When Tom Mahala didn’t go to baseball practice, his family knew he must be feeling pretty bad. State semifinals were just a day away, and Tom, captain of his high school team, never missed practice. But he had gotten a headache at the gym that morning, and the pain just wouldn’t go away. Tom called his coach to explain that he would have to miss practice due to a migraine.
“How did Coach Sheppard take it?” his dad asked him a few minutes later.
“How did Coach take what?” said Tom. He didn’t remember talking to his coach.
For Tom’s headache was not a migraine at all, but a bleed in his brain resulting from an Arteriovenous Malformation (AVM). An AVM is a rare condition, usually in the brain, in which a tangle of blood vessels prevents blood from flowing normally. The tangle is present at birth, but can remain asymptomatic for years or decades. The first symptom is often a severe headache or seizure due to a hemorrhage in the brain. Treating such a hemorrhage is an emergency.
Tom’s family doctor evaluated the 18-year-old and sent him via ambulance to a nearby hospital in Summit, New Jersey. There, doctors worked quickly. They put in a drain to relieve pressure from the bleeding in Tom’s brain.
They diagnosed the AVM and hoped to treat it endovascularly. This is a minimally invasive procedure in which doctors insert a very thin, flexible catheter into a leg artery, thread it through the circulatory system, and position it at the AVM deep within the brain.
Once in position, the catheter delivers a glue-like substance that blocks off blood flow to the problem area. But Tom’s artery turned out to be too narrow for the catheter. And there was worse news: diagnostic tests had also revealed an aneurysm–a bulging, weak area in the blood vessel walls behind the AVM. Tom’s bleeding could be coming from the AVM or from the aneurysm, and both were going to be difficult to treat.
For the moment, though, Tom’s bleeding had stopped on its own. He rested in his hospital bed, awake but mentally fuzzy. He could talk a little with his family, but had no short term memory. His teammates came to visit him after the baseball semifinals, and Tom had trouble understanding that they won the game.
Doctors were anxious to treat the AVM before bleeding resumed. A few days later, they were able to use the glue-like substance to block off, or embolize, the AVM. But over the next several days, Tom would experience more bleeding.
Meanwhile, Tom’s father–Tom Mahala, Sr.–had begun speaking with Dr. Robert Solomon, Chairman of the Department of Neurosurgery at New York-Presbyterian Columbia University Medical Center.
Tom Sr. was familiar with the stellar reputation of Columbia University Medical Center. He decided that while their local hospital was very good, Tom “needed to be with what many would consider the best.”
He made the decision to have his son transported to Columbia Presbyterian. That evening, Columbia’s transport ambulance carried the family over the George Washington Bridge and into New York.
Tom Sr. can easily recall how good it felt to arrive at Columbia that evening. “Once I walked in through the doors at the neuro ICU, I just felt so comfortable,” he says. “I was like… we’re in the Yankee Stadium now. This is the big league.”
Columbia’s “league” included an outstanding team of neurosurgeons who would handle Tom’s care. Dr. Solomon had been consulting with the family already, and would be their main physician. Dr. Steven Isaacson planned to perform Gamma Knife radiosurgery a few months later, once any swelling had subsided. And Dr. Sean Lavine, Clinical Co-Director of Neuroendovascular Services at New York-Presbyterian Columbia University Medical Center, would perform the emergency surgery shortly after Tom’s arrival at Columbia.
Tom Sr. and his wife, Mary, met with Dr. Lavine. Right away, something about the man’s manner and eyes put Tom Sr. at ease. “I felt very much at peace,” he recalls. Early the next morning, Dr. Lavine began the delicate surgery that would embolize Tom’s aneurysm–the problem that may have been the source of the bleeding all along.
Hours later, the surgery finished, the Mahalas met with Dr. Lavine again. Everything had gone well, Dr. Lavine said. He had been able to embolize the aneurysm, and had also found a second aneurysm tangled in the AVM–a nasty one. He embolized that one too. The next 24 hours would be critical for ensuring that Tom was well on the path to recovery.
Tom, Sr. credits not just the surgeon, but also the incredible quality of surgical after-care, with Tom’s recovery. Late that night, Tom, Sr. recalls, a very experienced night nurse was concerned about how Tom was doing. Sure enough, a prompt MRI revealed that Tom had had two tiny strokes–two blood vessels, just the diameter of hairs, had shut down in his brain.
What followed over the next several days, recalls Tom, Sr., was a “constant and meticulous tinkering of blood pressure meds” to keep the perfect balance of blood flow and pressure. Tom had no further strokes, and the ones he had were small enough that he could expect a full recovery. The post-surgical care, Tom, Sr. says, was “just unbelievable. Columbia Presbyterian was off the charts.”
Overall, he says, “the decision we made [to bring him to Columbia] and the care that we had was lifesaving.”
Tom returned home two weeks after his aneurysm surgery. That summer he began the slow process of physical and cognitive rehabilitation.
By October, Tom was well enough to receive Gamma Knife surgery from Dr. Isaacson. (Despite its name, the Gamma Knife isn’t a knife; instead, the surgery uses radiation from a large number of very highly-focused gamma rays to close off the blood vessels in the AVM.) That procedure also went well. Tom’s recovery continued, and the athlete grew eager to begin training again. Dr. Solomon gave his okay for Tom to resume playing baseball. Dr. Solomon also wrote a letter to the Naval Academy on Tom’s behalf, stating that Tom should be able to enroll in the Academy with no restrictions.
The Naval Academy granted Tom a medical waiver and admitted him for the following year. In the meantime, Tom attended a Naval Academy prep school, playing basketball and finishing the season a New England Prep All-Star.
Today, Tom is proud to have completed his first year at the Naval Academy. His journey since that day he missed baseball practice has not been easy. But thanks to the work of Dr. Solomon, Dr. Lavine, Dr. Isaacson, and the other skilled and experienced doctors and nurses at the Cerebrovascular Center, Tom is once again able to pursue the kind of mental and physical challenges he enjoys. He’s back in the game, he’s working hard–and he’s hitting it out of the park.
Learn more about Dr. Steven Isaacson on his bio page here.
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