Monthly Archives: June 2008

Home Again, Well Ahead Of The Schedule

Brain

I’m already home. No, I have no idea how this happened. The original expectation had been that I’d take four days or so to recover following the removal of the tumor from my left temporal, which happened as intended yesterday morning. I apparently was conversational the entire time, as intended, even though I barely remember a damn thing and indeed worried that I’d fallen asleep when I was supposed to be collaborating with the crew.

After the removal itself, I was transferred to the Intensive Care unit, where I spent most of last night sleeping intermittently, frequently checked by nurses to confirm that my eyes, nerves, and general left/right side were all in working order.

This morning the surgeon himself, along with the anesthesiologist, had a look at me and basically decided that I was well enough to leave today. Apparently this happens infrequently enough that the staff of the ICU didn’t really know the procedure for getting out. (They were, like every other single person I’ve met with at Stanford, incredibly friendly the entire time, and did figure it out eventually.)

So now I’m home, and about to go to bed. I may sound reasonably normal in e-mail, but the truth is that at the moment I have to grope around blind for the appropriate term — noun, mainly — some of the time. You don’t notice this when I’m writing, but you’d notice it fairly quickly when speaking to me in person. This should faded over the next couple of days as the area near the removed temporal area reduces back to its usual size. We’ll see how it actually feels when I’m done.

I’m exhausted now, so I’m going to bed. Have fun tonight, whatever you all are doing, and I’ll try to update you soon.

“Feels like a fire down below…”

Idiots, Life

We interrupt your regularly-scheduled litany of borderline-morbid neurological news for something completely different.

Frank and I were returning from coffee yesterday afternoon, and he was dropping me off at the side entrance to Cisco Building 20, when I noticed something unusual in the enclosed area housing the dumpsters. Through the narrow gap beneath the locked steel gates, bright orange flames danced, licking the air.

“Hey, do you see that?” I asked, pointing. Indeed he did. He slowed the car, and we took enough of a look to verify that, yes indeed, something was on fire in there.

By the time he’d parked the car, it was clear that more was burning than just the bits of cardboard we’d spotted earlier. The flames had spread to the contents of at least one of the dumpsters.

Since there didn’t seem to be an immediate threat of the fire spreading, we decided to call Cisco Security rather than 911. Not having their number in my phone at the time — I certainly do now — I headed to the building’s lobby to call in the alert, then headed back to the side entrance.

The first Security truck arrived promptly, but its occupant didn’t really seem to have much more idea of what to do than we did. “Yep, it’s on fire all right” seemed to be the extent of the immediate response.

This was approximately the point where Frank and I decided be a bit more… hands-on, and headed into the building to grab a fire extinguisher or two. I will cheerfully confess to a certain amount of glee at the prospect, as I had never had a chance to use an actual fire extinguisher against an actual fire before.

Standing on the concrete base of lamppost and bracing ourselves against the enclosure wall, we took turns aiming for the base of the flames and spewing gouts of powdery white extinguishing compound at it. This put out the visible flames, but we could tell that hot spots remained beneath the ashes.

At this point a second Security truck appeared, and its occupant actually unlocked the gates. We had a better shot at the flames now, but had completely discharged our extinguisher. After checking in his truck for another, the second Security guard came up empty, so Frank and I went back into the building for seconds. We handed one of our finds to the guard, who was apparently unfamiliar with the whole “pull pin to enable trigger” concept. A few more blasts of noxious white powder — nearly as suffocating to humans as to the combustive process — and some poking of the embers, and things seemed to be under control. (In the process we noticed that there was in fact a fire extinguisher attached to the inside of the enclosure. Security Guard #2 wasn’t any more aware of it than we had been.)

I had to leave to pick my father up from the airport at this point, so I missed whatever epilogue might have unfolded. While on my way to Terminal 1, though, I made the mistake of licking my lips. Ugh. There was enough powdery residue on my skin to convey a hint of bitterness, unwholesome and deeply synthetic. (That stuff’s probably carcinogenic. Hahahahaha. Carcinogenic! Ahahahahahaha! Ahem.)

This story has two morals. First and most importantly: when something’s on fire, call 911. Do not screw around with half measures. Do not assume that the employees of your private security firm have the training, equipment, or expertise to handle the problem effectively.

The second, less crucial moral has to do with the guy on the third-floor balcony who was jabbering away on his cell phone — and not, from the sound of it, to the fire department — while the contents of the dumpster were blazing merrily away a few dozen yards away from him. I feel a certain measure of satisfaction in the fact that he must have been engulfed in clouds of the asphyxiating powder our amateur efforts at fire suppression unleashed, and I hope it ruined his day. But he served to illustrate an important point: don’t be a self-absorbed little twit if you can help it.

Here endeth the lesson.

Next Steps

Brain, Family

Here’s the approximate timetable (for me, anyway) for the rest of this week.

  • Wednesday: Meet with the anesthesiologist and neurologist. Submit to another MRI. (This is an additional reason to keep my head shaved: during the last MRI, they had to adhere little saline-filled discs to my head, to serve as reference points and target markers: since said discs adhere poorly and imprecisely to hair, this required them to shave quarter-sized areas on various points around my scalp. I’m expecting that they’ll want to use such markers again, so I might as well beat them to the shaving punch. There are few things more dorky-looking than a little pseudo-tonsure halfway between your hairline and the whorl where any normal human would start developing a real bald spot.)

