Jamie Update

I have included some technical info for those in the family that are familiar with the lingo and may want the more technical/supporting details.

Jamie responded well to treatment at the ER Sat night. No complaints Sun-weds

Weds-
He had his MRI done Weds evening.

Thurs-
He work up Thursday with a severe migraine HA (headache) scale 1-10 it was a 9, with blurred vision and dots in vision/eyes, loss of peripheral vision. Jan gave him phenergan, ice pack, TLCTLC (I am still in Vegas until Sat) the headache decrease to a 7 on same scale. Jan tried to give him a Coke (for the caffeine effect) but jamie did not drink it--so you KNOW he isn't feeling well when he doesn't want a Coke!!! Jan took made an appt. with the doctor in Frenchtown. On way to MD, I received a call from MRI dept. at hospital requesting another MRI with contrast (a dye placed in vein/blood to determine venous flow/involvement). This was scheduled to for that afternoon. Jamie received an excellent evaluation-very thorough-by the nurse practitioner (the very one I was hoping to get to be our primary MD). Her assessment agreed with dx of migraine. She gave him a dose of Imitrex which worked very well (decreasing pain at 1-2 min with pain decreased to 2 (same scale 1-10) within 10 min). This med is effective only on migraines as it effects the spasming vessels and has no effect on muscles (tension HA) or sinuses (sinus HA). He went home feeling much improved. He was back to being the cute inquisitive Jamie we all love. Jan took him in for his second MRI that afternoon (thursday). That night Jamie's headache (same classic migraine symptoms) returned and he was given another dose of Imitrex.

Fri-
He work up Friday with a HA level 6 (scale 1-10) with vision problems (of course) and nausea. He stated that his head throbbed all night. It was too soon for another dose of Imitrex so Jan gave him the ibuprofen & phenergan. He tried to go to school anyway, but was unable to make it to school before the HA worsened again. Jan took him back to MD. She had MRI results (to follow) and called neurologist for followup. We were unable to get in today and have an appt. for Monday morning at 10am. While waiting for the MD's to confer, Jan and Jamie went home. His headache continued to increase (spike) and subside this morning/afternoon. The MD called and discussed options with me; we agreed completely; I called and talked Jamie into returning to MD office for an injection to basically "knock him out" put him to sleep the rest of today and possible some of tomorrow in order to give his brain a rest and allow him to recover and break the HA cycle. He was given a Toradol & Vistaril injection and a script for another type of Imitrex that is long lasting and would stay in his system (longer half life) and help fight off recurrent headaches. I believe it is called Axert. Jamie was not knocked out by Toradol/Vistaril but it did relax him (he takes after his mom a little too much in all this :) So, Jan gave him a dose of this med (Axert) this evening (on MD recommendation) to help push Jamie over the edge and let him sleep. As we all know it is awfully hard to sleep with a migraine. Jamie woke up after a couple of hours feeling much better, watched Forest Gump and returned to bed.

I will be flying back to Montana tomorrow (Sat morning) and will of course, keep you updated as this story progresses.

*Severe/debilitating migraine headaches run in Sara's family (maternal grandmother's side) and have affected nearly every family member for many many generations.

MRI results
I can send the MRI report to any who would like to read the actual report findings. A Dr. of radiology read the CAT scan and both MRI and the findings are related to all 3 scans.

The short version is that Jamie has a 5mm x 6mm hypo-intense lesion on the immediate sub-cortical right anterior frontal lobe of his brain. The lesion demonstrates a small rim like area of contrast enhancement with 2 central areas of decreased signal intensity suggesting non-enhancement. remainder of parenchyma is unremarkable.

translation: he has a small area that is darker then the surrounding tissue in the right front area of his brain. The area around the lesion has increased blood or venous support (contrast mentioned in the dye placed in his veins/blood for the procedure) which is worrisome as it could indicate a venous network to support a tumor. The rest of his brain is fine.

Basically, Jamie has a small low grade brain tumor (neoplasm). The findings are nonspecific and could be a number of things including a calcification from an infectious lesion like tuberculoma or cypticercosis--but it unlikely as none of the surrounding tissue is affected or edematous. It could also be an atypical cavernous hemangioma or post traumatic calcification with gliosis except again there is no evidence of hemorrhage or trauma in the surrounding tissue (and Jamie has never had a severe head trauma). Which leaves us with the initial hypothesis-- a small neoplasm (low grade brain tumor).

The plan: we will follow up with the neurologist Monday. We will treat the symptoms as the arise and try to keep Jamie as functional as possible (related to the migraines). The migraines may or may not be related to or enhanced by the tumor. We will do a repeat MRI in a period of months to re-eval the area and see if there are any changes (i.e. growth) and correlate the MRI results with his symptoms over the same period. We can not really decide what to do or even if we need to do anything about this little tumor until we know more about it's nature. It is my understanding, at this time, that he is not in any immediate risk of death or other adverse effect. All you can really do right now is to keep him in your prayers, thoughts, mantras, whatever your philosophy and wait. I will be keeping you all informed as we progress through the next few months.

