Thursday, October 11, 2007
A Very Long Day - Part 2: Midnight, PTC, Soccer
Previously: "A Very Long Day - Part 1"
While Jan was resting from his fall, I spoke with the vet about midnight (11am). Jan and I discussed our options, taking into account all the information we had on Midnight, her diagnosis(s), age, health, preferences and tried not to be selfish at the expense of our beloved friend. Many tears, and a couple of choked up phone calls later, the vet gave her the injection while we held her in our arms (2pm). The kids came home from school and we shared tears, regrets and memories of our beloved cat (345pm).
Parent Teacher Conferences (PTC) started at 430pm. Yes, same day. All the teachers sat around the edges of the large common room (where the kids eat lunch) and the parents took turns chatting with each teacher as they came available. It worked amazingly well. In summary, the teachers seem to genuinely care about the kids. Many of the teachers love our kids and believe they will be successful in their classes. Each of them have things to work on...organization topping both lists : ) I sent an email with the PTC results/grades to those I thought would be interested.
We rushed home at 715pm to pick up the kids, heat up some baked beans and head for the End of the Season Soccer Potluck at 730. Amazingly, we were on time :) The beauty of a small town:) Due to some unkind words he had received during the homecoming assembly, Jamie had not wanted to attend the event; but we didn't give him a choice. A couple of players & mothers had gone out of their way to call and come by to be sure Jamie was invited. As we walked in the door, Auri disappeared to hang with her friends. Jamie was more of a butterfly flittering here and there, returning to stay by us, only to leave again. Over the course of the evening, Jamie received a Letter in soccer (YEA!!!), a CD of pics, a photo collage of him playing on the team and a Frenchtown Soccer Sweatshirt (which we can take down and have his name put on). As they gave out awards for the best players, all-conference, most improved etc.... Jamie leaned over and wispered, " I'm going to play next year." It was a good night. :)
As we finally collapsed (gently in Jan's case :) into bed, it was hard to believe that it was only One Very Long day.
A Very Long Day - Part 1: Jan's Fall
Some days are just longer then others and yesterday was one of the longest days of my life. I swear that by the time we went to bed, it felt like we had lived through several days.
It all started with a loud CRASH, followed by an eerie moaning of obvious pain. I flew out of bed and found my own little nightmare. Jan had gotten up to go to the bathroom around 5 am, felt a little lightheaded, slipped on the rug, tried to catch himself (in the dark bathroom) and landed hard hitting the tub and toilet on his way down. I helped him to a sitting position. He was delirious. "Jan, Look at me." He did not know me, or anything else, he could not focus his eyes or follow a thought, "Do you know where you are?"....."Where I are?".... He started sweating profusely, skin clammy, pulse thready, he kept trying to get up, I made him stay on the floor. The phones were all downstairs. The kids were asleep, three floors down. "Shit" I waited for him to sit calmly and ran downstairs for the phone. I was going to call my neighbor to help me (he is a pharmacist), but I knew Jan would need x-rays so, I called 911 instead. They were on the way, I toweled Jan off and stayed with him. After 10 min (can we say eternity??) from the initial crash, Jan was suddenly back with me. Like a flip of a switch, he recognized me. "Do you know your name?" "Jan (his voice sounded like he thought I was out of my mind)" "Do you know my name?" "Sara" I started to tear up. "Do you know where you are?" "the bathroom" He thought I was crazy. I told him that he did not know the answers to those questions a few minutes ago, that he had fallen. He had no memory of the fall. I told him that 911 was on it's way and that I felt he needed to go the hospital to be checked. He stayed on the floor, while 911 showed up. I ran down to let them in and let them by Kizsie (our rott) who is still on house arrest since her surgery. Emergency personal stayed for about 40min (including waiting for the ambulance to arrive from Missoula) and then loaded him up and took him to the hosp. Auri woke up from the dogs barking and the flashing lights. I gave her instructions for the morning, leaving her responsible for the animals, her brother and getting to school on the bus and flew to the hospital (ok technically I was in my car). CAT scan, xray.... diagnosis: Concussion, poss fracture ribs (x-ray inconclusive), no major head injury, no punctured organs, lots of soft tissue injury. He has an abrasion on his cheek, a small cut on his hip, and multiple aches and pains, but he is otherwise ok.....whew. We were back home by 845am.
