I asked myself this question as a mom and clinician thinking on my feet the morning of June 13th in the ER after my son suffered his second tonic-clonic seizure of this year and the ER doctor was quick to turn to the CATSCAN as the first choice. This is an example of how life just happens regardless of whether or not one has cancer or is fighting cancer -- it's one heart-wrenched dilemma we faced during this cancer trail.
My husband said that he heard an NPR report on the recent studies of CATSCANS on children -- and how these have contributed to cancer in children. Of course I'm super sensitive about this topic being that I'm a cancer fighter -- the thought of my child developing a cancer makes me ill.
In neuroanatomy classes, as clinicians, we learned that when a patient goes into the ER and has a stroke then the choice of brain imaging is CATSCAN. Though it is the equivalent of roughly 300 x-rays, in the few minutes it takes to do it can reveal so much about a person's type of stroke or brain insult. You want to rule out a bleed, like a hemorrhage, because that determines the type of medication you give the patient. Imagine giving a blood thinning medication to a person who is already bleeding -- that person could bleed to death. In this instance you'd want a blood clotting medication. It's the doctor's call -- but we all can contribute to the discussion by providing clear details of the event and by careful observation.
In the ER my head was pounding 'think think think think think'.... why is she ordering the CATSCAN over the MRI? Is it a time sensitive thing she's doing because if he's behaving like there is a bleed then we need to go down the CATSAN route. Or, is it a convenience thing -- is it easier to schedule or cheaper to do?
In our son's case, there are so many things to weigh into the decision making process: his duplicate chromosome two has wreaked some havoc on his system -- making it more susceptible to things, everything from GI to lungs up through neuro stuff; but, he's also overcome things all along the way and we are super hopeful that one day, as an adult, these things will all be a distant memory buried in so many positive experiences filled with love. One day his body will be so strong that he'll be the case example of complete breakthrough -- like the athlete who makes an Olympics after being told that he or she would never run again prior to even qualifying for an Olympics due to an ugly injury. The other things to weigh in to the decision of CATSCAN or MRI is that he has a history of motor challenges in his brain. For instance, in apraxia, he knows what to say -- the formation of his words and ideas are fully functional in his brain -- but the connection to the mouth is off. Apraxia is motor related. He also has dysarthria -- another motor related thing stemming from the brain -- and this causes muscle weakness. In our case, the motor part causing the motor weakness is in the tongue and cheeks. The chromosome 2, the apraxia, the dysarthria are obstacles he's had to overcome obstacles -- he's worked so hard to get where he is today but these are always on the back burner in decision making processes when some big event takes place, like an ER trip.
This time the new thing that entered into the weigh in process was that after the seizure his tongue was paralyzed and so was his left arm. The first thing I thought was that he was having a stroke. So if this were true, a CATSCAN would be the first imaging you'd turn to because it could save one's life. Like I mentioned above, it is done within a few minutes and can image broken vessels causing bleeds in the brain if it's the type of stroke that is a bleed which calls for a clotting medication; if it's not a bleed type of stroke then one gets a blood thinner. If you give the blood thinner when someone is having a bleed then one can bleed to death which is why the CATSCAN and timing is important.
In our case, the paralysis came after the seizure. If no seizure happened, then it's safer to say it was a stroke especially if the tongue and arm stayed paralyzed. In our case, after about an 45 minutes (the time it happened plus the time it took to get to the ER, registered, and seen by the doctor) his tongue and arm slowly started to function again. Since the paralysis came with a seizure there is something called Todd's Paresis which mimics a stroke but isn't. In this case, the MRI is the best call since, though it takes about 45 minutes vs the few minutes of the CATSCAN, it does not expose the body to the 300 times radiation that the CATSCAN exposes one to. In fact, the MRI does not use radiation at all and therefore does not contribute to cancer.
Today we are recovering from a what was a cold; it's now a week since we had started a fever. He has an MRI appointment to rule out certain causes of the seizure. In our case, we are praying it was febrile and nothing else. We also have appointments set with his neurologist, GI, ENT, and pediatrician.
Like I also mentioned above, fighting cancer does not mean life stops. Life happens with all its easy and hard experiences and all these experiences have to be met face on. What did help the doctor in our case is learning how sensitive we are to cancer since I'm fighting (and it was obvious with my bald head); if I did not have cancer or concerns of radiation exposure then the CATSCAN would have been his only option -- which would have been ok if he was indeed having a stroke -- but he was having Todd's paresis instead.
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