*of note for those of you who are LDS-my mom will have his name placed on the temple prayer roll.

An interesting correlation- the general area of the brain where the tumor is directs planning, motivation & attention. Lesions in this area are noted to cause: apathy (occasional brief anger or aggressive outbursts), indifference, psychomotor retardation, motor preservation and impersistence, loss of self, stimulus-bound behavior, discrepant motor and verbal behavior, poor abstraction and categorization. Hummmmm, interesting, makes you wonder how long this little tumor has been there...

Jamie Migraine

Here is your kid update for this week.<br /><br />Auri is doing well, still very busy. Chemistry honors is making her stretch her brain muscles (esp. the math) :) It doesn't help that she has missed so many classes due to Volleyball. She is planning to go to Missoula this afternoon to see a movie with some friends from school. (Update- movie was moved to next weekend) She has found a group that she gets along with well-they even have seen Monty Python!! :) We opened her bank account in Frenchtown and she has full access to withdraw and deposit and even has an ATM card. We discussed the premise and rules of banking and that she had only 1 chance to have an ATM card-one overdraft and she would lose the privilege. She has been babysitting and wants to deposit some money in her bank. I am proud of her and support her growth. We will transfer 1/2 their money from Vegas to Frenchtown, but leave the LV bank open for when she goes there for the summer; as she will need a bank to put her paychecks in (she plans on working this summer) She may even get a job at the Frenchtown grocery or restaurant when she turns 16. She will have a learning lab/study hall next semester and therefore a lighter academic load. So, she would be able to work part-time.<br /><br />Jamie is also having to make up a lot of missed work from missing school related to Soccer. The school sends out letters to parents when their child is at risk (weekly). I got one this week for Jamie related to his English- at risk and Science- failing (due to missing assignments/low scores/incomplete). He has since turned in this work, but with soccer straining his time in school and for homework, he will have to buckle down a little harder. We are not riding him about this, as he is well motivated to stay eligible to play with his team. He seems to be doing well even without any allowances at this time (excepting a small learning lab class-only 6 students). I have a meeting set up with the special ed people (and his teachers) to discuss, assess and redo his IEP to fit into the FHS system (as it is much different thin the Vegas system and his current IEP is not feasible or even possible at FHS).<br /><br />He is progressing well in soccer and is now very proud that he is better then 5 other team players (almost half) according to the team captains.<br /><br />Of importance to all: Jamie had a bad day yesterday (saturday), but not related to behavior or grades. Around 1pm he complained of loss of peripheral vision in his right eye. He also admitted to a headache so he took 3 advil (he also has a sprained ankle) and left for the soccer game. On the bus it hurt to move his eyes, so he kept them closed. He played on the game for about 10-15 min then blacked out on the field. He was only out for a brief moment and woke up on the ground looking up at his team captain (who was closest to him when he fell). He sat the rest of the game out. We picked him up afterwards, and he stated he was fine (of course). We had dinner and ice cream (at <a href="http://www.bigdippericecream.com/">Big Dipper</a>-Yummy!!!) and Auri and Jamie were being silly in the back seat. Jamie suddenly cried out and stated that his head hurt when he laughed.<br /><br />3 strikes: off to the ER we go. Upon arrival he added that his head hurt when he turned quickly, but moving slowly did not bother him. All head pain was in the back on his head toward the left side. The MD did a good assessment, EKG &#38; CAT scan. EKG was perfectly normal. CAT scan showed a calcification in his right frontal lobe that requires further follow-up but is probably not related directly to Jamie's current problem (maybe his other problems?? or maybe even just an unusual anatomy (i.e. a bundle of vessels and not a calcification at all).<br /><br />His diagnosis: new onset-Migraine headache. Welcome to the family curse :) Although I freely admit a strong family history of migraines (everyone in my family has terrible migraines) I thought Jamie too young... then I remembered that he was 14.5 yrs. old... and we all started having HA in our teens... bummer :( They gave him phenergan and that helped. He has a slight HA this morning. He will be scheduled for a MRI on Monday to evaluate the area of calcification in his brain and I will try to find an MD to follow-up with next week. I will keep you up-to-date as we followup with the doctor. HE IS IN NO RISK AT THIS TIME.<br /><br />I will be in Las Vegas this week for MD appts and follow up. Jan is taking care of the kids, animals and home :) Our montana home is definitely keeping us busy. This week: electrical problems, and the well went out and had to be repaired, the same day as the pump for the creek went out (of course) so we had no water for a day, until Jan was able to get it repaired the next afternoon. He is so handy (with the help of some very nice neighbors)!!! <br /><br />The horses and Kizzie have been going through health issues but seem to be improving. Kizzie seems to have caught Giardia which is surprising until your see her in the creek attacking and biting and practically drowning herself trying to catch the water as it flows over the rocks.... silly dog! She has soo much fun; she goes crazy!!! Romeo is doing much better since he started obedience classes. Auri is doing better also; she is learning to have patience and control her temper... good skills for her to develop.<br />