Category Archives: Brachytherapy

Update – Keeping Up Two and a Half Years after Radiation Plaque Therapy

To all the readers of my blog, my apologies! I haven’t been ignoring you, but in the aftermath of my radiation and everything else that went on with the cancer, I found myself knee deep in getting back to work with my website business , acting, Voiceover and my music. These days, I think, time management is one of my biggest challenges.

So this is just a quick update to let you know I I am doing well. I have been returning to UVA every six months for follow-up visits and every six months getting excellent reports. There’s no sign of any return of cancer.

I have to keep returning every six months for five years. It’s hard to believe that this radiation therapy took place two years ago this past July and there’s approximately less than three years left on this journey.

So far I’m not necessarily experiencing the the blurring of the vision in my left eye that was predicted. I am trusting this is a good sign and that any ultimate damage from the radiation will hopefully be minimal – fingers crossed.

So many of you have been so helpful along the way and it’s been great to be back involved with the theater community, the music/songwriting community and all my business associates.

I look forward to adding more posts as things evolve



Months of Mystery Before Diagnoses of Ocular Cancer


“How did you know there was something wrong with your eye?”

This is the most common question I have received.

The first signs were a small visual effect in the inner right corner of my left eye.  I could only see it in certain lights. It was easily something I could ignore, as it wasn’t there all the time. It was a quivering, gelatinous spot mostly white & grey. This started probably as early as summer of 2009.

Gradually it became more common to see it in regular light. I remember at one point mentioning it to my ophthalmologist and he remarked he thought it was a visual affect from a cataract that was forming on the eye.

Almost suddenly in July or August of 2010 it became a shadow on my vision, geographic in shape with a white border.  For some reason I didn’t feel alarmed and didn’t immediately call my doctor.

Then I started occasionally see white spots, like shooting stars and the white border was more pronounced.  I went to the ophthalmologist. With a CRT scan they saw that there was swelling on the back of my retina. His first conclusion was this was a manifestation of my inflammatory disease, Reiter’s Syndrome that I have had for years and has often manifested as iritis or uveitis. The difference here was those always manifested in my right eye. This new issue was in my left.

The ophthalmologist decided to send me to a retinal specialist. Further tests and higher resolution pictures revealed a pocket of fluid raising the retina. It was near a “nevus” which is a mole on the eye.

The suspicion was it might be an internal scleritus and a regimen of oral prednisone was started. After two weeks there was no change and the conclusion was that the prednisone wasn’t having an effect (though I was told to stay on it for several more weeks).

At that point they ruled out a cancer. The Retinal Specialist told me there was there was too much fluid for it to be a melanoma and it didn’t fit as a lymphoma. But it was still a mystery. My specialist showed the pictures to his partner and her too was scratching his head.

In October 2010 my specialist sent me to University of Virginia’s eye clinic in Charlottesville. All of the same tests were run plus some and the doctor there was also uncertain of what was happening. Because the fluid appeared to be the primary manifestation he suggested that there was some sort of leakage of serum fluid from nearby blood vessels and suggested that trying a Cancer drug called Avastin may help.

A needle directly into the eye delivers Avastin. Currently it is used commonly for people with certain stages of macular degeneration.

In all this period I kept asking “Is this condition dangerous?”  “Is this retinal detachment?” I was always being reassured it wasn’t. The impression I had was that what I was facing was an anomaly.

I waited to see if it mya pass on its own. The idea of getting a shot in my eye and the building costs without health insurance were weighing on me.  I was also waiting for copies of test from UVA so I could consult with some other doctors.

The test information never came. The shadow seemed to settle down in to one spot and the lights calmed down so I focused on my life & business.

Suddenly just before Christmas I woke up one morning and the low frequencies in my right ear were gone, while the low frequencies in my left ear were enhanced and I felt like I had been hit by a truck.

I went to and Ear Nose & Throat doctor who suggested it may be Meniere’s disease. But Meniere’s is marked by severe Vertigo that I wasn’t having. He put me on Prednisone. Five days later I had to stop it as it was causing gastritis. About a week or so later I came down with full vertigo. I used the meclazine (Anti-vert) that helped a little but found better amelioration fro a remedy prescribed by my homeopath.

