Wed. Sep 08, 2010
Brain Matters, Part 3
In the ongoing story of Reid’s Brain Matters (Part 1, Part 2), we last left off at the neurosurgeon’s office, with him saying he needed just one more test to get the information he needed to make a final recommendation on how best to approach my aneurysm.
That test is called a cerebral angiogram, and my wife and I showed up at Emory at Dawn:30 on August 26th to get it done. After a couple of hours of the standard “hurry-up & wait” they finally walked me to the room where the procedure would be done.
That’s right, walked. You get no fun drugs on this particular ride. You walk into a freezing room that has $2 million worth of X-ray cameras on gimbals hanging from the ceiling, and an array of nine monitors on one side of the table you will be lying on.
So you hop up on this table (heated!), and a nurse briefly introduces herself, then proceeds to shave your crotch. That’s a bit faster than my dates used to go before I got married, but OK. And she’s not just shaving the spot where my right leg meets my hip (the place the catheter insertion will be done). Oh, she starts there, but she keeps moving to the left, and moving to the left, and before you know it, you appear entirely pre-pubescent.
To recap, in the first 2.5 hours since I awoke, I’ve had no coffee, no drugs, and now, I have no pubic hair. So I try to generate a little fun any way I can.
Dr. Frank Tong, the interventional radiologist, arrived and said we need to do a “check-in,” in which everyone states why they are there, to make sure we’re all expecting the same procedure. So he asks me, “why are you here today?”
I reply confidently, “Penile implant.”
A slight pause. Then he turns to the people behind the glass in the control room next to the procedure room, and shouts, “OK, get the Extra-Large implant ready.”
With nowhere else for this joke to go, I said, “We’re here for a cerebral angiogram to look at my right mid cerebral artery trifurcation aneurysm.”
Dr. Tong replied, “that’s precisely why we’re here,” and we moved on to the fun part. Ironically, the most painful thing that happened all day was the local injections of the pain killers. That was no fun at all, and there were four or five of them.
Once they access your femoral artery, your main job is to lay …very … still. They run a thin catheter from your leg up to your carotid artery in your neck, release a little dye, and rapidly take images from multiple angles (“Don’t move, don’t breathe, don’t swallow”). And they do finally offer you a drug cocktail Dr. Tong described as “like drinking a glass of wine.” But I found it to be more like a half glass of some watered down house wine.
When he was done, Dr. Tong showed me the images they’d captured. He told me that if you have an aneurysm, there’s about a 20% chance you have another somewhere else. But these images showed my entire brain’s circulatory system was clean.
Except for the obvious. Now, Dr. Tong is one of (I believe) three doctors at Emory who might perform the endovascular coiling, if that was the chosen solution. And as we reviewed the images, he said, “This one is going to require surgery.”
Which wasn’t exactly news to me. I said, “if nothing else, it looks to me like the neck of that aneurysm is too wide to keep the coils in.” He replied, “I agree.” And he added, “if I had this aneurysm, knowing what I know, I would fly across the country if that’s what it took to make sure Dr. Barrow was the one who would operate on it.”
So after about two hours motionless on that table, they eased me sideways onto a gurney with the first of many stern directions, “DO NOT move your right leg. AT ALL. Do NOT lift your head. Just … lie … there.”
They rolled me back to a recovery area and brought Susan back. She got a nurse to scrounge me a sandwich and a drink, and that (plus arising at such an unnatural hour) put me in the mood for a nap. So I slept half of the four recovery hours I was required to keep my right leg motionless.
And then you suddenly go from six hours of being motionless to “OK, it’s time for you to go.” They sent Susan to get the car and started getting me ready. First they took my blood pressure lying down, then got me to sit up so they could check it again. And finally had me stand up for a third BP reading. They said I was good to go, and would help me get into my clothes.
But I asked if I could go to the bathroom first, and they pointed to it about 20 feet away. I turned to take a step with my right leg, moved it forward, and when I went to put my weight on it I went down like a big old tree with storm damage. Freaked the nurses out, and me too. I didn’t go all the way to the floor, I landed hard on my right knee and caught myself … but didn’t feel a thing from the impact.
They helped me up, checked my incision, and finally helped me to the bathroom. That’s where I realized that my right leg felt numb from mid thigh to just below my knee. Turns out that a strong local anesthetic isn’t always entirely “local.” It had also numbed the nerves that control the muscles around my knee. The ones that support your weight when you take a step.
I nearly went to the ground again moving from the wheelchair to the car, and used my grandfather’s old beachwood cane for the next 12 hours or so. It is a very very strange feeling to not be able to trust your leg to support your weight when you otherwise have no pain in that leg. But it was better by the time I went to bed that night.
Anyway, the angiogram was pretty much a breeze, after they get those damn injections of pain killer done. And they got the last images they needed. With the Labor Day weekend, it was another week and a half before I got the final word from the doctor’s office: it’s definitely surgery, when do you want it?
So we’re planning on the week of October 18th. Dr. Barrow schedules surgery for Tuesdays and Thursdays, so it will be either October 19th or October 21st (Update: I got bumped a week to Oct. 28th). While he was apparently available as quickly as two weeks from now, I want some lead time. I need to take care of clients, take care of some family matters, celebrate a wedding anniversary a touch early (brain surgery is no excuse for forgetting your anniversary), and generally take some time to get my ducks in a row.
Six weeks ought to do it.
Add in the seven weeks that I’ve carried around the knowledge I have a cerebral aneurysm, all the Waiting and Contemplating, and that’s the real marathon, compared to what’s next. After the surgery, I’ll be in the hospital three to five days (a goodly bit of which I’m sure I won’t even remember), and then spend three more weeks recovering at home. At that point in a typical recovery, I might be released from surgical care, though I would still have a good bit of healing to do (the skull itself can take six months to a year to fully heal).
But I fully expect to be ready and able to eat more than is healthy for me on Thanksgiving Day.