Posts Tagged ‘dizziness’

An Abnormal MRI, too close to home

July 13, 2016

We’re doing the best that we can

To follow an abnormal scan

The rumor was tumor

But the answer was no cancer

And the treatment’s a flash in the pan.

 

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. All our plans have been put on hold pending resolution of my wife’s brain tumor.  Any identifiable patient information has been included with permission. 

Three weeks ago on Tuesday my wife, Bethany, awakened with severe vertigo. She couldn’t get out of bed without vomiting.  Over-the-counter meclizine helped but little.  I posted the case on a physician’s chat site the next day, and got the recommendation for the Transderm Scop patch (she had one left over from a recent trip).  It helped but the problem persisted.

I don’t like to be my family’s doctor, so that Friday morning we went to the Clinic Formerly Known As Mine. Bethany’s doctor found horizontal nystagmus (a twitching gaze), when looking to the right, and ordered an MRI with contrast.

Chaos dominates Friday afternoons, thus Friday’s MRI happened without contrast.

I have the training and education to imagine a large collection of really bad things, and by now I’ve learned that the awful moments in life come to us unanticipated. So I went through my catastrophic catalog and felt better for having done so.  My phone went off while I was gardening.

In general, you don’t want your doctor to have bad news, especially not on Friday afternoon.

The MRI showed a 2.2 centimeter something behind the left eye. The original report mentioned possible glioma with the strong recommendation for a contrast study.  The thing’s location didn’t account for the dizziness.

With advances in imaging, we have had to come up with a term that means an abnormal finding found by coincidence; we call it an incidentaloma.

I called my locum tenens recruiter to say I had put all plans on hold; she relayed the information to those facilities expecting me in Nebraska and Alaska. Bethany phoned our daughter to say she wouldn’t be coming to help with the new grandson.

That night I read Bethany the Wikpedia article on glioma: 1/3 benign, 2/3 cancer.

Bethany’s cousin’s first wife died three weeks after getting her glioma diagnosed; she only had time to pick out her husband’s next wife, and say a loving goodbye to her family. In the ‘80’s I had a patient with a glioma who lived for less than 100 days after diagnosis.

We didn’t talk about those things.

Bethany took the information in stride, with understated courage. I focused on the moment with the joy of uncertainty that gives hope.  I embraced not knowing and did my best to focus on the moment: stripping the last tart cherry tree of its fruit, bringing in the first green chiles from the garden. I clung to things precious for their normality.

We suffered through the next four days, our plans shredded, as Bethany’s dizziness faded and her balance improved.

With her vertigo improved and her calm unruffled, Bethany went in for the contrast MRI the Tuesday morning before July 4. In the afternoon our fax brought the new diagnosis of meningioma, a well-behaved tumor with little if any malignant potential.

Relief of a magnitude that brings tears defies description.

I relied on my status as a physician and on friendship to get us an appointment with a neurosurgeon the next morning.

He explained the choices: leave it alone, open surgery, or radiation. He said if it were his tumor, he’d prefer the radiation.  He also showed us the MRI image, with a bright cylinder an inch long and half-inch wide growing up from the floor of the skull just behind the left eye.

He doesn’t do that procedure, but his partner does. And that partner wouldn’t be back in the office till Tuesday the following week.

Basking in the light of a better diagnosis while marinating in the darkness of an upcoming brain procedure, we went about our business. We had ice cream with our neighbors, and friends over for dinner on Friday.

Yesterday we met with the neurosurgeon, who explained stereotactic radiosurgery. And today we met with the radiation oncologist.

The actual treatment consists of focusing a radiation beam on the tumor, zapping the same way sunlight, focused with a lens, burns one point.

The next step, the 3D MRI, remains unscheduled.

 

 

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The root that Mayo missed: whittling down the med list

May 18, 2015

The terror of driving on the left

March 21, 2011

  I thought we’d never arrive

I feared we’d never survive   

    I am not yet deft,

    When it comes to the left

The side on which Kiwis drive.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, today I left Wellington, New Zealand in preparation for a job in Wellsford, in the north part of the North Island

Arriving from Wellington at the car rental in Auckland just as rush hour traffic started to abate, we picked up a Toyota Corolla.

I like Toyota products; I just don’t like them with right hand drive.  I don’t particularly like driving, though I’ve done a ton of it in the last year, and I really don’t like driving on the left. 

My first clue that perhaps I’d gnawed off more than I could swallow came when I started to enter the vehicle from what would be the driver’s side in the US.  Bethany had her hand on the other side door latch.  When I pointed out our error we laughed because we had no other response.

For the last ten days I’ve been imagining driving on the left.  To get myself to sleep I reversed the chirality (handedness) of my old commute. 

Bethany recalled her three-month bicycle tour of England, Wales, and Ireland.  She remembered how every day she’d start going the wrong way until her companions reminded her. 

Our two-day stay in the Bahamas sprang to mind; while a pedestrian there I consistently looked the wrong way when trying to cross streets.

Back when we still did martial arts, one of the forms ran in a palindrome, with the first half a mirror image of the second half, and though the moves themselves were simple, mastery came harder than any for any other form.

The fact that I talked to others who have mastered the task of driving on the left gave me a misplaced confidence.

Backing out of the parking stall showed me that, when driving from the right, I had no sense of where the left side of the car was. 

Driving in traffic, which I had practiced mentally, terrified me more because every time I tried to signal a turn I turned on the windshield wipers.

As the sun went down and the twilight deepened we made our way north in a light drizzle, through spectacular country, as green as if no other color existed.  My fear behind the wheel detracted from my appreciation of the scenery.  Bethany kept her hands firmly clasped in front of her mouth so she wouldn’t scream.

Driving on the left for the first time brought a dizziness, but not in the physical sense.  More like the brain squirm the first time I went underwater and inhaled through scuba gear.  Without the blind confidence characteristic of testosterone poisoning, I gripped the wheel like a fourteen-year old with a learner’s permit, and, just like when I was learning to drive, I tended to drift towards the side of the lane I couldn’t see well.

The divided highway turned into a two-lane road, and we followed our GPS unit’s instructions towards Wellsford.  We arrived at dark and got fish-and-chips at a Chinese restaurant.  It had been frightening, I thought, but it could have been worse.

Things indeed got worse from Wellsford to Leigh (pronounced Lee), the last forty-five minutes of our prolonged learning experience.  The light drizzle turned to heavy rain, the road turned rough and noisy, darkness closed in, and the caution signs looked like Lyme disease germs.

We arrived in a downpour, sheets of rain testing our personal commitment to withstand erosion.  I carried our luggage up with the aid of a cap-mounted flashlight I’d bought in Barrow, Alaska, less than a month ago, on a day when the high missed the freezing point by fifty degrees Fahrenheit (twenty-seven degrees Celsius).