May 11, 2023
Fortunately for you the reader,
this is where the journey starts to slow down as I entered the waiting game. My
inpatient hospitalization was about 72hours and by that time I was itching to
get back home. Repeat blood work showed no great concerns and the MRI results
needed to be discussed with Neurosurgery.
On this date my wife and I sat
alongside a local Neurosurgeon who also happened to be the head of the Mobile
Stroke Unit for UR Medicine (God knows what you need at any time, and so,
He will bring just the right people to offer you what you need). I can only
hope that other professions share the sense of family and strong bonds that we
have within the medical field. Even though we couldn't get the answers to all
of our questions, empathy, friendship and just having the ability to be
comfortable enough to talk about our concerns was more than we could have asked
for.
There is a reason I chose
nursing, primarily to be an advocate for my patients and to have that time to
provide that level of empathy and comfort. Unfortunately, our healthcare system
is so overburdened and burned out that at times we have lost that sense of
belonging to our profession and instead have become robotic task-oriented
workers. Our world has come to demand answers to our health concerns
immediately and is unwilling to maintain the patience it takes to fully
diagnosis our ailments/illnesses. We live in a world of immediate
gratification and unwilling to recognize the human aspect of medicine. Unfortunately,
I do not see medicine changing until we as a society change our viewpoint and
over-reliability of healthcare institutions.
On the flip side, I now found
myself feeling like my own burden to the healthcare system. Granted I had
started this process many months prior allowing my PCP to drive my care. But
here I was taking up a hospital bed for someone else sick, in hopes of getting
immediate answers. Unfortunately, in my years practicing medicine I have come
to realize that there are two polar opposite spectrums to healthcare. On the
left we have the population who utilize emergency care as a means to provide
their basic primary care needs while the other side either refuses to be part
of the healthcare system or waits too long before figuring out what is wrong.
Having lived 40+ years and being relatively healthy, I fell hard right on the
spectrum. Nonetheless I had started this journey and now attempted to navigate
the system properly and appropriately.
For the first time my wife and
I came face to face with the resident taking up space in my cranium. I am
definitely not an expert at reading/interpreting MRI or CT images but
immediately we both saw "him". I am not a female and certainly cannot
come close to relating the emotion of carrying and then delivering a baby
however, this might be as close to that experience as a male will ever get. It
is a mixed bag of emotions seeing firsthand something growing inside of your
body (good or bad). It came with a sense of relief but also fear of the
uncertainty. For the people who are visual learners this is where I introduce
you to Brian. Congratulations are not necessary but looking at the prognosis
and course of treatment, Brian may make his appearance into the world at about
the 9mo mark! Below I have attached both my CT scan (dry, non-contrast) and
then my initial MRI imaging. I have attempted to label appropriately some of
the anatomy to help you get a better sense of where and how big Brian really
is. A big part of me is hoping that Brian weighs at least 8lbs at time of
"delivery" but fortunately he is still only a small peanut.
Findings:
Within the sella there is heterogeneous enhancement on the postcontrast images with a mass in the left lateral aspect measuring approximately 14 mm in AP by 11 mm in craniocaudal by 12 mm in transverse dimension, best seen on 10-6, 14-6. There is convex upper border to the mass. The mass extends to the left cavernous sinus and abuts the internal carotid artery. The mass is of high T2 and intermediate to low T1 signal intensity and likely separate from the pituitary gland, best seen on 9-11. There is mass effect on the pituitary gland which is compressed. The pituitary stalk is shifted slightly to the right. There is scalloping of the posterior border of the sella, left lateral aspect of the posterior clinoid, best seen on 16-33, likely representing chronic nature of the mass. Suprasellar region, optic chiasm, region of the cavernous sinuses are within normal limits. Differential considerations include craniopharyngioma, pituitary macroadenoma, meningioma which could be atypical, hemangiopericytoma.
IMPRESSION:
1. 14 x 12 x 11 mm mass in the left lateral aspect of the sella extending to the cavernous sinus and abutting the left internal carotid artery. Mass effect as described. Leading differential possibilities include craniopharyngioma, macroadenoma or
meningioma.
2. No evidence of acute infarction, hemorrhage, hydrocephalus.
3. Neurosurgical consult is recommended.
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