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New 2 board....411 please! (Read 3565 times)
Jia_Li
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My daughter is in the
process of being Dx

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Bethesda, USA, MD, Maryland
Gender: female
New 2 board....411 please!
Jan 14th, 2006 at 12:28pm
 
We took my daughter Jia Li to Boston on Thursday to consult with Dr. Scott. He wants us 2 return in 2 weeks for arteriogram to form diagnosis.
We are so confused because the local Neuro Interventional Radiologist (Children's Hospital Washington DC) said that he thought it was not  Moya Moya because on MRI/MRA the LIC is severely narrowed, her RIC is very large as well as Vertibral artery. This suggests that her condition may be congenital and not progressive. He did not see evidence of the collaterals which form the puff of smoke.
She has classic symptoms....migraine type headaches, involuntary muscle movement, and TIA like behavior with cognitive issues. She has problems tracking at school and noone can figure out what is going on. She is also adopted from China.
Because of the strong symptomology and confirmed narrowed LIC as well as evidence of sluggish blood flow in brain on MRI, Dr Scott wants her on aspirin ASAP and said that sometimes the classic puff of smoke is not seen. Has anyone had this experience with a confirmed Diagnosis? Can an MRI/MRA miss the puff and the arteriogram catch it?!? Also, if we fly to Boston, can we fly back the day after the angiogram? Can she safely travel that soon? If she gets the surgery, how long should we plan to stay in Boston with her? Will her hair (her prized possession) grow back normal if she needs the surgery? One last burning question...where (or who) is the donor vessel taken from?!?
Thank you SO much for the help. Needless to say...we are freaking out right now.
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Lore
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Re: New 2 board....411 please!
Reply #1 - Jan 14th, 2006 at 4:34pm
 
Hi Jai Li and Family,

Welcome to the MoyaMoya family.

I am sorry to hear of Jai Li's medical issues however, I am glad to hear you are taking Jai Li to Dr. Scott who is a MoyaMoya specialist. He will decide what type of surgery is best for Jai Li, if in fact she requires surgery, as a result of MM. The common surgeries are STA-MCA and EDAS. There is information on this board about the different types of surgeries under medical info. There are posts about the different types of surgeries under MM related information.  Also, Dr. Scott has a web site and it has a question and answer page. Some of your questions may be answered by viewing that page.

I realize this is very overwhelming to you. I am not a doctor but I will share with you my experience with being a caregiver to my brother who has MMD and underwent two STA-MCA bypasses this past May at Stanford.

My experience has been that one can have the classic symptoms of MMD and the collateral vessels not be present or seen. My brother is a prime example of that. He had numbness and tingling in his 30's then had TIA's and then had a stroke and the MM collateral vessels did not show up even on an angiogram at that time. It wasn't until several years later when another angiogram was performed that the collateral vessels were seen. Keep in mind, it is different for everyone. Also, the symptoms of MMD mimic other conditions as well. You are in good hands with Dr. Scott. 

Additionally, Dr. Scott will let you know when Jai Li can travel after her angiogram. I flew almost 3,000 miles with my brother only about a week after having both surgeries. Again, I don't know if Jai Li will be permitted to travel immediately after the angiogram or not. Dr. Scott will have to answer that question.

As for the hair, my experience with my brother having surgery at Stanford is they only cut the hair where they make the incision. They don't cut or shave your entire head. Now that may be different at Boston and it may be different depending on other factors but certainly Dr. Scott can also answer that question as it specifically relates to Jai Li.

Again, I know how overwhelming a diagnosis of MM can be and how the many questions flood your mind. Know that you have come to the right place for help and support. This is a terrific group of people from all over the world and you will most likely hear from others about their experiences. Especially those who have children and who have been to Dr. Scott.

Hang in there and in the meantime, don't hesitate to ask questions. We will answer you the best we can based on our personal experiences and knowledge level.

I hope I have been of some help to you. I definately wanted to acknowledge your post and welcome you to the MM family.

Please keep us posted on Jai Li.

Lore
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"What lies behind us and what lies before us are tiny matters compared to what lies within us." - Ralph Waldo Emerson
 
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Jia_Li
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My daughter is in the
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Posts: 19
Bethesda, USA, MD, Maryland
Gender: female
Re: New 2 board....411 please!
Reply #2 - Jan 20th, 2006 at 12:15pm
 
Lori

Thank you so much for sharing your brother's experience. I appreciate the information. You are right...it is so overwhelming just trying to comprehend all of this and thank God for this website so those of us scrambling for answers have such a rich resource of information.

