Ma.. Ma… Ma… My Schwannoma! (Part 9 – Holding Steady and a Cool New Doc)

It’s been well over a year since I last wrote on this subject. Meanwhile my old Radiation Oncologist dumped me and moved to California – Not before sending my new doctor pictures of the nice relaxing trip she had to Hawaii after dumping her old cases, like me, on the poor man!

That’s okay though because my new doctor is a very cool guy named Jerry Jaboin. Dr. Jaboin tells me that not many people study Trigeminals Schwannomas because people think they are boring. Well! To this I say:

“HA! FORGET IT! There ain’t nothin’ about me that’s boring! Not even my fuckin’ intercranial lesion!!! Who you callin’ boring!”

(By the way, great news, this tumor is pushing on my brain tissue so Dr. Jaboin says I can blame that inappropriate burst of profanity on the tumor! See Patt… Told ya. 🙂 🙂 🙂 )

So… seriously… With a few more thousands of dollars of MRIs under my belt here’s what I know:

Nothing.

Well okay…. something. I know that nothing has changed. Not even a little bit. The size of the tumor is identical to what it was 18 months ago. To be clear, that’s not bad. It’s good that it’s not growing and it might even mean that my stereotactic radiosurgery worked a little.

I also learned today that stereotactic radiosurgery actually can be done more than once. It just won’t do any good for me. <sigh>

And, I learned this:

There is stable compression of the left trigeminal ganglion, which is displaced laterally and inferiorly against petrous bone. 

To this I would say “Duh!” if I knew what those words meant 😉 To my credit I can say that I don’t actually think “inferiorly” is a word at all.

And… get this: my  “Intracranial flow-voids are patent.” At first I thought that said “patient” but I know for sure that there is no patience in my brain…. so… that’s not possible.

I was going to show you all my most recent MRI but the images won’t open on this PC. I think it’s intercranial flow-voids are impatient or impotent  or whatever and I need to reboot.

So… look…. the bottom line is that I have no new problems, an awesome new doctor, a new scapegoat for my bad language, and no reason to have another MRI for 12 – 18 months.  Honestly…. that is a good thing.

By the way, Dr. Peggy Mason, Dr. Jaboin think’s he’s met you before. I told him it’s unlikely because you are way too hip to hang out with these BORING schwannomas.

Love you all.

 

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This just in…. I lied….. Here’s a few views of my little friend….

 

 

 

 

 

Ma.. Ma… Ma… My Schwannoma! (Part 8 – Choice and Acceptance)

I had another MRI this past week. I saw the radiation oncologist two days later. The good news is that this time I am not bummed. I’m just ambivalent.

My tumor looks absolutely identical to how it did on the MRI three months ago. I could be disappointed that it still has not reduced in size. But I’m not. Rather, I am happy that it has not grown.

It has now been almost 2 years since I had the radiation treatment. Lots of great doctors did their best to treat it. Lots of great friends and family did their best to pray that it would shrink. It has been treated expertly and, after 2 years, it is likely not going to shrink.

I’ve had some funny, really stupid, thoughts of late. One day I actually said to myself: “Maybe I got a brain tumor because my body wasn’t really prepared for all that extra spinal energy when I got initiated into Kriya Yoga.” Now THAT is a stupid thought. If Paramahansa Yogananda comes to meet me in the afterlife the first thing he’ll do before introducing me to Babaji is to whack me upside my head! 🙂 Silly shit. I’m very sure the next thing he’ll do is tell me I should have done more Kriya’s not less. Duh.

Ok I’m being silly now. But, here’s the bottom line. You don’t always get what you ask for. You can’t change some things. So, I’m working on that phase of acceptance. I’m working to remember that I have a choice in how I react. It’s a blessing that my tumor is benign. It’s a blessing that my tumor is not growing. It’s s blessing that I live in a city with a world-class research institution. It’s a blessing that I have Patt to support me. It’s a blessing that I have a numb eyeball instead of, say, numb… well, never mind. It’s a blessing that this is an annoyance not a life-threatening ailment. There are lots of blessings to be found here.

