Dr. L stopped by this morning to check on Steve, discuss next steps and tell him the preliminary diagnosis.
The pathologists believe the lesion is an astrocytoma, the kind of tumor we discussed last week. They believe it is a grade 3 or 4 tumor (with 4 being the most aggressive). We will learn the definitive results when we return for appointments next Friday.
In general, grade 3 is treated with six weeks of radiation therapy followed by chemotherapy. Grade 4 is treated with radiation and chemo concurrently.
Steve's body is still reacting to the biopsy. The left side of his face is almost completely back to normal. He has experienced numbness on the right side of his face. He has lost the ability to taste well -- he can't really distinguish flavors. (His sense of smell doesn't seem affected, though.) Dr. L strongly suspects that all the pain Steve experienced yesterday during biopsy was related to swelling and irritation around the fifth cranial nerve, which might explain at least the numbness he's having now on his right cheek.
His vision is still double, but wearing the patch has helped his orientation some. (And it gives him a good excuse to say "Arg!" frequently.) His head aches, and not just in the lower back of his head as before. There are those healing holes from the biopsy plus wounds from where the halo was screwed into his head.
He was removed from most of the lines and monitors this morning, sat upright in a chair for a while and walked around the nurse's station with help. He relished sitting in the chair, taking pressure off the back of his head.
The current plan is for Steve to stay another night on the neuro floor. If he's doing well tomorrow, he'll be discharged. We'll stay a night at the hotel attached to M.D. Anderson, allowing him to rest, then drive back to Dallas Sunday morning. Jayshree will drive with us and will fly back to Houston that night.
Then, we'll return to Houston Thursday night and meet with doctors Friday morning -- follow up and suture removal with Dr. L, treatment plan with Dr. C and a visit with a radiation oncologist. We hope to be back home Friday night.
Radiation will need to start as soon as Steve's sutures are healed.
We are all struggling with the news. When you look at Steve, you just can't believe that there is an awful tumor growing in his brain stem. With the help of the steroids, he has been working, taking care of and playing with Cooper and Katie, washing dishes, walking Margie. We are greatly encouraged by all of that, by his excellent lifestyle and health (tumor notwithstanding), by his inspiring attitude and outlook, by the resources we've had available, by our faith, by your faith, by the stories of beating the odds and by news of miracles.
Even though we're a few hours from home, we've never felt alone, enjoying the company of Jim, Betty and Jim, Shauna, Swati and the nice people we've met along the way.
In review:
1. Steve is feeling relatively well considering everything he endured yesterday and the news he received today.
2. Pathology says the cells look like an astrocytoma, either grade 3 or 4.
3. Steve should be discharged Saturday. We would drive home Sunday.
4. We'll return in a week for follow up, official diagnosis and treatment plan.
Showing posts with label biopsy. Show all posts
Showing posts with label biopsy. Show all posts
Friday, January 18, 2008
Wednesday, January 16, 2008
Biopsy tomorrow
The MRI today showed that the lesion has grown about 2 mm since the last MRI from Dec. 22. Because the lesion has grown (and because of Steve's worsening vision), Dr. L suggested a biopsy for tomorrow.
We had planned to fly home this afternoon and return, if necessary, next week. Instead, Steve stayed at M.D. Anderson for lab work and an appointment with the anesthesiology department. Jim was with us, so he stayed with Steve, made sure they were in the right place at the right time, took notes, etc. I took a cab to the airport, changed my flight to the next one available and flew home.
I'm home with Cooper and Katie now. I'll get them ready for bed, pack for the next few days and drive to Houston tonight with Liz's help. Ami is driving back from Austin tonight to take over here again.
Steve will check in for surgery by 5:30 a.m. tomorrow. He will be sedated and fit with a halo that will keep his head stable. They'll give him more anesthesia, tighten the halo some more and send him for an MRI. The MRI will provide precise X- and Y-coordinates of the lesion. Those coordinates will be used to guide the wire and needle that will extract a tissue sample of the lesion.
A pathologist will be available to provide a quick reading of the tissue. Exact pathology results should be ready by next Friday, when we'll return for a follow-up appointment, including suture removal.
Tomorrow's procedure should be complete by noon or 1 p.m. Steve will be admitted to ICU and spend the night for observation. If there are no complications, he would be released sometime Friday. We will probably stay in Houston for a day or two after to make sure he's comfortable before the drive home.
I have a few of requests for you all.
1. If you have time, please leave a comment here for Steve or send an e-mail to stephen.damm@gmail.com. He already feels so much love and encouragement from you all -- I think an extra note right now would be even more meaningful.
2. Please pray for Steve, his doctors and his family, especially tomorrow morning.
3. Continue to think positively!
We had planned to fly home this afternoon and return, if necessary, next week. Instead, Steve stayed at M.D. Anderson for lab work and an appointment with the anesthesiology department. Jim was with us, so he stayed with Steve, made sure they were in the right place at the right time, took notes, etc. I took a cab to the airport, changed my flight to the next one available and flew home.
I'm home with Cooper and Katie now. I'll get them ready for bed, pack for the next few days and drive to Houston tonight with Liz's help. Ami is driving back from Austin tonight to take over here again.
Steve will check in for surgery by 5:30 a.m. tomorrow. He will be sedated and fit with a halo that will keep his head stable. They'll give him more anesthesia, tighten the halo some more and send him for an MRI. The MRI will provide precise X- and Y-coordinates of the lesion. Those coordinates will be used to guide the wire and needle that will extract a tissue sample of the lesion.
A pathologist will be available to provide a quick reading of the tissue. Exact pathology results should be ready by next Friday, when we'll return for a follow-up appointment, including suture removal.
