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Melanie Cole (Host): A brain tumor diagnosis can be terrifying and it can sound like a life threatening situation, but advances in medicine have made successful treatments of these a reality and we have a very inspiring story for you today. My first guest is Dr. Bjorn Lobo, he’s a neurosurgeon with Henry Mayo Newhall Hospital and my next guest is Holly Schroeder. She’s the President of the Santa Clarita Valley Economic Development Corporation. Thank you both so much for joining us today. Dr. Lobo, I’d like to start with you to sort of set the stage. Tell us a little bit about brain tumors. Are there different types and how are they classified?

Dr. Bjorn Lobo (Guest): Hi Melanie, thank you for letting me have the opportunity to talk about brain tumors. Brain tumors are – come in several different types. There are tumors that come from other parts of the body to the brain, we call these metastatic brain tumors. These are generally considered cancerous tumors, and then there are tumors that come from the brain tissue or the surrounding tissues of the brain and these are called primary brain tumors. Within the primary brain tumor realm, there can be malignant brain tumors and then there can be benign brain tumors. For brain tumors, malignancy is a hard classification to really quantify because, unlike other places in the body, malignancy really means it spreads locally and it can spread to other parts of the body. For tumors in the brain, they can be very aggressive but not considered malignant and they can cause problems just from growing inside, but not actually spread to other parts of the body and they may not actually destroy the local tissue around the brain as well. For this reason, even though tumors can be benign in the brain, you still have to be very careful with them because if they grow in size, they can cause significant problems.

Melanie: Dr. Lobo, sticking with you for a minute, have the treatments seen a change in the last 20 or 30 years? Are physicians still using treatments that are older? What had been the thought previously regarding therapies and what is different now?

Dr. Lobo: That’s a great question, so the tumor treatments have changed quite a bit in the last 30 years. Really what we’re seeing now is we’re going away from conventional surgery and using more adjunctive medicine such as radiation and chemotherapy for many tumor types. Now some tumors, the main treatment for them is still surgical removal, but a lot of times we have new treatments like radiosurgery which is actually just radiation treated directly to the tumor, rather than treating it with surgery itself, but many times we actually use a combination of treatments. The main thing that’s changed with brain surgery is actually about 30 to 40 years ago, the operating microscope came in and tumors that were considered inoperable at that time became operable, and now the main thing that’s changed with brain surgery in the last 20 years in the introduction of an endoscopic camera that we can take tumors out sometimes using a small opening and keyhole surgery to remove tumors, but again it really depends on the tumor type and where the tumor is located to find the most reasonable and the best treatment for that specific tumor.

Melanie: That’s so interesting. So Holly onto you. Tell us your story. What type of tumor did you have? How did you find it?

Holly Schroeder: Thanks Melanie for having me here. I was starting to have some vision problems earlier this year and I thought it was just a natural decline in vision that happens as you age, and I went to see my optometrist who said that my prescription was fine and something else was going on and referred me onto a variety of doctors that led to me getting an MRI that identified that I had a tumor that was squeezing the optic nerve and effecting my peripheral vision and really constraining my vision. The neurologist referred me to a neurosurgeon outside the Santa Clarita Valley area who I got a consult from, but because of my knowledge of Henry Mayo, I ended up also getting a consult from Dr. Lobo and learned that it was fortunately a benign meningioma but that it did need to be removed, and as he said having the right surgical approach was important, and so he explained to me what approach he would take and they did the surgery at Henry Mayo early this summer and removed the tumor and was able to go through a very rapid recovering. I was very fortunate on that and have had a follow up MRI and as of that test a couple of weeks ago, has had no recurrence of the tumor.

Melanie: Wow, so tell us a little bit about the experience actually going through it. Obviously it must have been terrifying for you Holly, but when you did your research and you chose Henry Mayo and then the whole process started, what were you feeling? Were you thinking the worst? Were they giving you hope and what was the procedure like for you?

Holly: Well scared obviously. I mean it is – even though we were fairly certain because of the type of tumor that it was benign. It’s still a life changing experience to hear those words that you have a brain tumor and that you’re going to have brain surgery and so the time leading up to the surgery, you just sort of have that worry kind of hanging over you. I would say that Henry Mayo and Dr. Lobo were extremely helpful. I’ve talked to Dr. Lobo a couple of times because I think in our first consult, I’m not sure I registered all the information that he shared with me and I had to hear it a couple of times to really make sure I understood what was happening and there was a difference in methodology between what Dr. Lobo recommended and what the other neurosurgeon recommended and so I had to sort through what was actually the surgical approach to be taken and where would I do the surgery and had to make that decision, which was a stressful decision point, but by talking to neurosurgeons and starting to understand what the risks were and what the advantages were, I became really confident that Dr. Lobo would be the best surgeon and doing it here at Henry Mayo would be the best approach for me, and so then leading up to the day of the surgery was still scary, and the surgery itself was 5 to 6 hours. Fortunately, I was asleep during that but of course your family is waiting during that period and that they were very relieved to hear the results that the surgery went smoothly. I was in ICU for about a day and half and then in the hospital for another day and a half but then I was released from the hospital. So basically after three days. So I went from brain surgery to being home in three days and then the recovery really every day got stronger and stronger and the recovery really did go pretty much like clockwork. Ultimately I was back to work less than one month after surgery.

