Grand Marais, MN, resident Paulette Anholm happily proclaims that she is a firm believer in “positive mental attitude.” In fact, her initials spell out PMA, as if her sunny outlook on life was preordained.

Paulette’s positivity, however, has been put to the test following a diagnosis of glioblastoma in March 2021, and two subsequent brain surgeries performed by Department Head Clark C. Chen, MD, PhD, at the University of Minnesota Medical Center. The first was in May 2021 and the other in June 2022. Paulette was referred to Chen after having two bouts of seizures. When she went to her local physician, she was informed that they were caused by a brain tumor. Paulette was then transferred into Chen’s care.

After reviewing her images, Chen met with Paulette to discuss her options. “Paulette’s tumor was wrapped around the arcuate fasciculus, which connects the areas in her brain responsible for speech and comprehension as well as regions responsible for visual comprehension” he said. “Prior to the initial surgery, we talked about the impact the procedure might have on her.”

Surgical options
Paulette and Chen also discussed different surgical options. “One option was a conventional surgical removal of the tumor, which exposes her to risks of losing her vision, speech, and comprehension,” said Chen. “The other was minimally invasive laser ablation during which we come in through a three-milimeter hole in the forehead, avoiding the areas of the brain essential for these functions. This option made the most sense for Paulette.”

During the first procedure, Chen targeted the visible tumors. “I didn’t treat beyond the region of the visible tumor to avoid damaging normal brain tissue,” he said. Recovery was very easy, according to Paulette. “I didn’t have any noticeable deficits, and I didn’t need any kind of rehabilitation,” she said. The tumor proved to be glioblastoma, a highly aggressive form of brain cancer. Following the surgery, Paulette went through radiation and chemotherapy.

More aggressive approach
Almost a year later, the tumor regrew in the same area and Paulette and Chen had to have another conversation about treatment options. “With the first surgery, we had hoped that the microscopic
tumors invisible to the eye would respond to chemotherapy,” said Chen. “Regrowth of the tumor suggested that the chemotherapy was ineffective, and I had to be more aggressive surgically and treat beyond the visible tumor to improve Paulette’s chances for beating this cancer.”

The decision to have the second surgery wasn’t a difficult one for Paulette. “I told Dr. Chen from the very first, ‘This [the tumor] isn’t part of my original equipment, I don’t want it in my brain,’” she said. Paulette acknowledges that she didn't realize how much she would lose following the second surgery. “People say that I’m making progress but I’m not the same as I was,” she said.

An avid reader before the second surgery, Paulette now struggles with visual comprehension and cannot read anything but small parts of the newspaper. “I can see the words in my head, but I can’t
make my hand put them down on paper,” she explained.

Talking with family and friends
In addition, Paulette has trouble communicating – finding the right words to say. Chen recommended that she use a circle of family and friends to regularly touch base with her and keep her talking for at least 15 minutes. She believes it’s the best kind of therapy. When possible, Paulette sees a speech therapist remotely and there is an occupational therapist she can see in Grand Marais to help her regain skills such as writing.

Despite post-op struggles, Paulette continues to stay positive – and to acknowledge the “ducks” that lined up for her to come this far. She believes, for example, that her successful battle with alcohol use disorder that began in the mid-1980s and continues today gives her the strength to fight her battle with glioblastoma. “I’m taking it one day at a time,” she said.

Making connections
Since her diagnosis, Paulette discovered several others with glioblastoma in Grand Marais and has reached out to one. She has also connected with a monthly brain tumor support group through her oncologist. “When we introduce ourselves, we say when we were diagnosed,” said Paulette. “That’s been the best thing for me to hear that some people have lived with this for two to three years. They’re up, they’re dressed, they’re not in care centers.”

Paulette acknowledges that glioblastoma is not like breast cancer. “It’s not like you go through the therapies and after four to five years, you are cancer free,” she said. “There are glioblastoma patients out there who are in remission and only need an MRI one or two times a year. Most people die from this. It’s hard because people think you’re going to get over it and I don’t necessarily think that’s true.”

PMA shines through
Despite everything she’s going through, Paulette’s positive mental attitude shines through. “It makes me feel good that Dr. Chen understands how important that is to me,” she said. “It has a function in my life and is helping me react to this diagnosis.”

Chen has a profound respect for Paulette’s attitude. “Glioblastoma remains one of the hardest cancers to treat for both the physician and the patient. In most instances, there are many setbacks in the journey with this cancer. In my personal experience, patients who maintain a positive attitude during this journey generally do better,” he said. “All of my glioblastoma patients who survive beyond expectation maintain a positive attitude and surround themselves with support.”

“Often in medicine, we talk about treatments, about clinical trials, about the ability of a surgeon to perform a surgery, or about the skill of the oncologist,” Chen continued. “We don’t talk enough about the patient. In my opinion, the best determinant for success in therapy is how the patient is doing physically and mentally. Success in fighting this cancer is a true partnership between the physician and the patient.”

Paulette agrees and adds, “My recovery journey, my spiritual journey, and my positive mental attitude all lined up to bring me where I am today."