I recently saw a great movie (titled ‘Race”) and one scene from it really struck me and persisted in my mind. Let me describe the scene to you: it is a movie about the track and field athlete Jesse Owens. Near the beginning of the movie Jesse is in college in the middle of a training session with the football team watching. One of these players makes a racist comment towards Jesse, clearly flustering him. The track coach notices this and in the next scene confronts Jesse about this. However, while confronting Jesse about this he deliberately riles up the football team and coach, in an effort to teach Jesse a lesson on the importance of focus; there is a poignant moment where all the football players are yelling, while the coach implores Jesse to focus on him, that “All of this is just noise. You are going to hear a lot of this in the years to come, you need to learn to block it out and focus!” The scene ends with Jesse focusing on his coach while successfully blocking out the other ‘distractions’. To make this point clear, the football players and coach can be seen yelling while no sound comes from their mouths.
This made me think of the concept of noise. This is not a new concept as many writers have referred to the idea of noise and the importance of shutting out noise in an effort to focus on the task at hand. Since my surgery the importance of being able to focus on the task at hand while blocking out all other ‘noise’ has become even more relevant. I find that the more I try to multitask the more mistakes that occur. I have learned that instead of trying to accomplish too much at once, it is better to get one task done well rather than two or three done shoddily. In sport this is easier, as the ‘noise’ is usually more tangible: whether it be crowd ‘input’, or your opponent is attempting to throw you off your game by ‘talking trash’. Don’t get me wrong, blocking out this noise can be difficult. I am simply saying that in sport, identifying this ‘noise’ is easier. But this isn’t only relevant to sports, it is applicable to life in general. Many of us have been diagnosed with a brain tumor showing us the fragile nature of our minds. I implore you to put your efforts into one goal, instead of being distracted by “noise.” Forget about that noise, it can only serve to distract you and delay you from your goals.
Because today is a day we honor our mothers, I have done much thinking about the importance of loved ones like our mothers and the importance of having a day like this; yes, the cynical side of me thought this is an artificial holiday created by card and flower companies in a ruse to make money. Then I realized so what if it’s a contrived holiday? Does my mind’s perceived origins of it mean that its aim is disingenuous? The answer is no; the holiday may fall on the second Sunday for arbitrary and questionable reasons, but we embrace it because mothers truly do deserve a holiday to recognize all they do for us.
In my life, I am lucky enough to have 2 mother figures. The first is my actual mother (a true red if you read my last piece), and I also have my wife, the mother of our 2 sons. (I failed to include my older sister in to this group as she is a mother of three). Each of these figures brighten my life, albeit in different ways. My mom only wants what is best for me, and will stop at nothing to make sure I receive the best of everything. I hate to use the term ‘Tiger mom’, but this is a woman who practiced as an Emergency Department physician and put her children through Yale, Harvard, and Tufts. Not only that, but she encouraged and supported my sister and me in our paths to medicine, with my older sister being an Emergency Department physician and me being a Family Practice doctor. She also wholeheartedly supported my younger sister’s less “conventional” choice of working in the financial sector. As hard as I may try not to call her a ‘Tiger mom”, this perfectly describes her.
My wife is different; she is more passive than my mother; but don’t be mistaken, this passiveness does not mean she has accomplished any less in her life. She graduated with a degree in Psychology from Harvard, and now practices as a Family Physician in Michigan and somehow manages to be an amazing mother while working on a full-time basis. Their mothering styles are different; the best example I can give is that if something were standing in the way of what either I or my sons needed, my mom would have no problem stepping on some toes to get what was needed. My wife, on the other hand, would make sure not to step on anyone’s toes but would still succeed at obtaining what was needed. Neither way is better, actually in both cases they get what they desire. I realized in thinking of the importance of them in my life that a day devoted to their appreciation is not enough. If I could I’d treat every day as if it were Mother’s Day to thank them for everything they do.
But this is only the brief description of my story and the importance these mother figures play in my life. There are almost 7.5 billion people on this planet; and every one of them has or had a mother. So my story, and the importance of the mother figures in my life is one of 7.5 billion. So call your mother today and tell her 2 things:
1. How much you love her
2. How lucky you are to have her in your life
Hi everyone! I wanted to thank you all for being patient with me during my hiatus. It has been many months since I last wrote an article for you.
