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June 2nd, 2008
06:51 PM ET

Deciding on a treatment plan

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

We now know Sen. Ted Kennedy flew down to Durham, North Carolina, over the weekend, and underwent awake brain surgery at 9 Monday morning at Duke. The operation was "successful," according to his surgeons, and a significant amount of his malignant glioma was removed. The whole thing was a bit of a surprise given that his doctors at Massachusetts General Hospital hadn't publicly raised the possibility of an operation. They mentioned only chemotherapy and radiation as his options. Clearly, over the last couple of weeks, the senator and his family decided they wanted more. They wanted to fight this tumor, and they talked to experts all over the country and finally decided on Dr. Allan Friedman at the Preston Robert Tisch Brain Tumor Center at Duke to help them in his battle.

So, what sort of things go into that decision making process?

Well, for starters, Duke is a highly regarded brain tumor hospital. The chief of neurosurgery has been at Duke for over three decades and removes around 90 percent of the brain tumors at that hospital. Its staff members,  along with those of several other hospitals, are regarded as experts in what is known as brain "mapping." Even as a neurosurgeon,  I find mapping to be a truly wondrous advancement.  As the patient, in this case the senator, lies awake on the table with his head immobilized, the doctors probe various areas of the brain with a device that looks like a small fork. Carefully, they "map" out the areas of his brain responsible for things like speech. While they are probing with a slight electrical current, if the patient suddenly has trouble raising his hand or identifying an object, the doctors know to stay away from that area – even if tumor is present. The risks would outweigh the rewards. First do no harm.

Kennedy may have ended up at Duke simply because he really liked the doctors and felt comfortable in their hands – attitude, such an important thing for a patient. He may have gone to Duke because he thought they were the "best." Finally, it could also be because of a vaccine clinical trial that is going on there. Just today, researchers at Duke reported on a small study that found that a cancer vaccine could double the survival time of people with one of the deadliest brain tumors, from around 14 1/2 months to 33 months.
 
The surgery Kennedy had today will most likely be covered by his health plan because removing the tumor is an approved treatment, even though he left his network of doctors in Boston to travel to Durham.  According to the NIH, health insurance and managed care providers often do not cover the patient care costs associated with clinical trials, if that is the route he decides to go.

All of this got me to thinking: how does the average person make these decisions? How do they decide where they are going to get treated and is it even possible for most to find the "best" in the country? I'm eager to hear your experiences and any tips you might have for fellow bloggers and patients.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


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soundoff (30 Responses)
  1. Anton

    I underwent brain surgery last year using something called Gamma Knife radiation surgery to remove a lesion. Was this considered for Senator Kennedy ? In my case the lesion's location presented a higher level of risk for a traditional lobectomy and so Gamma Knife which is a much less invasive and cost effective procedure. However the Insurance company is refusing to cover this.

    June 2, 2008 at 19:17 | Report abuse | Reply
    • Linda Marie Irish

      Hi..this is the first time I have seen this issue addressed, the use of cyberknife, or gamma knife to initially treat a bw rain tumor. I was diagnosed with non operable oligodendroglioma a few months ago, and sought other opinions all concurred. Now we are trying to get the cyberknife...I was glad to see your post-thank you for taking the time to post this Anton :)

      February 5, 2012 at 19:02 | Report abuse |
  2. Jeremy Bolluyt

    I am a family physician in Iowa, and had a malignant glioma resected 2 1/2 years ago. I choose the Mayo Clinic in Rochester, MN for my surgery. I also left my network and was penalized financially, but the brain is important as organs go, and I had no business getting it done locally in Sioux Falls SD. There are great resources available when looking for care, I believe the biggest difficulty was choosing in the ER minutes after getting life changing news. I was fortunate to have the guidance of my friend and primary care physician to give me the timely advice he did. In my research, Mayo, Duke and MD Anderson seem to be the big three, your thoughts?

