Sliloh's Rambles

“Know how sublime a thing it is to suffer and be strong.” ~Henry Wadsworth Longfellow

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3

Apr

2010

To Shunt Or Not To Shunt

Posted by Anita  Published in Brain Tumor, Pineal Gland brain tumor

Last night as I went to bed I suddenly heard this sound like water running, in my right ear only (my shunt runs right behind my ear on the right). It lasted only a couple of minutes. I have tinnitus already, quite a bit worse the last few months but it completely drowned that out. Then there are the horrendous headaches and recurring equilibrium problem, which was my only indication that I had a brain tumor. I am wondering if my shunt is malfunctioning.

The question is…do I still need a shunt? Because they removed enough of my tumor that it no longer blocks my third ventricle. They did however tell me that I might be dependent on the shunt. My yearly MRIs show the size of the tumor and I assume they show whether I have hydrocephalus but I don’t know how you check the functioning of a shunt (I missed my MRI last year). So as I was lying there listening to that, my thought was what if that bugger sucks me poor old brain dry? 😛

Some of the problems that can cause a shunt malfunction are:

  • Infection
  • Blockage
  • Calcification or breakage of the catheters
  • Separation (catheters may disconnect from the valve and reservoir unit)
  • Valve is broken or stuck
  • Wrong pressure valve (usually found in a fixed shunt)
  • Catheter needs lengthening
  • Over-drainage or under-drainage

See? there it is right on the list; over drainage! I wonder what that does to your brain? I’m not gung-ho on the idea of anymore surgeries in this lifetime or having my shunt removed only to find out I need it. I hate that thing though, I feel it when I lay in bed at night because I’m a skinny wench and my bed is hard. Oh and the lifetime of a shunt is 8-10 years. Mine was installed in 1999. Maybe I need a valve job 😛

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23

Sep

2008

What is a Pineal Gland?

Posted by Anita  Published in Pineal Gland, Pineal Gland brain tumor

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A tiny little structure deep in my brain that I never heard of until a tumor was discovered on mine. What is a Pineal gland? The answer to that has changed over the years. Hopefully we are closer to the correct function of that gland than they were in the past. There’s some ancient information here but I found it fascinating.

1. Pre-Cartesian Views on the Pineal Gland

The pineal gland or pineal body is a small gland in the middle of the head. It often contains calcifications (“brain sand”) which make it an easily identifiable point of reference in X-ray images of the brain. The pineal gland is attached to the outside of the substance of the brain near the entrance of the canal (“aqueduct of Sylvius”) from the third to the fourth ventricle of the brain. It is nowadays known that the pineal gland is an endocrine organ, which produces the hormone melatonin in amounts which vary with the time of day. But this is a relatively recent discovery. Long before it was made, physicians and philosophers were already busily speculating about its functions.

1.1 Antiquity

The first description of the pineal gland and the first speculations about its functions are to be found in the voluminous writings of Galen (ca. 130-ca. 210 AD), the Greek medical doctor and philosopher who spent the greatest part of his life in Rome and whose system dominated medical thinking until the seventeenth century.

Galen discussed the pineal gland in the eighth book of his anatomical work On the usefulness of the parts of the body. He explained that it owes its name (Greek: kônarion, Latin: glandula pinealis) to its resemblance in shape and size to the nuts found in the cones of the stone pine (Greek: kônos, Latin: pinus pinea). He called it a gland because of its appearance and said that it has the same function as all other glands of the body, namely to serve as a support for blood vessels.

In order to understand the rest of Galen’s exposition, the following two points should be kept in mind. First, his terminology was different from ours. He regarded the lateral ventricles of the brain as one paired ventricle and called it the anterior ventricle. He accordingly called the third ventricle the middle ventricle, and the fourth the posterior one. Second, he thought that these ventricles were filled with “psychic pneuma,” a fine, volatile, airy or vaporous substance which he described as “the first instrument of the soul.” (See Rocca 2003 for a detailed description of Galen’s views about the anatomy and physiology of the brain.)

Galen went to great lengths to refute a view that was apparently circulating in his time (but whose originators or protagonists he did not mention) according to which the pineal gland regulates the flow of psychic pneuma in the canal between the middle and posterior ventricles of the brain, just as the pylorus regulates the passage of food from the esophagus to the stomach. Galen rejected this view because, first, the pineal gland is attached to the outside of the brain and, second, it cannot move on its own. He argued that the “worm-like appendage” [epiphysis or apophysis] of the cerebellum (nowadays known as the vermis superior cerebelli) is much better qualified to play this role (Kühn 1822, pp. 674-683; May 1968, vol. 1, pp. 418-423).

