The more "scientific" name of the tumor I have is a "Vestibulocochlear Schwannoma". It is a tumor of healthy schwann cells that grow out of eighth cranial nerve. That particular nerve has a vestibular division, which sends information regarding balance, and a cochlear division, which sends information about hearing. Hence, vestibulocochlear schwannoma.
More commonly, it is called an acoustic neuroma or AN. A neuroma is a tumor made up of nerve tissue, so an acoustic neuroma is such a tumor growing out of the acoustic nerve. The words become less grave sounding when we break it down this way. :-)
As to why there is an over production of these otherwise healthy nerve cells, no one really knows. All the doctors I spoke to said that the cause boils down to a genetic disorder, which is not necessarily the same as saying that it is hereditary; just that one drew a not-so-good number in the genetic sweepstakes of life.
There are theories pointing to either loud noises or cellphone use as being causes, but for the most part these theories are unproven and generally unaccepted by the medical establishment. They are, however, particularly seductive to personality types who always seek to assign blame - "if someone comes down with something, he must have done something to deserve it." :-)
For me proof can be found in the empirical numbers. If cellphones are the culprit for instance, then the explosion of cellphone use in our world today must be accompanied by an explosion of these tumors (similar to the explosion of colon/rectal cancer cases that came a few years after the introduction of instant noodles in styrofoam bowls). But all the doctors I spoke to said there was no significant rise in the frequency of cases they saw in the last few years.
The good news is acoustic neuromas are benign or non-cancerous. That in itself is already excellent news. Another piece of very good news is that ANs are located near the ear and far away from the brain centers that control intelligence, emotions, and memory. Nevertheless, they do pose quite serious medical risks and problems. As these tumors grow (they are generally very slow growing, but growing just the same), they begin to press on the cranial nerves and the brain stem, thereby affecting the body's ability to communicate with the brain. If left unattended, one would end up, as Dr. Libarnes put it, "like Christopher Reeves". (I quickly pointed out that perhaps he meant "like Christopher Reeves before he died." But I guess he was correct either way, since being like Christopher Reeves before he died points one towards the same eventuality.)
Mine is already quite large, about 4 cm in diameter. By some estimates it might have begun more than ten years ago. Five years was the smallest estimate I got. By this time it had presumably already ravaged my auditory nerve (hence my hearing loss) and was visibly pressing against my brain stem, pushing it to one side. My search for treatment would have to begin quickly...
Treatment Options
Once one begins researching treatment options for acoustic neuromas, he will quickly come to the realization, as I did, that there is still no "universally accepted standard of care" for the problem. There have been vast improvements in the medical techniques and technology used to deal with ANs in the last ten years, but a consensus on the single best method has yet to emerge, a fact which makes the search for treatment all the more difficult.
I loosely summarize the available options into four -
1) Do nothing.
2) Have surgery.
3) Undergo radiation.
4) Have a combination of surgery and radiation.
DO NOTHING
Since ANs are supposed to be very slow growing, those with small ANs have the option to do nothing and wait things out. Maybe it'll stop growing, or maybe it's growing so slowly that you'll be 95 years old by the time it starts to push on your cranial nerves/brain stem. Unfortunately, this is no longer an option for me because mine is already too big and already pushing against my cranial nerves and my brain stem.
HAVE SURGERY
This is the "cleanest" alternative in the sense that you'll be totally rid of the tumor. But completely removing the tumor also raises the possibility that with it, you remove portions of your nerves and damage the ability of your body to communicate with your brain. Your face might become paralyzed. You might be unable to swallow. You're guaranteed to lose all hearing on the affected side. I decided against this option precisely because I wanted the best odds possible of preserving all the body functions I currently have.
UNDERGO RADIATION
Under this option there are two sub-options -
Single-session radiation (like Gamma Knife) wherein the tumor is zapped with enough radiation to "kill" it in one single session. This sub-option can only be performed on tumors less than 3cm in diameter (which therefore rules this out for me), because anything larger would require a radiation dose that will prove harmful to the brain; and this is probably why the second sub-option was developed,
Multi-session radiation (like Cyber Knife or Fractionated Stereotactic Radiation technologies) which spread the radiation over the multiple sessions, from 3 sessions to as many as 30 or 50. These are relatively new technologies, very attractive in that there is absolutely no downtime. One can have it done during his lunch hour and not even take any time off work. Someday, this may well become the standard of care, but as of now the jury is still out on whether it can really be effective on large tumors. Because imagine this huge very angry bear running at you, and I tell you that you can either use a bazooka or the equivalent of one bazooka shot in as many 0.22 caliber bullets as you want, shot from a stub-nosed revolver. Which option do you think you'd have more confidence in? :-) I ruled this one out because of the uncertainty.
HAVE A COMBINATION OF SURGERY AND RADIATION
The fourth option made the most sense to me. Have a combination of options two and three so as to minimize the risks in the two extremes. With complete removal, we eliminate the problem of the tumor but at the probable expense of the cranial nerves. With radiation, the single shot is not an option for a tumor my size. The multiple-session option on the other hand, poses no risk to the nerves but the certainty of successfully "killing" the tumor is called into question. Having a combination of the two seems like an elegant solution: have surgery to make the tumor smaller such that a small bazooka can safely be used. The beauty is that to make the tumor smaller, the surgeon can carve out the "core" of the tumor and leave the shell. I compare it to an orange. They'll take out the actual orange but leave the peel. Since the peel is the part that is either actually attached to or sticking to the nerves, then there is (hopefully) no actual contact between the surgeon's knife and the nerves. After a few months, we shoot the peel with a small bazooka, thereby "killing" it so that it doesn't grow into another orange.
Sounds like a plan to me.
I loosely summarize the available options into four -
1) Do nothing.
2) Have surgery.
3) Undergo radiation.
4) Have a combination of surgery and radiation.
DO NOTHING
Since ANs are supposed to be very slow growing, those with small ANs have the option to do nothing and wait things out. Maybe it'll stop growing, or maybe it's growing so slowly that you'll be 95 years old by the time it starts to push on your cranial nerves/brain stem. Unfortunately, this is no longer an option for me because mine is already too big and already pushing against my cranial nerves and my brain stem.
HAVE SURGERY
This is the "cleanest" alternative in the sense that you'll be totally rid of the tumor. But completely removing the tumor also raises the possibility that with it, you remove portions of your nerves and damage the ability of your body to communicate with your brain. Your face might become paralyzed. You might be unable to swallow. You're guaranteed to lose all hearing on the affected side. I decided against this option precisely because I wanted the best odds possible of preserving all the body functions I currently have.
UNDERGO RADIATION
Under this option there are two sub-options -
Single-session radiation (like Gamma Knife) wherein the tumor is zapped with enough radiation to "kill" it in one single session. This sub-option can only be performed on tumors less than 3cm in diameter (which therefore rules this out for me), because anything larger would require a radiation dose that will prove harmful to the brain; and this is probably why the second sub-option was developed,
Multi-session radiation (like Cyber Knife or Fractionated Stereotactic Radiation technologies) which spread the radiation over the multiple sessions, from 3 sessions to as many as 30 or 50. These are relatively new technologies, very attractive in that there is absolutely no downtime. One can have it done during his lunch hour and not even take any time off work. Someday, this may well become the standard of care, but as of now the jury is still out on whether it can really be effective on large tumors. Because imagine this huge very angry bear running at you, and I tell you that you can either use a bazooka or the equivalent of one bazooka shot in as many 0.22 caliber bullets as you want, shot from a stub-nosed revolver. Which option do you think you'd have more confidence in? :-) I ruled this one out because of the uncertainty.
