This was one of the most disturbing cases I have ever had - sometimes a diagnosis is made that is totally unexpected (and usually very rare) and is just very upsetting. Sometimes people were just dealt a bad hand.
I had a 14 year old girl come in with her Mom and Dad because she was having urinary symptoms. Big deal right? UTI (urinary tract infection) most likely. See it all the time. Next!
No, think again. This girl was having “trouble urinating (very vague)” not the more common “burning” when one urinates. She had already been to another ER two days prior where they reportedly diagnosed her with a UTI but was not improving on antibiotics - in fact the “trouble” was getting worse. She was having problems voiding very much at all. She was reportedly getting “tired” and thus was feeling weak and could barely get out of bed. The first thought, a spreading infection going up into the kidneys (pyelonephritis) was considered. However, the girl gave such tiny amount of urine, I thought, well, maybe she is retaining some urine and a catheter would improve things - and also give us a clean sample.
I was shocked when the RN came out and told me nearly 1.5 litres were in her bladder! This level usually occurs in elderly men with big prostates and they are usually in SEVERE distress. She looked barely uncomfortable. Now I was getting worried something more was going on. I went back in to more thoroughly examine her and the results confirmed my fears. She was severely weak in the legs - she could barely stand let alone walk (but her upper body was normal), she had no reflexes in the knees or ankles. She had diminished sensation as well. Some neurological was going on. My first thought was a herniated disk causing cauda-equina syndrome (pretty bad but usually surgically treatable) or some other compression syndrome. I mean, she was a healthy (although slightly overweight) girl. I considered something like Guillain-Barre Syndrome (very serious but usually resolves with supportive care). In any case, it was about 5am so I planned for admission but was able to get an MRI first thing in the morning before she went up to the floor. The results were worrisome at first - there was a mass in her spinal cord in the middle lumbar area. Not an expert on these things, I presumed that given her age and health, that most likely it was a benign condition - and told the family the findings and reassured them that most likely, things would be OK -but more testing would need to be done to be safe. 2 days later I was back at work and asked the peds resident what the diagnosis was. What would you guess but
Glioblastoma Multiforme of the spinal cord.
The worst brain tumour you can have - that usually kills you in months. Hell, I did not even know it could occur in the spinal cord - and it usually hit people (more men than women) in their 50’s! What was the chance something this tragic could happen in this poor girl? Pretty slim - in fact I am sure I will never again see another case of it under these circumstances in my career. I cannot imagine how the patient and the family felt when they had the news broken to them. I am glad I was not the one that had to tell them - I am not sure I could have handled it.
Canadian Pharmacy
that is very sad. I am thankful that my chldren are healthy, but makes me realize that things can change at any moment.
I once had a young lady (small children, husband, etc) get admitted with first-time seizure and new diagnosis of brain tumor. This was on maybe 12/10 of whatever year. Brain biopsy=GBM. She died on Christmas Day after her tumor had grown 4 or 5 cm in 2 weeks. It was unreal and very sad.
Ach, it killed my dad. I can’t even read the words “glioblastoma multiforme” without crying.
GBM has been working on me for 2 years now. I have one tumor in my corpus callosum and one in my occipital lobe.
I am fortunate to be young, 36, so the prognosis is better than most because I’m better able to tolerate the chemicals. I have 3 young children myself…of whom don’t have the intellect or coping skills to understand what the future likely holds. Luckily, outside of frequent seizures, I’ve been able to enjoy modest stability.
Unfortunately, I see such horrific things all the time.
The words “pediatric hospice” make everyone cringe.
Yup bad news. Gotta handle it all.
I was called from our office Christmas party by the ER to admit a 55 year old with new onset seizure. He was in CT but the description of a Jacksonian seizure(http://www.medicinenet.com/script/main/art.asp?articlekey=7457) was worrisome.
Sure enough, 4 cm mass in the R temporal. Radiologist shrugged,” Probably Glioblastoma with the surrounding edema, doubt astrocytoma…hm, could be an abcess but I doubt it.”
The patient took it about like I would. “I guess it’s over then…” His wife is sobbing. 4 school-age kids. I insisted that tissue diagnosis is critical.
We need a biopsy.
Why? What’s the point?
It’s important to be sure of the diagnosis. So we can know how to treat you.
But I’m going to die.
Maybe. But I want to be able to recommend appropriate care and I cannot be sure of my recommendations without tissue.
Two weeks later on open biopsy it is an abcess. A year of abx and he sees his daughter married. Now a grandpa.
When the rumor is tumor, and cancer might be the answer, only tissue will resolve the issue.
Thus speaketh the pathologist.
That is terrible- not what I was expecting at all!
A few years ago we took my 8 year old daughter in to Emergency for IV hydration, as for weeks they’d told us that she had a particularly virulent form of stomach flu that was going on. Imagine our surprise when they found 3 tumours the next morning…sometimes things just blindside you.
(She’s fine now- we were lucky. But I’ve never seen a doctor look so ill as ours did when the tumours popped out at us- I thought that our wonderful doctor was going to pass out in front of me.)
I work at a hospice, and we’ve had 4 GBMs in the month that I’ve worked there. Super sad stories, all of them.