Toronto’s Urban Angel offers last hope

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Our Stories

Toronto’s Urban Angel offers last hope

Toronto, October 20, 2016

By Maria Feldman

Biravina Pathmanathan at a followup surgery appointment with Dr. Karen Cross
Biravina Pathmanathan at a followup surgery appointment with Dr. Karen Cross, a plastic surgeon at St. Michael’s. (Photo by Marcelo Silles)

After being turned away from six hospitals that lacked specialized personnel and resources to solve the mysteriously debilitating pain radiating through the soles of her feet, 19-year-old Biravina Pathmanathan arrived at St. Michael’s Hospital in a final attempt to seek help.

“When Biravina showed up in my practice, she was a delicate young woman who was just barely over 60 pounds,” said Dr. Karen Cross, a plastic surgeon at St. Michael’s. “Hearing her story just tore my heart in pieces. I knew I had to intervene and fight for her, because if I didn’t, no one else would.”

Diagnosed as a child with a rare immune deficiency, Pathmanathan had a bone marrow transplant from an unrelated donor when she was five. Despite it being a 100-per-cent match, Pathmanathan’s body rejected the transplant and she developed Graft-Versus-Host Disease.

As a result of the GVHD, Pathmanathan’s white blood cells attacked her body and caused myriad symptoms. Her skin peeled and blistered, she developed joint contractures (shortening and hardening of the muscles) and eventually painful growths known as “cutaneous horns” formed on her feet.

Pathmanathan went from being healthy to a sick child in a wheelchair. The pain that would go on for years derailed Pathmanathan’s plans to attend college.

After her visit to St. Michael’s, Dr. Cross’ health-care team ran a series of tests to determine the cause of the pain and wounds. They confirmed that the growths and wounds on Pathmanathan’s feet had turned cancerous and a double leg amputation was the only viable option.

Did you know?
Since GVHD affects various organs of the body, a typical health care plan calls for a multi-disciplinary approach.

“This was such a hard decision for me,” said Pathmanathan. “No one wants to lose their legs. I knew that Dr. Cross tried everything to save my legs, but this was my very last hope for a pain-free, extended life.”

Pathmanathan’s operation required a highly specialized team and advanced equipment.

“We had to plan for everything and find creative alternatives,” said Dr. Cross. For example, routine blood pressure checks could injure her delicate skin. But the challenges extended far beyond the operating table.

“Dealing with mortality, the potential of losing one’s legs – it’s hard to handle at such a young age,” said Dr. Cross.

Dr. Cross connected Pathmanathan with another patient with a similar experience to help her overcome reservations about life post-amputation.

“Thanks to Dr. Cross, I am still here today,” said Pathmanathan. “I’m deeply touched by the excellent care I received, and extremely grateful to the hospital staff.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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