Michael Balzer: Hola. That's about the extent of my Spanish,
(Laughter)
but I learned one new word yesterday, and that's cráneo, skull.
I'm the guy who created my wife's skull
to save her life, her eye and even her soul. No, not really.
I was part of a team of Pamela, two surgeons and technology,
kind of, as I call it, the healer, the magician and the warrior,
and together we defeated the pain and suffering that was in her.
We'd like to invite you into our story.
Pamela Scott: When I was 16 years old, my mother died of a brain tumor.
And of course, this impacted me very deeply.
But it also left me with a tremendous interest
and passion in understanding health and medical research.
Now we live on a very small community in the Central Coast of California.
It's halfway between Los Angeles and San Francisco.
We have very limited specialty medical services there,
which is difficult for anyone who has a serious illness.
Major medical centers are at least 4 hours away.
Now, I'd like to talk to you about my pain.
Imagine having the worst headache you've ever had.
And imagine having that headache go on 24 hours a day, 7 days a week for months.
In the summer of 2013, this is what I was experiencing.
I went to my primary care physician, she had no idea what was wrong.
I went to emergency rooms, they had no idea what was wrong.
So I was referred to a local neurologist
who was very well thought of and respected,
and he diagnosed me with migraines,
kind of classic but severe migraine syndrome.
So, he prescribed a very complicated regimen of pills.
I took so many pills. I had trouble keeping track of them.
I also had injections, I had inhalant medication.
But the headaches kept getting worse and worse over the months,
until finally I could not sleep at night.
There were no imaging studies done, nothing was ordered by the doctor.
No MRI, no CT scans.
And so we really never had a very good idea
what was going on inside my head.
MB: So, she came to me and said,
"Can you come with me to see this neurologist?
He's not listening to me. I'm still having a lot of pain."
So, I did and sure enough, he was very adamant
to keep the same treatment going.
So, I had to tell him,
"You know her mother died at the age of 53 of a brain tumor.
Humor me, let's do an MRI."
He paused. I guess he was somewhat surprised
that I would say that.
And he relented and ordered the MRI.
PS: Now there are two types of MRIs.
One is a standard MRI which is fast and easy,
but it doesn't give very much information.
The other one is a better MRI, and it's done with contrast dye.
My doctor only ordered the first MRI even though he said, with that,
there was absolutely no reason to do it,
no clinical information that he thought would be important.
We did that MRI and I got a report back from the radiologist
that indicated there was something wrong in this part of my skull.
The radiologist recommended that we have the second type of MRI
in order to determine more specifically what that was.
My doctor, the neurologist, refused to do this
and said I should continue the medication, all the pills that weren't working,
go home and come back to see him in a year.
This was entirely unacceptable to me.
So, I went back to my primary care doctor, and she looked at the report,
and she ordered the better MRI with contrast dye.
And, to my surprise it did turn out that in fact I had a brain tumor.
MB: This is the report.
It's difficult to read but essentially it identifies the size of her tumor.
To put it in perspective, this was the size of the tumor.
About the size of a golfball.
This was lodged between her eye and her brain.
There's also some other medical jargon here,
but I'm somewhat of a visual guy.
So I created this to help me understand it.
I took my own measurements; I circled the area where the tumor is.
Now this is an MRI, bone does not show up in MRI, it's dark.
If you notice right above her left eye is a very dark space that's the tumor.
But it also indicates the type of tumor, a bony tumor.
PS: I think we all are uncomfortable when we think about our deaths,
but there's always been something that has frightened me more than death.
And that's the thought of having brain damage:
no longer being myself
because that's what had happened to my mother.
The problem with the location of this tumor
was that it was under the frontal lobe of the brain.
Now, the frontal lobe is where we have our intelligence,
our reasoning, our memories, it's the seat of our personality,
it's what makes us unique.
I went to two local neurosurgeons, and both of them said
that I really should consider the tumor inoperable
because in order to remove it,
they would have to do an ear-to-ear craniotomy,
so cutting my skull open, remove a piece of the skull,
and then, because of the location of the tumor, apply traction
to try to lift it or move the brain aside in order to reach the tumor.
Now, by doing that, both doctors said there was a very high possibility
I would have brain damage from this.
One doctor said I may never be functional again,
I may never be normal, I may never leave the ICU.
This was not acceptable to me.
