November 2002 rediagnosed with a recurring tumor I am going to bring you through the whole fun thing
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This is where you stick random tidbits of information about yourself.
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Brain Tumor History And Other Rants
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Wednesday, March 09, 2005
3/9/05
OK here's my last post before I go in Heather will be updating this with my status. This is a mixed posting with a bunch of quotes, a brief Bob's brains history, and a piece of scripture.
These 1st 2 are for Heather the rest are craziness. Well never fear I will be back with plenty more to say here. Thanks for your thoughts, prayers, and the time you take to read this stuff. My heads in a pretty good place from all the support from everyone and is in one piece, and in a couple weeks it will be again.
See you on the other side.
Sade Lover's Rock
I am in the wilderness
You are in the music
In the man's car next to me
Somewhere in my sadness
I know I won't fall apart completely
When I need to be rescued
And I need a place to swim
I have a rock to cling to in the storm
When no one can hear me calling
I have you I can sing to
And in all thisAnd in all my life
You are the lovers rock
The rock that I cling to
You're the one
The one I swim to in a storm
Like a lovers rock
Sade By Your Side
You think I'd leave your side baby?
You know me better than that
You think I'd leave down when your down on your knees?
I wouldn't do thatI'll do you right when your wrong
I-----ohhh, ohhhIf only you could see into meoh,
When your cold I'll be there to hold you tight to me
When your on the outside baby and you can't get in
I will show you, your so much better than you know
When your lost, when your alone and you can't get back again
I will find you darling I'll bring you homeIf you want to cry
I am here to dry your eyes
and in no time you'll be fine
You think I'd leave your side baby
You know me better than that
You think I'd leave you down when your down on your knees
I wouldn't do thatI'll do you right when your wrongI-----
I, ohhhh, ohhhIf only you could see into me
Oh when your coldI'll be there
To hold you tight to me
Oh when your aloneI'll be there by your side baby
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Just wanna be that someone you weren't looking for
Some nameless fascination that showed up at your door
And when you're sad and blue my jokes still make you smile
And I could be with you awhile
Alice Cooper
Heal me with your laughter
Make me smile honey, it’s been days
Hold me in your arms now
Lock me in your gilded cage
Hold me till you heal me baby,
Fix my hearts gaping hole
Fix me babe I’m broken,
Like that screen on your back porch
Billy Hector
The past didn’t go anywhere.
It never does.
I could go outside and pick up a rock older than any one living,
drop it on your foot and prove the past didn’t go anywhere.
Utah Phillips
“Turn and face the strange changes.
Ooh look out you rock n rollers. Ch-Ch-Changes.
Turn and face the strange changes.
Pretty soon now you are gonna get older.
Time may change me, but I can’t trace time.
I said that time may change me, but I can’t trade time.”
David Bowie “Changes”
“Days like this I don’t know what to do with myself.
All day, and all night.
I wander the halls along the walls and under my breathe
I say to myself I need fuel to take flight.
There’s too much going on.
But it’s calm under the waves,
in the blue of my oblivion under
the waves in the blue of my oblivion.”
Fionna Apple
Fix me babe I’m a broken like that handle on your back door.
Fix me babe I’m a broken like that screen on your back porch.
Fix me babe I’ve been shattered like that coffee cup on that floor.
Billy Hector
“Yesterday is a memory
Tomorrow is never what it’s supposed to be”
Bob Dylan
“We barely have time to react in this world none the less rehearse”
Ani Difranco
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Ancient history:
Here is my doctor's note at the end of treatment for my second round, but in doctor speak it lays out my history for those of you taking notes at home:
August 28th, 2003
RE: Robert Blasser
Dx: Oligo-astrocytoma, Low/Intermediate Grade Recurrent
DOB: April 12th 1973 (Current Age, 30 yr old)
I met today with Robert to review his recent MRI of August 26th, and to discuss plans for his future management, in view of my imminent departure for California.
I am pleased to report that his brain MRI remains entirely stable, without evidence of any new gadolinium enhancement. More importantly, MR multi-voxel spectroscopy and perfusion imaging are entirely without FLAIR/T2 residual abnormality being gliosis rather than residual tumor.
Robert himself, as you well know, has not recovered his blood counts following his last cycle of carboplatin/ temzolomide, and required a platelet transfusion yesterday, and is also re-starting Neupogen due to his ANC dropping again to 400/mm3.
