Date sent: 10/26/99 11:09 PM
Answer: No.

Apparently, a headache is not just a headache. This morning, I was walking around our house with Paul, discussing changes and improvements. (So many people are rallying to get the house ready for Dan to come home... we are awed and grateful... thank you...)... So, after Paul left, I noticed a message on the answering machine (I had not even heard the phone ring.) It was Dan. He said he had just spoken with Dr. Watts about the MRI, that there was "mass" there, that they didn't know what it was ... could be tumor could be absess... and that since Dr. Watts had not been able to reach Dr. Black he was asking a local neurosurgeon to come consult.

How do I express my shock and dismay? This definately was not supposed to happen. And, as many times as I have been through this story today with parents and siblings, I am still dumbfounded.

When I arrived at the hospital, I learned a couple more things, the site does enhance with contrast agent in the MRI. There is also associated edema (enough to push the midline of the brain slightly to the left). There are also enhancements with contrast are near the scalp.

The next step was to spend the day waiting to talk with the local surgeon and trying to reach Dr. Black's office. Apparently Dr. Black was in the hospital to do a quick morning surgery and then out again to fly away to some conference. Dr. Watts spoke with Donna from Dr. Black's office several times, she text paged Dr. Black, but the two docs never connected today. When I spoke with Donna, she said that as soon as the films arrive (Wed. since they were taken late Monday, they could not be fedexed til Tues, so will arrive Wed.) someone from their group will look at them. She also said that there had been films from the surgery sent to Dan at MVH proactively last week, but no one at MVH has seen them. Dr. Black will be back to the office Wed. afternoon, so hopefully he will be the one to read the new MRIs.

Anyway, the conversation with the local neurosurgeon did not give us much very new information. He said that it looked cystic with an edge of enhanced signal. He did not bring the film so that we could look at them together... .I had to just take his word for it. He said the radiologists report said possible tumor, possible absess. He said that since Dan is doing well clinically (looks good, no high fever or outlandish wbc's) that he was leaning against absess. If it were absess he would drain it, and then "dump gallons of penicilan" on it. If it were not absess he would drain it and suggest radiation therapy. The process to "drain it" would be a smaller surgery than the full craniotomy, but would be a definate additional "procedure." And, by implication I guess, the drainage would answer the question of is it absess or tumor.

Additionally, he was recommending getting a PET tomorrow, which could theoretically make the distinction between absess and tumor. Dr. Wyatt (local neurosurgeon... do you have all these guys straight yet?) called to arrange a PET and they said that they needed to make a particular isotope, he said ok, make it, they said the folks have gone home, he said call them back in, they said we don't have a call schedule... he said ok, no PET. I wasn't clear about this, but I think it had something to do with the fact that we will talk with Dr. Black tomorrow and he may have a better idea of how to distinguish, since he has the last mri's post-op.

I asked about treating the edema. He said that since there is still a question about what they are looking at, he was not opposed to starting decadron, but was not for it either. Why? Decodron supresses the immune response... the same immune response that causes the edema also fight the infection of an absess... So, if it is tumor with associated edema then decadron will help, if it is an absess, then the decadron will make it worse.

In conversation with both Dr. Watts and Dr. Wyatt, I asked about the sense of urgency. Earlier today, I had gotten the impression that if it were an absess, they might come take Dan away any minute into surgery.... which I had no clue how I could respond to that. So, talking to Dr. Wyatt eased that sense of IMMEDIATE urgency. However, both agreed that there was sufficient time to collect additional information to make a treatment decision, but that once a decision was made, we should plan to take action quickly... On the scale of days, I think.

Obvious questions:

How does one tell the difference between absess and tumor on an MRI?

Can a tumor really grow that fast?

Will we need to travel back to Boston for treatment?

In rehab news, Dan was fitted for a custom orthotic brace to help him walk, the OT and I discussed our proposed house modifications and when she could come for a home visit, speech continued to challenge Dan with logic puzzles.

The next question is, How is Dan? Shewwww, he still is getting headaches, and doing the which pain-reliever should I try today dance... His spirits were already dampened by just not feeling well. Today, he was in some serious fear. He was nearly speechless. There was not much to say.

Well folks, I am about spent for the night. Thank you for all your loving support, prayer, healing energy. Whatever your cosmology, please send a little into the universe for Dan.

Sincerely, Abi and Dan