Neither Carol Welsh nor the doctors treating her in Williamsburg, Virginia, could figure out how to fix her stomach trouble.

Welsh had tried to quell the morning attacks of nausea and vomiting that faded as the day progressed. She ate only bland food.

She took the acid-reducing drugs prescribed by her doctor and later, a local gastroenterologist.

She wasn't pregnant, didn't have eating disorder and doctors had found nothing physical that would explain her symptoms.
Could be stress?

Maybe, she thought, her problem was the result of stress. But why did she feel better as the day wore on? And she had been a competitive swimmer and top student in high school — she was accustomed to handling pressure.

Welsh's puzzling gastrointestinal problem became a crisis on April 19, 2000, a month after her 30th birthday.

That was the day she saw a different doctor from the one who had been treating her.

Minutes after examining her, family practitioner Clifford Henderson was on the phone, arranging for Welsh's admission to Williamsburg Community Hospital for a reason that had nothing to do with her stomach.

Pills not the answer

As the youngest of four daughters of a military family, Welsh had always placed a premium on handling things herself.

Immersed in her studies and interviewing for jobs after graduation, Welsh said, she soldiered on, trying to take her doctors' advice, which she described as “pop the pills and you'll be fine''.

Sometimes, she said, she suspected something serious might be wrong: She had lost ten pounds and sometimes felt mentally fuzzy, as though she needed stronger spectacles.

But then she would have a good day and be able to play tennis.

The weekend before Welsh's illness was diagnosed, she called her sister in suburban Washington and asked her to come help with her laundry.

Alarmed by the uncharacteristic request, Margaret Welsh drove to Williamsburg and recalled being alarmed by how thin and frail her sister looked.

Carol Welsh had recently developed two new problems: intermittent hiccups and trouble swallowing.

At the health centre, Margaret Welsh, convinced that her sister's concerns were being dismissed, insisted on a new doctor.

ER understanding

After futile attempts to reach other doctors who could admit her to the hospital, Henderson called his friend Maurice Murphy, an emergency room physician.

In the ER, Murphy listened intently and asked her lots of questions — about her hiccups, her difficulty in swallowing and her vomiting.

A neurologist ordered an MRI, which revealed the shocking cause — a large and rare brain tumour called an ependymoma.

“I never had a headache or seizures,'' Welsh said of the classic signs of many brain tumours.

The slow-growing tumour, which in Welsh's case was benign, develops in cells that line the ventricles of the brain and spinal cord where cerebrospinal fluid is produced.

To Henderson, the tip-off was Welsh's report that positional changes first thing in the morning triggered her nausea. It meant that the tumour had grown so large that it was obstructing the flow of cerebrospinal fluid in her brain.

Journal truth

A 2006 article in eMedicine, an online medical textbook, notes that the five-year survival rate for ependymomas is about 76 per cent in adults and about 14 per cent in children in the United States.

The following day Welsh was in the office of a George Washington University neurosurgeon.

“He told me I would have been dead in six weeks,'' she recalled.

Surgery was immediate and gruelling and its aftermath complicated. Welsh, hospitalised for seven weeks, contracted postoperative infections including pneumonia.

Her weight withered to 92 pounds on her 5-foot-6 frame.
One risk of any brain tumour is recurrence; Welsh has had two. The first occurred in 2003 and required a second surgery, which removed only 80 per cent of the tumour.

Removing the rest, she was told, was too risky.

The aftermath

She has undergone radiation, along with punishing courses of chemotherapy and steroids that have prevented the tumour from growing.

The treatment has left Welsh with deficits: She cannot drive, her speech is slightly slurred, she has trouble walking and her double vision and chronic headaches appear to be permanent.

“I'm not as sharp as I used to be,'' she said. Welsh is now being treated by a neuroncologist at the National Institutes of Health.