Glioblastology

Philosophy in the Wild

November 4th, 2016

The choice to tag line Glioblastology with, “A Graduate-trained philosopher documents his battle with glioblastoma” pays more than lip-service to my background and formal education. I completed undergrad and graduate work in philosophy at IU, Indianapolis (IUPUI). Outside of academia I held analyst, instructional design, training delivery, and project management roles with a Fortune 500 company and recently a smaller consulting firm. Through formal and informal channels I developed the following skills that equip me in my battle against brain cancer: research acumen, data analysis, written and spoken communication, and leadership. Surprising weapons to battle cancer, but my strength, resolve, and even attitude are thanks to the perspective gained by taking, what Thomas Nagel called, the view from nowhere: a view of the world that includes both one’s own perspective, yet sees oneself as a part of that view.

Adopting this view from nowhere, I value my own perspective; my own narrative, and I am eager to share the lessons that have benefited me as patient. But also, viewing myself as one piece of a broad portrait that includes family, friends, caregivers, a medical team, blog readers, and my sisters and brothers battling alongside me, I realize my unique draw is my ability to translate the technical into the digestible. Ultimately, it is my goal that technical terminology and narrative anecdote walk hand-in-hand; the former providing a background of knowledge against which the latter narrative plays out more vibrantly.

A good friend of mine—a good friend of the family, really, and a (retired) career professional in the pharmaceutical industry, gave me a lift a handful of times to radiation therapy. These were always great trips given the great conversation. Few life experiences shake us free from our own bullshit: a cancer diagnosis and adjusting to retirement after a successful career are two of those things—though, not likely so equivalent in other respects; hence, our conversations were relevant, poignant, thoughtful, and mutually appreciated. My friend shared the gist of a conversation he had with an oncology friend of his. It went something like this. “GBM is a terminal diagnosis, and difficult to deal with, but few of us have the opportunity to gain insight into our own passing. Think of the people on their deathbeds, wishing they had done this or that. Adam has an opportunity to consider those things he would like to make a priority.” Dead on. A benefit of receiving a difficult medical diagnosis is receiving, with the bad news, an opportunity to revisit priorities and align actions with values.

Writing this blog carries worries: worries about my many terminological and theoretical mistakes, worries about circulating misinformation—though, I do my best to perform due diligence and write with integrity, worries about sustaining the engagement of my audience, and worries that hours spent reading and writing, posting and sharing, turn out to be of little use to myself and others, now or in the future. Worries notwithstanding, the alignment of my actions with values encourages me to press on, speaking with the voice I trust, which is my own, informed by research, eager to offer new insights into old problems, helping others discover the joy of research as it informs a more intimate connection to our context, better relationships with our medical teams and caregivers, and feelings of empowerment that we may elect to participate in our care and treatment more actively, less passively.

I think this is what I mean by ‘Philosophy in the Wild’: the discipline is highly technical, specialists seemingly writing only for other specialists, and those unfamiliar with the jargon, unable to join the conversation. As with physical barriers, emotional barriers, legislative and systemic barriers, folks create barriers against our better judgment. Within philosophy much has been invested to understand human inference, reasoning, and decision-making, yet the technical nature of the discipline, the disproportionately high rates of white, male, and middle class undergraduate and graduate enrollment, the disappearance of tenure track professorship, and the adjunct faculty crisis and contribution to growing income inequality and poor access to healthcare reflect institutional barriers erected that stand between philosophers, studying reason and inference, and a general audience who would benefit from learning more.

The barrier I hope to break down for you is to provide tools to approach the study of your own diagnosis and treatment, informed by our best attempts to describe reasoning and inference. Not to dissent or deny treatment, but to understand why? Why this treatment, and not another?

Here are my tested skills, weaponized for battle against brain cancer: research acumen, data analysis, communication, and leadership.

Why?

Patient-centered healthcare is about empowering the patient to engage in their own treatment, care, and recovery. Doctors often prescribe medication, therapies, write referrals to specialists, and order tests, yet how often are these instructions offered in such a way that the person receiving care is empowered to articulate why the order was given?

