Sunday, August 24, 2008

A summary of sorts.

Music: Shocking Pinks - This Aching Deal (click to download)

Ever dreaded to meet your good doctor, knowing that the only thing he/she has in store for you is bad news? You're not alone. I've experienced this from all angles; my neurosurgeon, craniofacial surgeon and oncologist. Perhaps the scenario would be slightly different if I were to be in more "advanced" countries - whereby solutions were much more diverse and the doctor-to-patient relationship was a tad bit warmer.

A handpicked conversation with two neurosurgery consultants.

Me: Good morning, Doc.
Doctor: You thinking of heading into operation?
Me: Well, if it’s the best possible solution, I’d definitely go for it. Depends on your prognosis, Doc. I really am open to your suggestions.
Doctor: Because the tumour is quite big. If we don’t go in and remove the tumour, it’ll cause problems later. And your double vision, I think the cause of it is due to the optic nerve; the ocular motor nerve being affected by it as well. The nerve is compressed.
Me: How big is big, Doctor? I mean the size of the tumour you’re seeing on the MRI films. I’m not good at deciphering this.
Doctor: How big is big?

(My doctor rummages through the thick archive of files and searches for the ones scanned recently.)

Doctor: From what I have in hand it looks like its 4x2 cm.

(My doctor goes to show me the other areas that are affected by the brain cancer and explains that an aggressive form of surgery will need to be performed which involves craniotomy and maxilla facial surgery.)

Me: But what are the chances of removing everything. I mean will this aggressive surgery improve chances of removal or are we going to remove for the sake of downgrading the danger. This complicated technique that you’re going to deploy (craniotomy & maxillofacial surgery), will it further increase the chances of say, at least, a 90% removal?

(My doctor pauses briefly.)

Doctor: I’ll have to check with my head of department for better clarification of the matter. Where did you say you got your surgery done back in 2006?
Me: Island Hospital.
Doctor: Oh okay. Did you get your radiotherapy completed thereafter?
Me: Yeah got that done too.

(The head of department briskly walks in. Someone told me once that he’s an old Free School boy. Maybe he’s got some answers.)

HOD: What did your surgeon do? (He smiles.)
Me: Huh?
HOD: What did your neurosurgeon do in 2006?
Me: Uh…a craniotomy.
HOD: He didn’t ask for plastic surgeon first time around?
Me: No…
HOD: It has grown back and this time it is growing back rather fast. The core reason why you’re able to sit here and talk to me today is mainly because your brain as a whole is still okay, you understand? The problem is on the outside. Majority of it is resting on outside, infiltrated the bone and partially gone into your orbit and sinus. The tumor is also stretched along the surgical plain which is why you have a little lump on the top of your head right now too. For this surgery, it’s definitely a two person job; you need a neurosurgeon and plastic surgery to come in. The plastic surgeon has to open up your face and get reconstructive surgery done after that. Big surgery – at least 20 hours.
Me: Can you help explain to me the nature of this cancer? I mean could it be my diet? Lifestyle?
HOD: Chondrosarcomas are what we call embryonic cells. These cells are developed as early as when you’re in your mother’s womb. Most of these mature to become your eyes, your nose, and your teeth. And somehow these things have stayed there and over the years have become malignant. It’s got nothing to do with your diet, smoking…it’s just luck. That’s why it didn’t happen to your brother and that’s why it doesn’t often occur to anybody else.

(The HOD stares at us in silence for a brief moment.)

HOD: You know, I don’t recall your cancer being this bad. When did this first happen?
Me: In 2006.
HOD: I see. (He looks at the older files circa late Jan 2008.) Yeah, this one I remember. In the end, I honestly wouldn’t know how I’m going to open if I were to be handling your case. You need surgery. But my advice is that you need surgery done by a damn good neurosurgical team and craniofacial team. It’s gone very aggressive and you wouldn’t know if you’re going to go through 3 to 4 to 5 ops in your lifetime.

As acknowledged previously, I know for a fact that I have hit the 'jackpot' - a rare form of cancer that my oncologist remarked as, "You're the first chondrosarcoma case in Penang for 2008.". That's motivating. A guinea pig lined up for surgery in front of trainee doctors under the tender age of 25. Yes, you've probably noticed them if you walk along the corridors of our government hospitals of late. I'm not doubting these new talents as per se but I reckon in a brain op I'd rather put my last penny on the veterans, wouldn't you?

Perhaps if I dug a little deeper into the internet, I'd find a kindred soul out there who's battled this bastard of a disease. And I'd write to him or her...long letters of fascination and praise (while I still can). I shudder to think of facing anything right now...with or without surgery, it all looks bleak.

Go under the knife and I lose my right eye and the likelihood of experiencing loss of vision on my left when I undergo tomography radiation. This is due to the fact that I have done radiotherapy before in 2006. With an already weakened tissue, a void on my right eye socket and higher dosage of 'gray' (Gy) during irradiation, the oncologist mentioned that vision on my left eye could be severely affected in the long run. The current known standard of treatment for skull base chondrosarcomas is to set irradiation at 65Gy in 39 fractions - which contradicts the range 'tolerable' to our optic nerves (40-50Gy).

Another option to consider post-surgery: proton therapy. It's been known to be pinpoint and cause substantially lesser damage than the former (tomography radiation). The downside? Indicated by my doctor that unfortunately, the nearest centre to get such a deal within Asia would be off to Samsung Medical Center in Seoul, Korea or Japan.

Running through these options in my head, what would happen if I don't go into surgery within the next few weeks? My shiver at the thought of my cancer metastasizing to other organs. I don't mind being 'gung-ho' but that's pure folly!

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