Author Topic: Am I being overly sensitive?  (Read 5936 times)

tdlight

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Am I being overly sensitive?
« on: March 09, 2016, 10:53:03 am »
Earlier this week I emailed several doctors I had been actively consulting with to inform them I would be seeking treatment elsewhere.  The emails generally, with minor modification for each doc, went something like this:

Dear Dr. ______ I am writing to let you know I have chosen to seek CyberKnife treatment for my vestibular schwannoma at Stanford Neurosciences Health Center.  I wanted to let you know how much I appreciated the time you took to consult with me and in particular your pragmatic assessment of my treatment options.  It was a much harder decision process than I had anticipated and your guidance was an important part of that process.  Thank you.

One doctor from a well respected clinic that specializes in surgery replied a day later with the following message:

Dear Terry, Thank you for your email. Quite frankly, I do not think that radiation is the best treatment for you. In fact, if you are going to choose that, my recommendation would be to simply observe the tumor. There is little evidence to support radiation to prevent hearing loss progression. I do not treat patients with radiation, unless they exhibit growth of tumor. As you know, many of these tumors will not grow. If I was in your position, I would simply observe the tumor. If it does grow, you could then opt for radiation treatment. I am attaching an article from our group regarding observation of tumors. I am not sure if I had sent this to you previously. If you decide to go ahead with treatment, I wish you all the best.

I found this response somewhat disturbing.  I thought I would likely hear back with something more along the lines of, "Thanks for getting back to me and best wishes."  Why suggest a watch and wait strategy now when he was perfectly willing to open up my skull and remove a potentially non-growing tumor?  And then to offer up previously undisclosed research on conservative management also seemed disingenuous. 

Of course this has put the slightest bit of doubt back in to my mind after going through this very difficult decision process.  I know I am preaching to the choir about how difficult that process can be.  The doctors in this business must all know and appreciate how difficult the decision is, so to have one undermine my peace of mind with this sort of response was maddening.  I understand these are businesses that ultimately need to make a profit, and the doctors become, often unwillingly, the salesmen/women for the business.  But I would have expected a more supportive response to what I expressed to be a difficult decision.  To call in to question my treatment choice seems inconsistent with my perception of professional decorum.

Am I off base on this?
Diagnosed 1/15/16
Left Side, 5x3x4 mm, 1 mm from cochlea
High frequency hearing loss (still useful), tinnitus
Three fraction CK at Stanford completed 3/25/16

mcrue

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Re: Am I being overly sensitive?
« Reply #1 on: March 09, 2016, 11:10:20 am »

I think you need to name names.

With all due respect, Dr. Chang once said I was the perfect candidate for Cyber Knife at Stanford, as well as everyone else i consulted with in the radiation field, until I mentioned to him that my tinnitus was making me suicidal and that I feared losing my hearing nerve (therefore being unable to treat my tinnitus).

He more-or-less declined to treat me, and recommended I do no treatment if I was truly suicidal over my tinnitus. He ultimately referred me to have microsurgery claiming my tumor was aggressive at 1.8.

You never really know what's in a doctors heart, or what their true motives are.

Dr. Lunsford office actually emailed me my insurance confirmation, and then 3 days before I was to leave to Pittsburgh they canceled my entire Gamma Knife treatment with no apologies whatsoever, claiming their hospital at UPMC had made an error. They wanted me to pay a "sweet deal" of only $22,000 cash just 3 days before my treatment. Very unprofessional.

Yes, most doctors are biased towards their preferred method of treatment/skill,  and most are very skilled salesmen; however, Dr Schwartz from House (90% microsurgery) recommended radiation for me,  and Dr Chang (radiation) could have easily "cashed the check" and performed Cyber Knife if he was only in it for the money.

I often found strong conflicting views between the Gamma Knife and Cyber Knife teams, when in reality both of those treatments have proven almost equally successful. This was a huge turnoff.

