We had our follow up with Dr. Chiang, the neurosurgeon, today to discuss next steps for my treatment given my recent seizures and the apparent growth of one of the previously treated metastatic spots in my brain.
Actually, whether or not the spot in question has an active tumor in it remains to be seen. The inflammation and bleeding surrounding it could be due to radiation necrosis from my previous gamma knife procedure (that’s when radiation kills a margin of healthy brain tissue). Or it could be brand new metastatic tumor growth. The only way to tell for sure is to go in and get a biopsy of the tissue in question; if the pathology shows that the cancer is active it then can be treated with laser ablation immediately following the biopsy. Laser ablation is essentially “cooking” the cancerous tissue with laser heat through a thin probe inserted into the skull. Ablation would be the treatment option of choice because once a spot has been treated with targeted radiation (e.g., Gamma Knife) as this one has, it does not respond well to further targeted radiation. Fortunately Dr. Chiang is an expert in the laser procedure as well as gamma knife, so we feel quite lucky to be in her hands with this new development.
The other option we considered was to take the “wait and see” approach and see what a new MRI reveals in a few more months. However, our attitude towards my treatment has always been to be as aggressive as safely possible to extend my quality and quantity of life as much as we can. Given how well my systemic treatment (Herceptin and Perjeta) is working on the rest of my body, we don’t want things to go downhill on the mental front because we waited around to deal with a tumor versus getting immediate answers. We have several bucket list trips planned for later this year (more on those as they get closer) and we’d like to get on top of this issue so that we are chasing the cancer and it isn’t chasing us.
I have an MRI this Friday evening to get the latest and greatest picture of the spot in question, then another follow up with Dr. Chiang on Monday morning (3/6) to go over the results and plan the biopsy and potential laser ablation. It is a minimally invasive procedure but takes about 8 hours start to finish and will involve an overnight stay at Yale. Once we have all the details and the timeline, I will post with more information. We were told by the surgical coordinator that because it is an MRI-guided procedure, there is only one operating suite in all of Yale that is equipped for laser ablation, so it’s unclear how quickly I’ll be able to get scheduled in.
Also in the less-than-good-news category, I’ll have to continue taking these lovely anti-seizure drugs for at least six months to ensure no further episodes. The doctor assures me that my body will adjust and I will feel less spacey over time. I’m looking forward to getting my short-term memory back under control, as it is ridiculously wonky at the moment (if I owe you an email, text, or any other communication feel free to remind me at any point).
Finally, we wanted to thank everyone for the outpouring of support in the wake of my Dad’s untimely death, both in your kind messages and cards and your contributions to my bucket list fund. Unfortunately, I was not able to make it to the memorial service due to the risk of flying cross-country in my present condition (the doctors couldn’t assure me that I wouldn’t have problems with the air cabin pressure and my head). But Cas and his terrific boyfriend Spencer were able to make it out to the celebration, and I was able to FaceTime in to the memorial service on Sunday and see everyone and all the lovely photos and tributes to my Dad. I sure do miss him but know he is up there hanging out with the grizzly bears and keeping an eye on us all.