鈥淎 Battle with No End Date鈥 (A Brain Mets Story)

This patient story was originally published by .

Ronald Piscitello was only 47 years old when his life changed completely 鈥 not in an instant, but over the course of a long, confusing year. Today he is a changed man, and his wife and family are grateful to have him back after a frightening diagnosis and life-altering surgery. Ron beat some long odds, but thanks to the skill and wisdom of听听and the听听at NewYork-Presbyterian/Weill Cornell Medical Center, he is now a survivor of a very serious brain tumor.

Ron was at the top of his game in 2017听鈥斕he was a successful executive at a nonprofit on Long Island, with a loving wife, two young adult children, and a home on the south shore of Suffolk County. His wife, Donna, says they were like any loving family, 鈥渨orking and enjoying the kids, looking forward to life events, and just laughing our way through the journey.鈥 None of them thought too much about a strange issue where Ron started having trouble swallowing. Endoscopy didn鈥檛 reveal anything to worry about, but when the problem didn鈥檛 go away he was referred to a gastroenterologist, who ordered another endoscopy. That, too, showed no cause for concern and the assumption was that he had a little reflux, nothing more.

Donna recalls now that it was the weight loss that worried her more than anything. Ron was getting thinner as the swallowing issues were becoming worse, so his primary care doctor ordered blood work in search of more clues. 鈥淲e were so relieved that all those results were normal,鈥 Donna says, 鈥渂ut we were very confused by his deterioration.鈥

"We鈥檝e made a lot of progress over the past decade, and have new treatment options, so we are seeing longer and longer survival times."

Then in October 2018 Ron experienced a grand mal seizure. An MRI revealed a large mass in his brain, as well as another tumor in his lung. A neurosurgeon who was called in to consult confirmed the presence of a brain tumor and said it should be removed, and soon 鈥 that very weekend, even. It wasn鈥檛 possible to say for sure, but it was likely that the brain tumor had been caused by spread from the lung tumor 鈥 and metastatic brain tumors are very serious indeed.

Medication controlled the seizures and brain swelling, and much to their surprise Ron and Donna were told that instead of having surgery he would be discharged the following day and that they should call the following Monday to make a neurosurgical appointment.

Ron's MRI scan held a real shock for him and his family: A large metastatic brain tumor

鈥淲e were in complete shock,鈥 says Donna. 鈥淗e wasn鈥檛 having seizures, but he was so unstable that we were in disbelief he was being sent home. Knowing that he needed brain surgery, I immediately started searching online for the top neurosurgeons in New York State for metastatic brain tumors. All I knew was that I wanted the best for my husband. When I found Dr. Ramakrishna and read his biography, my instinct immediately was that yes, this is who I鈥檓 calling.鈥 Donna made the appointment right away and she and Ron went in to meet the neurosurgeon.

They were both impressed with how calm and methodical Dr. Ramakrishna was. He told Ron and Donna that yes, the tumor needed to be removed, but no, it was not an emergency. He ordered another MRI scan along with some other diagnostic tests, and only scheduled the surgery once he had all the information he needed.

鈥淚 don鈥檛 even remember if Dr. Ramakrishna told us what kind of tumor this was,鈥 Donna says now. 鈥淲e were just numb.鈥 It would not be confirmed until the surgery, but Dr. Ramakrishna was confident that Ron had a听听听that the lung cancer had spread to the brain before the original tumor had even been detected.

鈥淭his is a serious diagnosis,鈥 says Dr. Ramakrishna, 鈥渁nd it is often assumed it鈥檚 an immediate death sentence. But we鈥檝e made a lot of progress over the past decade, and have new treatment options, so we are seeing longer and longer survival times. That鈥檚 our goal听鈥斕听more years for patients to spend with their families, with better quality of life.鈥

Shortly after that initial seizure, Ron was headed into surgery. Donna says now that Dr. Ramakrishna鈥檚 calm demeanor and unfailing responsiveness assured them again and again that they had made the right decision in choosing him.

鈥淭he prospect of brain surgery was quite frightening, to say the least,鈥 Donna says. 鈥淏ut we were eager to have it done so Ron could be free of all the pain and anguish that came with the diagnosis. We really didn鈥檛 know what to expect, since this whole experience was so foreign for us. Dr. Ramakrishna鈥檚 calmness made it seem like, 鈥榃e got this, no worries. See you in a few hours.鈥 Being his patient is something we will always be grateful for, and that鈥檚 an understatement.鈥

Ron's post-operative scan shows that the tumor is completely gone (the white area at right indicates the cavity left where the tumor was removed).

Ron underwent open surgery in November 2018, and a few hours later Dr. Ramakrishna told the waiting family that he had removed the entire tumor and the surgery had been a success. Donna was flooded with relief and was happy to be there when Ron awoke in recovery. 鈥淲hen he woke up and asked for a breakfast sandwich at midnight, it confirmed my intuition about Dr. Ramakrishna,鈥 Donna laughs now. 鈥淗e had predicted a smooth recovery and estimated Ron would need a week in a rehabilitation center after discharge. In fact, it all went so well that he went home after just three days in rehab.鈥

Having had the tumor, the seizure, and the surgery took an undeniable toll on Ron, who also had to be treated by an oncologist for the original lung tumor. He now depends on his family more than he did before. He has physically recovered, but has some cognitive effects that can be a challenge for the entire family. 鈥淚t was all so hard,鈥 says Donna. 鈥淚t has been very hard for Ron to accept the fact that he is different now and will never be the same, but we were determined to have our man back at any cost. Our family has fought this as a battle with no end date, and we have grown stronger and closer than ever.鈥 Considering what they nearly lost, Donna says, they treasure every day now.

"This diagnosis was something out of a horror movie. Dr. Ramakrishna made it seem that this journey of ours was his only priority."

鈥淩on is more than five years out now from his lung cancer brain metastasis,鈥 marvels Dr. Ramakrishna. 鈥淭his is remarkable, and was unthinkable even just twenty years ago. I think this is a reflection of many factors. First, surgery is safer and more precise than ever, allowing us to diagnose and remove tumors with minimal downtime for the patient. Second, we work in collaborative multi-disciplinary teams. I鈥檓 proud to co-lead our听听alongside great physicians like听Dr. Kathryn Beal听from Radiation Oncology,听听from Neuro-Oncology, and all our colleagues from Rehab Medicine, Neuroradiology, and more. This collaborative approach we use ensures that we think of the best, most personalized treatments for each patient. Finally, there are so many new treatments, ranging from surgical (laser therapy) and radiation (Gamma Knife) to targeted therapy, that we are sometimes able to treat brain metastasis with drugs alone without surgery or radiation.鈥

Hear Dr. Ramakrishna talk about advances in metastatic brain tumor treatment in this video.

Donna is grateful for Dr. Ramakrishna鈥檚 dedication, and for his willingness to take her calls and answer her questions at any time of day. 鈥淭his diagnosis was something out of a horror movie,鈥 says Donna. 鈥淲e were so scared of the unknown, and we worried about 'what next?' before we finished each moment. Ron didn鈥檛 have the opportunity to be diagnosed while he was stable, so he couldn鈥檛 really prepare for what was about to change. Dr. Ramakrishna made it seem that this journey of ours was his only priority.鈥

Thinking back on the happy family they were five years ago, Donna says the biggest difference is that now they all have more听gratitude and appreciation听听they spend their time thinking not about what they don鈥檛 have, but what they do. Their lives are different now, but they are together, and they stay focused on that.

鈥淲ith any disease or surgery you just have to live one moment at a time,鈥 she says. 鈥淐onquer today and beat tomorrow, that鈥檚 our motto!鈥