My challenge – which I’m working hard to accept – is to CHOOSE to be grateful for the blessings rather than dwell on all the things that I want to be different. I’m trying to move into a space of gratitude.

I wonder if it will go away if I just do more Kriyas? 🙂

Ma.. Ma… Ma… My Schwannoma! (Part 7 – Bummed and Impatient One Year Later)

All of you know that I’ve kept a really solid sense of humor since I was first diagnosed with a (benign) Trigeminal Schwannoma. I would not have had 6 previous posts with a title this lame if I didn’t. But I have to tell you that I’m not in the joking mood today.

After hitting this little fucker with a big dose of radiation a year and a half ago I expected this annual MRI to show an unchanged to slightly smaller tumor. That is not the case.

It no longer takes more than 2 seconds for me to show you the tumor on an MRI image.Here it is, looking up from the bottom of my skull:

I’m not a radiologist but I certainly know by now that rule number one or two is to look for asymmetry. Not hard to find when you scroll through the studies. I’m good at that after almost 2 years.

You can’t tell much about the size but, if you look back a year, you can see that it looks about as it did before. If it were as before I would be a happy camper. Unfortunately it is slightly larger and I’m more than slightly disappointed. What I love about my doctor is that she doesn’t try to spin things. When I told her I was bummed she said “yeah, I’m disappointed too”. We were both surprised.

Schwann cells are not very radio-sensitive so this kind of tumor does not generally shrink. But it also does not typically grow. We can’t really tell if the tumor has grown or if this is still just post-radiation inflammation. The latter can actually go on for 2 or 3 years. That is rare but then I’m a special kinda guy.  Whatever it is, it’s slightly larger than it was a year ago.

Regardless, since I’ve been transparent about this all along, I just want y’all to know that this is a bummer and I’m having trouble today in keeping my humor up and running.

I’ve often been asked if they can do surgery and just remove it. The answer is that anything is possible but not everything is worth the risk.

First, if they did try to remove it they would almost certainly further damage the nerve. I’d still choose a numb eyeball over a numb face so there’s that.

Second, let me show you a picture I haven’t shared before. Here is an MR Image from the back of my head.

You can see the tumor on the right side of the image, Down below – all that shit that does not look like brain – that’s the base of my skull. The tumor is sitting in a little part of that area called “Meckel’s Cave”. Among other things that’s a bitch to get to. It’s also right where my carotid artery enters. It would sort of suck to accidentally cut through that.

Now… the easy thing to do is to use a Guillotine. The problem is that reassembly is tough (I told you my sense of humor about this sucks – that’s the best fucking joke I can come up with. Sorry.)

Interestingly, even among Neurosurgeons there are lots of sub-specialties. Apparently there are guys called “Skull base specialists” who have… like….. REALLY steady hands. They know how to operate down there. But that sounds about a million times scarier than having a room full of nice people shooting a linear accelerator at you for a few minutes. So, I’d vote “no” without a hell of a reason.

The good news is that Dr. Kubicky also votes “no”. She says that it’s difficult to believe that, with the dose of radiation I had, the tumor has really grown. She still thinks this is inflammation and wants to just keep watching it unless the symptoms change. For the first 2 years watching it was sort of fun. Now, now so much.

So, to summarize my rambling update: Next MRI is in 3 months. Until then, nothing much to do. I’m sure I’ll get over the bit of melancholia. In the meantime the only consolation is that I again have something to worry about other than politics.

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Ma.. Ma… Ma… My Schwannoma! (Part 6 – On Realistic Expectations and Patience)

It’s been about 9 months since I last updated everyone on my brain tumor and, if you think I’m not telling you enough then, all I can say is “have patience“. Hard as that may be, that’s what I’m learning to do.

Since I last bored you with my progress I’ve had 2 MRIs. One was last February and the other was last week. Both were multi-planer multi-sequence imaging studies both with and without Gadavist contrast. In the 6 months between the 2 studies the tumor has not changed in size. My radiation doctor says this is a good thing (yay me!). For a film with extremely high production values and an amazing voiceover see below.