It all started with a loud CRASH, followed by an eerie moaning of obvious pain. I flew out of bed and found my own little nightmare. Jan had gotten up to go to the bathroom around 5 am, felt a little lightheaded, slipped on the rug, tried to catch himself (in the dark bathroom) and landed hard hitting the tub and toilet on his way down. I helped him to a sitting position. He was delirious. "Jan, Look at me." He did not know me, or anything else, he could not focus his eyes or follow a thought, "Do you know where you are?"....."Where I are?".... He started sweating profusely, skin clammy, pulse thready, he kept trying to get up, I made him stay on the floor. The phones were all downstairs. The kids were asleep, three floors down. "Shit" I waited for him to sit calmly and ran downstairs for the phone. I was going to call my neighbor to help me (he is a pharmacist), but I knew Jan would need x-rays so, I called 911 instead. They were on the way, I toweled Jan off and stayed with him. After 10 min (can we say eternity??) from the initial crash, Jan was suddenly back with me. Like a flip of a switch, he recognized me. "Do you know your name?" "Jan (his voice sounded like he thought I was out of my mind)" "Do you know my name?" "Sara" I started to tear up. "Do you know where you are?" "the bathroom" He thought I was crazy. I told him that he did not know the answers to those questions a few minutes ago, that he had fallen. He had no memory of the fall. I told him that 911 was on it's way and that I felt he needed to go the hospital to be checked. He stayed on the floor, while 911 showed up. I ran down to let them in and let them by Kizsie (our rott) who is still on house arrest since her surgery. Emergency personal stayed for about 40min (including waiting for the ambulance to arrive from Missoula) and then loaded him up and took him to the hosp. Auri woke up from the dogs barking and the flashing lights. I gave her instructions for the morning, leaving her responsible for the animals, her brother and getting to school on the bus and flew to the hospital (ok technically I was in my car). CAT scan, xray.... diagnosis: Concussion, poss fracture ribs (x-ray inconclusive), no major head injury, no punctured organs, lots of soft tissue injury. He has an abrasion on his cheek, a small cut on his hip, and multiple aches and pains, but he is otherwise ok.....whew. We were back home by 845am.
Goodbye Midnight
We had Midnight, my cat of 17+ years, put to sleep yesterday. On monday night, I noticed she wasn't doing so well. She wasn't really eating, walking around very little, and basically just laying in dark corners. We'd noticed some other signs in the preceding days, and I kinda got scared. She weighed next to nothing (5 pounds, I'm told, which is down 2 from her usual 7 pounds).
So we took her in to the vet first thing tuesday morning, and left her there to run some tests and see what's going on. To be honest, I was surprised that she was still with us tuesday morning. That's how bad she seemed to me. Heck, when we got to the vet, I wouldn't have been surprised to find her passed away in the cat carrier.
They tell us they gave her IV water and glucose, as she was dehydrated (I tried to get her to drink, to no avail). We waited all day for the vet to call us with some news or results, but they never did, which kinda pissed us off. We finally got a hold of a night-shift vet at the hospital, who told us what the chart seemed to indicate: kidney failure, as well as liver failure. Both of those basically lead to the cat not eating or drinking.
Wednesday we finally talked to the doctor in charge of midnight, and the prognosis was pretty much what we figured. It's not like you can cure liver and kidney failure. To extend her life, we could do an IV therapy and see if that kick starts the kidney again (chances not good), as well as take her home and do months (or weeks) of subcutaneous fluids. I did that for one of Val's cats a few years ago, and it was no fun for the cat or us, and the cat just wasted away slowly anyway. I didn't want to put midnight through any of that.
In addition, we could try to force-feed her to see if the liver comes back. Chances there are equally slim. Also, she's had irritable bowel disease all her life, meaning that anytime she eats more than a few bites, she generally throws it all back up. So force-feeding combined with that didn't sound the least bit appealing.
Plus we didn't want her to hate us the last part of her life, constantly being force-fed and needles for subcutaneous fluids stuck in her. I've done some of that when she was younger (she had an episode of diabetes, so I had to give her insulin shots every day), and everyone's given medicine to a pet, i.e. shoving a pill or dropper down her throat. Anyone who's done that knows that the pet learns very quickly what's coming and generally disapproves, to say the least. I didn't want to have to do that to her in her last days.
Also, consider that midnight always hated other cats and dogs (darn prima donna..), and now she was stuck in a noisy animal hospital. I didn't really want to leave her there either, nor could I really bring her home to let her "waste away" at home. That ain't right, either.
So with a VERY heavy heart, we had a neighbor drive us to the vet (neither sara nor I figured we'd be in any shape to drive home afterwards), and had her put to sleep.
