Author Topic: how did you decide?  (Read 8304 times)

Twindy

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how did you decide?
« on: February 11, 2012, 08:24:58 pm »
You have been so informative and warm in your responses to me these last couple of weeks as I've been going through the shock of it all.  Seems hard to believe that it was just a few short weeks ago that I started this journey--seems like a lifetime already.  On day one I went in thinking I would be told my hearing was slightly diminished (it's at 96% word recognition) and I should come back as it got worse.  Instead, sent for MRI, met with doc., and scheduled for surgery all within a 5-hour time span.  Doctor was insistent that surgery is the only way to go.  Fast forward two weeks and I've been through pre-op exam and ready to go, but finally get in to see the radiaologist just to put my mind at ease that I'm doing the right thing.  He tells me that radiation is a valid option and it's what he would choose if it were him.  I'm scheduled for surgery next Friday--less than one week, and I've spent the day with hubby pouring over articles, looking at outcome numbers, statistics, etc and am more lost than ever.  I'm told I have a 60% chance of preserving hearing with surgery, but with radiation I am sure to lose it over time as the data suggests a steady decline over 10 years. 

I won't ask you what you think I should do, because I know you can't tell me.  But will you please share with me what factored into your decisions, how you made your decision, and if you've been happy with your choices.

Again, I thank you for the warmth and patience you've shown me these past couple of weeks.

Silver Sonnet

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Re: how did you decide?
« Reply #1 on: February 11, 2012, 08:57:03 pm »
Twindy, we've all been where you are, so we certainly understand.

When I was diagnosed, it was a shock just as it was for you.  The ENT who diagnosed me was someone I'd never seen before, and he told me that, while he performed this surgery for a living, he would not touch me because my case was "too delicate."  My family doc always referred me back to the ENT who did not want to talk to me.  Everyone I talked to--and I talked to lots of people--had a different opinion.  One day I met a man who had brain tumors (I don't know what kind) and had had CK or GK--I forget which.  He was miserable.  He said they'd given him too much radiation and his brain was "cooked," that pieces of it were flaking off and clogging his spinal cord.  He said he's had to have three surgeries to clear it so far.

After that talk and reading all the (old, but I didn't realize it at the time) horror stories about surgical options, I decided the tumors were my friends and that I would keep them.

Luckily, my sister is a very experienced nurse used to dealing with neurosurgery, and she put her foot down.  She found the study at the National Institutes of Health, and I called and talked to the head surgeon.  I told him the trouble I was having making a decision, and he told me that, since he was a neurosurgeon, he recommended surgery.  He said he had research supporting his position, and that if I was interested, he'd send it to me.  But he also pointed out that, if he were a radiologist, he'd recommend radio-surgery, and he'd also have research he could send me.

That honesty made me trust him, not something I do easily where doctors are concerned.  He sent me the research, and I looked over it.  What he sent was valid, credible material that looked fairly at both sides of the issue.  So I decided to go in for testing, but I still hadn't made a firm decision.

When I got there and had the MRI, he told me the decision had basically been made for me.  The tumor was cystic and growing rapidly; it had to come out right away.  There was no choice in surgical approach because the tumor had gotten so big, and CK was no longer an option because results didn't occur fast enough.  My only options were to choose the surgery and live (probably) or choose not to have the surgery and die in two to three months.

When he put it like that, the decision became surprisingly easy :)

Cheryl R

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Re: how did you decide?
« Reply #2 on: February 11, 2012, 11:14:26 pm »
Twindy, You just have to go with your gut feeling that which treatment you choose and when to do it will work for you.     We have all been thru this in varying degrees and it is not easy.    It is hard if what ever treatment has more happen than what you thought it would.  One can read here and research and still not have the "perfect answer"        You are from the first one here to question yourself and us about what to do.          As you know from all the pms that the chances are good at UIHC and part is just what the little bugger may be doing inside that no one could say for sure until see the tumor and nerves, if surgery is your choice.
                                                   I wish you well!                    Cheryl R
Right mid fossa 11-01-01
  left tumor found 5-03,so have NF2
  trans lab for right facial nerve tumor
  with nerve graft 3-23-06
   CSF leak revision surgery 4-07-06
   left mid fossa 4-17-08
   near deaf on left before surgery
   with hearing much improved .
    Univ of Iowa for all care

lrobie

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Re: how did you decide?
« Reply #3 on: February 12, 2012, 09:56:53 am »
Twindy,

Thank you for asking this question.  Still no decision for me.   :(

Lisa
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie

mk

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Re: how did you decide?
« Reply #4 on: February 12, 2012, 10:38:52 am »
Twindy,

I won't go to the radiation vs. surgery discussion, I am sure you have already read quite a bit on the forum.
What I will say is that I get nervous whenever I hear that someone got pressured and persuaded to make a decision within a few hours. I will admit that I haven't followed your posts closely, so I don't know what the size of your tumor is, where you are having surgery and the specifics of your situation. However, unless your AN is already very big/pressing on the brainstem/causing hydrocephalus etc, there is no reason to be rushed into any decision.

