BMX Athlete Josh Perry's Perseverance Living with Brain Tumors

Episode Transcript

Dr. Daniel Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa. This is the Brain & Life podcast. This week, I get to introduce a friend and one of our guest co-hosts this season, Dr. Reena Thomas.
She is a neuro-oncologist and also an associate professor at the Stanford School of Medicine. Reena, thank you so much for joining us.

Dr. Reena Thomas:
It is such a pleasure to be here, to get to speak with you today, Daniel, and thank you so much for the introduction, too.

Dr. Daniel Correa:
You joined us on a special episode featuring a brain cancer condition, and we'll be getting to that in a moment.
But since I have you right here, let's answer one of those questions that we hear about all the time, tumors, they can be benign versus malignant. Can you really speak to the difference between those two terms?

Dr. Reena Thomas:
It is really confusing, and for many of my patients, who first come to clinic in our Brain Tumor Center at Stanford, it is one of the first topics that can come up, which is what exact type of tumor the patient is presenting with and what does that mean? It is true, benign tumors, they often can grow, but they don't have the capacity to necessarily spread into and invade or grow into nearby tissues.
Malignant tumors do unfortunately move from one location to another within the body or surrounding organs. They can spread through blood or our lymph node system, and that's what makes it malignant. The types of treatment for benign tumors can really vary and differ from those that are malignant, because of the need to address this capacity for the malignant, cancerous tumors to grow and spread.

Dr. Daniel Correa:
This week, tell us about your guest.

Dr. Reena Thomas:
It was such a pleasure to meet and speak with Josh Perry. His inspirational journey and his ability to be vulnerable and open and share, and yet be so inspiring to hopefully all our audience, but including myself.
To share about how he has used a challenging circumstance for himself, and turned it into an opportunity to really persevere and inspire others to do the same. Find a voice as a patient, and use that voice for important advocacy work and coaching that he does for young people and adults alike.

Dr. Daniel Correa:
I'm really looking forward to hearing this episode and sharing it with everybody. And stay tuned, in the coming weeks, we will have another unique episode with guest co-host, Dr. Payal Patel.
She is a pediatric neurologist and assistant professor at the University of Washington School of Medicine, and she'll be interviewing Dr. Janna Friedly on long COVID.

Dr. Reena Thomas:
Also stay tuned for an interview with Wesley Hamilton, founder of Disabled But Not Really, a nonprofit organization whose mission is to enhance the physical and mental wellbeing of all. He talks about his experience of being paralyzed after a spinal cord injury.

Dr. Daniel Correa:
That was a great discussion and I really hope all of you stay tuned and subscribe to the episodes and series, so you don't miss any of our upcoming episodes.
Now, let's get to the interview and stay tuned towards the end, because we'll also continue with our discussion with a medical expert.

Dr. Reena Thomas:
Hello. It is my pleasure to welcome our guest today, Mr. Josh Perry. Josh Perry is a human performance coach. He is a strategist for optimization, and he brings together this empowerment to individuals of optimizing their mental, emotional and physical health and performance.
As a professional BMX athlete, we really look forward to hearing your perspective and the journey that you have had overcoming multiple brain tumors throughout your career. Thank you again for joining us today and I'd like to welcome you to the stage.

Josh Perry:
Well, I appreciate you having me as well, and I appreciate the time we'll be able to share today. It's always a pleasure and an honor to be able to have a platform to share my story and my passion for helping people optimize their health.
And really talk about what performance looks like and what it isn't opposed to what we often refer to it as, so I'm really grateful for the opportunity.

Dr. Reena Thomas:
To help us along the way, I would love for you to just share a glimpse into your life.

Josh Perry:
Starting out as a kid, had a traumatic upbringing as a child and really BMX fell into the right place at the right time. Been playing school sports my whole life growing up from T-ball into little league, basketball, and then BMX and action sports in general just took over. It started to unconsciously teach me the value of working towards something, falling down and getting up, because of the larger vision that was inside my head that no one else could see besides me.
But many people, including my teachers, didn't really understand. They actually told me that that was not responsible, it wasn't going to be worth my time and my efforts and things like that. I should work on school and get a good job, get a good education. I think I got a better education than I would've ever fathomed by sticking in academics. It was always that vision that is something beyond my current circumstances that I was working towards, and it allowed me to overcome a lot.