HAVE A COMBINATION OF SURGERY AND RADIATION
The fourth option made the most sense to me. Have a combination of options two and three so as to minimize the risks in the two extremes. With complete removal, we eliminate the problem of the tumor but at the probable expense of the cranial nerves. With radiation, the single shot is not an option for a tumor my size. The multiple-session option on the other hand, poses no risk to the nerves but the certainty of successfully "killing" the tumor is called into question. Having a combination of the two seems like an elegant solution: have surgery to make the tumor smaller such that a small bazooka can safely be used. The beauty is that to make the tumor smaller, the surgeon can carve out the "core" of the tumor and leave the shell. I compare it to an orange. They'll take out the actual orange but leave the peel. Since the peel is the part that is either actually attached to or sticking to the nerves, then there is (hopefully) no actual contact between the surgeon's knife and the nerves. After a few months, we shoot the peel with a small bazooka, thereby "killing" it so that it doesn't grow into another orange.
Sounds like a plan to me.
Different Surgical Approaches
Having decided that surgery would be necessary to make the tumor small enough for radiation, I now had to decide on what surgical technique to use. (The choices never end!)
To make things more reader-friendly I'll call the three different techniques or pathways as follows:
1) Above the ear approach
2) Behind the ear approach
3) Back of the head approach
Approach (1) was quickly ruled out because it was only for small tumors.
Approach (2) is usually performed by a 2-man team composed of a neuro-otologist (easier to think of as an EENT Surgeon) and a neurosurgeon. The EENT surgeon carves out a path through the back of the ear leading to the tumor. Then the neurosurgeon takes over and does the actual tumor removal.
Approach (3) is usually performed by neurosurgeons. While they may also work in 2-man teams, they do basically the same work of carving out a path from the back of the skull until the tumor can be seen and removed. I think of the 2-man team in Approach (3) as being Batman and Robin, while the 2-man team in Approach (2) is Batman and the Green Arrow.
Each of the approaches have their pros and cons. As a general rule, neuro-otologists will say that Approach (2) is better; while neurosurgeons who do not work with neuro-otologists will say that Approach (3) is better. I have come to believe that they are both correct. The better, safer approach for each of these surgeons is what they are used to. Surgery is a physical act, and therefore "muscle memory" comes into play. A surgeon will do a better job repeating a procedure that he has performed many times before.
In the end, I have chosen to believe that the advantages of one approach over the other is not so significant that I should let my choice of approaches dictate my choice of doctors. Rather, I should let my choice of doctors dictate my choice of approaches.
To make things more reader-friendly I'll call the three different techniques or pathways as follows:
1) Above the ear approach
2) Behind the ear approach
3) Back of the head approach
Approach (1) was quickly ruled out because it was only for small tumors.
Approach (2) is usually performed by a 2-man team composed of a neuro-otologist (easier to think of as an EENT Surgeon) and a neurosurgeon. The EENT surgeon carves out a path through the back of the ear leading to the tumor. Then the neurosurgeon takes over and does the actual tumor removal.
Approach (3) is usually performed by neurosurgeons. While they may also work in 2-man teams, they do basically the same work of carving out a path from the back of the skull until the tumor can be seen and removed. I think of the 2-man team in Approach (3) as being Batman and Robin, while the 2-man team in Approach (2) is Batman and the Green Arrow.
Each of the approaches have their pros and cons. As a general rule, neuro-otologists will say that Approach (2) is better; while neurosurgeons who do not work with neuro-otologists will say that Approach (3) is better. I have come to believe that they are both correct. The better, safer approach for each of these surgeons is what they are used to. Surgery is a physical act, and therefore "muscle memory" comes into play. A surgeon will do a better job repeating a procedure that he has performed many times before.
In the end, I have chosen to believe that the advantages of one approach over the other is not so significant that I should let my choice of approaches dictate my choice of doctors. Rather, I should let my choice of doctors dictate my choice of approaches.
The Express
Just finished watching a movie on DVD - The Express. It's the story of Ernie Davies, an African-American football player who led Syracuse University to its first ever national championship, and who also went on to become the first African-American to win the Heisman Trophy, given to the most outstanding player in college football.
He was all set to begin his professional career in the National Football League when he learned that he had leukemia. He never played another football game and his life was cut short at the young age of 23.
The story drove home a point that I have been telling myself these past weeks. This condition that I have, I would much rather not have, but really, there are a lot of worse things that one can have. With my situation, there is a clear path towards resolution (in fact, there are too many of them). While with many other illnesses and conditions, not a single clear path towards resolution exist.
As for the one in thirty chance of not making it past surgery, well, I think I have probably been closer to death before. I once dozed off for a few seconds while driving a car on Freeway 5 somewhere between Los Angeles and San Diego. Whenever I remember those few seconds, I still shudder at the thought, and the probability of something bad happening at that point was probably higher than one in thirty.
Besides, if I were God, I probably would be in no rush to see me just yet.. :-)
He was all set to begin his professional career in the National Football League when he learned that he had leukemia. He never played another football game and his life was cut short at the young age of 23.
The story drove home a point that I have been telling myself these past weeks. This condition that I have, I would much rather not have, but really, there are a lot of worse things that one can have. With my situation, there is a clear path towards resolution (in fact, there are too many of them). While with many other illnesses and conditions, not a single clear path towards resolution exist.
As for the one in thirty chance of not making it past surgery, well, I think I have probably been closer to death before. I once dozed off for a few seconds while driving a car on Freeway 5 somewhere between Los Angeles and San Diego. Whenever I remember those few seconds, I still shudder at the thought, and the probability of something bad happening at that point was probably higher than one in thirty.
Besides, if I were God, I probably would be in no rush to see me just yet.. :-)
5 Ways You Can Help Me
1) Please try to read this blog thoroughly before asking me questions. I started this blog for the primary reason that I do not wish to answer the same questions over and over again. :-) I have come to realize that I am not a particularly "social" animal, I do not thrive on human contact as much as others. This does not mean I am anti-social, which means "angry at" or "against" people. I do need your warmth and your fellowship, but let's try to skip the repetitive questions. :-)
2) Try not to call me. SMS is fine. There are times I don't feel like talking because I worry you might ask me repetitive questions. :-) For those whose calls I might have ignored, I'm sorry.
3) If, and I mean if, you have any intention of visiting me, please wait until I start blogging again after my surgery. The fact that I am well enough to blog would mean I am well enough to appreciate your visit. Bring happy thoughts and happy faces. Thanks in advance.
4) At this point, after weeks of agonizing over different treatment options, I would really prefer not to hear about the "friend of a friend who had a sister whose husband's brother" had the same thing and who went there and did this. By this time, nine days before surgery, such well-meaning advice only adds doubt and turmoil, which makes things more difficult.