One of the reasons I have not produced anything for you is that for the past several months I have been back in the clinic seeing patients, completing a portion of my family medicine residency training. As part of this training, once a month we have a 2½ hour seminar as part of our behavioral medicine curriculum. During this time we discuss a wide array of topics ranging from bipolar disorder to child abuse, all with the aim of improving our communication skills, and hopefully help us become more empathic physicians. One of the past sessions we were treated to a fascinating lecture on a less well known personality classification scheme. Most of us have heard of the Myers – Briggs test, where after an extensive set of questions, spanning many hours, you are given a set of 4 letters denoting your personality type. For example, you might be told that you are an ‘ESTJ’ meaning you are an Extrovert, Sensing, Thinking, and Judgment type. While I think this can be a helpful schema, my issue with it is the time required to take the test. During our session, rather than the Myers-Briggs test, we were given a different and much shorter personality test (it literally took me 7 minutes to complete) and based on the results were given a color that matched your personality type. I have included a copy of this questionnaire below, I encourage you to try it:
Personal Style Inventory
Robert W. Russell, Portland, Oregon
Used by permission
Each line below lists two contrasting traits. Your task is to divide seven points between the two statements on each line to reflect the balance of how each best describes you. Points may be divided in any way you wish, but both sides together must add up to seven. Give high points to the description that describes you well, while giving the other side low points. Do the same on each line for Part 1 and Part 2. For example, people who see themselves as quick in the way they handle things might fill out the first line like this:
Add up the total number of points for each column (A, B, 1, 2). the columns (A/B and 1/2) with the highest points determine your color. For example:
A ‘red’ is a very assertive person, a type A personality.
A ‘green’ is very task oriented, they are the thinkers.
A ‘blue’ is very compassionate and detail oriented.
A ‘yellow’ is more of an introvert, and always follows the rules.
I have also included a copy of the interpretation sheet and what the various colors mean:
The Four Basic Styles
TASK ORIENTED. FOCUSED ON RESULTS. EXERTS STRONG INFLUENCE IN GETTING THINGS DONE. ASSERTIVE IN EXPRESSION OF IDEAS. PREFERS BEING IN CHARGE. HAS STRONG OPINIONS.
COMMON STRENGTHS: Determined, decision maker, efficient, gets results, direct, takes charge, responsible, leadership qualities, risk taker, alert to opportunities, challenging limitations.
POTENTIAL WEAKNESSES: Dominating, unsympathetic, demanding, critical, superior, harsh, impatient, dictatorial.
PEOPLE ORIENTED, EXPRESSES OPINIONS AND EMOTIONS EASILY. IS VERY ACTIVE AND MOVES AT A LIVELY PACE. PREFERS STRONG INTERACTION WITH PEIOPLE. USUALLY HAS MANY INTERESTS. TENDS TO BE IMAGE CONSCIOUS.
COMMON STRENGTHS: Personable, stimulating, enthusiastic, dramatic, inspiring, innovative, articulate, concern for the welfare of others. Looks for ways to be helpful, friendly, tries to avoid being a burden to others, warmhearted.
POTENTIAL WEAKNESSES: Opinionated, excitable, phony, flighty, reactionary, exaggerates, showoff, pushover, bleeding hearts, doormats, too social.
DATA ORIENTED, LIKES THINGS TO BE WELL ORGANIZED AND THOUGHT OUT. PREFERS SPECIFIC PROJECTS AND ACTIVITIES THAT CAN BE SYSTEMATICALLY WORKED ON. ENJOYS PUTTING STRUCTURE TO IDEAS. THOROUGH AND CAREFUL ABOUT DETAILS.
COMMON STRENGTHS: Industrious, persistent, serious, vigilant, orderly, rational, methodical, factual, thorough, planners, thinkers, analyzers.
POTENTIAL WEAKNESSES: Indecisive, picky, withdrawn, data-bound, uncommunicative, critical, unsympathetic, analysis-paralysis.
