TRAVIS AIR FORCE, BASE, Calif. – An 11-year-old patient is receiving hyperbaric oxygen therapy at the David Grant USAF Medical Center at Travis Air Force Base in an attempt to stop, or at least, slow the rate of radiation damage before it reaches his brain.
At age 9, Jeremiah J. Harutyunyan – his family calls him JJ – underwent surgery Dec. 15, 2016 at a civilian hospital, to remove a brain tumor. He was then treated with radiation therapy and chemotherapy. About nine months later, JJ was diagnosed with radiation damage to his spinal cord. He is now unable to feel below his neck or breathe without a ventilator.
“This is a unique case,” said Lt. Col. (Dr.) Jason Kelly, 60th Medical Group Hyperbaric Medicine flight commander. “Far less than 1 percent of cases results in radiation damage to the spinal cord in patients treated for brain cancer. It’s even more of a rarity that this would happen in a child to the severity that he’s on a ventilator.”
JJ is suffering from delayed radiation complications, which can occur after a latent period of six months or more. Because the spinal cord carries messages between the brain and the rest of the body, damage to any part of it or the nerves at the end of the spinal canal can cause permanent changes in strength, sensation and other body functions below the site of injury. Radiation damage can remain the same or worsen.
“His MRI shows that the radiation damage is progressing further up into the brain stem,” said Kelly. “If we can stop the progression, it will stop it from affecting other brain functions.”
The Harutyunyans, who have no military affiliation, appealed to the Secretary of the Air Force to have JJ treated at DGMC. The Air Force approved treatment, noting that knowledge about treating spinal cord damage is limited within the medical community.
An email from the Secretary’s office went on to say that “Congress has been pushing the Air Force to improve its capabilities in this area” and a study about the case would benefit Air Force medicine and readiness.
“There are plenty of facilities that can take care of a child,” said Kelly. “There’s a handful that can take care of a ventilated patient. We’re the only facility in Northern California – and one of few in the country – that meets all the requirements to treat this rare case.”
Currently, there is no scientific treatment to reverse damage to the spinal cord, although researchers are experimenting with prostheses and medication to promote nerve cell regeneration or improve the function of the nerves that remain after injury, according to several medical journal reports.
“We tried many therapies that are the standard of care,” said Dr. Arati Rao, JJ’s current pediatric hematologist-oncologist at Kaiser Permanente Medical Center in Roseville, California.
Rao treated JJ for a year with Avastin – a cancer medicine that interferes with the growth and spread of cancer cells. She treated him for another five months with a combination of Vitamin E and Treatal. The latter is used to improve blood circulation by improving blood flow.
Seeing no improvement in JJ’s condition, Rao began contacting hyperbaric facilities. By recommendation, she contacted Kelly at Travis.
“Dr. Kelly was extremely optimistic and positive – if we could get approval to do this,” said Rao. “We’re all optimistic that (hyperbaric oxygen therapy) might help.”
JJ underwent an initial evaluation Nov. 27 and began treatment the following day. He is scheduled to receive 30 treatments before undergoing the next MRI.
“We’ve treated quite a few patients with radiation damage to the bladder or mandible,” said Kelly. “We’ve also treated patients with chest wounds who had breast cancer.”
Additionally, there are about 15 reported cases of hyperbaric oxygen treatment for radiation damage, but none as severe as JJ’s, said Kelly.
Since medical knowledge in this area is limited, detecting minor changes in JJ’s condition is difficult, said Kelly.
“He’s now breathing over the ventilator,” he said. “The breaths are involuntary, but we think that’s a positive sign.”
Additionally, JJ’s mother told Kelly that her son seems to swallow more on his own and he’s making more sounds when he mouths words, which is one of the ways they communicate.
“A win would be that we stop the progression (of damage),” said Kelly. “It would be a miracle if we reverse some of the damage – whether that’s JJ coming off the ventilator, regaining motor functions, being able to speak again or anything.”