    June 2, 2008 at 20:53 | Report abuse | Reply
  3. Michelle, San Diego

    It's very difficult to get the treatment you want, but I think it's possible.

    My experience came as a mom, my son when he was an infant was diagnosed with a rare, life threatening, disorder. I wanted everyone who saw my son from that point on to have experience with the disorder, and I was picky about who saw him at the hospital, how often I would let classes come in and see him (it was an educational hospital), and how many needles he'd get poked with. Choices about clinical trials, which I had to research on my own. I got on the phone with the main researcher at the NIH, and actually got him in the first try. Half my days were spent on the phone. If you want more, go get more. It was hard, as a single mom, who lost health insurance when I quit my job to take care of my son, who needed the health insuarnce, when he got sick with a terminal illness, and no medical background, to all of a sudden have to try to get the best care for him and stand up to doctors and make the best decisions about care. But it's possible. My sons since passed away, but he had the best care during his life, and that's what matters. If I had not fought for it, his life may not have been as good, so it's worth it.

    June 2, 2008 at 20:58 | Report abuse | Reply
  4. David - Maimi

    It would be nice to learn or understand how to approach or make such a decision. This article seems to do everything, but that.

    June 2, 2008 at 21:13 | Report abuse | Reply
  5. Angie Selig

    My husband Stuart has had two brain tumor removals performed by Dr. Allan Friedman at Duke. When my husband was first diagnosed 12 years ago, I was a medical technologist. The first thing you learn working in the medical field is to get 2nd and 3rd opinions. I took my husband to get 2 opinions before we went to Duke.

    I cannot say enough good words about Dr. Friedman. When we met him, he took one look at Stuart's MRI and told us that he believed he could get the bulk of the tumor out. We also liked the procedure of mapping in which the patient is awake throughout the surgery. It reassured us that Stuart would have use of his speech and motor skills. Like Senator Kennedy, my husband's tumor was on the left temporal lobe,

    By the time we left our appointment, we knew that this was the right surgeon. He is a truly caring person with a wonderful beside manner. We knew that we could call him or his staff anytime when we had questions before and after the surgery. I have worked with a lot of doctors in my time and he is the best I have ever dealt with.

    I also want to compliment how he and his team work together. Dr. Henry Friedman of Duke was Stuart's neurologist. He is also a truly amazing human being and doctor. The doctors, nurses and PA's on the brain tumor unit treat you like a person and not a number. They are all wonderful knowledgeable people.

    I mentioned above that my husband has had 2 brain tumor surgeries. My husband was diagnosed the first time with a benign oliodendroglioma in 1996, the week before we were married. The tumor grew back in 2003, this time as a malignant oliodendroglioma.
    After Dr. Friedman debulked the second time, Stuart had chemo and radiation. We are happy to say that he is 5 years cancer free. He still follows up at Duke every 6 months.

    Angie Selig

    June 2, 2008 at 21:31 | Report abuse | Reply
  6. Jennifer Durham, NC

    Hi Sanjay,
    I have two different friends whose husbands have been patients of Dr. Friedman. Both feel extremely blessed to have been living just a few minutes from Duke when their husbands were diagnosed.
    Brad survived for just over 5 years after his initial diagnosis. Dr. Friedman operated on him several times during those 5 years. Brad also participated in one of the drug studies the Brain Tumor Center was conducting ( with Avastin) and for awhile had some success. His family is still closely connected to the people there.There is a real sense of family among staff and patients (and their families)
    My other friend's husband Rich is now 3 years out from his initial diagnosis and taking one day at a time. His family also has a strong connection with everyone at Duke.
    Neither of those families would have chosen going through this but they are tremendously grateful for Dr. Friedman and everyone else at Duke.

    June 2, 2008 at 21:53 | Report abuse | Reply
  7. CONNIE

    I AM VERY HAPPY THAT THE SENATOR'S OPERATION WAS A SUCCESS. BUT I WONDER IF THE SAME THINK HAPPENED TO A JOE NOBODY, WILL HE BE ABLE TO CHOICE THE DUKE DR AND WILL THE OPERATION BE DONE SO QUICKLY! WHAT KIND OF INSURANCE THAT THE SENATOR CARRY, AND HOW MUCH DOES IT COST?

