ANA Discussion Forum
AN Community => AN Community => Topic started by: Soundy on June 11, 2010, 10:58:00 am
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I know this is totally irrelevant to anything but asking anyhow ...and not sure I know where it even belongs so landing it here and someone can move it if need be
I asked for written reports of pre-treatment MRIs because I didn't have all of them ...and surgical notes and post op reports ...just wanted to read them and see if there was anything that popped out at me that would explain anything that is going on ... as far as surgery went there were no moments noted out of the ordinary aside from the surgeon who was harvesting fat for graft nicking and artery and me almost bleeding to death ...glad his hands weren't in my noggin ... but this may be part of reason that my left legs goes numb and has since surgery and has been blamed on fibromyalgia and aging ... may be some scar tissue that swelling puts pressure on ... but that is another ball game
only thing that made me gasp was in a pre-op report from the neuro-oncologists office for the MRI he had done when they were deciding if I could do Gamma Knife … it listed Bennie at a whopping 9.68 cm and I just know this is a mistake so call thinking what else was messed up ... didn't talk to a tech or nurse or doctor since all were busy , but the receptionist and myself worked it out mathematically ...
3.2 x 2.75 x 3.3 =29.04 which would be cubic centimeters and if you divide that by 3 it will come out to 9.68 ... if they listed it as 29.04 cm I would have fell over from heart failure sure they had left something since what I had been told was removed was alot less ...
was this report just a non patient friendly version for 3-D calculations for gamma knife… have others seen things written this way ??? There is no 29.04 anywhere on the report ... that is just from me and the receptionists math … and multiplying the measurements I had been given then dividing by 3 and it is the only way to get at 9.68 … which I guess would be one third of the cubic cm of tumor mass …right ???…
Makes no real difference but just curious … so still plan on saying when asked that my tumor was around 3 cm and waiting for a better explanation … not that it matters which I said from beginning of this post
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Soundy ~
The AN Community forum is intended for posts like yours, that don't conform to a specific category, so no problem with placing it here.
I don't have an answer to your question regarding the sizing of your AN listed on the report you read although I'm sure there is one ...somewhere. It's very likely that your AN was approximately 3 cm and the report numbers are some kind of abstract calculation that doesn't pertain to the actual size of the tumor. I realize that its a moot point, now, but I can understand your curiosity and I hope you can find an answer.
I suppose this kind of validates my disinterest in reading my medical reports. I go by what the doctor tells me they say (he's very precise and doesn't mince words) or the fact that my surgery went well and I don't feel a need to know all the gory details. However, I suspect I'm in the minority with my lack of curiosity about these things. Still, it works for me. Of course, had my surgery have gone wrong in some way, you can rest assured that I would have been demanding copies of everything that pertained to my AN, so I completely understand your interest. I hope the mystery is solved, soon.
Jim
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I don't know how they would have come up with the 9.68 cm, but the volume calculation would be pi*3.2x2.75x3.3/6=15.2 cm cubed. Obviously someone messed up the calculations, or could it have been a typo?
Marianna
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you know what I thought of ?? I need to go back to math class... the measurements of my AN at removal time was 3.2cm x 2.75cm x 3.3cm when viewed on the flat MRI film so wouldn't multiply out to 29.04 cubic centimeters ??? ... not sure how I made it through calculus and trig ;D ... but it still hold that when multiplied them divided by 3 you come up with the 9.68 ... don't know why I was given the measurements I was given at surgery time instead of them just saying it was about 3cm ... those are it's measurements at widest points of it's little pear shape that it had become with the 2.75 being across the neck of the pear ... now I know I have had to have lost someone :D
I would almost guarantee that the 9.68 was some measurement that was for their eyes and had to do with measuring the tumor against bony structures ...my bones are small on inside and this is the reason they didn't want to do any radiation type procedure fearing the swelling that comes before tumor death would put too much pressure on stem
I am just poking around trying to find any clue and unless I get something I understand (which I do understand the reports written by my surgeon and PCP ) the stuff I got today only serves to confuse me and lord know I don't need that
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I should have type faster ...since I don't have a measurement of how thick my tumer was only the set I gave you which is like a flat slice of it at thickest I would imagine ...
Bennie is gone so doesn't matter ...
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The area of a rectangular solid is found by multiplying height x width x depth. This is the measure that your doctors used to estimate the size of your tumor, because 3.2cm x 2.75cm x 3.3cm does equal 29.04 cubic centimeters. Pi would come into play when measuring the volume of a cylinder, then you would measure pi x radius squared x height, but that is no more accurate than the rectangular solid when it comes to trying to measure an irregularly shaped tumor.
