The neurologist from MD Anderson's Brain and Spine Center squeezed Lorelei in for an appointment today. The appointment lasted 2 1/2 hours! I've never seen such a thorough examination. And even after all of that, we still don't know exactly why Lorelei's face is paralyzed!
Lorelei definitely has a Bell's Palsy which is caused by some pressure or inflammation around the 7th cranial nerve. The original fear (last Thursday) was that it was related to some new lymphoma in the area. The spinal tap taken that day came back clear. Then the Brain CT (taken Thursday before the spinal tap and bone marrow biopsy) appeared clear of any new masses in the area. Still no answers. So they did an MRI of her brain yesterday. After the MRI Lorelei asked if she could begin a prescription of steroids to help the paralysis go away sooner. (They usually treat Bell's Palsy with steroids and an antiviral medication. She's already taking the antiviral medication to help after the transplant.) But they didn't want to start her on steroids before the MRI because steroids can also reduce the appearance of lymphoma and could make a new tumor difficult to discern. Once the MRI had been completed yesterday it seemed reasonable to begin the steroids. But the neurologist and the transplant oncologist were still reluctant to prescribe them and wanted us to wait until the appointment on Thursday. They wanted the radiologist to have enough time to complete his review of the MRI first. We were sent "home" with nothing but more questions.
We were tempted to worry after leaving the hospital yesterday. We feared starting steroids too late might increase the odds that the palsy would be permanent. We had to keep our mind on Jeremiah 29:11 and remember that God has big wonderful plans for Lorelei.
New International Version (NIV)
"For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future."
When we got the call this morning (Wednesday) that the neurologist was working us in right away we rushed right over to the hospital. Upon meeting with the neurologist we learned that the radiologist had not yet completed his analysis of the MRI. The neurologist had asked him to pay extra special attention to some specific areas and that may have contributed to the delay. The neurologist is an expert at brain tumors but doesn't see a lot of cases involving nerves in the area where the 7th cranial nerve runs so he wanted the radiologist with daily experience looking at that area to make a final analysis. Hopefully we'll get the all clear from the radiologist tomorrow. It's possible that the MRI won't show anything because there was nothing but inflammation that caused the palsy in the first place and that inflammation went away even before the MRI was taken. Anyway, the MRI looked clear to us. After all, Lorelei is practically a neurologist since she thoroughly read the chart on the wall and read everything Wikipedia had to say about Bell's Palsy. So we're not worried.
Studies indicate that steroids are most helpful if given within 3 days of the onset of the palsy. Even though we missed that window, Lorelei went ahead and began a short six day course of them today. It shouldn't hurt and it might help.
The neurologist mentioned the possibility of doing a PET CT scan and maybe a few immunological tests. We'll meet with the transplant oncologist tomorrow and see if she agrees that any of those tests are advisable. We'll sleep tonight and fight Houston traffic tomorrow!
Posted on Wed, August 28, 2013
by Andrea Decker