Wednesday, April 11, 2012

A New Hope

Good news on the home front!

There are a few medications that have been getting researched for possible benefits for cavernous malformations, one of which is simvastatin (brand name Zocor ™) and is a generic and long studied medication typically prescribed for cholesterol management, and is readily available.

And as of yesterday I am taking this!

So here is the deal... there is no conclusive study that has gone through human drug trials for my condition.  But doing drug trials at all is difficult when you are dealing with a rare disease such as this, and only some 400+ patients registered internationally with this condition.  There is a drug trial currently started in the recruiting phase looking to test this medication for efficacy, so we'll know soon enough (I hope) if this has any legs.

Besides cholesterol management, simvastatin (and other statins) has been long known and studied to have cerebrovascular protective effects outside of cholesterol reduction and is used to reduce the occurrence of stroke.  While there are some risks associated with this medication, this potential use in my case has been vetted with my neurosurgeon, neurologist, family doctor, and father (who is a family doc by training) and basically seems like a no-brainer (and at least no harm likely).

Further, there has been a mouse model study (actual study here!)   to test simvastatin on cavernous malformations introduced by a type of genetic defect that is known to cause these.  "They tested their hypothesis by administering simvastatin, which is known to inhibit Rho activity, to mouse models with the Ccm2 mutations and saw that the drugs strengthened the damaged blood vessels in the mice."  My condition is known to manifest in part a leaky type vascular structure so the hope is if we can stabilize it, maybe I can have a chance to beat this thing free of major bleeds and have a lovely life "neurologically intact".

That would be cool.

So for now 20mg simvastatin daily for me.  Wish me luck as I embark on my self-study of 1!

Sunday, April 8, 2012

No More Hangovers!

I went on a great vacation down to L.A., and Palm Springs this week.  Visiting family, great weather, golf, pool, lovely!  I might have had a few drinks on a couple of nights.  But the next morning I don't suffer the consequences anymore!

Its great you know because I can't seem to notice getting the usual bit of a hangover that I would expect, you know slow start on day, bit of nausea etc.  Because I usually feel that way anyway, and is just blends in! :P

So my new normal has some upside, woo-hoo!   Party on then!

Tuesday, April 3, 2012

By the Numbers - Surgical Risk Presented

My favorite way to play the odds in Vegas!
Armed with some fresh data, here is an analysis of what has been presented by my neurosurgeon in terms of surgical outcomes for the removal of my brainstem cavernous malformation...

Doing surgery now:
  • 10-15% chance of new permanent neurological deficit, could be as simple as losing feeling in finger, or losing ability to move on left side of body.
  • 93% chance of successful resection, or 7% chance of failure leading to likely bleeds in the future as its not fully removed
Doing surgery after a hemorrhage external to the cavernous malformation that also creates a large opening in front of brainstem (a lot of maybes):
  • 8-12% change of new permanent neurological deficit
  • 95% chance of successful resection, or 5% chance of failure
Its worth acknowledging that these generic odds are extrapolated from the clinical experience of an expert but they are not necessarily my odds.  But look the world isn't perfect and its what I have to work with.

In my review of case studies and discussion with those that have had surgery, I will for simplicity say that having a failure during the surgery is a bad outcome on par with acquiring a new deficit.  Its a simplification but what is clear is that any brain surgery itself is a traumatic event and requires lots of rehabilitation (many months or more in some cases), and unknown consequences.  Some people even have stokes during their brain surgery or as a result of!

So to boil this down and oversimplify:
  • Now: 17-22% chance of poor surgical outcome (22% pessimistic)
  • Ideal: 13-17% chance of poor surgical outcome (17% pessimistic)
So WAIT!  you must be saying.  Because I know right the odds really don't get that much better, (20% relatively fewer poor outcomes).  That is why a substantial part of this analysis is how I am doing now, and that I should really be much worse off than I am before doing this makes sense, so that the risk/benefit analysis starts to play out better.   Perhaps getting further damaged from a bad surgical outcome when I am already more damaged makes good sense on the trade-offs.  As my neurosurgeon put elegantly in a doctor's note recently, I am currently "neurologically intact".

So playing this out... one meta study (a study of studies) seems to indicate that from brainstem cavernous malformation, the risk of a new hemorrhage is about 20-30% annually after the first clinical event and decreases over time especially after the first 2-3 years.  In one study the progression went like this for cavernous malformations generally (not just brainstem): 20% year-1, 13% year-2, 12% year-3, 5% year-4 and 5% year-5. 

Data on getting new problems from these bleeds is scant, but seems about 1/5-1/3 of these can result in a new permanent neurological deficit, so we might be looking at 4-10% annual chance initially of acquiring a new permanent deficit from the CM, and declining from there if it stabilizes, and a series of years might look like 7%, 4%, 4%, 2%, 2%, ... -- on acquiring a new permanent deficit from a new bleed.

So the trick here seems to pray for the best, hope it stabilizes, help it stabilize, etc.  No?