Near the end of this episode, the shadow in my eye suddenly moved to the center of my vision. Now it was extremely obnoxious. It was like having a smudge of soot on your glasses only you can’t get rid of it.

I went back to the Retinal specialist and elected to try the Avastin treatment.

In January of 2011 I had the first shot. Where it sounds difficult to have a shot in your eye, there is no pain involved and the procedure is so quick the worst thing that happens is there appears to be an oil spill suddenly floating to the top of your eye (which is really floating to the bottom, but because of the way the eye/brain interpret vision it seems to be going up.) We had a scheduled follow up for 4 weeks later.

Over the next ten days or so I had the impression that my vision was improving. A great sign. But it only lasted those ten days. Suddenly the shadow was just as prominent as before.  On my follow up I reported this. My doctor’s scans could show no improvement, but because I was reporting some he elected to try a second shot with a quicker follow-up. I asked to wait to take the second shot as I was in the middle of the worst cold I had ever had in my life. It had drained my energy, ended up lasting four weeks and was deep in my chest with unpredictable coughing. I didn’t want a needle in my eye and all of sudden fall into a coughing fit.

So finally in March we had the follow-up to the second shot. He was again disappointed with the result and started to suspect maybe this was a lymphoma. He said he wanted an MRI and possibly a biopsy.

The biopsy he described involved cutting the eye open, draining the vitreous from the eye, very carefully taking a needle to the location of the swelling and getting a sample, then refilling the eye with a substitute fluid for the vitreous and sealing it up.

Needless to say I had a difficult time wrapping my brain around the idea of this biopsy. Not to mention the cost that would be involved.  Just the idea of getting funds together for an MRI was creating more and more stress.

So I spent the next few weeks getting the prices from the area centers and hospitals for Mir’s. I finally had it and awaited my results. In the meantime, whether it was something from the MRI or a delayed response to the Avastin, the shadow in my eye moved. It went to the top of my vision.

When my retinal specialist reviewed the MRI with me at the end of March, he was encouraged that the shadow had moved. That it was appearing at the top of my vision meant the fluid had moved to the bottom of my eye and the scans were indicating the fluid was draining from the eye.

However, there was still a raised area beneath the retina. After a two-week follow-up, he was not as positive and suspected now that the fluid had been seated over a mass.

This is a scan from September, but it better illustrates the relationship between the fluid and the lesion. This is still when the shadow was in the lower left of my eye. But at tht time the doctors seemed to think the fluid and the raised area were the same thikng. It wasn’t until March that it became apparent the swelling below was a mass.

 He recommended I go to the Will’s eye institute in Philadelphia for a one-day workup to seek a diagnosis.

At the beginning of April I finally had qualified for a group health policy and was able to schedule a trip to Wills at the beginning of May.

On May 3rd I road Amtrak up the night before and stayed in a hotel a few blocks away from Wills. The next morning I was to be there at 7 am. I didn’t leave until 3:30 that afternoon. Most of the time I spent there was waiting. I think I spent a total of maybe two hours in tests and talking to doctors.

Where all my previous doctors had been uncertain about what was happening with me the conclusion at wills that afternoon was immediate, “You have a Malignant Melanoma and it needs to be treated with radiation ASAP.” They actually wanted me to return that coming Thursday to have it done. I had no financial resources to do that and I wanted to talk to my retinal Specialist. But most importantly I was emotionally drained by this news. As the procedure was described it would also tae away the center part of my vision. Just the emotional drain of thinking of the conversations I must have with my friends and family were weighing on my as I made my way back to the Amtrak station and waited for two plus hours for my train back to Richmond.

Update: SIx Months Post Surgery – A Patient Process

I have returned to UVA for several follow-ups with the surgeon who did the radiation Brachytherapy. At this point my impression is he doesn’t really see any change to the tumor. He says it takes about 18 moths to shrivel. He will begin taking pictures of it again in February, which will be 8 months since the radiation, at which point we can see any size differences.

I still have a shadow on my vision caused by the tumor and the vision is warped on that side.  Post surgery I also came down with iritis in the left eye that was managed with optical steroids. Unfortunately it also spread to the right eye and it took a couple of months to wean off of the medicine completely.

