8 Incredible Medical Stories
Local patients and doctors share eight remarkable tales of real-life medical drama right here in Pittsburgh.
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Photography by Becky Thurner Braddock
Morgan Dysert and Dr. Khaled Aziz, director of Allegheny General Hospital’s Center of Complex Intracranial Surgery.
Washington County native Morgan Dysert was finishing up her freshman year at the University of Minnesota in spring 2010. The athletic student figured the minor eye problems she was experiencing came from late-night study sessions. But her vision continued to worsen for a week, so she consulted an ophthalmologist.
The doctor couldn’t find anything wrong with Morgan’s eyes, but suggested she get a brain scan, to be safe. “That’s when we found out about the brain tumor,” Morgan recalls, “and so my mom immediately said, ‘I’ve heard about this Dr. Aziz — we should see him!’” Morgan’s mother was a director of nursing at Allegheny General Hospital, so she was already familiar with Dr. Khaled Aziz, director of the hospital’s Center of Complex Intracranial Surgery.
Morgan’s tumor, called a trigeminal schwannoma, was rare. And it was growing — already impacting the nerves that controlled eye movement and facial sensations. Her face was beginning to go numb. The tumor was benign, but her symptoms would continue to worsen and eventually become unbearable.
Dr. Aziz confirmed that it was a trigeminal schwannoma — and had more difficult news for Morgan and her family: Although these tumors can sometimes be treated with radiation, hers was too advanced. Morgan’s best removal option was a complicated, dangerous operation; the procedure would be particularly difficult due to the tumor’s location underneath her brain, near delicate nerves and the vital carotid artery.
Normally, risks associated with this surgery include bleeding, strokes and infections — yet Morgan says that Dr. Aziz approached her and her family with a confidence and compassion that allayed their fears. “He told me and my mother [about] everything that would happen [in the surgery] and all the horrible things that could go wrong — but [my mom] came out of that discussion smiling and believing everything would be fine. [That discussion] sticks with me. That was amazing.”
The surgery Dr. Aziz and his team performed on Morgan took about eight hours (the first hours were spent on the crucial positioning of Morgan for the extremely precise procedures to come). A separate team of specialists was involved in preparing an electrovisiologic monitoring system, which would watch her nervous system function throughout the surgery.
Dr. Aziz made a small incision at the base of Morgan’s skull above the jaw and went in underneath the brain (but outside the brain covering). Once that layer was dissected, he was able to follow her trigeminal nerve (a cranial nerve with ties to facial sensation, biting and chewing, and more) back to the tumor. The trick was to remove the tumor carefully without injuring any vital structures. He employed microsurgical techniques to ensure accuracy and also utilized a special computerized navigation system — similar to a car’s — as he moved, helping him to quickly target the tumor.
Finally, he used delicate ultrasonic aspirators to break up and suction out the tumor without damaging surrounding nerves and tissue — another example of the high-tech tools that allow today’s brain surgeons to cure what was once inoperable. “We were able to take out the tumor with minimum manipulation,” Dr. Aziz says, “so her symptoms began to disappear.”
Morgan’s recovery progressed swiftly. She was only in the hospital for five days, and her symptoms were gone in a week. She was able to start the fall semester of her sophomore year, with a pretty amazing story about what she’d done on her summer vacation.
Dr. Benjamin Shneider, director of pediatric hepatology at Children’s Hospital of Pittsburgh of UPMC, and Sam Zarpas.
At just a few months old, Sam Zarpas of Norfolk, Va., faced a dangerous medical crisis unprecedented in babies his age. It began with a rare autoimmune disorder called idiopathic thrombocytopenic purpura (ITP), for which local doctors treated him with steroids — the standard treatment, though the medication often impacts growth in children.
This worked initially, but a few months later, Sam’s eyes turned yellow; he had become jaundiced, indicating liver failure. Doctors thought he had autoimmune hepatitis, in which the body’s immune system attacks its liver. More steroids were prescribed but didn’t help, and his parents were frustrated and scared. “Health-care [professionals] here couldn’t figure out what was going on,” says his mother, Cindi, “but they kept pumping him full of steroids. They didn’t want to think outside the box.”
Fortunately, Cindi was friends with a doctor at Children’s Hospital of Pittsburgh of UPMC, so Sam’s liver biopsy was sent there. It attracted the attention of Dr. Benjamin Shneider, director of pediatric hepatology: “It’s rare to have ITP at 2 months [and] rare to have liver disease at 7 months,” Dr. Shneider says. “Were the two problems connected? That was the rub. Sam also had significant side effects from the steroids — high blood pressure and growth trouble. He was very sick.”
Though Sam was initially evaluated for a liver transplant, Dr. Shneider knew that this major surgery might prove only a temporary solution. He felt that the key to Sam’s immediate and longterm health would be a thorough and accurate diagnosis of his unheard-of combination of conditions.
Examining Sam’s liver cells, Dr. Shneider saw evidence of the rare giant cell hepatitis, and a condition called Coombs’ positive hemolytic anemia, in which antibodies destroy red blood cells. “But in Sam’s case, antibodies were destroying his [blood’s] platelets,” Dr. Shneider explains. “My take was that he had a disease similar to the Coombs’ subset of giant cell hepatitis, but instead of Coombs’, he had ITP. This situation was effectively unique.”
Dr. Shneider felt the medication Rituximab, used for overactive immune systems, could work for Sam, though it had never been used for his specific situation. “We were in uncharted waters with the experimental use of medication on someone so young,” says Cindi, “and the potential side effects were awful! But Dr. Shneider had a wonderful demeanor and confidence, and he kept us calm.”
Sam received four weekly doses of Rituximab, and within three months, his blood clotting factors and liver enzymes were just about normal. Doctors tapered his steroids to a minimum, ending his high blood pressure and growth problems. “He’s 3 now, and you’d never know he was sick a day in his life,” says Cindi. “He’s walking, talking, the right size and shape.”