Dr. Reena Thomas:
Maybe we can use this opportunity really to delve a little bit deeper into what brought you to medical attention? What were your initial symptoms and how did they manifest? What clued you in into something being wrong?

Josh Perry:
What I experienced was getting brought through the medical system and largely just dismissed. I believe it was because I was judged by my cover, 20 to 21 years old, depending on the time of the year and which year we're talking about, before I was diagnosed officially with a brain tumor. But really looked at my physical shape, my age, my blood work, but not looking deeper into various, different things, especially medical imaging, scanning of the brain, things like that.
I felt like I wasn't being heard. I felt like I wasn't being seen and I was dismissed because I was 20, 21, professional athlete, picture-perfect example of physical health. What I've learned through that experience is health is on the inside. It manifests outwardly sometimes, but not always. In my case, it didn't.
Every symptom I was experiencing, from the headaches to the migraines, to the vision issues that came and went until the last few months before I was officially diagnosed, where it was just couldn't see one day. But it started out waking up, and you wake up sometimes in the morning and you rub your eyes, a little foggy and then it clears up. It was just blurry all day some days.
Luckily, I hit my head one day in March of 2010 training for an event coming up. I tried a new trick and it didn't go well. I hit my head with a helmet, got knocked out and went in to see if I had a concussion, traumatic brain injury, bleeding, swelling, anything like that. That's when they accidentally found a brain tumor over a year and a half of complaining of all these symptoms.
That whole time, I think it was at least five, maybe six, seven times, I had friends drive me into the doctor's office, emergency room, urgent care, and it was just sent home with a script for pain pills and told, "Your headaches are normal."

Dr. Reena Thomas:
Wow, so it was really headaches, it sounds like pain and vision symptoms, but they were it sounds like, progressive over a year period of time before coincidentally, you happened to have a head trauma that led to the initial imaging that found the brain tumor.
Tell me about that diagnostic journey. Tell me about what was the circumstance like when you received that first diagnosis?

Josh Perry:
In reflection, if I didn't hit my head, I'd be dead today. My surgeon explained to me because of the size, and it was maybe eight or nine centimeters long by four centimeters wide and four centimeters deep into the brain. He had mentioned, he's like, "Man, another month or two, maybe three, you may have not just not woken up one day and there'd be a lot more suffering." Because as you pointed out, that year, year and a half time span between started to notice the symptoms and then the diagnosis.
They would be getting progressively worse to where it would just come and go week by week to where it was getting to more days of the week than not, and then it was just every day. The diagnosis, I'm driving myself this day, because pain wasn't that bad, I could drive. The head might hurt, my body was hurt from the crash, of course. I remember I had gone into the chiropractor the day before to get adjusted, things like that.
But this time I was driving there and I was just thinking, "Man, I hope I don't have to... It's already been a couple days. Worst case scenario, they just say a week, two weeks off the bike because I have a concussion, concussion protocol." That was my thought. I was just driving there by myself, just thinking, "Two weeks off, could be worse," and it got worse. I'm sitting there waiting.
I get checked in, I'm in the patient room and the nurse came in, did some vitals and paperwork. Then the doctor came in with my MRI results. He said, "The scan came out clear, there was an issue though." I was like, "Man, I know I tend to fall asleep really easily." My latency is really good, fall asleep really efficiently. MRIs, many people think they're annoying, which I do too. I know when I fall asleep, I start to twitch around a little bit and move.
I was like, "Man, did I move?" Because I know if you move, you don't get a clear image. He was like, "No, the images were fine, but there's something in your brain that shouldn't be there." I remember being super confused. I remember actually saying to him, "What do you mean there's something in my brain that couldn't be? I can't possibly have put something in there. What are you saying?"
That's when he went on to say, "Well, at this point we don't know if it's benign or cancerous, but there's a mass in your brain. I do want to let you know that in order to preserve your life, you have to have surgery immediately. Just want to let you know as well, I want to warn you, you may never ride your bike again. It's going to take some time to get back to recovery from the surgery."
In that moment, all I heard was I may have cancer, never going to ride my bike again and I may die. You know when you watch a movie? I think Saving Private Ryan did a really good job of this, one of the scenes where it's like everything slows down. There's like that ringing in the ear noise that just as the camera slowly zooms out, pans away, and it's just like everything stopped. People talk about out-of-body experiences.
This was one of my first that I vividly remember, and it was like everything just stopped. Time didn't exist, and I'm just listening to this information come in and come out. Then my brain just created this story. I just remember it was almost like I was watching this scene of my own horror movie that I'm in, and then everything just came crashing back in. I just like couldn't handle it and I just ran out. I heard what they were saying.
I was like, "Okay, I got to get out of here." I just went back to my car and I just sat there in shock. Then first thing that came to mind was like, "You got to call your mom. You got to tell her what's wrong." I remember she just started crying, asking, "Is everything okay?" I finally got it out and then I told her, and that was the experience. Honestly though, looking back now, this past April was 13 years from that first surgery and diagnosis.
It was the best thing that could happen to me, because it was the catalyst to me auditing myself and my life inside and out, and really taking accountability for where I was. I'm not saying that I blamed myself or I'm at fault for having a brain tumor. I don't think anyone, no matter how much they want to grow a brain tumor for whatever reason, could do that. But it taught me the importance of empowerment.
Here's my circumstance. Thanks to BMX, like I mentioned earlier, how do I overcome the situation? How do I create my ideal life that I can envision in my mind? But I think that was the first, what I call wake-up call for me, and really put me on this path I am today to really serve other people with what I had gone through. I was a teenager, when I realized my dream as an athlete in action sports.
I'm alive and I've had many other close calls with death on my bike and then just health-wise. But I think it was probably the single most important aspect of my life to this date, I'd say besides February, getting married to my wife. That was another one of those moments.