I know it was the best thing to do, but it still breaks my heart. I've had midnight for a very long time. You kinda grow attached. I'll miss her.
So we took her in to the vet first thing tuesday morning, and left her there to run some tests and see what's going on. To be honest, I was surprised that she was still with us tuesday morning. That's how bad she seemed to me. Heck, when we got to the vet, I wouldn't have been surprised to find her passed away in the cat carrier.
They tell us they gave her IV water and glucose, as she was dehydrated (I tried to get her to drink, to no avail). We waited all day for the vet to call us with some news or results, but they never did, which kinda pissed us off. We finally got a hold of a night-shift vet at the hospital, who told us what the chart seemed to indicate: kidney failure, as well as liver failure. Both of those basically lead to the cat not eating or drinking.
Wednesday we finally talked to the doctor in charge of midnight, and the prognosis was pretty much what we figured. It's not like you can cure liver and kidney failure. To extend her life, we could do an IV therapy and see if that kick starts the kidney again (chances not good), as well as take her home and do months (or weeks) of subcutaneous fluids. I did that for one of Val's cats a few years ago, and it was no fun for the cat or us, and the cat just wasted away slowly anyway. I didn't want to put midnight through any of that.
In addition, we could try to force-feed her to see if the liver comes back. Chances there are equally slim. Also, she's had irritable bowel disease all her life, meaning that anytime she eats more than a few bites, she generally throws it all back up. So force-feeding combined with that didn't sound the least bit appealing.
Plus we didn't want her to hate us the last part of her life, constantly being force-fed and needles for subcutaneous fluids stuck in her. I've done some of that when she was younger (she had an episode of diabetes, so I had to give her insulin shots every day), and everyone's given medicine to a pet, i.e. shoving a pill or dropper down her throat. Anyone who's done that knows that the pet learns very quickly what's coming and generally disapproves, to say the least. I didn't want to have to do that to her in her last days.
Also, consider that midnight always hated other cats and dogs (darn prima donna..), and now she was stuck in a noisy animal hospital. I didn't really want to leave her there either, nor could I really bring her home to let her "waste away" at home. That ain't right, either.
So with a VERY heavy heart, we had a neighbor drive us to the vet (neither sara nor I figured we'd be in any shape to drive home afterwards), and had her put to sleep.
I know it was the best thing to do, but it still breaks my heart. I've had midnight for a very long time. You kinda grow attached. I'll miss her.
Sunday, October 7, 2007
Homecoming and all
Well Auri went to the Homecoming dance last night with some girlfriends! She had a great time, stating it was "AWESOME!" She has made a nice group of friends and seems to be doing well. She has decided to join the school band and start playing the tuba again! I know I was surprised too! Most importantly, Auri has made it into the school play "Annie" (the musical) she will play the part of Ms Greer (one of Warbucks servants). The play will be Thurs Nov 29 thru Sat Dec 1.
Jamie is still mega-migraine free; Although he states that he has had little headaches off and on. He chose to stay home and "chill" instead of going to the dance last night. He is still working on his makeup work. There seems to be some confusion there....I will be speaking to the teachers this week. Parent- teacher conferences are Weds & Thurs. The soccer season is either finished or they may have a last game next week (divisionals). Jamie remains ineligible so he won't be able to get back on the team this year. Odds are that will probably affect him receiving a letter (i.e. letterman's jacket) this year...bummer. But, worse is that it decreases his bonding with the friends he made on the team :(
I think we will have to do something about that aspect, maybe the coach needs a manager like Auri does in Volleyball... I wish I had thought of that earlier! Maybe I will talk to him about having a little weekend movie party over here...
Kizzie (the dog) is recovering well from her ACL repair and remains on house arrest :) She gets very sad when we put the "lamp shade" collar on her and refuses to lift up her head (as if it weighed 20 lb. instead of a few ounces).
Everything else seems to be progressing well. There is always so much to do around here.... I will probably go find a part time nursing job to help with the bills. I looked into substitute teaching, and may follow thru with it, bit the pay is around $60 a day...that breaks down to $7.50 an hour. Nursing pays much less here then Vegas, of course, but I am sure I can at least double that wage. I am going to start rebuilding my massage skills and practice, starting with the kids and Jan (they are happy about that :).