SUPPORT ORIENTED. STAYS OUT OF THE LIMELIGHT. LIKES BEING PART OF CORDIAL AND FRIENDLY GROUPS. HIGH CONCERN FOR GOOD RELATIONSHIPS. SEEKS STABILITY AND PREDICTABILITY.
COMMON STRENGTHS: Flexible, cooperative, supportive, friendly, willing, dependable, personable, sincere, helpful, team player.
POTENTIAL WEAKNESSES: Conforming, retiring, overly sensitive, dependent, unpredictable, wishy-washy, hides true feelings, sarcastic, chameleon, the “company man/woman”.
Personally, before this lecture I despised personality tests; I hated the idea of being labeled and I also frequently find flaws in their findings. Yes, that’s true about me I will think, but this is definitely not like me. This test was different though, while yes it did label me as a certain personality, it was also incredibly accurate. Every bullet point that described my personality, my ‘color’ was true.
But what was the purpose of this test? For us, it helped us better understand ourselves and others, and hopefully will aid us in our interactions with colleagues and patients. But why should that exclusively help physicians? All of us have our color, knowing it will not only help us become more self-aware people, but it will also help us better understand others and where they are coming from. For us, even though we share the commonality of either suffering from Epidermoid Tumors or having a loved one afflicted with the condition, we are all individuals, different people with different personalities. It is impossible for any personality test to be 100% accurate, they are simply aimed at classifying your personality with few errors. For me the accuracy of this test was striking, with such little preparation time. More importantly, it highlighted to me the importance of self-awareness and how all of our interactions with others can be made better with this understanding. Take the test, find out what color you are. What color would you label your loved ones? Are there certain colors you are drawn to? For me, I turned out to be a ‘yellow’ with my wife being ‘green’. But I realized that a team filled with either yellows or reds would not make an effective team – you need diversity in colors to make a good team. Tell me what color you are, and what color your loved ones are.
In reflecting on my experience with this tumor, I kept coming back to the idea that love played an integral role both in my diagnosis and recovery. I realize I am not alone in knowing the importance of love. Perhaps, it was a loved one who implored you to see a physician to obtain a diagnosis; maybe your loved one makes sure to attend all of your appointments; love and support can be as simple as holding your hand during difficult times.
For me, I remember first trying to leave my wife out of the situation, believing being tough meant being a lone ranger; in reality, there really is no such thing as a ‘lone ranger’, even the Lone Ranger needed help (from Tonto). When I realized that the diagnosis was a grim one, I had to telephone my wife to have her by my side when I received the diagnosis. When I was waking up from my anesthesia after my 16-hour surgery, the first person I apparently called for was my older sister. When I was transferred to the ICU I remember holding my younger sister’s hand. My mother spent every night with me in my month and a half long stay in the hospital.
Why do I tell you this? Why is this relevant? I am like anyone else, and when the chips were down and I was shoved into a corner, I instinctively called for loved ones. Like I said, I am like everyone else; my nature to want loved ones by as I faced difficult situations is an instinct that we all share. I then thought of the idea of love, and its role in my ordeal: I realized that love not only got me a diagnosis, but it has also helped me through my recovery. The neurologist who diagnosed me reached his conclusion out of love; love for the art and skill of his profession. I was promptly seen at the University of Michigan because those who loved me quickly called and found the top neurosurgeon in the area. Every card, every visit, which brightened my day was done out of love.
With health issues like epidermoid brain tumors, we all need loved ones to help us traverse this terrain. Whether you are a ‘wait and watch’ patient or have upcoming surgery scheduled, the idea of love is how we get through this. Even though the thought of love may immediately place your mind in the realm of the traditional sense of the word, love can come in many forms; yes love of a fellow human is the more ‘traditional’ thinking behind the emotion, but we can (and do) love more than just people—we love places, arts, and professions too.
I do not tell you this to tell you how lucky I am to have those around me who love me, but to remind you that every relationship you forge, every loved one is a person you should cherish. It’s easy to be with a loved one during times of joy, but remember it is those same people that will also be there when you are down.
