Monday, November 30, 2015

Acoustic Neuromas

In the brain, there are 12 essential pairs of cranial nerves that carry out many different functions such as bringing information from the sensory organs to the brain, control muscles, help control glands, and help control organs such as the heart and lungs. Here is a diagram of the cranial nerves in the brain, in case you all were wanting to memorize them on your day off! To all my nursing friends, does this bring back memories from second year?!


An acoustic neruroma (also called a vestibular schwannoma) is a slow growing tumor that develops on the vestibulocochlear nerve, which is in charge of hearing and balance. This type of tumor is usually slow growing, and is seen more often in people with Neurofibromatosis Type 2 than in those with Type 1.

Causes: 

It is thought that acoustic neuromas develop from an overproduction of Schwann cells. Schwann cells help speed up how fast messages are sent along special nerve pathways in the brain. It is estimated that 5% of brain tumors caused by NF are acoustic neuromas.

Signs and Symptoms include:

  • Hearing loss -- this is the most common symptom of acoustic neuromas, and is seen in approximately 90% of patients
  • Tinnitus (ringing in the ears) 
  • Vertigo 
  • Problems with balance
  • Feelings of pressure inside the ear
  • Facial weakness and numbness 

Diagnosis:

The two most common tests used to diagnose acoustic neuromas are ear examinations and hearing tests. Usually the first test performed to diagnose an acoustic neruroma is an audiometry test, which is hearing test that measures how well a person can hear certain sounds. A patient listens to different sounds and speech and is attached to a machine that records the patients responses and measures hearing function. Another test that can be done is called a "brainstem auditory evoked response test", which provides information on a patients brainwave activity as they listen to different tones. While the patient listens to these different sounds, they have electrodes attached to their scalps, which help to pick up the brains responses to different sounds and tones.

MRI and CT scans can be used to determine the exact location of the tumor on the cranial nerve and the size of the tumor

Treatment(s): 

The two primary treatments for acoustic neruromas are surgery and radiation therapy. These surgeries have some pretty funky names so I'll do my best to describe them for you!

1. Translabyrinthine -- an incision is made behind the ear, and the bone behind the ear and some of the middle ear is removed to access the tumor. This type of approach allows the doctor to see the facial nerve, but it unfortunately results in permanent hearing loss.

2. Retrosigmoid/sub-occipital --- the skull is opened near the back of the head. Typically this is used to remove larger tumors, and there is a greater likelihood that hearing would be preserved... Horray!

3. Middle fossa -- a small piece of bone is removed above the ear canal to access smaller tumors, hearing may also be preserved with this approach too!

Radiation therapy is usually used when surgery for whatever reason is not an option.



I hope you all learned something new this week, I know I sure did!

Court



References used:
https://faculty.washington.edu/chudler/cranial.html
http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/brain_tumor/center/acoustic-neuroma/diagnosis.html 
http://www.webmd.com/brain/acoustic-neuroma-causes-symptoms-treatments?page=2#1

Monday, November 16, 2015

Why I Want to Be a Nurse

One question I commonly get from co-workers in my undergraduate position, my peers, and patients is "Why did you become a nurse?" Well, my answer isn't quite as simple as some people's might be. Sure, I have an innate desire to help people, but my passion for my career stems from something much deeper.

Having been hospitalized for tests, procedures and appointments, means I've had plenty of exposure to the health care system. I've had some amazing care over the years, but I've also had some that was extremely sub-par. I learned a lot about caring, compassion and empathy long before I immersed myself in nursing school and learned about these qualities.

There's one nurse that sticks out in my mind from the last 8 years of medical care I've received, and I attribute much of my passion for nursing to her, and her zest for life.

I remember sitting in one of my neurosurgeons offices after one of my many exhausting visits trying to figure out the root cause of my headaches, feeling completely defeated. Another appointment, and still no answers as to what was causing them. My doctors were stuck, they didn't know what else to try as at this point, I had done almost everything to try and get rid of these headaches. I was really struggling with chronic pain, anorexia, and depression at this point in time, and all I wanted were some answers.

I was starting to pick some of my things up and put my jacket back on when the nurse practitioner who worked with my neurosurgeon walked into the office and sat down next to me. I thought she was there to tell me something miraculous... they found the root cause of my headaches! They know what to do with me to get rid of this horrible pain! HORRAY! My mind was racing thinking of all the wonderful things she was going to tell me. Instead, Wendy grabbed my hand and looked me directly in the eyes as she said "Courtney, you have anorexia."

