Just checking out the possibility of blogging on my phone. It's tough and slow-going actually. And I can't post pictures or video unless I buy a better version of this app. So, maybe I'll just use it for short facts I learn in class. Here's one: the "rate your pain on a scale from 0-10" doesn't work on kids under 7. You have to show them faces that are really sad and get progressively happier and ask the child to point to how they feel.
Saturday, May 14, 2011
Friday, May 13, 2011
Tuesday, May 10, 2011
Monday, May 9, 2011
Brain tumors and stats
A primary brain tumor originates in the brain. This is in contrast to a metastatic brain tumor that originated in another organ, like the lung or breast, and then started growing in the brain secondarily. There are different kinds of primary brain tumors, but we had a "clinical correlation" session with a patient that had a malignant astrocytoma. This just sounds bad.
It was a normal day. The patient remembers taking a different route home from work that day than
he normally would have taken and getting off 83 North at a random exit. He then sat at the stop light just watching it turn from green to red to green to red. The next thing he remembers is being in the back of an ambulance. He had a grand mal seizure while sitting at the light. Everything happened so fast. "Like a lightening strike," he said. Within a few weeks he was having brain surgery on to remove a very deadly brain tumor.
The problem is that this was a particularly bad brain tumor to have. At the time, before some new advances in treatment and technology, 50% of patients died within 6 months and 96% of patients died within 2 years.
But here's the thing. Dr. Brem made a point that I will not soon forget. That I can't forget for the benefit of my future patients. "Statistics apply to a population. Statistics do not apply to your patient." For an individual the "statistics" are either 100% or 0%. You can't be 96% dead.
The patient ended up getting a left frontal craniotomy. Then things went from bad to worse when he got an infection at the site of his surgery. They had to do another surgery and remove about 1/4 of his skull. His coworkers left hats in his office, maybe more for their benefit than his because people could see the pulse of his brain through the skin on his forehead. He didn't know who brought which hat, but he tried to wear a different one each day and hoped he ran into the person who gave it to him that day.
After several weeks, or maybe months, this patient's scans remained clean. So much so that plastic surgery to replace his missing skull was an option. This was in 1991.
Twenty years ago.
It has been hypothesized that the infection was actually what saved the patient's life. Maybe the infection pushed his immune system into overdrive right at the site of the tumor, attacking and killing any remaining cells that would have allowed the tumor to grow back. So now they are working on mouse and non-human primate models of this "inducing infection (or chemicals your body makes to fight an infection) at the site of the tumor." Crazy. How awesome is it that this patient's seemingly unfortunate turn of events not only saved his life, but might have made available the idea that could save the lives of others?
It was a normal day. The patient remembers taking a different route home from work that day than
he normally would have taken and getting off 83 North at a random exit. He then sat at the stop light just watching it turn from green to red to green to red. The next thing he remembers is being in the back of an ambulance. He had a grand mal seizure while sitting at the light. Everything happened so fast. "Like a lightening strike," he said. Within a few weeks he was having brain surgery on to remove a very deadly brain tumor.The problem is that this was a particularly bad brain tumor to have. At the time, before some new advances in treatment and technology, 50% of patients died within 6 months and 96% of patients died within 2 years.
But here's the thing. Dr. Brem made a point that I will not soon forget. That I can't forget for the benefit of my future patients. "Statistics apply to a population. Statistics do not apply to your patient." For an individual the "statistics" are either 100% or 0%. You can't be 96% dead.
The patient ended up getting a left frontal craniotomy. Then things went from bad to worse when he got an infection at the site of his surgery. They had to do another surgery and remove about 1/4 of his skull. His coworkers left hats in his office, maybe more for their benefit than his because people could see the pulse of his brain through the skin on his forehead. He didn't know who brought which hat, but he tried to wear a different one each day and hoped he ran into the person who gave it to him that day.
After several weeks, or maybe months, this patient's scans remained clean. So much so that plastic surgery to replace his missing skull was an option. This was in 1991.
Twenty years ago.
It has been hypothesized that the infection was actually what saved the patient's life. Maybe the infection pushed his immune system into overdrive right at the site of the tumor, attacking and killing any remaining cells that would have allowed the tumor to grow back. So now they are working on mouse and non-human primate models of this "inducing infection (or chemicals your body makes to fight an infection) at the site of the tumor." Crazy. How awesome is it that this patient's seemingly unfortunate turn of events not only saved his life, but might have made available the idea that could save the lives of others?
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