Friday, December 11, 2009

the neurologist's report

Dr. Benson looked Mom over this afternoon. His first reaction was that Mom seems to have lost weight, which is likely: months ago, she had sunk down to a very thin 109 pounds; she then puffed up to almost 130 pounds. Over the weeks that followed, she stabilized at a more appropriate weight since the last time the doctor saw her, probably somewhere south of 120 pounds.

The doctor also felt that Mom was exhibiting cognitive decline; she was completely nonverbal with him, and only haphazardly responsive to instruction, but he also saw that she was reacting to faces, gestures, and actions in a way that indicated situational awareness.

We told the doctor about Mom's decline since her all-day sleep episode from about a month ago. He said this might actually have been the result of a seizure. The only way to determine precisely what's going on in Mom's head, especially as regards how much her language centers have been affected, would be through a test involving the touching of a wire directly to the exposed brain to see how the brain reacted to electrical stimuli. As we all agreed, this option was out: Mom's blood count is too low for us to risk opening her up, which is another reason why we like the new clinical trial Mom has entered: the only piercing of the skin will occur at whatever point the microcatheter is inserted (most likely the femoral artery).

We brought Dr. Benson up to speed regarding the new treatment; he agreed that it sounded like a reasonable course of action, but he gave us a general caution about taking extravagant measures that would yield few if any benefits. We've promised to give him a pile of data: the 10/28 MRI images from NCI (he was supposed to get these, anyway), the MRI images that will be done on 12/17, and the news articles about Dr. Boockvar's and Dr. Riina's research into intra-arterial Avastin delivery. Dr. Benson is going to become much more involved with Mom's case after the 12/18 operation: barring a messy and invasive test, the only thing we'll have to go on will be post-operative MRIs and clinical evaluations of Mom's cognitive abilities.

The most important thing I learned during our visit to the doctor was that an intracranial edema, if it's in a person's head long enough, can cause permanent brain damage, much the same way that constantly sleeping on the same arm can eventually cause permanent nerve damage. Mom has been living with her edema for weeks, possibly months. What this means is that Drs. Boockvar and Riina might succeed in shrinking Mom's tumors, but there's a chance that Mom will still be as cognitively impaired as she is now. We won't know until the procedure's been done and the Avastin has had time to work on the cancer.

That puts something of a damper on our hopes for what the docs at NYP/WC can accomplish for Mom, but we have to remain positive: we don't know anything for certain yet, and it'll probably be sometime in January before we know more.

And that's when Dr. Benson wants to see Mom again: mid-January. He told us that he thought we were doing a great job of caring for Mom. I was glad to hear that. Before he left the room, the doc shook everyone's hand, including Mom's. She understood that this was good-bye, at least for now.


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