Today I had the pleasure of reading a post by a fellow EBTS member. The post discussed frustrations she had with her Neurosurgeon. This post generated much response, and garnered many replies. I must admit that my initial emotion was frustration…frustration with the minimization by this Neurosurgeon, frustration with the lack of the ability of this clinician to portray his thoughts, and empathy for her frustration in dealing with this condition. I will share her post with you below:
Errrrgh. . .another visit to my (neuro) Ophthalmologist yesterday. Third one in the last 6 months. Lovely man except for one thing. His need to assure me that I am very fortunate that I do not have a malignant tumor, that I shouldn’t really use the term tumor because that sounds more frightening than what it actually is, and that really all “it” is, is a growth and you can get growths anywhere! Then he says we are just keeping an eye on this because of the proximity of it to the brainstem. . .I am a watch and wait. My Epidermoid is around my brain stem causing many symptoms which I am treated for. Three surgeons have said they do not want to operate because the risks of permanent damage currently outweigh the symptoms I live with at this time. I am fine with that! But what I don’t get is why so many medical professionals downplay the Epidermoid like its nothing to fuss about and don’t call it a tumor. . .sorry just feeling frustrated.
My frustration turned to anger with subsequent reads; anger that this brain tumor is being treated this way. Now that I have had time to reflect with a cooler head about my reaction, I’ve come to realize that the emotion, frustration, plays a major role in dealings with this condition.
To truly understand the topic of frustration, it’s necessary first to give you my definition of it. In my eyes frustration is a deep seeded emotion; this is in contrast to an annoyance. These terms are sometimes mistakenly used interchangeably.
While someone taking the last parking space in front of you may be a frustrating experience, I think of it more of an annoyance than a frustration. To me, living with a brain tumor inside your head and having your trusted physician trivialize the condition is frustrating.
I would be remiss if I mentioned frustration and did not interject my experience with the emotion: having been on the path to becoming an Attending physician (in medicine, there is a hierarchy to becoming a physician: this hierarchy is ordered medical student, resident physician, and attending physician. I was diagnosed with this brain tumor near the end of my residency). Then having this ‘path’ interrupted by the diagnosis of an Epidermoid Brain Tumor, becoming physically disabled overnight (as I once explained to my friend) has put me through many frustrations. These frustrations varied from fumbling with paper straw covers, to being viewed as incompetent by patients due to my poor physical and verbal ability.
The key to dealing with these frustrations is to focus instead on the positive and not to dwell on the negative. In my case, if I were to contemplate all of the frustrating factors that accompany my condition, I would no doubt spiral into a crippling depression. In fact, many around me have said, “Chris, if I were in your shoes I would become depressed.” A number of psychological and psychiatric professionals routinely screen me for depression, asking about my sleep and appetite and general mood. My wife, worried about my mental state, once told me, “If you keep bottling up your frustrations, there will come a time when it all boils over and spills out.” My response was that I was not ‘bottling up’ or ‘ignoring’ these frustrations; I instead chose to focus on aspects of my condition that did not frustrate me, and actually brought me hope.
I am not a daily meditator, but you are taught to try and ‘clear your mind’ when you meditate. “What are you seeing when you close your eyes [to meditate]?” my father, an avid and expert meditator once asked me (at the time I was trying to leech off his knowledge with meditation). At first, my response was that I would try and picture a tranquil mountaintop. (I was impressed with my answer and thought it was a clever way to clear my mind). My father’s response surprised me, “Mountaintops are something, remember you’re trying to clear you mind. Try instead to imagine a clear blue sky.” Furthermore, he taught me that thoughts may manifest as clouds coming through this sky. “Do not ignore these clouds,” he told me, “instead it’s important that you acknowledge them, but then let them pass.” He went on, “as you become more adept at meditation, these clouds will appear less and less.” What does this have to do with frustration? If you think of these frustrations as clouds that can only hurt you, then it’s important to acknowledge them but then to let them pass. In this case, yes there are people who minimize what you are going through, but remember that only you truly know what you are going through and that in the end, it does not matter what others say about your condition, what matters is how you let it affect you.
