Medicine is the science of the diagnosis, treatment, and prevention of diseases. But is not mathematics. Besides knowledge and experience, medical doctors need to have sensibility for the problem and inspiration.
Clara’s MRI with the subdural hematoma has been evaluated by four neurosurgeons, from different hospitals and countries. So, we have four medical opinions and some very different.
So, this post is about considering medicine as a human science too, than can be observed by distant points of view. So is important for the pacient or parents of a child in treatment to have an active engagement in the process, having a critical view of all the process.
These are the 4 neurosurgeon opinions:
Dr.1 – Clara´s neurosurgeon opinion is a conservative one: not doing surgery right now. He stressed the importance of preventing another head trauma and keep close monitoring on her, by transfontanelar ultrasounds and a new CT in the next 2 months. This is to observe if the hematoma is reabsorbed.
The treatment of a subdural hematoma depends on its size and rate of growth and some small subdural hematoma. less than 10mm wide (Clara has one with 12 mm in the wider area) can be managed by careful monitoring until the body heals itself. But if it´s not reabsorbed in this timeline, the dr. will proceed a trepanation surgery, inserting a temporary small catheter through the trepanation hole drilled through the skull and removing out the hematoma. It might be necessary to keep the catheter longer, doing a ventriculo-peritoneal shunt.
Dr.2 – The opinion is the hematoma can calcify and that will be worst for Clara. Even if she is not showing any neurologic signs now, the blood collection is a strange substance inside her skull and it is better to be removed now. The dr. would also perform a trepanation surgery.
Dr.3 – If Clara is not showing any neurologic signs, lets do nothing. The dr. didn´t mentioned about the precautions to be taken or the outcome.
Dr.4 – The opinion is that the hematoma will take years to calcify, so that is not anissue now. But because the hematoma has a higher osmotic concentration than the cerebrospinal fluid has, it may call water to the hematoma by osmosis, causing it to expand, increasing the intracranial pressure, which may compress brain tissue and cause new bleeds by tearing other blood vessels. The collected blood may even develop its own membrane too. Do the trepanation right away even if Clara has no signs of complications.
Parents – After searching about the pathology, published cases (95% in geriatric population) and evaluating all doctors opinions and expectations! we arrived to these conclusions:
1- We must keep a close monitoring on Clara now and also after this problem is resolved. Now, we monitor the frontal fontanella tension regulary, her head size, her mood, neurologic signs and she is in constant observation at home and at the kindergarten, wearing a soft helmet protection while playing.
2- By rule, surgeons always want to operate, no matter what. So if our neurosurgeon is chosing to monitore Clara even if all four neurosurgeons said it is a quite simple surgery (trepanation) we considere that he is evaluating well her age, signs and the postoperative risks:
-new or recurrent bleeding
-increased intracranial pressure,
3-We trust in our neurosurgeon because he has shown to be highly competent with Clara´s follow-up and for the decompression surgery he done on her when she was only 9 months old. Even so, is very important to hear other doctors opinions too during the all process. Everyone gains with that, specially the child.
We decided we are keeping with the ultrasound monitoring and neurosurgery appointments each 15 days. Any neurologic sign or a new head contusion, we call imediatly to the neurosurgeon at the hospital. They answer promptly.
So, after all this: asking questions to doctors is the best way to make all in a racional mode. A good doctor will explain all to his patient.
All these efforts to keep having these two smiling