[music playing] [music playing] Lori: They're the ones who raise the bar.

The ones dedicated to providing care in the most demanding of circumstances.

The ones that understand the healing benefits of kindness and compassion.

They're the people of Sarah Bush Lincoln, and they set the bar high.

Sarah Bush Lincoln, trusted compassionate care.

Right here, close to home.

Speaker 2: For over 50 years, Horizon Health has been keeping you and your family healthy.

And although some things have changed, Horizon Health's commitment to meet the ever-changing needs of our own community has remained the same.

Horizon Health, 50 years strong.

Speaker 3: Carle is redefining healthcare around you.

Innovating new solutions and offering all levels of care when and where you need it.

Investing in technology and research to optimize healthcare.

Carle, with Health Alliance, is always at the forefront to help you thrive.

Lacey: Thank you for joining us for this episode of Being Well.

I'm your host, Lacey Spence, and today we have another guest from Carle Health.

And we are talking with Dr. Wael Mostafa, welcome to the show.

Wael: Thank you for having me.

Lacey: Of course.

And so since you're a new guest of the show, we love to get to know our physician.

So can you please share a little bit about yourself?

Wael: Well, it has been a long story.

So I am from Egypt.

I went to medical school after high school for six years.

Graduated in 2001, then I joined neurosurgery residency over there, the training is seven years.

During that seven years, I did Masters of Surgery and a doctorate degree in neurosurgery.

I was fortunate to have a scholarship between Egypt and the University of Texas MD Anderson Cancer Center.

So I did my PhD thesis there.

Then I went back and practiced for faculty, then I decided that I would like to pursue further training in the United States.

So I came back to Loyola University and I did neurosurgery residency again, but in advanced position, graduated in 2016.

Then I went for two advanced Skull Base Fellowships in brain tumors skull base and open cerebrovascular-skull base at the Indiana University.

Graduated in 2018 and then joined Carle.

So it took about 16 years of training before I started at Carle.

Lacey: And we're thankful that it takes a minute before you start operating on the most intricate part of the body, which is the brain, the skull, things of that nature.

How did you end up in the Central Illinois area?

Wael: Well, during my training, I was in the Midwest, between Chicago and Indiana.

My family liked the Midwest.

I liked the Midwest as well, but I looked at the places that really in need of such a expertise.

And I found Carle to be very accommodating to advancing new techniques, offering advanced surgeries and skills within the community of Central Illinois, to try to do our best to keep patients close to family and close to home.

Lacey: Definitely, dialing in on that rural health.

So today, we're talking about brain, spine and skull base cancer.

So can you start by telling us what type of diagnosis you might have with certain types of procedures?

Wael: So, this is a very wide variety of tumors.

As we may hear of them, the brain itself is a mysterious organ.

It contains a hundred billion, almost a hundred billion neurons, neuro cells in just a single confined space.

So when there is a tumor coming to the brain, that is very delicate problem to address.

Some patients, depends on the location of the tumor, location of the type of the tumor in the brain, can give patients symptoms.

So we have two big categories of brain tumors; benign tumors and malignant tumors.

Benign tumors, which is a slowly growing tumors that can happen over the years.

Usually, it has delayed diagnosis.

Malignant tumors, unfortunately, which is more common.

They will have a drastic, rapid symptoms like seizures, weakness in one side, stroke-like symptoms, progressive severe headaches and others.

So that is very wide variety of tumors.

Lacey: And then what about with the spinal cord, also very delicate, I assume?

Wael: Yes.

So the spinal cord really has a, we have from the cervical thoracic and lumbar spine.

And the spinal cord goes from the exit of the brain, all the way to the upper lumbar vertebrae, then the nerve roots go into the legs started.

So there are benign tumors that can arise in the spinal cord from the nerve or from the covering of the nerve, like a meningioma.

And from the nerve itself, benign nerve sheath tumor is called the schwannoma or neurofibroma, if you will, can cause compression.

So can cause back pain, can cause a leg pain or weakness.

Usually, it is more drastic than the usual pain that we have on daily basis.

There are other malignant tumors that can go to the bone from other areas and start compressing on the spinal cord.

That is more drastic in nature, that is more progressive.

Patients can have more symptoms and they will end up in the ER more frequently.

Lacey: And then kind of our third thing we're talking about today, skull base tumors.

Wael: Yeah.

So the skull base tumors, which is my area of passion, started as any tumors in the midline, at the base of the skull.

And will start from the most front part, near the frontal lobes and vision nerves, all the way to the brainstem.

