I need our Medical Mafia's advice

[BeauV]

All,

I've received some pretty bad news about my Marine Corp 2nd Lt. He injured his back, infantry guys are often doing this, and it was taking a while to get better to they did an MRI. As expected, there is a small hernia of a disc. What was not expected was that they found a tumor inside the spine that is blocking a majority of the spinal column down near the bottom. The Marines sent him back to Balboa hospital, San Diego CA, (from Australia) where he had more tests and they believe that the lump is either a "maxopapillary ependymoma" or a "schwannoma". Both of which I'm now reading up on rapidly online.

Because we can afford it, in addition to the Navy Doc, we're flying our Marine up to UCSF and Stanford for a visit with their Doctors. In the mean time, I'm trying to learn as much as I can for my Marine.

My view is that if our Marine hadn't hurt his back, then the first symptoms of this tumor would have been nerve damage which could be much worse than what he's looking at now; which is pretty major spine surgery to get the tumor out. But, that's me looking on the "bright side". My Marine said: "Dad, you always find something positive about every completely fucked up situation." something which I am certainly guilty of.

For now, I'm officially not freaking out because the Navy Doc in particular - who is Lt Cmdr Arnett Klugh and is a Stanford trained neurosurgeon - isn't freaking out.

I may freak out later and need to be sedated with Rum, the sailor's cure for everything.

Any search vectors from our group's Medical Maffia would be greatly appreciated. I'd love to know if Lt. Cmdr Kluge is a good surgeon, and everything I can about these tumors.

Thanks for listening.

[SloopJonB]

I can't offer anything but good thoughts Beau. A scary time for any parent. You are absolutely right about the silver lining in the strain injury though.

[Orestes Munn]

Sorry to hear, Beau! There is nothing worse than worrying about your kid.

Both the complexity of the surgery and the potential consequences depend on the level of the spine we're talking about and there is always more than one approach. When I had my neck rebuilt because of a disk that had physically pancaked my spinal cord, I went first to the Navy spine guy at Bethesda, who proposed something 180º the reverse of what the Army spine guy at Walter Reed and five other uninvolved neurosurgeons proposed, and what I ultimately had done. If I had submitted to the first guy, I would have no neck motion today instead of great function, and would have been in the hospital for two weeks for pain control, instead of walking out the next morning.

So, a second opinion is essential and a third, in case of disagreement. If you send me a CD of the MRI, I can show it to some people around here.

E

[BeauV]

OM, before my Marine does anything he'll have at least four opinions. I hear you about the downstream side effects of the various surgeries. I will ask my Marine for the disk. Thanks!

B

[kimbottles]

Good luck Beau! We need to take good care of all our Marines, glad you are on it for this one.

(silver linings are good!)

[Charlie]

BV,

We're sending positive thoughts and prayers your way.

Charlie

[LarryHoward]

Beau

Tough news but confident he will get the best care. One problem I have seen with medical care in the operating forces is the generally young and health clientele can lead doctors to look at all pain as the result of trauma and not an underlying condition. Good that his doctor went further and didn't stop with the "vitamin M" (Motrin) that gets passes out for aches and pains.

[BMCBoid]

Beau,

My girl Laura is an RN with a lot of contacts in the medical field, especially surgeons.

I'll show her your post tonight and see if she knows anyone.

Bryan

[BeauV]

All, thank you for your rapid responses. Thank you also for all your support. While I'm obviously worried, I also believe that this isn't a life threatening problem (so far as I know). But anytime someone wants to take a knife and saw to my kid I worry.

Our own OM had a look at John's MRI and helped me understand that there's a bit of good news there and as Eric (OM) put it: "I'm on it."

This is exactly what I hoped would happen when I asked for help - thank you all!!

B

[Orestes Munn]

All, thank you for your rapid responses. Thank you also for all your support. While I'm obviously worried, I also believe that this isn't a life threatening problem (so far as I know). But anytime someone wants to take a knife and saw to my kid I worry.

Our own OM had a look at John's MRI and helped me understand that there's a bit of good news there and as Eric (OM) put it: "I'm on it."

This is exactly what I hoped would happen when I asked for help - thank you all!!

B

Not remotely life threatening. I'll be in touch.

E

[kimbottles]

It sure is nice to have such talent here on Scantlings!

[BeauV]

It sure is nice to have such talent here on Scantlings!

