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...