Dear Mrs. Kennedy,
Yes, both arrived safely. I am in the
midst of digging through the various piles and have found the packet with the
scans, and looked at them today. Let me address them individually:
Justin, his MRI shows ill-defined areas of relative darkening on each lateral
wing of the gland, right and left. You might impute these changes to tumor, but
the problem is that this could simply reflect the fact that we worked on each
side of the gland in performing our removal, and the resulting empty spots can
look like this too. I'm sure that at least some (and perhaps all) of what we see
can come from the postsurgical appearance. This, if there is some tumor and/or
hyperplasia hiding along the edges of where we worked before, you can't tell
easily unless it becomes more clearcut over time. I have to say that my
impression (from seeing the gland at surgery) is that he might end up with a
total hypophysectomy if he comes again to surgery, or something approaching it,
and I would hate to do that in someone as young as he. So, best thing for now is
pursue the redoing of the hormonal workup to try to pin down for sure, is he
showing persisting high cortisols or isn't he. Then some rational choices can be
For Jessica, she shows on her MRI very good emptying of the areas
we removed, the majority on the right but to a lesser extent on the left too.
This is not such a fuzzy picture as the one Justin presents, the edges of the
resection cavities are sharper and you get less of a sense of there being
anything visible along the edges. The gland is distorted, as postop glands tend
to be, but here I don't really see anything that looks suspicious for
I hope that helps, I don't know at what
point in the retesting they are--let me know as things develop--
regards and happy new year to you and the family,
nice touch with making Justin's disc blue and Jessica's (near) pink, I liked
Jess picked the colors for the CDs
Originally I'd hoped that he found clear cut tumors as that could make things so much easier. But now I'm thinking this might be the best thing as I'm hoping I can get Dr. F to see the wisdom (for our family) of having both kids go straight to BLA as I know that quite often after a second pit surgery, a BLA follows. The reason being, I'm afraid we could lose insurance if Bill's recovery (when he gets to surgery) takes longer than he anticipates. And I know there is no way to predict how long recovery will take. And even if recovery goes okay there is always the chance of Bill losing his job because the oilfield is going to pot at the moment. Either way, I'd like the kids to get to surgery ASAP, while I know we have insurance.
So it's time to email Dr. F and get his opinion.
Poor Bill has to go back to work in a few days. He doesn't seem to feel that bad (relatively speaking) when he doesn't have to work. I feel bad that he has too. It would be easier if his job wasn't so physically demanding.