Thursday, December 27, 2007

Good morning

Steve is feeling so much better. He still has a headache, but the pain is much less. He's eating, walking around more, joking.

Dr. A, the resident who has been with us since the St. Paul ER experience on Christmas Day, was just here. He better explained the MR spectroscopy, which I'll try to do here.

The two-to-four-day wait is for scheduling. The test isn't done very often, and imaging has to pull in the appropriate personnel in the middle of the holiday week. The RN and I both politely urged Dr. A to call radiology to get the process moving.

For some context, an MRI offers a 3D image of the brain (or whatever body part is being scanned). An MRI can show you the structures inside -- bone, nerves, masses.

An MR spectroscopy looks at the chemical makeup of the brain. During the procedure, the imaging would focus specifically on the area around the lesion and inside the lesion. There are certain chemicals that are expected in an infectious area; other chemicals are expected in a tumor. The results of the spectroscopy will point them in a direction, not necessarily provide a definitive diagnosis.

Dr. A says when he looks at the MRI image and sees how well Steve is functioning (notwithstanding the awful rebound from the steroids), he thinks Steve has some kind of demyelination -- a condition in which nerves are damaged -- that is perhaps just a one-time condition. (If before we were rooting for lymphoma, we're now really rooting for a one-time condition!) And, like every other doctor, he acknowledges that it could be a tumor, perhaps one that is wrapping around the nerves but not damaging them. Again, tumors in adults in this area of the brain are extremely rare.

Dr. A and Dr. C both now have mentioned that a biopsy would be the next diagnostic tool if necessary -- after the spectroscopy results are in and all the studies are back from the spinal fluid tests. The hope is we don't have to get to a biopsy, that they're able to determine something before then.

Next steps:
1. Steve continues to regain strength at the hospital.
2. He'll undergo the MR spectroscopy whenever all the people and pieces fall into place.
3. We'll go home and wait for results from the spectroscopy and the spinal fluid studies. Those results will determine the necessity for a biopsy.

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