A patient is prepared for a CT scan at Martha Morehouse Medical Plaza on Ohio State University's campus on Oct. 7, 2013.
A patient is prepared for a CT scan at Martha Morehouse Medical Plaza on Ohio State University's campus on Oct. 7, 2013.

Rebecca brought Ken to the emergency department because she was concerned that he was forgetting things, slurring his speech and had difficulty with his balance.

Rebecca told the nurse that the symptoms had been going on for a while. She called their family physician, who told them to go to the ED because the episodes seemed to be occurring more frequently.

The ED was busy the night before due to patients with injuries related to falls and car crashes. It took a couple of hours for Ken to get a bed. He told his wife that he was tired of waiting and that they could come back another day. She wouldn't let him leave without being evaluated.

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She remembered how hard it had been on her mother when her father suffered from Alzheimer's dementia, and she was upset that her friends thought he was developing it.

Dr. Erika Kube

Ken looked annoyed when I entered the room. I paid close attention to how he spoke as I asked what was going on. He told me that the only reason he was there was because his wife wanted to have him checked out. His wife said that he was sent to the ED because of his symptoms after she spoke with his doctor.

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Rebecca had noticed that Ken had periods where he seemed off. He had trouble speaking at times. He had to hold onto the wall or chair to keep from falling while he was walking. Ken brushed off the symptoms as nothing. He was thought to be developing dementia by Rebecca.

I did a detailed neurological exam to see if I could find any anomalies in Ken. He seemed to be a little late in answering some questions, but everything else was normal. Rebecca joked that he didn't have all the symptoms he had been having while in the ED.

I asked Ken about his medical history and he didn't have any major medical problems. He said his doctor gave him a clean bill of health. I asked the nurse to get blood and urine from Ken, and I ordered a brain Scan. I wondered if Rebecca was right about Ken having dementia.

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I was surprised to get a phone call from the doctor about an hour later. He told me Ken's brain was consistent with cancer. Ken did not have a history of cancer.

Before I told Ken and Rebecca what was happening, I took a moment to think. When I walked into the room, Rebecca immediately put her book down and held Ken's hand. I pulled up Ken's images so I could show them the abnormality.

When I told Ken that he had cancer in his body that had spread to his brain, he didn't say much. He looked at the screen with no expression on his face. Rebecca was upset and shook. She kept asking how it was possible that Ken was so healthy. I tried to comfort them as I felt sad for them. I explained that Ken would need to undergo further evaluation to determine where the cancer had spread from, which would then determine what treatments could be considered for him.

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He had multiple tumors in his brain and lungs, and underwent further scans that showed his primary cancer was in his lung. The spread of the cancer means that cancer cells separate from the primary tumors and travel to other parts of the body.

Ken was diagnosed with non-small-cell lung cancer, which is the most common type, accounting for 85% of lung cancers. The life expectancy after a diagnosis of brain cancer from the lung is usually poor. Ken met with an oncologist who told him that there was not a cure for the cancer, but that there were several treatments that could help him live longer and feel better.

When Ken came to the ED that cold winter evening, he was not expecting to be diagnosed with cancer. I was happy that Ken had an answer to what was wrong with him and that he did not wait to be evaluated. I was hoping that he would do well with his treatment and that he would be able to spend more time with Rebecca.

The emergency physician for Mid-Ohio Emergency Services is Dr. Erika Kube.

Drerikakubemd@gmail.com

The Columbus Dispatch reported that dementia concerns in a healthy man lead to a cancer diagnosis.

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