          <<<Check this out: My Schwannoma – The Movie>>>

I’m bummed despite the good news. See, for a small percentage of patients stereotactic radiosurgery on a trigeminal schwannoma will shrink the tumor a little bit. For most of us, simply stopping the growth is all we can expect. So, to the folks who don’t have my brain, this is great news because it’s as expected.

But, I’m not an average “as expected” kinda guy.

I set my personal objectives far above average and I expect any little motherfucker that wants to take up space and hang out in MY brain to do the same. Ya wanna be a piece o’ me ya gotta perform to my standards! My doc says that’s not the way things work. I say my tumor should hire my cousin Caitlin as a life coach!

(Actually… that makes no sense since I want the thing to die and dead tumors don’t need life coaches. – Yet another home run for cognitive dissonance. Damn).

That was where the bit about realistic expectations comes in. Here’s the part about patience.

My next MRI will not be for a YEAR. In that time, unless my symptoms change, I won’t see the doctor again. Schwann cells are not very radio-sensitive. So, even if the tumor does shrink somewhat, it will be over the course of a couple of years. When you have a numb eyeball, a couple years is a long fucking time. But, dead schwann cells are like a fine wine (strike that…. it’d be a mixed metaphor unless I find a way to tie life coaching and wine drinking together and I’m too lazy to do that right now even if it is pretty easy.) Anyway…

… But dead Schwann cells take a long time to result after radiation exposure. So, what I really should be doing is to be grateful that this thing grew slowly and happy that my doctor says the treatment is working as planned. But that’s hard.

What I think I learned today is that gratitude is easy to forget and patience is difficult to remember. But, both are keys to getting through any bout with adversity. So, over the course of the next year those are  the skills I need to cultivate.

See… the little bastard taught me something again 🙂

Cheers.

 

Twelve Gratitudes: Thanksgiving thoughts of gratitude with or without a Godhead.

Today I have every reason to be thankful for a wide array of wonderful doctors, technologies, friends, and, of course the blessing of being married to Patt Bilow.

If you are one of the regular readers of my blog then you know that I am among the least intellectually consistent people you will find. Although I don’t take the Bible literally, I am very active in my synagogue. Although I tend to be skeptical about most things spiritual, I spent many years as a disciple of Paramshansa Yogananda and the Self Realization Fellowship. Although I am really bad at it, I tend to be as much of a rationalist as my love for Judaism, my love of Kriya Yoga, and my love of all of the amazingly wonderful religious friends that I have in my life allows.

The whole point of writing this blog is that I do struggle with my rationalism in relationship to my interest in, and openness to accepting, other people’s viewpoints. This blog is all about my struggle and my skepticism. It’s intended to allow me to share my wavering thinking with all of you, in the hope that if even one of my posts helps someone else I will have done a good thing. So, once again, as I struggle with rationalism and religiosity, I wanted to talk about Thanksgiving and the ability to build a life of gratitude whether or not one is religious.

This year, I want to do this by sharing my personal set of gratitudes.

One of the most interesting things I’m grateful for is that someone invented a medical technology called MRI. What kind of guy would even think about hitting a human body with a magnetic pulse to get all your atoms to line up and then to image that body by measuring how long it takes them to go back to the way they were! The guy must be a genius. What completely blew me away though was to realize that the genius who invented this technique has almost diametrically opposite beliefs to mine.

You have seen me write here, several times before, that I typically don’t care much for beliefs in creationism or those who deny evolution. What blew me away was to find that Dr. Raymond Damadian the “father of MRI” converted to Born Again Christianity with Billy Graham in the 1950s. Now, if you think I have conflicting thoughts and feelings and views, this guy makes mine look like nothing.

I really don’t understand how a guy with this level of brilliance could be an advocate for creationism; even having written about it in his book. That said, he is clearly a genius, has done more for the medical profession than almost anyone, and has now done more for me than most other people in the world have done for me because, only through his invention, were they able to find my tumor.

