitals. They don’t because they are aware that Ukrainian medical science is unable to help them, and they cannot even dream of getting treatment abroad.

The gamma knife was invented in 1968 and was initially used in some narrow domains. However, wide-ranging applications were soon found for it, and the knife is now available in over 210 countries. In 2005 alone this instrument saved the lives of more than 300,000 patients with brain diseases because only the gamma knife guarantees high surgical precision.

The gamma knife uses the method of stereotactic radiosurgery on the problem area. The patient’s head is stabilized with the help of a special head frame and radioactive cobalt-201 is used for focused-source radiation. Each source’s own radiation does not harm the brain, but when the beams converge in one point (called the isocenter), the resulting radiation is sufficient for causing the desired biological effect in the pathogenic zone. No dissections are made during the procedure and even the patient’s head is not shaved. The process is painless.

The gamma knife technique is used in the treatment of arteriovenous malformations, brain tumors, and various functional disorders. This method is effective and does not cause any anesthesia— or surgery-related complications, such as hemorrhage. The procedure takes only a few hours, and most patients resume their normal activities the next day.

In the Czech Republic a national fund-raising campaign supported by the media was held to collect money for a gamma knife. President Vaclav Havel set an example by donating $100,000, and all Czech citizens ended up making contributions. It took 14 months to raise $3,000,000, the price of a gamma knife at the time.

In Ukraine the fund-raising campaign for the purchase of a gamma knife is still underway. Account information: Bank UDK in Kyiv, Account no. 35226009000051, MFO 820019, KP 6561020/2, YeDRPOU 02011930, payee: Romodanov Institute of Neurosurgery, Academy of Medical Sciences of Ukraine. For the purchase of a gamma knife.

The Berezovskys have donated 300 hryvnias.