The prognosis is good according to the doctor. He says 2.5% – 5 years.  Which means 2.5% of patients are likely to see it return in 5 years. For me those are great odds.

I have so much for which to be thankful. The support, thoughts and prayers I have received have provided me with fortitude in moving forward through seemingly unsolvable financial stresses. My goal is to get my business back to its former levels as soon as possible.

If anyone needs a website, knows of someone who needs a website, I would be glad to meet for a one hour free consultation. If you have a website and are not sure if it is doing all it should be for you, I also offer auditing services. Also, if anyone needs a voice over, I’m available.

Thanks to all who have supported me and who read this blog. I am still on a journey to restore balance to my life, and your help has been a great boon to me.

Multi-instrumentalist Kevin Beale to Donate CD Sales


My friend Kevin Beale has offered to help by donating sales of his CD’s through September. I’m grateful for the help in managing the financial challenges I face. (See Some Not So Good News.)

You can purchase them at the Kevin’s itunes Store. Please give the samples a listen and consider purchasing or sharing Kevin’s work with your friends.

Here’s a quick demo of his three cd’s –

  • the still small voice
  • split
  • The Late, Great Barnabus Jones
embedded by Embedded Video

YouTube Direkt

the still, small voice
– Kevin Beale
Split – Kevin Beale, Greg Ewan
Barnabus Jones – me, Jeff Down, BJ Kocen.

Kevin’s Music has been featured on George Maida’s “Electric Croude” on WCVE and he and I are part of the original The Electric Croude Band.

For more info, go to

Thanks to Kevin for his generous help. I hope you enjoy.

Notes on my Radiation Plaque Therapy (Brachytherapy)


One of the purposes in setting up this blog was to not only share my experience with my friends & family but also with others who may be facing a similar challenge. The following is written for all those audiences. I realize some of the material may not be of interest to all, but trust that each audience finds something of value.

Matthew Costello with Radiation ShieldFollowing are my comments about my initial Plaque Therapy surgery.

I haven’t verified this statistic, but I am told approximately 25 people a year in Virginia are treated for ocular melanoma. That makes it an unusual occurrence.


I was anxious anticipating the procedure. Radiation Plaque Therapy is a process where a disk about the size of a quarter is attached by sutures to your eye. It is a custom-made disk designed to point radioactive seeds at your specific tumor.

Just wrapping my brain around the idea that something would be sewn to my eye took quite a bit of trust. I was never quite clear where on the eye it would be attached. As it happened in my case, it was attached to the back of the eye as that renders less pain since there are fewer nerves back there.

Throughout this process, my best friend Holly, gave me rides and provided the hospitality of her rural home in Gordonsville. A quiet, renovated stationmaster’s house about 20 yards from the railroad tracks.

The surgery was set for 7:30 am which meant we had to be at the hospital at 5:30 am. Consequently I had to be up be up by 3:30 am to get prepared and take the 40 minute ride in to Charlottesville. Being as I am a night owl, not going to bed usually between midnght and 2 am, this was a challenge. As it turned out I only got about 3 hours sleep.


I remember the drive into Charlottesville in the still dark of morning.  We managed to make good time and Holly’s calm presence helped me to keep my anxiety in check.

Once we arrived we found our way to the Family Surgical Lounge around 5:40 am. Soon my name was called and we were guided to the second floor where I was instructed to change into a hospital gown and await the plethora of doctors, nurses & anesthetists I would see before going in to surgery.

Everyone was warm & friendly. It was clear they were looking out for me. The operating room nurse came to give me an overview of how the procedure would unfold.  Finally the anesthetist proceeded to give me a sedative and take me to the Operating Room around 7:40.

The Procedure

Though I was sedated with versed, I was conscious throughout the entire procedure.

Because I have bad back and a soft tissue hump in my cervical area, it’s difficult for me to lay flat without pain, so the first order of business was to get me transferred from the pre-op bed to the operating table get me somewhat comfy with extra pillows strategically placed under various body parts. I was told I was also receiving some medicine for muscle relaxation. Despite these best efforts, by the time the procedure was over, my back was locked and I was feeling my usual back pain.

Though I don’t recall the entire sequence of events, here are things I do remember. Because I was sedated with versed, which can cause lapses in memory, there is a margin of error to my report.

