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Fluid drain saves mayor

Luis Fábregas
| Tuesday, Aug. 8, 2006, 12:00 p.m.

Doctors said Monday that Pittsburgh Mayor Bob O'Connor could have died without emergency surgery to drain fluid from his brain.

O'Connor was sitting up, talking and eating yesterday but mostly unaware of the life-threatening complication, doctors at UPMC Shadyside said at a news conference.

O'Connor remained under close monitoring in the neurological intensive care unit after what doctors termed the most critical complication in the mayor's monthlong battle with brain cancer.

O'Connor's physicians said they were encouraged by his dramatic turnaround.

They said O'Connor, 61, was still recovering from receiving general anesthesia and somewhat confused about what happened.

"Probably, he'll never really remember what happened yesterday," said Dr. Frank Lieberman, director of the adult neuro-oncology program at the University of Pittsburgh Cancer Institute. "I don't think he is cognitively at a point where he could be expected to resume his duties. Indeed, that's why a deputy mayor was appointed."

O'Connor became so lethargic Saturday afternoon that he was not responding to severe poking and pinching and could not move his left arm and leg, said Dr. Stanley Marks, director of clinical services for UPMC Cancer Centers and one of O'Connor's oncologists.

O'Connor, who was diagnosed last month with primary central nervous system lymphoma, was never unconscious or comatose, but the doctors described him as very lethargic and stuporous.

The deterioration of his mental state set off a chain of events that began with a phone call from O'Connor's wife, Judy, to interim Chief of Staff Dennis Regan and ended with the appointment of General Services Director Yarone Zober as deputy mayor.

An emergency MRI showed three of O'Connor's four tumors were bleeding, a complication that was plugging the drainage system in the mayor's brain.

"It became abundantly clear that immediate intervention was necessary," Marks said. "If we had not intervened yesterday, that could have been life-threatening."

In a 30-minute operation Sunday, neurosurgeon Amin Kassam placed a straw-like catheter into O'Connor's brain to drain the excess fluid.

Kassam said the fluid build-up had been anticipated as a possibility several weeks ago because normal circulation of the fluid surrounding the brain and spinal cord is sometimes interrupted by brain tumors.

The catheter, also called a shunt, was placed behind O'Connor's hairline near his forehead, underneath the skin, and brought out over the neck.

The procedure required Kassam to shave a small patch of O'Connor's white hair and make an incision the size of a nickel.

The fluid, which doctors will analyze to determine the amount of cancer cells they contain, is draining into a plastic bag.

Almost immediately after the catheter was inserted, O'Connor's mental acuity and mobility dramatically improved, his doctors said.

"In God's grace, he woke up beautifully after that (procedure) over the afternoon," Kassam said. "We're optimistic that the level of improvement that we saw last night will continue."

There was no evidence of brain damage, Kassam said.

"There's nothing that occurred yesterday that I saw that suggests that anything irreparable had occurred in comparison to a week ago," Kassam said. "There's nothing structural that I see that has changed the picture."

Lieberman said the bleeding and subsequent fluid build-up likely occurred because the chemotherapy is working and not because the tumors are continuing to grow.

"In my experience with lymphoma...the only cases where I've seen intra-tumoral bleeding had been when the tumor's responding to treatment," he said. "I don't think I've ever seen a case where, as part of tumor progression when the tumor cells were alive and healthy and actively growing, there was bleeding, and certainly not into every site."

O'Connor's recovery has been plagued by complications, most of them side-effects from the agent methotrexate and drugs such as steroids that he has received in large quantities.

He has become extremely fatigued, something that has required him to receive intensive physical therapy.

O'Connor also has experienced severe bouts of hiccups during most of his hospital stay.

The level of his liver enzymes remains elevated.

As a result, doctors decided to halt a key component of O'Connor's experimental treatment -- the use of a chemotherapy pill called Temodar.

The setbacks have not dissuaded his medical team from continuing the methotrexate infusions, which they consider the most important part of the treatment.

Two treatments with the drug have caused O'Connor's tumors to shrink.

O'Connor was expected to receive the third round of that drug yesterday afternoon, Marks said.

Another MRI to measure the tumors likely will be performed in a week to 10 days.

The doctors, who weeks ago predicted O'Connor could return to work in late August, were not able to say what the setback means in terms of his return to work.

"I think at this point we are taking things day to day," Lieberman said. "I think, given how complex the situation has been over the past few weeks, it would probably be presumptuous of us to try and predict when he's going to be able to resume his duties."

Deputy mayor position offers extensive power

Mayor Bob O'Connor created a secret contingency plan two weeks into his monthlong hospitalization to appoint his closest policy adviser as deputy mayor, city officials said Monday.

Mayoral spokesman Dick Skrinjar and interim Chief of Staff Dennis Regan have denied for weeks that Yarone Zober, 31, was appointed director of the General Services Department so he could serve as deputy mayor. The city charter requires a deputy mayor to be head of a department.

Skrinjar revealed yesterday that the mayor wanted Zober to replace him if he was incapacitated as he underwent treatment for primary central nervous system lymphoma. That happened Sunday when doctors performed emergency surgery to relieve pressure that had built up in the mayor's brain.

The deputy mayor has the same powers as the mayor of Pittsburgh, except the "power of appointment or removal" of city employees, according to Pittsburgh's Home Rule Charter.

Pittsburgh is a "strong mayor" form of government, which provides wide-ranging authority.

The deputy mayor may:

• Initiate and veto legislation reviewed by City Council;

• Propose the city's annual operating budget;

• Propose abolishing, creating or changing city boards, commissions, authorities and government units, such as departments;

• Supervise all city employees and officers.

In the mayor's absence, the deputy mayor's duties are to:

• Publicly report the city's financial status in a yearly state-of-the-city address;

• Push forward plans for improving the city's economic, physical and social conditions;

• Seek funds from city, federal, state and county sources;

• Call meetings with City Council when necessary.

-- Jeremy Boren

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