After Cancer Diagnosis, One Doctor Takes On Two Roles: Expert And Patient

Oct 31, 2014

Dr. David Flockhart of Indiana University School of Medicine, a frequent guest on our show, joins us again to share his recent story of cancer. Unlike most other patients, Dr. Flockhart had a deep understanding of what was happening to his body from the very beginning. After reaching for (and missing) the banister as he jogged down the stairs one day, he began piecing together his strange symptoms.

Lewis: So you better take us to the very start of it, when you first started to notice any symptoms.

Dr. Flockhart: So, about four of five months ago, I noticed that I was having some difficulty running down stairs at speed. I’m a person who usually uses gravity normally to run downstairs. And a couple of times, I stumbled. And like a doctor, I blew this off. But then, about a month before the actual diagnosis, I noticed this was happening in my right hand as well. So I would lean out to get the banister when I am doing this this running down the stairs thing. And I missed the banister. And I’m a physician, so I put together the fact that this is not a peripheral thing, outside the brain, it’s inside the brain.

Lewis: You said, as a doctor, you knew it wasn’t peripheral. You knew it was in your brain. How did you know?

Dr. Flockhart: So, if you have symptoms that are affecting both the upper nerves in your body in the upper extremity and the lower, that’s not simply something that’s due to something in your hip or something in your arm. It’s something higher in the nervous system than that. But I have to say the symptoms I was having were evanescent. They were a few seconds. I would go days and weeks without them happening them at all. And at a couple of times, at any time, they have happen at once. But they both occurred, so I thought, it’s possible that these are separate things but that’s unlikely. So, this is physician thinking. As soon as I had the scan of my head, things happened extremely fast. I think I had something like six different scans, pet scans, MRIs, magnetic imaging scans, cat scans, including two functional scans, which allowed the neurologists to map the function of my brain. And they did fancy things, like ask me to remember things and pronounce stuff and imagine things and imagine this in my head while I was under the scanner.

Lewis: And the purpose of that?

Dr. Flockhart: The map the functional areas in my brain so that they could avoid them in surgery. So they knew what to avoid, and they knew where to go to get the tumor.

Lewis: Why so many? What were they really trying to get out of this tumor?

Dr. Flockart: So, imaging technology has progressed amazingly, Barb, in the last twenty years. In the last 30 years, actually. And the radiology has gotten fancier and fancier and fancier, and more and more specific. In many areas of medicine, including arthritis and inflammation but also cancer, we are now able to tell a lot more about images than simply the images themselves. We are able to tell what they do. So, in the case of cancer, there are these things called pet scans, positron imaging, which allows you to rate at which tumors are metabolizing stuff. So, how active they are. My doctors were able to look at it and say that it was a highly active tumor. It’s doing stuff. It’s actively metabolizing things. It’s aggressive.

Lewis: So how big? Where?

Dr. Flockhart: In my case it was 3 by 2 centimeters at the back of my left brain. That is one of the great miracles of this whole story. I met people in rehab subsequent to this who had lesions in other places, who were literally just drooling in the corner. 22-year-old woman who just died because she couldn’t control her secretions. And now I’m sitting here talking to you. Pure anatomic luck. She got I there and I got it here. Amazing.

Lewis: You got all these scans, you do the MRI. It’s surgery time.

Dr. Flockhart: So, the surgery was done after the functional MRI. It was done by Scott Shapiro, here at IU, who was the surgeon for Lance Armstrong. These guys did it under MRI-guided stereo tactic. So, in real-time they have the MRI machine in the operating room and they’re taking images during the surgery to check they are getting all the tumor and so forth. What they do is go in and take out what they think is the tumor. They pause, delay, redo the MRI and then go back in to check. If it is, they leave it alone and if not, they take out a little more. But an unbelievable level of imaging you’re dealing with. And not just fixed images, but images in real-time. This was amazingly successful. For most people with the tumor that I had, which is an aggressive, nasty brain lesion, many of these people can’t be operated on, either because the tumor is in a place where it would really just cause huge damage and you would come out not function or because they just can’t get at it. Neither of these were the case for me. It was relatively near the surface. Dr. Shapiro and his colleagues were guided by the functional MRI. So they not only got all the tumor, but as you can tell, they were able to leave nearly all of me.  

Lewis:  How long is a surgery like this?

Dr. Flockhart: I believe it was less than an hour.

Lewis: Really? Because it sounds so involved and the technology is so intense.

Dr. Flockhart: A lot of preparation beforehand, I think. I was expecting a day or two

Lewis: At the part where the tumor was located, what were the worrisome areas?

Dr. Flockhart: If the tumors if you worry about are spatial orientation, knowing where you are in space. So I had this issue with the banister and the stairs. And I had a very good, dear friend come and stay with me for two days, right after going through rehab, and she’s little and she’s Chinese. And I hit her five or six times that weekend. Not because I meant to, but because I didn’t know where my right arm was. It’s hilarious. Through rehab, I’ve learned to control my arm and my leg. And I’m able to do 90 percent of what I could do before. It’s important that I don’t get overconfident, as it is for all rehab patients. And it’s important that I’m careful. As far as doing stuff, there’s not much I can’t do. I just do everything a little bit slower.

Lewis: What was the recovery like those first few days? I imagine you were at RHI in a rehab facility.

Dr. Flockhart: The immediate recovery in the ICU I don’t remember. After a few days in the hospital, I went to Rehabilitation Institute of Indiana. There’s just amazing stuff. Incredible technology and highly-skilled people who aggressively hit you with a lot of tests to access what your deficits are and then very specifically designed therapy plans.

Dr. David Flockhart is a pharmacogeneticist at the Indiana University School of Medicine. There was a lot more of that conversation that we will be sharing with you over the next several weeks.

Explore the rest of the series of interviews with Dr. Flockhart:

Part 2: Forgetting How to Text, Relearning How to Write: A Doctor Works Through His Own Cancer

Part 3: "You Learn the Tricks": Cancer Patient and Doctor on the Rehab Process

Part 4: So Many Unknowns: A Doctor's Frustration with Cancer Is Not What You'd Expect

Part 5: In the Midst of His Own Cancer Treatment, A Doctor Scans Family DNA For A Link

Part 6: Sometimes The Most Effective Form Of Cancer Therapy Is Just Caring