I was given a local anesthetic which they called a “block”. It is like a lydocaine shot a dentist would administer only this time in my cheek just below my left eye. The OR nurse had warned me that it might hurt and she would be there to hold my hand. She jokingly said I could squeeze it hard if I needed, but, if it was too hard and broke it, I would have to pay for it.

One of the effects of this anesthesia is it affects the nerves to the eye in such a way as to cause temporary blindness in that eye. Thankfully I would not have to see the instruments and hands as they worked on my eye.

The doctor rubbed iodine around my eye, cheek & brow then some sort of plastic sheet was laid over me with my head poking through a hole in it.

Then another plastic layer was draped over my face. I had been warned about this as it may trigger my claustrophobia. I was grateful to have the versed running through the IV and that there was a tube with oxygen running under the sheet as well.

This sheet also had an opening for my left eye allowing the doctors access for the procedure but my good eye was blocked.  Because of the big light above them in the operating room, I could make out blurred shadows from time to time.

Throughout the procedure I remember him asking me questions and talking back & forth at various moments. I also recall feeling his hands on my face and my brow and around the eye as he did his work.

A “dummy” version of the plaque was sutured to my eye. As far as I could tell this was a way to test how the plaque should fit and make necessary adjustments before applying the real plaque.

They removed the dummy and proceeded to apply the real disk.

The vision in my left eye was slowly coming back as they put the real thing on, I could see vague shadows, not too distinguishable, the big light above them causing a reflection on my eye.

I was aware that he was suturing and would use the ultrasound to confirm details. In the lower left hand corner of my eye I could feel a stinging like a stick poking it, the Doctor said that would improve by the next day.

By the end all plastic was removed and my eye fitted with a lead shield and taped. I transferred back to the bed with some difficulty because of my back.


My memory of the exact return to recovery is blurry. Holly arrived in recovery after 9:30.

I remember the nurse giving me pain medication intravenously and I accepted his offer of nausea meds. When they kicked in, however, I began to feel that drugged sleepiness that can just take you over and I wanted to resist it.

Back to Holly’s

The nurse got me to Holly’s car and on the way home we got french fries. I exclaimed how terrific the fries were because I was sooooooo hungry –  best french fries ever!

I remember getting back home, into the house, being up for a bit, talking to Holly, then slept most of afternoon.

After my nap, the local anesthetics were beginning to really wear off and my eye ached as if someone had punched me in the face.  I made phone calls to friends & family. My appetite was good and I had ham with fresh organic vegetables for lunch.

Later my heavy lead shield kept slipping out of its nested position on my eye and the tape came loose. Holly did a masterful job of re-taping. Later that evening we ate polenta for dinner outside.

That day was marked with letting all the drugs wear off. I’m not one who likes to take pain meds . My pain threshold has been tested many times over my life. I think one of the worst pains I have ever felt was pain caused by photophobia from an iritis – it can only be described as the feeling of a dagger being driven back into your head. So the pain from this procedure, while being bad, wasn’t anywhere near as bad as that. This was more of an unrelenting ache. I found Tylenol by itself was enough to keep it to a bothersome distraction the first day or so except for my first nights sleep. The pain awakened me about 5 am. I took some more Tylenol and was able to get back to sleep in about an hour.

Subsequent Days

On rising the day following the procedure, my eye ached and there was pressure along with drainage in my left nostril which kept up for most of the day. All of this quieted as the day went on. The second night’s sleep was much easier though parts of the day I had some queasiness which I think was from something I ate and eventually passed.

In general I was able to watch TV, read a little, work on this account at my computer and take naps in between. Except for the facts I was functioning with one eye, had the persistent ache and there were irritating itches underneath the shield, I was interested in staying occupied.

Of course it’s not over yet and there are still the concerns: will the removal of the plaque be as smooth? What will the after effects of the radiation be? I’ve been advised that I’ll have double vision for a few weeks after the procedure because of the pressure on the eye from the plaque. Over the next few years the center of my vision in my left eye will become permanently blurred and I won’t be able to read with that eye.

As I write this I have less than 24 hours before the second surgery where they take the plaque off. Once that’s done it still takes a few months for the tumor to shrivel.

