Monday 18 February 2019

Living on a knife edge - how robots saved my life

Laurenz Egan's life was turned upside down when, aged 22, he was diagnosed with a brain tumour but then he was offered the opportunity to become the first person in Ireland to undergo robotic surgery

Laurenz Egan who had Cyber Knife Robotic Radiosurgery
Laurenz Egan who had Cyber Knife Robotic Radiosurgery

Joy Orpen

A few years ago, Laurenz Egan's future looked bleak – he had a life-threatening brain tumour. However, medical science had already taken a remarkable leap forward, which would result in a new form of treatment that would help resolve not only his problems, but those of thousands of other people living with life-threatening illnesses.

It's the stuff of a modern-day fairy story, complete with ghouls (disease) and magic wands (innovations), and it proves that, no matter how bleak things may seem, there is always hope.

Laurenz Egan, 39, grew up in Arklow, Co Wicklow. The eldest of four children, he loved athletics and playing football.

Following a degree in business studies, he taught at a centre in Bray that helped unemployed people get back to work.

He was happy with life, until he reached 22 and began to experience hearing problems. One GP said he had a build-up of wax in his ears; another ascribed the problem to a virus.

However, Laurenz's shrewd mum thought otherwise and arranged for him to see an ENT specialist, who confirmed the hearing loss. She suggested he have an MRI scan so she could "eliminate some nasties". When he returned the following week, she informed him he had a large tumour pressing on his brain, close to his inner ear. It was called an acoustic neuroma and was relatively rare.

"It was an out-of-body moment, when time stood still," Laurenz recalls. "The word 'shock' doesn't begin to describe what I felt."

That was a Thursday in late January 1997. Laurenz was admitted to Beaumont Hospital the following Sunday, where he was introduced to Daniel Rawluk, his neurosurgeon.

"He was an absolute gentleman and a very straight communicator," says Laurenz. "He could only give me a 30 per cent chance of coming through the surgery intact. But I saw it as a glass full – that 30 per cent was my good fortune. I went into theatre on the Monday and was there for many hours."

All seemed to have gone well, even though he lost all hearing in his left ear.

The following April, the young educator got yet another terrible blow when doctors discovered cerebral spinal fluid (CSF) was leaking from his brain.

So, in June, he underwent a second operation to stem the loss of fluid, but, though valiant efforts were made, they didn't altogether succeed. Laurenz, who was now in the high-dependency ward, was confined to bed, unable to move. This was due to the insertion of a lumbar drain to divert his CSF.

In truth, he was in a very bad space, both physically and emotionally. As a result of the surgeries, he endured alarming episodes when his body went into spasm.

Making matters even worse was the fact that he wasn't allowed to sleep, due to monitoring every 15 minutes. And, though it was the worst time of his life, Laurenz has nothing but praise for those trying to help him. "Beaumont is a brilliant hospital, with brilliant nurses and an incredible team of doctors. I can't stress that enough," he says.

However, a time came when Laurenz's strong reserves failed him.

"Though I am a religious man, I had a real row with God. I let rip that night," he says. "I didn't know what I was supposed to be learning [from the experience], and I didn't know what I was supposed to do next. A nurse sat by me all night wiping my tears and blowing my nose, because I couldn't even do that for myself. I cried my eyes out for hours, but, in the morning, things had changed. Now I knew there was more to do."

So Laurenz was finally ready to have his next surgical procedure, and this proved so successful that, after a few weeks – and with the leak now gone – he was able to go home. Following this surgery, he says he felt he could "move mountains". He remained working in Bray for the next five years, then he began managing a college of further and adult education in Thurles, Co Tipperary.

Along the way, he met and married his "sweetheart", Caroline Doherty, and they now have two beautiful children – Joe, 9, and Lauren, 7.

In the interim, Laurenz remained well, until 2007, when an MRI scan showed that the tumour had returned.

"It was a terrible shock, and all the more so because we now had a small baby and a toddler," says Laurenz.

This time, however, open surgery was not the preferred option given the risks involved. On the other hand, the tumour appeared to be slow-growing, so it didn't require urgent intervention. Then Daniel Rawluk told Laurenz about the CyberKnife Robotic Radiosurgery System– a non-invasive system of treatment for tumours, only available in the US. It seemed that it might work for Laurenz.

In time, the procedure became available in Germany and the UK. Finally, it arrived in Ireland, and Laurenz immediately agreed to be the first person in the country to try CyberKnife.

In October of last year, he met his radiation oncologist, Dr Clare Faul, and her "fantastic" team at the Hermitage Medical Clinic in Lucan, and, in November, he had his treatment.

During the hour-long procedure at the Hermitage CyberKnife Centre, Laurenz lay with his head carefully anchored. A robot, based on the ones that build cars, pinpointed the area to be targeted. It then delivered high-energy radiation with unbelievable accuracy to the tumour cells, causing them to deteriorate and, eventually, die.

Radiation attacks the DNA, or genes, of cells, preventing them from dividing and multiplying. It also helps to stop cells from regrowing.

The beauty of the CyberKnife system is that it has X-ray cameras that constantly track the position of the treatment target, ensuring that the radiation beam is always precisely focused and does not damage any nearby healthy cells.

And, in spite of the name, there was no cutting and no open wounds. "I was awake and felt relaxed throughout," says Laurenz. After his treatment, he was able to go home and to resume work shortly after. He is now confident he has a long, healthy future ahead of him.

Since then, Laurenz has completed a PhD in education, and has worked with street children in Romania. In addition to being dedicated to getting people back to work, he also runs marathons, coaches athletics with Moycarkey Coolcroo AC, and coaches juvenile hurling and football with Moycarkey Borris GAA club. But, most importantly, Laurenz is devoted to his lovely family. "I suck the marrow out of every day," he says – a man who is truly grateful to be alive.

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