Monday, June 02, 2008
Senator Kennedy's Surgery
The Washington Post has an informative article on Senator Kennedy's surgery. My thoughts:
First, I'm not surprised that the Senator went to Duke, and Dr. Allan Friedman, for his surgery. I predicted to a friend that he would either see Dr. Friedman, Keith Black at Cedars Sinai, or Mitchel Berger at UCSF (Jane's surgeon). These three are probably the top guns in deep brain tumor surgery in the US.
Second, I'm not surprised that the Senator was talking and feeling good after the surgery. Done well, brain surgery is surprisingly easy on a patient. There aren't any nerves in the brain -- just in the scalp -- so there's not a lot of pain associated. The biggest worry is swelling, and this will likely be approached with fluid restriction for a day or two and Dexamethasone (the hated Decadron).
Third, it's interesting to note that the Senator is planning to do both chemotherapy and radiation therapy. This is an aggressive path, and good for him. The latest treatment mode seems to be to take Temodar (an oral chemotherapy) concurrently with 3D Conformal radiation therapy. They'll likely radiate a 1-centimeter buffer area around the tumor resection cavity (the hole where the tumor was) to try to zap as many stray tumor cells as possible. That is, if it was a good resection. If there were parts of the tumor that couldn't be safely removed surgically, they may try to extend the radiation therapy into those areas.
Last, the Post article makes the point that the Senator's tumor type is not yet known. As I noted in the earlier post, "malignant glioma" is a generic term. I'm curious whether the specific tumor type will be released to the public.
One postscript: is disheartening to see the vitriol spilled in the comments section on the Post's article about Senator Kennedy's affliction. It's one thing to disagree with a person's political point of view; it's quite another to wish a person ill in such an awful, vicious way. I wonder how people who write such things can look themselves in the mirror. I hope they never get ill and have to face such hatred on top of their health challenges.
First, I'm not surprised that the Senator went to Duke, and Dr. Allan Friedman, for his surgery. I predicted to a friend that he would either see Dr. Friedman, Keith Black at Cedars Sinai, or Mitchel Berger at UCSF (Jane's surgeon). These three are probably the top guns in deep brain tumor surgery in the US.
Second, I'm not surprised that the Senator was talking and feeling good after the surgery. Done well, brain surgery is surprisingly easy on a patient. There aren't any nerves in the brain -- just in the scalp -- so there's not a lot of pain associated. The biggest worry is swelling, and this will likely be approached with fluid restriction for a day or two and Dexamethasone (the hated Decadron).
Third, it's interesting to note that the Senator is planning to do both chemotherapy and radiation therapy. This is an aggressive path, and good for him. The latest treatment mode seems to be to take Temodar (an oral chemotherapy) concurrently with 3D Conformal radiation therapy. They'll likely radiate a 1-centimeter buffer area around the tumor resection cavity (the hole where the tumor was) to try to zap as many stray tumor cells as possible. That is, if it was a good resection. If there were parts of the tumor that couldn't be safely removed surgically, they may try to extend the radiation therapy into those areas.
Last, the Post article makes the point that the Senator's tumor type is not yet known. As I noted in the earlier post, "malignant glioma" is a generic term. I'm curious whether the specific tumor type will be released to the public.
One postscript: is disheartening to see the vitriol spilled in the comments section on the Post's article about Senator Kennedy's affliction. It's one thing to disagree with a person's political point of view; it's quite another to wish a person ill in such an awful, vicious way. I wonder how people who write such things can look themselves in the mirror. I hope they never get ill and have to face such hatred on top of their health challenges.
Labels: brain tumor, health, Jane, media, medicine, politics, science
Tuesday, May 20, 2008
Ted Kennedy Brain Tumor Coverage
A friend asked me what I thought of the New York Times coverage of Ted Kennedy's brain tumor. I wrote a long, fast email, which I'm also posting here:
They gave the general tumor type (glioma) but not the specifics. There are several types of gliomas, including astrocytomas, glioblastomas, and oligodendrogliomas. Also four grades, from I to IV (the higher the number, the more aggressive). Malignant gliomas are grades III or IV, though so-called "benign" ones still cause lots of trouble because the cranium is an enclosed space and anything that squeezes the brain in that space can cause trouble. Jane's tumor was a mixed astrocytoma-oligodendroglioma, grade III.
They gave the location of Kennedy's tumor as left parietal, and said that area of the brain was involved in sensation, motor control and language. Would have been more accurate to say USUALLY involved in language. Not always. Whether or not often depends on handedness. Jane was left handed, and had her initial tumor in the left occipital and parietal lobes. (Toward the end it spread to the frontal lobes and into the right hemisphere.) Frequently, left-handed people have their language more distributed between the hemispheres than right-handers, but still centered largely in the left hemisphere. Jane had a Wada test that determined that her language was almost entirely in the right hemisphere. (She never did play by the book!) This allowed for a much more aggressive left-hemisphere surgery back in 1998 and 2000.