Dr. Reena Thomas:
Thank you so much for sharing that account because I can almost feel and see what that circumstance was like. For many of us providers, neurologists, neuro-oncologists, we know how much that each word means to a patient in that moment.
But also just hearing what was going through your head, makes it even more critical for us to do our jobs well in supporting patients going through this diagnostic journey. How did you go about learning about this diagnosis? How did you go about understanding the condition and how did that impact you and your family?

Josh Perry:
First steps were go to a neurologist that read my MRI, that explained some things. We talked about a lot of the different aspects of what I was going through. I still think I was in a state of shock and just going through the motions of processing everything. I think my parents were more tuned to the information and the actual diagnosis itself.
But after that, I went and met with my surgeon, Dr. Allan Friedman, at Duke University. The only thing I recall from that first consultation with him, was it was funny the way he just was so dry and just his humor with it. But he just was looking at the image and he was like, "This is a big one." I was like, "All right." Well, I don't know how it made me feel other than just laughed. I was like, "This guy's weird."

Dr. Reena Thomas:
But maybe that's what it was intended to do, make you laugh, put a smile. What can you say in that point, except to smile and recognize that it's one foot in front of the other at this point?

Josh Perry:
Yeah. No, I loved it. I'm from New England, so I just appreciated the bluntness, the forwardness of, "All right, here's what we're dealing with." But then he went on to explain what they suspected the type of tumor it was. They would only really know after the surgery and biopsy and things like that. But that's when he explained parts of like, "Yeah. If you didn't hit your head, you'd be dead in a couple months. Looking at the size of this thing, we don't know how long it's been growing in there. We do know you need to have surgery soon."
He actually moved his schedule around to get me in sooner than later because it was that severe. But I later went on to learn more about it, as I get into metabolic health and really understanding how to take care of my health and lower inflammation. But later on, I learned it was, and I still live with two new ones. I think I'm on diagnosis six, eight tumors later, something like that, they are meningiomas. What's crazy to me about that is that those types of tumors.
Well, one, thankfully I don't have spinal cord tumors, just the brain tumors because that could be very painful and limit my life in a lot of different ways. There's some perspective there to be grateful for that. When I say that on stage, people are like, "Wait, what?" I'll let that sink in for a minute. I'm like, "Yeah, that's the power of perspective because it could always be worse." But the other thing that is really interesting and really profound to me, is that knowing how meningiomas develop and where they develop.
I'd never heard of meninges layer before this, of course. But to think that it was four centimeters deep into my brain of where it was originating, reflecting back on the original MRI, I like to have everything out in front of me, the information. I just want to know what we're dealing with because in my brain, I'm already thinking, "Okay, what's going on?" My route the first time was just watching YouTube videos of brain surgeries. They told me it's like, "You may be awake, you may not."
That one, ironically, I was thankful to be awake, 2021 with Dr. Quinones out of Mayo Clinic Jacksonville. I was excited at the idea that he preferred awake surgeries, because this time around I was like, "Wow, I was afraid the first time. Now I'm excited because it's an experience that I don't think many people will ever go through being awake for your surgery. I get to participate in it, but I also get this other human experience."
I want to know everything because I feel better, and I've learned the idea of predictable conditions. If I know what's coming, I have less anxiety and less fear of that.

