One more challenge

Tuesday, October 28, 2008

Most people seek medical care to make certain that nothing bad is happening. They seek reassurance from their doctor that all is well. Unasked questions that linger fill patients and their families with dread until their concerns are addressed.

“Is my abdominal pain due to appendicitis?”
“Am I having a heart attack?”
And the 800 poi8nd gorilla in the room: “Is there something bad causing my headache?”

For golf legend Seve Ballesteros, there is something bad. Two weeks ago, he experienced a first time grand mall seizure. As part of the evaluation of a new onset seizure, a CT scan of his brain was done and revealed a large tumor. It is amazing that significant parts of the brain can be destroyed and yet the patient can have normal function. Looking back, though, friends had reported that Mr. Ballesteros had been complaining of headaches and perhaps he had had a few episodes of unusual or erratic behavior. Often the clues are recognized after the fact and help explain previous events.

Seizures are relatively common in children and younger adults and some may be due to an area of the brain that has an abnormal wiring pattern that can cause electrical surges. This can spread to the whole brain and make brain cells fire randomly all at one. This causes the jerking and stiffening motions of the body that we describe as a seizure. The brain doesn’t like the irritation, and like a computer, logs itself off and then reboots. During this time, the brain doesn’t take in new input and the patient can be sleepy and less than normally responsive. After a period of time, the brain returns its function to normal and the patient returns to normal as well.

When an underlying problem is found though, it needs to be addressed. While the CT scan can identify that a tumor is present, it can’t say what type of tumor it might be. Tissue samples need to be obtained to help make the diagnosis and plan treatment. The brain isn’t the most accessible organ and a neurosurgeon is needed to open the skull and biopsy the tumor. At the same time, it may be necessary to debulk the tumor or cut away parts of it to prevent increased pressure on normal brain.

This is what happened to Mr. Ballesteros and that led to two more bad things. The first is that as the normal brain tissue started to swell after the operation and another was needed to remove more skull to allow that swelling to happen. The second bad thing was the diagnosis. The tumor was malignant, a cancer called an oligoastrocytoma which arises from brain cells and can be rapid growing.

Treatment options include further surgery to cut away tumor. Because the tumor grows into areas of the brain that have vital functions, it is often impossible to remove all of it and radiation therapy is required to help shrink and control the size of the remaining tumor.

Survival rates depend upon many factors including how aggressive the tumor acts and how quickly it grows, the age of the patient and underlying medical problems. Mr. Ballesteros has many hurdles to face. He has already had two brain operations and is now undergoing a third within two weeks. Time will determine whether his brain can recover enough to tolerate radiation therapy. And then there is the question of function. While medicine can keep people alive, the goal is much loftier. The brain needs to be able to return to normal form so that the patient can enjoy life.

It is never good to be an interesting patient. Mush of medical practice deals with routine complaints and tests are performed to make certain bad things are not present. The reason to do those tests lies in the fact that some people do have bad things. It’s tragedy that the odds didn’t favor Mr. Ballesteros. After years of facing and conquering challenges in the golfing world, he now faces an opponent far more ominous than he did on the field of play. Hopefully, he has the ability to win one more round.

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