 My name is Jagdish. I am a very active person. I love to play with kids from last one year. I started getting pain in my back and for this also I already considered a few doctors. So what they have asked is like this might be for long sitting hours in office. So they tried to give some muscle relaxant medicines which was actually giving a solution for me for temporarily but it was not coming out fully. So again I used to get the back pain. So what happened in November is like I got back pain and I consulted a spine specialist. So the spine specialist again he also asked me for go for PG therapy and he also asked me to get some muscle relaxant medicines but the pain was not going out at all. So it was 24 by 7 and the pain was actually spreading to my legs towards my knee. Then the doctor asked me to do a MRI. So in MRI they are suspecting that there might be some cancer or there might be some tumors in my spine which is causing this pain. Me and my friends decided let's go for a second opinion so then we come to Manipal. Next day we met Dr. Bopanna and he is a doctor. What I can say is like he is actually coordinating with other doctors. He was taking the view of the other doctors while diagnosis also. They found that this is a case of Paragangulya and doctor gave me a confident that no need to worry that it's not a life threatening and we are going to cure it. I used to come to Manipal. I used to look at the board on the top of the Manipal. So Manipal life is on. So I used to always think about like whether really the life is on. They will be able to save my life. This young gentleman who came to us with severe backache and pain radiating down his legs had a tumor that was potentially curable in his spine and we were surprised to find the way it presented was very unusual with a long-standing history of hypertension and his backache actually followed much later. Now when you are presented with an unusual diagnosis which is difficult in such instances it takes a multidisciplinary team. On MRI we showed there is a large tumor involving the lumbar vertebral body L2 and it was spreading to the abdomen we call it retrofibrious structure as well as causing compression of the dural tube nerve structures and subsequently hindromanter biopsy which revealed there is a Paragangulya noma. Paragangulya nomas are very rare tumors in the vertebral bodies and not only that they are very highly vascular. Highly vascular means they bleed a lot during the surgery. These Paragangulya nomas can be of two types. Either they secrete hormones which can cause hormone problems or they may not secrete. In his case he had bad pressure and he had few symptoms on discussion which I felt that we need to make sure it is either producing the hormones or not. So we sent him away to do some special investigations on his blood and urine and that revealed that indeed these Paragangulya nomas are secretory by which I mean they were producing hormones in excess. This becomes an added problem with regard to surgery because if we don't use specific medications to control blood pressure and his heart rate during surgery when they open up this tumor and they remove it these hormones can suddenly get into the blood circulation and a sudden surge in these hormones can cause problems with blood pressure and heart rate and it can be of severe consequence to the patient. Therefore achieving a very good blood pressure control, heart rate control was important. So Jagdish went on a particular group of medications so that we could achieve a good control of his blood pressure apart from ensuring he is well hydrated. We did this after he got admitted, ensured that he was in the right state physiologically to go ahead with the surgery. We did the surgery in two stages. First one from the front, the oncosurgeons along with oncosurgeons they removed the retroperitone component of the tumor and before proceeding for the surgery as I said this tumor is highly vascular we have to embolize this tumor, embolize means cut off the blood supply. So our interventional radiologist he did an embolization of this tumor where 90% of the tumor was blood supply was cut off but still there was 10% of tumor which the tumor would bleed. So oncosurgeons first from the front they went and removed the part of the tumor which has spread to the abdomen and from the same sitting we removed completely the tumor from the front it was enrolling the L2 vertebral body and after that removing the body there is an empty space we have to put a metal cage so metal cage was put with bone graft material and during the surgery his blood loss was controlled with anesthetics managed the blood pressure. For anesthesiologist it is a huge challenge to manage such patients we with our facilities, state of the art facilities in our hospital we could manage this patient successfully first of all we manage the blood pressure by giving proper pre-medication to the patient along with other multidisciplinary approach during the operation a patient's blood pressure swings were very high so when our blood pressure was going up we managed with nitroglycerin and nitroproside infusions and we also gave magnesium, levate law and other medications to bring down the blood pressure to normal levels one more challenge that is faced by anesthesiologist once the tumor is removed the blood pressure is going to crash so for that we managed with proper fluid load vasopressors after the tumor removal during the second surgery from the backside we went because since the body has been removed the spine is unstable we have to fix the spine from the backside we fix the spine from two level above two level below the predicle screws we have fixed and rods we have put and fixation was successfully done so the tumor was completely removed without much of trouble patient didn't have any post-operative, any deficits and he is right now walking around and without any major troubles after surgery all the pains are gone out so you know like 24 by 7 if you feel pain in the body you won't feel you will be disturbed in the mind and you won't be able to do anything even while sleeping also you won't be sleeping peacefully so now I come out of the pain so now all the surgery parts also healed out also so now I am just doing a follow up so that there should not be a future recurrence or if there is a future recurrence doctor assure me that you know not to worry because we will kill that cells through radiation so there is nothing to be worried so you can enjoy your normal life as usually what you used to do before but I can end with like I wanted to thank Dr. Bopanna Dr. Praveen, Dr. Karthik Prabhakaran and also Dr. Sabir thanks a lot to all these doctors like they come all together they coordinated each other and to make me cure really thankful to the Manipal Hospital they really make me cure they really make me normal like earlier very much thankful for all the support, all the slabs in Manipal now this kind of clinical excellence this multidisciplinary background where we effortlessly communicate between specialties and the best interests of the patient is something we excel at in Manipal Hospital