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Sunday, February 19, 2023

Anxiety and alcohol seemed to be the problem. A brain scan found more. - The Washington Post

She thought anxiety and drinking made her ill. The truth was scarier.

"A middle-of-the-night trip to the ER revealed the false assumptions that wrongly had shaped her care

(Illustration by Cam Cottrill for The Washington Post)

When Brandie Boyd Meyer arrived at work and told her assistant she had a splitting headache, and after she seemed unsteady and took several breaks in her company’s “wellness room,” her closest colleagues concluded that the Dallas health-care executive’s drinking had spiraled out of control.

Meyer, then 35, had struggled for much of the previous four years with anxiety that developed after her first son was born. Panic attacks and later a diagnosis of alcohol use disorder followed. But despite multiple medications, months of talk therapy and attendance at Alcoholics Anonymous meetings, Meyer was getting worse. Her marriage was unraveling, she was struggling at work, and her family was contemplating an intervention to address her apparent secret drinking.

That afternoon in August 2019, her assistant and a colleague hustled her out of the building, drove her home, then phoned Meyer’s husband, Andrew. He returned home to find her lying on their bed in a fetal position, their 3-year-old son curled on top of her asleep.

“Andrew assumed I was passed-out drunk,” said Meyer, who soon wound up in a nearby emergency room after a bizarre middle-of-the night episode.

Within hours Meyer and her family were reeling from a discovery that exposed Texas-sized holes in the erroneous assumptions about her behavior — assumptions predicated largely on conjecture that had guided her treatment.

“One of the takeaways is that I was selective in what I thought each provider needed to know,” said Meyer, whose memory for the months leading to her diagnosis is spotty. “That was not helpful. But everyone missed [important clues] until I was in the ER.”

A physician who began treating her shortly after her hospitalization has a different take on what went wrong. “I think ‘young woman’s syndrome’ is a big part of this story,” the doctor said. She believes “a narrative took hold” based on Meyer’s age, sex and status as a new mother that was perpetuated without adequate scrutiny, delaying the correct diagnosis to Meyer’s detriment.

In late 2015 when Meyer was in the first trimester of her pregnancy, she experienced several episodes when she felt shaky and “out of it. ” She attributed the feelings to low blood sugar or being pregnant, but they did not disappear after her son’s birth in mid-2016.

Meyer didn’t initially mention them to her obstetrician-gynecologist — she did not have a primary care doctor — because they seemed inconsequential.

At the time she was contending with more immediate concerns. Her husband traveled frequently for work and she was a first-time mother juggling her own demanding job and a baby.

“I felt like a failure a lot,” she said.

Based in large part on her friends’ descriptions of their problems, Meyer concluded she was suffering from anxiety.

Based in large part on her friends’ descriptions of their problems, Meyer concluded she was suffering from anxiety. She told her OB/GYN about the shakiness and feelings of being “out of it” and panicky. The doctor ordered tests to check her thyroid; when the results were normal the doctor prescribed a medication to treat anxiety and depression.

But after several months on the drug, Meyer felt no better. In early 2018 she met with her priest, who had been open about her own struggle with anxiety, to ask about coping strategies. Meyer, who had no history of mental health problems, then scheduled a meeting with a psychiatry practice where she saw a physician assistant.

The PA prescribed a second antidepressant, then a third. Meyer took them for several months without improvement.

By then she felt chronically tired and was having trouble coping with her son, a high-energy, super-talkative toddler. “I’d get maxed out earlier than normal,” Meyer recalled. “Work was very busy and was taking a lot of juice.” She’d been promoted and her husband was traveling more often, sometimes as frequently as four days a week.

On weekends, she often took long naps. “Andrew could see I was really struggling and would try to get [our son] out of the house,” she said. Sometimes the pair spent four or five hours at the zoo.

“I could see I wasn’t pulling my weight, and I didn’t feel like anything was getting better,” Meyer remembered.

She had a new worry: her drinking.

In the evening after her son was in bed Meyer often drank wine as she talked by phone with her husband when he was out of town. But the next morning she often did not remember details of their conversation — or sometimes even that they’d had a conversation.

“It happened enough times that he and I became concerned that maybe I was drinking more than I realized,” Meyer said. She did not count her drinks nor did her husband initially eyeball the empty bottles to see how much she had consumed. They decided that her memory loss indicated a drinking problem.

Meyer concluded that she was using alcohol to medicate her escalating anxiety, which seemed impervious to medication and therapy, and had become an alcoholic.

It was a conclusion that became prominent in her medical records, reaffirmed and apparently unchallenged by two mental health specialists.

In late 2018 Meyer started seeing a social worker for regular talk therapy sessions.

After several months, he referred her to a psychiatrist whom she consulted in April 2019. Both confirmed her diagnoses of anxiety and an alcohol problem, she said. By then Meyer had taken four drugs to treat anxiety and depression; none had helped. Her panic attacks were more numerous and disruptive, occurring almost daily. She struggled to perform at work; colleagues began to notice something was wrong. She confided to a few that she was struggling with alcoholism.