The other problem was that if I did not remove the tumor,
the tumor could continue to grow
and would grow up into the frontal lobe there.
So I would have the same outcome ultimately
although we don't know how soon.
I needed to do something different.
I was anxious, yes.
So, I went to the Internet
which of course we have to be careful about.
It comes with the caveat because how much information,
particularly medical information, on the Internet is good information?
I'm going to guess about 10%.
90% of it - Facebook, no;
forums, no - not good information.
But I discovered that all major medical centers have websites
that you can go to and find so much information
you can read about the newest techniques in treating so many different diseases,
and they talk about the special treatments that they have,
along with providing links to videos and other information that is reputable.
So, this is what I did, and I learned so much.
I also learned that there was something called a "distant patient program".
I had never heard of this before.
And many of these university medical centers
will do an evaluation of your case by looking at your records
that you can send to them.
So you don't actually have to go there
and their team of physicians will go over your situation,
discuss it together, develop a provisional diagnosis
or their best guess about what it is and then determine the best treatment
that they would have to offer at their clinic or their hospital.
And then they would call you on the phone, and discuss that with you.
So I thought this was a wonderful thing to do,
and that's what I began doing.
MB: Now, everybody handles anxiety differently.
Pamela handles it with research, research and more research,
and she would come to me with this research.
"Can we get this?" "Can we get that?"
I have a IT background, so I accumulated a lot of information.
In fact, we had a white binder about 10 centimeters thick
of documentation, reports, scans that I created that she would take
to all the local surgeons, physicians throughout California.
However, we also needed to send this information
throughout the rest of the country.
So it was my responsibility to use email, facsimiles
even the web portals that somebody's medical systems put together
in order to present this information.
But I also do something else.
I started a 3D print company.
I also started a podcast.
In one of my episodes, I had talked about a Malaysian neurosurgeon
who printed a 3D skull and brain, and used that for practice surgery.
Now [in] Malaysia, [they] can't use cadavers, it's illegal,
so I could understand the reasoning for that.
Coincidentally, ironically, Pamela had a brain tumor,
and I thought to myself,
"Wouldn't it be neat if I could apply these skills
that I have just learned to be able to help her?"
So, I went to work but immediately I ran into roadblocks.
This software is horrendously expensive, and it's also for the medical community.
One, I'm not in the medical community.
Two, I don't have a lot of money.
So, like Pamela I used the Internet and did a lot of searching.
And I came up with two open-source research programs
that allowed me to do what I needed to do.
One of them was from Brazil, part of their Technology Center.
The other one was from a research company on the East Coast.
Through the two of these things,
after a couple of weeks of training - that I trained myself -
I came up with this.
This is a 3D volume render.
On the right hand side you see a bunch of slices.
These are CT scans. Bone shows up very well in these.
There's about 300 of them.
All together they rendered this skull here.
Now, the skull by itself is great for Halloween, but nothing more.
So, there're other powerful tools in here.
They're called ROI or "regions of interest,"
and they virtually allow me to slice the skull in half.
And I did it right over the left eye,
and you can see not too clearly the tumor,
and I'll highlight it a little bit here.
As you can see there is the tumor.
Now the magic behind this kind of software is that I can rotate it,
so here's an animation where I cut it in half
so that I can look inside this skull.
A few years back I would have had to kill Pamela
in order for this to happen.
No, I'm trying to save her.
So because of technology, I now have the ability to look inside there.
And I'll circle it here, again, there's the tumor,
Now I said earlier that I 3D print,
so I wanted to take this to the next level.
It's great to be able to look at this stuff on a computer,
but wouldn't it be great if I could actually touch it?
So I went to work, the same software gave me the ability to create a model
that I applied to a printer.
So, here is a time-lapse image.
Obviously if you've ever worked with a 3D printer, they're not this fast.
It took about 8 to 12 hours to create this skull.
Now this is kind of creepy, kind of reminds me of the Terminator.
However, this is that 3D printer,
and this, a year and half ago,
is the time-lapse that I created, and this is the skull.
Don't you think it kind of looks like her? (Laughter)
I like the cute little nose here.
Now, the reality is we want to look inside of it , so here is the tumor.
We can actually touch this tumor.
I was extremely excited about this, so I ran to her and said,
"Look, I've got your skull here! Here's your tumor."
She greeted me with a look of horror.
