The computer would focus the beam,
And I would doze, perchance I would dream.
And turn after turn
The tumor would burn
Ramsay Hunt wasn’t part of the scheme.
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Last winter I worked western Nebraska and coastal Alaska. After the birth of our first grandchild, I returned to Nebraska. My wife’s brain tumor put all other plans on hold. Any identifiable patient information has been included with permission.
Bethany had her stereotactic radio surgery on schedule. Even though the tumor involved no malignancy, the procedure took place at the June Nylen Cancer Center and involved a radiation oncologist. The festivities started off with the neurosurgeon using 4 screws to affix a frame to her head. Then followed a CT scan of the head, and three hours wait. When all was ready I walked Bethany to the linear accelerator, which didn’t make much of a visual impact. The frame screwed to my wife’s head got bolted to the table under the linear accelerator. I made a small contribution by suggesting a couple of rolled towels under her shoulders would favorably change the angle of her neck.
Then I walked back to wait. They said it would be an hour, and I thought about going out for lunch, but I stayed around, and twenty minutes later we walked out into the heat.
The next twenty-four hours went well but then the full impact of the radiation hit with nausea and vomiting. A couple of quick calls brought a prescription for Zofran which helped a lot.
Bethany seemed to have bounced back well, and she drove me to Omaha on a Saturday to catch a plane to Alaska very early the next day.
I brought a cooler full of 50 pounds of sweet corn to friends who live in Anchorage, before I started work on Monday.
By the time I’d landed, blisters had broken out on the left side of Bethany’s hard and soft palate; her description brought shingles to mind.
A while ago, leafing through a free medical journal called a “throw away” for good reason, I came across a photo quiz which showed zoster inside the mouth. I flipped the page to find the diagnosis of Ramsay Hunt Type 2. I scoffed, figuring if I hadn’t seen something like that in 30 years I probably wouldn’t ever. But three weeks later I looked in the mouth of a patient complaining of a “sore throat” and found exactly that.
I posted a poll on my favorite doctor’s social media site, and found that 80% of physicians haven’t heard of Ramsay Hunt Type 2, but 10% have seen it.
But it was the weekend. I told Bethany to schedule with her physician, and by the time she got an appointment she’d broken out with the worst cold sores she’d ever had, on the left side of her nose.
The viral culture eventually showed Herpes 1 (cold sores), not its cousin, the varicella zoster virus, or shingles.
Valcyclovir will treat both, but shingles requires a much higher dose.
And I can’t say I’ve seen two cases of Ramsay Hunt Type 2.