Advances: Medical News for Patients <span class="advances-issue">January 2019</span>

Amazing Stories: Toba

Toba

With nine children, Mordechai and Chana were no strangers to the ups and downs of parenthood. But even they could not have expected the news they received in August 2017 when their youngest child, daughter Toba, was only three weeks old. Concerned about a rapidly growing head size, their pediatrician suggested they see a neurosurgeon. Guidance from community organizations (the Rofeh Cholim Cancer Society and Refuah Helpline) and other parents led her to one specialist at NewYork-Presbyterian Komansky Children's Hospital: Dr. Mark Souweidane, Director of Pediatric Neurological Surgery at NewYork-Presbyterian/Weill Cornell Medical Center.

An ultrasound showed the presence of a large mass in her brain, which an MRI later confirmed to be a gigantic brain tumor occupying as much as two-thirds of the space inside her skull. It was by far the largest brain tumor Dr. Souweidane had ever seen in his 22-year surgical career.

Brain tumors detected at the time of birth, called congenital brain tumors, are extremely rare and almost universally fatal. By most estimates, either the tumor or its treatment was likely to prevent Toba from reaching two months of age. Dr. Souweidane and his team were determined to do all they could to beat those odds.

A biopsy performed by neurosurgeon Dr. Caitlin Hoffman provided some relief: the tumor was a benign teratoma. But even benign tumors inside the brain are a threat because as they grow, they compress vital structures. Toba's only choice was surgical removal. Yet the sheer size of her tumor, the involvement of vital blood vessels in the brain, and Toba's tiny size relative to the blood she could lose during the operation were all factors that were not in her favor.

"Dr. Souweidane told us he would treat Toba like his own child. He said he would remove as much as he could, while keeping in mind that his goal is always to keep the child safe," recalls Chana. "He is phenomenal, and he explained everything to us so well. Even when discussing what might happen, he passionately wrapped it up in a soft blanket of optimism and hope, so we wouldn't feel dismayed. After speaking with Dr. Souweidane, we always left the room with a smile." Buoyed by their confidence in him, Mordechai and Chana proceeded with the first surgery.

On September 2017, when Toba was just two months old, Drs. Souweidane and Hoffman removed nearly half of the tumor in a 10-hour operation. Not surprisingly, her recovery was rough, complicated by seizures, but over time she returned to her normal, joyous self.

The doctors gave Toba as much time as possible to gain weight and increase her blood volume before a second planned surgery. MRI scans eventually showed the tumor growing again when Toba was six months old. The surgeons removed virtually all of the remaining tumor tissue during a second multi-hour procedure. Due to the small bit of tumor they had to leave behind, the family and surgeons braced themselves, wondering if Toba could tolerate a third marathon brain surgery.

Then the unthinkable happened: a follow-up MRI showed no tumor. The first two surgeries deprived the remaining tumor tissue of the blood supply it needed, and it disappeared.

As Toba approached her first birthday in July 2018, there was no evidence of her ordeal. The surgery and her hospital experience resulted in some developmental delays, which are being addressed through physical, occupational, and speech therapy she can receive in her home. She continues to progress nicely and by all accounts should have a normal childhood.

Her family is overjoyed by the prospect that their little girl has beaten all odds and is likely cured. "She's doing amazing — very smiley and playful. She looks normal, like nothing happened," says Chana. "Dr. Souweidane doesn’t perceive his occupation just as a profession, but as a humanitarian mission to save lives. My husband and I keep on thanking the almighty G-d for leading us on the right path to the world-renowned NewYork-Presbyterian Hospital, to a great team who brought a cure and relief to our beloved daughter.”

To learn more about pediatric services, visit nyp.org/pediatrics. To find a pediatric specialist, call 800-245-KIDS.

Tips for keeping you and your family healthy this winter

Thermometer in snow showing low temperatures

Snowstorms. Freezing temperatures. Flu outbreaks. The telltale signs of winter can prove daunting to even the heartiest of people. Shorter days and colder weather can make it difficult for you and your family to find the motivation to be as active and healthy as during other times of the year. But motivation is key.

“Spending large amounts of time indoors, combined with low energy levels can set the foundation for a weakened immune system,” explains Dr. Donald Enoch, a Family Medicine practitioner with NewYork-Presbyterian Medical Group Hudson Valley. “Viruses can thrive indoors. If your immune system is compromised, you're likely to catch the latest bug and the misery that goes along with it.”