Dr. Reena Thomas:
It sounds like you've turned what can be a challenging circumstance and really tried to optimize, what could you do to best prepare yourself mentally, physically, for what challenges were in front of you?
Can you share a little bit more about your treatment journey? I know you've had multiple surgeries. How have you approached each?

Josh Perry:
Whether it was the Gamma Knife radiation, the second surgery, which I was awake for, each one of them seemed to have gotten easier, because I had already gone through the motions and I was going through them again. I was getting older, I was learning more. I was learning more about mindset and the mental and emotional connection that affects our physiology, and breath work and all these things.
But then a couple months after my recent surgery, August 2021, my at the time fiance asked me a very simple question that made me realize it wasn't so simple this time around. She was like, "Hey, do you remember a couple days before you went into surgery, you shared all of your logins and passwords to all the things, your manuscript for your book that you were working on all these things? Where do you think that came from?"
I was like, "Oh man, that was fear." That was suppressed fear because as much as I was compartmentalizing things, I remember writing something that I published on social media about how I felt so calm that I was afraid that I was going to die. Then we started talking with friends and family, and her and I have really gotten into human psychology and therapy and any documentaries or shows. We started to break open that question.
I was like, "Yeah. I was suppressing this real anxiety, this real fear and the stress and the trauma of what we were going through and what I've been going through it seems my entire life," which we all do as human beings. I think that's something that people disregard, is like no one's free of trauma, like little t, big T Trauma. We all go through it. But I'd been going through a massive amount since I was 21, 13 and a half years now.
I've gotten really good at compartmentalizing emotions to allow me to do the task at hand, which started BMX. It got easier and easier, but then on this last one, I wouldn't say it got harder because I've embraced this idea of processing emotions and the discomfort. I've tried my best, I'm human, so it'll never be perfect to be comfortable with being uncomfortable, when it comes to emotions and thoughts and things like that.
In one sense, the whole time it was getting easier, but now it seems like it's gotten more difficult. Now the timeline was, like I said, April 2010 surgery. Then two years later, a routine MRI showed two masses had grown back. This was November 2012, went through Gamma Knife radiosurgery. Dr. Friedman suggested that it was because when they got in there for the original surgery, it had wrapped around main artery, myopic nerve, and they didn't want to risk hitting either of those for many various reasons.
Death and stroke at the top of that, and paralysis, I should say. He just suggested it was some residual cell growth. We went through Gamma Knife radiation, perfect treatment for that. Six months, no sign of decreasing or no growth, so that's success. Next four years, we saw decreasing in both of them, so awesome. February of 2017, the diagnosis came from a routine MRI. We were in the interview we were putting together, and they said that the MRI showed two additional tumors on the other side of my brain.
These were a whole different case now that had popped up, and that's when they suggested the idea of neurofibromatosis. I looked into that and I was like, "It's a genetic disorder that creates brain and spinal cord tumors, and this, this and that." I got into doing all these different things to empower myself from a holistic perspective. It was going well and no side effects, no progression. But then in May of 2021, I woke up in the ambulance from having seizures in my sleep one night.
Thankfully, my wife is a trained medical professional, she was there and helped me out with that. Then that's when they revealed not only did I have two tumors on each side, two that were stabilized from years of shrinking that just stabilized, two that had been progressively growing in the last year since I had the MRI. I had a fifth golf ball size brain tumor in the frontal lobe, little to the left of my brain.
When Dr. Quinones got in there in August of 2021, he said there was a bunch of other little ones in there, so that's something we're still exploring. Then just at the end of last year, like August, September was a year from out of surgery, I had another MRI, of course, just to check on things. They found two additional tumors again in the meninges layer, very small. But that's when we decided to go through Gamma Knife to treat them.
Actually, I go back to get MRI to see what's going on with those, but we caught those so early. But that's the timeline. That's what, four or five different diagnoses? It's now like seven, eight, or nine brain tumors, which I still have two today. I'm speculating that it could be something that we don't know yet, which they're saying I'm an anomaly, because we did a whole genetic sequencing of myself and the tumor tissue.
There's no even correlation of even the cluster of different genes that point to what I'm experiencing, we're just finding them.

