An Israeli Fight Against Brain Cancer

Thursday, January 31, 2019 |  Yochanan Visser

Israel's first prime minister, David Ben-Gurion, once famously said that to be a realist in Israel, one must believe in miracles.

Those words accompanied me during the last month as I witnessed a military-style operation by Israeli citizens the likes of which I had never before seen.

A member of my family in Israel (for privacy reasons I call him Avi) was diagnosed two years ago with Glioblastoma Grade 4 (GBM), a highly-aggressive form of brain cancer that has so far proved incurable.

In Israel, this form of cancer is almost always treated with standard therapies such as chemotherapy, radiation and, in highly exceptional cases, through surgery. 

Medical marijuana has been added to the treatment regimen in recent years, and until January 1 of this year, the Novocure helmet had been available for GBM patients.

The innovative Israeli approach to GBM has now become unavailable to most patients, having been removed from the basket of treatments covered by our universal health care due to a government budget deficit.

Life expectancy for patients with Glioblastoma is less than two years.

The condition was discovered in November 2016 after Avi was found unconscious and bleeding in the bathroom of his house. After being transferred to Ichilov Medical Center in Tel Aviv, doctors determined that Avi had suffered a so-called "Grand Mal" seizure caused by a tumor in the right hemisphere of his brain.

This all happened less than three months after Avi had married Sarah (also not her real name), and a month after they had discovered Sarah was pregnant.

What followed was a long period of uncertainty as Avi was treated with prolonged chemotherapy and radiotherapy (radiation). Every three months, he'd go in for an MRI, with the whole family tensely wondering if this time the tumor would be gone.

Avi also received a medical marijuana prescription from his doctor because it has been  proven that the natural drug stunts the growth of Glio cells and even kills them. 

I believe that Avi's unwavering spirit and optimism has also played an unheralded role in the fact that he is still alive and has very few complaints about his physical condition. But that optimism was put to the test recently when, in December 2018, doctors found a new tumor in the front lobe of Avi's brain.

This tragic discovery was again preceded by two epileptic seizures.

What happened next is the kind of thing I've never witnessed anywhere else in the world, despite having spent years working with oncology patients. A number of Avi's family members formed a WhatsApp group under the name "Prince Avi." The support group consists of people with an academic and medical background, but also of people who have expertise in other fields.

Together, they began to investigate alternative treatment options around the world.

The English-speakers in the group searched through Google for any treatments that could save Avi's life, while others contacted Rabbi Firer, who has built up a reputation worldwide as a consultant on medical treatments for life-threatening diseases. He is often consluted by medical experts in Israel.

After a week, it was decided that the group would approach Trial-in Pharma based in the central Israel town of Modi'in, which is a company that is doing research on trials all over the world. These trials are new treatments with promising results which had been developed in laboratories and are then tested on volunteer patients before being approved for general use by governments.

At the same time, members of the Prince Avi group contacted religious organizations and rabbis and requested that they pray for his complete healing. Thousands of Jews in Israel began petitioning heaven for his recovery.

It was around this time that a cousin of Avi's, a former IDF officer, used contacts he had made while studying in New York to find help in the United States. He eventually got in touch with Dr. Andrew Lassman, a Jewish-American expert on Glioblastoma, for an e-consultation.

After two weeks of treatments and a number of consultations, the group, together with Avi, decided to go for a multi-front approach including several known and new treatments that could overlap one another. 

With almost military precision, this incredible, selfless endeavor honed in on the use of Gamma Knife and auto-immune therapy. The group found and contacted Dr. Christopher Duma, an American expert in the field of Gamma Knife (GK) treatment of Glioblastoma. Duma no longer believes in chemotherapy and radiation as the right way to treat GBM. He has patients who have been tumor-free for more than twelve years after treatment with the Gamma Knife machine.

Duma's team at Hoag Hospital in Newport Beach, CA requested Avi's latest MRI. Two days later, Duma responded with exactly what the group was hoping to hear: Avi was an "ideal patient" for Gamma Knife treatment. Duma told Avi to come to California as soon as possible, and requested his complete medical records.

But there was a new problem to overcome.

Parts of Avi's medical records existed only in Hebrew. But it just so happened that a member of the Prince Avi group is a researcher in cancer therapies, and offered to shoulder the grueling task of translating the files into English.

Nor was that the end of their challenges.

Avi had never been to the United States and needed a visa, a process that usually takes weeks, at best. The cousin who had studied and lived in the US turned to friends at the Israeli consulate in New York and asked them for help to get the visa urgently. The visa was issued that same day.

And then yet another problem presented itself.

The Gamma Knife treatment was going to cost $33,000, including travel and accommodation expenses. Dr. Duma had told Avi to come to California with all haste, but how could such an amount be procured quickly?

The Prince Avi group decided to turn to the Israeli organization Kav L'Chaim (Lifeline) for a fundraising campaign. They decided, in collaboration with Kav L'Chaim, to first campaign within the family and circle of Avi's friends to raise the needed funds. Within three days, all the money had been raised and tickets to California were booked.

Almost immediately upon arriving in the US (which happened just last week), Avi and his companions began to face new challenges around every corner.

First, the scheduled meeting with Dr. Duma didn't take place due to miscommunication within the hospital. Duma rescheduled.

In the meantime, Avi and his friends needed to rent a car and find accommodation in Newport Beach. But after waiting for an hour at the rental car desk at Los Angeles International Airport, they were told that no vehicles were available. They tried another rental company, which did have a mini-van to fit them all, but charged an exaggerated rate due to high demand.

Upon arriving at their rental apartment in Newport Beach, the group found that the landlord had provided an incorrect code for the key lockbox. After a four-hour ordeal via Airbnb, the landlord finally arrived and let them into the apartment.

On Monday morning, Avi and his companions headed to Hoag Hospital and finally met with Dr. Christopher Duma. Sarah participated via video chat as Dr. Duma explained his approach to treating Glioblastoma. He has developed a method for tracking down the Glio cells, which is tricky because they use brian's white matter, the so-called "pathways," to travel to other parts of the brain. Dr. Duma creates a sort of "firewall" around those areas to isolate the cancer cells.

While there is still no official cure for Glioblastoma, Dr. Duma's methods have proved remarkably more successful than more traditional treatments.

On Tuesday, Avi was wheeled into surgery for his Gamma Knife treatment, officially known as Stereotactic Leading Edge Radio Surgery. It lasted no more than 40 minutes, after which Avi was free to return home. The MRI-guided procedure had discovered five spots where the Glio cells had formed tumors. The Gamma Knife radiation had eliminated them all.

A nurse involved in the operation later told the group that they had come to Dr. Duma "just in time."

Everyone involved in Avi's support group say they are Israeli realists. What that means is that they fully believe God was with them every step of their incredible journey, and that Avi will be healed.

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