Wednesday, 30 January 2013

One step forward, one step back ....

OK, so I have not received an email or letter in response to my query regarding the change in measurements of Feckit and Fuss, but I have been sent an appointment at the Oncology/Radiology Clinic for 21 February. I kind of get the feeling that I have offended someone by asking .... but I will have my questions answered in person at least!

Another development in this ongoing health saga is that when I saw the dentist for my six-monthly check at the beginning of the month she was concerned to find a small dark red area high on my gum above my front teeth. The area is completely painless and I was not aware of its existence as it is so high up. Anyway I was referred to the oral surgeon for his opinion and saw him last Monday following a short wait of 3 weeks.

The oral surgeon (OS) was concerned to find that the discoloured area has now turned black although it is painless unless probed or forcibly pushed on. After taking a full medical and dental history he went on to explain several possible conditions which can cause pigmentation in the mouth and identified the most likely which might be implicated in my case.


"The oral cavity is a common site of various brown or black pigmented lesions, e.g., amalgam tattoo, pigmented nevi, Addison’s disease, Peutz-Jeghers syndrome, racial pigmentation, melanotic macules associated HIV infection, smoker melanosis, drug-induced pigmentation and melanoma."


"The amalgam tattoo is a frequent finding in persons who have had amalgam restorations (ie, fillings). When the amalgam is removed with a high-speed dental handpiece, amalgam particles can be embedded or traumatically implanted in the oral mucosa. Silver from the amalgam leeches out of the embedded particles and stains (ie, tattoos) selected components of the fibrous connective tissue (eg, elastic, reticulin, oxytalan fibers) and highlights the blood vessels. The pigment is often solitary, macular, gray-black, and found near where amalgams were placed and subsequently removed."

Because this lesion has appeared where a "post" from a capped tooth was removed in 2009, just prior to commencement of my radiology treatment, OS feels that it is possible that this might well be the cause. 

INFECTION:

The OS felt that infection, although a possible cause, was less likely as there are no visible signs such as swelling, exudate or pain.


This he felt to be another possibility resulting from the "post" removal followed shortly after by radiation therapy, which may have compromised the blood supply to the bone.

MELANOMA:


Oral melanomas arise silently, with few symptoms until progression has occurred.
Most people do not inspect their oral cavity closely, and melanomas are allowed to progress until significant swelling, tooth mobility, or bleeding causes them to seek care.
Pigmented lesions 1.0 mm to 1.0 cm or larger are found.
Reports of previously existing pigmented lesions are common. These lesions may represent unrecognized melanomas in the radial growth phase.
Amelanotic melanoma accounts for 5-35% of oral melanomas. This melanoma appears in the oral cavity as a white, mucosa-colored, or red mass. The lack of pigmentation contributes to clinical and histologic misdiagnosis.

"The prognosis of Primary Oral Melanoma (POM) is much worse, with 5-year survival rates generally ranging from 10% to 25%, or according to some authors 15%-38%, partly because of diļ¬ƒculties to detect pigmented lesions and poor resectability due to the anatomy of the region, major extension in depth versus cutaneous melanoma, and early metastasis.

The median survival for all POMs is slightly over 2 years (18-46 months) from the time of diagnosis, depending on lymph node involvement, increased tumor thickness, and level and vertical growth phase of the tumor at the diagnosis. POM is an uncommon malignant tumor that originates from melanocyte proliferation.

BETWEEN A ROCK AND A HARD PLACE!  .......... That is how my OS described the position with regard to any treatment! 

If he excises the area and finds bone destruction (osteonecrosis) the healing time may be very long because of the prior radiotherapy.

But because there is a small chance that it may be a melanoma then the area must be excised and sent for histology as soon as possible in order to get a definite diagnosis. 

I understood only too well what he was saying and felt that a definite diagnosis was essential for both of us in order to plan how to proceed. So I am booked for an excision under local anaesthetic on 11 February.

I am hopeful that this little black area on my upper gum is merely an amalgam tattoo from all the previous dental work that this tooth received.


Thursday, 24 January 2013

"can I make it on my own?"


