Hospitalization & discharge at UCLA

Tue 08/14/07

A recent entry in Susan's journal: I'm encouraged as I look forward to what God has to show me about his love and faithfulness!

Wed 08/15/07

Susan said, "With all the prayers by all these people I should become someone like Mrs. Billy Graham by now. But we know God does things differently than we think. Look at what He did with Jesus, and how He had to die. He was not just humiliated, He was rejected."

Susan's journal: God continues to teach me about my commitment and responsibility, first to Him, then to others. I pray for grace to follow His commands and divinely love His people.

Thu 08/16/07
Susan has had several other tests during this hospitalization focusing on a possible 2nd stroke and the source of pain: an MRA (magnetic resonance angiography) of brain and neck, an ECG (electrocardiogram) with cardiac ultrasound, and a CT (computed tomography) angioplasty. These were used to analyze her circulatory system around the heart and brain without being invasive – the results showed normal arteries and blood flow with no plaque or blockage. Thanks to God.
Regarding stroke, there is a small area of restricted blood flow near the mid-brain that was not evident on a previous brain MRI, "downstream" from the stroke area in her occipital lobe from 07/03/07. It could be the result of a new event, or may have been there since July. It's small enough to have been missed on previous MRIs and small enough not to pose a problem. It was not likely the cause of Susan's pain this week and obviously was an important issue to understand and rule out. She's on low-dose aspirin for stroke prevention.
Regarding pain, doctors believe Susan was tapered too quickly from decadron, a powerful steroid that counters brain swelling. Most patients are on it several weeks prior to surgery and benefit from a 3-day taper. Susan had been on it for about 6 weeks prior to her 2nd surgery; so the normal taper schedule resulted in a swelling rebound with intense pain. She's back on decadron with a 4-week taper and doing better.
Regarding tumor, here's the really good news: Dr Liau took out about 95% of it. I've learned to be cautious with these estimates; but she got almost all of it on the left side, leaving only the small inoperable portion that had crossed the midline to the right. The goal is accomplished – less tumor means better outcome of radiation & chemotherapy.
Susan was discharged on Thursday and is home again resting comfortably with medications for anti-inflammation, anti-seizure and pain. She's in good spirits, and is getting pretty good again at deadpan sarcasm. Before we left the hospital, she remarked about "The Price Is Right" on TV: "Now there's a real low point in a person's life when they don't spin the wheel around completely. Humiliated on national TV. And I think I've got problems."

Here are some of Dr Liau's note from surgery on 08/06.

• Pre-Op Diagnosis: Left frontal brain tumor; Post-Op Diagnosis: Left frontal glioblastoma multiforme
• Operation: Left frontal craniotomy with resection of primary brain
• Complexity: This was the case of high complexity given that the patient had already had previous surgery for her left frontal brain tumor. There was significant amount of scar tissue from the patient's previous surgeries as well as subfalcine herniation of the tumor across the midline. The tumor itself was noted to be very vascular; and this combined with its location just millimeters away from eloquent language cortex made this a very challenging case of high complexity. This case took an extra 2 hours.
• The BrainLAB intra-operative navigational instrument was registered using anatomical and surface landmarks...The brain was noted to be quite swollen due to compression from underlying brain tumor...gross tumor was encountered which was noted to be necrotic, grayish purple, and very vascular...tumor tissue within the left frontal lobe was clearly abnormal by virtue of its color, consistency, and texture were carefully resected...The intra-operative MRI scan showed a large left frontal resection cavity, with gross total removal of the enhancing tumor in the left frontal lobe. There was a small amount of residual tumor crossing the midline to the right, but it was felt that this area of tumor was too deep to be resected safely. There was no evidence of any bleeding, infarct, or any other intra-operative complications.

We celebrate God and give thanks that so much tumor was removed without complications or deficit to Susan, a direct answer to prayer. The fact that tumor was so easy to identify from its abnormal appearance is a marvel. We truly are grateful to Dr Liau for her excellence and care, and we thank God that he made the advantages of UCLA's technology available to Susan.