...This morning, we returned to Fortis Escorts Hospital to see the plastic surgeon, receive a full diagnosis, and discuss different treatment options for little Manish. For the first time, Manish's father Kusun was also able to come along.
It is apparent that Manish's condition is quite unique. The chief radiologist, chief plastic surgeon, and chief pediatrician at Fortis Escorts, as well as physicians at the All India Institute of Health Sciences in Delhi, have had difficulty pinning down what is causing the tumor on Manish's face. Is it a vascular malformation or a hemangioma? I wish we could say with certainty, but even the best doctors in Faridabad and New Delhi cannot definitively diagnose his condition.
While three of the top doctors in Faridabad stopped their other patient flows to discuss the case even further, we had Manish's blood drawn for a CBC (complete blood count). The doctors wanted to see if Manish's tumor was hogging platelets. Manish was adorable as he looked with such curiosity at the needle before realizing the pain that it would inflict.
The doctors finally agreed that, given the flow patterns on the contrast MRI scans, the tumor is most likely a hemangioma. The pediatrician prescribed Manish (9.52kg) with tablets of Omnacortil (20mg) to be taken once daily. This is a strong steroid treatment that will hopefully slow or even stop growth of the hemangioma until it enters the involution stage.
The bad news is that Manish may have to live looking like this for the next 5 to 8 years. We could perform a surgery now, but any hemangiomatous tissue left behind could still continue to proliferate. The risk of infection, especially so close to the eye and brain, caused by opening the tumor is prohibitively high. It is far better for Manish to be disfigured for his youth than to become permanently blind, develop meningitis, or die. This has been an incredibly educational few weeks for me. I had no idea something that looks so out-of-control could actually take care of itself with time. Although I feel somewhat powerless, this is yet another lesson that we are all just human. Life, even if it is disfigured, is still beautiful.
The great news is that Manish is otherwise healthy and will hopefully respond to the medication in time for it not to proliferate to the extent that it covers his right eye. Manish was on medication previously, but not a proper dosage. If you live in a slum in India, you can't just call up the public hospital to ask about your prescription. They would laugh at you on the phone. It sounds like Dolly and Kusun have been confused about proper use of the steroidal syrup they were prescribed before. Since Manish showed no typical signs of steroid medication (such as swelling, lack of appetite, or gaseousness), the doctors here at Fortis Escorts believe that Manish's previous treatment has had little if any impact.
We bought Manish's tablets at the pharmacy and his parents will start his treatment today. Next Tuesday, we will return to the hospital to see how Manish is reacting to his treatment and determine the extent of its side effects on him.
Manish isn't just a celebrity in the hospital here. He is quickly gaining medical attention on the other side of the planet. I am working on having Manish's MRI scans uploaded to radiologists and a renowned leader on infantile hemangiomas in Canada. Many thanks to these generous doctors for helping to provide truly global care to Manish.