week 1 of neuro over and done with

week 1 of neuro over and done with
i thought neuro would be a scary rotation - just because it is -- well, brain surgery and all. at any rate, it's been a busy week. i had 2 interesting patients - one was really sad, the other has a good prognosis. i guess i'll talk about the sad one first.

on thursday, a lady came in with her 12 year old dog. big guy - oddly light for his substantial size. only weighed 60lbs, but he came up to my hip. some sort of chow/greyhound mix. he was a really, really nice dog - sweet-natured. at any rate, she came to see us because the dog recently had 2 seizures. no other clinical signs, just the seizures. the bad news was evident as soon as i heard the dog's history. 12 years old, no previous history of illness, sudden onset of seizures. no metabolic issues like hypoglycemia that could be causing seizures. there's 1 thing you think of immediately and that's brain tumor. typically a meningioma - as that's the most common brain tumor in older dogs. the woman was crying from the minute she started to explain the dog's problems to me - she barely got through 'he's been having seizures' before the tears started. she's really been struggling with this.

so a seizure is caused by a single neuron or a group of neurons in the forebrain that - for whatever reason - become overstimulated and start to fire. there are different types of seizures, ranging from brief absence spells, in which an animal or person just spaces out, to what used to be called grand mal seizures - but are actually tonic-clonic seizures. those are the biggies in which the animals are rigid, unresponsive, cry out, lose bowel and bladder control, and usually have post-ictal symptoms like disorientation, ravenous appetite, and maybe transient blindness.

so with that said, our biggest recommendation for diagnosis was first what's called a met check - 3 radiographs of the chest to look for metastatic cancer. for some reason, cancer in dogs loves to go to the lungs. if we suspect cancer, any type, we always look in the chest first. so we did our rads - and they were normal - yay! the next step in this case was CT scan of the brain. i was sure what we'd find. and sure enough - there it was - a big tumor, sitting in the olfactory lobe of the brain. probably a meningioma- although without doing histology, there's no way to be 100% sure that's the type. but it's definitely a tumor, and it's definitely big.

the owner was distraught, but i think she was prepared for it. the options for treatment are multiple - surgery followed by radiation, surgery alone, radiation alone, or palliative treatment (treating the symptoms without treating the tumor - steroids and phenobarb for the seizures). the owner is mulling over the options, but i don't think she has decided yet what to do. it's been an emotional couple of days for her. she came down from about 2 hours away and stayed in a hotel here while her dog was with us for 2 days. she was alone - and it made me feel bad. i can see why veterinarians get compassion fatigue. i felt so bad for her that i wanted to do something to help her - but there wasn't anything i could really do - except try to recommend a good hotel for her. it made me really sad for her.

i wasn't there when her dog was discharged and went home today. i had to be at school from 6:30-12pm, taking care of my patients. that patient wasn't going home till 3pm. i actually came back to be there, but the owner was running an hour late. i wound up going home and crashing into bed for 6 hours...wasn't the plan, but that's how it happened. it sucked, but i have to get away from that place sometime - as jim says, i'll burn myself out if i don't. i have to be back tomorrow at 7am to take care of my one patient left in ICU. that's my happy story - but i'll save that for later...

i had multiple other cases throughout the week - but my brain tumor patient and my little back dog have been the most interesting.