In the spring of 2019 Meyer began going to AA meetings, which proved helpful. “It was a safe place to talk about all the things that felt crazy and that I was attributing to alcohol,” she said. “Plus it was a great place to get free candy and really bad coffee.”

But her deterioration was evident. Once she was attending a strategy session when an executive, startled by her expression, asked, “Are you okay?” Meyer assured him she was. “I must have looked really out of it,” she said. Meyer had begun having seizures, although no one recognized them as such.

In May as she was backing out of her garage she nearly hit the wall. Her husband shouted a warning, “but I just didn’t respond or stop,” said Meyer, who managed to avoid a collision. She told her psychiatrist about the incident. The doctor advised Meyer that she might be experiencing a side effect of the anti-anxiety drug Xanax and cautioned her not to take it if she was driving.

Because her memory is muddled, most of what Meyer knows about the events in her office, which occurred three months later, she learned after the fact. She doesn’t remember being driven home, lying in bed with her son or the behavior that led her husband to call 911 hours later when he awoke to find her standing over him unable to speak. And she has only a hazy memory of the ambulance ride to an ER.

A CT scan of Meyer’s head performed soon after she arrived revealed the shocking cause of her debilitating symptoms: a peach-sized tumor had invaded both frontal lobes of her brain and was causing cognitive and personality changes and increasingly severe seizures.

Because of its massive size, doctors suspected it was an aggressive cancer. They initially told her husband she might survive only a matter of months.

Meyer was quickly transferred to UT Southwestern Medical Center in Dallas and was taken to the operating room less than 48 hours after her colleagues spirited her out of the office because they thought she was drunk. (She had not consumed any alcohol; her headache and other symptoms were the result of the brain tumor.)

Pathologists determined that the tumor was an oligodendroglioma, a rare cancer that attacks the brain and spinal cord. Roughly 1,100 cases are diagnosed in the United States annually, usually in men between the ages of 35 to 44. These tumors are classified either as less aggressive — they typically grow slowly for years before causing symptoms — or as faster-growing and more aggressive high-grade malignancies. Symptoms can include seizures, memory loss, personality changes including anxiety and panic attacks, as well as cognitive problems.

The cause of oligodendrogliomas is unknown, although radiation exposure is believed to play a role. Treatment consists of surgery to remove as much of the mass as possible, sometimes followed by radiation or chemotherapy. The cancer is treatable but not curable.

Meyer’s tumor, which doctors told her might have been present for at least a decade, was found to be low grade. “We were so relieved,” she recalled. Surgeons were able to remove about 75 percent of it.

A few weeks after surgery she met with brain tumor expert Elizabeth Maher, a neuro-oncologist on the staff of the Harold C. Simmons Comprehensive Cancer Center at UTSW.

“I was totally blown away by her whole story,” said Maher, adding that Meyer’s symptoms were “textbook” for oligodendrogliomas.

‘I think the classic missed opportunity along the way is that she was a young woman who was getting treated for anxiety and depression and getting worse.’
— Elizabeth Maher, physician  none

Her records contained descriptions of incidents that had been attributed to a mental health problem or to alcohol use, although no one ordered a blood alcohol level, Maher noted. Nor did those treating her appear to consider that something organic might be causing her psychiatric symptoms.

“She had her baby and she starts to have depression and anxiety and worsening short-term memory and difficulty concentrating and confusion,” Maher said, adding that such problems are too often reflexively brushed off as postpartum. Maher noted that records show that Meyer sometimes stared into space during therapy, evidence of absence seizures that went unrecognized.

“I think the classic missed opportunity along the way is that she was a young woman who was getting treated for anxiety and depression and getting worse,” Maher observed. “It can be very hard for women to get anyone to take them seriously.”

Meyer, now 39, said she believes self-diagnosis played a role and wishes she had seen a primary care doctor. She did not mention, or misattributed, warning signs. She didn’t tell her therapist or psychiatrist that she sometimes vomited after a staring spell or that she had developed urinary incontinence in the months before her diagnosis because she assumed that was normal after childbirth. Both can be associated with seizures.

In the weeks after surgery Meyer said her cognitive ability, memory and general quality of life improved significantly.

To delay tumor progression — a process that can take years — postoperative treatment may involve radiation or medication including chemotherapy. For the past year Meyer has been taking a newly-approved drug targeted at a specific mutation. She also takes medications to manage seizures and undergoes quarterly MRI scans.

Adjusting to a diagnosis of brain cancer has been a process, Meyer said. She participates in a cancer support group for people under 40 and has met a woman from her church with the same tumor. In December 2020, after doctors advised her to “live your life,” she gave birth to her second child.

“I’ve made my peace with it,” Meyer said of her diagnosis, “and then I’ll think ‘Oh — I’m a cancer patient and I’ll always be a cancer patient.’” Finding out what was wrong after [her older son] was born “would have saved a lot of heartbreak and stress.”

To her neuro-oncologist, Meyer’s case underscores an important caveat. “Don’t be wedded to the narrative,” Maher advised. “Be wedded to the facts.”

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Anxiety and alcohol seemed to be the problem. A brain scan found more. - The Washington Post

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