In applying for medical school one of the most frequently asked questions on the interview trails is, “What do you want to do in medicine?” While the interviewers know that there are countless responses to this question including answers like: “I hope to become a surgeon,” or “I would like to work in an under-served community” the answer that is often sought by these interviewers is “I would like to be heavily involved in research.” These interviewers realize the importance of research. he interviewees have come to realize this and make it part of their standard response, even though in reality only a small percentage of physicians are actively involved in research.
I must admit that when I was asked this, I ‘towed the party line’ and would make sure to include ‘research’ in my response. I was not being completely dishonest with this answer, as the idea of taking part in research studies intrigued me and I did hope it to be part of my career in medicine. Where I may have been misleading though is the amount I wished to delve into research; if one’s career in medicine could be broken down into percentages, many of these interviewers would like research to be 30- 40% of one’s medical career where in reality for many, besides the required residency research project, research only encompasses 5- 10% of their career. This is only a generalization; thankfully, there are many physicians that devote most of their time to research.
But now that I’ve become older (and hopefully wiser) I have come to realize why the response of ‘research’ is so sought after; in medicine, research is what drives innovation and change. Without research we wouldn’t be nearly as knowledgeable as we are in topics like Heart Disease and Cancer. In fact, without research driving the progress of medicine, we would likely still be in the Dark Ages of medicine, with life expectancies in the 30s and preventable diseases like polio ravaging the population. Much of medicine is reactionary: if someone presents with a heart attack, steps are taken to identify the blockage and to relieve it; if a person were found to have cancer, medications (and sometimes radiotherapy) is given in hopes of hitting the cancerous cells. While both of these actions are vital to the care of these patients, they are both reactions.
Research takes a proactive approach – instead of fighting these diseases and conditions, isn’t it more rational to prevent them from occurring? Perhaps my training in Family Medicine biases my opinion, but I’d like to believe that the thought that ‘an ounce of prevention is worth a pound of cure’ is a widely accepted axiom. In my eyes, research follows this approach, leading the cutting edge of medicine, preaching a proactive approach rather than reaction.
When I was asked to write for the Epidermoid Brain Tumor Society (EBTS) I immediately jumped at the idea. Even though I was not a member, I had followed the group ever since my diagnosis and surgery. Their leadership especially impressed me: both Linda Frevert and Fay Powell, besides being incredibly kind, were instrumental in my decision to write for them. They have been so supportive and positive from the beginning.
As I have become more involved with the EBTS, I have been able to witness EBTS’s involvement in research. Early research surveys involved members at the beginning of organization and more recently an international member conducted a study with voluntary EBTS member participants which will further the knowledge and awareness of epidermoid brain tumors and our struggles with them.The study will be public this fall 2015.
Perhaps writing for the EBTS is my own way of contributing to medical progress.
*** Although there are no current research studies for epidermoid brain tumors, EBTS strongly urges members to voluntarily have tissue saved from surgery for future research.
We all like to think of ourselves as someone who works alone, a lone ranger. In fact, the term ‘lone ranger’ comes from a popular television series, based on a novel, in the 1950’s. Now, calling someone a lone ranger is synonymous with deeming them as someone who needs little or no help; someone who is completely self-sufficient. What people often forget is that the Lone Ranger needed the help of Tonto. I tell you this because it highlights the fact that everyone needs help; no one gets where they are without it.
In my current condition, I’ve come to realize the importance of the aid of others. As physicians, we are often presented with cases that are beyond the scope of our skill set: at that time we ask for ‘help’ from consultants and specialists. No matter what branch of medicine, there are always times in which a consultation is needed: for example, if a 50 year-old woman with a history of urinary problems goes to her Urologist’s office for these urinary problems, but reveals that she has been coughing up significant amounts of blood; the Urologist would say, “You should be seen for that in the Emergency Department (ED).” The ED physician, after evaluating the patient, might enlist the expertise of a specialist, a Gastroenterologist. The Gastroenterologist might in turn, need the help of the patient’s Family Doctor to manage her high blood pressure or diabetes. My point in this convoluted scenario is that everyone in medicine needs help; the ‘lone ranger’ is an antiquated notion that is simply not realistic. This idea, I’ve realized, goes beyond the practice of medicine. We all need help.
