82-year-old aunt used to experience special discomfort occasionally.
She was given medicine and was fine for some time, then the discomfort increased again.
Several times in the last eight months, she fell ill, and once in the bathroom, her leg slipped, and she fell, and she had to undergo a major operation!!
Due to all these troubles, her appetite decreased, and she had to endure stomach problems as well.
Recently, she was admitted to the hospital under the care of Dr. Rajesh Trivedi, and he suggested seeing me due to her stomach issues.
When I went to see her, she was having difficulty breathing. I asked what the problem was.
She couldn’t speak clearly at that moment, so her son told me…
“Sir, she has lost her appetite for the last eight months, and due to the medications and the operation, her stomach has become warm. She suffers from gas, acidity, and constipation. She coughs occasionally due to these issues.”
Me: “What is the breathing problem?”
Son: “Sir, she didn’t have any breathing issues before. But now, she is having difficulty breathing due to asthma, which was diagnosed a few months ago.”
Me: “But having asthma at this age is very unusual!”
Son: “Let it be, sir. We are tired; we have tried everything for the last six to eight months. She hardly eats anything. Please try to understand; feed her something at least.”
Me: “So, she doesn’t feel hungry at all?”
Son: “She does, but she only consumes liquids. Due to all these problems and the medications, there is so much heat in her stomach that it affects her chest. Even simple things like eating roti (bread) or grains bother her. She can’t digest anything properly.”
Me: “She can’t digest anything means…? Explain it to me in detail.”
Son: “Whatever she eats, she vomits immediately, sir.”
Me: “Immediately?”
Son: “Yes, sir. Immediately. And sometimes, she chokes in her throat.”
Me: “Chokes?”
Son: “Yes, sir. Chokes and occasionally has phlegm in her chest.”
Me: “There are no symptoms of gas, acidity, or indigestion! These symptoms can occur due to food getting stuck in the food pipe. But there are no symptoms like this.”
Son: “That’s what I’m telling you, sir. We are clueless. Please diagnose her thoroughly.”
I called Dr. Roshan Patel and discussed her symptoms with him.
Two days later (after her breathing difficulties reduced), we decided to perform an endoscopy to check her food pipe.
Even after conducting the endoscopy two days later, her food pipe appeared completely normal!
We were puzzled. All the symptoms seemed to indicate problems in her food pipe, but the endoscopy showed no abnormalities. Now what?
After thinking deeply, it struck me! Something inside her brain seemed to be the problem.
Normally, during an endoscopy, we give anesthesia to the patient. But in her case, due to low oxygen levels, we had to administer the anesthesia very lightly. Even without anesthesia, when we perform an endoscopy, patients might gag or cough occasionally, but she didn’t have any such reaction!!
I explained to her son that her symptoms might be due to a struggle in the brain or a neurological deficit. I suggested an MRI of her brain.
After conducting the MRI, we found a mass in her brainstem, which controls the movements of the throat. Due to this brainstem tumor (low-grade glioma), she was having difficulty swallowing (bulbar palsy), occasional coughing (aspiration pneumonia), and breathing issues like asthma.
Because of this tumor, her balance was also affected, and she fell, leading to a fracture in her leg! There is no solution at this age, so we suggested keeping her on a liquid diet and providing her with oxygen support. 🙏🏻
This cancer is very slow-growing, so symptoms appeared after 8 months. It was difficult to diagnose because there were no neurological symptoms. We reached the root cause only after thorough testing.
Lesson Learned:
Focusing on a small aspect in any situation can sometimes blur the bigger picture, and we might not be able to reach the root cause.
Our body is a marvel of nature’s wonders. It is very difficult to understand where to find the link to specific symptoms.
Case credits: Dr. Rajesh Trivedi, Samir Gami, Roshan Patel, Dhaval Patel, Parthavi Patel, Nirav Godhani, Jainesh Dodia