    June 2, 2008 at 21:58 | Report abuse | Reply
  8. Beth Poole

    Dr. Gupta:

    I am so happy for Dr. Kennedy that he was able to secure and very quickly I might add, the services of the neuro dept at Duke.....and along with that....he got the "teaching doc"....not the learning doc.......

    Most patients do not have the contacts, or the "famous" tag, to get such quick treatment.....

    I admire the kennedy family....always have always will....and for years they trudged through suce horrible luck and pain....

    Yes, the Kennedy Name, the Kennedy money, allows for quicker and easier access for the test trial treatments that he wll receive.....

    We all like to think that if something like that would happen to us that the same treatment would happen to us.....

    But most of the time, it is just not soo!

    I am happy for his family......and him.....but I also pray daily for loved ones of mine that deserve equitable health care.....and they are not doing to get it......it is either money....wrong insurance....or tobe frank.....they aren't famous enough....that is so sad....

    I know famous people get sick too....but they seem to get the better doctor too....? why is thatz?

    June 2, 2008 at 22:23 | Report abuse | Reply
  9. Glenn Kopf

    For Ted Kennedy, I do not think he was really limited in his options for receiving treatment for the glioma in his brain. The Kennedy's are a historically affluent family with considerable wealth and I do not think he was the least bit inhibited in any way where he could choose to receive treatment. I am happy for him that he chose Dr. Friedman to consult with and to perform the surgery to remove the tumor, as Dr. Friedman is a surgeon, researcher and manager of impeccable credentials at one of the premier medical facilities in the U.S.

    But obtaining the best medical practitioner in a particular subspecialty is not an option for millions of Americans due to the provisions of their managed care provider or the fact that they have no medical insurance at all.

    I have had several knee reconstructions in my life and I am embarking on a total knee replacement in July. Fortunately, when U had the reconstructive surgery, I was not limited by my father's medical insurance where I could seek treatment. As a result, I was able to seek treatment at the Mayo Clinic in the 1970's. In 1986, I was able to return there for my last reconstructive surgery only because the doctors at the Mayo Clinic were my orthopedic providers. With my impeding knee surgery, I was not able to get a referrak back to the Mayo Clinic becayse I am now on New York State Medicaid, but fortunatlely I am in the capable hands of one of the best knee replacement surgeons in the country by the grace of God, otherwise I would have been at the mercy of my managed care provider and the surgeons within their network. So it is not always possible to obtain the best healthcare possible, particularly if you have to rely on the network's providers only.

    June 2, 2008 at 23:17 | Report abuse | Reply
  10. K. Langton

    We live in NW Washington State. When my husband was diagnosed with a glioblastoma multiforme brain tumor (GBM) in 2/04, my internet research led me to a number of brain tumor centers in the US and Europe. After phoning/emailing each, I narrowed the options down to Duke in N.C. and MD Anderson in TX. We finally went with Duke, after phone consultations with Dr. Henry Friedman (no relation to Allen) and his phys. assist., Steve Silverman. While we have a local oncologist, Duke set up my husband's chemotherapy protocol, and review his MRI's (done locally.) Lou also visits Duke every 3-6 months. He is now a 4 yr. + survivor! I believe the expertise of the docs at Duke have saved/prolonged my husband's life.

    Our initial insurance (when my husband was still working) covered almost everything, so we were very lucky. Our insurance situation has changed now, and last year our out of pocket medical expenses were $31,000. We have gone from comfortable middle class to almost being broke (but for the generosity of my parents) due to this medical crisis. I don't believe one's income should dictate the quality of one's medical care. We need universal health care, NOW!

    June 3, 2008 at 00:09 | Report abuse | Reply
  11. George Hawkins

    Dr. Gupta,

    There is an excellent book entitled "Taking Charge of Your Medical Fate."

