another meeting with Dr. Kim (neurosurgeon #2)

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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