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Mike Kubiszewski has a pet saying that covers any glitch during the course of his workday: “It’s just a bump in the road.” As a short-haul trucker, a bump in the road is a little annoyance that slows him down for only an instant. Then it’s on to the next stop.
In 2007, Mike hit a bump in the road that thrust him headlong into a rough patch: brain cancer.
It started with numbness in his left arm. Mindful of the fact his father died early of a heart attack, Mike went to see his family doctor. The physician had a computed tomography (CT) scan done on the Muskego resident on a Friday.
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Magnetic resonance imaging (MRI) uses magnetic signals and a computer to create three-dimensional images of the human body based on differences between types of tissues. In Mike’s case, the MRI scan showed a shadowy image on the right frontal lobe.
The diagnosis: anaplastic oligodendroglioma, a rare, malignant tumor in the brain. Brain tumors are unpredictable. Some grow rapidly; others may be found while small and removed, only to grow back again. And since the brain is the body’s control center, even a tiny bit of trouble there can have a life-altering effect on other parts of the body. Mike’s tumor was large, about the size of a lime. He needed treatment quickly.
His wife’s boss recommended Froedtert & The Medical College of Wisconsin, where teams from the Clinical Cancer Center and Neurosciences Center specialize in complex neurological disorders such as brain tumors like Mike’s. With the team approach to cancer, there are no prima donnas — just a cooperative nucleus of specialists in neuro-oncology, radiation oncology, neurosurgery, neuroradiology, neuropathology and neuroanesthesiology — as well as support staff who see the patient over the course of treatment.
The bonus of an academic medical center is the continual and productive collaboration between physicians, since many teach and do research in their specialty. The convergence of team members all on one floor of the Clinical Cancer Center makes this collaboration easier. It also means doctors come to the patient, rather than the other way around. Rarely does the patient have to walk more than a hundred steps to see a doctor, get a blood test, undergo an MRI or fill a prescription.
For any patient facing surgery, trust in the surgeon goes a long way. Early on, Mike learned that Wade Mueller, MD, a Medical College of Wisconsin neurosurgeon, is part of a team well-experienced in treating brain tumors of all types. Dr. Mueller also rides motorcycles — an activity near and dear to Mike’s heart. The two hit it off immediately.
In November 2007, just a few days before his 44th birthday, Mike underwent a two-hour operation to remove the tumor. Dr. Mueller used the “awake” surgical approach, in which the patient is fully or partially conscious during the procedure.
The grasp of two fingers and the hesitant answers of the patient help direct the progress of the surgery. During the operation, a nurse stood close to Mike, her middle fingers resting in his palm. “I was holding her hand so tight,” Mike said. Meanwhile, delicately probing the exposed brain, Dr. Mueller posed a steady stream of questions, casual and otherwise, to his conscious but nearly immobile patient. Mike’s responses guided the experienced neurosurgeon to the spongy, discolored tissue that elicited no response: the tumor.
Dr. Mueller worked with a team of eight, aided by critical preoperative brain mapping.
A functional MRI (fMRI), a unique derivative of the standard MRI, is used to measure minute changes to brain function in real time. Using data from Mike’s fMRI scans and other diagnostic tools, the surgical team knew ahead of time how his brain was wired. Dr. Mueller could confidently navigate the nooks and crannies of his patient’s brain, and knew which areas to remove and which areas to avoid. Today’s advances in neuro-oncology disarm the public’s usual perception about brain surgery. Many times, Mike has asked his doctors if his recovery is “some kind of miracle.” The usual answer from these experts who have seen all types of brain anomalies is “no” — the forward march of science is the miraculous part.
The goal of brain surgery is a modest one: to keep the patient functioning as normally as possible. In Mike’s case, he had Guillain-Barre Syndrome, a rare neurological disease that can affect the nervous system permanently. Yet, this disease had absolutely no effect on his tumor or subsequent treatment, according to another member of Mike’s physician team, Mark Malkin, MD, Medical College of Wisconsin neuro-oncologist. Nevertheless, it is usual for glioma patients to go through the “big three” of cancer treatment – surgery, radiation therapy and chemotherapy.
Mike underwent radiation therapy soon after surgery. Christopher Schultz, MD, Medical College of Wisconsin radiation oncologist, was part of Mike’s treatment team.
Specialists in Radiation Oncology constructed a mask of Mike’s face that immobilized him during his treatments for pinpoint accuracy. The radiation therapy was designed to treat any remaining visible tumor that could not be removed safely during surgery, as well as to treat possible adjacent microscopic tumor cells. MRI and CT images obtained following surgery were also used to plan the radiation therapy so that the dose “cloud” matched the size and shape of the operative bed, minimizing unnecessary treatment of adjacent brain tissue.
The chemotherapy phase of Mike’s treatment involved taking pills daily during six weeks of radiation therapy, and then for five consecutive days each month for another year, during which he was able to return to work. Thanks to advancements in chemo, Mike did not experience nausea and missed very few days while in a full year of the therapy. In fact, almost from day one he was back in the driver’s seat performing his usual workday duties.
Mike’s tumor may come back. He will get regular MRI scans (more than two dozen and counting). He will keep appointments with Dr. Malkin for the rest of his life, but they will become less frequent the longer he is tumor free.
Mike’s encounter with a big bump in his life has made every moment he spends with his two young sons, Ben and Zach, and his wife, Judy, especially precious. He is counting the years until he can retire. And he’s confident he’ll get there. “I have a lot of people praying for me,” Mike said.
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