Dr. Reena Thomas:
Maybe we can bring things back together. I would just love your high-level thoughts on your outlook and what brings you hope.

Josh Perry:
I think what brings me hope is just I am inspired by so many different people's stories. Some that we could judge as better or worse than my circumstance, which I don't like that, because I think every human being on the macro goes through the same emotional experiences and the micro looks different. Because I get a lot of people that say like, "Josh, your story is so much worse than what I've ever experienced."
I'm like, "You can't look at it that way because then you deny your own reality. When you do that, you create this judgment of yourself." I think that what I have learned, is we all must embrace and accept that our emotional experiences, our journey in the micro is unique and there's no judging better or worse to another person.

Dr. Reena Thomas:
If you had the opportunity to go back in time, what words would you say? What would you tell yourself, if you were able to be back in the room when you were just receiving that diagnosis?

Josh Perry:
I would try my best to tell myself that trying to suppress all the emotions that you're feeling, all the thoughts that you have running through your brain, is just denying your reality, and it's creating more stress and trauma, and more pain and suffering. I would try to relay the message that it's okay. It's more than okay, because what you're going through is very traumatic. Embrace what you have going on, express it, get those emotions, those thoughts out.
There's nothing to be ashamed of. I think as a man, as in action sports, I felt really embarrassed to share because I thought I was weak with this diagnosis of a disease. I think just those types of things, just feel what you feel, think what you think, get it out, talk with someone, but also focus on what you want. I think I did that largely because I couldn't fathom a life without my bike, which I'm a little over three years now where I took it away from myself.
I walked away. I didn't have to, I could still be doing that today, but I was like, "Let me just see what life's like without that." But I think because of that, it allowed me to focus on what I needed to, to overcome to get back to what I wanted to.

Dr. Reena Thomas:
Thank you so much. So many words of wisdom, Josh, it's been truly a pleasure to have this conversation. Thank you for all that you do, and for inspiring others along their diagnostic and treatment journey, too. I really appreciate that.

Josh Perry:
Well, I appreciate you, Dr. Thomas. I appreciate the platform, the time, and it's a pleasure getting to speak with you as well, or allowing me to do a lot of the talking as I've done. But I greatly appreciate it.

Dr. Daniel Correa:
We're excited to start taking your questions and feedback, and sharing those responses here with you on the podcast.
You can also email or record an audio message and send it to BLpodcast@brainandlife.org. Of course, you can also reach the Brain & Life team at Brain & Life Mag, that's M-A-G.

Dr. Reena Thomas:
Welcome to our listeners. This is Reena Thomas, welcoming a dear colleague and friend, Dr. Michelle Monje. We are so honored to have you with us for today's podcast. Dr. Monje is professor of neurology and of neurosurgery and pediatrics, and pathology and psychiatry here at Stanford Medicine.
She is a leading expert of biomedical science in the neurosciences, leading multiple trials that are advancing care for patients with brain tumors, and the neuroscientific understanding of brain tumor's impact to the brain. It is my pleasure to welcome you. Thank you for joining us.

Dr. Michelle Monje:
Thanks so much for having me.

Dr. Reena Thomas:
We wanted to spend some time today to talk about the realities, both the realistic and also the concrete aspects of what patient care activities involve pertaining to patients who are newly diagnosed with brain tumors.
As a pediatric neuro-oncologist, what is your role and what are you able to provide patients when they come to your clinic to meet you for the first time?

Dr. Michelle Monje:
When we meet a new patient, one of the most important things that we have to do is to explain the disease that the patient and their family is facing, what their therapy may look like for them, and what we expect that that therapy will do, both in terms of benefit, but also in terms of potential harm.
Many of our therapies for brain tumors, including surgery, radiation, chemotherapy, even more experimental and newer therapies like immunotherapy, each can have a really important impact on the nervous system and the nervous system function in the long term. It's just very important as we embark on a therapeutic journey together, that patients and their families understand that and know what to expect.

