The Short Version
Based on some tremors I was experiencing in my right hand starting June 8 and a single odd episode of speech disturbance on July 3, I saw my primary doctor and then was referred to a neurologist who suspected I was having partial seizures. After an EEG and MRI test were performed, they found several small lesions in my brain. An MRA (magnetic resonance angiogram of the blood vessels to the brain) and CAT scans followed, which revealed a small mass in my upper left lung. The doctors suspected lung cancer that had spread to the brain.
The Longer Story
The first sign of something amiss occurred on June 8, 2010 when I was taking notes for several hours for a training session. My right hand suddenly spasmed and jerked while I was writing. This happened several times that afternoon. Since that day, I have continued to have difficulty writing fluidly and have to concentrate on relaxing my arm and slowing down to keep my writing more legible. I initially attributed this problem to fine motor muscle fatigue, but as I said it continues to occur and it also became more frequent and now includes trembling at times when holding a glass or even a fork full of food.
The next sign came on July 3 at a barbeque when I had about a 15-minute episode where I could not speak the words for common concepts that I could almost visualize in my brain. It was very similar to a "tip of the tongue" situation, but I knew it was something different and could tell when it started and when it subsided. The last minute or so of this episode included some tingling in the tips of my right fingers. I thought this may have been brought on by dehydration, but checked the symptoms of dehydration on the web and found it was not a match. My next concern was a TIA, which is a warning mini-stroke. I sent an email to my doctor describing my symptoms. As it was a holiday weekend, she was not available, but I received a reply on July 5 from one of the associates at the practice saying I should make an appointment.
I did not rush to make the appointment in part because I didn't want to make this a big deal and in part because I was in the midst of a very busy travel season for work and leisure. I finally had my appointment with Dr. Caplan on July 23. She thought the tremors were intentional tremors and the episode was not too serious, but worth looking into further so she had me go to see a neurologist, Dr. Mary Angelopolous.
I had my appointment with Dr. Angelopolous on August 11. She suspected that the tremors and the episode with the speech problem were related and were possibly due to partial seizures. She ordered an MRI with and without contrast, and an EEG. I had the EEG on August 13 and the MRI on August 14. I was scheduled to have a follow up appointment with Dr. A on August 20, after I returned from another week of business travel.
But instead, on Monday August 16, Dr. A called me at 9:30 in the morning saying she wanted to see me that afternoon at 1:00. That's when I first knew there was trouble. I called Doug who came home immediately from work to be there with me at the 1:00 appointment. At the appointment, Dr. A told me that both the EEG and the MRI came back abnormal. The EEG showed slowed reactions in both parts of the brain and some sharp waves, indicating that I was having seizures. On the MRI, there were 4 or 5 small rounded lesions scattered across different parts of the brain. These were apparent both with and without the contrast, but lit up with the contrast, indicating inflammation. The possible causes she cited were cancer (most likely a secondary site), a blood clot that spattered in the brain, some kind of infection, or vasculitis (a swelling/inflamation of the blood vessels in the brain, potentially caused by some autoimmune disease).
Dr. A wanted me to cancel my business trip (I was to leave two hours after this meeting) and have more tests done ASAP. I was very reluctant to cancel my trip, but ultimately decided I should. So then I had an MRA (magnetic resonance angiogram that looks at the blood vessels in the brain) of the head and neck and a CAT scan of the chest, abdomen and lungs on Wednesday, August 18. She also put me on anti-seizure medication since the lesions had caused some short circuits in the brain's electrical system that led to the seizure I had on July 3 and could cause other more serious seizures if left untreated.
I had a follow up meeting scheduled with both Dr. Caplan, as my primary physician orchestrating all of this information, and with Dr. A, for Friday, August 20.
At the 11:30 meeting with Dr. Caplan on August 20, I learned that the CAT scan revealed a 2.5 cm x 1.4 cm mass in the upper left portion of my lung. The mostly likely prognosis was lung cancer that had already spread to my brain.
Dr. Caplan arranged for Doug and I to meet Dr. Theresa Law, an oncologist, that afternoon at 3:30. At that meeting, Dr. Law showed us the film of the CAT scan where the mass appeared and told us it was very likely that it was lung cancer.
She said that due to the fact that it had already spread to the brain, there wasn't much likelihood that surgical removal would be of much benefit. And because the lesions in the brain were so small and scattered in so many different places, surgery was unlikely for that as well. She said the likely timeline was six months to two years.
She said the top priority was to reduce and control the brain lesions, which would likely be done with radiation and then possibly followed by chemotherapy, but this was getting ahead of ourselves. The next step was to do a biopsy of the lung to determine if in fact it was a cancerous mass and if so, what type of lung cancer it is. The biopsy was scheduled for August 23. In the meantime, she prescribed a high dosage of steroids to begin to reduce the inflammation of the brain lesions. The next step would be to do a PET scan to determine if the cancer had spread anywhere else. This has not been scheduled yet.
We then had the weekend to try and process all of this information and start to share the bad news with family and friends.
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