A 19 July 2012 look inside my brain

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MRI capsule

For those who don't know – and it's something I was very vague on before my brain became the subject of several of them – MRI is Magnetic Image Resonance. It's a way to scan parts of the body invisible from the outside without the dangers of x-rays, and produces far better images for the experts to interpret. They can use the MRI to build a 3D image of the scanned area, and thus can measure with great accuracy different features of it. If MRIs are done over a period of time, then changes can be noted, and also interpreted, if they reveal enough information.

   On 19 July, 2012, I had the first MRI in 18 months. I could have had them more often, but I made the decision not to. I had my reasons and if you aren't in my position then you probably won't understand. As I wrote to a friend in whose medical knowledge and opinion I have great trust:

   In hindsight, it would have been useful to have had 4 or 6 monthly MRIs instead of none in 18 months, but as there was no way I would be likely to change much in attitude to ongoing treatment no matter what an MRI revealed, and because I felt comfortable not knowing, I had no desire to. Sometimes there is as much or more hope and contentment in ignorance as there is in revelation. To have had frequent MRIs made me feel a little like a lab rat under these circumstances, but it came to the point where it would be useful, maybe, for later researchers who had access to my medical records to have more information than I've been giving them.

   And as well, I should have said, there comes a time when we do need to know if something has changed dramatically. It's not just about me.

   When an MRI is finished, the specialist trained in interpreting these images produces a report. In my case, we pick up the images within ten minutes of completing the MRI, but the report takes longer. It goes to my oncologist and is copied to the GP. Our GP is the first to explain to us what he makes of the report, which he did as soon as he got it.

   So that's how it goes.

   The original report was vague, and the reason for this is that the MRI itself was not revealing in any definitive sense about changes to the tumour over the 18 month period.

   This doesn't mean there were no changes. On the contrary, there were ones which could be very significant. Or they could be little more than changes over that period to any live tissue growing where it shouldn't be and that we've been attacking by whatever means possible since we knew about it.

MRI scan slice 19 July 2012

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   According to the report, the mass of the original tumour itself doesn't seem to have increased a great deal. There is, according to the report, no great increase in oedema. That surprised me after seeing the scans, because what I saw in the 2D images suggested to me it had – but obviously when a 3D composite can be used to estimate volume fairly accurately in the hands of an expert, it just shows how easily someone untrained can be misled by appearances.

   But there are changes, as I said. There are cystic areas which have developed. Have they grown slowly over a long period, or are they perhaps very recent? Because of my decision not to have more frequent MRIs, we don't know, and there is absolutely no point in speculating. Are they ominous signals, or the sort of changes, not so sinister, that would be bound to happen anyway? No-one knows.

   We do know one thing. I am locked into taking Avastin until it becomes pointless to do so. It seems to have been pivotal in containing the tumour for me for nearly two years, starting at a time when things looked very grim. It will not do so forever, and my body keeps telling me this day by day as I see the physical changes taking place. I can't know about any damage or change to internal organs until that happens.

   Things can change in a flash, but so far they haven't. What we do is to continue. As my Buddhist colleague would always say when asked how he was, "So far, so good."

   Impermanence and change are two elementary Buddhist principles. The day we ignore them is the one they'll get us.

   My good medical friend said regarding this report – and I'm certain it's what the oncologist will say when I see him next:

   I think the only insight I can give is you is that few if any people can give you real insight into what this means.

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