Unilateral Hearing Loss

Vestibular schwannoma (aka acoustic schwannoma): Benign tumor from Schwann cells that wrap vestibular CN8 branches.

Typically small ovoid. (This is the largest internal auditory canal (IAC) schwannoma I have come across.)  Large chronic IAC schwannomas enlarge the IAC (trumpeting)

They avidly enhance.

If the patient presents with unilateral sensory hearing loss, what is the best imaging study to order?

MRI Brain IAC with and without contrast.

What is the Dx?

Vestibular schwannoma

http://radiopaedia.org/articles/acoustic-schwannoma

Different patient:  Confusion. When should you order MRI Brain with and without contrast?
To evaluate for confusion start with CT Head, then if indicated MRI Brain without contrast. Because of the blood brain barrier, contrast adds little information to an MRI brain.  It just makes it more expensive.

Reasons to use contrast:

1.      In a patient with cancer, looking for intracranial metastatic disease.

2.      A patient with known multiple sclerosis, some neurologist order contrast. Healing or actively demyelining lesions will enhance. 

Mt Taylor Quadrathalon 2014

In the 30-39 age group I placed 17/30
13 mile bike up, elevation gain 1,800 feet, time: 1:11:34
5 mile run up, elevation 1,300 ft, time: 1:15:34  
1.8 mile ski up, 1,300 ft, time: 58:36  
Snowshoe up, 700 ft, time: 37:28 
Total uphill time: 4:03:10  

Snowshoe down time: 15:20  
Snowboard down time: 20:38
Run down: 1:02:52  
Bike down: 39:58 
Total downhill: 2:18:46

Total time: 6:21:56   

The downhill was changed.  The traditional downhill did not have snow so they made a snowcat trail down the sidehill.  It was steeper with a bunch of turns.  I was so glad I packed up my snowboard.

The ski fold in thirds and fit in the backpack.  

Leadville 100 MTB Race

14,000 – Approximate feet of climbing

My watch stopped counting calories at 9,999.

Max HR 164, Average HR 135

Krehl help me build up this 29r hardtail.  It weights 32.8 lbs.

 The midpoint is Columbine peak at 12,600 ft

 Beautiful Country

12 hours 0 minutes 3 seconds

Solar Eclipse

My primary kids told me there was going to be a solar eclipse. This was two days before boards.  I was so cocooned up in my studying that I had not heard about it.  With a little warning I would have bought an arc welding lens.  A few places in town were giving away disposable viewing glasses, but they had long lines and quickly ran out. One of the primary kids said their teacher told them to make a pinhole camera.  This is a 5mm image projected on the back of the pinhole camera I made after I got home from church.

Some of our friends invited us up to a nearby park to look through their arc welding lens.  This is the picture through that lens.

Albuquerque was in the center of the path to have the moon cross the center of the sun.  People flew in from other states.

I took Maggie up to the park and she thought the pinhole camera and looking thought the welding lens was pretty fun.  The next day, Maggie asked me what I had done with our pinhole camera.

Four Corners Off-Road Triathlon

1 mile swim, 15 mile mountain bike, 5 mile run.

Well, a small part of me still feels I should have backed out.  I am getting over a cold that moved into my chest. The swim started well with a solid crawl.   About a 1/8 of the way into the swim, I got the worst asthma of my life.  A few times I year I will get exercise induced asthma (usually running in the winter).  I was pursing my lips during exhalation to stent my airways.  Superimpose that to my lack of swim training.  When I say lack, I mean none. I did not finish last, but nearly (there were three swimmer behind me). I finished the swim in 43 minutes.  I kept a close eye on my watch, the cutoff for the swim was 50 minutes. The swim hurt.  I thought about signaling the firefighters on the jetski.  But I wanted to do the bike.  I really wished this was the spudman tri and I was in the snake river with the current carrying me to the finish.

Some kind soul let me borrow their farmer john tri wetsuit.  The floatation was so nice.  I may hunt for an inexpensive farmer john.

Next time I will take my inhaler.

The bike was fun.  Mostly single tract. Some good climbing (see picture).  Quite a few sand washes (it is New Mexico).  Krehl, thanks for the 29 tires.  The 2.25 width helped in the sand.  I bought some 29x2.1 small block 8 tires for my Leadville 100 race in August.  When I was putting on tires for this tri, I decided to put on Krehl's tires and I felt lucky every time I came to a sand wash. I passed 5 people and got passed my 3. 

The run was also off road.  The first half was like running through the sand dunes. Then we ran around the Farmington reservoir.  A few spots had exposure.  But if you fell you would land in the reservoir.  They had a kayaker running safety hanging out nearby. It was a fun narrow challenging hiking trail.  Much more fun than running on the road.  I was slow.  1:08 for 5.3 miles.

Total time 3:45.  My heart rate monitor says 3921 calories.

The off road course was fun.

I finished 109 of 110 finishers. 121 people started.
Swim: 43 (105th place)
First transition: 5:58
Bike: 1:42 (101th)
Second transition: 3:13
Run: 1:08 (107th)
Total time: 3:45

The Music Truck

‏

I an effort to prevent daily tantrums, Jess and I have been misleading. Everytime the ice cream truck drives around our neighborhood, we make a big deal about the "music" truck. Maggie would get excited and tell us she heard the music, or saw the "music" truck. We never lied and told her it did not have ice cream. We just never told her it that it had ice cream. An adult would wonder, "why does this truck drive around to neighborhood to supply entertaining music?"

That poor driver. He would see Maggie and I playing in the driveway or working on bikes, so he would hopefully/expectantly drive up our cul-de-sac. "Hope springs eternal in the human breast." Maggie never knew to beg for ice cream, and I am too cheap.  So his jaunts down our road were always fruitless.

We have been wondering how long before she figured it out. She is four and it has pictures on the side.

All things come to an end.

Well a couple days ago, it clicked. "Mom, does the 'music' truck have ice cream?"

With a smile, "Yes, yes it does."

I will miss our charade. It was always fun to point out the "music" truck.

...I think we will continue to call it the "music" truck.

Sugar Cookies

Maggie wants to make sugar cookies for Santa.

This is one of Jess's favorite recipes.

1/3 cup Butter
1/3 cup shortening
3/4 cup sugar
1 teaspoon baking powder
1 egg
1 teaspoon almond extract
2 cups flour

Beat sugar, shortening, sugar, baking powder and dash of salt.
Beat in egg and almond extract.
beat ing flour til barely mixed.
Wrap in saran wrap and chill in fridge for 3 hours.
Roll half at a time, 1/8 in thick.
Cut out.
Place on ungreased cookie sheet
Bake 375 7-8 min, until edges are firm and bottoms are lightly browned