Wednesday, May 09, 2007

Gamma knife treatment

Tammy Guzman finished her shift as a cashier at the Goodwill store on Arden Way, returned to her apartment and found her son Anthony complaining. "Ahh, my head hurts," he whined. A warm shower and a snack, she thought, would help her 5-year-old feel better. But the freckly faced redhead got worse. He lay on the loveseat screaming, his mouth twisted to one side, his little limbs shaking, his eyes rolling up and back. After a frantic ambulance ride to Sutter Memorial Hospital, Anthony Guzman was admitted to the intensive care unit with a rare congenital abnormality, a tangle of vessels that had ruptured and were now spilling blood into his brain.

The diagnosis -- a bleeding arterio-venous malformation -- not only put Anthony in grave danger, but left his mother and the doctors overseeing his care facing a dilemma. Brain surgery to remove the malformation and stop the bleeding could kill Anthony or, at best, leave him paralyzed, blind or with severe language and mental disabilities.

Waiting out the hemorrhage could be deadly, too. But if he survived this, neurosurgeon Sam Ciricello told Guzman, her son would likely be an excellent candidate for gamma knife treatment. A precision dose of radiation through the gamma knife could destroy the abnormality, eliminate the risk of additional bleeding and give him a shot at a normal life.

Now, two months and almost two weeks after that trip to the emergency room, Anthony is back home, raising havoc with his little half-sister Jada, ready to return to his kindergarten class at Greer Elementary School and jumping up and down on his mother's loveseat.

This day almost never came. Shortly after his hospital admission, a special X-ray of the vessels surrounding the malformation convinced Ciricillo and fellow neurosurgeon Edie Zusman that the safest approach was to let Anthony wait out and recuperate from the hemorrhage.

It was a calculated risk. "It's never easy to sit and watch a child get sicker," Ciricillo said. "But sometimes you have to take a chance that the child is going to get sicker to get a better outcome in the long run."

Guzman put her trust in the surgeons. "I am not a doctor, so I don't know," she said. "What else am I going to do? I was just really wanting my baby to be alive." Relying on her boyfriend and others for help with her other child at home, Guzman spent day and night at the hospital, eventually abandoning her job and taking on debt to stay by his side.

At first, Anthony just got sicker. The bleeding on his brain caused swelling and dangerous pressure inside his skull. He was lapsing into a coma. To increase his odds of surviving, doctors used strong sedatives to keep him comatose and immobile. They hooked him up to a ventilator to help him breathe and covered him with a cool blanket to quiet his restless body and mind so he could begin to heal.

But Anthony continued to deteriorate as the brain pressures kept rising. After three days in the coma, Zusman opted to perform a risky procedure to relieve the pressure. She drilled a tiny hole into Anthony's skull and inserted a drain to remove a small amount of cerebral spinal fluid. "It was clearly a life-and-death situation," said Zusman. "The goal was to get the best long-term outcome, for him to be able to move his arms and legs and have a joyful life."

The risk paid off. Anthony's condition steadily improved, the pressure gradually dropping to normal levels as excess fluid dried up. "When the brain swelling is that severe, a tiny volume difference makes a huge difference in pressure," explained Ciricillo. After 11 days, Anthony was eased out of the coma. When he awoke, he was alert but the hemorrhage had left him weak on his left side and temporarily unable to walk.

By the end of April, Anthony had regained most of his physical strength and coordination. He was ready to undergo the gamma knife treatment. Anthony seemed almost eager on Thursday to get the job done, helping the gamma-knife nurse push a cart full of equipment through the hospital corridors and hardly wincing when the anesthesiologist inserted a needle into his tiny hand to start the medicine that would sedate him for the next several hours.

A frame was secured onto Anthony's head, and the medical team -- a radiation oncologist, radiation physicist and Ciricillo - used measurement tools and magnetic resonance images of his brain to pinpoint the location and geometry of the malformation and to develop a computerized treatment plan.

Anthony was then placed on the gamma knife table, his head inside a 350-pound titanium helmet dotted with 201 14-millimeter holes through which the tiny radioactive beams -- or gamma knives -- would seep.

Doctors will not know for several weeks or even months how well the radiation worked to destroy the malformed vessels and shut down their blood flow. But they are confident Anthony is on the road to lasting recovery.

On Friday, all signs pointed in that direction, as Anthony played video games and gleefully tormented his little sister.

Amid the happy chaos, Guzman was cautiously optimistic. "I am feeling good, she said. "I am relieved at least that the procedure is over. I hope it's going to stick."

A savings account to help with the Guzman family expenses has been set up with U.S. Bank under the name Tammy and Anthony Guzman.


Wrinkle cream rip-off

WOMEN paying up to $175 for anti-wrinkle creams are being ripped off by false and misleading advertising by cosmetic giants, The Daily Telegraph can reveal. The makers of Lancome, Clinique, Estee Lauder, L'Oreal and Payot have all been ordered to withdraw advertisements in the past year after complaints to Australia's Therapeutic Goods Administration.

The TGA's complaints panel found while the creams, peels and serums were only cosmetics, they were making claims that were therapeutic, or which would make a physiological difference. In one case, Estee Lauder argued that because they were known as a cosmetics firm and their product Perfectionist Correcting Serum was being advertised in a fashion magazine "readers could not reasonably expect the product to have a therapeutic use". They told the TGA the product used optical technology among other things to blur the effect of wrinkles. This was despite promising in their advertisement their $160 product could fill in and smooth out expression lines instantly and "helps the skin amplify its natural collagen production".

The complaints panel said it was unable to accept the claim was merely cosmetic and had "no doubt" it was a therapeutic claim. In another complaint, the panel said it was concerned about the comparison Payot made between its $175 Payot Rides Relax to injections of the wrinkle-relieving toxin Botox. The panel ordered Payot to withdraw its claims that the serum was "wrinkle correcting".

The Australian Consumers Association would like to see the TGA having the power to fine the cosmetics industry instead of merely ordering them to withdraw their ads. ACA health policy officer Viola Korczak said the companies were continually trying to push the boundaries when making claims about their products. "It is in the companies' interests to put out an ad with a misleading claim because if someone does lodge a complaint, by the time it is processed, the ad could have run for weeks or months," said Ms Korczak. "There is little incentive for them to follow the rules."

She said a breach of the Therapeutic Goods Advertising Code was no more than a slap on the wrist. The ACA has a member on the complaints committee, along with representatives of doctors, pharmacists and alternative health care professionals. Ms Korczak said the committee was under-resourced, had a backlog of complaints and did not monitor advertisements itself but relied on complaints. However, in what is a multi-million dollar dirty tricks war, most complaints are made by rival companies and few by genuine consumers. Unless the product is registered as therapeutic, cosmetic companies can only use terms relating to the appearance or look of the skin, hair or nails.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.


1 comment:

Longevity Science said...

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Body Size and Human Longevity