1.2 Late Antiquity

Although Galen was the supreme medical authority until the seventeenth century, his views were often extended or modified. An early example of this phenomenon is the addition of a ventricular localization theory of psychological faculties to Galen’s account of the brain. The first theory of this type that we know of was presented by Posidonius of Byzantium (end of the fourth century AD), who said that imagination is due to the forepart of the brain, reason to the middle ventricle, and memory to the hind part of the brain (Aetius 1534, 1549, book 6, ch. 2). A few decades later, Nemesius of Emesa (ca. 400 AD) was more specific and maintained that the anterior ventricle is the organ of imagination, the middle ventricle the organ of reason, and the posterior ventricle the organ of memory (Nemesius 1802, chs. 6-13). The latter theory was almost universally adopted until the middle of the sixteenth century, although there were numerous variants. The most important variant was due to Avicenna (980-1037 AD), who devised it by projecting the psychological distinctions found in Aristotle’s On the soul onto the ventricular system of the brain (Rahman 1952).

1.3 Middle Ages

In a treatise called On the difference between spirit and soul, Qusta ibn Luqa (864-923) combined Nemesius’ ventricular localization doctrine with Galen’s account of a worm-like part of the brain that controls the flow of animal spirit between the middle and posterior ventricles. He wrote that people who want to remember look upwards because this raises the worm-like particle, opens the passage, and enables the retrieval of memories from the posterior ventricle. People who want to think, on the other hand, look down because this lowers the particle, closes the passage, and protects the spirit in the middle ventricle from being disturbed by memories stored in the posterior ventricle (Constantinus Africanus 1536, p. 310). Qusta’s treatise was very influential in thirteenth-century scholastic Europe (Wilcox 1985).

In several later medieval texts, the term pinea was applied to the worm-like obstacle, so that the view that the pineal gland regulates the flow of spirits (the theory that Galen had rejected) made a come-back (Vincent de Beauvais 1494, fol. 342v; Vincent de Beauvais 1624, col. 1925; Ysaac 1515, part 2, fol. 172v and fol. 210r; Publicius 1482, ch. Ingenio conferentia). The authors in question seemed ignorant of the distinction that Galen had made between the pineal gland and the worm-like appendage. To add to the confusion, Mondino dei Luzzi (1306) described the choroid plexus in the lateral ventricles as a worm which can open and close the passage between the anterior and middle ventricles, with the result that, in the late Middle Ages, the term ‘worm’ could refer to no less than three different parts of the brain: the vermis of the cerebellum, the pineal body and the choroid plexus.

1.4 Renaissance

In the beginning of the sixteenth century, anatomy made great progress and at least two developments took place that are important from our point of view. First, Niccolò Massa (1536, ch. 38) discovered that the ventricles are not filled with some airy or vaporous spirit but with fluid (the liquor cerebro-spinalis). Second, Andreas Vesalius (1543, book 7) rejected all ventricular localization theories and all theories according to which the choroid plexus, pineal gland or vermis of the cerebellum can regulate the flow of spirits in the ventricles of the brain.
~Lokhorst, Gert-Jan, “Descartes and the Pineal Gland”, The Stanford Encyclopedia of Philosophy (Fall 2008 Edition), Edward N. Zalta (ed.).

René Descartes (1596-1650) was a French philosopher, mathematician, scientist, and writer.  He has been called the “Father of Modern Philosophy”.  He wrote;

“Since it is the only solid part in the whole brain which is single, it must necessarily be the seat of the common sense, i.e., of thought, and consequently of the soul; for one cannot be separated from the other.”

I’m glad he was wrong because I’d hate to think since I’m now without a pineal gland that I have no soul. 😉 Still, his work in ‘Treatise of Man’ and ‘Passions of the Soul’ is very interesting reading.

By the end of the nineteenth century, several scientists introduced the hypothesis that the pineal gland is a phylogenic relic, a vestige of a dorsal third eye. A modified form of this theory is still accepted today. Also, scientists began to theorize that the pineal gland is an endocrine organ. This was proven in the twentieth century. The hormone secreted by the pineal gland, melatonin, was first isolated in 1958. Melatonin is secreted in a circadian rhythm, which is interesting in view of the hypothesis that the pineal gland is a vestigial third eye. Madame Blavatsky, the founder of theosophy, identified the “third eye” discovered by the comparative anatomists of her time with the “eye of Shiva” of “the Hindu mystics” and concluded that the pineal body of modern man is an atrophied vestige of this “organ of spiritual vision”. The pineal gland is occasionally associated with the sixth chakra (also called Ajna or the third eye chakra in yoga). It is believed by some to be a dormant organ that can be awakened to enable “telepathic” communication.