Tomorrow's procedure should be complete by noon or 1 p.m. Steve will be admitted to ICU and spend the night for observation. If there are no complications, he would be released sometime Friday. We will probably stay in Houston for a day or two after to make sure he's comfortable before the drive home.
I have a few of requests for you all.
1. If you have time, please leave a comment here for Steve or send an e-mail to stephen.damm@gmail.com. He already feels so much love and encouragement from you all -- I think an extra note right now would be even more meaningful.
2. Please pray for Steve, his doctors and his family, especially tomorrow morning.
3. Continue to think positively!
Sunday, December 30, 2007
Twists and turns
The less complicated news first:
Andy, Julie and Adam brought Cooper and Katie to Zale for a fun visit this morning. Cooper and Katie loved "bed rides" (at the direction of our friend David who had been visiting when they arrived). Steve raised the bed as high as it could go then tilted the head then the feet up. The kids also watched part of the new Veggie Tales DVD that Mike and Berta delivered yesterday.
Will, Holly and Conor arrived with boxes of Sal's pizza, enough to feed our hungry crowd. We had a great time in the nearby living area, 10 of us taking over, pushing tables and chairs around to suit our needs, eating, laughing and playing.
The more complicated news:
We think Steve will be released tomorrow.
Dr. M, the neurosurgeon who we first saw at UT-SW, has told Dr. W, the neurosurgeon who can do stereotactic biopsies, not to do the biopsy this week.
Dr. M isn't convinced that Steve has a high-grade glioma despite the MR spectroscopy results. (A neuro resident accidentally told us today that the MR spec results indicate -- though don't prove -- a high-grade glioma. We hadn't heard the "high-grade" description before this morning.) He's not convinced because of Steve's paucity of symptoms. He just doesn't look or function like a patient with a high-grade glioma in his brain stem.
Instead, he wants Steve to have a follow-up MRI in two or three weeks, followed by a biopsy if necessary.
Are you confused? We are a bit puzzled. I think it would help if we were actually talking with Dr. M, instead of hearing the information from Dr. C (the attending neurologist). Dr. M apparently is still hopeful that Steve's lesion is demylination. But even if it's not, Dr. M thinks there's time to be conservative -- to wait on all the spinal fluid studies to come back, to watch for signs of the tumor responding to the steroid treatment -- before exposing Steve the risks associated with a stereotactic biopsy of the brain stem.
The plan now is to continue to wait for the neuro-oncologist to come by for an initial consultation. She should be here tomorrow (we're guessing she won't be here this late on a Sunday). Then Steve would be released to go home.
Recap:
1. The MR spectroscopy indicates, but doesn't prove, a high-grade glioma.
2. Dr. M has called off this week's biopsy.
3. The neuro-oncologist is expected to stop by tomorrow to begin discussing possible treatment plans.
4. We may go home tomorrow. (We're learning that nothing is definite, though.)
5. Follow-up appointments will include another MRI, consultation with Dr. W (neuro-surgeon for biopsy) and follow-up Dr. M (original neuro-surgeon).
6. We're conflicted with news that the tumor is a suspected high-grade glioma (very gloomy finding) and that Dr. M, who is highly regarded and backed by years of experience, thinks it's not a glioma at all.
Andy, Julie and Adam brought Cooper and Katie to Zale for a fun visit this morning. Cooper and Katie loved "bed rides" (at the direction of our friend David who had been visiting when they arrived). Steve raised the bed as high as it could go then tilted the head then the feet up. The kids also watched part of the new Veggie Tales DVD that Mike and Berta delivered yesterday.
Will, Holly and Conor arrived with boxes of Sal's pizza, enough to feed our hungry crowd. We had a great time in the nearby living area, 10 of us taking over, pushing tables and chairs around to suit our needs, eating, laughing and playing.
The more complicated news:
We think Steve will be released tomorrow.
Dr. M, the neurosurgeon who we first saw at UT-SW, has told Dr. W, the neurosurgeon who can do stereotactic biopsies, not to do the biopsy this week.
Dr. M isn't convinced that Steve has a high-grade glioma despite the MR spectroscopy results. (A neuro resident accidentally told us today that the MR spec results indicate -- though don't prove -- a high-grade glioma. We hadn't heard the "high-grade" description before this morning.) He's not convinced because of Steve's paucity of symptoms. He just doesn't look or function like a patient with a high-grade glioma in his brain stem.
Instead, he wants Steve to have a follow-up MRI in two or three weeks, followed by a biopsy if necessary.
Are you confused? We are a bit puzzled. I think it would help if we were actually talking with Dr. M, instead of hearing the information from Dr. C (the attending neurologist). Dr. M apparently is still hopeful that Steve's lesion is demylination. But even if it's not, Dr. M thinks there's time to be conservative -- to wait on all the spinal fluid studies to come back, to watch for signs of the tumor responding to the steroid treatment -- before exposing Steve the risks associated with a stereotactic biopsy of the brain stem.
The plan now is to continue to wait for the neuro-oncologist to come by for an initial consultation. She should be here tomorrow (we're guessing she won't be here this late on a Sunday). Then Steve would be released to go home.
Recap:
1. The MR spectroscopy indicates, but doesn't prove, a high-grade glioma.
2. Dr. M has called off this week's biopsy.
3. The neuro-oncologist is expected to stop by tomorrow to begin discussing possible treatment plans.
4. We may go home tomorrow. (We're learning that nothing is definite, though.)
5. Follow-up appointments will include another MRI, consultation with Dr. W (neuro-surgeon for biopsy) and follow-up Dr. M (original neuro-surgeon).
6. We're conflicted with news that the tumor is a suspected high-grade glioma (very gloomy finding) and that Dr. M, who is highly regarded and backed by years of experience, thinks it's not a glioma at all.
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