Source

I recently moved to Obstetrics and Gynecology a few days ago and it's been nice so far. We usually finish early, but we start so early too, because of that I am planning on moving my cycling time to the evenings and maybe doing strength training in the morning with push-ups. I have to cycle through my usually 45 mins course.

We have morning reviews by 8 am where we discuss cases that happened over the night during call hours.

Before I left pediatrics I really had a scary moment that would throw you into one of those scary movie scenes if you are into stuff like that.

My last post about pediatrics

Source

If you read my last post about the cancer unit in pediatrics then you'd recall that I explained how cancer affects its victims.

It was quick pathophysiology with pictures.

Today I want to narrate how I've seen cancer (Leukemia in particular) affects the brain.

Leukemia

Source

As I discussed in the formal post, Leukemia like other cancers is caused as result of abnormalities in DNA structure and function leading to excessive growth of these cells.

In leukemia, the cells that are affected are the White Blood cells (Leukocytes) from which it derives its name...Leukemia (Meaning Leukos- White and Haima "Blood").

Leukemia hardly forms solid tumors and since blood reaches every organ it is easy for other organs to be affected like the Brain, eyes, Heart, Lungs, and Kidneys.

In children, the specific type of leukemia that affects them is Acute Lymphoblastic Leukemia.

It is so called because the White Blood Cells involved grow very quickly and are lymphoid in origin (meaning they normally stay in the lymph nodes).

Leukemia in the eye

I have seen one cases like this and I was hoping to make people connect to it and the one that affected the brain.

The title of this post is a little miss leading because Leaukamia from the onset is already in the blood and in some way in the brain but when we are worried is usually when we start seeing the symptoms and signs of this disease.

When I first came to the unit about 3 months ago, the first of Leukemia patients had marked eye affection really caught me and made me emotional.

He is the only son of a widow who currently has the Welfare department running everywhere looking for funds to help.

When I came, the worse had already happened and we were struggling to make sure more damage doesn't happen.

The patient is an adolescent male, who came to the hospital about a year ago and commenced chemotherapy at about that time but later skipped doses of chemo due to financial constraints.

My Senior Registrar talked about how brilliant the boy was. He uses to memorize the long names of his medication and it almost made my Senior Registrar cry just describing the story.

After the moments when he couldn't afford treatment passed, I think the mother was also convinced that the boy was healed by faith, making it less likely that he'd show up for treatment.

Months later when he reemerged, he was struggling with vision, the color of his pupil (Actually the Iris, had yellowish infiltrates) changed, headaches and then he went blind.

It is the most compelling case I have seen and usually, health workers want to help in any way they can and many have tried, even contributing financially.

The eye is an outgrowth of the brain and can be affected much like any other organ that forms part of the system.

The most Recent Case

I was giving Chemotherapy long into the day when one of the patient's mothers came with a complaints about her daughter. She explained that her daughter had been seeing two men who had been trying to attack her.

I came into the ward from the back, close to the patient's bathroom and I saw it for myself...

She was saying in a loud tone "Leave me alone, what do the two of you want?"

She continued this for about an hour. I called my Seniors and explained her hallucinations
to them and they explained they was a case where the brain was being affected in a patient dealing with Leukemia.

This second patient is a female adolescent, about the same age who came with complaints that had nothing really to do with the disease but were an incidental finding after investigations.

We were giving her pre-induction drugs to prepare her for chemotherapy (she is receiving Allopurinol and Prednisolone). I really hope she doesn't skip her treatments.

She is later to receive Vincristine, Methotrexate, and some other chemo drugs.

Conclusion

Leukemia is deadly and can affect the brain. It will give off symptoms like headache, hallucination, blurry vision, and even blindness.

Skipping medication hinders treatment on a normal day...but skipping chemo long periods is very dangerous and can cause deadly and life altering complications.

REFERENCE

• Wikipedia Leukemia
• Retinal Manifestations of Leukemia
• What a sad place to be
• NCBI Delerium in Leukemia
• Wikipedia Retina

I'd like to invite @bhoa to criticize my work. I'd be grateful if you pick out some points I could improve on in my subsequent posts.