This month I had my annual MRI scan to "check up" on my two skull base meningiomas, Feckit and Fuss.

= = = = = = = = = = = = = = = = = = = = = = = = = = = = 

FINDINGS
The homogeneous high T2 signal and enhancing 2 cms left petroclival mass remains similar in size and appearances with sparing of the cavernous sinus.
(in January 2012 this tumour was 2.1 cms)

The homogeneous high T2 signal and enhancing 1cm crista galli mass is also unchanged from previously.
(in both March 2009 and January 2012 tumour was 0.9 cms)

No other new lesion or abnormal enhancement is seen.
The overall parenchyma remains normal with preserved ventricles.

COMMENT
The two meningiomata are unaltered.

= = = = = = = = = = = = = = = = = = = = = = = = = = = = 

The following are (referenced) conclusions with regard to observation and follow-up for meningioma and are from: 

Radiation_Oncology/CNS/Meningioma


Majority (~2/3) of asymptomatic, incidentally found meningiomas are stable on imaging. If they progress, the rate of growth tends to be 2-4 mm per year and tumor doubling time is on average 20 years

Calcified and hypointense on T2 meningiomas appear less likely to progress; elderly patients appear to have slower growth rates

Reasonable to consider observation for asymptomatic meningiomas, particularly in elderly patients or patients with skull-base (high operative risk) tumors. If so, MRI at 3 months, then 6 months later, then annually is considered reasonable

For younger patients and patients with non-calcified tumors, consider treatment due to higher expected growth rates

oooOooo


I have not been given a neurology appointment for 2 years now and the radiologist-oncologist does not think it necessary that I see a neurologist this time either. I am happy with that. She also suggests that they switch from annual check MRIs to 18-monthly ones .... not so happy with that but will go with her decision. 

However, I would like to know why Feckit (the one treated with radiation) appears to have reduced in size by 1mm while Fuss appears to have increased in size by a similar amount. So, as I am unlikely to speak to any specialist for a further 18 months, I have written asking whether the measurements given in the radiology reports are accurate or only approximations.

This may well be considered an imposition but I think it is entirely reasonable to ask for an explanation of the apparent changes in size of both tumours (especially as both are described in the report as 'unaltered'). Hopefully I will receive an answer before too long.

It is unlikely that many specialists have any concept of what it is like to walk around with a couple of tumours inside your head which may or may not be affecting your brain's functioning both now and in the long term! 

Of course I am very grateful that Feckit has been treated (apparently successfully thus far) and hope that he/it will shrink over time, but I am concerned that Fuss may be actively growing and need an answer if I am to "make it on my own" ........  as apparently I must.



Tuesday, 8 January 2013

Farewell to 2012 ...... a year in pictures!



JANUARY

We went for a weeks trip to Melbourne to visit with our son who was on holiday there. We had not seen each other for over 10 years!


And I also had the pleasure of meeting up with some distant Aussie relations tracked down via my ongoing interest in family genealogy.



FEBRUARY

Our French friends At last came over to New Zealand for a holiday and visited with us. It was wonderful to find that nothing had changed between us .... the years apart just rolled away!



MARCH

Once again I enjoyed entering a St Patrick's Day Bowls Tournament!


Our Golden Wedding Anniversary .... its hard to imagine even now that we have been married over 50 years!  Of course, we had a lovely celebration with NZ family and close friends!





APRIL

The end of quite a successful bowling season!



JUNE 

The arrival in UK of a lovely grandson! 


JULY/AUGUST

I took a trip to the UK (on my own!) to visit our youngest daughter and her new baby boy. It was wonderful to see her after so long!




And to see our eldest daughter and grand-daughter again!







And catch up with most of my mad rellies!




AND have lots of cuddles with the baby!!




OCTOBER

We had to say goodbye to dear old Ollie ..... 16 years young. What a treasure and joy he was.



DECEMBER

BIG family Christmas holiday with our middle (NZ) and youngest (UK) daughters, their husbands and lovely children!


















So another year over and a new one has begun ................ !!!