Monday, July 16, 2007

As with anything, there are no guarantees...

This past week (7/9-7/13) I had the privilige of going on rounds with my clinician and meeting patients. It was the first time I got to see what problems the patient had and how the doctor planned to fix it. Previously, I had been mainly observing surgeries in the OR, in which we really don't see the evolution of the treatment, just the actual "fixing." One of the first patients I got to meet suffered from partial seizures. There are two main types of seizures: partial and generalized. In partial seizures, the most common type, the electrical activity is limited to one focal area in the brain. In generalized seizures, the electrical activity propagates throughout both hemispheres of the brain and can be usually characterized by loss of conciousness. This patient suffered from numbness of the left side of her body and prior to the onset of a seizure, would feel great anxiety and experience an aura of some sort. She had been on anti-epileptic drugs, but they were no longer effective. The cause of her seizures were rooted in the tumor she had. She had previously had surgery to remove the tumoregenic tissue and to determine the state of the tumor. Now the tumor had grown back and making her seizures worse. To treat her, the best option would be to remove the tissue. However, the tumor was in a sensitive area where some crucial motor neurons were still intact. She was told that surgery would most likely improve the frequency and level of her epileptic episodes, but there were no guarantees and that she would still most likely experience the numbness in the left side of her body.

Another patient we saw, had a tumor that grew fives time its size from 5 years ago. The figure above shows an MRI scan of a brain tumor in the brain. Here the tumor looks white. This is becuase the tumoregenic tissue produces high contrast relative to normal braint tissue. This patient had done extensive research and knew what he was getting into. What was different about this case was that his family was in the room with him. It was a very intense situation for me, to see how the family was reacting to the prognosis of his condition. No matter what numbers my clinician was giving him, he didn't seem to understand that nothing is guaranteed. I believe he was going to get back to my clinician on what he planned on doing. One of the more interesting aspects of this case was how adamant the patient was on getting the statistics of his outcome. To me, the prognosis was obvious: you have a huge tumor in your head, take it out or else you will definitely lose cognitive function. Pecentages are all relative.

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