–following removal of large tumour on spinal cord

By Nafeeza Yahya
A COLLABORATIVE effort between NeuroSpine Services Inc., and the Georgetown Public Hospital Corporation (GPHC) has resulted in the removal of one of the largest intra-medullary spinal cord tumours ever attempted here in Guyana.

Kishan Sarju, a 39-year-old father of three, now has a fighting chance at being able to walk again, and to spend quality time with his family.

This life-changing surgery will pave the way for the Belvedere, East Berbice resident to improve his neurological functions.

Sarju was once an industrious sugar worker attached to the Albion Estate. His life changed after he fell while loading a punt on December 14, 2020. He thought it was just “another fall”, but it would later change the course of his life, as he was diagnosed with a spinal cord tumour, and was initially told it was inoperable by a panel of National Insurance Scheme (NIS) physicians.

During an interview with the Guyana Chronicle, Sarju explained that while loading punts, he would often fall, but despite the pain and discomfort, he never paid much attention to them, since he had to provide for his wife and children who are aged six, eight and 10.

“While working, I would fall and get knock, but I didn’t take it for anything. I am a poor man, and have bills, so I just continue to work. I used to get lower back pain, and after it continued, I went for a MRI. I was told I have some damages to my nerves, and they gave me some pills and I went back to work again. And while working, I find that my left foot start drag,” he recalled.

He said that after this persisted, he stopped working the night shift.

“I start do day work in the gang’ that was lighter work, ‘cause I got my family to mind. But my foot got worse, and I fall down from the labour punt on December 14. I couldn’t help myself; the workers help me out the water, put me in a truck, and carry me to the dispensary and then to the Port Mourant Hospital,” he added.

Sarju explained to this publication that he initially received assistance from NIS, and was seeing one of the Scheme’s doctors once per month. However, his condition worsened to the point where he was in unbearable pain, was experiencing weakness, and was rapidly losing function in his lower and upper limbs. Eventually he became bedridden.

After several more tests were done, he was told by the NIS-appointed physician that he had a tumour attached to his spinal cord, and that there was nothing that could be done to improve his condition.

He endured sleepless nights, as he thought about his children growing up without a father, or his being unable to provide for them.

LAST RESORT
Sarju recalled that he was advised, and eventually encouraged to see Neurosurgeon Dr. Amarnauth Dukhi. Not wanting to give up, he travelled to a private hospital in Georgetown, where he met Dr. Dukhi.

“A family told me about Dr. Dukhi, and insisted I see him. I went and took my reports with the MRI of my spine and brain,” he said, adding: “Dr. Dukhi said I have a mass on my cervical spinal cord; in the neck back. When I get the news, a chill passed through my body, as I wonder what would be the next step. But he ask for some time to study the scans, and when I went back, he said the only thing was a slim chance for surgery; no other option, ‘cause if left as it is, I would die. He explained the difficulty and risks with the surgery, but it was my only chance of surviving. So, I didn’t think twice at this God-given opportunity. The same day, NIS medical board called me, and I went to see them. They told me I have a drop limb. They said they will send a report.”

He recalled that when he returned home, he was despondent, not only because of the diagnosis, but because NIS was no longer paying him.

According to him, the payments stopped after six months, even though he was bedridden, and in no condition to return to work. How he was going to pay for this life-saving surgery was also weighing heavily on his mind.

Sarju said that even with the help of family and friends combined, he wouldn’t have enough to offset the expenses. Relatives began seeking ways to source the money, but were unsuccessful.

He told this publication that many thoughts crossed his mind, and when he had given up all hope, he got a phone call from Dr. Dukhi’s office.

“A day I lie down in bed feeling frustrated, but I prayed when I got a call from Dr. Dukhi’s office saying that he looked through all the reports, and that he will do the surgery for free. The only thing I could have done was cry; my tears just started to fall. I couldn’t control my emotions, because I didn’t expect that. Even now as I lay here, I cannot believe I can move my hands and feet again,” Sarju told the Guyana Chronicle from his bed at home.

