I didn’t post the details any earlier because of an unusually happy and busy weekend, and I also went back to work this Monday morning.  To re-cap, last Friday was my first check-point MRI since the surgery – and it showed no sign of tumor recurrence. Carolyn_cone This was the expected result based on the histology and sequencing information, but it’s still nice to have hard data to confirm that the tumor isn’t doing anything aggressive or surprising.  To celebrate, I took the girls out for ice cream — Carolyn’s first ice cream cone, which incidentally, is another happy item from my list accomplished.

Waiting:

The WashU Center for Advanced Medicine is a world-class place, but they really ought to think harder about their waiting room music.  Despite confirming our appointment time by text and telephone and pre-registration, we still sat 45 minutes in the radiology waiting room before a kind nurse told us that the 3-Tesla magnet was going to be occupied by another patient for an additional hour, and that perhaps this would be a good time for us to get lunch.  During the wait, the music was vile.  First, John Mellencamp singing “Hurt so good”.  My apologies to the <possibly> dozens of John Mellencamp fans world-wide, but his particular brand of country/rock fusion has never done it for me. Can you really think of a less appropriate refrain in a hospital setting than “make it hurt so good?”  Then, Katy Perry singing a toneless and asinine refrain a few dozen times, followed by Phil Collins with a song that was last seen being mercilessly and rightfully mocked in “The Hangover.”

Speaking of hurting so good, the nurse who put in my IV butchered things a bit. By now I consider myself a connoisseur of needle sticks, but when she was making the switch between the needle and the syringe, she fumbled, resulting in much blood spilling down my arm.  It worked out fine in the end; obviously she hit a good vein.  I’ll add that tying the strings to a hospital gown behind your back is a fairly challenging PT/OT task for the recently impaired.  Perhaps the rehab hospital should drill people on this task.

The MRI:

I’ve had a few of these, and although I was usually doped or unconscious, I had a decent idea of what to expect.  The tube you’re in starts cold and uncomfortable and becomes hot and even more uncomfortable by the end.  The noise is something between a jackhammer, an alarm clock, and a cell phone ring.  It would have been a great opportunity to practice relaxation / visualization, but for reasons unknown, they decided to start with a functional MRI that my doctor did not order, and I was instructed to keep my mind as empty as possible.  Halfway through the test, my left ear became unbearably itchy; meanwhile I was under strict orders not to fidget or move.  I visualized the sensory neurons responsible for the itch as an amplifier dial, and myself mentally turning down the gain, way down.  The trick worked well enough to get me to the end of the MRI.

The Results:

MRI_1This image shows three comparable cross-sections of my brain.  Pre-surgery is far right, and you can see the bright T2 FLAIR signal from the tumor in my right frontal lobe.  Note well that this probably over-estimates the actual size of the tumor as the signal included some swelling from the initial seizure.  The middle image was taken one day after my surgery, which shows a well-defined resection cavity with no visible tumor left behind.  The left image was taken last Friday; it has some brightness on T2, but this is almost certainly glial scar formation. I don’t much care for glia cells dividing in my brain, but this is probably protective.  In any case, the MRI looks like everyone expected it to look, which is fine by me.  The resection cavity is largely gone, as the brain is rather squishy and tends to expand to fill up cavities on its own.  It is comforting to know that I no longer have a great big sloshy hole inside my head.

The next steps:

As mentioned previously, median time to recurrence for my grade of tumor is 4-8 years, so I may have to fight this damn thing again at some point (I vigorously emphasize the conditional and indeterminate nature of that sentence — plan A is to eradicate any residual glioma cells before they get a chance to re-grow).  Based on Friday’s result, happily I won’t need to fight it again immediately. Can the doctors promise me that there’s nothing worrisome within that bright glial scar?  Sadly no. Until we have better diagnostic and imaging tools, I’m stuck with binary (yes or no) and low-resolution feedback (every three months) on my anti-cancer regimen.  In one of my periodic bouts of bravado, I told one of my friends that I could have this cancer thing resolved in a fortnight if only I had real-time feedback on how many NK cells are infiltrating my CNS and residual number of glioma cells in my brain.

“My faith is an island in the setting sun”

These lyrics are from Paul Simon’s “Proof” from “Rhythm of the Saints,” one of the very best albums every recorded.  At this point, I am getting back to real life again, still meditating, eating my anti-cancer veggies, and exercising daily, and I don’t need to deal with any medical issues until mid-October.  We are settling into what I previously described as a “long, cold war against cancer”.  I wish that I had better information on how well my anti-cancer regimen is working, but in the absence of proof, there just is no substitute for having faith that you’re doing the right things.

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