Today we know that the pineal gland It is sensitive to different levels of light and is essential to the functioning of an animal’s biological clock. In many animals, including humans, it synthesizes a hormone called melatonin in periods of darkness. Melatonin synthesis is halted when light hits the retina of the eye, sending impulses to the gland via the optic nerve. Besides influencing daily, or circadian, rhythms such those of as sleep and temperature, the pineal gland and melatonin appear to direct annual rhythms and seasonal changes in animals.

So, I’m sometimes sad to be missing the seat of my soul, my third eye and especially my circadian rhythms, but I am happy to know I can survive without it.  As for the circadian rhythms, I do see the effect. I stay up at night, sleep whenever and don’t generally function on a 24 hour day. I tend towards 30-36 hour days way too often and about 5 hours worth of sleep. I sometimes wonder if I’ve lost some precious potential to reach a higher degree of spirituality for my lack of a pineal gland but then I believe that resides elsewhere, where my soul resides also.

There’s much more at the cited link. It’s the most comprehensive information I’ve been able to find about Pineal glands and so very interesting how our knowledge has progressed.

Edited to add links to my previous posts about Pineal Gland Brain tumors.

Pineal Gland Tumor

What is a Pineal Gland Tumor?


“Ordinary riches can be stolen, real riches cannot. In your soul are infinitely precious things that cannot be taken from you.” ~Oscar Wilde


2 comments

17

Sep

2008

MRI ponderings

Posted by Anita  Published in Brain Tumor, Pineal Gland brain tumor

I just had my yearly one and am supposed to see the neurosurgeon so he can look at it but I came home in between because it was going to be an hour and a half wait (that and I desperately needed my allergy meds). So not having thought of it earlier I just called them to see if I should bring last years in to compare. They said no. The whole thing is strange since I moved here.

In Michigan the copy I got always had a report in it, and they also kept a copy. In the reports they compared it to the previous one. Not this guy, he throws it up on his lightbox, tells me I’m fine and that’s all I ever hear. The last report I actually saw a couple years ago it WAS growing. It’s my brain and my tumor and I’d like to know what is actually going on with it. I’m the freaking patient! So because this dr isn’t all that nice and acts like I’m a pain for even coming in and having MRI’s (which he told me to do), I will ask my medical dr if she is getting reports and if not I’ll ask her to request them. It’s my brain, I’d like to know what’s going on with it.

6 comments

7

Sep

2008

What is a Pineal Gland Tumor?

Posted by Anita  Published in Brain Tumor, Pineal Gland brain tumor

mytumor

Many people come to my blog from searches for pineal gland tumors. I thought I’d try to be a bit more informative about these brain tumors than my last post which was about my personal journey with the diagnosis and treatment of my own tumor. So here’s a list of things I know (or believe) to be true about pineal gland tumors, from my experiences and from extensive reading. I am by no means an expert or doctor so do make sure you are discussing this with a doctor! I’m posting this more as a means of reassurance for people newly diagnosed with this type of brain tumor.

I was diagnosed in 1999, with my shunt surgery immediately following. In 2003 I had most of my tumor removed at Duke University Brain Tumor Center. My tumor is growing, but not fast and it’s much, much smaller obviously so I’m really not worried.  Other than the really strange feeling from the hydrocephalus, and yes, the upward gaze problem, I have really had no big problem with this. I have gone through things that to me were much worse, the tumor was a snap to deal with really.

