Surgical consultation; Oct 30

We met with the neuro-surgeon as scheduled on Thursday. As you know, Brian was not very gung ho on the idea of surgery for many reasons. I could recap them, but I am tired of retelling it. Forgive me.

We both fully expected the surgeon to come in and convince Brian surgery was the best option at this point in time. Brian had never met with this neuro-surgeon. In April of 2007, when we discovered the recurrence and knew we needed to take surgical action, Brian had a lengthy telephone conversation with him to discuss surgery. Brian also revealed to this doctor at that point in time that we would most likely be traveling to California for the surgery with a doctor that we had used in the past. He was incredibly supportive and Brian remarked back then how impressed he was at the surgeon's approach and attitude. I researched the surgeon and remarked how impressed I was at his mug. (seriously, go click, Me-ow!)

Where was I? Oh yeah.

Dr. K comes in and tells Brian he is glad to finally meet him. He wastes no time beating around the bush and says, "Well, you know why you are here. You know what is going on. You just have to decide what you want to do about it. Brian, if I remember correctly from our last conversation (note: 18 months ago) the Lord is in control here." What? Be still my beating heart. Did I just hear a doctor, no wait, a SURGEON, say "the LORD?" He didn't say, "your God" or "your faith." No, he said, "THE LORD." I immediately felt peace in his presence.

He went on to discuss and think through out loud exactly all the same scenarios we have played out. Is this tumor? Is this treatment change? (from radiation or chemo?) If it is tumor, then surgery isn't really improving much except debulking something that is growing at an alarming rate and wouldn't be worth the risk. If it is treatment change, then it could do some good to debulk and relieve some pressure. He thinks there is a pretty decent area to enter with fairly little risk to Brian. "Fairly being the key word" in his words. There is always risk with any surgery. As he gets deeper into the enhancement, he gets closer to vital functions for Brian - mainly his speech.

The thing is, the enhancement isn't showing all the normal characteristics of tumor progression. It also isn't showing all the normal characteristics of treatment change. It is showing signs of both. Experience and instinct tell him it is more likely tumor progression. While the Petscan is encouraging, it is difficult to believe.

(In the what-the-heck-is-that and why-are-you-showing-this-to-me categories: This is Brian's brain. The top picture is from the Spring. The bottom picture is from the Fall. You can see the considerable growth of the odd area of enhancement on the right (which is actually flip-flopped from reality: the tumor is on the left just above Brian's ear.) It is now the size of a golf ball. The various colors of enhancement on the bottom are more typical of tumor progression. The more definitive lines around the enhancement are more typical of treatment change. )

Then he said something that made a lot of sense and we hadn't really considered, "If it is treatment change, then theoretically, it shouldn't really change much for the next scan. I think it is very reasonable to watch this for the next scan and make a more informed decision then. If it doesn't change, and you are not having additional problems, we could very well continue to monitor this."



Also, he said, "Brian, at some point in time, you have to say, 'no more surgeries' and put yourself in the Lord's hands and submit to whatever His will may be for your life." And that is exactly what Brian has done. Still, to hear a surgeon say it, was somehow comforting. It was comforting to know God led us here to this surgeon who is a fellow believer.



So, here is where we are: Brian has another oncologist appointment on Monday. We will discuss what chemotherapy we continue with from here. The last thought on this was that if we are considering this may be treatment change, it wouldn't be unreasonable to continue with the same chemotherapy. We will further discuss this on Monday. Brian repeats his MRI on November 17. We will make an appointment on Monday to get those results. No surgery for now.



Here are Brian's and my thoughts: The fact that the enhancement is growing at an alarming rate, is obviously concerning. The negative PetScan is encouraging and directly contradicts normal tumor progression. However, false negative brain Petscans are not uncommon. The fact that the enhancement is following neither the normal characteristics of tumor progression nor treatment change is difficult to decipher. We think it is God's way of saying, "KEEP BELIEVING. No matter what, trust Me. I have a plan for you and will take care of you either way. Keep hoping in Me. If it is tumor and Brian continues to worsen, I have you in My hand. I will be with you the entire way until Brian comes home with Me. If it is not tumor, then your entire hope is in Me. Regardless, enjoy your 'borrowed time,' live each day like it may be your last, and continue living in faith."



So, we will continue doing exactly what we have been doing. I think we are doing it well.



KEEP BELIEVING