Woman, 64, needs to deal with brain tumour
Dear Dr. Roach: In January 2014, I was diagnosed with a benign neoplasm of my cerebral meninges (meningioma). I am a healthy 64-year-old Caucasian woman. I do not take any medications. The finding was incidental. I have no symptoms from the meningioma. I sometimes feel as if my mental capacity has declined somewhat (such as memory), but I attribute this to the normal aging process. I have been getting an MRI every year since the diagnosis, the last one in November 2017.
Results of that test showed that the tumour was 2.9 centimetres by 1.6 cm by 2.7 cm. The mass measured 2.3 cm by 1.3 cm by 2.1 cm when I had the first MRI in 2014. It seems to be slowly growing. What are your thoughts on this? Do you advise surgery at this time? C.C.
A meningioma is a type of brain tumour that arises from the meninges, the lining of the brain. Most of these are benign, although they do range from benign to cancerous. Even the cancerous tumours very rarely spread.
The main problem with this type of tumour is that they grow, and there is not a lot of room inside the skull to spare. An enlarging tumour can compress the brain, and that can lead to symptoms. Depending on the exact location of the tumour, it can cause weakness, loss of vision or loss of hearing or smell. Another common symptom is a seizure. Changes in mental function are less common, but I am very cautious about ascribing symptoms to aging.
Although the change in size seems small, the tumour has approximately doubled in size since 2014. That is a clear indication for treatment. It will likely keep growing and cause symptoms. Surgery is a treatment option, as is radiation, but only an expert can make the assessment of what is best in your situation. If the tumour is in a favourable location, most authorities would recommend surgical removal of the tumour.
Dear Dr. Roach: I recently went to my dentist. He noticed that the enamel on the back of my upper teeth, especially the front, is wearing away. He asked me if I experience acid reflux. I said I don’t think so, because isn't that something I'd notice?
He then asked if I feel refreshed after waking up from eight hours of sleep. (I'm a new mother, and babies are next-level exhausting.)
He said to try an experiment: Take a Pepcid at night and if I start to feel more refreshed, then I'm probably having acid reflux that prevents me from going into deep, refreshing sleep. Do you recommend this?
H.C. I admire your dentist for noticing the enamel loss and considering the diagnosis of gastroesophageal reflux disease. Dental enamel can be lost in an acid environment, so it’s a reasonable thought. However, it is normally severe acid reflux accompanied by frequent acid taste in the mouth that leads to tooth damage. There certainly are cases of asymptomatic GERD, but I think tooth damage is unlikely without further symptoms.
Repeated vomiting, especially in people with a history of an eating disorder, is a much more common cause of enamel loss than GERD, and that may be a possibility.
I would not recommend a medication trial because there are no reliable symptoms. (I agree with you that poor sleep in a new mom is not always due to reflux.) If GERD is really a concern, a diagnostic test, such as a 24-hour pH monitor or an endoscopy, would be my preference before considering a long-term course of treatment.