Melanie: Wow, what a story Holly, and Dr. Lobo how do you go about explaining this very complicated – because as Holly said, she was researching the surgical aspects to try and understand the side effects and the surgical experience of the physician, how do you go about explaining this complicated topic to a patient and convincing them that this is one of the best ways to go about this?

Dr. Lobo: Well my approach to medicine has always been treat every patient like a family member and not everyone’s as knowledgeable as Holly was about what was going on so you have to start off with the basis. 1) You start off with the education of what is a brain tumor. 2) You start off with what to expect; what’s going to happen if you don’t have this done because you don’t necessarily have to have surgery done for every single brain tumor that’s there, and then you have to start talking about what are the different approaches and what are the benefits and I always go through multiple different approaches and I tell them what’s my decision making process and sometimes even while I’m talking to the patients, I may change my decision making process as I talk to them. Every patient is different. For example, if Holly was 50 years older and she was near end of life, we would be talking about a different approach than something like we did for her, and the reason why is because we want to tailor our surgery, tailor the treatments to what her goals for life are. Now for Holly her goal was to have this taken out and to have good vision, so my treatment really corresponded to how do we get all the tumor out, or as much as we can, and still preserve her vision and even put it in the state where it will improve and if the tumor ever did come back or ever did need recurrent treatment, how would we come back and take care of it then. So all of those processes were discussed with Holly and we kind of came up with a game plan together as far as what we wanted to get done.

Melanie: So in your last wrap up, Dr. Lobo, tell us about some of the new technology that you may have used with Holly or other patients that you feel are advancements in brain tumor surgery, what you see on the horizon as well.

Dr. Lobo: So for Holly we used a very new microscope that has the ability to really give us a great visualization of the tumor as well as the optic nerve. We did a different approach that not all surgeons do for Holly, which is something called an extradural clinoidectomy. That’s basically taking off the bone that covers the optic nerve as it leaves the brain space and enters the orbit and we do that outside of the actual brain space, so this is a technique that’s been around for a little while but it’s so rare for most general practicing neurosurgeons to do, that you have to have specialized treatment to do that. That was the main difference in surgical treatment that I was offering than the other neurosurgeon who had recommended surgery to Holly was offering. And the reason why I offered this was specifically to open up the optic canal, take out any tumor that was invading into the optic canal where we can’t generally get to with a conventional craniotomy or opening the skill to remove the tumor and this was really going to help decompress the optic nerve, make sure that here was no tumor that we were leaving behind in there and it was really going to help relieve her vision. Now that was a surgical approach that’s been around for about 15-20 years that’s now becoming more mainstay. I think the main thing that we’re going to see as time goes by with neurosurgery is going to be smaller and smaller approaches to do the same type of operation that we were doing. We’re going to learn different techniques and advance those techniques, and really it’s going to be learning about different medications to potentially treat these tumors without actually surgery. That would be I think what the goal of medicine is going to be for brain surgery, which is not to have to have surgery, but to actually treat many of these problems with medications and find out which kind of medications will actually prevent these tumors from growing and which ones will actually make them smaller in size but that’s a little bit of a way off. In the meantime, we’re working pretty diligently to try with different techniques as far as learning new operative procedures and also using new equipment to help with localize where tumors are and make the operation as minimally invasive as possible but still as maximally effective.

Melanie: And Holly, last word to you, what an inspiring and interesting story that you’ve told us today, tell us about the people and the staff at Henry Mayo Newhall Hospital that helped you and what would you like listeners to know about Henry Mayo and Dr. Lobo and your whole experience having your brain tumor removed?

Holly: I had absolutely the best experience, every person that I interacted with the entire time I was at Henry Mayo was exceptional and took really great care of me and was super supportive of my family that was there to support me and also Dr. Lobo mentioned the microscope, the specialized microscope that enabled them to do the surgery and it’s my understanding that that’s a pretty specialized piece of equipment that’s not found in every hospital and as he indicated is not necessarily done by every neurosurgeon, and what I learned and as we debriefed the surgery is if we hadn’t used that approach, and used that equipment and done the surgical approach that Dr. Lobo took, there probably would still be tumor that was left in the optic canal and that would have continued to grow and ultimately probably would have continued to impact my optic nerve and would have eventually blinded me. So because of the quality equipment and quality surgeons that were available to me at Henry Mayo Hospital, I was able to prevent that and able to completely remove the tumor and prevent that terrible outcome of losing my sight. Every nurse, every person I interacted with was really just so caring. When I would ask somebody to assist me in getting up, assist me if I wanted to walk around a little bit. I wasn’t always sure if I was talking to an assistant nurse or the chief nurse and yet every person treated me with kindness and care and helped me with whatever I needed in that moment, they really were just looking out for my health and I could really tell how much they cared about me and wanted me to heal and get better and get on with my life and be healthy and I was just so grateful for the wonderful care that I received.

Melanie: Thank you so much both of you for joining us today and, Holly, for telling us your story and, Dr. Lobo, for sharing with us the advances in brain tumor therapies and what we can look forward to on the horizon. Thank you both again. What a great segment. You’re listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, please visit henrymayo.com, that’s henrymayo.com. This is Melanie Cole, thanks so much for tuning in.