Blogging in B Minor

I haven’t posted the post-op MRI which will show you the drastic change made as a result of surgery.  Essentially, where the tumor existed before you will see a “black hole” on the MRI scan for lack of a better term.  This represents the area where the tumor previously existed and is now gone.  Here is a picture of that scan:

And you might recall the pre-op MRI image.  This image isn’t the “cloudy” image that it was before it went through the malignant transformation from a grade 3 to a 4, or etter referred to as a glioblastoma multiforme. 

And here is a saggital view of the post-op MRI:

As you can see, this was a sizable resection and the tumor was sitting right on top of the motor strip so all of those fibers were taken.  It’s really a miracle that I’m walking with a cane and I’ve started walking without one here and there.  We can only credit God here - working through Dr. Zusman and pulling off what only He can pull off.  I mean, this is a 2cm x 3cm portion of my brain that is completely gone.  Motor strip tissue gone.  So, there is nothing more to say here.

Anyway, this is just a quick update.  I have a pretty busy Sunday and should have a busy week.  I am now really wanting to get back to work!  There are fears but I can’t let those drive my life (having seizures, having side effects from the vaccine).  But if I can go back to work and do chemo with concurrent radition (I went over lunch and had radiation treatments last time), I can do this. 

I’m still dealing with some ups and downs which leads to being irritable which isn’t fun for mainly my wife!  But I know I’ll get over that.  I think I’m struggling more with this one more than issues in the past.  The GBM is hard to take.  I’ve been breaking my own rule of not staying in today but I will recenter myself.  I also wanted to learn more about the vaccine and as a result of my research ran into statistics.  You have read my posts about this so I had to go back and read the post I made back some time ago called “The Median Isn’t the Message” which puts the world of stats into perspective.  So that took care of that.  I still am working on stay in today.  I’ll get it but I’ve just stumbled a bit. 

Well, more to follow this week…

Cheers,

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Tags:  Brain Surgery , Brain Tumor , brain tumor vaccine , Christian , Dr. Edie Zusman , GBM , glioblastoma multiforme , grade 4 , MRI

Well, the preliminary results came in last night as I met with my Neuro-oncologist.  Not so good.  My last MRI showed a slight bit of contrast as you may recall but no growth which was good news.  However, in the 60 days or so since then, it’s doubled in size.   It’s still small compared to many malignant brain tumors but it’s now behaving more aggressively.  60 days ago it was 1.2 cm x 0.7 cm.  Per this scan, it’s now 2.1 cm x 1.6cm.  There is more contrast and it’s looking higher grade than before.  We’ll perform what’s called a perfusion MRI very soon which is the best way aside from biopsy to try and determine grade.  Grade 3 tumors can behave this way - it doesn’t mean it’s higher grade. 

On the positive side of it all, there are a lot of options on the shelf.  The only option that isn’t available is partial brain radiation.  My brain has already been treated with 60Gy which is the maximum so we can’t go there.  There are other modalities of treatment however that can be used to attack the problem.  Certainly surgery is one and if that is the choice, it would be less complicated from a recovery standpoint because last time I followed the surgery with 5 weeks of radiation w/concurrent chemotherapy.  Radiation won’t be part of it if that is the option taken. 

The fMRI from yesterday also mapped what areas of motor strip in my brain control certain motor functions in relationship to the location of the brain tumor.  This technology, which the Neuroscience Institute didn’t have a year ago (they had something called “brain lab” which was sort of step down, less precise method of mapping) provides for much more precision when resecting a tumor in ensuring that neurological function is preserved.  Of course it’s brain surgery so it’s always risky but the fRMI is a huge help and a risk mitigator.  Secondly, there is Gamma Knife.  I don’t know if this is an option or not.  If traditional surgery is, this might also be an option in lieu of survery.  It’s a preferable option if it can be just as effective because it’s a non-evasive, walk-in/walk-out, same day treatment.  Most rest for a few days then get back to normal actives in a few days - slowly.

Chemotherapy will be something I’ll have to resume at some point but not now.  I have to stop the growth so that’s the first order of business.  As I said though, the previous surgery set up future surgeries.  My neurosurgeon did a few things to provide easy access to the area of the tumor so getting to the area is much easier and quicker.  The fMRI will be of great assistance.  The fact that it has grown and I have been leading a normal life the last 60 days (1 mild focal seizure) seems to tell me this growth isn’t pushing up against the motor strip (theoretically anyway) so it’s a matter of sitting down with the team and making some decisions. 

