Thursday, October 25, 2007
Diagnosis: Stage 4 Neuroblastoma (Cancer)
Patient:
Adullah (Zohaib) Umair, almost 3 years old.
Primary Diagnosis:
Stage 4 Neuroblastoma, confirmed 24 Oct 2007.
History:
My son, Abdullah (Zohaib) Umair had been consistently complaining about back pain while visiting Dubai. It seemed that he was having difficultly sleeping and had heavy breathing while even asleep. He had not passed his stool for more than a day now. We took him to the emergency of the hospital. The doctor in emergency called the resident pediatrics doctor on call. The doctor wanted to do an x-ray before attempting to relieve the patient's constipation with an enema, as earlier attempts to do that had failed with a suppository.
An x-ray was done of his abdomen. I believe the radiologist was unavailable at that time, the resident improvised by reviewing the x-ray film himself and concluding it looked all good.
The enema relieved the child's constipation in approximately half an hour. We were all happy that the child was relieved of the pain.
Unfortunately the heavy breathing came back later at night. I was very concerned as this was not normal. The following day the pains returned. We (me and my wife) took the child back to the hospital and took him to a specialist pediatrician. The pediatrician discounted the child pain as fake, as children at this age tend to copy what they see.
The symptoms persisted now with a fever. We went again to the hospital, to another specialist pediatrician who wanted to admit the child as he may have a chronic disease and did not really understand why the child had a fever.
Seriously disappointed and unsatisfied we took him another child clinic. The doctor there found a clear throat infection and started the child on antibiotics. The relieved the child of pain and fever. We thought the issue was identified and action taken to address the issue. Unfortunately the back pain never went away. Worried about this we took the child back to the 1st pediatrics specialist and I exhibited serious dissatisfaction at not being able to identify why the child was in pain. The pediatrician reluctantly requested an abdominal ultrasound for our satisfaction.
The ultrasound revealed a 6mm calculus in left kidney - uv junction. Unsatisfied with the medical competence and diagnostic capabilities in Dubai, we decided to pursue further treatment in Pakistan, where we had many influential doctors in our immediate family. We went straight to the airport and took the 1st flight to Pakistan within 3 hours. A pediatrics urologist was identified and the child's case reviewed with him. The urologist recommended shock wave lithotripsy to eliminate the stone as it was large for the child to pass out normally. The recommended technician / doctor performed the procedure and the pain was relieved almost instantly. The child was relieved of pain, but the fevers still persisted. The technician diagnosed a mal rotated kidney and the specialist concluded that was the primary reason for the stone formation. Further tests were required, but not immediately. We decided to pursue these tests on our return to Canada in a few days.
We now returned to Dubai, where as soon as the plane touched the runway, the child started complaining about the back pain again. Unsure of where we stood, I attempted to identify the best urologist in Dubai. We immediately took our child to him at Zahra hospital in Sharjah, he recommended a CT scan to ensure that there were no microscopic stone fragments which may be causing this issue. The CT scan facility at Zahra hospital was completely booked for the day and we would be required to wait until the next day.
I decided to get the CT done at Zulekha hospital in Dubai the same day. The radiology team seemed to panick. They informed that they saw a mass crossing the mid line and wanted to do a CT with contrast. I faxed the preliminary report, speculating neuroblastoma, to my family doctor in Toronto; who recommended that we get back ASAP and take the child straight to the SickKids hospital in downtown. I called my younger brother to the hospital and told him to make immediate arrangements for us to go back home to Toronto. We took the 1st direct flight out of Dubai to Toronto in 5 hours. The non stop flight lasted approximately 16 hours. The child slept through most of the journey, in pain.
Medical Diagnosis:
Abdullah (Zohaib) Umair was diagnosed as having a stage 4 neuroblastoma in October 2007 at the SickKids Hospital in Toronto, Canada.
The diagnosis was confirmed with a CT scan, bone scan, bone marrow aspirate, bone marrow biopsy, bone biopsy, MIBG Scan and urine test. The whole diagnostic process after neuroblastoma spculation took 1 week.
His treatment was started on the NB8097 protocol, one of the most intense chemo protocols.
The primary tumor was on the adrenal gland and had crossed the midline and over to the spine. It had spread to the bone marrrow and the bones. The MIBG showed the cancer spread almost everywhere between the pelvic area and the skull. Thus it was staged as stage 4.
