Monday, April 10, 2006

"The good news is that I don't think you have a brain tumor."

The bad news was that the doc didn't know exactly what was wrong.

The worse news was that a brain tumor wasn't even on MY differential diagnosis until he made that smart-ass remark. I was 21 and a nursing student, so I suppose he can be forgiven for presuming that it was. Don't all student nurses self-diagnose? Don't most of us eventually self-diagnose with something terminal? Guilty, but not that time. I was just thinking maybe I had Meniere's I was having dizzy spells that came on with no provocation that I could identify. I wasn't experiencing tinnitus, and the hearing loss was intermittent, not progressive and it was associated with upper respiratory symptoms.

Nine months later when the doc still hadn't come up with a diagnosis after putting me through a boatload of tests, I was really worried that I might have a brain tumor. He ordered one last flurry of tests and a diabetic friend gave me the diagnosis before the doctor came up with the same answer: Hypoglycemia. The high point on my glucose tolerance test was a fasting sugar of 70. It was all downhill from there -- 4 hours worth with a low of 40. It was probably a good thing they quit after 4 hours. No symptoms, but my blood sugar was still on a downward slope. It was still headed down and I had become symptomatic by the time I bumped into my friend. She gave me a snack and her diagnosis. I was able to keep the blood sugar under control by altering my diet and the dizzy spells were history.

I doubt that the doctor EVER made another flippant remark about brain tumors to another patient. I wasn't very gentle when I presented him with my friend's diagnosis for his confirmation. I made sure that he understood just how frightened I had been when he took so long to figure out the actual diagnosis after his off the cuff remark. To his credit, he listened to my entire rant and apologized with convincing sincerity.

Last July I had an episode of vertigo that lasted about a week. My internist didn't find anything to be overly concerned about at the time and prescribed Meclizine to slow things down. It's happened twice more since then. Both subsequent episodes lasted 4-5 days, so at least they're getting shorter. The third episode started the same day I was scheduled to see my ENT about something entirely different. I'm back on the medical carousel trying to figure out what is causing the intermittent symptoms. One thing leads to another and I still don't have a clue what's wrong. My ears check out. So do my eyes, not that visual problems cause vertigo, but the balance test (called an ENG or electronystography) showed a borderline signficant irregularity that was "possibly opthalmic (retinal) in origin", so I was off for an eye exam (normal) this morning. I'm no closer to an answer, but at least this time, thanks to that PET scan I had in December, I'm the one making the smart-ass remarks about being pretty sure there's no brain tumor.

I have an MRI scheduled for Wednesday and another visit to the ENT the following week for the results which will probably be normal. I've determined that my blood sugar and blood pressure are normal during these episodes, so that eliminates a few possible causes. The current ENT wants to see me when the vertigo recurs. I'd just as soon it never did even if that means the puzzle doesn't get solved. I'm determined not to engage in Googlology. I'm afraid I'll find out that there are things I really should be worried about and I just don't have the time for that.

The better choice is to make an appointment with my internist and let her put the rest of the pieces of this puzzle together. If there's an answer, I'm sure she'll find it.

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