Are you comfortable with your surgical team? Are you conviced that they have a lot of experience specific to AN removal? Surgical results can range from excellent, on the hands of an experienced team, to very poor at the hands of not-so-experienced surgeons/ENTs. Same goes for radiation patients (although I have never heard of "cooked brains" flaking off, planning for treatment, deciding radiation dose etc are all important).

So I would take a step back and ask myself if I am confident that I have received the right advice, if I feel rushed to have surgery, if in the back of my mind I feel that I would like to have more research done and if I am convinced that this particular team is skilled in AN removal.

Having done both radiation and surgery, I can comment on my opinion for both, but I really think that the first thing that you need to do is to decide whether you feel you need more time.

Marianna
GK on April 23rd 2008 for 2.9 cm AN at Toronto Western Hospital. Subsequent MRIs showed darkening initially, then growth. Retrosigmoid surgery on April 26th, 2011 with Drs. Akagami and Westerberg at Vancouver General Hospital. Graduallly lost hearing after GK and now SSD but no other issues.

Twindy

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Re: how did you decide?
« Reply #5 on: February 12, 2012, 11:12:04 am »
Thank you,
Marianna, my tumor is 11x4x6.  I am 40 years old with two active teenagers.  I work part time as  a preschool director/teacher.  My only symptom is the slight hearing loss.  To answer your questions, my doctor is experienced in this and does 1-3/per week, I trust his skills.  He said the radiologist would likely send me right back to him.  Thankfully, I decided to meet with the radiologist anyway and he did not send me back but rather said the decision is mine to make.  He says there is a slightly better chance at saving hearing with surgery so perhaps that tips the scale a bit in favor of surgery.  The surgery date is this upcoming friday! I didn't want to do it in in March/April as we have a lot of things going on then, but could easily do it in mid-May.  Doctor didn't want wait that long.
A few days ago I as thinking I just want this done and over with, but am now thinking I need to slow down, so your response is confirming my gut.

As someone who has done both, I actually would like to hear about your personal experiences if willing to share.

Cheryl R

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Re: how did you decide?
« Reply #6 on: February 12, 2012, 12:08:16 pm »
Twindy, In every exam room there is a sign on the wall about patient rights and responsibilities. You should have the right to make sure the time is right for you.    I haven't read UIHC's for a while but have been there enough to see it.    When I was working at Boone we had to make sure a patient saw this as part of their admission packet, in this case.      Since this is somewhat of an elective surgery for you and not an emergency,I would make really sure why Gantz wants to do this so soon besides just saving your hearing.         As I already told you, that he wanted to do my facial neuroma the next week and I asked if a month was possible so was scheduled then.        Having the surgery if that is what you do want to do, goes better when you are relaxed and ready for it.              Having been to him for 10 yrs,I think some of it is his personaility, but one needs to feel as comfortable as possible for a major surgery.         Many of us here have known his good experience and good staff carebut you also have to be ready for it.                      I wish you well in what you decide.
                                                Cheryl R                                       
Right mid fossa 11-01-01
  left tumor found 5-03,so have NF2
  trans lab for right facial nerve tumor
  with nerve graft 3-23-06
   CSF leak revision surgery 4-07-06
   left mid fossa 4-17-08
   near deaf on left before surgery
   with hearing much improved .
    Univ of Iowa for all care

lrobie

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Re: how did you decide?
« Reply #7 on: February 12, 2012, 04:02:13 pm »
Twindy,

Are you saying that your doctor said he does 1 to 3 AN removals a week?

Lisa
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie

Twindy

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Re: how did you decide?
« Reply #8 on: February 12, 2012, 04:47:11 pm »
yes, that is correct.  That is what he told me.

jockieau

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Re: how did you decide?
« Reply #9 on: February 12, 2012, 05:21:34 pm »
Hi Twindy

In my humble opinion it sounds as though you are being rushed through something that you don't need to rush through.  Your tumour sounds relatively small, so unless there is a medical reason for the urgency I would say you have as much time as you like to make your decision.  Perhaps you feel bad pulling out of the surgery that has been scheduled for this Friday, but if things don't go the way you want you will have lots of time to question why you rushed (or were rushed) into it.  Don't feel bad if you decide to hold off and spend some more time making this incredibly important decision.

I was like you when I first found out about my tumour, thought it would be whipped out immediately, etc etc.  Now I have decided to have surgery when there is visible growth (happy with that decision), I have found the surgeons I will use, and am pretty relaxed about it all.  I would really implore you that unless there is an urgent medical reason for the surgery, postpone it and spend the time researching your options.  I needed about 6 months to get my plan sorted and to feel that I had paid due diligence researching my options to be fully informed.