Those words hit me like a load of bricks. I felt breathless. It took me a minute to process what she was saying. I knew I had an eating disorder, so that wasn't a surprise to me when she "broke the news". What surprised me was, Wendy said the words that nobody had the courage to say before. She made my problems real. She recognized my silent cry for help. She realized that I needed validation, that I needed someone to bring me back to reality. All I remember at this point in time is my eyes filling up with tears, I started to cry. I felt relieved. Wendy sat there in complete silence as she stroked my back. She let me sit there until I could gather myself enough to say:

"Thank you"

Wendy didn't do anything life saving, she didn't perform CPR, or give me a medication that would save my life. She didn't find anything abnormal in my neurological assessment. but she recognized the emotional pain I was experiencing, and that takes a special person. Wendy didn't medicalize  me like so many people had in the past. I've seen my chart, with words like "anorexic", and "depressed" scrawled across the page. I didn't choose  to have depression, I didn't choose to have anorexia. These illness are not me, they were part of me, but they did not define who I was. I was (and still am not) a diagnosis. I am a person with a diagnosis, and that's how Wendy saw me. She saw me as a young teenager who was terrified, and recognized that all I needed was someone to talk to. To her, I was a holistic being, I was so much more than a file number or a condition. I was a person. Who had feelings, who felt pain, and who just needed a little bit of validation.

It was after this encounter that I really realized that I wanted to be a nurse. I wanted to be someone that my patients could trust, I wanted to be someone that made a difference in the outcomes of an ill individual. I wanted to be a voice for those who couldn't speak up for themselves. Wendy saved my life, and I felt such a strong desire to reciprocate and give back to my community.

Now, I don't expect to have the same kind of experience in my future nursing career. All I expect of myself is that I put my scrubs on everyday and remember that my patients are people. I've seen it all too often... nurses are busy. They have heavy schedules, are caring for a number of very ill patients at one time. There are medications to give, dressings to be changed, patients to be re-positioned, new orders to be processed, admissions, discharges, deaths... the list of tasks that a nurse has on any given day is endless. There are days that I work that I don't even get to use the washroom in the 8 hours I'm there because I am so busy, but I will NEVER neglect my duty as a nurse to see my patients as holistic beings. I will never forget that they too, may just be looking for a little validation.


- Court

P.S. For any of my nursing friends reading this.... 199 days till graduation! Woo hoo!

Monday, November 2, 2015

Finding Courage Behind Ignorance

You know, over the years I've come to realize that people will say almost anything behind a computer screen. They're protected, anonymous. People can say what they want and not have to deal with the consequences. People find solace and comfort knowing they're protected in cyberspace, and this a troublesome problem.

Recently, I came across an article on Facebook called "Horrible Disease: 64-Year-Old Woman Covered in Benign Tumors". Intrigued and interested in the article on Neurofibromatosis, I clicked the link and was soon blasted with people's ignorance and hurtful comments. The article itself said that this woman was "once beautiful" and that statement really made me think. Why was she once beautiful? Is she no longer beautiful because of the tumors covering her face? Is she no longer beautiful because she doesn't meet what society's "standard" of beauty is? The ideal body has always been some form of "slim", with a face with prominent cheek bones and big eyes. In order for a female to go into the modeling industry they have to be 5'6-5'11 and weigh between 90-120 lbs... meaning the standards of beauty have been unrealistically set. WHY is this society's standard? Why are we so focused on physicality when there is so much more than appearance to human nature? Why are we judging this lady based on her physical assets?

After reading the article and watching the video, for some reasons I decided to scroll down and read some of the comments posted, hoping that I might be able to discover more people in the NF community that I could network with. Unfortunately, I found nothing but ignorance and cruelty. I read through the comments, keeping track of two different things:

1. Hurtful comments
2. Comments that encompassed compassion, empathy and kindness

I was shocked when the number of cruel comments completely outnumbered those of kindness and compassion. My heart physically hurt... why are people so cruel?...I kept asking myself. How does this benefit someone? I've debated about posting some of these comments below, but I'm not going to because I want this to be a place of positivity where people feel safe, I don't want any attention to be drawn to the negative aspects of social media.

After sitting in front of my computer for well over half an hour trying to think of something to say to these people who were making awful comments, I came up with nothing. Nothing that I say will change their perspective, nothing that I can say will make them less ignorant or less demeaning. I don't need to start a war on Facebook to make change, because I want the change to start here. 

For so long, I strove to be the girl who fit society's definition of beauty. I wanted to feel like I fit in. If I looked like I was supposed to, people would like me... right?! After trying for so long to "fit in" I realized that I wasn't doing something right. I needed to make a change. I came to the realization that I can try my very hardest to fit that cliche beauty standard, but there would ALWAYS be someone out there who disapproved, or thought I could be better. I asked myself why I cared what other people thought of me and I came up with nothing.... why should I care what people think? As long as I am happy with me, then shouldn't everyone else simply accept that? 

Now, the point of this post was not to highlight the cruelty of some people or to bring shame to this article. The point of this blog is to provide one thing to anyone reading: courage. Now, courage sounds all great and mighty but it requires us to let go of what other people think of us. It requires us to act boldly, to be brave, and dive into a web of self-acceptance. Courage isn't something you'll wake up one day with, or develop over a week. Courage is an ever evolving concept, where our vulnerability is made visible to everyone, and I believe that once we let go of what other people think of us, we gain more insight into our own self worth ... THAT is when we will start to make change in the NF community. We don't need to retaliate on social media, we just need to show people that regardless of what they think or say, we will still always love ourselves. In the end, that's all that matters... right? 

Have a wonderful week everyone, try and say something positive to yourself and one other person today!

- Court