History of Present Condition:
Robert initially presented on October 10th 1999 when he experienced a partial complex seizure: he was in the middle of a conversation with his girlfriend when he became aware of his eyes then his head deviating to the left; he was well aware of the event, was able to describe what was happening to him, jumped up and “snapped out of it”; the event lasted no longer than 20 seconds. The following day, while walking down a corridor at work, he experienced a second episode, his eyes move to the left, followed by his head. He walked to the mens room with a friend, asked for assistance, became incoherent, and dropped to the floor. He was apparently “out of it” for about 3 minutes. He was transported by EMS to St. Claire’s Hospital, where a brain CT scan revealed a right frontal lobe lesion. Dilantin was given and he was transferred to NYU on October 13th the following consultation with Dr. Devinsky. A Brain MRI on October 15th revealed a minimally enhancing 3 cm x 3 cm lesion in the right posterior frontal lobe.
On October 18th 1999, extra-operative functional brain mapping was performed, with placements of subdural and depth electrodes. No seizures were recorded. On October 25th, a right craniotomy was performed by Dr. Werner Doyle. The post-op brain MRI performed on October 26th confirmed a near total resection of the tumor. The pathology was called a difuse low-grade ganglioglioeurocytoma by Dr. Douglas Miller at NYU. Review by Dr. Marc Rosenblum at MSKCC yielded a diagnosis of low-grade oligoastrocytoma.
Robert was switched from Dilatnin to Tegretol, and subsequently followed with serial follow-up MRI’s, which were entirely stable until the study of January 15th 2003. This study demonstrated some extension of the T2/FLAIR signal abnormality inferiorly to the operative cavity, without any obvious gadolinium enhancement. Accordingly, I referred Robert to Dr. Werner Doyle, who reoperated on him on January 17th 2003, with resection of the recurrent tumor.
The pathology at NYU, reviewed by Dr. George Kleinman, was called a recurrent ganglioglioneurocytoma, but far more densely cellular than the initial tumor in 1999, with fewer oligo-like cells. The MIB-1 index was also increased focally to up to 15%, compared with the initial tumor, raising the concern that this tumor was developing anaplasia. Review by Dr. Marc Rosenblum, however, still held that the tumor was a low-grade oligo-astrocytoma.
Accordingly, after much discussion with my colleagues as well as with Robert and his father, I elected to treat him first with as aggressive chemotherapy regimen on an NYU IRB-approved protocol, including temozolomide (150mg/m2/day x 5 days) and Carboplatin (AUC = 8 per day x 2 days), cycles to be repeated every 4 weeks for a total of 4 cycles.
Robert has now completed his four cycles of chemotherapy, but has experienced, not unexpectedly, significant myelosuppression with delayed recovery, necessitating use of platlet and red cell transfusions, as well as Neupogen, and Neumega. He has I believe required one or two hospitalizations for febrile neutropenia. Of note, concomitant with each 5-day cycle of chemotherapy, he experienced break through seizures, likely due to chemotherapy causing increased hepatic catabolism of Tegretol, resulting in sub-therapeutic levels.
Impression and Recommendations:
Clearly, any further therapy must await complete resolution of his pancytopenias. However, after his next brain MRI in 2 months’ time I would recommend his starting up the following “maintenance” chemotherapy regimen, which should be extremely well tolerated: (a) Temozolomide at 75mg / m2 / day x 42 consecutive days at bedtime followed by a 14 day break. (b) calcitriol 0.5ugm daily continuously.
I would check his LFT’s every 2 months, and, at least initially, his CBC every two weeks. He must hold the temzolomide for at least one week if he develops any infection, cold or fever, etc.
In review of his relatively low/ intermediate tumor status, his young age, the mixed (oligo-astro) nature of the tumor – all of which portend a much more slowly transforming tumor – I have not recommended either irradiation or myeloablative chemotherapy with autologous stem cell rescue to obviate the irradiation. Certainly, one more recurrence, and the latter approach is absolutely that which I would recommend.
It has been a pleasure being involved in his care, and I do so much appreciate your own heavy involvement and commitment to his day-by-day management.
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The longer you live, the longer the doctors can make you live. If you die, they can’t help you. That is the moral here.
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2 Corinthians 6:16So we do not lose heart. Though our outer nature is wasting away, our inner nature is being renewed every day. For this slight momentary affliction is preparing for us an eternal weight of glory beyond all comparison, because we look not to the things that are seen but to the things that are un-seen; for the things that are seen are transient, but the things that are unseen are eternal
Thanks again....
Bob
4:03 PM
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