I sat for my vile of blood to be taken for regular CBC, checking counts following a Temodar week. My veins are good, my demeanor calm, and my sleeves rolled up. The gray vinyl armrest tinged with blood, from a quick cleanup job. I am inclined to grab a blue glove and sani-wipe from the wall-mounts to volunteer a more thorough pass when a woman is called in and directed toward the seat next to me. A curtain separates us. She begins, “I don’t know why I am here. My doctor didn’t tell me about any lab work,” she grumbles, frustrated, disgruntled, and I get it. Our lives are busy. Where can I save time? What will I make for dinner? Why am I here?

I am a cancer patient, and like mallrats, cancer patients are clinic rats: we have had daily radiation therapy, chemo, we give blood usually every week or two, during therapy weeks. I have brain cancer, so I have an MRI scan every eight weeks. I get to wear scrubs on scan days! The hospital billed insurance $115k for my debulking surgery, so I’ve learned for what procedures Anthem requires a pre-certification. I like to interpret my own labs available in my electronic health records because I’m starting to get into some biomarker ranges concomitant with my nutritional choices. All this is to say, I’m a happy stick for the nurse. Woman on that side of the curtain: she is not.

See how we are different? What could her doctor have said in 30 seconds during an office visit to save our nurses some anxiety at the lab—and maybe get that old blood cleaned up?

I am invested in my care, treatment, and recovery because I have received treatment from medical practitioners who help me understand why such and such treatment is required. This has sparked my own research, examination of the facts, and seeking to answer that all important why?

What’s to Come?

There are competing theories to best explain the origin of cancer. The accepted view is that cancer is caused (primarily) by genetic mutations that cause cancerous cells to rapidly divide, metastasize, and obstruct vital body functions, leading to morbidity. The acceptance of this theory—the genetic theory of cancer, drives clinical practice. Theory informs our treatment options for cancer. Radiation therapy and chemotherapy among them, targeting and ideally impairing the cell division processes of genetically mutated cancer cells.

The medical community asked itself a question, and this question, although steeped in decades of clinical research, empirical findings, replication studies, and analysis, is not dissimilar from the question on the lips of the woman on the other side of the curtain. She is curious, why? The medical community is responding in clinical practice to the theoretical question: if cancer is a genetic disease, why should we treat with this therapy and not another? A more fundamental question is, why should we accept the genetic theory to explain the origin of cancer and not a competitor theory? We have uncovered further considerations: what makes for an acceptable theory? Why are some theories accepted and not others? How does theory acceptance drive clinical practice? Maybe most interesting to readers: what other cancer origin theories are out there? What clinical practices are impacted should the community accept an alternative theory?

Philosophy can help us, out here, in the wild. In the next post I will get us thinking about alternative cancer origin theories by way of discussing our cells and our bodies. Medical theories are data. Once two or more competing theories are on the table, we can speak to the reasoning method called inference to the best explanation (IBE). Good news! We are already thinking like someone trained in this method! The late philosopher of science Peter Lipton asserted that so-called contrastive questions (those of the form: Why P and not Q?) are central to the IBE method of reasoning.

Cheers- AH
Brief Lessons in Person-Centered Care: Please Do Not Place the Chair in the Center of the Room

October 24th, 2016

You are reading one in a series of short posts translating the patient experience to an action-oriented context for clinicians.

My wheelchair was outfitted with a tray, which might be convenient if I were cruising the halls of the locked brain injury unit, snacking on Doritos I took away from lunch, sipping stale hospital coffee from a Styrofoam cup, with the red straw pinched on the end like the metal receiving mold of a stapler, greeting staff with a Cheshire grin—“should he be out of his room?” The tray, brittle plastic, sold to Boeing in the late-1970s to pop up from the arm rests. Ginger ale. Always ginger ale.

My tray was not for convenience, though, but for safety, my left-arm, limp with hemispatial neglect, a side-effect of a gross total resection, edema, and subdural fluid collection, which, for what it’s worth, is still there, in a pocket, inferior right parietal lobe, above the occipital lobe; though, my proprioceptive issues are greatly improved, no small thanks to the persistence, skill, and expertise of my therapy team, two OTs in particular, and my wife, who is, “his wife, not his therapist.”

The dead-fish left arm, kenesio-taped to the tray during early therapy sessions to keep it from getting caught up in the spokes of the wheelchair, had earned its independence. I was complicit in my in-room exercises, and for a reward, earned the activity of navigating my wheelchair without supervision around my room, to and from lunch, and down the hallway to my favorite reading spot, a large window at the end of the fourth floor, overlooking the main drive, a quarter mile or so, lined with trees, where I would read three Einstein papers during my stay. The staff likely is still not sure if I was actually reading Einstein, or, you know, “reading” Einstein.