    It's a step-by-step guide to navigating the medical world to determine the best course of treatment.

    It was written by Lawrence C. Horowitz, M.D., a close friend and advisor to Senator Edward Kennedy, who recently helped Senator Kennedy find the best course of treatment for his malignant brain tumor.

    I sincerely hope that you, your listeners, and your readers will be able to make good use of this information.

    George Hawkins

    June 3, 2008 at 00:50 | Report abuse | Reply
  12. Mike Dougharty

    Even though I do not have a brain tumor, I was diagnosed with the neurological disorder of Multiple Sclerosis. Once I was diagnosed, I used the internet to find out all I could about the disease and to also locate what I thought was the best place for treatment within traveling distance. I was lucky to locate the MS clinic at Baylor University medical center in Houston ( a 4 hour drive) and meet with a physician who is not only a practicing neurologist, but also a researcher in the field. I found that, if possible, working with a doctor who deals only with your illness is better than dealing with a general neurologist. They have a better understanding of the nuances of the disease and are always up to date on the latest treatments. Luckily my insurance covered this physician and hospital, even though out of state. I recommend that patients never settle. If you feel uncomfortable with what your physician says, find another. In neurology there are so many opinions and options. The best advice I would also give is to keep a positive attitude. Realize that we all will have something sometime...none of us can avoid it. No one laughed louder when I fell down due to weak legs than myself. You have to keep a sense of yourself...go with the flow and continue to live your life. Don't let the diesease win.

    June 3, 2008 at 00:59 | Report abuse | Reply
  13. archana

    its wonderfull to see him walking again

    June 3, 2008 at 01:31 | Report abuse | Reply
  14. Robert Couch

    I also like the senator was diagnosed with the same brain cancer. Mine was right behind my right eye and the size of my fist!! I got big hands!
    I live on the Olympic Penn. of NW Washington state. In regards to your thoughts about where does one go to deal with something as serious as this I would share the following. When I entered the emergency room in Port Angeles while having a mild seizure the doctors gave me a cat scan of my head a found the "lump". I said what does that mean and they replied "your going to UW Seattle right now!! Okay so in a ambulance I was put and 5 days later I awoke not remembering anything. Well UW is considered one of if not the best hospital in the world I happen by chance? to get operated on by one of if not the best team of brain surgeons in the world headed up by a Dr. Silbergale, not sure I spelled that right. They told be at least a dozen times how excited they were that they were able to remove the whole tumor. Well that sure did help because I have never had after 2 years any recurrence of the cancer. I had my 7 weeks of radiation and 4 months of Tumador (chemo) but that God Im sure that having christians all over the USA made a difference along with the 4 docs who removed my second brain. I have MRI's every 6 monts and next year will go on a yearly scan. One brain is Good!!
    Thank you Robert Couch

    June 3, 2008 at 12:00 | Report abuse | Reply
  15. Nora

    I'm in the middle of deciding what to do about a follicular neoplasm of the thyroid - admittedly not nearly as serious as a brain tumor, but worrisome nonetheless - and I'm considering several factors before I make any final decisions about what to do and where to do it.

    First, I am lucky to be living in the NYC Metro area. Obviously, I've got a lot of very, very good choices available as far as facilites and doctors go.

    Also, I am sort of blessed/cursed because I have such good insurance - and before anyone jumps on me for that, all I can say is you don't know how difficult healthcare decisions can be when you have _too many_ options at your disposal - good insurance often means hospitals and doctors are a tad too eager to push a lot of unnecessary testing/procedurs on you, and it's up to you to sift through the options, do the research and decide what's practical and necessary for your particular situation. Thanks to the interference of lawyers and insurance execs, doctors tend not to be very helpful during the decision-making process. The onus is on the individual.

    For me, medical necessity, various risks weighed against each other (small chance of neoplasm actually being cancerous v. risks of surgery and my personal aversion to staying overnight in a hospital, for example) and my personal comfort with any particular situation, facility and/or individual are what I ultimately go by.