COMPLEX SURGERY
Meanwhile, this publication also spoke with Dr. Dukhi who recalled his first encounter with Sarju. The doctor said he’d initially thought that the tumour was inoperable.

“He came into my office at Woodlands Hospital on a wheelchair. Upon first examination, he was extremely flaccid; no movements in upper or lower limbs. At first glance, I thought it was inoperable myself. Radiologically, his MRI showed an extensive spinal cord tumour; basically, his entire neck from where his brain joins with his spinal cord was all tumour. So, his entire cervical spinal cord was tumour tissues. I could not have seen the nerves of the spinal cord; all you could have seen was tumour. It had invaded the entire cervical spinal cord, hence the reason he became immobile. This also led to other complications in the spinal cord. Cystic dilations called syringomyelia were seen superiorly in the lower brain stem, and the entire lower spinal cord, thoracic and lumbar spine. These complications further contributed to his loss of neurological functions from this neck down,” Dr. Dukhi explained.

However, after carefully reviewing the scans, and subsequently reconstructing it into a 3D format, Dr. Dukhi noticed that even though all he was seeing was tumour, the patient still had some viable nerve fibers in the cervical cord. These types of mass lesions are consistent with intra-medullary spinal cord ependymoma or astrocytomas.

Realising there was an option to operate, though costly, Dr. Dukhi related that after listening to Sarju’s heartbreaking story, he knew there was no way he could have afforded the surgery privately. It was then that he took a decision to approach NeuroSpine Services Inc., which had all the equipment needed for such a surgical procedure, and could provide them free of cost.

Given the complex nature of the surgery, hi-tech equipment is needed to monitor the spinal cord’s functions during the operation.

Dr. Dukhi had made up mind, after reviewing the case, that he would also offer his surgical expertise, free of cost, to Sarju. He penned a letter to the GPHC, seeking permission to use its facilities, including the operating threatre and the Intensive Care Unit (ICU), for post-operative care.

Consent was subsequently given, and NeuroSpine Services Inc., provided the equipment for the surgical procedure. October 8 was the date set for the surgery.

ENCOURAGING RESULTS
After more than eight hours, the tumour was successfully removed. Sarju was discharged from GPHC on October 14.

This surgery, according to Dr. Dukhi, was one of, if not the most difficult spinal surgery he has ever done, and he is extremely pleased with the results thus far. The post-surgery results are very pleasing, and hence the doctor is very optimistic that Sarju, with extensive therapy, can return to a normal life.

“It was an extremely successful case. I thought it was another opportunity to save someone; to give a family joy and comfort; an opportunity to put someone back on their feet,” Dr. Dukhi said. “So I knew I had to find a way to make it happen. Our aim now is to rehabilitate him in such a way that he walks again. His chances with rehabilitation and strengthening are very good,” he added.

He posited that this is another accomplishment for neurosurgery in Guyana, and could not have been possible without the combined efforts of NeuroSpine Services Inc., and their staff, and the GPHC, especially the anesthesiologists, Dr. Arturo and Dr. Fernando.

Dr. Dukhi explained that the location of the tumour in the neck involved the nerve that innervates the muscles that control heartbeat and breathing, basically regulating the cardiovascular and respiratory system. At any time this could have stopped, and it would have been a different result, had there been any damage to those nerves during the procedure.

“So, to see him moving his limbs and breathing as per normal; to be able to discharge him in such quality clinical condition gives us hope. And we expect to see him walk again,” the neurosurgeon said.

Further, the doctor highlighted that in any part of the world, this is an extremely difficult spinal surgery, and there are many neurosurgeons who would think twice about attempting to perform it.

“We are happy that we were able to successfully remove the entire tumour here in Guyana, in a private/public partnership, and more so, we are even happier to see that the patient was able to move his hands and feet again. I want to give special thanks to the entire neurosurgery team, such as Dr. Gabriel, Dr. Anna Singh and others. Without them and the preparations, this would not have been such a success,” Dr. Dukhi said.

For now, Sarju will continue with physiotherapy at the Port Mourant Hospital. This is a very important part of his recovery process.