The neuropsychologist entered around 6:30pm, June 6, 2016—so says my journal, my reliable eyewitness to those few weeks. (A week and a half out from surgery.)

He pulled a chair to the center of the room.

Sat.

“You’ve been through a lot. How are you doing?”

“I’m really doing well, all things considered! I’m enjoying the schedule here, and I really appreciate the opportunity to rehab my motor and sensory deficits.”

This is my stock answer. I explain that I am expecting the pathology report soon to hear about the type of cancer that grew itself into a baseball-sized tumor in my right parietal lobe. “It will be good to know what we’re up against.”

I am still unsure if the pathology report was available in my records at that time, which the neuropsychologist would have, and probably should have, read, prior to his stop-and-chat, and it is not implausible to think everyone else had read it but was waiting for my neuro-oncologist to break the news. (Which would happen four days later on June 10, 2016.) Or maybe the neuropsychologist never read it. It is also possible that the pathology report was not yet available.

At any rate, my response, “…really waiting on that path report … can’t wait to hear what we’re up against,” is reason enough to suspect that this patient is unaware of his diagnosis.

“You appear to have a positive outlook. Do you feel anxious?”

[I’m in a locked brain trauma unit, separated from my family, less than two weeks out from major brain surgery, unsure of the type of brain cancer I have.]

“No, not anymore than what I would guess is to be expected. I actually feel pretty good, and I think having the mass resected from my brain has improved my overall health.”

[This much is accurate. My right ventricle was squashed into a pancake and the mass had occupied all available space in my parietal lobe, pinching the optic nerve bundle on its way back to the occipital lobe. I was having daily seizures, and episodic paralysis on my left side. Each of these symptoms improved after resection. I really was feeling pretty good post-op. Good enough to read Einstein, anyway.]

“Have you heard about the exciting new research for treating glioblastoma?” the neuropsychologist asks. He begins his ode to the polio vaccine: a soliloquy to research and the promise of a cure for glioblastoma. It is a grand love song to the miracles of modern medicine in which I tacitly feature as a supporting character.

In fact, this continues to be—the polio vaccine, I mean, a common response to people hearing about my diagnosis.

“Have you heard about this the polio vaccine!?”

It’s not just for New Deal Presidents, anymore.

This compulsion to share uplifting news grows from fascination and wonder with great respect and discomfort for our own mortality, “What if this were my diagnosis?” Our mortality is curious. It raises the Cartesian punch line that maybe I am strictly a thinking thing, and if that is the case, is that thinking separate from my body, or is it emergent from my physical processes? The churning, whirring, buzzing of a busy brain, and in the absence of these processes, so goes the thinking, and frighteningly enough, so goes me?

I think; therefore, I am.

I am not.

Therefore, I am not thinking.

The neuropsychologist continues.

“Mhmm,” I nod along.

“Have you watched the 60 Minutes Episode?”

“No, unfortunately I haven’t had the chance.”

“Maybe it was on Dateline. It’s really cutting edge.”

I rally from somewhere deep, “Oh! Thanks so much for sharing the information!”

Let us not give ourselves over to cynicism, it fails to be productive, but neither should we fail to learn lessons when available. My talented and bright sister-in-law would call this a #teachablemoment. I advocate a person-centered approach to healthcare, and I gather many of you do, too, if only implicitly. What I mean is this: there is a time in medicine’s recent past that, owing to any number of factors, the piss-poor antiseptic practices, the intimidation of meddling with one’s personal constitution, the inaccessibility of information, or maybe the poor track record of doctors was still appreciably better than at-home treatment, a patient would visit a doctor when sick, take his advice—certainly a “he” in these cases, and bite the bullet, drink the booze, what doc says, goes. If you’re not that sick, you don’t need the doctor, anyway, and if you’ve called for the doc, I suspect his advice ought to be followed.

The doctor-patient relationship I mean to evoke in this instance brings to mind fond cultural memories of our Little House on the Prairie obsession with frontier America, unbridled horses, one-room schoolhouses, and whatever else they packed into Back to the Future III. The doctor was an authority. An expert. An altruistic one at that, and so, what reason would we have not to take doc’s prescription to heart?

