Schwannoma Case Study # 13, Susan Chapman Ruggiero & The Story of a Schwannoma in her Foot

Hello everyone!  Welcome to our 13th Schwannoma Case Study.  In this Case Study our friend Susan Chapman Ruggiero tells us of the discovery and removal of a Schwannoma in her left foot.  We thank Susan for taking the time to tell her story, and wish her well in her continued recovery! - Neil

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1)  How old were you at the time of your diagnosis?

I was fifty-five when I first approached a doctor about my schwannoma. It was removed before I turned fifty-six.

2)  Do you have any history of Schwannomas in your family?

Not that I know of.

3)  Where was your Schwannoma located?  And what were the symptoms that lead to your diagnosis?

My schwannoma was located inside the bottom of my left foot. It presented similar to a blister about the size of a pinky finger nail about three years ago. I asked several of my regular doctors about it but they all just shrugged.  The ‘blister’ doubled in size over the last year to about the size of a thumb nail. I use this description because that is what it looked like. A shiny slightly raised bump. I had no symptoms related to this bump.  There was never any pain or discomfort from it.  I went to a podiatrist that my husband sees for nail issues.

4)   Could you describe, in whatever detail possible, what kind of surgical treatment was performed on your Schwannoma, and if you would consider it successful? (Or describe what you may know about the surgery that may yet be performed, if you haven't been operated on yet).

My schwannoma was removed through the bottom of my foot. I underwent general anesthesia at an out-patient surgical facility. The incision required nine stiches to close. I was in and out in four hours.

5)   Having gone through the experience, what do you think are the most critical questions for someone to ask their doctor about surgery and treatment of this kind of schwannoma?

We had no idea what this was until three weeks after it had been removed. X-rays revealed a mass. An MRI proved it was not vascular. My doctor knew little more than I did when she went in. She shared with me just the typical information for any foot surgery. She removed the tumor and described it as the size of an extra-large egg, totally encapsulated and benign. I would have liked to speak with someone who had gone through any type of foot surgery that was as disabling as this. I was not prepared for what was ahead.

 6)   Can you describe what the recovery process was like for you – if you feel you have made a positive recovery…and what things you have done that have been of most help to you?  (Also, you are free to describe what doctors tell you to expect from your recovery if you haven't been in surgery yet)

My recovery has been successful, but in the beginning it was absolute hell.  The pain was incredible.  I have had much pain from seven broken bones and multiple surgeries but nothing prepared me for this. The medications I was given were not effective at all. Basically I was unable to walk for six weeks.  I employed a knee scooter for some mobility in my home. I did not leave my house except for doctors’ visits to examine my incision and to have the stiches removed. They told me there would be some pain and that there would be improvement every day and both these were true. They told me to use ice and I did not until I was walking and needed relief.  It may have helped earlier. The removal of the stiches about three weeks after surgery set me back about a week and included the return of bleeding and intense pain.

Three months after surgery, I am completely confident in my daily activities. There is still some pain from the scar, walking barefoot is out of the question.  I have random shooting pain from the nerve that the tumor grew off – I think. I expect this will diminish as the nerve heals. I keep rubbing assorted lubricants into the scar in hopes it will diminish as it feels like I am walking on a piece of string all the time.

7)  Are you able to do all or most the things you did before? (Also feel free to describe your abilities even if you are still living with the tumor or tumors)

I have not explored all my previous activities i.e.: skiing or wind surfing, but I am not afraid to face them when the opportunity presents itself. I have been swimming in the ocean and several lakes (with swim shoes). I am also back to my daily ¾ mile swim in the college pool. I always have the needed materials to protect the scar on hand. I do worry that I may split the scar open if I stress the area too much.

I could not have done this without the dedicated help of my husband.

I am grateful for all the information that is currently available on this blog. I continually return to learn more about this ailment. I wish I knew more about my tumor and had this information before embarking on this endeavor.  

If anyone has any questions or comments, I can easily be reached at buffysxc@comcast.net. 

With my nieces and nephews, the reason I need two good working tumor-less feet!

"Where do You See The Future of Schwannoma Treatment and Research Going?" Three Neurosurgeons Weigh in on the Question

Hello everyone!  Today I'd like to offer our Schwannoma Survivor friends a new blogpost that features the perspectives of three neurosurgeons - as they weigh in on the question "Where do you see the future of schwannoma treatment and research going?"  It occurred to me some time ago that answering, or even trying to answer, these kinds of questions is going to be key for survivors in the future.  New approaches as well as new understandings of schwannomas will be integral in hopefully creating new treatment options that will lead to the best possible results.  In any event, I asked three neurosurgeons, who have very generously offered their assistance to the Schwannoma Survivors page, what their perspectives may be on this issue, and below are their answers...I hope you find them helpful!

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Dr. John C. Liu

Co-director, USC Spine Center

Professor of Neurosurgery, Keck School of Medicine of USC

Keck Medicine of USC

Dr Liu writes:

Developments in the diagnosis and treatment of schwannomas continue to evolve and include different diagnostic MRI modalities to differentiate schwannoma from other types of tumors that may present in a similar fashion.   Continued research into the genetic make up of schwannomas may help our understanding in the etiology and why certain tumors may progress to malignancy.  

New techniques in minimally invasive access to the spine as well as intra-operative navigation can make removal of spinal schwannomas safer with faster surgical recoveries.  Focused radiation treatment as opposed to surgical resection may offer additional options in treatment.  

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Dr Alfred T. Ogden

Columbia University Medical Center

Department of Neurosurgery

Dr Ogden writes:

The future in the treatment of spinal schwannomas lies in defining the correct applications and limitations of minimally invasive approaches.  The vast majority of spinal schwannomas are effectively treated with open surgical approaches.  The experience of numerous clinicians has shown that these tumors can be removed with minimally invasive approaches.  What we have yet to define is what the comparative outcomes are between minimally invasive approaches and open approaches in terms of postoperative recovery and neurological outcome.  Just because something can be removed through a smaller opening doesn’t necessarily mean that it should. 

The other modality whose role is well defined for intracranial schwannoma, but not for spinal schwannoma is radiosurgery.  Although most would consider the indications for radiosurgery for spinal schwannoma very limited at present, I would expect this to change significantly over the next ten years.

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Dr. Bohdan Chopko

Stanford University School of Medicine

Clinical associate professor, Neurosurgery

Dr Chopko writes:

 I believe that understanding the genetic issues underlying  Schwannomas has some exciting promise for new therapies. If a specific gene mutation or overexpression can be targeted, then it would be theoretically feasible to develop a pharmacologic treatment for these tumors, perhaps avoiding surgery in some cases. On a more immediate topic, advances in minimally invasive and endoscopic surgery are reaching a broader use. These techniques allow surgeons to make much smaller incisions and allow patients to hopefully return to more active lives in a more rapid fashion.

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Disclaimer: The contributing physicians and their associated medical facilities assume no liability whatsoever for the comments or advice offered in the content of this blog.   The consulting physicians have offered their advice generally on the issues relating to treatment of Schwannomas.  Consulting physicians and the Schwannoma Survivors & Schwannoma Fighters group always insist that a person should make all major medical decisions in consultation with one's own physician.