2) Try not to call me. SMS is fine. There are times I don't feel like talking because I worry you might ask me repetitive questions. :-) For those whose calls I might have ignored, I'm sorry.
3) If, and I mean if, you have any intention of visiting me, please wait until I start blogging again after my surgery. The fact that I am well enough to blog would mean I am well enough to appreciate your visit. Bring happy thoughts and happy faces. Thanks in advance.
4) At this point, after weeks of agonizing over different treatment options, I would really prefer not to hear about the "friend of a friend who had a sister whose husband's brother" had the same thing and who went there and did this. By this time, nine days before surgery, such well-meaning advice only adds doubt and turmoil, which makes things more difficult.
5) Help my family, try to make things easier for them. Try to check this blog for updates before asking them. It's not exactly an easy time for them too.
Thanks very very much!
The Golden AN
A little ditty, inspired by the one of the most successful Sesame Street sketches of all time (successful in the sense that I believe everyone around my age remembers it, even thirty years after, kinda sorta...)
So we'll take the golden AN,
and remove as much as we cAN,
then we shoot what's left with some rays from the doctor mAN...
Afterwards, I hope I can still drive the tAN vAN;
That's the plAN!
So we'll take the golden AN,
and remove as much as we cAN,
then we shoot what's left with some rays from the doctor mAN...
Afterwards, I hope I can still drive the tAN vAN;
That's the plAN!
Doctors
After leaving Dr. Libarnes' Cardinal clinic with my diagnosis on June 23, 2009 I consulted with 6 other doctors regarding treatment (Dr. Libarnes himself was not a surgeon, and therefore could not be responsible for my care). Overall, with the exception of one particular doctor from that hospital where politicians seek political asylum, I found them to be a great bunch, generally brilliant, compassionate, and kind. I'd like to mention some of them here:
Dr. Charlotte Chiong - Neuro-otologist, Capitol Medical Center. She partners with Dr. Gap Legaspi as the neurosurgeon, and together they form the Batman-Green Arrow team that performs Approach #2 surgeries. I did not have the opportunity to meet Dr. Legaspi. What I remember the most about Dr. Chiong was that she spent a full hour with me during the consult. Out of the corner of my eye, I kept sensing her secretary signalling to her that she had to be somewhere else soon, but her demeanor never changed, her patience never wavered.
Dr. Ed Mercado - Neurosurgeon, Cardinal Santos Medical Center. A dynamic personality who oozes competence and confidence. Can switch comfortably between boardroom English and street slang. In short, a cool guy who's the best at what he does. I've been trying to think which local actor I would choose to play him (since this is often a good way to describe someone). Probably Eddie Garcia (a younger Eddie Garcia of course).
Dr. Willy Lopez - Neurosurgeon, Medical City. More of the quiet, studious type. Radiates intellect and compassion. Probably to be played by Rowell Santiago. Rowell Santiago today, not Rowell Santiago of the Sharon Cuneta days.
Dr. C. F. Fung - Neurosurgeon, Private Clinic, Hong Kong. - Arguably Hong Kong's best. Level-headed, mature type who was remarkably gracious answering our questions mostly posted through my cousin Jarvis who's a doctor in Hong Kong, although eventually I did have a personal consult with him in early August. Closest guy I can think of to play him would be John Woo himself in a cameo role, wearing a crazy wig. :-)
My sister Jocelyn also had a number of phone consults with some US doctors, namely:
Dr. John Adler of the Stanford Medical Center
Dr. William Slattery of House Ear Institute
and
Dr. Michael McDermott of the UCSF Medical Center
Overall, these guys also left me with the same general impression: Brilliant, thoughtful, deliberate, with a touch of humor and compassion.
Now I had to pick one, a process which is infinitely more difficult than deciding on which actors would play them. :-)
In my family there was, I guess understandably, a strong preference to see me seek treatment in the US. I really do see their point; all other things being equal, the best US doctors are probably a bit better than the best Philippine doctors, only because they have better access to technology, and have had a larger pool of patients to gain experience on (because of the much larger US population). In fact, I remember that during my first consult with Dr. Mercado, I asked him the following question: "If I were your son, what would you advise me?" Even he acknowledged that he would send me to the US but only provided it was to one of the top 5 surgeons.
BUT, the way I looked at things, all other things were not equal. I told my family that surgical skill was only one factor, we also had to consider logistics, comfort, and resources. Dr. Mercado also inadvertently touched on this when he answered my question above. He said that Filipinos not only did not end up with the top 5 surgeons, they tend to end up in the US equivalents of Dumaguete or Cagayan de Oro, simply because these places were where their logistical support and resources were.
As Sun Tzu once said:
"When an army is dispatched on a distant campaign the expenses borne by the people together with the disbursements of the treasury will amount to a thousand pieces of gold daily. There will be continuous commotion both at home and abroad, people will be exhausted by the requirements of transport, and all affairs will be disrupted."
I told my family that I had no doubt they would be willing and ultimately able to help and support me whatever the resource requirements. But I asked them if such would be practical? Are the differences in technology and surgical skill so large and so clear that we should ignore all other considerations and seek treatment from top surgeons in the US? Difficult to answer, but I believe the answer is "no". I would much rather have very good treatment here at home, see my daughter before leaving for the hospital, and recover on my own bed.
In the end, after a few difficult weeks, I decided to go with Dr. Ed Mercado, for the following main reasons:
1) He inspires my confidence. For both tangible (i.e. reputation, record, etc.) and less tangible (i.e. demeanor, "connection", etc.) reasons.
2) I am comfortable with his methodology - to "debulk" the tumor or make it smaller by removing its core, leaving behind the shell which will later on be "killed" via Gamma Knife radiosurgery. In my layman's mind, I am convinced this method provides the best odds of leaving the cranial nerves intact.
3) I have a preference for having treatment in the Philippines and recovering at home.
Accompanied by Kathy and my sister Christine, we went to see Dr. Mercado last August 6 to set a surgery date. I am at peace with the decision. I believe God was with us then, and I believe He will be with me six days from now...
Dr. Charlotte Chiong - Neuro-otologist, Capitol Medical Center. She partners with Dr. Gap Legaspi as the neurosurgeon, and together they form the Batman-Green Arrow team that performs Approach #2 surgeries. I did not have the opportunity to meet Dr. Legaspi. What I remember the most about Dr. Chiong was that she spent a full hour with me during the consult. Out of the corner of my eye, I kept sensing her secretary signalling to her that she had to be somewhere else soon, but her demeanor never changed, her patience never wavered.
Dr. Ed Mercado - Neurosurgeon, Cardinal Santos Medical Center. A dynamic personality who oozes competence and confidence. Can switch comfortably between boardroom English and street slang. In short, a cool guy who's the best at what he does. I've been trying to think which local actor I would choose to play him (since this is often a good way to describe someone). Probably Eddie Garcia (a younger Eddie Garcia of course).
Dr. Willy Lopez - Neurosurgeon, Medical City. More of the quiet, studious type. Radiates intellect and compassion. Probably to be played by Rowell Santiago. Rowell Santiago today, not Rowell Santiago of the Sharon Cuneta days.
