Pictured: Paul and Tricia Dietzler take a selfie together the morning before her second surgery at Hoag.
What was an Idaho woman with a brain tumor doing driving almost 1,000 miles across two state lines to get to Orange County, California?
Tricia Dietzler was in too much pain to contemplate that question as her husband, Paul, drove her 14 hours to Hoag and its nationally ranked Pickup Family Neurosciences Institute in September 2023.
Healthy and active her whole life, Tricia started having headaches, double vision and facial pain over that summer. Eventually, her doctors performed a scan and found a softball-size skull-base tumor that extended into and around her eye socket.
Her diagnosis, later confirmed by Hoag, was a rare and malignant salivary gland tumor called acinic cell carcinoma (ACC). ACC does not respond well to chemotherapy or radiation, and the location of the tumor meant surgery would be incredibly complex and risky.
After meeting with physicians locally, Tricia’s confidence wasn’t where it needed to be. Her boss and close friend, Mike Brown, knew Hoag well; his sister, Marcy Brown, is its senior vice president and chief operations officer. Mike urged Tricia to give Marcy a call.
Almost immediately, Tricia was connected with renowned Hoag neurosurgeon Robert G. Louis, Jr., M.D., F.A.A.N.S., Hoag’s Empower360 Endowed Chair in Skull Base and Minimally Invasive Neurosurgery, Chief of the Neurosurgery Division and Director of the Skull Base & Pituitary Tumor Program. After an initial telehealth consult, Dr. Louis enlisted other Hoag experts to review Tricia’s scans and biopsy report.
“The complexity of her case was a 10 out of 10,” Dr. Louis said. “But we felt it was within our scope of expertise.”
Days later, friends helped Tricia and Paul pack up and hit the road. They found a temporary rental nearby and checked into a hospital they had never been to, in a city far from home. But almost immediately, Tricia said, any sense of unfamiliarity melted away.
“I never felt like a stranger,” she said. “We were treated so well. We really felt seen and respected.”
Everyone from the receptionist to the medical team greeted her warmly, she said. She was especially impressed with Dr. Louis and otolaryngologist Timothy Kelley, M.D., program director of Head & Neck Cancer within Hoag Family Cancer Institute.
“Dr. Louis and Dr. Kelley set me at ease,” she said. “They’re amazing. I felt like a person, not a patient. I liked that they work side-by-side, so you have fewer procedures. A provider back home told me, ‘We stay in our own lane,’ but to me that didn’t make sense. Why not collaborate? Hoag’s approach resonated with me.”
Dr. Louis and Dr. Kelley quickly assembled a multidisciplinary team involving neuroradiology, neuropathology and medical oncology. During the workup, neuroradiologist Melissa Yu, M.D. discovered something unexpected on Tricia’s MRI. In addition to her tumor, Tricia had a brain abscess thought to be related to an earlier procedure back home, which led to an infection that explained her worsening symptoms over the summer. Dr. Yu immediately discussed her finding with Dr. Louis, who revised his surgical plan due to the added complexity.
Tricia’s surgery would now possibly require two stages and be performed using Surgical Theater’s 3D imaging technology, pioneered in part at Hoag’s Center for Advanced Visualization & Immersive Therapeutics. This state-of-the art technology allowed Hoag’s team to remove 40-50% of the tumor minimally invasively through Tricia’s nose, while also relieving pressure on the nerve in and around her eye. This resolved her double vision, improved her visual acuity and relieved her headaches.
Following that first surgery, a comprehensive review in two separate multidisciplinary tumor boards determined that surgical resection would be the best course to remove Tricia’s residual tumor. Dr Louis and Dr. Kelley planned and performed the second surgery, involving a craniotomy, to remove the remaining tumor pressing on her brain as well as the salivary gland from which the tumor arose.
“Before each surgery, they were very honest with me,” said Tricia. “They said, you could end up with blindness, stroke, paralysis or short-term memory loss. I looked at my husband before each surgery and said, ‘I pray I can see your face and remember you when I come out of this.’”
Tricia had full confidence in her Hoag team and its approach, but she was aware of the risks. For his part, Dr. Louis had concerns that Tricia might emerge from the surgery with neurologic impairment, including potential sight, function and cognition loss.
“But I woke up and the worst thing that happened was my upper lip was numb,” Tricia said. “Of all the things that could have gone wrong, that’s it. They did such a beautiful job.”
“Tricia and her case exemplify how our Hoag team combines the most advanced techniques and technologies with multidisciplinary collaboration, planning and expertise to deliver the best possible outcomes,” Dr. Louis said. “At Hoag, we provide world-class care for complex tumors, but it’s how we care for people — treating them like family – that truly sets us apart.”
Hoag’s team removed 95-98% of Tricia’s tumor and, two months after she left Idaho, she returned home with no neurological issues, no visual problems and no facial pain. She received radiation treatment at home to target any remaining tumor and will soon learn how successful it was in eradicating the cancer.
Tricia said she feels “blessed to be alive,” and blessed to have found Hoag.
“Hoag is bar-none the best hospital anywhere,” she said, holding back tears. “Even the sweet woman who cleaned my room knew me by name. On my last day there, she wished me well. Everyone there made me feel like a person, someone who needed help and was seen. I’ve had other surgeries in my life, and that’s not normally how you feel.”
Today, Tricia is looking forward to the future while finding meaning from her ordeal.
“When you get a cancer diagnosis, you think, ‘Why me?’ It took me a little bit, but I realized that God chose me so that I would share my story to help someone else facing a similar situation and in need.”
Someone in a similar situation, needing help and willing to go the distance for the care they need.
To learn more about the Skull Base and Brain Tumor Programs within Hoag’s nationally ranked Pickup Family Neurosciences Institute, and Hoag Family Cancer Institute, visit hoag.org/neuro and hoag.org/cancer.