I have the videotape of Jane's Wada test, by the way -- I remember it as strange and fascinating to watch, but I haven't viewed it in years. I also have a photograph of her open cranium.
One article quoted Keith Black, a neurosurgeon at Cedars-Sinai in LA. He's a rock star among brain surgeons, more famous but NOT more sought after than Jane's surgeon (Mitchel Berger). Keith Black was written up in TIME magazine a decade or so ago, I think.
One article rightly says that age has a lot to do with prognosis. Getting a malignant glioma at age 76 is not a good thing. Another article rightly says that the disease is "treatable but not curable."
The articles refer to the disease as brain tumor and not brain cancer. The distinction is subtle; generally, cancers can metastasize to other tissues, but brain tumors cannot. (You can't get a brain tumor in your lungs, but you can get lung cancer in your brain.) Doctors will very rarely say "brain cancer" in my experience, probably because to do so is imprecise, but a lot of brain tumor patients and advocates (I'm not among them) prefer to use the term "cancer" because, I think, it sounds more urgent. A tumor sounds like something that can be sliced off, like a wart. Brain tumors, especially gliomas, tend to have lots of tendrils and stray cells throughout the brain; it's rare that they're encapsulated. (One NYT article said this, in a roundabout way.)
They gave the general tumor type (glioma) but not the specifics. There are several types of gliomas, including astrocytomas, glioblastomas, and oligodendrogliomas. Also four grades, from I to IV (the higher the number, the more aggressive). Malignant gliomas are grades III or IV, though so-called "benign" ones still cause lots of trouble because the cranium is an enclosed space and anything that squeezes the brain in that space can cause trouble. Jane's tumor was a mixed astrocytoma-oligodendroglioma, grade III.
They gave the location of Kennedy's tumor as left parietal, and said that area of the brain was involved in sensation, motor control and language. Would have been more accurate to say USUALLY involved in language. Not always. Whether or not often depends on handedness. Jane was left handed, and had her initial tumor in the left occipital and parietal lobes. (Toward the end it spread to the frontal lobes and into the right hemisphere.) Frequently, left-handed people have their language more distributed between the hemispheres than right-handers, but still centered largely in the left hemisphere. Jane had a Wada test that determined that her language was almost entirely in the right hemisphere. (She never did play by the book!) This allowed for a much more aggressive left-hemisphere surgery back in 1998 and 2000.
I have the videotape of Jane's Wada test, by the way -- I remember it as strange and fascinating to watch, but I haven't viewed it in years. I also have a photograph of her open cranium.
One article quoted Keith Black, a neurosurgeon at Cedars-Sinai in LA. He's a rock star among brain surgeons, more famous but NOT more sought after than Jane's surgeon (Mitchel Berger). Keith Black was written up in TIME magazine a decade or so ago, I think.
One article rightly says that age has a lot to do with prognosis. Getting a malignant glioma at age 76 is not a good thing. Another article rightly says that the disease is "treatable but not curable."
The articles refer to the disease as brain tumor and not brain cancer. The distinction is subtle; generally, cancers can metastasize to other tissues, but brain tumors cannot. (You can't get a brain tumor in your lungs, but you can get lung cancer in your brain.) Doctors will very rarely say "brain cancer" in my experience, probably because to do so is imprecise, but a lot of brain tumor patients and advocates (I'm not among them) prefer to use the term "cancer" because, I think, it sounds more urgent. A tumor sounds like something that can be sliced off, like a wart. Brain tumors, especially gliomas, tend to have lots of tendrils and stray cells throughout the brain; it's rare that they're encapsulated. (One NYT article said this, in a roundabout way.)
Labels: brain tumor, health, Jane, language, medicine, people, politics
Wednesday, May 07, 2008
CIO Digest Returns
After a brief hiatus, Symantec has resurrected its CIO Digest magazine. for the current (April 2008) issue, I interviewed three healthcare IT leaders, asking them about their challenges with device management, enterprise security, storage, compliance, and communications. The article, entitled Best Medicine, can be found here (pdf).
Labels: clips, health, marketing, medicine, science, technology, writing
Monday, February 11, 2008
David Kuo heads to Africa
He tells the why and how better than I could recap it here.
Labels: brain tumor, faith, health, politics, world
Friday, February 01, 2008
Weighty Matters
Now that I sport a healthy Body Mass Index of 23, I'm more relaxed reading stories about obesity and related health challenges. I sense (but can't document with multiple examples) some pushback against the very concept of an obesity epidemic. I also sense (but again can't document) that science writers stories on this topic to have some fun with language. For example, this paragraph from a story found on PhysOrg.com, discussing a British Medical Journal article on debate about an obesity epidemic:
Cheap joke, but it made me chuckle.
In summary, a large body of evidence documents that over-nutrition and obesity are a major global health problem, say the authors [emphasis mine].
Cheap joke, but it made me chuckle.
Labels: health, science, writing