Jan and I will be going to Vegas Oct 16 to pack up the rest of our stuff, load up the Uhaul and head back to Montana before the snows arrive (or at least before it gets bad). Grandpa Brew will come up and stay here with the kids Tues/Weds so that they can go to school, then take them back to Idaho for a few days till we pick them up on our way through. (No school Thurs/Fri).
Jamie is still mega-migraine free; Although he states that he has had little headaches off and on. He chose to stay home and "chill" instead of going to the dance last night. He is still working on his makeup work. There seems to be some confusion there....I will be speaking to the teachers this week. Parent- teacher conferences are Weds & Thurs. The soccer season is either finished or they may have a last game next week (divisionals). Jamie remains ineligible so he won't be able to get back on the team this year. Odds are that will probably affect him receiving a letter (i.e. letterman's jacket) this year...bummer. But, worse is that it decreases his bonding with the friends he made on the team :(
I think we will have to do something about that aspect, maybe the coach needs a manager like Auri does in Volleyball... I wish I had thought of that earlier! Maybe I will talk to him about having a little weekend movie party over here...
Kizzie (the dog) is recovering well from her ACL repair and remains on house arrest :) She gets very sad when we put the "lamp shade" collar on her and refuses to lift up her head (as if it weighed 20 lb. instead of a few ounces).
Everything else seems to be progressing well. There is always so much to do around here.... I will probably go find a part time nursing job to help with the bills. I looked into substitute teaching, and may follow thru with it, bit the pay is around $60 a day...that breaks down to $7.50 an hour. Nursing pays much less here then Vegas, of course, but I am sure I can at least double that wage. I am going to start rebuilding my massage skills and practice, starting with the kids and Jan (they are happy about that :).
Jan and I will be going to Vegas Oct 16 to pack up the rest of our stuff, load up the Uhaul and head back to Montana before the snows arrive (or at least before it gets bad). Grandpa Brew will come up and stay here with the kids Tues/Weds so that they can go to school, then take them back to Idaho for a few days till we pick them up on our way through. (No school Thurs/Fri).
Thursday, October 4, 2007
Kid update
Well, it has been another interesting week in the Vilhuber home :)
On the bright side, Jamie has not had a headache in the week!!!! Yeah. He did however, have the flu (vomiting/diarrhea) on Monday and therefore missed school-again :( His teachers seem to be working with him and the special ed paraprofessional is great! I have received word that since we restated the slim fast break his behavior has improved significantly in his last period class. His first & second period classes state that they have not seen any behavior issues so far this year :) He is trying hard and doing well. We went to the chiropractor this week. Jamie has been complaining of neck, back and ankle pain. The doctor did scans along the spine to check for inflammation and muscle tension to help assess problem areas related to spinal/nervous systems. Jamie adjusted easily (MD is quite gentle and effective) and immediately stated he felt better (and his posture was notable better).
Auri is behind in a few classes and is working on getting the work she missed with volleyball turned in. She missed Tuesday as she was not feeling well (general yuckiness) She has skipped practices this week to focus on school work and so that we could go to the chiropractor after school. She has been complaining of neck and back pain and the doctors scans concurred. She was easily adjusted and states she feels much better.
I have been emailing the teachers and staying on top of the kids to do their work. The have a system similar to the ones in Vegas to follow school progress. It is called the PASS system. Bob, I can send you the website/ID & password; so that you can follow their grades if you like.
Kizzie is back from surgery today. Her ACL was repaired successfully :) Now she has 2 months of recovery. She is currently on house arrest with an Elizabethan collar to prevent her licking her wound open (I'm sure you all remember that she is a compulsive licker!) She is a bit depressed about the collar, but that's life. We have to ice her leg 2-3x a day and passive ROM 2-3 times a day. She will probably require some PT as she has not walked on her leg in a month and she is not using now either... we shall see...
The animals are enjoying Montana as much as we are.... we keep receiving 'gifts' from the cats... mice, bats, huge caterpillars, birds etc. Dogs and cats both love bounding through the tall grass :). Jan and I went riding yesterday and had a great time! Sypreme and I enjoyed our first trot and canter, it was great! We did have to walk them down a hill (side of mountain) that we went up as they were to upset to go down by themselves (it didn't help that it was a burned out area and we had to be careful of the holes where roots had burned out underground.) The rest of the ride was great.. too bad we can't go everyday :)
We are trying to plan a trip to Vegas to pack and haul the rest of our stuff up here. Aiming for 2-3rd week of October (to beat the snow and take advantage of "no school" days)
On the bright side, Jamie has not had a headache in the week!!!! Yeah. He did however, have the flu (vomiting/diarrhea) on Monday and therefore missed school-again :( His teachers seem to be working with him and the special ed paraprofessional is great! I have received word that since we restated the slim fast break his behavior has improved significantly in his last period class. His first & second period classes state that they have not seen any behavior issues so far this year :) He is trying hard and doing well. We went to the chiropractor this week. Jamie has been complaining of neck, back and ankle pain. The doctor did scans along the spine to check for inflammation and muscle tension to help assess problem areas related to spinal/nervous systems. Jamie adjusted easily (MD is quite gentle and effective) and immediately stated he felt better (and his posture was notable better).
