Posts Tagged ‘meclizine’

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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Medical Advice at Parties.

July 8, 2012

At parties I’m asked for advice

It’s happened way more than twice

Wouldn’t you know

Sometimes I say ‘no’

But I usually try to be nice.

 

Bethany and I received a surprising number of last-minute invitations to parties today. 

People ask me for medical advice in social situations.  On one occasion, shortly after my mother’s death, I snapped and yielded to the urge to sarcasm and immediately regretted it.  Yes, the request arrived at an inappropriate time and place; no, the patient had never seen me on a formal professional basis; yes, I had every right to turn the request down.  But I did so with finesse and eloquence, a misapplication of good verbal skills.

Today I recommended the book, Love, Medicine, and Miracles in the buffet line, and a trial of over-the-counter meclizine while eating spanokopita.  I listened intently to an alcoholic’s relative, and agreed counseling would be a good idea.  I nodded while a person detailed a coworker’s headaches.

In med school and residency and even later, the docs who mentored me would say, “It comes with the territory.”  I suspect the phrase comes from traveling salesmen who would use it to describe the positive and negative things about working in a particular area.  The advantages of working in Montana differ from those of New York.

I would worry more about seeing a patient as a collection of diseases rather than as a whole human being if I didn’t talk about so many other things with the same set of people.  Today I had discussions about archery, firearms, ballistics, gardening, stone fruit, bicycles, New Zealand, and Alaska.

Yesterday I had a good talk with a friend, just back from 8 weeks of locum tenens (substitute doctoring) in Barrow.  The Inuit filled their quota of 21 bowhead whales; on one day they brought in three.   Weather socked the place in more than once, preventing critically ill patients from reaching services on a timely basis.  We agreed that Barrow ranks as a place on the fringe of the 21st century, that theft was nonexistent, and that the North Slope people smile more than any population we’ve seen.

Bethany and I spent two weeks in June in southern Alaska.  Four days of fishing, four days with friends, and four days of Continuing Medical Education with the Alaska Academy of Family Practice’s 27th Annual Scientific Conference in Kenai.  The sun set about 11:30 and rose a couple of hours later.  Which gave us a lot of time to fish but played havoc with our sleep.  Not nearly as bad as the 8 weeks of unremitting day without a single sunset the first time I went to Barrow. 

I might go back to work in Alaska, eventually, but Barrow remains outside my zone of comfort, like working in Sioux City and having the nearest referral hospital in Dallas.