  • Thursday: The main event. Put Dan under, open up his skull, bring him back to consciousness under sufficient sedation that he won’t freak out about the existence of the improvised access panel on his head, and probe him with electrodes while asking him various questions in a mixture of languages to map out the temporal lobe. Remove as much of the tumor as is feasible. Put Dan back to sleep and close him up.

  • Friday onward: Recovery. Give the bones a chance to knit, watch for signs of infection, perhaps keep me somewhat centered in a narcotic fog. (I don’t know that I’m getting any really good drugs, but I can hope.)

  • Tuesday of next week, maybe: Meet with the neurosurgeon and neurooncologist to map out further treatment plans. Chemotherapy is pretty much a given, but as I’ve written before, this is not as grim as it sounds. The chemotherapy agents used against brain tumors are supposedly well-tolerated, so the sick-as-a-dog puking-my-guts-out scenario seems distant and unlikely.

    Radiation is the big question mark. It can be effective in helping to kill the tumor cells, but it can also have some undesirable side effects, in particular upon vascularization (read: the distribution and character of blood vessels within the brain). The fact that this particular tumor is fairly superficial, lying close to the junction of brain and skull, means that the radiation won’t have to penetrate much healthy cerebral tissue to be effective. This is good, and may reduce to the potential downside.

    My father’s tentative inclination is to keep radiation in reserve, but he’s quick to add that the state of the art is advancing rapidly, leaving much published research inherently behind the curve. I suspect that this is one of the topics we’ll go most into depth on whenever we do meet with the neurosurgeon and neurooncologist. (Again, there’s no guarantee that it will be next Tuesday. A Tuesday, most likely, because that’s when the two practice together.)

I expect that I’ll be discharged from the hospital sometime in the middle of next week, but I don’t know exactly when, and I’m not sure that anyone else does at the moment, either. It will be predicated largely upon how quickly I recover and heal, and whether any complications arise on the way.

I will try to keep folks posted as best I can. This depends a bit on when I regain consciousness, how soon I’m allowed to use my computer, whether I can get any kind of network connection in my hospital room, etc., etc. It may well be that the place to look for the earliest first-hand sign of post-op life is my Twitter feed, since in theory I’ll be able to update that from my iPhone even if I don’t have WiFi. (Of course, lately Twitter has me completely beat when it comes to succumbing unpredictably to seizures, so… no promises.)

The Good, The Bad, and The Ugly

Brain, Family

(Guest-starring Lee Van Cleef as The Man Made of Scalpels.)

I still haven’t received an actual tangible version of the biopsy results — I will apparently have to send a fax requesting them, and will likewise receive a fax in response. This feels oddly archaic, especially in a day and age where I was handed my imaging results on a CD-R the day after they were taken, but never mind that.

I do know, roughly speaking, what they say, having had a chance to discuss them with my surgeon a little over a week back. They’re a bit of a mixed bag in some respects, but overall, things could be a lot worse. Here, then, is a summary of what we know, albeit not in the order promised by the title.

First, the bad: it’s an astrocytoma, rather than an oligodendroglioma. This means that it lacks the chromosomal deletions that would maximize the effectiveness of currently-available chemotherapy. So it goes.

Next, the good: it’s a low-grade astrocytoma — Grade II on a scale where Grade III is ominous and Grade IV is serious stuff indeed — and it is, as far as we know, not malignant.

This brings us to the ugly, of which there are actually a few separate bits.

  1. When it comes to brain tumors, “benign” is a bit of a misnomer. A red herring, even. Nearly all other areas of the body feature membranes to keep things tidy and compartmentalized. This serves to contain, for instance, a benign skin tumor. The brain lacks any such membranes, so while a benign tumor won’t send out little metastatic seedlets to colonize other parts of the brain, it won’t be confined, either. Given enough time, it will grow and crowd healthy tissues — hence the need to control it.

  2. The odds of completely removing and/or killing the astrocytoma are somewhere between slim and none. The best that can be done is to remove as much of it as possible without affecting the function of healthy tissue, and then attacking what’s left with chemotherapy and possibly radiation.

  3. One of the obnoxious habits exhibited by astrocytomas is a tendency to eventually go malignant, even if they didn’t start out that way. It seems to happen to pretty much all of them eventually. (When you start out with a somatic mutation in p53, the gene that’s responsible for keeping other mutations in check, most anything goes after that.)

  4. With all of the preceding is said and done, median survival time for patients with astrocytomas is eight years and change. For those of you whose statistics are rusty, this means that half of those surveyed live longer, and half, well… don’t.

    This may sound grim, but I have every intention of being on the very far side of the bell curve. I have a first-rate medical team, a pathologist father who I trust will keep me from doing anything clinically stupid, and an incredibly warm and supportive group of friends and family who are stumbling over each other to offer their assistance in any way they can. (More on this last point in an upcoming post.)

    Lastly, the science on this stuff is moving quickly. The current arsenal of chemotherapy drugs is quite recent, and if I’m not mistaken, the weapon of choice against oligodendroglioma only appeared on the field something like six years ago. So there’s some basis for hope that the longevity curve will stretch out before me as I walk it.

Upshot: I’m totally banking on being ahead of the lot of you when they start rolling out the military-grade neural interface packages. I’ll have an easily-reopened hole in my head and a little cavity where they can stash the hardware-wetware bridge. You’ll envy me, suckers.