Auri is behind in a few classes and is working on getting the work she missed with volleyball turned in. She missed Tuesday as she was not feeling well (general yuckiness) She has skipped practices this week to focus on school work and so that we could go to the chiropractor after school. She has been complaining of neck and back pain and the doctors scans concurred. She was easily adjusted and states she feels much better.
I have been emailing the teachers and staying on top of the kids to do their work. The have a system similar to the ones in Vegas to follow school progress. It is called the PASS system. Bob, I can send you the website/ID & password; so that you can follow their grades if you like.
Kizzie is back from surgery today. Her ACL was repaired successfully :) Now she has 2 months of recovery. She is currently on house arrest with an Elizabethan collar to prevent her licking her wound open (I'm sure you all remember that she is a compulsive licker!) She is a bit depressed about the collar, but that's life. We have to ice her leg 2-3x a day and passive ROM 2-3 times a day. She will probably require some PT as she has not walked on her leg in a month and she is not using now either... we shall see...
The animals are enjoying Montana as much as we are.... we keep receiving 'gifts' from the cats... mice, bats, huge caterpillars, birds etc. Dogs and cats both love bounding through the tall grass :). Jan and I went riding yesterday and had a great time! Sypreme and I enjoyed our first trot and canter, it was great! We did have to walk them down a hill (side of mountain) that we went up as they were to upset to go down by themselves (it didn't help that it was a burned out area and we had to be careful of the holes where roots had burned out underground.) The rest of the ride was great.. too bad we can't go everyday :)
We are trying to plan a trip to Vegas to pack and haul the rest of our stuff up here. Aiming for 2-3rd week of October (to beat the snow and take advantage of "no school" days)
Saturday, September 22, 2007
Jamie Update
I have included some technical info for those in the family that are familiar with the lingo and may want the more technical/supporting details.
Jamie responded well to treatment at the ER Sat night. No complaints Sun-weds
Weds-
He had his MRI done Weds evening.
Thurs-
He work up Thursday with a severe migraine HA (headache) scale 1-10 it was a 9, with blurred vision and dots in vision/eyes, loss of peripheral vision. Jan gave him phenergan, ice pack, TLCTLC (I am still in Vegas until Sat) the headache decrease to a 7 on same scale. Jan tried to give him a Coke (for the caffeine effect) but jamie did not drink it--so you KNOW he isn't feeling well when he doesn't want a Coke!!! Jan took made an appt. with the doctor in Frenchtown. On way to MD, I received a call from MRI dept. at hospital requesting another MRI with contrast (a dye placed in vein/blood to determine venous flow/involvement). This was scheduled to for that afternoon. Jamie received an excellent evaluation-very thorough-by the nurse practitioner (the very one I was hoping to get to be our primary MD). Her assessment agreed with dx of migraine. She gave him a dose of Imitrex which worked very well (decreasing pain at 1-2 min with pain decreased to 2 (same scale 1-10) within 10 min). This med is effective only on migraines as it effects the spasming vessels and has no effect on muscles (tension HA) or sinuses (sinus HA). He went home feeling much improved. He was back to being the cute inquisitive Jamie we all love. Jan took him in for his second MRI that afternoon (thursday). That night Jamie's headache (same classic migraine symptoms) returned and he was given another dose of Imitrex.