The key to prevention is recognizing the safety risks and patterns of illness in advance — while there’s time to do something about it, and to make you better equipped to cope if illness does strike. These simple prevention and lifestyle tips can go a long way toward keeping you and your family healthy all winter long:

  1. Get a flu shot: The best way to prevent the flu is by getting vaccinated each year, and it’s still not too late to get one. Says Dr. Enoch, “Most everyone over the age of six months should receive the flu shot, particularly those people who are at high risk for developing complications from it. These include seniors, young children, and those with certain medical conditions, such as asthma and heart disease.” People infected with the flu virus can spread it to others up to six feet away — through coughing, sneezing, or talking. It can also be transmitted by unknowingly touching a surface or object that has the flu virus on it and then touching your mouth or nose.  A flu shot can reduce the risk of illness by 50 to 60 percent, and can decrease the severity and side effects if you do get sick.
  2. Enjoy time outdoors: Breathing in fresh air, regardless of the season, is good for the body. Fitness experts and researchers have found that outdoor activity in cold weather offers many benefits, such as increasing energy while decreasing tension, frustration and depression. Plus, increased exposure to sunlight may help fend off seasonal affective disorder (SAD), a type of depression linked to seasonal changes.
  3. Exercise: Regular exercise helps strengthen the immune system, which helps reduce risk of illness. Exercise can also help reduce the risk of cold and flu. Even a 10-minute workout can make a huge difference in how you feel.
  4. Practice hand hygiene: Frequent hand washing throughout the day plays an essential role in maintaining good health, especially during the winter. It not only helps protect the immune system and prevent against developing flu and cold, but it also protects others around you. In addition, research studies show that those who carry and use hand sanitizers had 59 percent fewer cases of stomach bugs than non-users. When used correctly, these products nearly eliminate germs.
  5. Eat smart: Always have a healthy breakfast, which provides the all-important fuel boost for your body at the start of the day. Follow it up with a small lunch and dinner and healthy snacks in between. Focus on healthy fruits and vegetables, lean meats, and whole grains. Limit your intake of fatty foods.
  6. Socialize more: Friendships counteract the harmful effects of stress hormones, which can lead to illness. Winter is a good time to reconnect with old friends, plan dinners, movie nights and game nights to stay involved and engaged with others.
  7. Get enough sleep: This is probably the most important thing to do this season, because any other precautions you take against cold or flu — the right food, supplements, even vaccinations — won't offer the same protection if your body is too fatigued to use them properly.
  8. Visit your doctor: If you feel aches and fatigue coming on that could signal the flu, ask your doctor about antiviral medications, which are effective only if taken within 48 hours of exposure. Says Dr. Enoch, “It's important to distinguish the flu from the common cold, to avoid experiencing possible side effects from unnecessary medications.”

To find a family medicine physician at NewYork-Presbyterian Hudson Valley Hospital, visit hudsonvalleydoctors.nyp.org or call 914-788-4635.

Managing facial pain and spasms caused by vascular compression

Young worried african american

Did you ever stop to consider what makes the human face so expressive? It’s capable of such a wide array of movements — from obvious to subtle — that can convey a world of meaning without a word being spoken. That world of facial language and its other functions are made possible by the facial nerves.

“Two types of nerves figure prominently in facial function,” explains Dr. Marc Otten, Director of Columbia Neurosurgery at NewYork-Presbyterian Lawrence Hospital in Bronxville. “The first is the trigeminal nerve, which carries sensory information from the face, and the other is the facial nerve, which controls the muscles of the face. When blood vessels compress the trigeminal nerve or facial nerve as it exits the brainstem, it can cause intense electric shock, or disfiguring and debilitating spasms.”

Like other nerves in the body, the trigeminal and facial nerves are subject to disorders. People with dysfunction of the trigeminal nerve may not be able to eat, drink, or go out in the cold without experiencing excruciating pain. For people with facial nerve dysfunction, facial expressions can be compromised, as can the ability to eat, drink, or speak normally. It can also become difficult to open the eyes to drive or walk, leading to dangerous situations.

Many conditions can cause nerve disorders; trauma, skull base fractures, injuries to the face, nervous system diseases (such as stroke), infections of the ear or face, tumors and various toxins. Says Dr. Otten, “When there is excess pressure on the nerves – either as a result of tumors or blood vessels pushing up against them — it causes abnormal stimulation to the area. The result is spasms or tics.”

