DOWN TO HER BONES CANCER PATIENT HAPPY TO BE HOME.

Byline: Carol Rock Staff Writer

NEWHALL - A bruise on the back of her leg prompted Carol Ramnarine to visit her family doctor in March 2004. Just over a year later, she made medical history.

In June, she became the first person to receive total marrow irradiation using TomoTherapy technology at the City of Hope. And now she's recovering at home in Placerita Canyon.

Ramnarine, 53, is a retired educator with a doctorate in early childhood education. Married for 34 years, she is the mother of two grown children and enjoys art, reading, swimming, gardening, computers and travel.

``I had just started exercising when my friend noticed a bruise as I got off one of the machines. I went to see the doctor because it grew into a hematoma by the weekend.''

She was admitted to the hospital, where she underwent a bone marrow test. The diagnosis: multiple myeloma, a relatively uncommon disease of the blood cells that weakens the bone and leads to fractures.

Ramnarine's treatment involved a drug step program using thalidomide, aredia and steroids in an attempt to stop cancer cells from reproducing. Thalidomide's ability to kill fast-growing cells caused severe birth defects in babies born to women who used the drug to combat morning sickness in the early 1960s; that same trait has proven beneficial to cancer patients.

``The reality is that bone marrow is all over your body,'' Ramnarine said. ``There is a potential that you could carry a hidden series of cells, and they could reproduce again. Myeloma cells overproduce and interfere with other blood cells, and the kidneys, liver or other organs can't function properly.''

After her step treatment, Ramnarine became part of a clinical trial at City of Hope that resulted in her groundbreaking treatment.

TomoTherapy sends thousands of tiny radiation ``beamlets'' to spiral around the tumor and focus radiation with surgical precision. Unlike traditional full-body irradiation, the limited radiation limits the broad spectrum of side effects that some patients consider worse than cancer itself.

``She was an appropriate candidate,'' said Dr. Jeffrey Wong, chairman of the hospital's Division of Radiation Oncology. ``She was responding to therapies, and her disease was at a minimum tumor burden state, making her eligible to go through a high-dose therapy regimen.''

One of the treatments for Ramnarine was a peripheral blood progenitor cell transfusion that involved harvesting healthy blood and marrow and reintroducing it into her body to replace cells destroyed during therapy.

In the spring, a special cast was built to immobilize her leg during the TomoTherapy. In addition, she wore a mask to shield her face from the radiation, and she would wear it eight times as the tumor was bombarded with the spiraling beams.

The year between diagnosis and treatment involved careful record- keeping for Ramnarine, who charted her activities, treatment and progress on her computer. The regimen of marrow aspirations, chemotherapy and record of side effects is sprinkled with notations of everyday life - visits to the veterinarian with her dog, to the auto mechanic, a surprise visit from one of her children, the arrival of a new bathing suit.

One of the things she chronicled was her experience during the TomoTherapy itself:

``Typical of my personal approach to medical procedure, I attempted to shift my mind into an imaginary world. The drumming sound of the TomoTherapy machine became the roadway of my childhood; I imagined myself riding a red wooden bobsled with my siblings and friends down Crofton Road in Garfield Heights, Ohio.

``About two-thirds of the way through the treatment, the drumming would turn off, my imaginary bobsled would hit the snow bank causing playmates to fly off in several directions, the giggling childhood memories then faded back into reality as the doors opened ... it was the last 27 minutes I found most difficult. I no longer was able to entertain my mind.

``I began to feel the fatigue of being still and lying on a platform. I felt like the kid who kept asking their parents 'Are we there yet?' It was a countdown of time. The staff kept me motivated and resolved. I remember even singing to them one of Peter, Paul and Mary's folk songs; off-key and with a dry throat. They were terrific, tolerating almost anything from me to complete our mission.''

Wong said that Ramnarine's side effects were notably less than those experienced by patients undergoing standard whole body irradiation. By focusing the radiation on the tumor, healthy cells are not eliminated in the process. The medical team will continue to monitor her for any side effects, such as inflammation of the lung, increase in thyroid activity and development of cataracts, common in patients receiving chemotherapy or radiation.

Ramnarine's outlook is positive. Recuperating at her Placerita Canyon home, she is looking forward to seeing her pets again and spending more time with large groups of people, two activities that have been suspended until her blood cell counts improve.

``You cannot go through what I have been through without having a sense of rebirth or transformation,'' she said. ``There is definitely a spiritual relationship to healing.''

Carol Rock, [phone]

carol.rock(at)dailynews.com

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Photo:

(color) Newhall resident Carol Ramnarine is happy to be back home after undergoing an experimental cancer treatment.

David Crane/Staff Photographer