Fri-
He work up Friday with a HA level 6 (scale 1-10) with vision problems (of course) and nausea. He stated that his head throbbed all night. It was too soon for another dose of Imitrex so Jan gave him the ibuprofen & phenergan. He tried to go to school anyway, but was unable to make it to school before the HA worsened again. Jan took him back to MD. She had MRI results (to follow) and called neurologist for followup. We were unable to get in today and have an appt. for Monday morning at 10am. While waiting for the MD's to confer, Jan and Jamie went home. His headache continued to increase (spike) and subside this morning/afternoon. The MD called and discussed options with me; we agreed completely; I called and talked Jamie into returning to MD office for an injection to basically "knock him out" put him to sleep the rest of today and possible some of tomorrow in order to give his brain a rest and allow him to recover and break the HA cycle. He was given a Toradol & Vistaril injection and a script for another type of Imitrex that is long lasting and would stay in his system (longer half life) and help fight off recurrent headaches. I believe it is called Axert. Jamie was not knocked out by Toradol/Vistaril but it did relax him (he takes after his mom a little too much in all this :) So, Jan gave him a dose of this med (Axert) this evening (on MD recommendation) to help push Jamie over the edge and let him sleep. As we all know it is awfully hard to sleep with a migraine. Jamie woke up after a couple of hours feeling much better, watched Forest Gump and returned to bed.
I will be flying back to Montana tomorrow (Sat morning) and will of course, keep you updated as this story progresses.
*Severe/debilitating migraine headaches run in Sara's family (maternal grandmother's side) and have affected nearly every family member for many many generations.
MRI results
I can send the MRI report to any who would like to read the actual report findings. A Dr. of radiology read the CAT scan and both MRI and the findings are related to all 3 scans.
The short version is that Jamie has a 5mm x 6mm hypo-intense lesion on the immediate sub-cortical right anterior frontal lobe of his brain. The lesion demonstrates a small rim like area of contrast enhancement with 2 central areas of decreased signal intensity suggesting non-enhancement. remainder of parenchyma is unremarkable.
translation: he has a small area that is darker then the surrounding tissue in the right front area of his brain. The area around the lesion has increased blood or venous support (contrast mentioned in the dye placed in his veins/blood for the procedure) which is worrisome as it could indicate a venous network to support a tumor. The rest of his brain is fine.
Basically, Jamie has a small low grade brain tumor (neoplasm). The findings are nonspecific and could be a number of things including a calcification from an infectious lesion like tuberculoma or cypticercosis--but it unlikely as none of the surrounding tissue is affected or edematous. It could also be an atypical cavernous hemangioma or post traumatic calcification with gliosis except again there is no evidence of hemorrhage or trauma in the surrounding tissue (and Jamie has never had a severe head trauma). Which leaves us with the initial hypothesis-- a small neoplasm (low grade brain tumor).
The plan: we will follow up with the neurologist Monday. We will treat the symptoms as the arise and try to keep Jamie as functional as possible (related to the migraines). The migraines may or may not be related to or enhanced by the tumor. We will do a repeat MRI in a period of months to re-eval the area and see if there are any changes (i.e. growth) and correlate the MRI results with his symptoms over the same period. We can not really decide what to do or even if we need to do anything about this little tumor until we know more about it's nature. It is my understanding, at this time, that he is not in any immediate risk of death or other adverse effect. All you can really do right now is to keep him in your prayers, thoughts, mantras, whatever your philosophy and wait. I will be keeping you all informed as we progress through the next few months.
*of note for those of you who are LDS-my mom will have his name placed on the temple prayer roll.
An interesting correlation- the general area of the brain where the tumor is directs planning, motivation & attention. Lesions in this area are noted to cause: apathy (occasional brief anger or aggressive outbursts), indifference, psychomotor retardation, motor preservation and impersistence, loss of self, stimulus-bound behavior, discrepant motor and verbal behavior, poor abstraction and categorization. Hummmmm, interesting, makes you wonder how long this little tumor has been there...
Jamie responded well to treatment at the ER Sat night. No complaints Sun-weds
Weds-
He had his MRI done Weds evening.
Thurs-
He work up Thursday with a severe migraine HA (headache) scale 1-10 it was a 9, with blurred vision and dots in vision/eyes, loss of peripheral vision. Jan gave him phenergan, ice pack, TLCTLC (I am still in Vegas until Sat) the headache decrease to a 7 on same scale. Jan tried to give him a Coke (for the caffeine effect) but jamie did not drink it--so you KNOW he isn't feeling well when he doesn't want a Coke!!! Jan took made an appt. with the doctor in Frenchtown. On way to MD, I received a call from MRI dept. at hospital requesting another MRI with contrast (a dye placed in vein/blood to determine venous flow/involvement). This was scheduled to for that afternoon. Jamie received an excellent evaluation-very thorough-by the nurse practitioner (the very one I was hoping to get to be our primary MD). Her assessment agreed with dx of migraine. She gave him a dose of Imitrex which worked very well (decreasing pain at 1-2 min with pain decreased to 2 (same scale 1-10) within 10 min). This med is effective only on migraines as it effects the spasming vessels and has no effect on muscles (tension HA) or sinuses (sinus HA). He went home feeling much improved. He was back to being the cute inquisitive Jamie we all love. Jan took him in for his second MRI that afternoon (thursday). That night Jamie's headache (same classic migraine symptoms) returned and he was given another dose of Imitrex.
