TUESDAY July 23rd, 2019
Chris received the results of his brain MRI earlier this week. The MRI was negative for any signs of lymphoma; however, it did show that Chris has intracranial hypotension. Intracranial hypotension is a condition in which there is negative pressure within the brain cavity, and is likely the result of a Cerebral Spinal Fluid leak following his lumbar puncture. Typically, these CSF leaks will self heal in 2 to 3 weeks following a lumbar puncture, however, Chris has to get a lumbar puncture every 3 weeks with his chemo; thus, explaining the persistent headaches.
As a result, Dr. Shah recommended Chris get a consult with an anesthesiologist specializing in pain management. He wanted to see if Chris was a candidate for an epidural blood patch. An epidural blood patch is a surgical procedure that uses the patient's blood (inserted into the epidural space) to close a hole in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture.
After meeting with the anesthesiologist today, she did not feel comfortable performing a blood patch because Chris had blood cancer and she fears she could accidentally introduce the lymphoma to his CS space with the treatment.
Fortunately, she did alert us of some other possibilities to alleviate the headaches including a Sphenopalatine block ("During a sphenopalatine ganglion block, pain-relieving medicine is injected to the region where the ganglion lies. This may reduce the release of the chemical norepinepherine activating the pain sensitive nerves and reduce the pain." https://www.cedars-sinai.org/programs/pain-center/conditions-treatments/sphenopalatine.html) or the use of IV cosyntropin during his next LP.
It's good to know we have some other options to help with Chris's headaches. We'll see how Chris feels about trying either of the options during his next LP (likely August 5th or 6th).
Chris's lab draw and nurse visit went well today. His hemoglobin is 9.4. His AST, ALT, WBC count, and absolute neutrophil count are all normal. His LDH is slightly more elevated than Friday, but the nurse was not concerned.
Chris has another lab draw/nurse visit on Friday, followed by his PET scan (to assess his progress so far) on Monday, an appointment with opthamology (to assess the improvement of his double vision) on Tuesday, and the start of round 3 of chemo on Wednesday.
I will continue to update with any news.
V
Chris received the results of his brain MRI earlier this week. The MRI was negative for any signs of lymphoma; however, it did show that Chris has intracranial hypotension. Intracranial hypotension is a condition in which there is negative pressure within the brain cavity, and is likely the result of a Cerebral Spinal Fluid leak following his lumbar puncture. Typically, these CSF leaks will self heal in 2 to 3 weeks following a lumbar puncture, however, Chris has to get a lumbar puncture every 3 weeks with his chemo; thus, explaining the persistent headaches.
As a result, Dr. Shah recommended Chris get a consult with an anesthesiologist specializing in pain management. He wanted to see if Chris was a candidate for an epidural blood patch. An epidural blood patch is a surgical procedure that uses the patient's blood (inserted into the epidural space) to close a hole in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture.
After meeting with the anesthesiologist today, she did not feel comfortable performing a blood patch because Chris had blood cancer and she fears she could accidentally introduce the lymphoma to his CS space with the treatment.
Fortunately, she did alert us of some other possibilities to alleviate the headaches including a Sphenopalatine block ("During a sphenopalatine ganglion block, pain-relieving medicine is injected to the region where the ganglion lies. This may reduce the release of the chemical norepinepherine activating the pain sensitive nerves and reduce the pain." https://www.cedars-sinai.org/programs/pain-center/conditions-treatments/sphenopalatine.html) or the use of IV cosyntropin during his next LP.
It's good to know we have some other options to help with Chris's headaches. We'll see how Chris feels about trying either of the options during his next LP (likely August 5th or 6th).
Chris's lab draw and nurse visit went well today. His hemoglobin is 9.4. His AST, ALT, WBC count, and absolute neutrophil count are all normal. His LDH is slightly more elevated than Friday, but the nurse was not concerned.
Chris has another lab draw/nurse visit on Friday, followed by his PET scan (to assess his progress so far) on Monday, an appointment with opthamology (to assess the improvement of his double vision) on Tuesday, and the start of round 3 of chemo on Wednesday.
I will continue to update with any news.
V
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