Dr. C. F. Fung - Neurosurgeon, Private Clinic, Hong Kong. - Arguably Hong Kong's best. Level-headed, mature type who was remarkably gracious answering our questions mostly posted through my cousin Jarvis who's a doctor in Hong Kong, although eventually I did have a personal consult with him in early August. Closest guy I can think of to play him would be John Woo himself in a cameo role, wearing a crazy wig. :-)
My sister Jocelyn also had a number of phone consults with some US doctors, namely:
Dr. John Adler of the Stanford Medical Center
Dr. William Slattery of House Ear Institute
and
Dr. Michael McDermott of the UCSF Medical Center
Overall, these guys also left me with the same general impression: Brilliant, thoughtful, deliberate, with a touch of humor and compassion.
Now I had to pick one, a process which is infinitely more difficult than deciding on which actors would play them. :-)
In my family there was, I guess understandably, a strong preference to see me seek treatment in the US. I really do see their point; all other things being equal, the best US doctors are probably a bit better than the best Philippine doctors, only because they have better access to technology, and have had a larger pool of patients to gain experience on (because of the much larger US population). In fact, I remember that during my first consult with Dr. Mercado, I asked him the following question: "If I were your son, what would you advise me?" Even he acknowledged that he would send me to the US but only provided it was to one of the top 5 surgeons.
BUT, the way I looked at things, all other things were not equal. I told my family that surgical skill was only one factor, we also had to consider logistics, comfort, and resources. Dr. Mercado also inadvertently touched on this when he answered my question above. He said that Filipinos not only did not end up with the top 5 surgeons, they tend to end up in the US equivalents of Dumaguete or Cagayan de Oro, simply because these places were where their logistical support and resources were.
As Sun Tzu once said:
"When an army is dispatched on a distant campaign the expenses borne by the people together with the disbursements of the treasury will amount to a thousand pieces of gold daily. There will be continuous commotion both at home and abroad, people will be exhausted by the requirements of transport, and all affairs will be disrupted."
I told my family that I had no doubt they would be willing and ultimately able to help and support me whatever the resource requirements. But I asked them if such would be practical? Are the differences in technology and surgical skill so large and so clear that we should ignore all other considerations and seek treatment from top surgeons in the US? Difficult to answer, but I believe the answer is "no". I would much rather have very good treatment here at home, see my daughter before leaving for the hospital, and recover on my own bed.
In the end, after a few difficult weeks, I decided to go with Dr. Ed Mercado, for the following main reasons:
1) He inspires my confidence. For both tangible (i.e. reputation, record, etc.) and less tangible (i.e. demeanor, "connection", etc.) reasons.
2) I am comfortable with his methodology - to "debulk" the tumor or make it smaller by removing its core, leaving behind the shell which will later on be "killed" via Gamma Knife radiosurgery. In my layman's mind, I am convinced this method provides the best odds of leaving the cranial nerves intact.
3) I have a preference for having treatment in the Philippines and recovering at home.
Accompanied by Kathy and my sister Christine, we went to see Dr. Mercado last August 6 to set a surgery date. I am at peace with the decision. I believe God was with us then, and I believe He will be with me six days from now...
Aug. 1-4: Hong Kong and the Resolution of the Final Doubts
Back in early July, after I learned of my condition and the possibly risky treatment and potentially lengthy recovery, I resigned from my job of the last four years. We agreed with my employers that July 31, 2009 would be my last day.
So I decided that the first few days of August would be a good time for a trip to Hong Kong for some R,R & G - Rest, Relaxation, and Gluttony :-) before making the final decision on choice of treatment. What can I say; I love food. If I had to make a "bucket list" ala Jack Nicholson/Morgan Freeman, half the list would probably involve food. :-)
I went with Kathy but set the ground rules early: no shopping, no lugging around shopping bags. The trip would be built around the eight meals.
True enough, our first five meals were planned and carried out with military precision:
Lunch, Aug. 1 - DIN TAI FUNG, The Concord Mall, Tsimshatsui. I first tasted Din Tai Fung dumplings on a trip to Singapore in early 2008, and had made it my life's mission to taste it again. We had two orders of the xiaolongpao and one order of their distinctive siomai. Good thing we did not attempt to go to the original Hong Kong branch located at the less accessible Whampoa Gardens. We learned at this newer outlet that the original store was a franchise that had, in the words of the manager we spoke to, "disappeared". This company-owned outlet in Tsimshatsui was apparently now the sole option for having Din Tai Fung dumplings in Hong Kong.
Dinner, Aug. 1 - MAIN STREET DELI, The Langham Hotel, Tsimshatsui. The Reuben sandwich was great, and unexpectedly turned out to be the most memorable experience of the trip.
Lunch, Aug. 2 - SERENADE RESTAURANT, Hong Kong Cultural Center, Kowloon. We had lunch with my cousin Jarvis and my nephew Paul. She originally offered to take us to the more expensive Victoria City, but I told her I would prefer some place with a more extensive dimsum menu, so we settled on Maxim's City Hall near Hong Kong Harbor, but since that was under renovation, we ended up at Serenade, also part of the Maxim's Group but located parallel on the opposite harbor. Great selection, great dimsum.
Dinner, Aug. 2 - CRYSTAL JADE, IFC Mall, Central District. Although there are a number of other Crystal Jade branches in Hong Kong, I picked this one because I thought I remembered it would be the shortest distance from the MTR trains. Boy was I wrong! :-)
Lunch, Aug. 3 - FU SING, Sunshine Plaza, Wan Chai. When we stepped out of the Lockhart Road Exit of the Wan Chai MTR station and found ourselves amid the hardware stores and tile shops, I am sure what went through Kathy's mind was "How could there possibly be a good restaurant here??" :-) But there it was, hidden away inside a building, Fu Sing. Not a wide dimsum selection, but arguably the best asado in Hong Kong, and distinctive radish cake.
After five meals though, I realized that I had not tasted anything great. Much as I did not want to, I had to accept that my appetite had been affected by my state of mind. Food simply did not seem to have the same flavor. I made up my mind that the new mission was to get well, return to Hong Kong, and do this all over again. :-)
One good development during the Hong Kong trip was that quite unexpectedly, I got to talk with Dr. Fung and was able to settle some remaining doubts in my mind. At that point I was leaning towards Dr. Mercado, but had some lingering concerns that his "back-of-the-head" surgical approach might be a bit more risky than the "through-the-ear" approach. I had heard that doing things through the back of the head involved moving aside the brain stem and the cerebellum (I can't remember where exactly I heard that information, but most likely it was from my sister Shirley, who had by this time made it her mission in life to know all there is to know about ANs), which struck me as particularly risky-sounding.
On Aug. 3 my cousin Jarvis called me at 10:30 in the morning and told me that if I wanted some time with Dr. Fung, he could accomodate me at 11:00 before his clinic hours officially started. My first thought was, of course, "that's 30 minutes from now!" but it's a good thing Hong Kong is such a compact city because we actually made it. And I'm glad we did. Dr. Fung was able to explain that a tumor my size was already in contact with both the cerebellum and the brain stem, so involvement of the cerebellum and the brain stem was unavoidable whichever approach was used. More importantly, he informed me that both the cerebellum and the brain stem were not overly sensitive structures and would be able to withstand a fair amount of "movement". If indeed these ended up damaged during surgery, it would be because the surgeon was incompetent and not because of the approach he used.