Fri-
He work up Friday with a HA level 6 (scale 1-10) with vision problems (of course) and nausea. He stated that his head throbbed all night. It was too soon for another dose of Imitrex so Jan gave him the ibuprofen & phenergan. He tried to go to school anyway, but was unable to make it to school before the HA worsened again. Jan took him back to MD. She had MRI results (to follow) and called neurologist for followup. We were unable to get in today and have an appt. for Monday morning at 10am. While waiting for the MD's to confer, Jan and Jamie went home. His headache continued to increase (spike) and subside this morning/afternoon. The MD called and discussed options with me; we agreed completely; I called and talked Jamie into returning to MD office for an injection to basically "knock him out" put him to sleep the rest of today and possible some of tomorrow in order to give his brain a rest and allow him to recover and break the HA cycle. He was given a Toradol & Vistaril injection and a script for another type of Imitrex that is long lasting and would stay in his system (longer half life) and help fight off recurrent headaches. I believe it is called Axert. Jamie was not knocked out by Toradol/Vistaril but it did relax him (he takes after his mom a little too much in all this :) So, Jan gave him a dose of this med (Axert) this evening (on MD recommendation) to help push Jamie over the edge and let him sleep. As we all know it is awfully hard to sleep with a migraine. Jamie woke up after a couple of hours feeling much better, watched Forest Gump and returned to bed.
I will be flying back to Montana tomorrow (Sat morning) and will of course, keep you updated as this story progresses.
*Severe/debilitating migraine headaches run in Sara's family (maternal grandmother's side) and have affected nearly every family member for many many generations.
MRI results
I can send the MRI report to any who would like to read the actual report findings. A Dr. of radiology read the CAT scan and both MRI and the findings are related to all 3 scans.
The short version is that Jamie has a 5mm x 6mm hypo-intense lesion on the immediate sub-cortical right anterior frontal lobe of his brain. The lesion demonstrates a small rim like area of contrast enhancement with 2 central areas of decreased signal intensity suggesting non-enhancement. remainder of parenchyma is unremarkable.
translation: he has a small area that is darker then the surrounding tissue in the right front area of his brain. The area around the lesion has increased blood or venous support (contrast mentioned in the dye placed in his veins/blood for the procedure) which is worrisome as it could indicate a venous network to support a tumor. The rest of his brain is fine.
Basically, Jamie has a small low grade brain tumor (neoplasm). The findings are nonspecific and could be a number of things including a calcification from an infectious lesion like tuberculoma or cypticercosis--but it unlikely as none of the surrounding tissue is affected or edematous. It could also be an atypical cavernous hemangioma or post traumatic calcification with gliosis except again there is no evidence of hemorrhage or trauma in the surrounding tissue (and Jamie has never had a severe head trauma). Which leaves us with the initial hypothesis-- a small neoplasm (low grade brain tumor).
The plan: we will follow up with the neurologist Monday. We will treat the symptoms as the arise and try to keep Jamie as functional as possible (related to the migraines). The migraines may or may not be related to or enhanced by the tumor. We will do a repeat MRI in a period of months to re-eval the area and see if there are any changes (i.e. growth) and correlate the MRI results with his symptoms over the same period. We can not really decide what to do or even if we need to do anything about this little tumor until we know more about it's nature. It is my understanding, at this time, that he is not in any immediate risk of death or other adverse effect. All you can really do right now is to keep him in your prayers, thoughts, mantras, whatever your philosophy and wait. I will be keeping you all informed as we progress through the next few months.
*of note for those of you who are LDS-my mom will have his name placed on the temple prayer roll.
An interesting correlation- the general area of the brain where the tumor is directs planning, motivation & attention. Lesions in this area are noted to cause: apathy (occasional brief anger or aggressive outbursts), indifference, psychomotor retardation, motor preservation and impersistence, loss of self, stimulus-bound behavior, discrepant motor and verbal behavior, poor abstraction and categorization. Hummmmm, interesting, makes you wonder how long this little tumor has been there...
