Fireside Chats

Martin’s Story: Signs of a brain tumour are easy to ignore. I hate to admit it, but I said that all I needed was a neck massage and new glasses to deal with three weeks of left sided foot drop and numbness and a week or so of stumbling. It was the stumbling that made my wife insist I call my family doctor. My doctor listened to my symptoms on a phone appointment and I had a brain CT three days later. She is so smart; of course, when I described the symptoms to my doctor, it clicked that the ”having to lift one’s foot” is actually “foot drop,” and the odd sensation in the foot is “numbness.” There is a definite progression from an “odd feeling” to a “symptom.” At the CT, I had an inkling something was wrong by the way the radiologist did not come to say hello after the procedure. Usually, we do a doctor-to-doctor debrief to let colleagues know it is all OK, unless it isn’t. My family doctor came to my home the next day to break the bad news in person. Sitting there in the sunshine with the grandkids playing in the yard listening to her tell me I had a brain tumour was quite the moment. She left me with some Dexamethasone and Ativan as the mass in the brain was big. It took just four days to get an organic diagnosis. Four days later, I had a CT of my chest and abdomen which found eight other masses. That told us that I was riddled with cancer. Not a good day. Later, we would find another metastasis in my eye when the immunotherapy caused a rare papillitis. I had a chest biopsy 14 days after the Brain CT and stage 4 melanoma diagnosed within days. There was another instance of that doctor-to-doctor thing: the one who stabbed me (very skillfully) said, as I was recovering from the day surgery, that the tumour looked black and he thought it was melanoma, which was confirmed a day or so later. So, within three weeks of calling my family doctor, I had a pathological diagnosis. I saw my oncologist two weeks later; this was the first glimmer of hope in a bleak month. There was some back and forth about the brain tumour and I had a distressing visit with a neurosurgeon who showed me the MRI. It looked like a lot of the right side of my brain was swollen and the tumour looked big and deep. Surgery would leave me in a wheelchair. The alternative was provided by the neuro-radio-oncologist: she said I could be treated with the “gamma-knife” which is accurate down to one millimetre, though it would not necessarily cure the brain tumour as it might not get all of it. I realised that talking about cure was overly optimistic and I should go for being able to walk for as long as I can. Next, the tumour board met, and I got my therapeutic diagnosis seven weeks after presenting to the family doctor. I was going to be treated with gamma knife for the brain tumour and then receive dual immunotherapy. I did also get a liquid biopsy, as my research is in genetics, and I have a friend who does this (though it was done by a different group to keep things straight). Interestingly, a BRAF mutation was seen that was not in the lung biopsy. I had my gamma knife stereotactic radiotherapy 9 weeks after diagnosis, then began to receive the dual immunotherapy just 12 weeks after my first appointment, with a further 25 medical appointments/scans/biopsy/bloods etc. during that time. Three months after starting immunotherapy, the tumours were shrinking and the glimmers of hope became a lot brighter. Of all of these procedures, the chest biopsy was the most dangerous – the largest of the chest lesions was really deep, so seven inches of steel was put into my chest. This would have been fine, as I was totally numb with local anesthetic, but because I am a doc they kindly let me watch it on the screen. Oh look, there is a huge sword deep in my chest right next to some major blood vessels! I better not move. Definitely a birthday to forget!