  • A pineal gland brain tumor is very unlikely to kill you. I know of one woman that was in my tumor group who did die some time after her surgery to remove hers. She ended up with locked-in syndrome and died from complications.
  • A pineal gland brain tumor can become an emergency health problem if it blocks the aqueduct of Sylvius, which serves as a passage allowing cerebrospinal fluid (CSF) to leave the center of the brain where it is first produced. Pineal tumors often compress this aqueduct, causing a build up of pressure of CSF in the brain (hydrocephalus).
  • If it is not large enough to block the aqueduct of Sylvius, you can probably live with it with no problem.
  • If it does block the aqueduct of Sylvius, causing hydrocephalus, you will need treatment to either install a shunt as an alternate pathway for fluid to drain (which is what I had done) or have a procedure called a stereotactic third ventriculostomy. Third ventriculostomy creates a tiny opening in the bottom of the brain using a small endoscope to allow the CSF to escape. This procedure is usually performed under local anesthesia.
  • A pineal gland tumor can also cause visual changes as a result of involvement of the nearby tectal region which has a primary role in controlling eye movements. These changes may include: inability to focus on objects, double vision and impairment of eye movements. I was having trouble with my upward gaze, my tumor was quite large and growing, hence my decision to have a second surgery to hopefully remove it all.
  • You doctor may prefer to do a biopsy, I did not choose that route, although obviously they biospied my removed tumor.
  • The two treatments I have discussed with my surgeons were surgical removal and radiation. I went with the surgical removal.
  • Most pineal gland tumors are benign! Do not panic.
  • You do not need a pineal gland to live. Mine has been gone since 2003 and was so entombed in tumor, probably for years, that who knows when it quit functioning.

Well, that’s it folks, the extent of my knowledge unless you want the gory details of surgery 😉 Seriously, if you have to have a brain tumor, this is probably the best one to get.

Edited to add the last one on the list because someone came here from a search “do you need a pineal gland to live?” As far as I know I’m still alive 😉

Edited again to add a link to my previous tumor post and a newer post:

Pineal Gland Tumor

What is a Pineal Gland?

114 comments

3

Jun

2008

Pineal Gland Tumor

Posted by Anita  Published in Pineal Gland brain tumor

“There’s something there.” Those were the words said to me by a doctor in the E.R. in 1999 after a CT scan. I went in because even though I felt fine, I had this strange feeling when I was walking that I was listing to the right. Very weird. They then ordered an MRI and told me I had a brain tumor and hydrocephalus. I was admitted for however long it took to arrange an ambulance to take me to Henry Ford Hospital for surgery. That entire time is pretty hazy to me. Probably because I told them I was highly claustrophobic so they gave me some really awesome sedative for the MRI (which I don’t even remember having).

mytumor

At Henry Ford they explained that they’d be inserting a shunt in to drain the fluid on my brain. They said mine was a pineal gland tumor and was large enough that it blocked the drainage duct for cerebral spinal fluid. No more nice smooth skull for me, I now sport a large lump on the right. It wasn’t really explained to me until afterwards when I hurt all over that they actually ram a rod down under your skin to make a path for the tube, which they ran from the shunt, down my neck, under my breast, and attached it into my abdomen next to my navel . I can still feel it when I stretch and for a long time you could see it because I was so skinny. That was because I was really sick afterwards. Could not stop vomiting. The doctors had no idea why, but suggested that it was because my brain was unused to a normal pressure.

I healed and life went on with MRIs every six months. However the tumor was growing so something needed to be done. Back at Henry Ford they said they wouldn’t operate but they did want to go in there and take a biopsy. They also wanted me to go down there 6 days a week for radiation, which I just had no way to accomplish. So a friend on my tumor group gave me a web address for Duke University Brain Tumor Center. I contacted them via the web form and one of the doctors called me the next day, told me to send my MRI and they’d take a look. A few days later they called and said “We think it can and should come out.” So April 7th, 2003 off to Duke I go! The surgery took about 4 hours and I was under the impression for a couple of days that they had gotten the whole tumor. They didn’t, it’s attached to my hypothalamus and if they had tried scraping it off I’d have ended up with brain damage. It wasn’t that bad, much better than my first surgery! I was out of the hospital in 4 days and home in a week. Tumor size reduced from 4.6 cm to about 6mm! The surgeon called me on Easter Sunday to tell me it was “The best kind of benign it could be.” And then gave me this hugely long name that I can’t remember or spell.

I have now graduated to MRIs once a year and yes, it’s growing again. However, I think I had it growing for years before I had symptoms, so I believe that I’ll probably die from old age before it becomes an issue again. Here’s hoping anyway!

The whole reason for this post was because I saw my Surgeon’s name mentioned on the news. Allan H. Friedman, MD is the one who just operated on Ted Kennedy. My experience with the staff at Duke was amazing. I’m like most people, not real fond of hospitals, but they were so caring and compassionate.

I gave Dr Friedman a picture I made (being a fledgling Poser user at the time), but I waited until after surgery to give it to him. I didn’t want him to think of it and start laughing right in the middle of things 😉 That man is my hero.

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Edited to add links to a couple of my other blog posts
What is a Pineal Gland Tumor?

What is a Pineal Gland?

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