Dr. Reena Thomas:
Tell us a little bit about that dynamic in the clinic when you're also caring for patient families and the caregivers that are providing that support to patients as they go through the diagnostic process and therapeutic process.

Dr. Michelle Monje:
It's just really important to meet the patient where they are, to answer questions that they may have. To explain what we can offer right now, but also what might be coming because of research and because of clinical trials. We are working really hard in the background outside of the clinic, some of us directly running laboratories, others working closely with scientific colleagues to find better and safer therapies.
There's a lot of work on how to better treat the brain tumors. There's also a lot of work on understanding the neurobiological consequences of cancer and cancer therapy on the nervous system, and to mitigate some of those long-term effects. It's important for people to know what we can presently offer and what we might be able to offer in the future.

Dr. Reena Thomas:
For our audience today, could you share a little bit about the jargon of clinical trials? What does it mean to be a Phase 1 clinical trial?
What does it mean to be Phase 2 or 3? How should patients and their families approach the thought process and decision-making around clinical trials?

Dr. Michelle Monje:
Absolutely. Clinical trials are the way that we develop and provide new therapies, and that's particularly important when there isn't a very effective therapy for a particular kind of brain tumor. The process of clinical trials actually begins before even the Phase 1 clinical trial begins in the laboratory, where scientists are trying very hard to understand a brain tumor to develop new therapies.
Often there's been a great deal of testing in experimental model systems in the lab, and we think that there's a therapy that might be helpful for a particular kind of brain tumor. Then once we have that, what we call preclinical evidence, typically a therapy is opened in an early phase or Phase 1 trial, which seeks to test the safety of that potential therapy. Now, we don't bring things to trial that we don't think might be helpful for patients.
But in a Phase 1 trial, the goal is to establish that this is a therapy that will be tolerated in a particular patient population. Then if that safety is established in a Phase 1 trial and we think that there's activity of that agent, we really think it's a promising strategy to bring forward and test for efficacy. Then in Phase 2 and 3 trials, that's the goal is to test whether or not the therapy really does help the outcomes for that kind of brain tumor.

Dr. Reena Thomas:
Can you share a little bit about your work and what you do in the lab, for patients who might be interested in clinical trials for their brain tumors?

Dr. Michelle Monje:
One major thread of work in my laboratory is to understand how brain tumors emerge in the childhood nervous system. What biological and developmental processes are being taken advantage of by that tumor. What mutations are within the cell that gives rise to the tumor, are allowing for it to arise. And how we might best treat that both by targeting the things that those cancer cells are susceptible to, but also the signals that those cancer cells are taking advantage of in the nervous system.
Along those lines, we've identified potential medicines and other kinds of therapies, like immune-based therapies, that we find in the laboratory fight that cancer and reduce the growth of that cancer, extend the survival of animal models that might be bearing that kind of cancer. Then for those therapies that most promising, we translate those to clinical trials so that we can offer that therapy to patients with that kind of brain tumor and try to improve their outcomes.
Another important thread of work in my laboratory is to understand how cancer and cancer therapies affect the nervous system. How it affects the way that different kinds of cell types in the nervous system that need to work together, are able to work together or not after that therapy and how those therapies affect the function of the brain. We know that after cancer therapies, there can be really important long-term consequences in many kinds of chemotherapies, for example, as well as radiation therapy that affects the nervous system.
Can cause a lasting syndrome that's often described as a brain fog characterized by impaired attention, memory, speed of information processing, multitasking, and executive function. This can be especially devastating when it happens in the developing nervous system, because then not only nervous system and brain development is affected, but also ongoing kinds of adaptability and plasticity that brains need to have in order to work optimally.
We try to understand exactly what's happening and how we might intervene upon that, how we might make these therapies less toxic. How we might rejuvenate the brain, how we might try to mitigate any dysfunction that's caused by cancer or cancer therapies.

Dr. Reena Thomas:
We had the opportunity to meet and speak with Josh Perry, who has taken his diagnosis of meningioma and the recurrent treatments that he has gone through for his meningiomas.
Taken that in and embraced it as a platform that he talks about openly with individual patients newly diagnosed with brain tumors, and really advocating for them and informing them so that they're prepared as they go through the journey. Can you tell us a little bit about what a meningioma is?

