Medical Mystery 7-23-09

Post date: Jul 23, 2009 4:57:33 PM

Our "quick visit" to the neurologist in Rohnert Park on the way home from Ferndale turned into an all-day affair.

Rowan (who is 4 1/2) has a dent on the left side of his head, between his eye and his ear. It is first visible in photos on July 6, but I didn't actually notice it until around July 11, when it became more exaggerated. All anyone can say at this point is that it's almost undoubtedly related to his trigeminal nerve, and that the muscle on top of his head has atrophied.

It could be a benign idiopathic condition called trigeminal neuritis that resolves on its own in about 6 weeks. It could be an autoimmune disease called masticatory muscle myositis (MMM), or a related disease called polymyositis. It could be an infection, or the result of a head injury we don't know about. Or it could be cancer--a brain tumor, a nerve sheath tumor, or lymphoma.

Here are some photos. Front:

From the top:

From the side:

From the back:

The neurologist doesn't think it's trigeminal neuritis or MMM, because they are usually bilateral and include jaw problems.

Tests we've had so far:

• General bloodwork--nothing abnormal.
• Neospora caninum (parasite that can be in raw food)--negative.
• MMM: negative (though if he's in the early stages, it could conceivably turn positive later).
• Chest x-ray: clear.
• Abdominal ultrasound: clear.

Because it's on one side, the neurologist is worried that it's cancer. Our next series of tests will be this coming Monday. That will include an EMG, a spinal tap, and an MRI.

In a weird disconnect, I spent some time yesterday searching the web for dogs who had a similar condition. I found multiple instances of young dogs who had ONE side of their heads cave in overnight, just like Rowan. I only found one instance of a dog where the dents appeared on both sides. These incidents were typically reported on pet forums, where the frantic owners were asking for advice. In most cases there was no followup about what the final diagnosis was. But it has to make you wonder--did all of these dogs have cancer? Really? If the more benign diseases are always supposed to be bilateral, why are there so few stories of dogs whose heads caved in on both sides? None of it makes any sense to me.

I won't be able to accompany Rowan to the appointment since I will be in Vancouver visiting my brother's family. My beautiful sister-in-law is terminally ill after a long battle with cancer. She is the same age as me and is the world's best mom to 3 great kids. When something like this happens, there is no way to make your peace with it. It's something that you will carry in its broken state forever, like a piece of shrapnel lodged in your chest.

There was a time in my life when I tried to interpret events according to a larger cosmic pattern, when I wanted to believe that things were wending their way towards a happy ending that our finite human minds couldn't comprehend. But I've given up on that idea. We have the miracle of our lives, we have our memories, we have our loved ones (including our pets, of course), and we have our communities. Sometimes all we can do is endure.