I thought to myself, "Why?"
but then it dawned on me, for the first time she came away
with what was inside her causing her all that pain.
But what does Pamela do? Research.
PS: I had found something miraculous
and something that most doctors were not familiar with,
and had never heard of.
There were 2 major medical centers
on the East Coast, so across the country from us,
that have developed a new surgical technique
for the kind of tumor that I had.
It was perfect.
One was Johns Hopkins Medical Center,
the other one was the University of Pittsburgh Medical Center.
In this procedure, groundbreaking,
there would be a team of a neurosurgeon working with an oculoplastic surgeon.
They would make a tiny incision, truly tiny in the crease of my eyelid,
and then the neurosurgeon would go over the eye
and directly into the tumor to remove it in very tiny bits,
small increments, over the course of several hours.
Thus I would have no craniotomy, no movement of my brain,
and this would eliminate the risk of brain damage.
I was very excited about this, and I really wanted it done.
Now UPMC could get us in within a few weeks,
so I went ahead and scheduled the surgery there as soon as I could.
MB: So a few weeks later, we got on a plane,
and we went to Pittsburgh, Pennsylvania.
The next day she had some labs done, and we had an opportunity
to talk to the surgeons, in particular the neurosurgeon Dr. Gardner.
So I asked him because I had sent him one of these skulls,
and said, "What do you think of it?"
He kind of chuckled, he said,
"We passed it around in one of our meetings."
He said, "We thought it was extremely cool how we can look at something, touch it,"
because normally all they had was some images and some text documents,
so they were able to touch it, now we had a fellow with him, he said,
"The huge potential of using this for education is enormous
because now we can take data from a patient immediately
and apply it into a tangible model and use that
as the Malaysian neurosurgeons use for practice."
PS: My surgery was very successful.
This photograph was taken 10 days after the surgery.
The surgeon had encouraged me, to get up and walk every day,
and so I was walking a little bit and Mike's idea on day 10
was that we would go a half mile and walk to a museum
and then walk around the museum.
So this is what we did.
MB: It was a great museum. PS: It was.
And you would never know
that I had had brain surgery 10 days earlier
unless you peeked under those big dark glasses,
and then you might think that I had an affinity
for purple eyeshadow on just one eye, but no one had any idea.
And 5 hours after this photo was taken
I was back on a plane to California,
and 10 days after that, I was back at work in my office.
Pain-free, no impairments whatsoever, driving my car and absolutely fine.
MB: This is an object that rotates. So I did 2 things.
I did 2D resolution images, and I also did a 3D scan of her head
and sent that to them, so they can rotate it,
zoom in on it, look at it from different angles.
This allowed us not to ever have to go back to Pittsburgh
because they and all the information at their fingertips.
I see huge potential in this: long distance surgeries
and long distance postoperative checkups.
PS: Now, this is a close-up photograph of both my eyes, 2 months after surgery.
There's no photoshop, no make-up, completely natural.
Can you tell which eye had a brain tumor removed?
MB: That one. PS: You're always wrong.
(Laughter)
Now, I am a psychotherapist by profession, dealing with people
who are going through difficulties going through traumas and stress.
They often ask me, "How do you cope? What do I do?"
I like to use a metaphor of inner archetypes,
the characters within us that are through mythology and literature,
and I always talk about having an inner healer,
having an inner warrior, having an inner magician,
and how do we bring those resources up out of ourselves.
And there are times perhaps when we're too depleted
and we have to seek those resources externally.
And this is a wonderful thing to do.
Now, Mike and I obviously dream big, and I like to think of my life as a book,
and I am the author of the story.
It's an adventure story, and it's not always fun,
but it's always a very interesting story.
And I hope at the end of my life that I can hold up this book and say,
"I am very happy with the way this turned out."
MB: I hope I'm a protagonist in your book and not an antagonist.
However, in my book she is one of the heroes.
She went through a lot of pain and suffering.
I was not going to cry so soon -
(Applause)
thank you -
but she persevered where other people have not.
She is a warrior to me.
But I also want a special note to the two surgeons, notably Dr. Gardner
and the technology and the people behind it.
CT scans just came out, MRIs were still on the drawing board
that's when her mother fell into a coma.
They determined that it was a brain tumor from the CT scan, but it was too late.
I wonder today how that story would turn up.
Thank you.
(Applause)