One would expect that I would be a fan of a guy who started his college career as a violinist at Juilliard and ended it as one of the most important inventors of a medical device ever. But you certainly wouldn’t expect me to be that much of a fan of a creationist. So the first thing that I want to say is that I am thankful for this guy, and the second thing I have to say is that my respect for him shows once again that I should not make value judgments about a person because of their religious beliefs. I am thankful that I’ve had another opportunity to come to realize this. Dr. Damadian has given me two new things for my collection of gratitude.

• One, I am grateful for MRI.
• Two, I am grateful for yet another lesson in religious tolerance.

I’m also indebted to the guys who invented Stereotactic Radiosurgery. Swedish neurosurgeon Lars Leksell first described it in a seminal paper in 1951. His work led to the Gamma Knife. But Dr. Barcia-Salorio in Madrid is the first guy to use something similar to what I just had done. He used a fixed cobalt device rotating around the patient’s head, not for tumors but for blood system malformations. Then Osvaldo Betti in Buenos Aires developed a machine, where you sit in a rotating chair and a linear accelerator (linac) moves in non-coplanar coronal arcs around the isocenter, which is the math wiz way of saying “the thingy ya wanna hit“. I layed on a flat bed which I think came from Federico Colombo in Vincenza who described a multiple non-coplanar arc concept that moved the linac around a couch in 1984. So, gratitude comes again. This time for:

• Three, I’m grateful for the noble, honorable, ethical, life-affirming uses of radiation that stand in opposition to all the negative results of nuclear science.

But these folks are all people of the past. The present is full of blessings as well. My Neurosurgeon Dr. Burchiel, my Radiation Oncologist Dr. Kubicky, and their entire staffs are medical blessings of the present. The dosimitrist and medical physicist are mathematical blessings of the present. Even my overly expensive American medical insurance system is a blessing in its own way. These are gratitudes 4, 5, and 6

• Four: I’m grateful that I live in a city where I can drive for 20 minutes to OHSU, a world-class teaching hospital with great doctors and a budget that allows them to own world-class instruments.
• Five: I’m grateful that mathematics, medical science, and physics have merged in ways that can save, rather than destroy, lives.
• Six: I’m grateful that I get to work for a company that gives me acceptable medical coverage, despite the costs.

But, clearly, the present has many more blessings than the doctors and scientists. More important than anything else is the people who I call friends and colleagues who have been so supportive:

• Seven: I’m grateful for the myriad friends of the Jewish, Muslim, Hindu, Buddhist, Christian, Catholic, Eastern Orthodox, Mormon, Unitarian Universalist,  and other traditions, who offered their prayers for me.
• Eight: I’m grateful for my Objectivist, athiest, and other non-religious friends who offered such encouragement over the past few months.
• Nine: I’m grateful to live in a community, here in Portland, that offers me the extraordinary friendships of people like Traci, Cindy and Tom, LeeAnn, Jon and Mair, Julie, Ann and Robin, Peter and Yukiko, Michele and David, Mike, and many, many more.
• Ten: I’m grateful for WordPress, Facebook, and Twitter which have given me connections to my family, friends, and colleagues near and far; and which have allowed me to reconnect with my past in a profound way.
• Eleven: I’m grateful for my own psychological makeup which gave me a sense of humor, the strength to be powerfully brave in the face of fear, the willingness to work through my feelings publicly, the ability to remain lighthearted amidst darkness, and the ability to turn everything into humor.
• Twelve: More than anything, I’m grateful to have Patt Bilow by my side, no matter what.

These twelve gratitudes certainly have a spiritual component. Arguably, they may have a religious one. But, I think it’s fair to say that it is not necessary to have a specific view of God in order to maintain these 12 senses of gratitude. Certainly it does not require one to be Christian, or Jewish, or Muslim, or Hindu, or atheist, or anything else. It doesn’t require one to meditate. It doesn’t require one to pray. It doesn’t require one to forsake anything. It doesn’t require one to embrace anything. At least, in all of those cases, it doesn’t require any particular religion or belief system.