That's when I decided, as I described in a previous post, that I would let my choice of doctors dictate my choice of surgical approaches, instead of the other way around.
Then we left for Fu Sing... :-)
So I decided that the first few days of August would be a good time for a trip to Hong Kong for some R,R & G - Rest, Relaxation, and Gluttony :-) before making the final decision on choice of treatment. What can I say; I love food. If I had to make a "bucket list" ala Jack Nicholson/Morgan Freeman, half the list would probably involve food. :-)
I went with Kathy but set the ground rules early: no shopping, no lugging around shopping bags. The trip would be built around the eight meals.
True enough, our first five meals were planned and carried out with military precision:
Lunch, Aug. 1 - DIN TAI FUNG, The Concord Mall, Tsimshatsui. I first tasted Din Tai Fung dumplings on a trip to Singapore in early 2008, and had made it my life's mission to taste it again. We had two orders of the xiaolongpao and one order of their distinctive siomai. Good thing we did not attempt to go to the original Hong Kong branch located at the less accessible Whampoa Gardens. We learned at this newer outlet that the original store was a franchise that had, in the words of the manager we spoke to, "disappeared". This company-owned outlet in Tsimshatsui was apparently now the sole option for having Din Tai Fung dumplings in Hong Kong.
Dinner, Aug. 1 - MAIN STREET DELI, The Langham Hotel, Tsimshatsui. The Reuben sandwich was great, and unexpectedly turned out to be the most memorable experience of the trip.
Lunch, Aug. 2 - SERENADE RESTAURANT, Hong Kong Cultural Center, Kowloon. We had lunch with my cousin Jarvis and my nephew Paul. She originally offered to take us to the more expensive Victoria City, but I told her I would prefer some place with a more extensive dimsum menu, so we settled on Maxim's City Hall near Hong Kong Harbor, but since that was under renovation, we ended up at Serenade, also part of the Maxim's Group but located parallel on the opposite harbor. Great selection, great dimsum.
Dinner, Aug. 2 - CRYSTAL JADE, IFC Mall, Central District. Although there are a number of other Crystal Jade branches in Hong Kong, I picked this one because I thought I remembered it would be the shortest distance from the MTR trains. Boy was I wrong! :-)
Lunch, Aug. 3 - FU SING, Sunshine Plaza, Wan Chai. When we stepped out of the Lockhart Road Exit of the Wan Chai MTR station and found ourselves amid the hardware stores and tile shops, I am sure what went through Kathy's mind was "How could there possibly be a good restaurant here??" :-) But there it was, hidden away inside a building, Fu Sing. Not a wide dimsum selection, but arguably the best asado in Hong Kong, and distinctive radish cake.
After five meals though, I realized that I had not tasted anything great. Much as I did not want to, I had to accept that my appetite had been affected by my state of mind. Food simply did not seem to have the same flavor. I made up my mind that the new mission was to get well, return to Hong Kong, and do this all over again. :-)
One good development during the Hong Kong trip was that quite unexpectedly, I got to talk with Dr. Fung and was able to settle some remaining doubts in my mind. At that point I was leaning towards Dr. Mercado, but had some lingering concerns that his "back-of-the-head" surgical approach might be a bit more risky than the "through-the-ear" approach. I had heard that doing things through the back of the head involved moving aside the brain stem and the cerebellum (I can't remember where exactly I heard that information, but most likely it was from my sister Shirley, who had by this time made it her mission in life to know all there is to know about ANs), which struck me as particularly risky-sounding.
On Aug. 3 my cousin Jarvis called me at 10:30 in the morning and told me that if I wanted some time with Dr. Fung, he could accomodate me at 11:00 before his clinic hours officially started. My first thought was, of course, "that's 30 minutes from now!" but it's a good thing Hong Kong is such a compact city because we actually made it. And I'm glad we did. Dr. Fung was able to explain that a tumor my size was already in contact with both the cerebellum and the brain stem, so involvement of the cerebellum and the brain stem was unavoidable whichever approach was used. More importantly, he informed me that both the cerebellum and the brain stem were not overly sensitive structures and would be able to withstand a fair amount of "movement". If indeed these ended up damaged during surgery, it would be because the surgeon was incompetent and not because of the approach he used.
That's when I decided, as I described in a previous post, that I would let my choice of doctors dictate my choice of surgical approaches, instead of the other way around.
Then we left for Fu Sing... :-)
Technology Adventure
I'm planning ahead here...
Theoretically, there shouldn't be any problems blogging from my hospital bed. Cellphones are like small computers these days and as long as I can pick up some GPRS signal from my room, I can access Blogger.com and blog away.
But what if the cellular signal is weak and I can't pick up any GPRS signals, then internet access becomes unavailable.
Supposedly though, I can send email to a specific email address provided by Blogger.com and that email gets posted as a blog entry automatically. That's nice, but in itself it doesn't solve anything since without a GPRS signal, it'll also be impossible to access email from my phone.
But, supposedly also, I can send email as an SMS message via a Smart cellphone, so if I put these two together, then theoretically, as long as I have enough of a cellular signal to send SMS, then I can send email via SMS, and get the contents posted automatically on my blog. I'll be limited to 140 characters per email though, so we'll be getting Twitter-like posts. Still, that's a pretty impressive, McGyver-ish leap. No PC, no wifi, no 3G, no EDGE, not even GPRS. Only SMS straight into a blog entry.
I'm going to give it a try a bit later, after I figure out the Smart email via SMS thing. If it actually works, I'll be very impressed. :-)
Theoretically, there shouldn't be any problems blogging from my hospital bed. Cellphones are like small computers these days and as long as I can pick up some GPRS signal from my room, I can access Blogger.com and blog away.
But what if the cellular signal is weak and I can't pick up any GPRS signals, then internet access becomes unavailable.
Supposedly though, I can send email to a specific email address provided by Blogger.com and that email gets posted as a blog entry automatically. That's nice, but in itself it doesn't solve anything since without a GPRS signal, it'll also be impossible to access email from my phone.
But, supposedly also, I can send email as an SMS message via a Smart cellphone, so if I put these two together, then theoretically, as long as I have enough of a cellular signal to send SMS, then I can send email via SMS, and get the contents posted automatically on my blog. I'll be limited to 140 characters per email though, so we'll be getting Twitter-like posts. Still, that's a pretty impressive, McGyver-ish leap. No PC, no wifi, no 3G, no EDGE, not even GPRS. Only SMS straight into a blog entry.
I'm going to give it a try a bit later, after I figure out the Smart email via SMS thing. If it actually works, I'll be very impressed. :-)
Technology Test
This entry was posted via a text message from a Smart cellphone.
Well I'll be damned... :-)
---
Txt msg to the Philippines (Ex. 639197654321@mail2.ph).
Well I'll be damned... :-)
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Txt msg to the Philippines (Ex. 639197654321@mail2.ph).
What I Believe About God
I do not believe, as I think my mother does :-), that my condition is some sort of divine punishment from God.
Let me be very clear. I am not saying that I have not done anything worthy of punishment. Let me say it here and now: I am a sinner. It's just that I do not believe God doles out earthly rewards and punishments in a pattern that is recognizable to human logic. I think the Biblical story of Job supports this conclusion. God allows trials and tribulations into our lives for different reasons.