Before my ordeal, I was always reluctant to ask for help. I aspired to be a ‘lone ranger’. In fact, I have mentioned before that I initially began my training in the specialty of Emergency Medicine (EM). I then switched to Family Medicine after one year of EM training. I have many reasons for this switch, but one of the main reasons is that when I entered into Emergency Medicine, I was hoping to be in a specialty of medicine that required little assistance from others. After being in the ED I realized this wasn’t the case: actually most cases required the aid of others. This trait of mine became magnified immediately after my surgery, as I hated the idea of asking for help. Even asking my assigned nurse for medications for pain was difficult for me. After my discharge I continued to be reluctant to ask for help. Not only did I still have my lone ranger mentality, but also I viewed the acceptance of help as an exposure of my weakness. I feared that accepting help put my disabilities on display.
Thankfully, time has shown me the error of my ways: I now have no issue in asking for help. This can be as simple as allowing someone to hold a door for me (where every instinct in my body tells me to open doors for others) or as complex as accepting help in returning to work. It is called ‘help’ for a reason; this act is in service of another.
The scale of this might differ: a person helping someone cross the street might ‘help’ on a smaller scale than Martin Luther King, Jr. uniting a whole race. To me, help is help, whether the act is a big or small one. In this example, I see both as reaching in the same areas of their heart to help regardless of the scale, I’ve realized that no one gets where they are without some help. All people who achieve success on any level have great people behind them. The help I ask for might seem minor, but my acceptance of help in these instances signifies my willingness for assistance in other grander issues.
We all need help to achieve our goals. Great people accomplish great things only with the help of those around them. Have you accepted the fact that you sometimes need help?
To some, time represents a variable – one that can factor into an equation; Einstein famously conquered time in his Theory of Relativity, deducing time to a mere number that could be changed. We as a society are obsessed with the concept of time: one needs to look no further than the library or cinema to find scores of entertainment surrounding this topic (think of the novel 1984, or the Back to the Future movies). In fact, Nostradamus was made famous because of his perceived ability to break the laws of time and foretell the future. There is actually an entire industry devoted to this ability to ignore time to see into the future (i.e. psychics).
Whether or not you believe in people’s ability to see into future, time has been a key factor in my recovery, and plays a role in everyone’s lives.
When I was in the hospital my physician told me, “Chris, you will recover, but you have to be patient, it will take time.” I realize now the truth behind his words. While therapy along with cognitive strengthening plays a vital role in my recovery, completing these serves to lessen the time spent ‘recovering’. Hidden amidst these aids to recovery is the secret variable of time. Now in my recovery, there were (and are) times when I would hang onto and rely on this intangible idea as an excuse not to participate in therapy or cognitive exercises; part of me is very rational using only scientific data to guide my decisions; yet another part of me is guided by instinct or ‘gut decisions’. The reason I tell you this is that my rationale for skipping a workout or therapy appointment exposes these two sides of my thinking: my ‘gut’ tells me that I’d improve regardless of the therapy and that time is all I need to recover; but luckily my rational side chimes in and tells me that time is only one underlying factor in my recovery—therapy and strengthening are also crucial to the process. Thus if you think about it like a mathematical equation, it would be something like this: therapy + cognitive strengthening + time = recovery. Every factor is vital to this equation: if you only relied on time to recover (ignoring therapy and cognitive exercises), then you would not get your desired outcome.
But this piece is not titled ‘Therapy’ or ‘Cognition,’ it is titled ‘Time’ because I want to discuss the role that it continues to play in my recovery. I hope you come to the realization in reading this that we all can learn lessons that time teaches us. A great man once told me that “yes, you can come to grips with the fact that time is key to this process, but what people sometimes don’t realize is that you have to give time, time.” Sometimes we do not have patience to wait for time to take effect; when this happens our equation is incomplete and we cannot achieve our desired result.
