©
Contributions by Archivers
Haircut or root canal?
I remember in 1991 when I was deciding about having Gamma Knife treatment, that the put-down then was that it would "fry the brain." Soon thereafter we began to get talk about how it would make surgery difficult if there happened to be tumor regrowth. And now most recently we are being warned that only radiated acoustic neuromas become malignant! It's enough to be disturbing.
I'm reminded that Theodore Rockwell, a founding director of Radiation, Science & Health Inc, wrote recently about the unfortunate fear of radiation in this country. In The Scientist (March 3, 1997) he observed: "About 1 million medical procedures involving radiation are performed each day in the United States. These are our latest and best medical techniques, yet thousands of people avoid such life-saving procedures out of fear of radiation."
We should be thankful, of course, that microsurgical techniques have also improved greatly in the last decade. Still, as one neurosurgeon has put it, in terms of patient discomfort radiosurgery versus microsurgery is somewhat analogous to comparing a haircut to a root canal. I chose the haircut.
Microsurgery and Radiosurgery: Best and Average
surgery in the best hand offers better results than Gamma Knife
(from a medical publication)
Now I don't know if that is true or not, but if we accept it as true, we need to concentrate on that word "best". Most of us a average by definition. Microsurgery is a very very skilled craft. By contrast, GK or FSR are routines which are largely mechanised and very repeatable. It is therefore axiomatic that the variation between the "best" surgery and "average" surgery i.e. what we are likely to get, is very much larger than the variation likely to be present in any of the various radiotherapies.
You know, I like to use car analogies in discussing treatment. Well, let's call the Surgeons hand builders of cars, and the radiosurgeons the mass production companies. I know that I can buy a Rolls Royce hand-built and splendid -- but only about 1000 a year available. If I buy any other hand-built car, most others will fall way behind the standards of any new Chrysler, or whatever that I can buy for a fraction of the Rolls' price...
The problem is, with surgeons you can't "test before you buy". So at best, you go on reputation, but unfortunately like the rest of us humans, even the best surgeon can have an off day. When you work to the tolerances and under the strains that these guys do, even a very minor thing will reflect in the standard of your work. Still the chances are you couldn't get the best guy in the first place...
So you go to the radiosurgeon, he plans the treatment -- he has a chance to change his plans -- and probably reviews them in a team session before you are treated. Then the machine is set up by the technicians -- then it's checked -- then it's checked again. Then you are treated, using a checked and repeatable process... In the case of FSR it has to be repeatable to work in the first place.
Doctors are a crapshoot
Up until I had my AN surgery (in '92) I was never sick except for the usual cold & flu stuff (I live in Chicago so anyone who lives around here knows what that's like!). So I never went to a doctor. Since the AN surgery I have been to several different doctors, including my surgeon who removed my AN, to complain about the stiffness I get in my neck. My original surgeon said "Its all in your mind. It has nothing to do with the surgery." OK doc. For 36 years I felt just great and now suddenly, after a major surgery I get horrible neck pains. Thanks for removing it, and getting my insurance money doc! Take care! Next!
Seeing that he was no help I went to a pain clinic. They gave me Edivil (Hope I spelled it right!). This helped a little but man did I get drowsy, plus it gave me a side affect that guys don't like to think about! So I quit that stuff. The pain clinic had no other options but at least they were willing to look at me and listen. Next!
Went to another doctor and told him my problem. He scribbled some stuff on a legal pad and said it was my nerves due to stress. Next!
Went to a doctor at a sports medicine clinic. He was way off base! Was into homeopathy and shot essence of horse tail into my neck for 3 weeks straight. I must have been nuttier than him for letting him talk me into it! He bilked my insurance for quite a bit too. Next!
I finally found a good one. A rheumatologist who prescribed Flexoril 40 MG each night. That works but I have to take it everyday for the rest of my life. But he was pretty good. Listened to my story and said "Lets try this. If this does not work I have lots of other things to try." He also said my problem was definitely related to the surgery. Finally!
I would say doctors are a crapshoot. Some are good others are borderline quacks! Not just doctors; surgeons, lawyers, building contractors, TV repair folks, auto repair folks - there are good ones and bad ones. And AN surgery is a crapshoot. One tries very hard to maximize one's odds, and then one prays.
Shop around for the person who will be doing that AN treatment. Find one who listens and has a good track record of saving your present functionality (hearing, facial nerve, balance) whether its surgery, radiation, Gamma knife, whatever. And make sure they talk about post-op rehab. Mine did not. He just said go home and take it easy for 6 weeks then go back to work...
Michael Kuechenberg
February 1998
©
Last Edited: Wednesday, October 30, 2002