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Hibbing man revels in results of a brain surgery never-before performed in Minnesota

Peter Carvalho talks about the two operations he has undergone in the past five years to treat a brain tumor. The first resulted in a long and difficult recovery. The second, performed in December, was a new type of minimally invasive procedure with low risk of injury and shorter recovery time. Steve Kuchera / skuchera@duluthnews.com1 / 4
Peter Carvalho recovers after his operation in December. He was discharged two days after brain surgery. Peter Carvalho photo2 / 4
Peter Carvalho touches the barely visible scar left by a new type of minimally invasive brain surgery he underwent in December. The larger “L”-shaped scar was from a 2013 operation to treat the same tumor. Steve Kuchera / skuchera@duluthnews.com3 / 4
A small hope chest decorated by a young cancer patient sits near a message Peter Carvalho wrote for himself in his Hibbing apartment. Carvalho’s brain tumor caused personality changes that strained and ended friendships and personal relationships. Steve Kuchera / skuchera@duluthnews.com4 / 4

HIBBING — No longer willing to fight the return of a life-threatening, mood-altering brain tumor, Peter Carvalho decided to end it all.

It was May 4 of last year, and the Hibbing man gulped down the entirety of his anti-seizure medication and all of his sleeping pills, hoping to fall asleep and never wake up.

Through those dark moments that likely were influenced by the tumor itself, an epiphany somehow occurred. It resulted in Carvalho not only deciding to fight what he calls "this demon inside of me," but to become the first person in Minnesota on the receiving end of a high-tech, minimally invasive form of brain surgery.

It was the second brain operation in Carvalho's 27 years of life. Both were successes, medically speaking. But the aftermath this time was totally different.

"It was the same feeling that I had after the first surgery with no recovery side effects and basically (the good feeling) multiplied by 10," Carvalho said this week during an interview in his one-bedroom apartment in Hibbing. "It was like, 'I feel like my true self again.' "

'Millimeter precision'

Dr. Clark ChenBranded as the ClearPoint Neuro Navigation System, the surgery was performed on Dec. 12 at the University of Minnesota Medical Center. The neurosurgeon, Dr. Clark Chen, had been lured to Minnesota just last year from the University of California, where he had pioneered the same surgical technique in that state.

The ClearPoint surgery takes advantage of Magnetic Resonance Imaging (MRI) to serve as the surgeon's "eye," Chen explained in a telephone interview this week. Because of that, the surgeon doesn't have to make the traditional L-shaped cut in the patient's skull, pulling back the "flap" to reveal and remove the offending tumor. Instead, the surgeon makes a 3-millimeter cut and inserts a probe. Guided precisely by the MRI, the surgeon then uses lasers to burn the tumor.

"What we can do is shut off the heating the moment the tumor's destroyed, but before the heat gets to the normal brain," Chen said. "And we have millimeter precision in that regard."

Among other things, there's a cosmetic difference between the two surgeries. The scar from Carvalho's first brain surgery, performed in 2013, still is clearly visible on the top of his head. But the reddish mark left by the laser-guided surgery, performed a month ago today, already is barely visible.

What shows on the surface isn't nearly as significant as what's underneath.

A lifelong tumor

Carvalho had that original surgery in New York City, where he grew up after being born in Brazil. The brain tumor was hereditary and was always with him, he knows now. Because of where it sat in the brain, it affected his personality as it grew, he learned later. He thinks it may have affected him all along.

"My whole life I was never really a good guy," he said.

The last six months before that first surgery in 2013, his behavior deteriorated, Carvalho said. His friends disappeared. His marriage fell apart. He lost his job.

But he felt fine, Carvalho said, until one hot weekend. He was in his car, at a stop sign, when he had his first epileptic seizure. The car crossed a curb and a lawn before resting against a house. Paramedics arrived, at first assuming that the young man was drunk. But after conducting field tests, they rushed him to the nearest hospital, Stony Brook University Hospital. The brain surgery was performed almost immediately, under emergency conditions. Had the hospital been another 15 minutes away, Carvalho was told later, he would have died in the ambulance.