    So it's research, research, research, add a great huge dose of common sense and practicality, and then choose what best suits my personal beliefs, ideals, and standards.

    Should I decide an actual surgical biopsy is truly necessary, I'll most likely opt for the NY Thyroid Center at Columbia Presbyterian - they'll do it same day (they'll observe for several hours and let you go home if everything's looking okay) as opposed to just about every other facilty, and they have the best thyroid surgeons in the country on their staff.

    June 3, 2008 at 15:55 | Report abuse | Reply
  16. Ed

    I have been following the Ted Kennedy situation closely given that my mother passed away a year ago from Glioblastoma (GBM) at age 76 and my wife had a low grade malignant tumor (not GBM) removed from her right parietal lobe in October. His situation is all too familiar for me.

    Its always good to be hopeful, but unfortunately, the reality of Ted Kennedy's situation is not being accurately portrayed to the public. If in fact he has GBM, given his age and physical condition, then regardless of the treatment from Duke (which my mother had as well), then the prognosis is really not good (most people die within a year).

    The treatment that he will undergo, including the clinical trials in which he participates, often have very toxic side effects and can severely impact the quality of life. In the end, it may extend "life" for several months but the quality for the patient and the family is severely impacted and its an excruciating situation for all. That was our experience. Having witnessed their future, I wish them well.

    Having said that, I believe that Dr. Gupta and the media should be more realistic and forthcoming about the road ahead and stop articulating overly positive, feel good messages espoused by political supporters like "he's a fighter" or the "surgery was successful." Ted Kennedy is a nationally recognized figure...he is incredibly unfortunate to be the victim of this horrendous disease...but his plight (if accurately reported and discussed) could help raise awareness and money for research into treatment. If this is GBM, Senator Kennedy will die from this...its just a matter of when. Now that everyone is finally talking about this crisis...and the public is being educated...I wish we could deal in the "facts" and stop "glossing" over all the bad news. It could do some good.

    June 3, 2008 at 18:56 | Report abuse | Reply
  17. Nydia Johnson

    I am glad that the senator is doing well. I wonder ,however, how much of our tax dollars goes into paying that unnecessary helicopter ride and the great insurance that the congress has. It is not right
    that the average American can';t have access to the same level of
    excellent care as those we elect into office. We need insurance reform.

    June 3, 2008 at 22:49 | Report abuse | Reply
  18. Rob

    When my partner was diagnosed with an aortic aneurysm and a regurgitating aortic valve in 2000, we asked his Dallas physician who the best doctor was to perform this challenging surgery. He quickly identified Dr. Joseph Coselli in Houston and within a matter of days, the surgery was performed. I don't know how our insurance compares with Senator Kennedy's, but I feel we were able to access the best available too.

    June 4, 2008 at 09:35 | Report abuse | Reply
  19. Pat

    My mother (age 73) was diagnosed with a GBM in February. She had a craniotomy to remove most of the tumor from the right side of her head. It has been difficult to get any real information from the doctors as they seem to be reluctant to give patients bad news. She started radiation and suffered a Cerebrial Spinal Fluid leak after just twelve treatments. This has required two additional surgeries to seal the leak. Currently she has lost most of her motor and emotional functions and her prognosis appears to be grim.

    For patients who are not wealthy or famous, it is much more difficult to obtain comprehensive care. I' m not sure that universal health care is the answer as it is likely that those individuals who have a poor expected outcome would not be treated as the available care could be rationed.

    June 4, 2008 at 10:37 | Report abuse | Reply
  20. Dr.Alokesh Bagchi,MS,FAIS,FICS.

