Neurosurgeon #2, he's a keeper

Finally a doctor I respect, understand and like. This one's a keeper. (I'm sure Troy's glad to hear that, he's sick of coming along for these 2nd, 3rd and 4th opinions, with a $50 copay for each, but he's been a trooper!)

We left again, with no more definitive answers, but more information on why there are so many questions. Let's start at the beginning:

- what is it? he doesn't know, and here's why: He thinks it is probably a meningioma, which was the initial diagnosis. (by the way he says there is only 1, the second blip only shows up on 1 slide, so he doesn't think it's actually anything to note) But this doesn't show up like typical meningioma. When you get an MRI they take pictures of slices of your brain. They do it from top to bottom and front to back and side to side. Then they inject you with a contrast dye and take the same pictures again. Meningiomas typically only show up on the second set of pictures, after you get the dye to light it up. Mine shows up on both sets of pictures, which leads them to view the mass as something else, possibly containing bone, or marrow, or blood. It could be a bone tumor, it could be a fatty tumor, it could be many things, so they want to rule some of those out BEFORE treating it as a meningioma. That's good news. We like knowing that they want to be sure of what it is, before they zap it with a laser or cut it out. Good call!

- what do we do about it? he doesn't know, and here's why: If it's bone or another type of tumor, we have to treat it differently. If it is a meningioma, they're slow growing, rarely cancerous and still eligible for both options radiosurgery, or the traditional crainiotomy (brain surgery). But we can't decide what to do, until we know more about what it is.

- how do we find out, and when will we know? we do more scans and hopefully in 2-3 months, we'll have a more definitive answer. They're scheduling a CAT scan right away. That will show him if the mass is bone, and then he can work to further determine if it's a bone tumor, abnormality, or whatever, and we'll move in that direction. In 2-3 months, he suggests we do another MRI, which will help determine the growth rate. If it's slow growing, like most meningiomas, we can then determine what to do and when to do it.

- do we need to remove it? yes, most likely, we do, the question is when. Meningiomas are slow growing, but I'm young and I will likely have to deal with it at some point before I die. If we discovered this when I was 92 years old, he'd say ignore it, you won't be around long enough for it to matter. It's NOT causing problems now, so it doesn't need to be removed immediately. If it's a slow-growing, meningioma, then it could be 20 years before it's large enough to put enough pressure on any part of my brain to notice a problem. So yes, in theory we could wait an not have to deal with it for years to come. But, I'd be older then and you always recover better from surgery when you're young, plus, when it's smaller you have more options such as the radio surgery. Once it's bigger, your only option is full blown brain surgery.

- what are the surgery options and which is best? the second half of that question is tough to answer, but we'll know more about what's best when we know what it is. There are basically two types of procedures for us to consider a crainiotomy (knife into scalp, saw through scull, cut out tumor tissue and close head back up) or radiosurgery (targeted radiation rays blasted to exact point in my brain to freeze tumor and stop future growth.)

- what are the pros and cons of crainiotomy? pros, you remove the tumor and any questionable surrounding tissue, you do pathology on the tumor to determine exactly what it is and if it could cause future problems elsewhere in your body. Cons, this is brain surgery. You spend 2 days in intensive care, 4-5 days in the hospital, minimum of 2 months before you get energy and ability level back, plus setbacks after that. Oh, and they have to shave some of your hair off.

- what are the pros and cons of radiosurgery? pros, no cutting, no shaving, no scar, you don't even get undressed for the surgery, you leave the hospital the same day, you can drive yourself home (but they don't suggest that) Cons, the tumor stays in there, it just stays the size it is and the radiation stops it from growing any larger which would cause the future problems, you don't get to do pathology, so you don't know what it is, or whether it could cause future problems down the road. (upside of that is, I'll have to get an MRI and CT scan at least once a year for the rest of my life, so if something did turn up, we'd know quickly.)

- what next? We schedule a CT scan in the next week or so. That will tell him immediately if it's bone which leads in a new direction, if it's not, we'll continue to assume it's probably a meningioma. We schedule a follow up MRI in 2-3 months and see if it's grown, etc.. and we come back to see him. (unless of course something important is revealed in the CT scan, then he'd want us back immediately for a completely different set of options, but that's not what he's expecting.)

- are we wasting precious time? no, he doesn't see anything to indicate this is fast growing and even at 2.7 centimeters, he says I'm a long way from the radiosurgery cut off points. He say that rather than a round ball, my tumor is long and skinny, like a comb. That makes it easier to target all the outside of the tumor, so it can be 5-6cm long and still be okay for radiosugery.

- what about the possible mini-stroke? he doesn't think that's the case. he thinks the spot on my brain is from the migraine drug reaction, when I thought I was having a heart attack and experienced the numb, tight, weak feeling on my left side. He thinks that did kill some brain cells, which is what showed up, but that's deep in the center of my brain. He says the risk of stroke from birth control pills is in the large blood vessels of the brain, and he doesn't see ANY problem there. His advice was to weigh our options, if the ovarian cysts are also a threat to my lifestyle, he says to go back on hormone and control the cysts, but preferably just progesterone and not estrogen. We're waiting that out for a month or so to see how it goes.

Okay, I think that covers the basics, so now you're as up to date as we are. More to come after the CT scan, if it shows anything or after our follow up in 2-3 months. Until then, keep the good thoughts and prayers coming!