Sunday, September 16, 2007
Jamie Migraine
Here is your kid update for this week.<br /><br />Auri is doing well, still very busy. Chemistry honors is making her stretch her brain muscles (esp. the math) :) It doesn't help that she has missed so many classes due to Volleyball. She is planning to go to Missoula this afternoon to see a movie with some friends from school. (Update- movie was moved to next weekend) She has found a group that she gets along with well-they even have seen Monty Python!! :) We opened her bank account in Frenchtown and she has full access to withdraw and deposit and even has an ATM card. We discussed the premise and rules of banking and that she had only 1 chance to have an ATM card-one overdraft and she would lose the privilege. She has been babysitting and wants to deposit some money in her bank. I am proud of her and support her growth. We will transfer 1/2 their money from Vegas to Frenchtown, but leave the LV bank open for when she goes there for the summer; as she will need a bank to put her paychecks in (she plans on working this summer) She may even get a job at the Frenchtown grocery or restaurant when she turns 16. She will have a learning lab/study hall next semester and therefore a lighter academic load. So, she would be able to work part-time.<br /><br />Jamie is also having to make up a lot of missed work from missing school related to Soccer. The school sends out letters to parents when their child is at risk (weekly). I got one this week for Jamie related to his English- at risk and Science- failing (due to missing assignments/low scores/incomplete). He has since turned in this work, but with soccer straining his time in school and for homework, he will have to buckle down a little harder. We are not riding him about this, as he is well motivated to stay eligible to play with his team. He seems to be doing well even without any allowances at this time (excepting a small learning lab class-only 6 students). I have a meeting set up with the special ed people (and his teachers) to discuss, assess and redo his IEP to fit into the FHS system (as it is much different thin the Vegas system and his current IEP is not feasible or even possible at FHS).<br /><br />He is progressing well in soccer and is now very proud that he is better then 5 other team players (almost half) according to the team captains.<br /><br />Of importance to all: Jamie had a bad day yesterday (saturday), but not related to behavior or grades. Around 1pm he complained of loss of peripheral vision in his right eye. He also admitted to a headache so he took 3 advil (he also has a sprained ankle) and left for the soccer game. On the bus it hurt to move his eyes, so he kept them closed. He played on the game for about 10-15 min then blacked out on the field. He was only out for a brief moment and woke up on the ground looking up at his team captain (who was closest to him when he fell). He sat the rest of the game out. We picked him up afterwards, and he stated he was fine (of course). We had dinner and ice cream (at <a href="http://www.bigdippericecream.com/">Big Dipper</a>-Yummy!!!) and Auri and Jamie were being silly in the back seat. Jamie suddenly cried out and stated that his head hurt when he laughed.<br /><br />3 strikes: off to the ER we go. Upon arrival he added that his head hurt when he turned quickly, but moving slowly did not bother him. All head pain was in the back on his head toward the left side. The MD did a good assessment, EKG & CAT scan. EKG was perfectly normal. CAT scan showed a calcification in his right frontal lobe that requires further follow-up but is probably not related directly to Jamie's current problem (maybe his other problems?? or maybe even just an unusual anatomy (i.e. a bundle of vessels and not a calcification at all).<br /><br />His diagnosis: new onset-Migraine headache. Welcome to the family curse :) Although I freely admit a strong family history of migraines (everyone in my family has terrible migraines) I thought Jamie too young... then I remembered that he was 14.5 yrs. old... and we all started having HA in our teens... bummer :( They gave him phenergan and that helped. He has a slight HA this morning. He will be scheduled for a MRI on Monday to evaluate the area of calcification in his brain and I will try to find an MD to follow-up with next week. I will keep you up-to-date as we followup with the doctor. HE IS IN NO RISK AT THIS TIME.<br /><br />I will be in Las Vegas this week for MD appts and follow up. Jan is taking care of the kids, animals and home :) Our montana home is definitely keeping us busy. This week: electrical problems, and the well went out and had to be repaired, the same day as the pump for the creek went out (of course) so we had no water for a day, until Jan was able to get it repaired the next afternoon. He is so handy (with the help of some very nice neighbors)!!! <br /><br />The horses and Kizzie have been going through health issues but seem to be improving. Kizzie seems to have caught Giardia which is surprising until your see her in the creek attacking and biting and practically drowning herself trying to catch the water as it flows over the rocks.... silly dog! She has soo much fun; she goes crazy!!! Romeo is doing much better since he started obedience classes. Auri is doing better also; she is learning to have patience and control her temper... good skills for her to develop.<br />
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