All it really requires is to look around, to seek blessings in everything around you, to embrace yourself for who you are, to refuse to give into negativity  (which I am too oft prone to do), and to appreciate your life for what it is, what you can accomplish, and who is surrounding you to support you along the journey.

So this Thanksgiving I want to once again remind us that it is not necessary to have a specific Godhead in order to feel thanks. If you are religious, that is great.  But please don’t think that your religion, or any religion, or any individual believe system is the only path to grace. You don’t need anything supernatural or mystical to feel a sense of gratefulness and thanksgiving, you need only look around and appreciate.

Happy Thanksgiving!

Ma.. Ma… Ma… My Schwannoma! (Part 1)

This is my brain:

I rather like it. It’s a nice brain. Admittedly, some of it might have been damaged when I tried to read Derrida’s “Of Grammatology” and to make sense of Foucault [note gratuitous PoMo snark]. But, basically, I dig my brain.

Chapter 1: Tingling

A couple of months ago now I began to have some numbness and other odd sensations in my face. I went to the doctor who sent me to get a CT scan to see if I had a stroke. The answer was “no”. From there I went to a neurologist who was a very talented guy but whose initial diagnoses was “huh. weird.”: He sent me to the hospital for an MRI.

Philosophy Lesson: Be careful what you ask for

As it happens, I think MRI’s are one of the most amazing things that physics has ever produced. I sort of always wanted to see one done. Of course I wanted to see one done on someone else but what the fuck. At least i got my wish.

Chapter  2: My MRI

Anyway……. The MRI showed a small tumor on my trigeminal nerve (that’d be CN5 if you ever need to pass the neurobiology 101 test). Were it anywhere but inside my skull it would be called a “nerve sheath tumor” but because it’s cranial it’s called a Schwannoma. That’s actually sort of odd because the deal is that the sheath covering your nerves is made of Schwann cells so it’s really the same thing. But, I guess if you have to resect your brain to get to something you need to give it an extra cool name. Beat’s me…

Chapter 3: Facebook Freakout

When I discovered my new friend I posted about it on Facebook. Rightly so (and I know out of love) a lot of my friends freaked out. This is because you can’t tell people you love that you have a brain tumor on the internet without making it sound terrible. So, before I tell you where my treatment plan is as of today, I want to tell you exactly what this thing is and why it’s not as terrible as it sounds.

Biology Lession: Trigeminal schwannomas

A trigeminal schwannoma is the second most common type of intracranial nerve sheath tumor, It is rare (Ha! Again I am unique!); second only to the much more common acoustic schwannoma. These tumors typically develop at the base of your skull and are formed of the Schwann cells (a type of glial cell) that accelerate the transmission of neuronal spikes across the length of axons. Basically these cells form the Myelin sheath of a nerve. [This I learned from taking neuroscience and neurobiology classes on Coursera!]. It is possible for these tumors to be malignant. But it is VERY rare.

Chapter 4: Where we are today

Now that you know what my tumor is and that it is most likely benign let me share where we are today. I met with a neurosurgeon at Oregon Health Sciences University today. He told me that there are 2 possible next steps. Either I could have a localized radiation treatment (i.e. “radiosurgery”) using one of several technologies (e.g. a Gamma Knife”) or I could have surgery. The surgery would be more complex and would likely end up with more numbness than I have today, not less. The radiation would be an outpatient procedure that would cause the tumor to shrink. The advantage of the surgery is that they could actually biopsy and study the tumor and could insure it is not malignant. The real question is this: is it worth an invasive surgery to determine that a most-likely benign tumor is truly benign at the cost of probably making one of the symptoms worse. Or is it better to assume that it’s benign (which statistics say it is) and just do the radiation? The neurosurgeon is trending toward recommending radiation but will consult with his colleagues.

Meanwhile, I will be seeing a friend of a friend who is a radiation oncologist to get a second opinion.So, with that, I’ve told you most of what I currently know. I cherish the friendship and support of everyone surrounding both my physical and my cyberspace communities. I love you all, I appreciate your support, love, prayers, thoughts, and kind words. And I’ll post more when I know more.

XO 2 Y’all!