After being diagnosed with anxiety and alcohol use disorder, a healthcare executive continued to experience worsening symptoms. Then, a visit to the ED revealed the true cause of her symptoms — a rare cancer that can cause seizures, personality changes, cognitive issues, and more, Sandra Boodman writes for the Washington Post.

She started to feel shaky and 'out of it'

In late 2015, Brandie Boyd Meyer was in the first trimester of her pregnancy when she experienced several episodes. She started to feel shaky and "out of it." At the time, she attributed the episodes to low blood sugar or pregnancy, but she continued experiencing symptoms after her son was born in mid-2016.

After hearing her friends' descriptions of their issues, Meyer determined that she was likely suffering from anxiety. When she told her doctor about her symptoms, they ordered tests to check her thyroid. However, her test results were normal, and the doctor prescribed a medication to treat Meyer's anxiety and depression. After taking the drug for several months, she did not feel any better.

In early 2018, Meyer met with a physician assistant (PA) at a psychiatry practice. In the following months, the PA prescribed two other antidepressants, but she still saw no improvement.

Then, Meyer's alcohol consumption started to increase. In the morning, she often did not remember conversations she had with her husband while she was drinking.

"It happened enough times that he and I became concerned that maybe I was drinking more than I realized," Meyer said. Meyer and her husband, Andrew, decided that her memory loss signaled a drinking problem. Meyer determined that she was self-medicating her anxiety by drinking 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," Boodman writes.

Meyer had tried several medications and started attending Alcoholics Anonymous meetings, but her symptoms continued to worsen.

When Meyer was attending a strategy session with an executive, they asked, "Are you okay?" She assured him she was fine. "I must have looked really out of it," she said. While Meyer said she was fine, she had started having seizures, but no one recognized this at the time.

In August 2019, Meyer arrived at work with a splitting headache and had to take several breaks in her company's "wellness room" throughout the day. That afternoon, Meyer's assistant helped her leave her office, drove her home, and called her husband. When her husband returned home, he found her lying on their bed in a fetal position, with their 3-year-old son curled on top of her asleep.

"Andrew assumed I was passed-out drunk," said Meyer.

Soon after, Meyer was taken to the local ED after her husband awoke to find her standing over him in the middle of the night unable to speak.

'Doctors suspected it was an aggressive cancer'

At the ED, a CT scan of Meyer's head revealed the true cause of her debilitating symptoms — a peach-sized tumor in both frontal lobes of her brain.

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

Less than 48-hours after Meyer's colleagues rushed her out of her office, she was taken to the operating room at UT Southwestern Medical Center (UTSW).

After the surgery, pathologists determined that the tumor was an oligodendroglioma, a rare cancer that targets the brain and spinal cord. Typically, these tumors are classified as either slow-growing and less aggressive or fast-growing and more aggressive high-grade malignancies. In general, symptoms include seizures, memory loss, personality changes, and cognitive problems.

While experts do not know what causes oligodendrogliomas, they believe radiation exposure plays a role. There is no cure, but treatment consists of surgery to remove as much of the mass as possible, sometimes followed by radiation or chemotherapy.

In Meyer's case, doctors believed her tumor might have been present for at least a decade. However, the tumor was found to be low grade and surgeons were able to remove about 75% of it. "We were so relieved," she recalled.

A 'classic missed opportunity'

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

"I was totally blown away by her whole story," said Maher, noting that Meyer's symptoms were "textbook" for oligodendrogliomas.

Meyer's records were full of descriptions of incidents that had been attributed to anxiety or alcohol use, but no one ever ordered a blood alcohol level test, Maher noted. In addition, her doctors did not seem to consider that something else could have caused 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, noting that these issues are frequently brushed off as postpartum. 

"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."

According to Meyer, who is now 39 years old, self-diagnosis played a role in her diagnosis. Looking back, she said she wishes had seen a primary care doctor and brought up her symptoms with her doctors.

After her surgery, Meyer said her cognitive ability, memory, and general quality of life improved significantly. For the past year, she has been taking a drug that targets a specific mutation to slow tumor progression.

"I've made my peace with it," Meyer said, "and then I'll think 'Oh — I'm a cancer patient and I'll always be a cancer patient.'" Still, she said being diagnosed after her older son was born "would have saved a lot of heartbreak and stress."

According to her neuro-oncologist, Meyer's case highlights a key piece of advice. "Don't be wedded to the narrative," Maher said. "Be wedded to the facts." (Boodman, Washington Post, 2/18)