The following is my thesis. Our doctors do their best work when their patients are active, involved, engaged, participatory, willing, and honest. A person-centered (or “patient-centered,” if you like, but that sees the person as patient first, like the difference between “a colored person” or a “person of color,” yes?), anyway, a person-centered approach to healthcare places a responsibility on the person seeking treatment to view their self as an advocate, as vitally important to healing, as a part of their medical team. Doctors who are committed to person-centered healthcare inspire and recognize these qualities in the persons under their care.

Consider these mistakes committed by the doctor who visited me that evening: my diagnosis was unknown to me at the time of our meeting. Was I told my diagnosis during that conversation? I cannot answer that question.

The polio vaccine is administered for treatment of GBM under certain conditions to patients who meet strict qualification guidelines for acceptance into a specific research trial. Was application to that research trial recommended to me during that conversation? I cannot answer that question.

Dateline is not cutting edge; a recent peer-reviewed journal article in a field of specialty is. Was I provided with the resources to learn more about this new treatment option during that conversation? I was not.

Doctor exits.

I scribble away in my notebook. I breathe deeply. I position my tired left arm, using my able right arm, onto the wheel, and push myself to the wardrobe in my small hospital room to begin changing for bed. The path is obstructed. Doctor has left his chair in the center of the room.

Each of these transactions during this experience—the diagnosis, the clinical research, moving the chair, I was not empowered to take an active role in my own care; it was about doctor as authority, doctor as expert, and that is why this experience, despite all my rattled, broken, and fatigued body has been through these few months, stands out as one of the most negative. Power was withheld from me that evening.

Soon, or in some time, we will visit a sick friend; maybe a dying friend, and this will be an opportunity to empower or to hold on to power. I ask that we embrace the former and recognize when we are stubbornly adhering to the latter for our own insecurities, fears, or discomfort.

Keep learning. Keep fighting.

Cheers- AH

Personal Journal: June 6, 2016
What is GBM, Anyway? Part II.

October 20th, 2016

In Part I of this post we followed my journey toward GBM diagnosis, I briefly discussed Standard of Care (SOC), and I teased the post you are presently reading by connecting the etymology of glioblastoma to the Greek “glia,” meaning “glue” to indicate the affected cell types for malignant glioma–namely, non-neuronal brain cells such as oligodendrocytes and astrocytes. These glia comprise 90% of the brain. Together, the neurons and glia are denoted by the word parenchyma– gold-star word alert, meaning the functional bulk of tissue rather than structural or connective tissue.

It is clear that together we are wading into waters ankle-deep with medical terminology, but I hope you’ll stay with me. On the other side we will have learned something about our brains and bodies.

Understanding glia contributes to our evolving understanding of GBM. At least one ideal outcome to better understanding GBM is that we may better understand how to effectively fight, and ultimately, to cure, the disease. Of course many of you are reading along because you support me, and are interested in my fight, and I value your support. Part of being a good partner with you, is that I restrain from offering hyper-technical descriptions of cancer and associated treatment. I am not a medical professional, and I am not here to provide an alternative to Wikipedia, which would be both superfluous and not nearly as comprehensive. At any rate, I plan to stick to the narrative, for the most part. I’ll introduce technical knowledge into the discussion when I think it is warranted by its significance to understand the journey we are walking. Firming up our grasp on glia is one of these moments.

Glia play an important role in protecting, insulating, and facilitating neuronal connections, but that sells our glia short. Astrocytes play a central role in creativity and imagination. More striking, Albert Einstein’s brain, rather anatomically unremarkable in many respects, displays a higher concentration of astrocytes, densely populated in the areas of the brain involved in spatial reasoning and mathematics. Do we have astrocytes to thank for the upheaval of the Newton’s classical mechanics and ushering in of the age of relativity?

Oligodendrocytes, also glia cells, insulate axons to protect nerve fibers which carry electrical impulses away from the neuronal body and communicate with other axons or muscle fibers at connection points called synapses. So much to learn about these fascinating cells that play an important role in our thinking, perceiving, abstracting, moving, and feeling our way through the world. For each of these glia types discussed there is the risk of cancer: astrocytoma, oligodendroglioma, glioblastoma, and so on. These cancer types are graded according to World Health Organization (WHO) criteria, with a higher grade indicating cells exhibiting more rapid growth and greater divergence from normal cells. Glioblastoma multiforme (GBM) is a grade IV glioma/astrocytoma.