And we have common benign tumors like a pituitary adenoma, which is the patient will feel that my peripheral vision is not doing so right.

We have tumors in the nasal cavity that malignant, that can extend to the base of the skull even into the brain.

And we also have tumors in the back, compressing the brainstem, arising from the hearing and vestibular nerve, the balance nerve called acoustic neuroma, that can push on the brainstem if it is larger or increase pressure in the brain, we use the medical term hydrocephalus.

Those are needs more attention and more multidisciplinary approach with other teams.

We are fortunate to have my colleagues from ear, nose and throat.

They are fellowship trained.

Not all of them, they are working in the same area.

They are even specialized on the front part or near the ear.

We have both a category that I'm fortunate to have them working with me.

Lacey: Before we dive into kind of needing a team to treat a patient adequately, what made you want to specialize in the skull base tumors?

Wael: Well, it is the most difficult tumor and you can see from my background, I always go to the most difficult part.

So, it is really, there are very few expertise that can provide patients with that.

And I would love to be helpful for those patients that really in need of those expertise.

Lacey: Excellent.

So how might people know that they have a tumor in these areas?

I know you were kind of talking about a wide variety of symptoms, but sometimes we might think it's just your regular nose pain or your regular headache.

Wael: So common is common.

The common problem is if a patient had persistent or worsening symptoms, that needs to be checked out.

And it started with the primary care physician to raise some attention about the issue.

They may start with a regular imaging.

So if a patient has intermittent headaches and mild headaches that goes away with the weather, that is, we all have those symptoms.

However, if the symptoms are persistent or getting worse, and the patient himself, he thinks that this is not my normal symptoms, I would really encourage a patient to be checked out.

Of course, there is drastic symptoms that push the patient to go to the ER, or see a doctor like seizures, weakness, stroke-like symptoms, hearing loss.

That's another thing or vision loss.

Those are more drastic patients, but for headaches, if it is persistent or getting worse more than the patient thinks, I think this needs to be checked out.

Lacey: So if somebody is diagnosed with a tumor in one of these areas, what are their treatment options?

What do they look like?

Wael: So, first we have to look at the imaging.

So the patient usually will get a CT scan first, or go straight to a MRI, which is magnetic resonance imaging, that we look in detail depends on the location of the tumor, the type of the tumor.

We look also for the relationship of the brain around the tumor.

If there is a swelling around the brain, around the tumor within the brain, that means more aggressive nature usually, or the brain does not like it.

If it is a benign, we need more treatment.

So we'll have that.

And then we'll continue the investigations with looking at the rest of the body, if we need a blood work, and then we will have a tumor conference, call it tumor board, with a multicenter reaction, and then we'll discuss the case and we'll move forward with the options of treatment.

The treatment options, usually it can be surgical resection, sometimes even medical treatment, for cases for pituitary adenoma for example, that they are secrete hormone prolactin.

The treatment is not surgery, even if they are big.

The treatment is medical treatment and the surgery can be followed by radiation and chemo and in case of malignant tumors.

Lacey: In the time that you've gotten your education and started practicing, have you noticed a lot of changes in this field?

Wael: Absolutely.

So when we started the practicing and starting training, they are all about how can we help patients with resecting more of the tumors to relieve the mass effect?

What are the techniques that we can refine ourselves to resect more?

Now, this is not enough.

Now, it's how I do that with preserving the quality of life, with preserving function.

That is very important, and this is actually the present and the future of neurosurgery.

Lacey: Is trying to make people be able to have more quality, a better quality of life post-surgery?

Wael: Absolutely.

Lacey: Gotcha.

So between brain spinal and skull base, which would you say is maybe most common that you're seeing?

Wael: Well, unfortunately the common for the brain is tumors coming from elsewhere.

Patients with lung cancer, all of a sudden they have symptoms in the brain.

We get the imaging and they have metastasis to the brain, that's the most common.

The second most common is still tumor coming from the brain itself, it's malignant grade four, it's called glioblastoma.

There are common benign tumors called meningioma which is a benign tumor coming from the covering of the brain, that is very common.

And sometimes even, it's an incident that if a patient had a fall or a car accident rear ended, and we will have a scan and you'll find this meningioma.

We don't need to do surgeries in every brain tumor.

There are some tumors that we can watch safely without a problem.

Lacey: I'm sorry if this is a dumb question, but with any of these types of tumors, is there ever a visible sign that you can see from the outside?

Wael: Well, the only thing, most of those tumors, no.