Furthermore, I do not even think the human mind is capable of discerning what is a real blessing and a real punishment. For instance, most, if no all of us would think of a financial windfall as a blessing, but I really cannot imagine that God will use money as a reward, when the Bible says that the love of money is the root of all evil.
I remember a story I heard when I was a young boy; I believe it's a Chinese story meant to illustrate the unpredictability of fortunes:
There was once a poor farmer.
One day his horse, his prized possession, ran away.
"What misfortune!" his neighbors cried.
But a few days later, the horse not only found its way home, but also brought along a wild horse it had befriended.
"What luck!" his neighbors shouted.
However, a few days later, the farmer's son, while trying to "tame" the wild horse, fell off and broke his leg.
"What misfortune!"
But that very same day, a government draft board came into town to draft soldiers into the army to fight a bloody war. They skipped over the farmer's son when they saw he had a broken leg.
"What luck!"
A similar theme also runs through the lives of several Biblical characters: Moses comes immediately to mind. Joseph too. My point is that I am not taking this condition of mine as a particularly bad thing, because sometimes God uses these things to take us to a better place.
Lastly, I also believe that being a Christian doesn't mean that real earthly misfortune will not befall me. That is not my pact with God. I will not say to God that I will be a Christian so I expect a smooth life. I do not believe that God promises us any such thing on our earthly journey. What He does promise us is in the eternal afterlife.
These are the things that I believe about God in the context of what I am going through now.
Let there be no misunderstanding - I must ask for forgiveness for my sins. But that is something I must do always, and not only when perceived "misfortune" falls upon me.
I seek guidance, then leave myself in His hands; because after all is said and done, He knows best.
Let me be very clear. I am not saying that I have not done anything worthy of punishment. Let me say it here and now: I am a sinner. It's just that I do not believe God doles out earthly rewards and punishments in a pattern that is recognizable to human logic. I think the Biblical story of Job supports this conclusion. God allows trials and tribulations into our lives for different reasons.
Furthermore, I do not even think the human mind is capable of discerning what is a real blessing and a real punishment. For instance, most, if no all of us would think of a financial windfall as a blessing, but I really cannot imagine that God will use money as a reward, when the Bible says that the love of money is the root of all evil.
I remember a story I heard when I was a young boy; I believe it's a Chinese story meant to illustrate the unpredictability of fortunes:
There was once a poor farmer.
One day his horse, his prized possession, ran away.
"What misfortune!" his neighbors cried.
But a few days later, the horse not only found its way home, but also brought along a wild horse it had befriended.
"What luck!" his neighbors shouted.
However, a few days later, the farmer's son, while trying to "tame" the wild horse, fell off and broke his leg.
"What misfortune!"
But that very same day, a government draft board came into town to draft soldiers into the army to fight a bloody war. They skipped over the farmer's son when they saw he had a broken leg.
"What luck!"
A similar theme also runs through the lives of several Biblical characters: Moses comes immediately to mind. Joseph too. My point is that I am not taking this condition of mine as a particularly bad thing, because sometimes God uses these things to take us to a better place.
Lastly, I also believe that being a Christian doesn't mean that real earthly misfortune will not befall me. That is not my pact with God. I will not say to God that I will be a Christian so I expect a smooth life. I do not believe that God promises us any such thing on our earthly journey. What He does promise us is in the eternal afterlife.
These are the things that I believe about God in the context of what I am going through now.
Let there be no misunderstanding - I must ask for forgiveness for my sins. But that is something I must do always, and not only when perceived "misfortune" falls upon me.
I seek guidance, then leave myself in His hands; because after all is said and done, He knows best.
Crunch Time Reflections
Well, here we are... crunch time. We're now officially less than three days away from start of surgery.
I'm a bit nervous of course. I don't really consider myself to be a particularly brave man. I'm not panicky though, I'm embracing my destiny and not running away from it.
"Brain surgery" : the words sound grave no matter how I say them. But really, as I've said before, my situation is not as bad as other possible scenarios. We're not going into the deepest recesses of the brain and we're not dealing with anything malignant. If you're going to have a brain tumor, mine is probably the best to have.
Ironically, it's our fifth anniversary today. Maybe we'll do something with Steffi later. On the left you'll find one of my favorite pictures. It was taken in Camp John Hay, Baguio, earlier this year in relatively more "carefree" times.
I like it because Steffi seems so happy, although there's an inside story as to what she is really laughing about. :-) But overall it makes for a good, happy picture.
My goal is to return to this spot within two years and take this picture again.
Last night I asked myself what regrets I have. Oddly, I really feel like I have no regrets. I say "oddly" because I know I've made many mistakes in my life, but somehow there are no nagging, gnawing regrets. Maybe it is an instinctive human mechanism wherein over time, we make ourselves feel better about the mistakes we made. As Ernest Hemingway said: "A man can be destroyed but not defeated."
The poker player Stu Ungar said sometime near the end of his life something to the effect that all the bad things he did in his life, he did to himself. I know that such a statement is wrong, because we cannot hurt ourselves without hurting those who love us, so there is no such thing as doing bad things that hurt only ourselves. Furthermore, any bad act is a sin against God, regardless of who is the object.
Still, I do have some appreciation of the sentiment behind his statement. What he meant was that he never consciously did harm to others, and I would agree that, "that" is worth something. I think of myself the same way. I'd like to think that no one is worse off from having encountered me in his or her life. From the people I know intimately, to the people I encounter briefly on the street, I'd like to think that they encountered kindness and gentleness.
Ironically, I think the two people I treated worst in my life are my mother and my wife.
On second thought, maybe this is not surprising at all. Since they affect my life the most, I guess it is to be expected that it is with them that I will address differences of opinion.
With my mother, the differences in philosophy and thought processes are so vast that I really doubt we can have a totally harmonious relationship in this life. But bottom line, I know she loves me and she knows (I think) that I love her. I know we will have much better relationship in the afterlife.
As for my wife, I think there is much more room to show her my appreciation. But I'll address that after my surgery. :-) One problem at a time.
At the end of the day, I would like to be remembered as a "good and decent man". But hopefully, there will be no need for such remembering just yet... :-)
I'm a bit nervous of course. I don't really consider myself to be a particularly brave man. I'm not panicky though, I'm embracing my destiny and not running away from it.
"Brain surgery" : the words sound grave no matter how I say them. But really, as I've said before, my situation is not as bad as other possible scenarios. We're not going into the deepest recesses of the brain and we're not dealing with anything malignant. If you're going to have a brain tumor, mine is probably the best to have.
Ironically, it's our fifth anniversary today. Maybe we'll do something with Steffi later. On the left you'll find one of my favorite pictures. It was taken in Camp John Hay, Baguio, earlier this year in relatively more "carefree" times.I like it because Steffi seems so happy, although there's an inside story as to what she is really laughing about. :-) But overall it makes for a good, happy picture.
My goal is to return to this spot within two years and take this picture again.
Last night I asked myself what regrets I have. Oddly, I really feel like I have no regrets. I say "oddly" because I know I've made many mistakes in my life, but somehow there are no nagging, gnawing regrets. Maybe it is an instinctive human mechanism wherein over time, we make ourselves feel better about the mistakes we made. As Ernest Hemingway said: "A man can be destroyed but not defeated."