Let’s assemble our puzzle.

The brain is 90% glial cells. In a grade IV glioma, the resistance to therapeutic intervention is the following. Mutated cells easily track through the white matter of the brain, surrounding neurons, and invading vital brain functions. GBM, through cell division, branches, spreads fingers of abnormal cell growth (“Abby someone. Abby Normal. I’m almost certain that was the name.“) A malignant glioma can never be 100% resected because these branches, or fingers, even if visible on an MRI scan, are so invaded into healthy brain, a complete resection would sacrifice vital functions. The multiforme of “Glioblastoma Multiforme” indicates gross malformation of tissues, topographically, in other words, the structures of the central nervous system (CNS), microscopic malformation at the cellular level, as just discussed, and genetic malformation resulting in aberrations in the signal pathways that trigger cell division of mutated glia. These signal pathways, involving molecular signals, which latch onto receptors in cells to initiate activities such as metabolism and mitosis, likely deserves its own discussion–let’s table that for now.

GBM, perhaps unhelpfully, but at least sardonically (#smh #cancersucks) is called “the terminator” just for these reasons: its pervasiveness, its resistance to therapeutic intervention, its unknown origins, and so forth. Consider the new treatment options showing success at our best cancer institutes: Optune, an electric-field emitting “cap” or “hat” that a patient wears at least 18 hours each day, alternates an electric field, pervading the brain, thousands of times each second. The electric field interferes with cellular mitosis (division). When glia attempt division, the electric field prevents proper alignment of the involved protein-chains and results in cell death. Optune is shown to delay tumor growth and extend overall survival rates when used instead of chemotherapy alone. This is the recent medical intervention I have employed in treatment of my own GBM.

CONCLUSION: We set out to answer, What is GBM? Along the way we learned that GBM is an aggressive cancer affecting parenchymal cells of the brain responsible for creative thinking, reasoning, nerve fiber protection, and other neuronal-supportive tasks. These cells comprise the bulk of brain tissue; hence, GBM spreads easily to surround neurons and vital brain structures. Innovative new treatments focus on disrupting cell division.

Keep learning. Keep fighting.

Cheers- AH
Glioblast-OMG: What is GBM, Anyway? Part I.

October 9th, 2016

In Part I, I’ll share with you the journey that led to my GBM diagnosis (dx). In Part II I will share more information about what GBM actually is.

When an MRI scan revealed a 71mm primary brain tumor on May 13, 2016 (more background on the About page), my PCP called Whitney and me into her office. Together, we read the radiology report. You know the expression, it’s all Greek to me? Well it was, but for those who know me, you know that I’m a head-first, dive-in, full-commit student of topics that pique my interest. A baseball-sized tumor in my brain was an interest-piqueing phenomenon. At this early stage, though–that is, on 5/13/16, armed only with the radiology report, the pathology still a mystery, my appetite for knowledge would have to wait for more substantive medical information. That next piece of the portrait was painted by my talented neurosurgeons, affiliated with IU Health and Goodman Campbell Brain and Spine. Drs. Troy Payner and Aaron Cohen-Gadol. Drs. Payner and Cohen, with the assistance of resident Dr. Bracha, and an incredible anesthesiologist and OR team performed an awake craniotomy and surgical resection on May 26, 2016 (two weeks out from MRI).

Likely there is medical nuance I neglect, but I’ll use the following terms somewhat interchangeably: resection, craniotomy (cranio), or debulking surgery–surgery with the intent to resect/remove the maximum amount of tumor, while protecting the maximum amount of healthy brain tissue. A cranio is the first step in standard of care (SOC–remember that acronym, I’ll use it frequently) for treating primary brain tumors. The cranio was performed while the patient was awake–oh, the patient, that’s me! Dr. Payner’s decision, with the support of his colleagues, to perform the procedure while I was kept awake was to functionally map eloquent cortex functions (sensory and motor), while resecting tumor. The goal of this procedure is to aggressively remove tumor and leave the patient’s quality of life in-tact, to the extent it is possible.

*Aside.*

I went to grad school for philosophy, and I cannot tell you how excited my friends and faculty were to hear that a fellow philosopher would undergo awake brain surgery. I can finally put to bed the question whether we are living in the Matrix! On that cliffhanger, let’s save the awake brain surgery story for a future post.

