He had severe heartburn. Could his balance problems be related to this?

A ride to Cincinnati

The response was immediate. It was unlikely this would be a response to the PPI, her friend wrote. A nutritional deficiency was certainly possible. But the friend would also be concerned about a tumor. When did her brother plan to go home? If he stayed in Chicago, one of their colleagues there might be willing to speak to him right away. He didn't say it, but she had the feeling he was telling her that she wasn't exaggerating, that her brother desperately needed to be seen. She was vice chair of the department of neurology at the University of Cincinnati, just five hours away by car. She contacted another colleague, Daniel Woo, the neurologist who was admitting patients to the neurological service that evening. She explained her brother's symptoms and he agreed that he should come. Woo would make sure he got an MRI as soon as he was admitted.

They drove to Cincinnati the next day and he had the MRI. His sister saw the images appear on the screen. There, right behind his ear, amid the gray swirls of his brain, was a bright white mass, about the size of a golf ball. It was a tumor, one of the largest she had ever seen. The neurosurgeon went to tell the patient what he had found. This was likely an acoustic neuroma – a slow-growing tumor that is not cancer. The tumor arises from the cells that protect and support the nerves that control balance and hearing in the middle ear. For reasons not yet well understood, these cells begin to grow uncontrollably, but slowly. As the tumor grows, it disrupts the nerves and causes one-sided hearing loss, tinnitus (ringing in the ears) and balance problems. It was also the tumor that had caused the nausea and vomiting that had ruptured his esophagus. Woo explained that even though it wasn't cancer, it had to be removed or it would continue to grow.

Because the tumor was so large and close to so many important structures, it could not be removed in one operation. The first operation, performed three days later, lasted twelve hours. After the operation, the first thing the patient noticed was that the metallic taste, which had been his daily companion for months, had disappeared. The nausea – also gone. But so did his hearing in that ear. And his balance was even worse. Along with most of the tumor, the surgeon was forced to remove the nerves on the right side of his brain responsible for hearing and balance. The patient had to relearn how to understand where he was in the world, using only half of his previous equipment. The second operation to remove the remainder of the tumor took place six months later.

All this happened four years ago. The recovery was slow. And even now he still can't bowl. His balance is better, but not nearly as good as before the tumor. But his brain works in all the other ways he appreciates. And these days he has a lot more things to think about: He and his wife now have a daughter who is just over a year old.

Lisa Sanders, MD, is a contributing writer for the magazine. Her latest book is 'Diagnosis: Solving the Most Baffling Medical Mysteries.' If you have a solved case to share, write to her at Lisa.Sandersmdnyt@gmail.com.