More later but we need to figure some things out.  Is it hard?  ABSOLUTELY!.  This sucks.  But we can’t do anything about it.  I worry about finances, going on leave, impact on my family and all kinds of things.  I worry about everything else more than I do myself but we have to put all of that on the side and just focus on what we can for now.  You see, we can’t have it double again.  It can’t evolve into a grade IV.  So we fight - we hammer on it in the best way possible within whatever constraints we have in life.

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Tags:  blood brain barrier , Brain Tumor , Faith , MRI , MRI enhancement , My Story , oligoastrocytoma , primary motor cortex , seizure

My next scan was originally scheduled for October 6th but I have experienced a few focal seizures over the past several weeks that have made us decide to move this up and take a look now.  The last seizure wasn’t real severe but was enough that I took some additional meds to put it away.  This time we are doing something different, too. 

The type of imaging study that is being performed this time is an fMRI, or Functional MRI.  Subjects participating in a fMRI study are asked to lie still and are usually restrained with soft pads to prevent small motions from disturbing measurements. This really isn’t any different from a standard MRI - you’re always given pads around your head and arms.  Anyway, the primary difference with an fMRI study as compared to a standard MRI (both can last 1-2 hours - how fun to be in a “tube” that long, huh!) is subjects may view movies, hear sounds, smell odors, perform cognitive tasks such as memorization or imagination or in my case, press a few buttons and perform other motor function tasks using my left-side (recall I have a right-frontal brain tumor - deficits are contralateral so we want to see impact to the left side).

So, put simply without getting into a lot of scientific jargon, the goal of this is to “map” more or less the areas in and around the tumor that are directly affecting certain motor functions (the movement of my left shoulder, or knee, or fingers for example).  When we know that, we can determine what areas of the tumor could be relatively safe to debulk with limited neurological deficits - at least in theory.  Nothing is without risk.  After all, this is brain surgery.  So, we’re aren’t preparing for surgery here at all but given the seizures we need to see what is going on.  We’ve been watching it every 60 days so this time we just moved it up a bit - no big deal.   

Here is a picture of an fMRI machine to give you an idea of the environment.  Again, getting tubed an hour or two (and sitting absolutley still) is a chore, but I have done ok with it so the technicians have said.

And guess what?  I can’t do anything about what is going on, can I?  Nope.  I pray for the best outcome.  We know that God is in the middle of our lives - Rachael, Aidan (6) and Keegan (1).  It’s certainly hard not to let physical symptoms get to you - I won’t lie.  But when they do, you just have to keep rolling along.

I’ll post results here when I can.  As I mentioned before - the lack of posts means I’m doing good!  I’m enjoying life.  Soccer has been a blast with Aidan.  Being involved, running around a field in soccer clothes (I used to play competitively) and playing with him and all of his team, helping with the coaching and teaching the kids - what a great experience and just a few months ago I was on chemotherapy. 

More in a day or two….

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Tags:  Brain Tumor , brain tumor survivor , Faith , fMRI , MRI , MRI enhancement , oligoastrocytoma , Oncologist , seizure

I haven’t posted for a bit as I have been busy with work - putting in a lot of time lately.  This too will have to be quick but I’m going to go in this week and most likely adjust my meds again. 

 Yesterday I had a focal seizure that just wouldn’t go away.  I ended up taking 450mg more of one of my meds than I typically do in the AM (this occurred in the morning) and it still hadn’t subsided after 1 hour.  This one was in my left leg as opposed to upper left extremities so it’s in a different location.  Anyway, I took an Ativan which is pretty powerful so work for the day was done!  My co-worker agreed to drive me home which was so nice of him.   Even on the way home this just kept going so at this point it had been nearly an hour and a half.  When I got home I took one more Ativan, went and laid down and didn’t wake up until 3pm - everything was fine.  I think I mentioned that my Neurologist sees no correlation between these episodes and changes in the brain tumor.  I’ve done my own research and there are mixed theories.  It’s hard to know.  So, we’ll just follow up.  I have a functional MRI set up for the beginning of October which will I’m sure be very revealing.  Until then, all I can do is deal with things as they come.  It’s hard not to let your mind wander but as much as possible you just have to take it a day at a time…

 More later….