Before retiring this brief aside concerning surgery, I will say, and I say it every chance I get, my neurosurgeons are absolutely gifted, and I am in their debt for balancing aggressive tumor removal, with protection of my sensory and motor function. Drs. Payner and Cohen successfully performed a gross total resection (GTR–another acronym), meaning >90% tumor resection. Patient outcomes–overall survival (OS), is greatly improved by a GTR vs. partial resection. My surgeons’ skills have added time to my life, more time with my wife, more time with my kids. Thank you to my entire medical team.

Seriously. More on the cranio in future posts. I can’t wait to tell you about being awake for my own brain surgery.

*Back to the narrative.*

OK! The resection gave my medical team tumor tissue to perform the biopsy and generate the pathology report. (We opted not to biopsy the tumor pre-op because the damned thing was so big, it was coming out, no matter what it turned out to be.)

Post-op I was inpatient at the operating hospital for some time prior to moving to an acute rehab facility, where I continued to be inpatient, working with a neuro-specific physiatrist and OT/PT team to recover lost function resulting from brain injuries caused during surgery–even successful surgery requires rehab and recovery. It is of note that my acute rehab facility included my residency in a locked brain injury unit. (More fodder for future posts.) On June 10, 2016 (four weeks out from MRI; two weeks out from surgery), Whitney and I caught a wheelchair-accessible ride to the IU Neuroscience building in downtown Indianapolis to hear the official diagnosis.

Tough diagnosis.

Glioblastoma multiforme (GBM): the most common and aggressive form of primary brain tumor. The cause of GBM is unknown. GBM develops either from a lower grade astrocytoma or as a mutation from healthy brain tissue. Tease, tease, tease, I must say that mutating cells reflects the current dogmatic view in cancer research that cancer is a genetic mutation. Research dating to at least the 1920s suggests that rather than genetic, a metabolic origin may be at work in the development of some forms of cancer. I hope you’re as excited to read the posts I’ll have on this topic, as I am to share them with you. My post-dx transition to a calorie restricted ketogenic diet is a lifestyle change I have embraced to take an active role in my own treatment. Nutritional supplements or diet changes are not SOC, they are not FDA approved, and if you ask the medical community, research does not support the efficacy of such metabolic or nutritional resolutions for cancer. That said, clinical trials are underway. This topic (therapeutic ketosis) will be a feature of my blog. Plenty more to come.

I must say unequivocally, loud and clear, please hear me: I am not a trained medical professional. I am a smart guy, who reads, who wants to live as long as possible, and I view myself as active in my own self-care and treatment. I trust my doctors. I have followed and will continue to follow SOC. I am wearing the Optune device. Big pharma is not out to hide the cure to cancer. My disagreements with SOC, where they appear to be disagreements, at any rate, are avenues of research for me because I want to beat the statistics. Please know that the blog you are reading is my first step toward documenting my battle with GBM. Let those things that work and those things that fail play out here so that when my case study is written there is primary source material available.

Recall I said the radiology report was all Greek to me. So was the pathology report. But here the Greek can help us. Glioblastoma, from the greek glial, effects the “glue” of the brain–non-neuronal cells. This is what makes GBM so hard to fight, it moves about the cabin of the brain, with no regard for the fasten seatbelt sign. Hey, GBM, you’re in my seat, causing edema, seizures, possible personality changes, unconsciousness, and other such problematic symptoms. By the numbers patients see 12-15 months of survival post-dx. Approximately 3-5% of the diagnosed population is with us 5 years out from dx. These are statistics, folks, and just because 3 out of 5 dentists recommend Crest, Colgate is still doing fine. (God, I hope Colgate didn’t just go out of business.)

This is where I will leave things for now. In Part II, I will say more about glial cells–astrocytes, oligodendrocytes, and share how my neuro-oncologist (NO) thinks my GBM developed.

I would love to hear what questions, thoughts, ideas, or topics you’d like to hear more about. Tweet me, comment here, or drop an email.

Keep learning. Keep fighting.

Cheers- AH

Philosophy in the Wild

Brief Lessons in Person-Centered Care: Please Do Not Place the Chair in the Center of the Room

What is GBM, Anyway? Part II.

Glioblast-OMG: What is GBM, Anyway? Part I.