It sure as hell is. Quite a team we've got here.

B

[JoeP]

Wow Beau, sorry to hear of the injury but it sure looks like your son is or will be in good hands. What a great group you folks are.

[BMCBoid]

Laura says that you are in good hands with either UCSF or Stanford, however, word on the street is Stanford has much better food.

Surgeons in Sonoma county prefer those two for ortho/spinal cases.

[Bull City]

Beau,

I have no medical advice, but will keep your son in my prayers. Please keep us posted.

Bob

[Tucky]

Sorry to hear this- take care. Worrying about adult children is really difficult. Best wishes. I have no expertise to offer but send good thoughts.

[BeauV]

Our own OM just took me through a bunch of feedback from various medicos that he knows. The summary is, this is something that needs to be taken care of, but "It's not rocket science."

Interestingly, Eric suggested that the right sort of surgeon for this job was a neurosurgeon and not an orthopedic surgeon, as the primary task was untangling the nerves from the tumor, not getting the back bone open. I received precisely the same advice from a friend who is a cardiovascular surgeon for exactly the same reason. It is interesting to think about, as one needs to know enough to understand what the really difficult part of a procedure is and put the expert in that particular task in charge even if they need assistance from someone else for the less difficult bits.

Now, my Marine gets two more opinions on Monday and then we talk again and he makes his decision. Thank you Eric!!

Scantlings comes through again!

[LarryHoward]

That OM dude is more than just a good looking skull atop a malnourished body.

[Orestes Munn]

With all due respect to the phylum orthopoda, "suggested" is too polite for the terms I used. Let them stick to bones and joints that don't encase important and delicate squishy bits.

[TheOffice]

Beau,

Glad it is not as bad as you probably feared! It is crazy how some tumors are detected. Jon Lester, now of the Cubs, was diagnosed after back pain following a car accident, the manager of the Red Sox was diagnosed last week during hernia surgery!
For routine back surgery, in some cities it is common for orthopods to operate, in other cities neuros have a monopoly. I'll defer to Eric, but FWIW I agree with him on this one!
I wish your son the best!
Joel

[Lin]

Beau, I am sorry to hear that your son is facing this. I am glad to hear he has the benefit of several opinions, with knoweledge as to how to best deal with this.

I had never heard of schwannomas before, until a good friend of mine was diagnosed with one, 2 & 1/2 years ago. My friends' schwannoma tumor is in his neck, between a carotid artery and his larynx. He has had three surgeries, thus far. Two to try and remove as much of the tumor as possible and a third to rebuild the area surrounding his larynx as he lost much of his voice. He regained much his voice. However, as they only got 85 % of the tumor, It is now growing back and he is is awaiting more surgery.

It is nice to have the support and help from some in here. Eric, you rock! I agree, that location is important.

Beau, hang in there. Stay positive. Anything we can do, please ask.

[Slick470]

Thoughts are with you and your Marine Beau. Nice to have such a knowledgeable group here.

[BeauV]

Update:

My Marine when in for surgery early this morning. The Navy neurosurgeon at Balboa Hospital has reported back that the tumor was a Schwannoma which is benign 99% of the time. The surgery took a long time because the tumor was mixed up with a lot of nerves, all of which remained undamaged during the operation. However, to get the entire tumor (which they did) it required a lot of "fussing around" to avoid nerve damage. As a result, after all of this John's surgeon says that he has an extremely high chance of complete recovery but will always have a bit of stiffness in his lower back, due to the repair to the popped disk that started everyone looking in this spot to begin with.

A BIG THANKS to our own OM. Eric, your suggestions on which sort of doctor and additional scans were spot on. Thank you for all your help. As always, Scantlings comes through.

Beau

[LarryHoward]

Update:

My Marine when in for surgery early this morning. The Navy neurosurgeon at Balboa Hospital has reported back that the tumor was a Schwannoma which is benign 99% of the time. The surgery took a long time because the tumor was mixed up with a lot of nerves, all of which remained undamaged during the operation. However, to get the entire tumor (which they did) it required a lot of "fussing around" to avoid nerve damage. As a result, after all of this John's surgeon says that he has an extremely high chance of complete recovery but will always have a bit of stiffness in his lower back, due to the repair to the popped disk that started everyone looking in this spot to begin with.

A BIG THANKS to our own OM. Eric, your suggestions on which sort of doctor and additional scans were spot on. Thank you for all your help. As always, Scantlings comes through.