Lacey: Okay.

Wael: Unless they have a sudden weakness or facial droop for things like that, but there are some tumors in the skull base world, skull base tumors that can be compressing on the eye from the back, that the patient will notice that the eye is... One eye is protruded more than the other, for example, but those are rare tumors.

Lacey: And so it's very important that you stay in touch with your primary care doctor, so you can keep an eye on all of these things, especially if they're having just vision trouble.

And again, you said that it was when the symptoms become intense, to be able to monitor that with a primary care doctor is important?

Wael: Absolutely.

Lacey: Gotcha.

So are you able to talk about some of the cutting edge technology and things that are offered through Carle?

Wael: Yeah.

So one of the things that, when I came to Carle, I thought how we can build a center of excellence for brain tumors skull base surgery.

And one of them is adapting the most advanced techniques that I've learned in residency and in fellowship, and one of them is fluorescence-guided resection.

Fluorescence guided resection is, let me tell you before how we resect brain tumors.

First, we have a navigation, a GPS in surgery.

And we use that, we still use it for sure.

And we use that to delineate where the tumor and even before we open the skin.

And then in surgery, we use that, we use ultrasound just to make sure that we are resecting most of the tumor out.

But nowadays, and recently, the patient can have a dye either, usually it's oral before surgery and it circulates in the body.

And then we have a specific filter in the microscope and we look at the brain where the tumor is and the tumor will glow and the rest of the brain will not.

So fluorescence-guided resection is very important now.

An important tool for us, for achieving maximum and safe resections.

That's we have at Carle, and I'm happy that the hospital provided people of Central Illinois with such a... We were the first one to adapt it within Central Illinois and the other tools that they advanced in the scopic techniques.

So for skull base, not all skull base tumors we have to resect it from the brain, we have to open from the skull.

We can go through the nose and do the resection of the tumor without even an incision.

So in order to have that, we have the proper tool to do that as well.

There is one more thing that, tumors near the speech area.

Patient's speech is very important quality of life, we spoke about that.

Lacey: Right.

Wael: And we have to do, for example, awake craniotomy.

So the patient will be awake while I'm resecting the tumor, talking to anesthesia and neuro-psychology, and the other team, while I am stimulating on the brain and resect it, and to provide the maximum resection with less side effects for patients.

That is also, we have at Carle.

The fourth thing that I, for example, we have deep tumors in the brain or deep hemorrhages in the brain.

Instead of going through the brain parenchyma and the brain matter itself and causing problems, we can go with a tube with navigation, like a GPS, very deep in the brain.

So it will spread the fibers in the brain rather than destructing them and then land on that tumor or a hemorrhage and do the surgery as if we are doing under the microscope.

Lacey: I'm sorry, I'm still stuck on doing the procedure while they're awake.

I feel like that would have to be intimidating for a patient.

Wael: Well, first I have to talk to the patients.

Not every patient is a candidate for that.

But I found it actually very, the patients are very excited about the idea.

There was one patient, for example, that he is playing the violin and I offered him the surgery.

And I told him, bring the violin with you.

And we can, while we are resecting the tumor, we'll let you play the violin.

He said, "No, I'm fine, I'm okay."

But there is another, other patients that they are very excited about it.

And we went through it and actually we achieved a great results with minimal side effects for them, especially if they are young.

It is really affecting older morale, affecting the response for treatment afterwards, the recovery, their family is happier.

I think that is very important.

Lacey: And it's in my notes, and I'm sorry if you talked about it, the Tesla seven MRI machine.

Wael: Yes.

Lacey: Is that one of the things that you were referring to?

Wael: That is a totally different thing, this is very advanced.

We are actually very fortunate to have it in Central Illinois.

To put in perspective, there are almost about 10 machines in the country and four of those machines are in a hospital, and one of them is at Carle.

This is multi-million dollar machine.

Basically, it's an MRI machine, but it has a very high field.

So the techniques and the visualization of the seven Tesla MRI is amazing.

It tells us a lot of information.

Just also to put in perspective, the regular MRIs that we use currently in all our hospitals are 1.5 to three Tesla.

This is seven Tesla.

So big advances in clinical world, big advancement in research world as well.

Lacey: Yes.

I know last season we had a gentlemen on from Carle and he was telling us about the research that was being done with that.

And so it's wonderful to see that it's obviously still being utilized and new things are learned every day.

So what does recovery from a surgery such as brain spine or skull based look like?

Is it important to have a very good support system?

Wael: Absolutely.

