It has been over a month since Susie started taking antispasmodics. We were hoping to see neurologic improvement, but her condition is largely unchanged. We met with her local Neuro-Oncologist this week for follow-up and to discuss next steps.
First and foremost, her MRI was very similar to her MD Anderson scans from December; so physiologically her scans are stable. It is unclear if the region affected by the stroke event is brighter, but it has not shrunk or expanded. Nevertheless, we were comforted to hear the enhancement does not look like tumor progression.
Understanding the above, we need to take a more aggressive stance towards improving oxygenation of her left temporal and frontal lobes. We discussed Hyperbaric Oxygen Therapy (HBOT) and Avastin (bevacizumab). As Susie has a propensity for collecting side effects, we’ve decided to try HBOT. My next step is to work with our insurance for coverage, as Aetna considers HBOT experimental for stroke and Glioblastoma. The treatment is approved for radiation necrosis.
From what I have read, HBOT increases tissue oxygenation and suppresses inflammation. When we learned of Susie’s SMART Syndrome diagnosis, my sister suggested I look into HBOT. She considers it for patients whose tissue is in areas that tend to be poorly oxygenated after surgery. In terms of the brain, the use of HBOT is controversial. I have read a few studies that show both benefit and lack of evidence. I even found an article that said it might be harmful for Acute Ischemic Stroke patients. The articles I found most interesting are:
- Hyperbaric oxygen therapy for traumatic brain injury: bench-to-bedside
- Hyperbaric Oxygen Therapy for Acute Ischemic Stroke
- Management of brain necrosis as a result of SRS treatment for intra-cranial tumors
Surprisingly, there are quite a few options for Hyperbaric Oxygen Treatment in Austin. I’m curious to understand what is the difference between them are. Some only have single person devices, while others support the patient with support staff.
- Health South Rehab Hospital (near Brackenridge Hospital)
- St. David’s Healthcare (multiple locations)
- ATX Hyperbarics (Westlake Medical Center)
- Arise Medical Center (Bee Caves)
- Baylor Scott & White (Central Texas)
- Restore Cryotherapy (North Austin)
All in all, we are happy we still have options.