Polite Dissent

Strangers in Paradise #81
Terry Moore, script and art

This issue of Strangers in Paradisetreats us to several medical scenes. The first deals with David and his brain tumor, and the second deals with anorexia nervosa. There is a third medical scene that deals with issues of a more personal nature. I won’t address it here other that to point out that their sample collection and storage plans seem overly simplistic.

I. David and his Brain Tumor
The brain tumor that David has is a glioblastoma multiforme. It is the most common primary tumor of the brain (that is, a tumor that originated in the brain, as opposed to a secondary tumor which is a cancer that has spread to the brain from elsewhere). Glioblastoma multiformes account for just over half of all primary brain tumors.

A glioblastoma multiforme is also known as a Grade IV Astrocytoma. Astromcytomas are cancers that arise from the support cells of the brain, not the nerve cells. These cancers are graded from I (least aggressive) to IV (most aggressive). This makes glioblastoma multiforme the most aggressive of the astrocytomas.

Symptoms vary depending on where in the brain the tumor is located. Headaches, seizures, partial paralysis, memory problems, and personality changes are all common. Tumors can hide deep in the brain and not produce any symptoms until they are quite large — this is what appears to have happened to David.

The median survival of a patient after diagnosis with glioblastoma multiforme is 3-6 months. Treatments such as radiation, surgery, and chemotherapy can prolong this survival to around a year, but there is no cure for a glioblastoma.

• David’s statistics that 10,000 people die in the U.S. every year from glioblastoma multiforme is correct.
• However, his stated expected survival time of 12-18 months is very unlikely — particularly in a tumor of that size — especially considering his choice not to treat it.
• I don’t like the way he calls it genetic. I understand that by this he means it is not caused by some outside influence such as infection or trauma, and that’s true. But as a doctor, when I hear “genetic” I think inherited disease, and that’s not likely to be the case here.
• The medical art of David’s brain is well done.

II. Casey and Anorexia Nervosa
The anorexia scene in this comic is well done. The acute symptoms shown are common (dehydration, electrolyte imbalance, and cardiac arrhythmias). Casey herself mentions some of the long term complications. She discusses having to take supplements daily for the rest of her life (In this, I assume she is referring to calcium and vitamin supplements related to the osteoporosis caused by her anorexia). She also mentions infertility, which can be another long term complication of anorexia. I would also like to point out the high mortality associated with anorexia (10-18%, the highest of any psychiatric disorder) and the high relapse rate (only about half recover completely).

Previous Strangers in Paradise Medical Reviews: Strangers in Paradise #61-63 (”David’s Story”) Strangers in Paradise #36 (Tambi and Bambi’s fight to the death).