Some doctors are strictly against "cracking your skull open;" likewise, some are strictly against radiation treatments. What's in their heart is up to you to decipher. Whatever decision you make, it's only natural to second guess down the road.
« Last Edit: March 09, 2016, 11:42:37 am by mcrue »
5/19/2015 - 40% sudden hearing loss + tinnitus right ear

6/26/2015 - AN diagnosed by MRI - 14mm x 7mm + 3mm extension

8/26/2015 - WIDEX "ZEN" hearing aid for my catastrophic tinnitus

12/15/2015: 18mm x 9mm + 9mm extension (5mm AGGRESSIVE GROWTH in 5 months)

3/03/2016:   Gamma Knife - Dr. Sheehan

tdlight

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Re: Am I being overly sensitive?
« Reply #2 on: March 09, 2016, 11:26:45 am »
mcrue -

I thought about that (naming names) and was concerned I would be guilty of creating the same sense of doubt I am experiencing by calling in to question a clinic/doctor some here are likely in the process of seeking treatment with.  I don't want to do that.
« Last Edit: March 09, 2016, 11:31:12 am by tdlight »
Diagnosed 1/15/16
Left Side, 5x3x4 mm, 1 mm from cochlea
High frequency hearing loss (still useful), tinnitus
Three fraction CK at Stanford completed 3/25/16

mcrue

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Re: Am I being overly sensitive?
« Reply #3 on: March 09, 2016, 11:28:15 am »
mcrue -

I thought about that and was concerned I would be guilty of creating the same sense of doubt I am experiencing by calling in to question a clinic some here are likely in the process of seeking treatment with.  I don't want to do that.

Clinic? Your half way there!
5/19/2015 - 40% sudden hearing loss + tinnitus right ear

6/26/2015 - AN diagnosed by MRI - 14mm x 7mm + 3mm extension

8/26/2015 - WIDEX "ZEN" hearing aid for my catastrophic tinnitus

12/15/2015: 18mm x 9mm + 9mm extension (5mm AGGRESSIVE GROWTH in 5 months)

3/03/2016:   Gamma Knife - Dr. Sheehan

tdlight

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Re: Am I being overly sensitive?
« Reply #4 on: March 09, 2016, 05:23:09 pm »
Whatever decision you make, it's only natural to second guess down the road.

That's why my newly adopted theme song for this road trip is, and will continue to be, Bob Dylan's Don't Think Twice, It's Alright.

Listen here: https://www.youtube.com/watch?v=S6UCrNQOn4A

"You just kinda' wasted my precious time. Don't think twice, it's alright."
« Last Edit: March 09, 2016, 05:27:07 pm by tdlight »
Diagnosed 1/15/16
Left Side, 5x3x4 mm, 1 mm from cochlea
High frequency hearing loss (still useful), tinnitus
Three fraction CK at Stanford completed 3/25/16

Blw

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Re: Am I being overly sensitive?
« Reply #5 on: March 09, 2016, 06:06:10 pm »
There are countless research studies that have been published which support radiation. Every person's case is different and there is no one size fits all. But radiation clearly has its place in treating these tumors. If the surgical argument is that irradiated tumors can regrow, that also happens for surgical removal. If they argue that you'll lose your hearing, depending on the type of surgery, you can be 100% guaranteed to lose it with surgery. If all things are equal, one of the biggest factors supporting radiation is that it lasts a few hours, and is done as an out patient. For surgery, it is major surgery and indeed brain surgery, so every thing that could go wrong with tumor removal gets compounded by all the risk factors of major surgery.

GaryWNT

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Re: Am I being overly sensitive?
« Reply #6 on: March 10, 2016, 07:22:27 pm »
tdlight,
Each of us approach these things in our own way. I had a similar experience when I decided to go with Cyberknife by Dr. Chang. When I informed another doctor who I had consulted, he sent me a response that was much like the one you received. It caused me doubt for a day or so and then I let it go. I went on with CyberKnife at Stanford. I'm four months post treatment and have remained stable in terms of hearing (minor loss before but not worse after), some tinnitus, again not worse than before. I'm very happy with my choice and I hope you will be, too. Dr. Chang has been great, very responsive to inquiries via email.
Gary
Sudden hearing loss in left ear 02/15
MRI 07/15 showed 2.5cm AN
CK at Stanford (3 days) 11/16
No change in symptoms (Mild tinnitus, mild balance issues, moderate hearing loss)
1st follow up MRI coming 04/16
some evidence of central necrosis on the treated left acoustic neuroma 05/10/2016

tdlight

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Re: Am I being overly sensitive?
« Reply #7 on: March 10, 2016, 08:15:17 pm »
Thanks for the reply Gary.  Sounds like the same process for me... just moving on.  Also, I appreciate the supportive words as I mentally prepare for treatment.  It's nice to hear from someone who knows what I'm going through.  Congratulations on the smooth recovery; may it continue forever!
« Last Edit: March 10, 2016, 08:20:07 pm by tdlight »
Diagnosed 1/15/16
Left Side, 5x3x4 mm, 1 mm from cochlea
High frequency hearing loss (still useful), tinnitus
Three fraction CK at Stanford completed 3/25/16

