pre op starting this Friday

We're currently scheduling all of the pre op appointments for Mark this Friday 12/2. He will be doing blood tests, giving a pint of blood, a new MRI, other xrays and other tests that need done before surgery. He will also go back on Monday 12/5 to give his second pint of blood. After that, we're waiting for surgery. It will be Tuesday 12/13 @ 7:30am. Fortunately, Mark's family will be here before, during and after surgery for support.

surgery date has been set

We finally got the results of the blood test and the indicated that there were no signs of infection and no signs of valley fever and all other blood work was normal....so, now that the lungs are clear and we know it is not valley fever, we can now focus on what is in the brain.

We have decided to go with Dr. Martin as our surgeon. We discussed with him the various treatments:

1. gamma knife (radiation)
2. biopsy first then determine if do gamma knife or crainiotomy
3. crainiotomy

We discussed the various pros/cons of the various treatments with several doctors. The gamma knife is less invasive and has a few less risks, but since we really don't know what kind of tumor it is, it is unclear if this is the right treatment or if it would even be effective. We're assuming we know what kind of tumor it is, but we really don't know for sure without testing it. For example, if it did end up being some sort of inflammitory item or something else strange, this would not be the right treatment. We could biopsy it first to determine exactly what it is then we could decide if gamma knife was right or if we just need to take it out; however, there are risks of bleeding associated with this procedure and Dr. Martin and Dr. Kim both suggested that the risks were very close to the same as if you would take it out and biopsy it at the same time. The third choice is what we're going to go with...remove the tumor and biopsy it at the same time.

A surgery date has been set: Tuesday, December 13, 2005 @ 7:30am

What's next:
----------------
11/28/05 - pre op appointment where he'll give a pint of blood, have another MRI, have xrays and other procedures and we should bring all films, etc.
12/05/05 - give 2nd pint of blood for possible use in surgery
12/12/05 - call between 2-4pm to confirm surgery time
12/13/05 - get admitted @ 5:30am, surgery @ 7:30am
hospital stay about 5 days

discuss PET scan results

------------
We met with:

Dr. Shukla
320 superior #240
Newport beach, ca
949 548-5111

Talking points: discuss PET scan results

Here's the results of our conversations:
The PET scan showed that the left lower lung problem is now just about gone, probably was some sort of pneumonia or mucus plug.
Won't need to do anymore followup on lung issue, it is no longer a concern!
Valley fever is still a possibility for thing in brain, waiting for blood results from that test.
Blood tests showed that there were no signs of an infection and that other blood work was normal.
The PET scan did show a dark spot where the brain tumor is, which indicates that it probably is not a high malignant tumor in the brain since it didn't show too much blood flow in the PET scan.


Whats next?
---------------
Get valley fever and dilantin level results from blood test.
Surgery is likely for removal of brain tumor, we'll probably be setting up an appointment.
We're still reviewing pros/cons of each surgeon.
Mark is leaning towards Dr. Martin who will do a full removal with biopsy to determine where tumor came from.

lung discussion with Dr. Shukla

------------
We met with:

Dr. Shukla
320 superior #240
newport beach, ca
949 548-5111

Talking points: what is mass found on left lung?

Here's the results of our conversations:
Had any lung problems before? May have had pneumonia when young? Has quite a few sinus problems, especially when surfing. Had some allergies previously, but not really bothersome too much now. Currently has a little bit of phlegm, but not too dramatic.
Eye problems? Recently has had some eye problems focusing on small print, but am also now 43 :)
Any joint problems? Have had trouble in left hip and general stretching problems and recent right knee pain.
Any fevers? Did have 101 on 10/6/05
Dr. Shukla showed us the questionable mass in the lung on the scan. He said that it doesn't look like cancer, because it branches out like it is an infection. It has lots of squigglies which is not cancer-like but could be a fungus infection (i.e. valley fever), parasite or some other kind of infection. A PET scan (functional scan that shows up tumors) needs to be done with CT and fusion, if it is positive and verifies that the tumor is there, we need to biopsy, if negative and we don't still see it in the scan,we won't need to biopsy and would just need follow-up (up to 2 years) to make sure it is not growing. Chance of it being bad news is quite small. Looks benign. Possibly something left over from a previous infection/cold. The pulminologist said that there is so much activity in the brain that it is difficult to see specifc tumors in the brain with a full body scan. There are other PET scans specifically for the brain. He said that the brain tumor may or may not show up in the full body scan. Since it is fairly small, it may not show up.
During our visit, we called Dr. Kim and asked if brain thing could possibly be a parasite. Dr. Kim said that it is possible that it could be a worm/parasite in the brain!
Dr. Shukla also told him that physiologically, the lung thing would not be a problem to operate on brain; however, we definitely need to find out the cause of the lung lesion so we can possibly know more about what could be in the brain.