So far, the procedure wasn’t anywhere as bad as I feared. Of course it’s something I would have preferred to not have experienced. The reasons for the procedure are still of great concern. I really had no choice. One way or another, it seems some form of sacrifice is called for when cancer shows up.

I’m just so grateful that I have such great support and seem to be ahead in the fight.

Upcoming Radiation Plaque Therapy


My Radiation Plaque therapy is finally scheduled for late July.

The procedure is outpatient surgery and will be performed at UVA. I’ll be able to come home for the few days in between. However, as I understand it, radiation protocol says I have to stick at home and not go out in public.

I hope to post some updates while I’m wearing the plaque. One of my hopes for this blog is that it may bee a source of information for anyone else who may face this challenge.

Some Not So Good News

Matthew CostelloFamily, Friends and Newcomers

I find myself in the uncharacteristic position of publicly sharing some very personal challenges. You may or may not be aware that I am facing uncertainties caused by  life changing events.

I know there have been times when friends of mine have gone through similar struggles (and worse) and after I and other friends found out about their challenges we always sat around saying “why didn’t they say something?” So I find myself in that position and therefore have decided to reach out.

Cancer Diagnoses
In the beginning of May 2011 I was diagnosed with a Malignant Melanoma beneath the retina inside my left eye. This followed a long journey of many months going to various doctors to determine what was causing a swelling on my retina.

Throughout this period of diagnoses, I was without health insurance and my medical debts mounted.

I also faced other health issues since September 2010; a temporary loss of hearing combined with vertigo during the winter followed by a debilitating virus for over four weeks in February.  As you can imagine dealing with my recent diagnosis and past issues, the time I usually devote to my business has been drastically affected.

Consequently I have exhausted my financial resources, my income has been reduced and I am facing still more time to devote to getting the treatments for the Melanoma which will limit my ability for the next month or so.

As of April 2011, I re-qualified for my health insurance and, going forward, I am covered for the radiation that I have to undertake . The radiation treatment will have the effect of damaging the vision in my left eye over the next 2 – 5 years. Because of the radiation, the center vision of the left eye will become permanently blurred over the next few years.  There is a small possibility that this will not be as bad as they say.

Quite honestly, like any person facing cancer, I’m scared. However, I find the more I share with people, the stronger I become.

Requesting Help

I am faced with having to find some other ways to supplement income. It is very difficult to ask for help, but there are times in one’s life where circumstances require the effort.

I know it is a tough time for everyone right now and if you are considering being supportive, please know I am very grateful. What ever way you choose to help, I appreciate it deeply.

Thoughts and Prayers

Of course these are most welcome and in some ways most powerful. Facing the difficult decisions associated with this condition are stressful and require me to reach deep inside for strength. The more I talk and share these challenges with people, the stronger I feel. So thank you for thoughts & prayers. I welcome and receive the support they give.

Innerscape by Matthew Costello

Click to Purchase Innerscape

Dining Out by Matthew Costello

Click to Purchase Dining Out

Purchase Music
Please consider purchasing a digital download or CD of one or two of my albums that I wrote, recorded and produced in the 1990’s. These are instrumentals. Even if these don’t become your favorite songs, it will be a great feeling to raise money through the sale of my music.

Please consider sharing this with some of your friends and asking if they can also make a purchase.

This is a great way for me to generate passive income to supplement the income generated by my Website Development business. The money that comes in through the store is counted as taxable income and I also do not receive the full amount. On a $9.99 album purchase I receive $6.99.

If you would like to purchase some of my music, please follow this link to my Costello-Music online store. If you purchase a download or CD, please send me an email letting me know so I can keep track. Reverbnation doesn’t share the information about who bought downloads or CDs.

Hopefully over the next few months I can finish a collection of my songs that I’ve been working on for a long time. Of course your feedback about this work is very welcome.

Other friends have suggested they would like to make a donation to help. If you would like to make a donation, please use the Paypal link.


Recently I came across a quote posted by Julian Lennon on Facebook. It rings powerfully for me these days as I have already received help from several of my friends. Please keep this in your hearts:

“Rather than getting even with those that hurt you, the challenge is to get even with those that help you…”