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Tags:  Brain Tumor , Brain Tumor Research , MRI , My Story , seizure

My MRI was on Tuesday and I had an appointment yesterday with my Neuro-oncologist.  Overall the news was good.  The size of the tumor has not changed which is great news, again.  There has been an increase in what is called T1 shortening and mild enhancement associated with the lesion.  In layman’s terms, this means the blood-brain barrier of the cell walls have broken down somewhat - it’s a vascular change in the tumor is all.  A change - it’s irritated for some reason.  The cause?  It could be from all of the treatment over the last year.  It’s been hit with a heavy course of radiation with concurrent chemotherapy over 5 weeks.  The was preceeded by surgery which resulted in a biopsy and finally I completed 8 1/2 rounds of chemotherapy.  So this is really my first post-treatment scan.  The report indicates that this “could” be related to post-treatment changes and of course recommends continued follow-up imaging.  We are doing that anyway.

This is the first scan that they haven’t used the term stability but my doctors also didn’t say this is anything to cause major concerns - we just need to keep watching it.  And they all know me very well!  I’m the straight shooter.  Reality is all I want to hear so no holding back ever happens here. 

I’ve said it before and I will say it all the way down the road.  It’s all in God’s hands here.  We are all human and I have my own times when I can sit and reflect on what is happening in my life, our lives - think about my two kids, my wife and what all of this means to us.  But in the end, we all know that a lot of analysis and worrying isn’t very helpful to our daily lives.  So we are human - there is not some kind of power we can employ to feel “ok” about everything all the time, but you accept it - you accept your circumstances because you have to and I have learned to live with it - and so has Rachael but around the time of my scans we feel vulnerable and it’s hard not to think about it because it’s put front and center.

In a week Aidan starts soccer - every Wednesday and Friday we’ll be going to practice from 6:30 to 7:30pm.  That will be a lot of fun for us - a great Father/Son time.  He loves to get out there and kick the ball, run around and just have a great time and I think he really loves to kick the ball further than his dad.  Games every Saturday until November.  He is a competitive little boy - we’ll see how this goes but I know it will be a lot of fun - probably more for me!

That’s it for now… 

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Tags:  blood brain barrier , Brain Tumor , chemotherapy , glioma , God , MRI , MRI enhancement , oligoastrocytoma , radiation oncologist , Radiation Therapy , survivor , Temodar

As luck (or a hashed immune system!) would have it, I ended up with a cold.  Who cares at this point - it’s par for the course and I’m working on bringing myself back out of this over time.  It will take about 6 months and I will take antibiotics the entire time which will help me.  Now I’m not sure if this was caused by me, but my son woke up on Wednesday morning with a terrible cold - running a temperature and the whole nine yards.  I’m watching out from all sides!  He’s worse than I am for some odd reason.  I feel bad for him - he’s been in camp all week and had to miss yesterday and today.  I’m hoping he can finish out tomorrow at least.

Also on Wednesday I had some strange sensations in my left bicep - just slight contractions on and off in the afternoon.  They started again in the evening and at that point I knew it was my long lost friend - focal seizures.  So, after a period of time I became annoyed with it (I was trying to watch Dateline or something) and took an additional 200mg of Lamictil and they said goodbye.  For those of you that can’t envision this - this time it was like having a strong twitch in an area of your body - you try to turn it off but you can’t.  You see, a focal seizure can be as simple as that or a marching numbness in your hand or arm.  So many people have this classic vision of a seizure - someone flopping around on the ground.  That’s just not what they are all about.  There are a lot of different types.  I spoke to my neurologist about it - there’s nothing you can read into this.  It means nothing.  People can have clean scans for years and have seizures throughout - I actually never have them since 7 months ago or so.  People can have tumor growth and no seizure activity.  It’s just not an indicator of anything.  So you deal with it which is why when it happened I took a pill, talked to my wife about it and went about my business (back to the Dateline thriller!). 

You just can’t get all caught up in this stuff - you have to have faith in God and turn it all over to Him - period.  Could you imagine if I took every issue - a seizure, an upcoming MRI scan (I have one next Tuesday), some weakness I feel on the left side of my body, statistical survival rates, etc. and worried about them and placed it all on my shoulders?  I’d be an anxiety-ridden mess!  I remember when I came back to work and had 2 weeks of radiation left.  I was worried about how I’d get through that and still work but I turned it over to God.  And?  And I worked, left at lunch and went to the Institute and had radiation treatments, came back to work and finished my day - and I was on chemotherapy at the same time.  I got through it but not because of me - I had some help there.  The task ahead of you is never greater than the power behind you, right?  It’s true.