The poker player Stu Ungar said sometime near the end of his life something to the effect that all the bad things he did in his life, he did to himself. I know that such a statement is wrong, because we cannot hurt ourselves without hurting those who love us, so there is no such thing as doing bad things that hurt only ourselves. Furthermore, any bad act is a sin against God, regardless of who is the object.
Still, I do have some appreciation of the sentiment behind his statement. What he meant was that he never consciously did harm to others, and I would agree that, "that" is worth something. I think of myself the same way. I'd like to think that no one is worse off from having encountered me in his or her life. From the people I know intimately, to the people I encounter briefly on the street, I'd like to think that they encountered kindness and gentleness.
Ironically, I think the two people I treated worst in my life are my mother and my wife.
On second thought, maybe this is not surprising at all. Since they affect my life the most, I guess it is to be expected that it is with them that I will address differences of opinion.
With my mother, the differences in philosophy and thought processes are so vast that I really doubt we can have a totally harmonious relationship in this life. But bottom line, I know she loves me and she knows (I think) that I love her. I know we will have much better relationship in the afterlife.
As for my wife, I think there is much more room to show her my appreciation. But I'll address that after my surgery. :-) One problem at a time.
At the end of the day, I would like to be remembered as a "good and decent man". But hopefully, there will be no need for such remembering just yet... :-)
Game Time
Ok, here we go...
I am scheduled to check in around noon of Monday. I'll spend the rest of the day getting preliminary tests and, I suppose, being checked up on by the medical team. I suppose I'll get to speak with the anesthesiologists (who play a big part in this) and also with Dr. Mercado to go over the details of my surgery one last time.
I get wheeled into the OR very early Tuesday morning, where Dr. Mercado and his partner Dr. Gimenes will spend the next 5-7 hours drilling a hole through the back of my head and "carving" out the core of the tumor. As agreed upon they will leave the "shell" of the tumor untouched, so that there will no attempt to separate tumor from nerve.
After the operation I'll be kept asleep for another 24 hours using Propofol, the drug that Michael Jackson was "abusing" to manage his sleep. Throughout this 24 hour period they'll awaken me a few times (simply by stopping the Propofol drip) to check my responses before starting the drip again and putting me under. I'll also be on a respirator throughout this time.
Therefore I really only begin the process of coming out of surgery sometime Wednesday afternoon. By that time, I imagine I'll be groggy, weak, and in some pain; but if all goes according to plan, I should have all my mental and physical faculties intact. Except of course, if there are complications.
Ahh, the dreaded complications. I guess this whole affair would be boring without them. :-)
I've been "quoted" a 3-5% possibility of death. I'm guessing this is probably on the conservative side, the true odds are probably around 2%. Still, 2% would mean that one out of fifty patients never make it out, and that's a fairly scary thought. But I guess this possibility comes with the territory. Anytime someone goes under the knife, he exposes himself to this possibility. People die undergoing liposuction; and let me tell you, if you have go this way, "brain surgery" certainly sounds a whole lot better to me than "butt reduction". :-)
The complication I worry the most about is hydrocephalus. Literally, "water in the head". The condition can be caused if cerebrospinal fluid does not circulate well and begins to build up in the brain, causing increased intercranial pressure. The way I understand it, my brain structures have been in a constant state of compression for quite some time now (because of the tumor pressing on these structures) that ironically, relieving this compression might actually impact circulation negatively and cause the build-up of cerebrospinal fluid. Of all the complications, I dread this one the most, because it is the only one that has the potential to decrease IQ. (Note: death does not decrease IQ, it eliminates it.) Being already of low IQ I do not wish to diminish it further. :-) For that would leave me with only my good looks and lights-out three-point shooting ability to earn a living for my family. :-)
Lastly we might also have complications if things do not go entirely as planned and there is some damage to either the cranial nerves, the cerebellum, or the brain stem. I could end up with some physical problems (i.e. coordination, difficulty walking, facial palsy, difficulty swallowing, etc etc etc)
There are probably more possible complications. But these are bad enough that I do not wish to continue learning about the others. :-)
So there. If you've read this far, I thank you. Keep me in your thoughts and prayers. Forgive me for saying this, but review the 5 Ways You Can Help Me. Once surgery begins, pay especially close attention to No. 5: Help my family. Be supportive. Do not pepper them with questions and "what-ifs", both well-meaning and otherwise.
I thank you all...
I am scheduled to check in around noon of Monday. I'll spend the rest of the day getting preliminary tests and, I suppose, being checked up on by the medical team. I suppose I'll get to speak with the anesthesiologists (who play a big part in this) and also with Dr. Mercado to go over the details of my surgery one last time.
I get wheeled into the OR very early Tuesday morning, where Dr. Mercado and his partner Dr. Gimenes will spend the next 5-7 hours drilling a hole through the back of my head and "carving" out the core of the tumor. As agreed upon they will leave the "shell" of the tumor untouched, so that there will no attempt to separate tumor from nerve.
After the operation I'll be kept asleep for another 24 hours using Propofol, the drug that Michael Jackson was "abusing" to manage his sleep. Throughout this 24 hour period they'll awaken me a few times (simply by stopping the Propofol drip) to check my responses before starting the drip again and putting me under. I'll also be on a respirator throughout this time.
Therefore I really only begin the process of coming out of surgery sometime Wednesday afternoon. By that time, I imagine I'll be groggy, weak, and in some pain; but if all goes according to plan, I should have all my mental and physical faculties intact. Except of course, if there are complications.
Ahh, the dreaded complications. I guess this whole affair would be boring without them. :-)
I've been "quoted" a 3-5% possibility of death. I'm guessing this is probably on the conservative side, the true odds are probably around 2%. Still, 2% would mean that one out of fifty patients never make it out, and that's a fairly scary thought. But I guess this possibility comes with the territory. Anytime someone goes under the knife, he exposes himself to this possibility. People die undergoing liposuction; and let me tell you, if you have go this way, "brain surgery" certainly sounds a whole lot better to me than "butt reduction". :-)
The complication I worry the most about is hydrocephalus. Literally, "water in the head". The condition can be caused if cerebrospinal fluid does not circulate well and begins to build up in the brain, causing increased intercranial pressure. The way I understand it, my brain structures have been in a constant state of compression for quite some time now (because of the tumor pressing on these structures) that ironically, relieving this compression might actually impact circulation negatively and cause the build-up of cerebrospinal fluid. Of all the complications, I dread this one the most, because it is the only one that has the potential to decrease IQ. (Note: death does not decrease IQ, it eliminates it.) Being already of low IQ I do not wish to diminish it further. :-) For that would leave me with only my good looks and lights-out three-point shooting ability to earn a living for my family. :-)
Lastly we might also have complications if things do not go entirely as planned and there is some damage to either the cranial nerves, the cerebellum, or the brain stem. I could end up with some physical problems (i.e. coordination, difficulty walking, facial palsy, difficulty swallowing, etc etc etc)
There are probably more possible complications. But these are bad enough that I do not wish to continue learning about the others. :-)
So there. If you've read this far, I thank you. Keep me in your thoughts and prayers. Forgive me for saying this, but review the 5 Ways You Can Help Me. Once surgery begins, pay especially close attention to No. 5: Help my family. Be supportive. Do not pepper them with questions and "what-ifs", both well-meaning and otherwise.