Or we could estimate it by finding the volume of a sphere (4/3 x pi x radius cubed) using an average of the three measures of your tumor, but only if you really, really want to.
Sara
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OK, quick math refresher:
As Sara pointed out, the calculation height x width x depth represents the volume of a square; not a good representation of the oval like AN.
The volume of a sphere is (4/3 x pi x radius cubed), or when talking in terms of diameter, (pi x diameter cubed/6.) Now an AN is not a perfect sphere, but rather has an ovoid shape. So the customary way to estimate volume is to use pi x (dimension1) x (dimension 2) x (dimension 3)/6.
When reporting your measurements of 3.2cm x 2.75cm x 3.3cm, this is not from the "flat" image, but it is a 3-D measurement. It represents the transverse (from side to side), AP (from front to back) and CC (from top to bottom) dimensions. Of course I don't know which one is which for your case, but sometimes the radiologist report indicates this next to the numbers.
Sometimes surgeons and radiologists will add the portion that is inside the IAC in the overall "longest" measurement, but still 9.68 cm is a huge measurement for that.
Marianna
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MRI imaging software these days will often include a tool for calculating the volume of a tumor from a series of images. (Google 3D-Doctor for an example of the software). I think it is quite possible that the 9.68 figure was produced by the imaging software, and it is sheer coincidence that it is 1/3 of the product of the dimensions. It makes sense to me that the true volume of a pear-shaped tumor would be less than that calculated for a true ovoid.
Steve
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I love that we are surrounded by brainics! When I went back to college at age 41 as a freshman, I placed so far out of the math part, I had to take remedial 7th grade algebra and geometry. I felt like such a dolt. I tuffed it out though and can now balance my checkbook most of the time.
Pi r squared? NO!! Pi arrr round!!!
Capt Deb(http://i235.photobucket.com/albums/ee60/Captdeb_photos/happy_face_mummy_goofing_around_md_.gif)
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Marriana ... the 3.2 x 2.75 x 3.3 are the measurements on MRI film taken from a slice of AN at thickest point , so are a flat measurement of that slice ...and were given to me by the surgeon in describing the measurements of my no longer round but now going to pear shape tumor ... so that would be square cm of that little slice surfice had it been taken out and lain flat to measure ... been fun trying to figure out what the 9.68 means ...guess if I have to know I will have to call and talk to the doctor, radiologist or someone other than the receptionist ... as for figuring cubic cm ... I know my tumor was going pear shape and no longer round ...but pears and for that matter balls that grow in nature (including in skulls ) are not going to be perfectly symmetrical , so with commow formulas it would be near impossible to come up with the cubic measure without alot more measurements and I guess a computer model of the 3-D version of the tumor ...also got to thinking with all the measurements I could build a model and then drop it in liquid and measure the displacement we used to figure volume of irregular structures a million years ago when I remembered all this math stuff well enough to pull A's
I think I will give up and the mathematics refresher ...it is making my head spin :D... I loved algebra and geometry and all things math when I was in 7th grade through high school ...those classes were the highlight of my day .. :o ... I used to be a nerd in the good old days
Jim Bob ...Pi 'r square
Bobby Joe ... Pi 'r not square ...
Billy Bob ...corn bread 'r square ... Pi 'r round
Capt Deb ... the above was a famous conversaton my dad had with himself every time he made apple pie or corn bread ...I don't guess they had names but he had different voices for each part
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;D
(http://i235.photobucket.com/albums/ee60/Captdeb_photos/skull_sword_through_head_lg_clr.gif)
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Pi are TOO square! Or maybe that's cobbler.
At any rate, liquor bottles are round. Let's get our priorities straight.
Sara
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well some bottles are round ...and demijohns are round ...but some bottles , like those preferred around here (not in my house but the neighborhood) are rectangular and flat so to better slip into a hip pocket or inside a boot ...slip on boot , not lace up ... and my campfire cobblers are round cause I make them in a cast iron Dutch oven ...home in the oven ones are rectangular ...like the bottles ;)
I called this morning and just received word that the number was 9.68686868.… and didn't just stop at 9.68 and that was a co-inky dink that it matched me and the receptionist math ... and that the number and others on report were measurements that were irrelevant to me ...
OK ...if it was in my head it was relevant >:(... and when I told the guy (radiologist assistant ) I was talking to this he said yes it was and what he meant it was not relevant to the patient to know ..and I answered back kinda wise arse like and he apologized and said that it was one of many , maybe thousands of numbers that the computer generated when getting precise measurements of tumor and bone and this and that and everything else in my head ... and that my tumor measured approximately 3.3 cm at the widest point ... he said the number there was a mistake made when typing the report and not a report a patient would normally see as they try to make reports sent to patients concise and easy to understand ...kinda feel like he was trying to get rid of me but don't think he was lying about anything ...
