Dear Doctor Chris,
My name is H, from Surabaya – Indonesia. I’m in Penang to have my son’s health checked (since Sunday Peb 23, 2014 – my son’s in ward of Hospital X since Tuesday Peb 25, 2014). Just got info from my friend to ask you to seek second opinion.
To give you a brief of the story, I attach all the report tests taken in Surabaya, then what has been tested in Penang, will be written down side below.
My son, 4 yr 9 mo old, has had several tests in Mitra Keluarga Hosital Surabaya which lead to “ suspected Ca gaster” with unconfirmed tests below :
- Endoscopy & CT Scan reading which stated “probably” Ca Gaster
- Blood Test which didn’t support those two tests.
- PA Test which didn’t show : no malignancy
- Thorax radiology : normal
What I want to know is :
1. While you’re looking at those reports and readings, can I send a DVD containing the whole video of endoscopy & CT Scan photos & and those attached reports, so that you can have proper direction what we will discuss here in this case
For your information, my son’s and my family health history and chronology :
1. We don’t have any cancer history in our bloodline (me & my wife) – up to our grandparents. My father died (@53 y.o) because of heart failure, my grandpa (from my mom) died (@72 y.o.) because of stroke, my grandma (from my mom) died (@68 y.o.) because of diabetes. My mother (60 y.o.) is still alive but sometimes she has gastric problem when she’s late to eat. My parents in law are both alive, father-in-law is healthy (82 y.o.) and mother-in-law (72 y.o.) suffer hypertension
2. I have allergic history to seafood (childhood), but not with my wife.
3. My son doesn’t like fruit.
4. The symptom was started by Jan 20, 2014 by vomitting and diarrhea, once only, each. There was several times of pain in his gaster (just complaining but not so bad), and no fever.
5. By Jan 27, 2014, the pain was getting stronger (but after belching or farting, it’s soon ended). We went to pediatrician, which suspected : helicobacter pyluri infection. The treatment was 2 antibiotics + 1 H2 blocker (gabbryl + abbotic + ranitidine) for 1 week.
6. By Peb 3, the pain was there, and still be treated by 2 antibiotics + 1 H2 blocker (gabbryl + abbotic + ranitidine) for 1 week (bloodtest showed negative for H. Pyluri, but HB was 8), but consumed until Peb 6 when we decided to go to gastroenterologist in Surabaya which suggested to do 1 full month of food allergic selftest before doing endoscopy. But then I decide to meet other gastroenterologist (suggested by the previous one) to have endoscopy, which then decided to be executed in Monday 10Peb14.
7. By Peb 10, endoscopy test was done which was suspected as Ca Gaster due to there are 3 lumps in the my son’s gaster. Early blood test was taken and showed Negative for H. Pyluri, and the HB was still 8, so that blood transfusion (B+) was done 100mL. Samples for PA was taken.
8. By Peb 11, CT Scan (1.5 Tesla) and Thorax radiology tests were taken. Blood transfusion (B+) was done another 100ml.
9. By Peb 12, complete blood test including CEA Marker test was taken but the CEA Market was only 0.83 & CRP was only 2. The HB showed in the test was increasing, to be 11.5. Complete result was attached.
10. By Peb 14, the biopsy test result was finished and found no malignancy
11. By Peb 15, we decided to leave the hospital since there’s no decision from the doctors team (paediatric gastroenterologists, paediatric surgeon) what it is, and how to treat this.
12. By Peb 15, I met dr. P, then he asked me to come to Penang hospital.
Some actions taken by me & medication given after leaving the hospitals are :
1. I stopped giving milk (Pediasure S26), and any dairy products such as cheese (kraft), breads, tea drinks, chocolate containing food & beverage, fried food, any fabricated sausage & nugget, since Peb 13 until now – to reduce gastric acid production
2. I started giving honey + propolis to replace milk by Peb 13 until now, and giving porridge / misoa (rice noddle) / mushy rice and grounded steamed beef / finely shredded beef, no chicken, no fish/seafood to avoid food allergic.