Common nerve disorders

  • Trigeminal neuralgia (tic douloureux):  A chronic pain condition caused by irritants to the trigeminal nerve. Flare-ups, which can last a few weeks or months and then disappear for a time, manifest as intense bursts of pain in part of the face, usually one side of the jaw or cheek. The pain may be burning or sharp, and so severe that the patient is unable to eat or drink. A flare-up begins with intermittent tingling, numbness, or electric shock-like sensations in the cheek or jaw that can last from a few seconds to two minutes. They may become more and more frequent until the pain almost never stops, and be so intense that it has been linked to depression and disability. “Most common over-the-counter and prescription pain medicines don’t work with this condition,” notes Dr. Otten. “Typically anticonvulsant medicines are prescribed, as are tricyclic antidepressants to help relieve pain. If medicines have failed, surgery may be an option. Unfortunately, many people resort to tooth extractions and extensive oral surgery before they even receive the correct diagnosis. This is why we are hoping to raise awareness about this condition.”
  • Hemifacial spasm (tic convulsif): A condition that causes frequent uncomfortable “tics,” or muscle spasms on one side of the face. As the condition worsens, the tics can become more and more frequent and intrusive. “The source of the problem is a nerve, but the manifestation is the tic, which is a muscular contraction,” explains Dr. Otten. “As the disorder progresses, patients may report spasms in the muscles of the lower face, which may cause the mouth to be pulled to one side. Hemifacial spasm may ultimately affect all the muscles on one side of the face, in an almost continuous state of contraction.” The first line of treatment usually consists of a series of Botox injections to help stop the spasms. In severe cases, a surgical procedure called microvascular decompression may be used, which involves repositioning the artery that irritates the nerve as it comes out of the brainstem.
  • Glossopharyngeal neuralgia: This involves recurring attacks of severe pain in the back of the throat, the area near the tonsils, the back of the tongue, part of the ear, and/or the area under the back of the jaw. “The pain is due to irritation of the glossopharyngeal nerve, which helps move the muscles of the throat and carries information from the throat, tonsils, and tongue to the brain,” says Dr. Otten. The same anticonvulsant and tricyclic antidepressants used to treat trigeminal neuralgia may help the condition. For permanent relief, however, surgery may be needed.

Dr. Otten concludes, “Facial pain and convulsions caused by nerve disorders can vary in severity, depending upon the extent of the injury to the nerve. Symptoms can range from mild twitching or pain to full contraction of the muscles, or debilitating pain. It’s important to keep in mind, however, that these symptoms don’t necessarily imply a vascular compression. Each patient’s physician needs to make a careful investigation in order to make the right diagnosis. Once that has been established, a treatment plan should be individualized for maximum benefit to the patient.”

To find a neurologist, visit doctors.nyp.org or call 877-697-9355.

Win big with healthy Super Bowl snacking

Football party

It’s coming! Two powerhouse football teams are getting ready to square off on February 3 for a Super Bowl victory. But why not make it a winning day for yourself too?

Oftentimes, the Super Bowl means super bowls — of guacamole, chips, chicken wings, mac & cheese, you name it. They’re fun to eat, but you may pay the price later that night with digestive issues such as heartburn, acid reflux, and irritable bowel syndrome.

Gastroenterologists at NewYork-Presbyterian caution that fatty and spicy foods, alcohol, and carbonated beverages can be hard on the gastrointestinal tract. Snacking close to bedtime can exacerbate the situation — especially for those who suffer from acid reflux. They advise people who are prone to acid reflux to avoid eating within an hour of going to bed.

Yet there’s no need to entirely pass on game day snacking. The keys are moderation and control. Consider using a smaller plate when selecting your snacks. This will help you to eat less. In addition, pace yourself, especially when consuming alcohol. And finally, keep this in mind: we tend to eat more when we are in the company of others, so pay more attention to the action on the football field than the action at the buffet table.

With this in mind, here are some Super Bowl snacking tips that your digestive system may thank you for later:

  1. Limit spicy foods that can trigger conditions like irritable bowel syndrome, indigestion, and acid reflux.
    1. Instead of: wings, nachos and chili
    2. Try: pitas, hummus and yogurt and chili made with chicken and zucchini and carrots.
  2. Limit dairy, as lactose can be a problem for many.
    1. Instead of: boxed mac and cheese
    2. Try: mac and cheese made with whole grain pasta and cheeses that are low in lactose, like brie, parmesan, and aged cheddar.
  3. Beware of beans as overindulgence can lead to gas and indigestion.
    1. Instead of: chili and chipotles made with hamburger meat and beans
    2. Try: chili made with veggies like cubed potato, turnip, daikon radish or pieces of cauliflower.
  4. Limit fat, as it takes longer to digest — eating a lot of fatty food can lead to indigestion.
    1. Instead of:  fried wings, potatoes and burgers
    2. Try: grilled chicken skewers, or consider making potato skins with low-fat cheese and turkey bacon bits. Make an effort to bake, not fry, food. 
  5. Have choices. Make sure you complement your traditional Super Bowl smorgasbord with nutritional options. Examples include: yogurt dip, nuts, fruits (especially berries), multigrain or whole-grain crackers and chips, non-spicy guacamole, baked (not fried) chicken or fish, salads, fresh vegetables, and water with lemon or citrus garnishes.

For more healthy eating tips, visit nyp.org/nutrition. To find a gastroenterologists, call 877-697-9355.