I explained I was having ongoing headaches and was just trying to read everything before during and after surgery to see if I could find any clues ... he said a neuro surgeon should do that and I told him that I no longer have one due to insurance that says I don't need one ...he said he would send me a copy of what I need written in English ...I did end our conversation telling him I could now add irrelevant to the word unremarkable that health professionals should not use with a patient flippantly ;D ... and I realize that I said from the get go that it was probably irrelevant ...but that is different ... I was talking about my own head and we can call our own irrelevant or unremarkable
so now I know that it was kinda nothing ...but I can see at some point in my treatment that reading that report would have made me crazy and scared to death , not just curious like it did now ....
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got written the copy report yesterday and it said just what guy over phone said and just what my surgeon told me pre-surgery and they also sent a copy of last MRI report from December 2008 , that made mention of the little white spots that are unremarkable and nothing to worry about ...no new clues to anything ... after losing lyrica due to finances and starting neurontin a few days ago , my headaches are pretty much gone except for the sneeze , sudden move cough etc ones ...do have a return of more staggering walk but Doc is in hopes that as promised this will fade a little over time ... but unlike lyica , the neurontin does nothing for fibromyalgia pain so have achy hips and legs carrying me around ... the break from that while taking lyrica was nice ...
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Hi Soundy,
Mathematically, the Volume calculation for an ellipsoid is v=(4/3)*pi*radius1*radius2*radius3, which is derived from the volume of a sphere v=(4/3)*pi*radius*radius*radius. In your case the volume calulates out to about 15.2 Cubic cm. It's arough estimate since the AN's shape is not a perfect ellipsoid.
My guess is that the 9.68 cm number is a mistake, or a correct measurement of the wrong structure.
I hope you find relief for the headaches soon.
Regards,
Rob
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all math aside ..
came in from day camp yesterday and get my mail ... letter from the neurologist that was assigned me after my original surgeon decided to write country music instead of being a surgeon :o ...in my mail box I find a letter that said that if I had any questions about my surgery or subsequent treatment address it to him not the radiologist ... he requested in the future if I had questions that I make and appointment , come in and talk with him ... can't afford to talk to him at $215 a pop
and first off , I contacted his office first for the copies and was directed to a new phone number for radiologist office that did MRIs and wrote up the reports ... then only gasped and went further when I got the conflicting number that turned out to be nothing even though it was something ... I have came in and talked with him and got no answers ... he said according to reports he had read , the surgery was textbook and that there was no evidence that the headaches I have are surgery related :o ...didn't have them before and have everyday since but it is not related ... that was when I decided that what ever pain control my PCP could give me was my option ...
so tripping along with my trusty PCP at my side ... I guess it is because we have a 13 year relationship and know each other in and outside the realm of doctor and patient , that he is the only doctor that has really taken my headaches seriously ... he has held my hair back from my face as I vomited in a trashcan when a wreck was in progress ...like I said he REALLY has gotten to know me ...
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Oh Soundy,
I am so sorry for your torment. I have heard that cliche before regarding the "textbook case". Does that relieve the doctor from having to deal with the after effects of a procedure?
Do they really think that they can send you on your way to deal with headaches or other after effects from surgery or any other procedure, while they go on to the next case, completely exonerating themselves from any further care? Do we need a patient advocacy board? Is it all about the almighty dollar???
Jackie
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I think considering all things my surgery went fairly well ... I am still here and thankful for that ... but it seemed from the letter like I was almost being accused of something ... I don't know if they think I would try to come back on the practice or hospital for damages( no plan on that unless I learn that there is a wrench or something that was left inside my head ) ... I think that I am entitled to my records on everything ... the surgeon sent most reports but not all to my PCP and when he didn't send the report he sent letters advising him on what was going on ... from the surgeon and the neuro I was turned over to I get the attitude that everything went well and is over and done with ... I am physically alot worse off now ( except for the part about no breathing anymore without surgery ) than I was before surgery ...
I think I have everything now and honestly do not think I will find anything that will help as far as the why of the headaches ... a friend suggested it was phantom pain like a person who has lost a leg has in a limb that is gone ... she said maybe I really had a ear ache because my inner ear workings were cut off ...don't buy that but we had a few laughs ... we are kinda nutty sometimes and maybe a little weird ... and laughing is good as long as I have something to cure the "ear " aches I get if I laugh to hard