I have my 60-day MRI check on Tuesday - see my Neuro-Oncologist on Wednesday to discuss and then I’ll be done for a few months.  Things are good! 

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Tags:  Brain Tumor , brain tumor survivor , chemotherapy , Faith , God , MRI , My Story , Radiation Therapy

Thank you all for your thoughts and prayers this week - they are so appreciated. To cut to the chase, my studies came back and showed stability with no growth! Needless to say we are so happy. There are some interesting observations to be made regarding the results that I will get into but the real take away here is that everything is stable and either my treatment is effective or the tumor itself is just not growing. I have discussed before that there is really no way to prove that ongoing chemotherapy is the reason for stability, however, given I had experienced tumor growth between January 2007 and May 2007, had surgery in June and then from that point forward I have had stability we have to assume the radiation and chemotherapy are doing the job along with supplements and other steps I have taken in my life.

Now to the results. I will spare all of you the report details and just paste in the impression section from each study which is the most important.

5/27/08 MRI Brain w/wo and Perfusion MRI

IMPRESSION: NO SIGNIFICANT CHANGE SINCE PREVIOUS EXAMINATION. THE PERFUSION STUDY DOES NOT SUGGEST A HIGH-GRADE LESION. THERE IS A SLIGHT DEGREE OF GADOLINIUM ENHANCEMENT SIMILAR TO PREVIOUS STUDY SUPERIMPOSED ON AREAS OF INTRINSIC HIGH T1 SIGNAL.

This test included essentially two parts - a standard MRI that looks at the tumor anatomically - I always have this every 60 days and that has been coming back stable. A second study was run that I have never had before that is called a Perfusion MRI. This is a special technique for evaluation of microscopic blood flow in cerebral capillaries and venules. It basically creates what is called an MRI perfusion “map” of a high grade brain tumor and demonstrates areas of increased capillary blood volume in the tumor. This technique is used quite frequently to demonstrate areas of a tumor with highest malignancy potential to aid biopsy planning (a biopsy should target the highest malignancy areas because the WHO grade of a tumor is based on the highest grade cells found in the tumor).

Ok, out of breath now but I think it’s good to understand this stuff. You can always blow by all of this stuff if you want of course. So what does this impression above mean - it says that it doesn’t suggest I have a high-grade lesion? Huh?! Well, we know I do. Pathology resulting in a grade 3 oligoastrocytoma dx trumps any imaging studies. However, to put this in simple terms - when a tumor is growing or becoming more aggressive, it requires more blood. To acquire more blood, it needs to increase vascularity (growing more veins basically) which allows more “throughput”. This study says that this isn’t happening. GOOD NEWS! On to the PET scan.

5/28/08 Brain Imaging PET Metabolic

IMPRESSION: THE PET SCAN HAS REMAINED UNCHANGED COMPARED TO THE PREVIOUS EXAMINATION DONE ON 03/15/07. THE LESION IN THE RIGHT POSTERIOR PARASAGITTAL FRONTAL LOBE IS RELATIVELY HYPOMETABOLIC SHOWING UPTAKE APPROXIMATELY EQUAL TO NORMAL WHITE MATTER AND SUBSTANTIALLY LESS THAN GRAY MATTER. THIS WOULD ARGUE AGAINST A HIGH-GRADE NEOPLASTIC PROCESS BUT DOES NO RULE OUT A PERSISTENT LOW GRADE NEOPLASM.

PET stands for Positron emission tomography and is an imaging technique which produces a three-dimensional image or map of functional processes in the body - in this case the brain. Without getting into major details, like the perfusion test above, it will look to see if there is metabolic activity - we want this test to come back showing that my tumor is hypometabolic, not hypermetabolic. Also, what is typically done is the PET “map” that is generated is typically overlayed on top of the MRI scan so the Neuroradiologist can look at anatomic and metabolic views (what the structure is and what it is doing biochemically).

Ok, having said that, no change since my PET scan in March of 2007. This is great news. Also, like the perfusion study, they concluded that this would argue against a high-grade neoplastic process (high grade tumor). Again, we know it is so the take-away here is it’s not growing, it’s stable and metabolically it’s not changing. This is all great news!!