    Respected Dr Gupta, Came to know about you, from Indian Newspaper Times Of India, Delhi dt.04/06/08. I was a Active Laproscopic Surgeon , in active practice from 1986. last April 20 tha i was diagnosed to have Left Auditory tumour, with CP angle Compression. I was further investigated a nd Surgery( Left Craniectomy with Subtotal Tumour Decompression wasdone at Apollo Hospitals Delhi. Post operative period was uneventful. Now i am on Radiotherapy 5 days a week X 5 weeks. My active life is shattered. I was a heavy Cellphone User from the Last 10 years(1998). Should we raise our voice to make people aware of this dangerous gadget, that too when Rev Kennedy too seems to have it.
    Please advice.
    Regards

    June 4, 2008 at 11:16 | Report abuse | Reply
  21. Robert

    It is wonderful that Teddy will get the best care in the world, but what else do you expect from a member of congress who enjoys the best health care plan in the world, and also a member of a very wealthy family.

    A lot of us have health care plans that are stingey with what should be slam dunk treatments for things like high blood pressure or scratched corena. I've had the insurance company refuse to cover my treatment for an eye injury to remove a chuck of metal from the cornea. Give you three guesses what they would do with a brain tumor like Mr. Kennedy.

    The sad fact would be that my course of treatment would be to make my peace with God and try to get my affairs in order before the cancer killed me. Surgury, chemo and radiation are kinda out of my budget range when I struggle to pay the bills. I can't work, I can't afford to stretch my life. The only real choice would be a choice to try and live a few more months or just end it before things got nasty.

    June 4, 2008 at 12:10 | Report abuse | Reply
  22. Gary

    It is often difficult to identify the "best" doctor. Often physicians who have published extensively may be very good academically and researchers but lacking in technical skills or personal skills. Likewise, many physicians in community hospitals while they may not be well published yet they are very skillful, knowledgeable and know how to interact with patients and their families. In short, looking at a list is no substitute for actually meeting with a physician, talking to them and talking to other patients who had both good and bad experiences. Same goes for the hospital and staff.

    June 4, 2008 at 12:23 | Report abuse | Reply
  23. Phil

    In our family's experience the decision was based on the need for a surgery right away, so traveling far away to find the best in the country was not an option. if your family member is diagnosed at an early stage you have more options. my father survived surgery and regained speech to a limited extent, and was able to meet his 2nd grandson, before the tumor returned, inoperable.

    June 4, 2008 at 15:40 | Report abuse | Reply
  24. Jacqueline Skubal

    Since May 23, 1992 we have been on a journey for answers as to how to help our daughter recover from her Floppy Baby Syndrome diagnosis. The reasons we found for this diagnosis were not the ones we expected. This treatment plan seems to work on what the next issue we needed to address was.

    After our daughter’s birth we had concerns regarding the causes for her Floppy Baby Syndrome. Floppy Baby Syndrome means she had low tone in her muscles and she felt like a rag doll when held. We went to two specialists who were unable to explain her rapid growth and low muscle tone.

    We found allergy and asthma issues and developed a plan for dealing with them. Through her love of music and reading music we explore a language problem that focuses on navigation terms like prepositions in music therapy.

    This March, our daughter saw a physical therapist to figure out her right side problem. Her muscles should work in pairs but they don’t when her calf muscles contracts, the shin muscles should relax. Her right side stays contracted so it needs to exercise to get these muscles relax more. The only way we can retrain the muscles is through walking and daily exercises at home prescribed by the physical therapist that we presently do and trips to the exercise club. So what our daughter is trying to do is strengthen up her right side and get the muscles to work together contracting and relaxing the way they should. Her left side is overly strong so the focus will be to get the right side stronger and get both sides of her body to work better together.

    Our daughter’s learning style is best worked with on one to one bases. Her diet restrictions are less then when we first started this journey. We have found at least one genetic disorder that maybe one of the causes. This is how a treatment plan works for our daughter’s health issues.

    June 4, 2008 at 21:29 | Report abuse | Reply
  25. Ed

    10 years from now, brain tumors will be raking in a lot of money for
    hospitals and doctors in this field. With the heavy use of cell phone these days, brain tumors will sky rocket in the future.
    Sad, but true.

