When my neuro-oncologist came in with only a nurse-practitioner this afternoon, we knew that the implication of what was seen during my operation a month ago was much better than we thought. We thought that the discovery of many small tumors near the tumor that was removed was ominous. However, today we were told that the neurosurgeon 'just' wants to irradiate the nerve fibers on which the tumor was situated to get any remaining tumor cells; these nerve fibers branch off from the spinal cord and control my right hand. The small tumors near the tumor that was removed are probably not new, and are not of current concern. The radiation will be designed to miss the spinal cord and thus should not over-radiate part of my spinal cord. Therefore the next step is calculating whether and how the nerve fiber can be irradiated, and whether the irradiation should be by gamma-rays here at NIH or by protons at Mass General in Boston.

In brief, the operation was an unqualified success.

My recovery for the first three weeks after my operation was rapid and steady. The incision healed very well with no leakage; the muscle pain was much less severe than I was led to expect, and I was off the narcotics within 2 weeks; and I started going into work, albeit for only part of the day, after a little over two weeks. This past week Debbie felt that the incision didn't look as good as it had previously, and I started running a very low grade fever. Consequently, the nurse-practitioner who did the initial poking and prodding (senior doctors don't do that kind of stuff) pulled in a junior neurosurgeon who pulled in a more senior neurosurgeon. The conclusion was that I have a low grade infection-I am now on antibiotics-and a fluid pocket, which they decided to drain.

Fortunately, the incision and fluid pocket are on my back, so I did not have to see the massive needle and enormous syringe, a combination appropriate for an elephant. After all the needles that have been stuck in me over the past four years, I still can't watch them being inserted. The removal of a large amount of fluid (the appearance was not worrisome) from this pocket has left a depression, which will fill in. It was amusing how apologetic the neurosurgeons were that the pocket formed and that they didn't catch it earlier (I was checked out two weeks ago).

We appreciate all the support we have received over the past month and a half. This event has been much harder on my family than on me--after all, I was asleep for the operation and can't see the incision--and the support they received from family and friends was extremely helpful.