Carvalho woke up a changed person, he said. "Almost immediately after waking up I felt this deep regret, like what have I done with my life?"

Photo by Steve KucheraBut recovery was slow. For about six months, Carvalho had difficulty expressing his thoughts and feelings, he said.

Chen said he thinks surrounding brain tissue must have been damaged during the surgery.

"I remember clearly meeting my ex-wife for the last time after the surgery and there was so much I wanted to say to her, but I just couldn't," Carvalho said. "I just gave her a hug and cried."

The tumor returns

When he regained his cognitive abilities, he had no reason to stay in New York, Carvalho said. He moved to Hibbing because his mother had moved there.

A language specialist, Carvalho taught English as a second language and supplemented his income by working at a convenience store. He was there one night in early 2015 when he suffered another epileptic seizure. At Fairview Range Medical Center, he learned the tumor had grown back. He wasn't surprised; the doctors at Stony Brook had told him that likely would happen.

But he wasn't sure he wanted to do anything about it.

"I had given up," Carvalho said. "I had already said to myself that if this tumor grows back I'm just going to let it kill me."

A neurosurgeon at University of Minnesota Health tried to persuade Carvalho to agree to surgery, telling him that without it he had only two years to live. He still resisted. The first surgery had left him in debt, he said, and he didn't want to face another difficult recovery.

He explains the May 4 attempt to take his own life as influenced by the tumor again causing personality changes. "It's kind of in the sense-of-self place in the brain," he said.

But once he had swallowed the pills, he reconsidered, Carvalho said. He didn't want to be remembered for taking his own life, he realized. He forced himself to throw up the medications, and then experienced what he calls a breakdown, isolating himself for a week.

But after that, he started to rebuild his life, Carvalho said. He quit smoking and gave up marijuana. He adapted a self-disciplinary regimen that included meditation, exercise and a healthy diet.

Through an online languages site, he met a Japanese woman, fell in love with her, and the two became engaged.

'Sounded like sci-fi'

Suddenly, Carvalho had a reason to pursue surgery, he said. He was working with a U of M neurosurgeon who wanted to make sure the conventional surgery would be as safe as possible. But in early November, he got a call from Chen.

"He described to me this procedure that, frankly, to me sounded like sci-fi," Carvalho said. "He told me that one of his patients (in California) went golfing two days after the surgery."

It sounded good, Carvalho decided. It lived up to the promises, he said this week. He woke up from the surgery feeling great and soon connected with the nurses in the intensive care unit, one of whom was from the Bronx and another from Hibbing. He has had no side effects, no cognitive difficulties. Although not yet able to return to work, he spends six to eight hours a day studying languages.

The tumor was 98 percent destroyed, he was told. He faces radiation treatment and possibly chemotherapy to keep it from coming back. After that, he has been told, he'll probably be free of it for good.

For now, Carvalho has more rebuilding to do. In the months before the surgery, his personality deteriorated again, he said. He lost friends. He damaged his relationship with his fiance. He's hopeful that can be repaired.

Either way, sooner or later Carvalho will move to Japan, he said. He has been drawn to the country since his youth, and he recently learned that he's 15 percent Japanese. He can teach English there, and he's working on learning the Japanese language — his seventh.

He's faced again with financial challenges. Insurance would have covered 65 to 70 percent of the conventional surgery, leaving Carvalho to pay around $45,000. But only half of the cost of the MRI-guided surgery was covered, saddling him with a bill for $85,000. He's seeking help via the Go Fund Me website.

Still, Carvalho can point to an experience that occurred on Tuesday as evidence of the difference the surgery already has made.

It was an immigration interview, in preparation for Carvalho becoming a naturalized U.S. citizen.

"Whereas old me would have been absolutely terrified, real me ... wasn't nervous at all," he said. "And I crushed it."

How to help

Paul Carvalho's GoFundMe page can be found at gofundme.com/phccancerfund.

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