Social Experience:
Adullah (Zohaib) Umair, almost 3 years old.
Primary Diagnosis:
Stage 4 Neuroblastoma, confirmed 24 Oct 2007.
History:
My son, Abdullah (Zohaib) Umair had been consistently complaining about back pain while visiting Dubai. It seemed that he was having difficultly sleeping and had heavy breathing while even asleep. He had not passed his stool for more than a day now. We took him to the emergency of the hospital. The doctor in emergency called the resident pediatrics doctor on call. The doctor wanted to do an x-ray before attempting to relieve the patient's constipation with an enema, as earlier attempts to do that had failed with a suppository.
An x-ray was done of his abdomen. I believe the radiologist was unavailable at that time, the resident improvised by reviewing the x-ray film himself and concluding it looked all good.
The enema relieved the child's constipation in approximately half an hour. We were all happy that the child was relieved of the pain.
Unfortunately the heavy breathing came back later at night. I was very concerned as this was not normal. The following day the pains returned. We (me and my wife) took the child back to the hospital and took him to a specialist pediatrician. The pediatrician discounted the child pain as fake, as children at this age tend to copy what they see.
The symptoms persisted now with a fever. We went again to the hospital, to another specialist pediatrician who wanted to admit the child as he may have a chronic disease and did not really understand why the child had a fever.
Seriously disappointed and unsatisfied we took him another child clinic. The doctor there found a clear throat infection and started the child on antibiotics. The relieved the child of pain and fever. We thought the issue was identified and action taken to address the issue. Unfortunately the back pain never went away. Worried about this we took the child back to the 1st pediatrics specialist and I exhibited serious dissatisfaction at not being able to identify why the child was in pain. The pediatrician reluctantly requested an abdominal ultrasound for our satisfaction.
The ultrasound revealed a 6mm calculus in left kidney - uv junction. Unsatisfied with the medical competence and diagnostic capabilities in Dubai, we decided to pursue further treatment in Pakistan, where we had many influential doctors in our immediate family. We went straight to the airport and took the 1st flight to Pakistan within 3 hours. A pediatrics urologist was identified and the child's case reviewed with him. The urologist recommended shock wave lithotripsy to eliminate the stone as it was large for the child to pass out normally. The recommended technician / doctor performed the procedure and the pain was relieved almost instantly. The child was relieved of pain, but the fevers still persisted. The technician diagnosed a mal rotated kidney and the specialist concluded that was the primary reason for the stone formation. Further tests were required, but not immediately. We decided to pursue these tests on our return to Canada in a few days.
We now returned to Dubai, where as soon as the plane touched the runway, the child started complaining about the back pain again. Unsure of where we stood, I attempted to identify the best urologist in Dubai. We immediately took our child to him at Zahra hospital in Sharjah, he recommended a CT scan to ensure that there were no microscopic stone fragments which may be causing this issue. The CT scan facility at Zahra hospital was completely booked for the day and we would be required to wait until the next day.
I decided to get the CT done at Zulekha hospital in Dubai the same day. The radiology team seemed to panick. They informed that they saw a mass crossing the mid line and wanted to do a CT with contrast. I faxed the preliminary report, speculating neuroblastoma, to my family doctor in Toronto; who recommended that we get back ASAP and take the child straight to the SickKids hospital in downtown. I called my younger brother to the hospital and told him to make immediate arrangements for us to go back home to Toronto. We took the 1st direct flight out of Dubai to Toronto in 5 hours. The non stop flight lasted approximately 16 hours. The child slept through most of the journey, in pain.
Medical Diagnosis:
Abdullah (Zohaib) Umair was diagnosed as having a stage 4 neuroblastoma in October 2007 at the SickKids Hospital in Toronto, Canada.
The diagnosis was confirmed with a CT scan, bone scan, bone marrow aspirate, bone marrow biopsy, bone biopsy, MIBG Scan and urine test. The whole diagnostic process after neuroblastoma spculation took 1 week.
His treatment was started on the NB8097 protocol, one of the most intense chemo protocols.
The primary tumor was on the adrenal gland and had crossed the midline and over to the spine. It had spread to the bone marrrow and the bones. The MIBG showed the cancer spread almost everywhere between the pelvic area and the skull. Thus it was staged as stage 4.
Social Experience:
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