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By Adam

By Adam

Hi, Sal. Hi, Everyone. 

Since Sal got back to San Francisco this past Monday, we’ve met with a number of amazing doctors. We have learned a lot more about her diagnosis and what happens next. 

The communication with doctors in the U.S. started even before Sal got back from Singapore. Working with her amazing coworker and travel companion, George, we got Sal’s CT and MRI images from Singapore uploaded to Dropbox on Friday night. Before they had even finished uploading, our close friend Kate had started an email chain with me and all of the key people in the Neurosurgery and Neuro-Oncology division at UCSF. Kate had done her post-doc there. 

The group is led by Dr. B, and is among the best in the world. As a testament to their acclaim, the UCSF group had also been recommended by Sal’s Singapore doctor, halfway around the world. I followed up, and sent the UCSF team Sal’s CT and MRI scans on Friday night. 

We heard back over the weekend from Dr. T, a neurosurgeon in the UCSF group. Based on the MR and CT images from Singapore, he said, “this looks like a low grade anterior frontal lesion on the left.” This was consistent with what the doctor in Singapore, Dr. T2, had thought.

On the MR images, the tumor looks like a small cloudy white patch on the front left side of the brain along the edge. Both Dr T2 from Singapore and Dr T from UCSF thought it looked like a low-grade growth--meaning it’s slow growing. That’s good. They also both saw calcium deposits, called calcification, which also indicate it’s slow growing. Calcium takes time to build up. Also good. 

And it wasn’t large. The Singapore medical report estimated the total inflamed area, or lesion--which is bigger than the the tumor because it includes inflammation around the tumor--at 3.9 by 3.1 by 3.1 cm. Obviously, not large is good.

We are blessed to have a number of personal connections to experts in the field. It started with K getting the UCSF team to look at our images over the weekend. And on Friday night I had also talked to Dr B. Dr B is a long-time friend of Sal and her family, and also a world-renowned neurosurgeon in Boston. I reported to him what I’d heard from the doctor in Singapore: low-grade, lower frontal left region. 

Dr. B thought this was all a very positive report. He told me that the lower frontal left is a region that is easily operable--that there is a very low risk of impairing brain function when operating in this area. They call it a “non-eloquent” part of the brain. This is very good. Dr B also told me that he would send anyone in a situation like this to the team at UCSF. 

On Monday we got a third opinion on the scans from Dr S, the head of Radiology in the UCSF group. She said, “Imaging features are most consistent with an oligodendroglioma of the left anterior inferior frontal lobe.” This was the first time we’d heard a name--oligodendroglioma. I sent this verbatim to Dr B in Boston to decipher, and he replied “That's a very positive report.” Our wonderful friend K from SF agreed. 

That it’s a low-grade oligodendroglioma is just a hypothesis at this point. We won’t know exactly what it is until there’s been a biopsy after it’s removed. The biopsy results will determine what, if any, follow-on treatment occurs. Everyone who has looked at the images so far has agreed that it looks like a low-grade growth, so we are optimistic. 

Today we talked to the head of Neuroradiology at Stanford, Dr W (thanks to our friend J). He had independently reviewed the images from Singapore, and he had come to the exact same conclusion as all the other doctors: low-grade, in a place that is easily operable with low risk of side effects, and that surgery was certainly the way to go. It was very reassuring to get this unbiased second view. 

We are planning surgery for sometime in the next 2-3 weeks. We have asked to find a time when both neurosurgeons, Dr T and Dr B, from the UCSF group can attend the surgery. They have tentatively suggested Wednesday November 9. We will post an update when we know for sure.

We are so grateful to have such an amazing team of doctors and incredibly knowledgeable, generous and loving family and friends.