    June 9, 2008 at 08:26 | Report abuse | Reply
  26. Cynthia

    I have been following Ted Kennedy's tumor situation very closely, as it hits very close to home for me. My mother (age 65) was diagnosed with a GBM in Nov. '06. After a resection (surgery), her recovery was slow, and she was not strong enough to start chemo and radiation until 7 weeks after surgery – and by then her tumor had grown back. After the treatments had weakened her sufficiently, the cancer won the battle 4 months later – in April '07.

    (I agree with Ed, who mentioned earlier, that the news about TK's prognosis seems overly positive. It is very rare for someone with a GBM or stage IV malignant glioma – I think this is what he has – to live much beyond a year. And with his advanced age, his prognosis worsens. I wish the media would report the probability of what may come and maybe this would help publicize the need to put more money into researching a cure and/or prevention of brain cancer – and other cancers – altogether.)

    The decision about where to go and what to do with the information that you or a loved one has been diagnosed with a serious brain tumor is a difficult one. I did lots of research online, and reviewed top 10 lists on best cancer centers and best neurology and neurosurgery centers in the US. Considering the seriousness and time sensitivity of my mother's illness, we knew there was no time to be going all over the country. Luckily, one of the best treatment centers for brain tumors was less than a 2 hour drive away from her home – UCLA. As far as getting in to see the best surgeons, we are not a famous or an exceptionally rich family, but we are persistent. I just called and called and called. I spoke to everyone I knew that might know someone that could get her in quicker. After diagnosis, we met with 4 neurosurgeons within 2 weeks and her surgery happened right after that. Very quick. Because we could see how fast the tumor was growing by my mothers increasing symptoms.

    My mother's insurance did not cover her surgery or any treatments done at UCLA, but luckily my parents could afford to cover the surgery out of pocket. One thing we found out was that if you have no insurance, or are going to an out of network provider, ASK FOR A DISCOUNT! My father got sometimes up to 40% off the regular price of the various services because he was not going through insurance. The chemo and radiation was done at a place in network, so all of that was covered.

    My biggest advice for anyone having to make these, literally, life or death decisions is do as much research as you can on doctors, treatments, meds, etc. (by internet, books, National Brain Tumor Institute, American Brain Tumor Society, anyone in the medical community you know), and don't be afraid to ask lots of questions and be a pest (a nice pest) by calling and leaving multiple messages, if necessary, to get your questions answered or get that appointment you need.

    Good luck. Hope this helps.

    August 16, 2008 at 04:01 | Report abuse | Reply
  27. Petreccia Samuels

    Dr. Gupta my daughter was diognosed with asteoartrhitis last year. She is 13 yrs old. Two years ago she fell on her hip and we just did not think of it as anything untill she started walking lean and feeling pain at the same time. I took her to the a physician here in Jamaica, his name is Dr. Adolpho Mena not a native of Jamica. Of course he did the necessary exams and xrays and we were told that she had this disease and after getting other opinions we were told that she would never walk normal again and that there was nothing that could be done. That was very painful to hear, but we of course believe strongly in the almighty father above and believe that she will be healed oneday. So here i am asking your oppinion on this matter and to find out if there is anything that can be done. Please help me it is really stressful for a teen to be going through this situation.

    September 10, 2008 at 14:11 | Report abuse | Reply
  28. Baseball Regulation

    You fell? You'd better be careful next time. =) My friend had an injured knee due to a fall while playing baseball. Now we lost a player :(

    February 4, 2009 at 03:10 | Report abuse | Reply
  29. Tana Brickman

    rain tumors are diagnosed by the doctor based on the results of a medical history and physical examination and results of a variety of specialized tests of the brain and nervous system. Treatment of a brain tumor depends on the type, location, and size of the tumor, as well as the age and health of the patient.;..^.

    Cheers
    <http://homelifestylecentral.com/index.php/

    June 10, 2013 at 01:37 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.