For those interested, here is an image of a Brain PET/MRI fusion:

When first looking at these results, it would be easy to think I have a lower grade tumor but that simply isn’t the case. I saw the results and it created confusion at first. I thought “this is odd - this completely contradicts the pathology?” However, I remembered, too, that mixed gliomas can behave like low-grade tumors on film as well - and they can fool many neuroradiologists into thinking they are in fact low grade or even infarcts related to strokes if being discovered for the first time. This is why it was so important that I had everything looked at by UCSF and Mass General back in May of last year.

And speaking of that, it has been a year since I was “officially” diagnosed. We knew well before that time what we were dealing with but the official diagnosis came down in May and here at the end of June it will be 1 year since my craniotomy - and 2 weeks after my craniotomy my 2nd son, Keegan, was born so he will be having his first birthday. Needless to say, we will be having a much calmer June this year than we did at this time last year. It’s hard to even keep things straight when thinking back to last year - it was surreal. But I will say this, we know that we can walk through anything. Our family has endured. And we know that with God’s guidance, we aren’t alone in any of this. This type of trial tests every ounce of your character. It pushed us to what we thought was the brink only to find that it was going to get harder. But we knew that it was temporary as hard as it was - one day at a time we could walk through it. Life is hard sometimes which is why we have to enjoy every day. Are blue birds singing at my window or yours every day?! Nah. But, some days they are! And the more I can focus on the positive in my life, what I have today - my family, my two wonderful boys, a renewed appreciation for the gift of life (really, I think human nature just does this if you are faced with a diagnosis such as mine) and so many other luxuries that many in the world don’t have.

Thank you again for your thoughts and prayers. A big week indeed. I will continue on chemo - we talked about that. It is harder as time goes on - your marrow keeps getting hammered and after awhile it basically says “I keep getting up and then I get hammered again so why should even try recovering anymore!”. Therefore, the fatigue sets in more consistently. But, I’m finishing cycle #8. I want to make it to 12 - 1 year. Then I will finish. Both UCSF and the Neuroscience Institute agree that if I can tolerate the treatment it’s the best course.

Keep on going….

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Tags:  Brain Tumor , Brain Tumor Research , Faith , gadolinium , MRI , MRI enhancement , PET Scan , prayer , Resources (Brain Tumor) , supplements

Just a really quick post this AM.  This is a big week for me - I could really use your prayers.  Today I have my standard 60-day MRI.  Tomorrow I’m having a PET scan.  For those that don’t know, a PET scan looks at a brain tumor from a metabolic perspective instead of anatomically which is how an MRI views the tumor.  It produces a 3-dimensional image or map of the tumor and detects what is called a “tracer” which is in the form of a radioactive isotope that is injected into your blood.  In my case, the tracer, if my brain tumor is highly active, will race to the tumor and the results of the PET will show “high metabolic activity”.  Glucose is in the tracer and if my tumor is in a state of high metabolic activity, it will feed on glucose.  Therefore, the tracer will “pop” on images where this is taking place.  This is the easiest way I know of to explain it!

When I had the PET in March 2007 the results indicated “relatively low metabolic” activity which was consistent with a stable or low grade tumor.  Of course I found out in June when I had surgery and a biopsy that my tumor was a grade 3 oligoastrocytoma so the low matabolic activity was more due to stability than a low grade tumor as grade 3 is a high grade tumor.  

I did something to my back over the past several days so I am NOT looking forward to laying on these tables for an hour at a time over the next several days!  They aren’t the most comfortable in the world, particularly considering you have to remain very still.  Here is a picture of the PET equipment to give you an idea.

On Thursday I meet with my Neurosurgeon and Neuro-oncologist to review everything.  So, a big week indeed.  I always have some anxiety when I have scans - but I turn it all over to God.  This isn’t my plan here and if I took it all on myself I don’t know where I’d be today.  But even still, it makes me feel anxious re: results is all, particularly because the MRI is here and now.  The PET is tomorrow so I won’t worry about that one…

So if you think about it and are reading this, a short prayer about positive results would be much appreciated.  Your support has been great!