Beau

While certainly secondary to a good recovery, what are they saying about his future as an infantry officer given that stiffness. I know he is very highly motivated I that regard.

[BeauV]

Update:

My Marine when in for surgery early this morning. The Navy neurosurgeon at Balboa Hospital has reported back that the tumor was a Schwannoma which is benign 99% of the time. The surgery took a long time because the tumor was mixed up with a lot of nerves, all of which remained undamaged during the operation. However, to get the entire tumor (which they did) it required a lot of "fussing around" to avoid nerve damage. As a result, after all of this John's surgeon says that he has an extremely high chance of complete recovery but will always have a bit of stiffness in his lower back, due to the repair to the popped disk that started everyone looking in this spot to begin with.

A BIG THANKS to our own OM. Eric, your suggestions on which sort of doctor and additional scans were spot on. Thank you for all your help. As always, Scantlings comes through.

Beau

While certainly secondary to a good recovery, what are they saying about his future as an infantry officer given that stiffness. I know he is very highly motivated I that regard.

Larry,

OM said that the "stiffness" probably wouldn't be painful and it wouldn't be weak, it would just be less mobile than if he still had a disk.

My son's Navy doc at Balboa said that he'd be plenty strong enough to lug around his pack and armor etc... (These guys carry about 125 lbs of stuff) once he was fully healed up. He also said that a Marine in the Infantry has a very different definition of what is an acceptable "low level of pain" compared to the rest of us.

[LarryHoward]

God to hear. That would indicate that the doc will not push for a medical board or submit a finding of not fit for full duty.

[Orestes Munn]

The generic issue here is loss of mobility in the lower spine, due to the removal of a disk and surgical fusion of two vertebral bodies. It's usually not bad--I have a fusion in my neck and I move pretty normally. I don't see that going to a board. The neighboring joints do have to compensate, however, and an active person, an infantry officer, say, is going do put a lot of wear on the neighboring disks in a lifetime. Fortunately, the surgeons will remain ready to help.

[LarryHoward]

The generic issue here is loss of mobility in the lower spine, due to the removal of a disk and surgical fusion of two vertebral bodies. It's usually not bad--I have a fusion in my neck and I move pretty normally. I don't see that going to a board. The neighboring joints do have to compensate, however, and an active person, an infantry officer, say, is going do put a lot of wear on the neighboring disks in a lifetime. Fortunately, the surgeons will remain ready to help.

I guess as an aviator riding an ejection seat and routinely pulling 7.5 g's, I grew up with a fear of telling the flight surgeon anything other than "I'm feeling great, Doc". All it took was a "Maybe we should take a closer look" to risk your continued flight status.

[Orestes Munn]

The generic issue here is loss of mobility in the lower spine, due to the removal of a disk and surgical fusion of two vertebral bodies. It's usually not bad--I have a fusion in my neck and I move pretty normally. I don't see that going to a board. The neighboring joints do have to compensate, however, and an active person, an infantry officer, say, is going do put a lot of wear on the neighboring disks in a lifetime. Fortunately, the surgeons will remain ready to help.

I guess as an aviator riding an ejection seat and routinely pulling 7.5 g's, I grew up with a fear of telling the flight surgeon anything other than "I'm feeling great, Doc". All it took was a "Maybe we should take a closer look" to risk your continued flight status.

They were concerned about all that expensive and classified machinery you were riding around on. When they rebuilt my neck, they sent me home with some Army form saying that after 60 days I could march forever with a 100 lb load. Needless to say, I never showed it to anyone.

[BeauV]

The generic issue here is loss of mobility in the lower spine, due to the removal of a disk and surgical fusion of two vertebral bodies. It's usually not bad--I have a fusion in my neck and I move pretty normally. I don't see that going to a board. The neighboring joints do have to compensate, however, and an active person, an infantry officer, say, is going do put a lot of wear on the neighboring disks in a lifetime. Fortunately, the surgeons will remain ready to help.

I guess as an aviator riding an ejection seat and routinely pulling 7.5 g's, I grew up with a fear of telling the flight surgeon anything other than "I'm feeling great, Doc". All it took was a "Maybe we should take a closer look" to risk your continued flight status.

Ya, they have a little bit different attitude about infantry officers. I think the operative question is: "Can you walk?" if yes, you're fit for duty.