I thank you all...
Night Before
All systems go, surgery in nine hours. Wonder if i'll get any sleep tonight.
I hope all goes well.
Signing off...
I hope all goes well.
Signing off...
Intensive Care Friday
Stili in intensive care. Things look well. Think i have everything back, but very weak, head very heavy. Eating jello, first time in 3.5 days. Don't come yet.
The real Friday
Apparently yesterday was Thursday and now is the real Friday. Finally out of ICU into my regular rm 318. Still pretty immobile. Weak, heavy head. Angry at my nurse most of the time.
Hotdog Solves Small Crisis
As of last night there was a small crisis of unsolvable hiccups. Finally resolved this morning with small hotdog. Apparently total lack of food for 4 days had thrown body off. Things looking up i think.
Sunday Update
I should actually be quite well now if not for this maddenning case of hiccups. It's normal though, so at least it doesn't suggest that something has gone wrong. If all goes according to plan, I'll get a scan Monday, and be released Tuesday, and continue these hiccups at home.
A New World
As of around 11pm Sunday they've removed the last IV tube. I hope in the nxt few hours it will allow me to slowly and gingerly explore my post-op world. I've not seen myself in the mirror for almost a week now. Haven't shaved, haven't made pooh-pooh as man was meant to pooh-pooh.
This moving arround will also help me conquer a hospitalized man's horror hours - the time from 10 - 6 when the rest of the world goes to sleep but a hospitalized man finds himself wide awake and all alone.
Lastly, i suspect that as my body senses a return to the normal, the hiccups will stop.
This all a bit not covered by official doctors' orders, but i think both my wife and sister feel it is not widely irresponsible and sounds a bit logical...
So we'll see...
This moving arround will also help me conquer a hospitalized man's horror hours - the time from 10 - 6 when the rest of the world goes to sleep but a hospitalized man finds himself wide awake and all alone.
Lastly, i suspect that as my body senses a return to the normal, the hiccups will stop.
This all a bit not covered by official doctors' orders, but i think both my wife and sister feel it is not widely irresponsible and sounds a bit logical...
So we'll see...
A New World - the Results
I shaved
I wee-weed like a grown man
I poo-poohed like a grown man.
Now dressed in an old pair of Nike shorts, an old t-shirt and standard hanes briefs, but i feel like a million bucks.
The hiccups really went away but came back after I lay back down. I may have to wait 3 hours until they come pick me up for the CT SCAN, but i feel we've turned a good corner
I wee-weed like a grown man
I poo-poohed like a grown man.
Now dressed in an old pair of Nike shorts, an old t-shirt and standard hanes briefs, but i feel like a million bucks.
The hiccups really went away but came back after I lay back down. I may have to wait 3 hours until they come pick me up for the CT SCAN, but i feel we've turned a good corner
Liberation Day
Scheduled for discharge today, Tuesday, exactly eight days into this process. Hope everything goes according to plan, I'm excited for things to be more 'normal'.
The Week That Was : Aug. 17-26, 2009
As most of you know, I underwent brain surgery last week, on the morning of August 18, to be exact.
The purpose of the surgery was to get me ready for the second stage of my treatment plan: Gamma Knife Radiation. So let me be very clear, I am at this point by no means rid of my tumor yet. About half of it is still there. This is by choice, we will leave it there, although we will radiate it, "kill" it so that it doesn't start to grow again. Ironically, the first stage is by far the more difficult and more invasive. The radiation should be relatively easier to get through. So I'm glad we've more or less gotten past this first stage. We just have to wait a few months for the swelling to go down, for the tissues to stabilize, and then we can radiate. The reason we could not go go directly into radiation was because my tumor was already quite large and the necessary dosage of radiation might be harmful to my brain, so we made it smaller first.
In a month or two I'll get a new mri and I can put up a comparative scan so we can all see how much exactly is left.
The more inqusitive among you may ask, having gone ahead with actual surgery, why not just go for the whole enchilada and try to take the whole thing out. Yes, this was an option. BUT, the more we tried to take out, the more we risked taking out bits and pieces of nerves, which would leave me with possible functional losses such as facial paralysis, inability to swallow, coordination problems, etc. Those were risks I did not want to take.
So from the start, I made it very clear to my surgeons, Dr. Eduardo Mercado and Dr. Michael Louise Gimenez, that I wanted to err on the side of caution and preserve function at all costs. I thank those two fine surgeons for respecting my wishes. In a way, it was a bit of a dis-service to them because implicit in those wishes was an "order" to undershoot perfection; and in short, I may have kept them from full fullfillment of their craft. So I thank them as much for their skill as their humility and humanity.
In my mind the resuts are beautiful. I have my matinee-idol smile back in full radiance. I feel no loss in coordination and can swallow perfectly normally, something which will be critical to the food trips to come.
I do have some unconrollable hiccupping and GI disturbances, but in all, while very bothersome, I consider these very minor and I believe wholeheartedly that they should resolve on their own. My brain is not swelling up, and I believe I've lost no functions.
In short, I'm Back!
The purpose of the surgery was to get me ready for the second stage of my treatment plan: Gamma Knife Radiation. So let me be very clear, I am at this point by no means rid of my tumor yet. About half of it is still there. This is by choice, we will leave it there, although we will radiate it, "kill" it so that it doesn't start to grow again. Ironically, the first stage is by far the more difficult and more invasive. The radiation should be relatively easier to get through. So I'm glad we've more or less gotten past this first stage. We just have to wait a few months for the swelling to go down, for the tissues to stabilize, and then we can radiate. The reason we could not go go directly into radiation was because my tumor was already quite large and the necessary dosage of radiation might be harmful to my brain, so we made it smaller first.
In a month or two I'll get a new mri and I can put up a comparative scan so we can all see how much exactly is left.
The more inqusitive among you may ask, having gone ahead with actual surgery, why not just go for the whole enchilada and try to take the whole thing out. Yes, this was an option. BUT, the more we tried to take out, the more we risked taking out bits and pieces of nerves, which would leave me with possible functional losses such as facial paralysis, inability to swallow, coordination problems, etc. Those were risks I did not want to take.
So from the start, I made it very clear to my surgeons, Dr. Eduardo Mercado and Dr. Michael Louise Gimenez, that I wanted to err on the side of caution and preserve function at all costs. I thank those two fine surgeons for respecting my wishes. In a way, it was a bit of a dis-service to them because implicit in those wishes was an "order" to undershoot perfection; and in short, I may have kept them from full fullfillment of their craft. So I thank them as much for their skill as their humility and humanity.
In my mind the resuts are beautiful. I have my matinee-idol smile back in full radiance. I feel no loss in coordination and can swallow perfectly normally, something which will be critical to the food trips to come.
I do have some unconrollable hiccupping and GI disturbances, but in all, while very bothersome, I consider these very minor and I believe wholeheartedly that they should resolve on their own. My brain is not swelling up, and I believe I've lost no functions.
In short, I'm Back!
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