Steve Mores' symptoms didn't scream brain tumor.
They screamed, "Go to the dentist!"
Mores, 57, of Aurora, had a toothache and a swollen face. His tongue felt numb, as did his gums and eventually the entire left side of his face. He was losing energy and didn't feel like playing with his band, the Prairie Surfers, even though he'd been the drummer for 18 years.
Early last year, Mores took the logical, yet often dreaded step of visiting the dentist. But his dentist didn't find anything unusual during two exams and an X-ray.
An ear, nose and throat specialist did an MRI when Mores visited because his teeth still hurt, his gums were still numb, his face still swollen.
"That's when they found the tumor," Mores said.
It was called a vestibular schwannoma, and it was technically benign. But that doesn't mean it wasn't harmful. It just means the tumor wasn't cancerous, wouldn't spread from its "precarious" position under the base of his skull and spine near his left ear to anywhere else in his body.
The tumor was the size of a golf ball, and it had to go.
Radiation failed and the increasing severity of his symptoms eventually screamed, "Get a second opinion!"
The second opinion the Aurora salesman sought led him to be the ninth person to undergo a new procedure for tumors of the skull base, simply called adaptive hybrid surgery, which is being conducted only at Northwestern Memorial Hospital in Chicago.
The procedure removed Mores' tumor and got him back to the drum set, back to traveling two weeks a month for his job selling home air quality products, back to living with energy and optimism.
"It was so depressing not to be able to do that," Mores said about playing with the Prairie Surfers, a group of longtime friends that performs what Mores calls "Americana rock" from artists such as The Beatles, Rolling Stones, Tom Petty, Richard Thompson, Pete Yorn, The Shins and The Fray. "Being back is awesome."
Mores' first option after his tumor was found was radiation, a treatment often used to shrink irregular growths. But it backfired, and his tumor grew larger, expanding to nearly double the size of a golf ball.
Radiation is supposed to take about five months to work, but Mores said his symptoms worsened and he didn't know why. He grew nauseated, even at the sight of food or grocery commercials, and he lost nearly 30 pounds from his 175-pound frame.
"I didn't want to lose weight," he said. "I liked where I was at."
He didn't want to quit playing with the band, either, but for a few months last summer and fall, Mores called in a backup.
"We had a sit-in drummer that played several gigs for him because he just didn't feel up to it," said KC Holcomb, Mores' longtime friend and the band's lead guitarist and vocalist. "He was not himself as far as that was concerned. ... It was tough to see him go through that because he is such an upbeat, positive guy."
Mores' wife of 32 years, Nancy, said he tried natural remedies to calm his shifty stomach and ease his discomfort, buying peppermint and ginger and seeing an acupuncturist with some success. But it was puzzling that radiation didn't help.
"That interim when he wasn't getting any better and not understanding why was the hardest," she said.
For a while, Mores tried to wait it out, thinking the radiation was working more slowly than predicted. But the physical effects of the tumor were debilitating. All he wanted to do was sit on the couch with a pillow on his stomach.
"I basically had to live with the symptoms: Extreme nausea, throwing up a lot and that kind of cool stuff," Mores said. "Headaches, dizziness, my balance was bad. I was losing some of the hearing in my left ear, but I'm waiting for this thing to shrink."
Later Dr. Orin Bloch, a neurosurgeon who performed Mores' surgery, said there are risk factors that make certain tumors unlikely to shrink with radiation.
"Tumors with more cysts tend to react adversely to radiation and grow," Bloch said. "His was the cystic type."
The tumor was still pressing against the nerves that induce nausea, the nerves that control sensation in the face and the muscles used to chew. It was still compressing the nerves that connect the brain to the balance organ in the inner ear. And now it was even bigger.
A family friend who works as a nurse at Northwestern referred Mores to Bloch. When Mores heard about the adaptive hybrid surgery, he knew it was his best option.
"It was risky, but it was, I felt, the only choice," Mores said. "With the technology they have today, it was operable. Years ago, it might not have been."
New tumor approach
The new adaptive hybrid surgery allows doctors to compare a visual of how much tumor they have removed during surgery with an MRI image showing how much tumor there was to start.
Bloch said surgeons typically have to make an educated guess about how much of the irregular growth remains when they're removing the last 5 percent, which is the trickiest part because it is actually stuck to nerves and arteries.
Taking out too much, in Mores' case, could have caused permanent facial paralysis or hearing loss.
The adaptive hybrid system uses reflective instruments, a camera and a screen showing a pre-surgery MRI. Guesswork is replaced with a real-time image.
"Using that technology, we can show the computer system where we've removed the tumor and where it's left behind," Bloch said.
In most cases, surgery will come first, then patients will seek radiation to kill that last 5 percent of tumor that's too risky to remove.
"In his case, it happened a little bit in reverse because he happened to have been treated with radiation at first," Bloch said.
But it still worked, Mores said. He left the hospital 3½ days after the Oct. 16 surgery, and was back playing with the band after about three weeks.
"He's just like a new person -- full of energy, getting back socially with his friends," Nancy Mores said. "His personality came back."
With the tumor gone, all Mores has to do is get annual MRIs to ensure it doesn't return. Bloch said a regrowth is possible but unlikely.
Mores' successful surgery is part of the first phase of a trial Northwestern Memorial is conducting on the adaptive hybrid surgery, which recently was approved by the Food and Drug Administration.
Bloch said the next step involves a randomized trial comparing the effectiveness of the new method to more traditional techniques.
"We're hoping that this will change the way we approach these tumors," Bloch said. "We hope to see a paradigm shift in coming years as to how these tumors are treated in the (medical) community at large."