So I think the recovery starts with even talking to the patient and the family before surgery.

Lacey: Okay.

Wael: To set an expectations, what they think they will have, for the moment they will go into the operating room till you go to recovery, intensive care, hospitalization, then physical therapy, working with them and potentially rehab.

And then afterwards, if they need chemo and radiation, how we will do that.

Our job is to try to be this process as seamless for patients and families as we can.

And I try to always to educate patients and family about all this process.

And sometimes it's overwhelming in the beginning, but if they have questions, we can come back and readdress that.

And my job is to make them feel that they are ready to have the surgery done and they know what they are going through.

Lacey: And so earlier, you had mentioned that it's not just you who ends up developing this care plan, so to speak.

That it ends up being full body care with teams of doctors.

Can you kind of walk us through a scenario where you would be working with a different type of department I guess.

Wael: I am very fortunate to have a large team working with me and a lot of expertise.

Again, for the awake craniotomy, patients awake.

I cannot do that without a anesthesia, that they are knowing the advanced protocol and the intensive care team to take care of every little things to make sure patients are okay.

Goes all the way to the oncologist, the radiation oncologist, the endocrinologist who is the medical doctor that can treat and fix the hormonal imbalance for skull base tumors.

Also, I am very fortunate to have a very good support from ear, nose and throat.

We have fellowship trained colleagues who came from Cornell, came from other places, to help us with the big skull base tumors.

I cannot overemphasize the importance of my nursing team.

The nurses that I work with, I'm very fortunate to call them my colleagues and family, either in the office or in the hospital.

Also, my neurosurgery colleagues, they are wonderful support to me.

The research team is very advanced, including my colleagues at the University of Illinois, Beckman Institute.

Those are huge team.

I'm just the front, I cannot be successful without all those students.

Lacey: You drive the race car, but they're your pit crew.

All right, forgive my analogy.

So in our last couple of minutes here, would you mind maybe telling us about one of the more difficult cases you've had to cover?

Wael: So one of the more difficult cases that I had is a patient, a young lady that referred to me from an eye doctor that she's losing vision.

And then I talked to her and she said, "I've been losing vision, I cannot see with my eye for quite a bit."

And then she was, I digged into more information.

She got really divorced from her husband without any reasons, obvious reasons.

He's actually still taking care of her because he does not know what happened and why she's acting like that.

She strained from her family for two years, and she was referred to me with one of the largest skull base tumors that I've seen.

Lacey: Wow.

Wael: It's about three inches tumor in the base of the skull, compressing the vision of, compressing the frontal lobe.

So we went for surgery and successfully, we removed the tumor out.

Her vision came back and her behavioral issues resolve it, up to the extent that I was very touched.

Her sister sent me a letter thanking me that for bringing her back to the family, and she's happily back to her kids and husband.

I'm thrilled, I'm more than thrilled.

Lacey: What does it mean to you, to be able to have this kind of impact on not just her, but several of your patients?

Wael: Just, I want to tell you a secret.

So I have a wall, sticky part that I can put it in the wall in my office.

Lacey: Bulletin board?

Wael: Yeah, bulletin board in front of my office, where I sit and all those letters, I have it in front of me.

So when I feel down a little bit, when I lost battle with another patient, I look at those and say, "Well, you have to keep yourself motivated.

We are trying to do our best to help patients and families, and you have to keep going."

Lacey: Very well put.

Is there anything else you'd like to add in our last minute?

Wael: Well, I just want to tell the family and the people of Central Illinois that we are here for you, and we will do all our best to provide you with a world-class care, just close to home.

Lacey: Awesome.

Well, thank you so much for being on the show.

Wael: My pleasure, thank you for having me.

Lacey: Of course.

And thank you for joining us for this episode of Being Well, and we hope you stay well.

Speaker 3: Carle is redefining healthcare around you.

Innovating new solutions and offering all levels of care when and where you need it.

Investing in technology and research to optimize healthcare.

Carle, with Health Alliance, is always at the forefront to help you thrive.

Speaker 2: For over 50 years, Horizon Health has been keeping you and your family healthy.

And although some things have changed, Horizon Health's commitment to meet the ever-changing needs of our own community has remained the same.

Horizon Health, 50 years strong.

Lori: They're the ones who raise the bar.

The ones dedicated to providing care in the most demanding of circumstances.

The ones that understand the healing benefits of kindness and compassion.

They're the people of Sarah Bush Lincoln, and they set the bar high.

Sarah Bush Lincoln, trusted compassionate care.

Right here, close to home.

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