Dr. Michelle Monje:
Meningiomas are the most common primary central nervous system tumor. They occur on the surface of the brain. The brain has multiple layers of protective covering, and, of course, the skull is one of those protective coverings.
But between the brain and the skull, there are layers of meninges, and these are additional protective coverings. Meningiomas are tumors that emerge from the cells that are part of those protective coverings.

Dr. Reena Thomas:
What are some of the symptoms that you've seen in young people who present in your clinic newly diagnosed with a meningioma, for example?

Dr. Michelle Monje:
Because meningiomas happen on the covering around the brain, their symptoms depend upon where exactly the meningioma is growing. If they are growing over the cerebral cortex, which is one very commonplace for meningiomas to occur, or in between the two hemispheres of the brain where meninges go down into that invagination between the two sides of the brain. Then the symptoms are attributable to where the meningioma is growing and what structures it might be compressing.
Different functions in the brain are localized at different places, and often meningiomas occur over the covering of the frontal lobes. Some of those symptoms may be attributable to exactly where that tumor is compressing. Patients sometimes have headaches and nausea because of the increase in pressure from this new mass that is occupying space within the cranium. Or they may have seizures because the tumor is compressing a part of the cerebral cortex.
Potentially motor weakness, loss of sensation if the tumor is over parts of the brain that are important for motor function or for sensation. Or even cognitive disruptions if the tumor's compressing parts of the vortex that are important in associative cognitive function. People come with a different constellation of symptoms depending on exactly where that tumor is.

Dr. Reena Thomas:
Can you share a little bit about the new developments that you have seen or seem promising in the space of the effects that treatments have on the brain and that recovery process after treatment?

Dr. Michelle Monje:
As we understand more about how cancer and cancer therapy influences the brain and brain function, some potential therapeutic interventions are becoming evident. One thing that we know is a problem after cancer therapies, is that those therapies impair what we call mechanisms of neuroplasticity. The way that the brain has to change and adapt so that we can learn and remember.
Leveraging what we've discovered in the laboratory, there have been some really exciting early-phase clinical trials of either medicines or lifestyle interventions, like aerobic exercise, in small populations of patients after really intensive central nervous system therapies, that have shown improvement in cognitive function and even structural changes. Visible changes in the brain that really indicate regeneration of those processes.
I'm very hopeful that as we understand more and as some of those clinical research endeavors expand, that we will have hopefully really effective therapies to offer patients, to help them recover cognitive and other neurological functions after cancer and cancer therapy.

Dr. Reena Thomas:
Thank you so much. I would like to conclude our conversation by just asking you, what do you love most about your job and what you do, and what keeps you going?

Dr. Michelle Monje:
Well, I love taking care of patients, and I love the process of trying to find better therapies for them. I focus myself on pediatric high-grade gliomas, which are a really devastating group of brain tumors.
We don't have a lot of great therapeutic options for those tumors yet, but I'm incredibly motivated and compelled by my patients to try to find better therapies, and so that process gives me hope.
I really love being able to offer potentially helpful new therapies through this process of basic laboratory research to clinical trial translation.

Dr. Reena Thomas:
Thank you so much, Dr. Monje. It's been a pleasure to get to speak with you today. Thank you for sharing your expertise and insight with our audience, and looking forward to what's to come in the world of neuro-oncology clinical trials and translational work.

Dr. Daniel Correa:
Thank you again for joining us today on the Brain & Life podcast episodes. You can also sign up to receive the Brain & Life magazine for free at brainandlife.org and even get the Espanol version. For each episode, you can find out how to connect with our team and our guests, along with great resources in our show notes. We love it when we hear your ideas or questions.
You can send these in by email to BLpodcast@brainandlife.org and leave us a message at 612-928-6206. You can also follow the Brain & Life magazine and me on any of your preferred social media channels. These episodes would not be possible without the Brain & Life podcast team, including Nicole Lucier, our Public Engagement Program Manager. Rachel Coleman, our Public Engagement Coordinator, and Twin Cities Sound, our audio editing partner.
I'm your host, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea. Most importantly, thanks to our community members that trust us with their health and everyone living with neurologic conditions. We hope together we can take steps to better brain health, and each thrive with our own abilities every day. Before you start the next episode, we would appreciate it if you could give us five stars and leave a review. This helps others find the Brain & Life podcast. See you next week.

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