Jockieau

Cheryl R

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Re: how did you decide?
« Reply #10 on: February 12, 2012, 07:11:12 pm »
Lisa,  I also have been going to Dr Gantz at Univ of Iowa for 10 yrs now due to being found to be NF2.      There have been several on here over time who have went there, including many from out of state.        They are up to around 70 a year now along with many cochlear inplants.        I have got to know one nurse in the skull base area and she also has said how they have been doing more and more.   
I am also puzzled over his wanting to do Twindys  surgery so soon.      He wanted to do my facial neuroma in 2006 the next week but I was able  to go a month so could have all in order.                I do know even with my first surgery 10 yrs ago another gal had hers the day before me.    I talked to her and then saw her at the first post op visit.          A person needs to feel ready for when they do have their surgery.                                         Cheryl R
Right mid fossa 11-01-01
  left tumor found 5-03,so have NF2
  trans lab for right facial nerve tumor
  with nerve graft 3-23-06
   CSF leak revision surgery 4-07-06
   left mid fossa 4-17-08
   near deaf on left before surgery
   with hearing much improved .
    Univ of Iowa for all care

rupert

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Re: how did you decide?
« Reply #11 on: February 12, 2012, 07:34:41 pm »
Hello Twindy,

              It certainly sounds like your being rushed.  Your AN would be considered small.  Many people with AN's of that
size go with watch and wait.   Usually the Docs would wait 3 - 6 months to  take another MRI to chart stability or growth then go from there.   I have not seen many on these forums that were scheduled for surgery so quickly unless there were major issues.  These you would have known by now.   Personally,  I would get several other opinions.  One or two for surgery and one or two for radio.
    I haven't read all your posts to date.  Where in the country are you located?  Would you be willing to share who your doc
is?   Maybe more on here have had experiences with them.    Good luck,  I know it's tough right now.

Twindy

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Re: how did you decide?
« Reply #12 on: February 12, 2012, 08:01:53 pm »
Thank you all for your replies and you are all confirming my gut instinct to slow down and explore all options.  I am in Iowa City--small Iowa University town with an EXCELLENT hospital with a top-ranked Oto. department.  Dr. Gantz is my doc.  Like I said, I completely trust his skills as he's been doing these for 30 years and does them weekly.  He was eager to show me a paper he just wrote comparing his mid-fossa results vs. radiosurgery in saving hearing (60% mid fossa for tumor my size vs. "you will lose your hearing in 6-10 years with radiosurgery).  Now, he didn't say I needed to it in Feb., he said in the next "several months," but when I asked if I could do it first of June, he said no, it should be sooner.  He seems to think the sooner the better for preserving hearing.  Now thinking about all of this, he did note there was some fluid which he said may be part of why I've maintained such good hearing thus far-maybe he's worried the fluid will disappear and then suddenly no hearing???

Thinking back on it, I was in such shock that I think I just nodded my head and agreed to whatever seemed needed to be done.

I'm sure you get these sort of confused posts all the time on here--thank you for sticking with us newbies!

What factors came into play with all your decisions.  Would anyone do it differently second time around?

rupert

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Re: how did you decide?
« Reply #13 on: February 12, 2012, 08:26:44 pm »
   I've always wanted to live in Iowa.  Might retire there.

   Sounds like your Doc has it covered, just up to you about timing.   Mid fossa would probably be your best chance at hearing preservation.  In hesitation,  I might throw out something to think about.  AN's are notorious for killing hearing.  Most people will have some hearing loss.  Most, not all  usually have hearing loss ahead of their treatment and hearing loss is usually how they find these things.  Surgery or radio, there is a  probability there will be some hearing loss before or after the procedure,  or in time.  Take your time and good luck.  Bryan

lrobie

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Re: how did you decide?
« Reply #14 on: February 12, 2012, 08:34:28 pm »
While I think you have time to wait, I wish I would have acted at least a little sooner.  I was diagnosed in 2009 and have been W&W.  Last August, my AN showed a 2.5 mm growth and I was at 88% speech recognition.  Went back this past week and now I'm at 64%.  Once I got over the initial shock of having the AN and doing a lot of research at that time, I slowly got away from it and didn't always think about it.  I was hoping I was going to be one of those who can be in the W&W with no symptoms or problems.  I also have some balance issues along with constant tinnitus. 

Lisa
6/2009 7mm x 4mm  W&W
8/2011 9.5mm x 5mm
2/2012 UPMC Follow-up , slight growth
Surgery on 7/18/12 w/Drs. Friedman & Schwartz (mid-fossa)
www.caringbridge.org/visit/lisarobie