Questions:

What is involved in a biopsy? If we did need to do a biopsy, it would be easy to do based on spot and would be an in/out procedure using a small needle under local anesthesia.

If it is a parasite, are there any nutritional ways to fight it? No, you would need an anti-parasitic drug

What is involved in the PET scan? You must first call insurance, to get pre-approval because it is a $5000 test.
It is an out-patient test.
It is a full body scan, which is good to see if there is anything else
During the test, we will also take cat scan again so we can see if there is any improvement of what was found in the lung previously, which is possible that it could go away.

Whats next?
---------------
get blood test results from 11/1/05 to see if there are any signs of infection, I will also call and ask them to test the blood sample for valley fever
get pre-approval for PET scan
schedule PET scan as soon as possible
11/10/05 tentative meeting with Dr. Shukla to review PET scan @ 5:15pm (may schedule earlier, depends on when we can get PET scan)

another meeting with Dr. Kim (neurosurgeon #2)

------------
We met with:

Dr. Kim

Talking points:
Check new MRI/Functional MRI
Show him previous functional MRI as well for comparison

Here's the results of our conversations:
Wants to see how it goes with pulminologist (Dr. Shukla) on Wednesday. Dr. Shukla will look at CT scan and chest xrays and will decide if he can biopsy the lung mass or not.
If we get a diagnosis from the lung biopsy, it may be able to tell us what the type of brain tumor is. If we can't biopsy it or if the results are inconclusive, we'll have to decide what to do about the brain tumor.
If the lung biopsy can verify that it is a tumor and we know what kind it is, gamma knife would be the way to go.
If we can't tell what it is from the lung biopsy, probably best to take it out. This can be done with a needle biopsy first or just take it out. Needle biopsy is a smaller surgery, but there is a likelihood that it will have to come out anyway.
Dr. Kim feels that there is a better advantage to take it out, and would probably need more follow-up afterwards.
We should get another blood test to check for certain infections (Mark did this later that afternoon.)
If blood test says it is an infection, we can possibly treat it other ways.

From looking at the new mri scan, Dr. Kim confirms that he now just sees one tumor and not two and that there is a vein close by.
The tumor is behind the sensory area for the right side of the body.
It is in a critical area, but because it is fairly small, so there are lower risks of permanent side-effects based on its location.
Swelling should go down quickly after tumor out.


Questions:

When should surgery happen? Within in the next 4-6 weeks.

Is the tumor getting bigger or smaller? Size looks the same

Questions about numbers on first functional MRI? Do you see any issues with sequencing? The functional MRI doesnt' show specifics of what the brain is doing (i.e. sequencing)
it only shows the general areas for different functions (i.e. auditory, reading, etc.)

What kind of treatment would be required after tumor removed?
Continue with dialantin? Yes, he would continue for 3 months or more
He will continue to get periodic MRIs after surgery to check for recurrance.
If biopsy confirms malignant tumor, what then? If the tumor is malignant, radiation or gamma knife follow-ups would be required.
If tumor is infection related, Anti-infection drugs would be needed.

What about about chemo impregnated wafers to insert in the cavity caused by the removal of the tumor if tumor is malignant?
These wafers are more of an option for the future, they haven't yet been approved for metastatic tumors.
This tumor is small, it is actually smaller than one of the wafers, so it would not fit in the cavity.

What sort of hospital stay if we go for tumor removal? 2 or more days
What sort of recovery is expected? couple of weeks

What's next:
11/01/05 blood test to check for infection signs
11/02/05 1st meeting with pulminologist Dr. Shukla @ 4:30pm