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Tags:  Blood Sugar , Brain Tumor , Christian , MRI , My Story , Neurosurgery , PET Scan , Pictures , prayer

I believe I’ve mentioned that I’ve been feeling a lot more fatigued lately than before.  I have also picked up some type of flu - pretty much just hit me head on so I didn’t start chemo yesterday as planned and will likely hold off for several more days until I can see how my body does with warding this off.  I can’t tell if it’s a 24 hour issue or some other type of flu.  Not fun though!  So, I’m having to pause my chemo which is not preferred at all.   On another note, we performed a lot of work on my blood to try and understand the source of the nosebleeds and bleeding in my mouth that I have experienced on a few occassions.  No such info came out of the analysis - platelets and specialized studies on them are fine so at this point it’s “unexplained”.  The bleeding has subsided so that is good by I’m an answer man so I’d obviously like to undertand what the issues are related to.

I can really tell a difference when I don’t have the anti-convulsants on board.  I didn’t have any until mid-morning today after missing last nights dose completely and I woke up today with strange sensations in my lips and left hand - the same numbness that I felt in Dec 2006 that started me down this course.   Obviously this is just a staple in my regimen (the ACs) but it has completely straightened out the focal seizures I was experiencing. 

Aside from this stuff, everything else is going well here.  Aidan and I are involved in a soccer clinic on Tuesday evenings which is a great night out for us.  He’s learning the rules and techniques of soccer and I’m participating with him.  I played competitively growing up so it’s great doing this with him.  He really looks forward to it. 

I think I mentioned that at the end of this month I’ll be having an MRI Spect and a PET Scan - the PET should produce great info looking at it metabolically for the first time in a year (I had a PET last March).  Standard MRI looks at the tumor anatomically wheras a PET scan can look at it from a metabolic standpoint - how much or little metabolic activity is taking place.  If there is high metabolic activity detected via PET, that could be an indication that the tumor is on the move.  We are so blessed to have the technologies we do - and to be in a position to use them.  I remember that every day.  There are so many that live in coutries and are in socio-economic groups that don’t allow them to access this type of healthcare.  We don’t know how good we have it here.  I really don’t think most of us do.

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Tags:  Brain Tumor , chemotherapy , MRI , My Story , PET Scan , Temodar

Some good information should be available on Monday from UCSF.  For those of you that are not aware, The University of California, San Francisco has a Brain Tumor Center and it is one of the best in the country - certainly on par with Duke, Mass General, UCLA and others. Dr. Mitchel Berger, the head of the Department of Neurosurgery is performing a film review of my most recent set of MRIs which is something I have done on a number of occassions.  You may recall that he along with Dr. Peter Black at Mass General both agreed that I should have surgery back last June which was contrary to the opinion I was given here at the brain tumor center.  I have relied upon Dr. Berger ever sense from a radiological perspective to interpret my scans to ensure I have this second checkpoint.

In addition, I have been on the phone with the UCSF Department of Neuro-Oncology.  I am seeking another opinion with regard to my go-forward chemotherapy strategy.  For this case review, I have sent them just about everything.  MRI films, pathology, operative reports, 1p19q gene deletion test results, recent lab work, recent dictations from my Neuro-Oncology appointments, etc.  This review will allow me to have another opinion now that I have finished the 6 months of pulse therapy using Temodar which is the standard of care.  After 6 months, there isn’t a lot of information in terms of the right course to take - do you stay on chemo?  How long?  The same type?  Lots of questions.  Some with brain tumors may not know that in many cases you can contact brain tumor centers and facilitate these types of reviews with some footwork and organization.  It is WELL worth the effort and logistical challenges. 

So, on Monday or Tuesday of next week I should have opinions / impressions related to my scans (growth, stable, etc.) - and the verdict here has been stable all along and back in October of last year Dr. Berger concurred that all was quite stable.  I will also have the complete case review from a Neuro-Oncology perspective which will provide me with great information moving forward.

I was able to get some information through some connections from Dr. Jonathan Finlay who is at UCLA.  His response, to me, was shocking - he said the standard is to stop at 1 year which is consistent with my understanding but that he personally has his pediatric and adult patients continue INDEFINITELY as long as they have residual tumor present on MRI.  Wow.  Long term risks such as leukemia come into play with these drugs but I’m sure he views the long terms as the lesser of two evils so-to-speak, particularly if you’re dealing with grade 4 tumors.  So, we’ll see what UCSF says.

More to come next week.

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Tags:  Brain Tumor , chemotherapy , Dr. Mitchel Berger , MRI , Oncologist , tumor , UCSF