To your point about not seeing the collaterals right away...if they are not seen during the angiogram but all other symptoms are present including a diffusely narrowed Internal Carotid artery, I wonder if they will still perform the procedure. Maybe this is a sign of getting it early, before the collaterals have had the time to completely form. Our local Interventional Radiologist totally dismissed MM after seeing no collaterals and told us not to worry about a thing. I know that we are in good hands with Dr Scott...and I am so glad that we persued it anyway.
I hope your brother is doing OK now. He is lucky to have supportive family around!

Stephanie
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Mar
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Re: New 2 board....411 please!
Reply #3 - Jan 20th, 2006 at 5:15pm
 
Hi Stephanie,

I just wanted to welcome you to our MM family and let you know that you and Jia Li, are in our thoughts and prayers.

To answer your question, YES, as Lore mentioned with Kevin, we have seen many cases where an MRI/MRA can miss the puff of smoke and the arteriogram catch it. The Angio is the definitive diagnostic test for MMD. A few members have mentioned that their doctor also said that they do not need the angio to diagnose MMD, but that is how you distinguish the MM expert from the less experienced doctor, IMO. Your type of situation is specifically why we always advise going to a MM specialist, a neurosurgeon who knows the different factors involved from experience and will explore the appropriate avenues to get the answers before any damage is done.

One last burning question...where (or who) is the donor vessel taken from?!?
Well, that depends on what type of surgery the doctor performs. Again, another important factor for a MM specialist, for the doctor to know which type of surgery best suits that specific case, and that the doctor has experience performing all the procedures. In your case, IF Dr. Scott performs surgery; he primarily works with children and he’ll most likely take the donor artery from Jia Li’s herself, a “scalp artery” and attach it directly to the brain surface, to induce new blood vessel growth to the brain over time. All the procedures for MMD have the same concept, in that, getting blood to the blood starved brain to prevent a stroke. Some need it faster than others, depending at what stage of the disease you’re at. Many factors are involved with each individual case, and it’s different for each person. Generally speaking though, with the surgery, the patient has an excellent outcome.

We’re here with you every step of the way. Please feel free to ask anything or just vent, we understand. You’re in great hands with Dr. Scott and I’m so tickled you stuck with it and went to a MM expert.

Mar
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STrantas
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Philadelphia, USA, usa, 490, 122, PA, Pennsylvania
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Re: New 2 board....411 please!
Reply #4 - Jan 22nd, 2006 at 12:04pm
 
Jia_Li wrote on Jan 14th, 2006 at 12:28pm:
Also, if we fly to Boston, can we fly back the day after the angiogram? Can she safely travel that soon? If she gets the surgery, how long should we plan to stay in Boston with her? Will her hair (her prized possession) grow back normal if she needs the surgery? One last burning question...where (or who) is the donor vessel taken from?!?


Stephanie,

First I want to preface my post by saying that everyone's experiences are different.  I'll tell you what my experiences are as I had my two surgeries with Dr. Scott a little over two years ago.

can we fly back the day after the angiogram? Can she safely travel that soon?
Absolutely!  Dr. Scott does suggest you stay overnight but you will be able to fly home with Jia Li the next day.  This was my experience with my one year post-surgery angio.

If she gets the surgery, how long should we plan to stay in Boston with her? Will her hair (her prized possession) grow back normal if she needs the surgery?
  We were in Boston for 2 weeks for my two surgeries.  Is Jia Li going to have both sides done?  or just one?  My surgeries were a week apart.  As for her hair!  Absolutely!  Dr. Scott will only shave a part of her hair as needed for the surgery.  My picture (<-----) was taken about 6 weeks after my surgeries.  Cant even tell that I had brain surgery!  The person who cuts my hair explained that my hair was only shaved.  Those treated with chemo or radiation, for example, are the ones whose hair usually grows back differently than what it was originally.  No worries there!

I think Mar did a beautiful job in explaining where the donor arteries come from so I won't reiterate!

-Shari
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Dr. Scott did my surgeries - 12/29/03 and 1/5/04
STrantas http://www.facebook.com/home.php?#!/strantas?ref=p STrantas  
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Jia_Li
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My daughter is in the
process of being Dx

Posts: 19
Bethesda, USA, MD, Maryland
Gender: female
Re: New 2 board....411 please!
Reply #5 - Jan 23rd, 2006 at 11:38am
 
Wow...you guys are great! Imagine steering thru this alone...it would be ten times worse!!!!

Thanks again...will keep you posted and you are all in our prayers for continued recovery success.

Stephanie
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