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PHACE Fall 2017 News
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PHACE Syndrome Community
The PHACE Syndrome Community (PSC) is in its fifth year helping PHACE families. Although our community is still very small, with less than 500 participants in the PHACE Syndrome Registry based at the Children's Hospital of Wisconsin, the diagnosis is becoming more widely recognized and utilized.

The PHACE Syndrome Community Board and the PHACE Medical Advisory Board are 100% volunteer-run and includes PHACE parents, grandparents, family friends, and prominent PHACE doctors. 
PHACE Family Conference

The PHACE Syndrome Community is proud to announce the 2018 PHACE Syndrome Family Conference will be held in Atlanta, Georgia on June 29-July 1. The conference will be held at the DoubleTree Atlanta Downtown hotel, a five-minute walk from some of Atlanta's great attractions (Georgia Aquarium, Coca-Cola Museum, and Centennial Olympic Park). The bi-annual family conference is the most anticipated event for PSC members. This conference provides excellent networking for families affected by all areas of PHACE and allows our families to talk with, and learn from, the leading global PHACE experts. Registration will open in late 2017 so keep your eyes out for more information and start planning your trip to Atlanta now! 

Ask The Expert
Rebound Growth of Infantile Hemangiomas After Propranolol Therapy
by Dr. Beth Drolet

Oral propranolol has become the first line therapy for infantile hemangiomas that require treatment. Many children with PHACE syndrome will receive oral propranolol during the first years of life in order to prevent complications from their hemangiomas. As physicians’ experience with propranolol for treatment of infantile hemangioma grows, they have noted that there is “rebound growth” after stopping propranolol. “Rebound growth” means the regrowth of the hemangioma at ages when an infantile hemangioma would not typically be expected to grow, for example, after 12 months of age.  Approximately 5-25% of infantile hemangiomas will grow after stopping the oral propranolol. This is very dependent on the age of the baby at the time the medicine is discontinued, and the size of the hemangioma. “Rebound growth” has also been seen previously with other medications used to treat hemangiomas, but it appears to be much more common with the use of oral propranolol.
            A large study, performed by our Hemangioma Investigator Group (HIG), set out to determine factors that may predispose infants to rebound growth.  The goal of the study was to describe a large group of children with infantile hemangiomas that responded to oral propranolol therapy and determine the frequency of rebound growth. The group also hoped to identify specific features of the children that had rebound growth. We studied 997 patients who were given oral propranolol for the treatment of infantile hemangiomas. Rebound growth was common with 231/912 (25.3%) experiencing regrowth of their hemangioma after stopping propranolol.   Children whose propranolol was discontinued before 9 months of age had the highest risk of rebound growth, while children who stopped propranolol at an older age (12 and 18 months) were less likely to have rebound growth.  Females and those with deep skin involvement (as opposed to superficial only) were also found  more likely to have rebound growth. In addition, the study also showed that 10% of children had rebound growth even when the medication was used until 18 months of age.
            This data has been supported by other studies and is certainly in line with what we see in clinical practice. Children with PHACE syndrome often have large, deep hemangiomas and those of us that care for large numbers of children with PHACE syndrome have found that they frequently need to be on oral propranolol for a longer period of time. We do not have a definitive understanding of why this happens and need further studies to determine the correct dose and length of therapy for treatment of hemangioma in children with PHACE syndrome. It is very likely that even within the group of children with PHACE syndrome the length of therapy will vary greatly.  These differences underscore the need for doctors and families to work together to individualize treatment plans, considering both the dose and the duration of the oral propranolol.  Factors to consider include the reason for treatment, the response to treatment, and how the child is tolerating the medication. The Hemangioma Investigator Group is currently analyzing data from 14 different institutions and the International PHACE Syndrome Registry to better determine the safety, efficacy, and duration of treatment of propranolol in PHACE syndrome.
In This Issue
Elyse Camacho's Story

Elyse (above, right) was born in the summer of 2006. Labor was induced due to high blood pressure and family history of pre-eclampsia. Elyse was perfect when she was born and seemed to be doing well, yet the next morning during her checkup, the hospital pediatrician noticed a slight heart murmur. Before being discharged, he performed an echo-cardiogram and sent us home, telling us not to worry and instructed us to return in a couple of weeks.

However, at three days old she began to show symptoms of heart failure; We had no idea this was happening. Thankfully, we had decided to take her to a different pediatrician and that’s when everything went downhill. 

Our new pediatrician wasn’t comfortable with this “slight murmur” that the first pediatrician had heard. She immediately got on the phone and sent us to see a pediatric cardiologist. Hours later, she was diagnosed with coarctation of the aorta and other heart defects that required two major heart surgeries when she was a week and half old and then at three months old. 

Due to internal bleeding and other complications, Elyse was diagnosed with PHACE Syndrome at about six weeks old. We learned that she had many internal hemangiomas and that she would be at risk of stroke due to brain blood vessel anomalies.

Our first year was extremely rough; Lots of other symptoms began to appear. She was in and out of the hospital frequently. We had to switch her hemangioma treatment twice because their growth was not slowing or stopping. Elyse had hemangiomas near her airway, GI tract, spine and eyes. These hemangiomas were all life threatening due to their location. Thankfully, we had a wonderful team of doctors in Chicago, who reached out to other specialists for advice. Once Elyse was on the right treatment, her condition stabilized and was able to come home, with home nursing.

Once home, she was able to thrive with the help of our early intervention team. Elyse was a year old before she was able to sit, crawl or stand. She was developmentally behind due to being at the hospital for so long. She was also 100% tube fed. Her team worked her little butt off and she started walking at two years old. Her feeding tube also came out at three years old, right before she started preschool.

Elyse is now a very happy 11 year old that loves her theater classes and enjoys watching musicals. She still sees several specialists throughout the year, but we have no major concerns. Nothing compared to that first year.  

Connect
Are you a PHACE family? 
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  Family Friends and Supporters

Please help us treat PHACE and register your affected family with the PHACE Registry at the Medical College of Wisconsin. Please contact Angela Beltrame (anbeltrame@mcw.edu) or 414-955-2847, or Katherine Mueller (kamueller@mcw.edu) or 414-955-2846 for more information on registering.

Would you like to see our past Newsletters?  Click -->here<--

Thank you to our past business sponsors
http://www.phacesyndromecommunity.org/conference

PHACE Syndrome Community
Our organization is run ONLY by the generosity of our PHACE families and their surrounding families and community. The PHACE Syndrome Community Board and the PHACE Medical Advisory Board are 100% volunteer-run and includes PHACE parents, grandparents, family friends, and prominent PHACE doctors. Please consider donating to help our cause. Your donation will help us sustain and grow our organization and the care for affected families into the future. - http://www.phacesyndromecommunity.org/donate
 
Our 2016/2017 Board
Lana Alokhina - Secretary
Adriane Baylis
Maureen Beckwith - Treasurer
Paul Butera
Cristina Camacho
Kristin Garben
Jerri Lauffer - VP of Outreach
Mary Alice Kaspar
 
Michael Kotyk
Jen Meints - Past President
Steven Russakoff
Jill Salas - President
Dr. Dawn Siegel
Nancy Stracener
Andrew Ziffer - VP of Operations
Janet Ziffer
PHACE Syndrome Community, Inc.
4514 Chamblee Dunwoody Rd., Suite 450
Atlanta, GA 30338, USA
info@phacesyndromecommunity.org
(678) 744-3971
Copyright © 2017 PHACE Syndrome Community, Inc., All rights reserved.


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