If we’ve decided that time is one of the key variable in our equations, sitting passively on our hands and letting time pass only acknowledges one of the factors in our ‘equation’ while ignoring the others. All of the variables must work together for the equation to work. But in writing this, I know that the factor of time is often overlooked, making us frustrated when we do not get what we want. Just remember that it may take time, and that sometimes you have to wait for time.
In being a member of the EBTS, I have seen that many of our members are undergoing either treatment for or surveillance of your tumor. Whichever group you fall in to, just know that time is your ally. Realizing that time is a factor in your recovery is half the battle. Then you have to “give time, time”.
This past month I had the pleasure of corresponding with a very prominent neurosurgeon. Dr. Cormac Maher specializes in skull base tumors, often the location for Epidermoid Tumors. In fact, in full disclosure, he is the Neurosurgeon who operated on me. To be exact he is a Pediatric Neurosurgeon, but when I saw one of the head adult Neurosurgeons at the University of Michigan, he told me (regarding my tumor) “Chris, I am going to have one of my colleagues, Dr. Maher a Pediatric Neurosurgeon, see you. To be honest, he is much more experienced than I in this location. If it were my son I’d want him to see Dr. Maher.”
Neurosurgery is an amazing field; one that not only requires exact precision, but also one that demands an incredible amount of time and devotion. Knowing this, I was very grateful that Dr. Maher would take time out of his busy schedule to answer my questions. This is what I asked him:
CC: First off, Dr. Maher, I wanted to thank you for taking the time out of your day to answer these questions.
Are there locations that are more common for you to see?
CM: The most common location that I see are lesions located just to the side of the brainstem, wedged in the “CPA” or cerebellopontine angle.
CC: For patients whom which the wait and watch alternative is taken, are there specific intervals with which you monitor the tumors?
CM: I think the proper follow-up interval will depend on patient-specific factors such as the age of the patient, the presence of any symptoms, and the size and location of the epidermoid. I would follow larger lesions with much more frequent scanning than tiny lesions. I would also follow with more frequent scanning if I thought that any neurological structures such as cranial nerves would be in jeopardy if the lesion grew. Most importantly, I would monitor very closely if the lesion was threatening to obstruct the flow of cerebrospinal fluid pathways, possibly resulting in hydrocephalus. Of course, if a lesion is very worrisome – either because of its location, size, or symptoms – we tend to offer surgery as a first line of treatment.
CC: What new surgical approaches you advocate?
CM: It really depends where the lesion is located. For some intraventricular lesions or lesions at the skull base, endoscopic removal has become more accepted as a first choice therapy. This has the advantage of a more minimal approach and a shorter hospital stay. For most epidermoid lesions, their location makes them less than ideal candidates for this sort of resection. If a more traditional craniotomy is required, microsurgical tools are improving all the time. Probably the most important advancement in the last 10 years with respect to any brain lesion resection surgery has been the intraoperative MRI scanner. This tool allows us to examine the brain for any residual lesional tissue even while the operation is still in progress. The identification of residual during the operation increases the likelihood that we can achieve a total removal.
CC: What do you warn patients regarding possible adverse effects of the surgery?
CM: The size and location of the lesion will determine the amount and type of risk involved. The most dangerous lesions are usually located near the brain-stem or cranial nerves. Larger tumors are generally more difficult to remove than smaller ones. I try to tailor my preoperative risk discussion to the patient’s particular situation as best as possible.
CC: With regards to post-op complications, we have had many members that worry about meningitis and/or infections of the wound, are there steps they can take to prevent these?
CM: Most surgical infections are the result of bacterial organisms that are introduced at the time of surgery. All surgeons administer antibiotics just before they start the operation and that is generally thought to be helpful. Obviously, it is important to maintain a sterile environment during the operation. Once the operation is over, unfortunately, there is very little to be done that can decrease the odds of infection beyond common sense tactics such as keeping the wound clean. Some surgeons (including me) will place patients on antibiotics for a short time after surgery but this has never been proven to be helpful at prevention of infection – even after several large studies have attempted to study the practice.
CC: Thank you again Dr. Maher for both your time and your expertise.