I wanted to get this information written down while it was still fresh in my mind.
The degree of our good fortune seems to increase every time we meet with a doctor. The things we learn continuously make the divine guidance we’ve experience on our journey more and more apparent.
Today we met with Dr. Suresh Magge, the surgeon who performed Sophie’s operation. One of the first questions he had for us (other than, “How is she doing?”) was if the metal detectors at the airport had indeed failed to detect her titanium brackets. It seems that he has never actually had one of his brain surgery patients go through airport security between appointments with him. He had always heard that the brackets shouldn’t set off the metal detectors, but our case was the first opportunity for him to confirm that bit of information. Understandably, most of his patients simply avoid travel for the first year or so after their operation.
He had a look at her scar, and remarked that it was healing very nicely. Out of curiosity, I had him describe the size and location of the slab of bone he removed for the surgery, as well as the number and placement of the titanium brackets that hold the bone in place while it heals. He described a hole circular in shape and approximately two inches in diameter, close to the base of her skull. He couldn’t remember if he used three or four brackets (it’s always three or four), but after feeling around a bit he found one of them for me to feel under the skin. It protruded out just a little further than I had expected it to. We’re not talking about a huge bump, but it surprised me.
We showed him how well she’s running and walking around, and he checked a few other indicators of her neural health. Overall, he was impressed with how quickly she had returned to normal operational capacities.
Dr. Magge brought up that he would like to have Sophie in for her first MRI before we meet with Dr. Packer. His remarks about Dr. Packer quickly led both Rochelle and me to conclude that this man is not only important, but is viewed with a kind of awe and reverence by his peers. He is very difficult to schedule for appointments, and it is noteworthy that he is interested in seeing Sophie. Usually he doesn’t concern himself with brain tumor patients who do not require chemotherapy or radiation treatment (these cases represent the vast majority of all cases studied). However, he has requested to see Sophie. So, our appointment with him is on the 15th of March (that was the soonest available when I made the appointment a week ago on the 19th of January).
Next we talked about the pathology report, which is one of the reasons Dr. Packer may be so interested in Sophie’s case. What everyone initially presumed had been pulled from Sophie’s cranium was a PA (pilocytic astrocytoma). PA is the most common type of pediatric brain tumor, and is given the lowest grade in the World Health Organization scale (that 1 to 4 scale I discussed last time). Thus it is considered the most benign (only slightly mutated cells), the least aggressive and subsequently the least likely to reoccur. PMA (pilomyxoid astrocytoma) is a newer type of tumor that is only recently being separated from that grade one PA classification.
Sophie’s tumor, as we previously learned, is indeed a PMA. I mentioned to Dr. Magge that I had found and read a paper on PMAs from the Johns Hopkins staff. He immediately asked if it was written by Dr. Burger. I replied that I couldn’t recall (but I have now confirmed that his name does appear on the paper). Dr. Magge explained that the paper was likely written by Dr. Burger because this man is the leading authority on PMA. Not only did he write that paper, he wrote the text books on the subject. He was also more than likely the eyes at Johns Hopkins that viewed Sophie’s slides and identified her tumor as a PMA. If you read none of the information in that last link, note this tidbit:
Pilomyxoid astrocytomas were first described by Dr. Burger and his colleagues in 1999. They recognized them as relatively rare tumors with some features of pilocytic astrocytoma, but a distinctive microscopic growth pattern, as well as a higher recurrence rate and chance of spreading within the brain.
This type of tumor is still considered largely benign and less aggressive, but it represents its own category because the data suggest that PMAs are (for some unknown reason) slightly more likely to return after removal. While the cells may have most of the qualities of a nearly harmless PA, PMA tumors, when not identified properly, can often return undetected and cause serious problems. Dr. Magge stated that the only difference going forward between a PA patient and a PMA patient is that Sophie will have MRIs slightly more frequently to watch for any regrowth.
While the Johns Hopkins Neuropathology Division seems to be doing most of the major research into PMAs, the Columbia University has set up an entire website resource with tons of information (I haven’t even looked over it all yet).
Remember, every link I provide in the text leads to additional information and reading. If you are interested or need to know more, please follow the links. I make every effort to present the information I gather in as clear and simple a manner as possible while maintaining the integrity and truthfulness that it contained when I found it, but I am not perfect. Please leave comments to add your information, ask questions, and share your stories.