3. I started giving meals 5-6x/day with smaller portion by Peb 14, rather than 3x/day previously
4. Medication taken and given since leaving hospital under paediatric gastroenterologist’s suggestion are : Neciblok Sucralfate suspension (3X daily, 5cc), Ranivel Syrup Ranitidine 75mg/5mL (2X daily, 5cc), Nexium esomeprazole 20mg tablet (2X daily, 1 tablet).
5. Oral pain killer (paracetamol) given after the IV was removed by Thu Peb 13. The dosage was paracetamol 20mg divided into 3 packs of powder, and given once in Fri Peb 14 dawn, once in Sat Peb 15 dawn, once in Sun Peb 16 almost midnite. Then I continue with Dumin syrup (paracetamol), 5ml this early morning (around 3:30am)
Some symptoms I observed before and after Peb 13 :
1. BEFORE : sound of abdominal bloating which then followed by severe pain in my son’s stomach, usually happened once (in between Peb 3-9) in between 2.30 – 4am and once in between morning (after breakfast) till evening (after dinner), and soon disappear after a very foul smell fart. AFTER : sound of abdominal bloating which then followed by less severe pain in my son’s stomach, only happened once (in between Peb 3-9) in between 2.30 – 4am, and soon disappear after a very foul smell fart.
2. BEFORE : frequency of less severe pain (beside the severe ones) in my son’s stomach, usually happened 3-4 times in between morning (after breakfast) till evening (after dinner), and soon disappear after a smell fart/belching. AFTER : only happened 2-3 times.
3. When the pain referred by #1 above is happening, I fingered my child’s stomach and could feel a lump under his chest (upper abdomen) . Both BEFORE and AFTER are the same.
4. Both BEFORE and AFTER are the same : no fever, no vomiting (except once in Jan 20 & twice in Peb 8), normal faeces, weight in between 15-16 kgs, while his height is about 102cm.
Now, in Hsopital X Penang, my son is diagnosed as “favour to Burkitt’s Lymphoma”.
1. Monday, meet paediatric surgeon, then let the P Hospital pathologist did a review of the biopsy sample taken in Surabaya that I brought, and it was claimed as LYMPHOMA, then further PA was taken to make sure.
2. Tuesday, before steroid treatment, all blood test was normal, except LDH 275, HB 10.5, albumin was lesser than minimum limit for kid.
3. Wednesday, after steroid treatment, all blood test was normal
4. Friday, after steroid treatment, all blood test was normal
5. Saturday, after steroid treatment, all blood test was normal, except HB was 8.7
6. Sunday (yesterday), after steroid treatment, blood transfusion was done at 150mL.
7. Monday (this afternoon), the further PA reading was given :
IMMUNOHISTOLOGY (the atypical cells are positive for CD20 and almost all cells exhibit MIB-1 activity. The cells are negative for bcl-2 and strongly positive for bcl-6. The cells are consistently negative for Tdt (x2).
MICROSCOPIC DESCRIPTION (the sections of the gastric biopsy show reactive lymphoid follicles as well as a focus of malignant lymphoid infiltration of the lamina. The cells are medium sized and exhibit prominent nuclei, with prominent granular chromatin and nucleoli, occasionally multiple mitoses are seen, and lymphoepithelial lesions are not seen.
DIAGNOSIS (mucosal infiltration by high grade B cell lymphoma, favour Burkitt lymphoma)
8. In the faeces, there’s no blood within this week, in two times of “buang air besar”
The quickest action will be done by Wednesday Mar 5, 2014 are :
1. Bone Marrow Test
2. Suntik obat dari brain to prevent B cell spread
3. Prepare a chemopot in the chest
Since those 3 actions are scary, could you please prioritize your time to see me ? I’ll go to your clinic. Looking forward your reply urgently.