CattAN

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Re: Am I being overly sensitive?
« Reply #8 on: March 11, 2016, 06:15:46 pm »
Dear tdlight,

Dr. Wilkinson from the House Clinic called me after reviewing my MRI and suggested I wait six months and repeat the MRI.  If there is growth, then I can go for radiation.  I am in my sixties, so radiation is a better option for me.  I did not follow Dr. Wilkinson's opinion, and I opted  to get CK with Dr. Chang and Dr. Gibbs at Stanford. 

Dr. Wilkinson continued to call me and send letters asking that I follow-up with him.  I informed his Assistant that I had radiation and no longer need the follow-up.  He still sent another letter asking that I contact his office for an appointment.  This gave me the impression that this clinic is practicing sales tactics with patients who contact them for a free consultation.

I have no regrets about my choice, and even though I work very close to the House Clinic in Los Angeles, my choice was to fly to Palo Alto for treatment.  I thought the Stanford team had more experience with both surgery and radiosurgery so their approach is based on knowledge and interest in patient care.  I highly recommend that you listen to two interviews with Dr. Chang that Francesco Barbera posted on the ANA website (look up Franseco's blog).  These interviews address all aspects of surgical and radiation treatment choices. Many of my questions were answered, and my choice was confirmed when I listened to Francesco's interviews, not once but twice :D

Good luck to you.  You are in very good hands.

CattAN
« Last Edit: March 11, 2016, 06:20:09 pm by CattAN »
Right side AN diagnosed 6/7/2015
12x11 mm
Swelling to 15x13 mm @ six months
SSD, tinnitus, some balance issues....
~~~~~~~~~
Stanford CyberKnife1 9/2/2015 (single fraction)
Dr. Steven Chang & Dr. Iris Gibbs

tdlight

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Re: Am I being overly sensitive?
« Reply #9 on: March 12, 2016, 10:39:29 am »
CattAN -

Thank you for the reply.  Very interesting information on the House Clinic.  It seems like they don't know when to give up.  I appreciate their desire to do what they feel is right for the patient (and make a profit), but at some point it starts to feel like used car sales. 

It was Francesco's interviews that convinced me I needed to make the leap and seek treatment at Stanford.  Dr. Chang's pragmatic and unbiased approach to treatment really came through in those interviews.  I immediately knew I needed make that trip to Palo Alto.  My interactions with the staff there have been exactly what one would hope for.  I'm looking forward to "spring break" in the bay area!

It sounds like you too have opted to be proactive in your treatment rather than wait and see if there was growth.  Most doctors I have spoken with have agreed that is a reasonable path, but it is the one aspect that has allowed some doubt to creep in to my decision.  (I suppose that is why I was so bothered by that docs reply.)  I have had significant hearing loss at a fairly rapid rate, the hearing on my unaffected side is not great, my tumor is very small and it is very near the cochlea.  All those factors led me to believe immediate treatment was best for me.  I feared what another one or two mm in growth would bring.  May I ask what led you to seek immediate treatment?

Thanks for your thoughts.
Diagnosed 1/15/16
Left Side, 5x3x4 mm, 1 mm from cochlea
High frequency hearing loss (still useful), tinnitus
Three fraction CK at Stanford completed 3/25/16

CattAN

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Re: Am I being overly sensitive?
« Reply #10 on: March 12, 2016, 04:42:48 pm »
Hello tdlight,

I decided to get treatment after I was diagnosed as the size of my tumor is/was 2.2-2.3 cm; the threshold for radiation is 2.5 cm.  I feel lucky to be a candidate for radiation.  It is a much less invasive approach, but everyone is different.  I kept hearing this from all the fellow AN'ers, and at first it sounded corny but now I realize that there are factors such as age, location of the tumor, and size of the tumor that can sway one's decision one way or another.  There will always be unknowns, but you can limit your risks by becoming well informed and reading the literature.

CattAN
« Last Edit: March 13, 2016, 07:14:57 pm by CattAN »
Right side AN diagnosed 6/7/2015
12x11 mm
Swelling to 15x13 mm @ six months
SSD, tinnitus, some balance issues....
~~~~~~~~~
Stanford CyberKnife1 9/2/2015 (single fraction)
Dr. Steven Chang & Dr. Iris Gibbs