A Patient’s View: Living with Astrocytoma
In the winter of 2009, Brant Gallion was in Russian territory, climbing a piece of equipment on an oil rig in the Caspian Sea, when he thought he was being electrocuted, lost consciousness and fell 5 feet to the deck on his back. He revived about a half hour later, uninjured and surrounded by crew members.
“I rested the next day and thought that was the end of it,” says Gallion, a 35-year old engineering consultant who lives in Bryan, Texas.
In June 2010, after returning to Texas, he had a second episode. “I collapsed and once again felt like I was being electrocuted, then lost consciousness,” he recalls. “I woke up and went back to work. I didn’t draw any conclusions at the time, but I began to suspect a neurological problem.”
Four months after the second incident, in October 2010, he had a generalized seizure while working in Katy, Texas. A colleague called 911, and he was taken by ambulance to Memorial Hermann Katy Hospital, where he underwent a CT scan and MRI.
The following day he was transferred to Memorial Hermann-Texas Medical Center, where he was prescribed an anti-seizure medication and referred to Dong H. Kim, M.D., director of the Mischer Neuroscience Institute (MNI) at Memorial Hermann-TMC and professor and chair of the Vivian L. Smith Department of Neurosurgery at UTHealth Medical School.
Two days later, Gallion was in the exam room with Dr. Kim, who is noted for his experience with brain tumors and cysts of all types. He recommended a biopsy based on the imaging studies, which showed a diffuse lesion in the right posterior frontal lobe, with MRI characteristics suggestive of a low-grade astrocytoma. Dr. Kim also referred him to neuro-oncologist Jay-Jiguang Zhu, M.D., Ph.D., director of MNI’s Clinical Cancer Program and an associate professor in the Vivian L. Smith Department of Neurosurgery.
Dr. Kim made an immediate impression on his patient. “He has enormous presence, and I had the feeling that I was in the best possible hands. I didn’t have any context for neuroscience then and didn’t understand Dr. Kim’s stature in that world,” says Gallion, who was 31 at the time. “It took me about a year and a half after that initial meeting to put him into context.”
Gallion met with Dr. Zhu a few weeks later. “He discussed the clinical symptoms of seizures and the MRI abnormality through his eyes as a neuro-oncologist,” he says. “I wanted to let all this wash over me, and in the end I passed 2011 and early 2012 with quarterly MRIs but without any surgery. I was busy with a company startup and had other personal obligations. I was afraid it might be the beginning of a downward spiral, and that if I had the biopsy, I wouldn’t recover fast enough to meet those obligations. I had also decided that if it was an aggressive tumor, I’d rather just let it play out.”
Surveillance MRIs during those 18 months showed no significant change in the lesion.
Ready to find out more
In May 2012, Gallion was ready for the biopsy. Dr. Kim performed the surgery and, using motor-mapping techniques, found that the bulk of the tumor was located in the right motor strip, an area that controls movement on the left side of the body.
He was able to remove a small amount of tissue for pathological examination; total resection would have resulted in paralysis. In a Neuro-oncology Tumor Board conference attended by Dr. Kim, Dr. Zhu, and radiation oncologist Angel Blanco, M.D., the team recommended radiation and the initiation of chemotherapy.
After recovering from surgery, Gallion began 30 fractions of radiation therapy over a span of 42 days with concurrent daily temozolomide, followed by chemotherapy with temozolomide five days out of every 28, a regimen he continues today. Temozolomide is an oral chemotherapy drug that can be taken at home, with outpatient monitoring for side effects.
A new normal
“My new normal is a quarterly MRI to check on the tumor, which has been stable,” he says. “I’ve had to make lifestyle adjustments that were for the best – better sleeping and eating habits and eliminating sources of stress. I’m fortunate that my condition doesn’t dominate my life. Even during the time of surgery and recovery, I produced more work than during any other period.”
Gallion, who has had no seizures since February 2013, describes his treatment as “a pretty good experience. Dr. Kim made me want to quit what I’m doing and become a doctor. Unfortunately, that’s not my skill set. Dr. Zhu is also a wonderful doctor and uniquely gifted in his bedside manner and professionalism. Often they bring a resident along to my checkups or a resident sees me first and then reviews the assessment with Dr. Kim or Dr. Zhu. It’s fun being part of the teaching process – even if I am the case study.
“You always want to ask the doctor what the bottom line is, what will happen next,” he adds. “There’s no answer to that and no finality or written script in anyone’s case. For me, that’s made life more exciting and satisfying.”