I know a lot of you have been wondering what happened at my appointment last Thursday. My cousin, who I’m staying with, was the one who recommended that I get a check up in Singapore. She said Singapore is well renowned for their research in neuroscience, that they even have an institute that focuses on exactly that- the National Neuroscience Institute (NNI). NNI then paired me up with a neurosurgeon, Dr. Ang, with whom I had my consultation.
My appointment was actually at the Singapore National Eye Center (SNEC), which is part of the whole Singapore General Hospital (SGH) campus. The whole campus is huge, with each department having its own building or ‘block’. The SNEC building was very impressive, about six levels, all devoted to eyes! Since it was a public hospital, it is very unlikely that walk-ins are welcome, all patients must come in with an appointment. I’ve never experienced such efficient processes for a consultation (compared to my experience in Manila where it’s usually a first come first serve basis or also with an appointment but you still end up waiting for hours because the doctors come in late!). You come in, get a number for registration, soon a nurse calls your name for pre-consult check-ups. Since it was an eye center, eye checks were done. Then they let you wait for your turn for the consultation. The whole process only took an hour at most, including the consultation (in Manila, I usually wait about 30-45 minutes before I get my vitals checked then another hour or so for my consult..).
Now for the consultation. My tita of course was with me, never leaving my side. I tried not to show her that I was actually nervous because then she would worry about me. So I go in with clammy hands but with spirits aiming high. Dr. Ang then requests to see my MRI images via DVD discs that I brought from home. As I look at the images, which is obviously not the first time for me, I am taken back to reality. I sometimes forget that I have this tumor. Luckily, it hasn’t caused me any pain, well aside from the complication it brought- my diabetes insipidus. But other than that, nothing. No severe headaches and no blurring of vision. I’m actually very thankful that I haven’t experienced any of these. So I look at the images and there it is.. my brain tumor, about the size of a coin.
Dr. Ang explains to me the images and the current situation. I try to follow him, almost predicting what he would say as I’ve heard the same explanation before and I’ve done my research. He would explain to me in layman’s terms but I would follow it up using medical terms. At some point he had to ask me if I was in the medical field, I laughed saying no and that I’ve just been reading so much about my condition.
I liked that everything was pretty much consistent. All the things he said were also what doctors back home told me. He asked if the other doctors suspect it was something else aside from a pituitary adenoma. I didn’t want to give him any hints and I was curious to hear what he had to say. He said the tumor could actually be another type: a craniopharyngioma. This is also a benign tumor. I didn’t tell him I was already told of this probable diagnosis when I had a consult with one of the heads of neurosurgery in the Philippines- Dr. Mercado of Cardinal Santos.
Another issue worth noting is the black shadow or debris near the tumor. Before I left, another neuro from home, a friend of my tita’s, recommended to have my second MRI done because of this discovery. The debris is in question whether it is blood (that could be a hemorrhage) or proteinous fluid. I was told to get lots of bed rest before getting my second MRI done to see if any changes would occur. I believe it was still there but its form was inconclusive.
The good news: whether it is a pituitary tumor or a craniopharyngioma OR if the debris is a hemorrhage or proteinous fluid, there’s just one way to find out and that is through the transsphenoidal surgery. This was another thing I was glad about that was consistent with what the doctors back home recommended as the form of treatment.
Surgery really was the answer compared to the other types of treatment:
1) oral medication- this would have been suitable if my hormone levels were abnormal but since they’re normal, this treatment would only complicate things further.
2) radiation- since the diagnosis is inconclusive, radiation is not recommended. Dr. Ang explained that radiation wouldn’t even get rid of the tumor, it would just stop it from growing. My tumor’s position is near the optic nerve, which explains why the doctors are observing my vision so closely. The significance of this when considering radiation is that it could further harm my optic nerve. Therefore, my vision might not get affected by the tumor if radiation was performed but then it could still damage my optic nerve- so this was not the procedure for my condition.
Two choices were given to me: get the surgery anytime I was ready or observe for another 3 months and perform another round of tests to see any progress or changes. I told Dr. Ang that the latter was definitely out of the question. I really don’t want to wait any longer to experience other complications. I mean, was I going to wait until I get severe headaches, until my hormones go haywire or until I go blind?? Obviously not.
So it was surgery time. Now the choice was between getting it done in Singapore or Manila. Dr. Ang was gracious enough to praise our doctors back home saying I could get it done there because we have really good doctors. But then he talked to me about the risks of the surgery:
1) brain fluid leakage- wherein they would need to get skin from my thigh to fill the cavity to prevent any leakage
2) bacteria from the nasal passageway ascending to the brain causing meningitis
3) further damage to the pituitary gland, affecting overall hormonal function
4) further damage to the optic nerve, which would affect my vision
Dr. Ang emphasized that my age and the position of this tumor that makes the diagnosis inconclusive are factors to consider for surgery. At such a young age, the surgery should be done because we don’t want any damage to happen to my vision. If the tumor grows, it would eventually cut my vision in half, causing bitemporal hemianopsia. He was basically saying that since I’m only 24 years old, it would be a shame if my vision was already affected hereon and for the rest of my life.
There was only one surgeon I would have wanted to perform the surgery if I decide to get it in Manila and it was Dr. Mercado. However, he explained his technique which involved an incision under the lip to enter the nasal passageway. I wasn’t quite sure I was comfortable with this. So I asked Dr. Ang and he said that was the traditional way of doing the procedure but they don’t do that anymore. It is done endoscopically straight through the nose. With the risks explained and no other surgeons from home I would consider performing it, I decided to tell my parents that I’d prefer getting the surgery done in Singapore.
Since there is no need for immediate surgery, my parents decided that I would go back home and wait for their return on April 22 from Europe and we would all go back together next month for the surgery. Even though my family asked about the cost of the surgery in Singapore to compare with how much it would cost if done in Manila, I felt warmth in my heart when they told me that cost is really not an issue- that wherever I want it done is up to me and they supported me with my decision. I had no words to explain how loved I felt at that moment since the surgery in Singapore will cost a lot of money, a pretty significant difference from the cost back home.
So there you go. That’s the latest update. I’m hoping to catch a flight home tomorrow, Tuesday. I will be making a lot of calls to finalize some things before I leave. Details I know so far about the surgery:
-Surgery will be in May, first or second week
-I need to be back the week before the surgery for pre-surgery check ups, just to confirm that I’m fit for surgery
-Dr. Ang will perform the surgery
-Will be performed at the Singapore General Hospital theater surgery room
-Surgery shouldn’t take more than 4hrs
-I will be completely sedated during the surgery
-Surgery to recovery period will last 7-10 days
-I will be at the ICU for 1-2 days after the surgery then I will be confined for the rest of the recovery period
-I will have to ask how long after the recovery period at the hospital is needed before I can travel (to go back to Manila) and other additional costs (like having a companion stay with me at the hospital, etc.)
If you have any other questions you’d like to ask me about my consultation and the surgery, feel free to write a comment below! 🙂