Several people have asked me what the doctor said when he called to confirm the surgery. I recorded the phone call so I would not have problems remembering it and typed up exactly what he said:
Dr. Hardesty Call confirming surgery
We agree that there is a small cavernous malformation in that front part of
where your brainstem meets your spinal cord at the cervical medullary
junction. It is a difficult location to
get to surgically, but it is surgically accessible. Dr. Spetzler’s recommendation to you was that
it really depends on your symptoms and your level of botherness, how much it
bothers you. If you want to go through
with the surgery that’s reasonably invasive, but provides a good chance of
getting that cavernous malformation out, we would be willing to offer that to
you.
I mentioned that my current neurosurgeon said that I am in a
lose/lose situation and continuing to get worse. The Dr’s response: We agree, if you are continuing to get worse I
think it should probably come out.
The way we would get there is, the lesion is on the right
side just barely, but we would do an approach on the lateral side on the left to
get the angle just right to get there. Because if we came on the right side we
would have to kind of reach around and so we would actually recommend a left
sided, what’s called a far lateral approach.
That’s a craniotomy at the base of the skull on the left side where we
take off some of the bone, open up the lining, the dura, and then head towards
the cav mal and take it out. The only thing
is that at times we have to take off enough bone that it destabilizes the area between
the skull and the spine. And at times
people do require fusion later in life after this kind of procedure. But we wouldn’t anticipate you needing it at
the time of the initial procedure. But
the hope would be to not take off enough bone to cause instability. This is just a warning.
I asked what is fusion: that would be
putting little screws and rod between the bones of the skull and the neck, kind
of like a brace inside. That would
reduce your neck mobility a little bit in terms of nodding yes and no, but not
totally. Again, that is not an upfront thing
that is something down the line that might have to happen.
I asked that I have heard that a lot of time the symptoms
you go into surgery with often get worse with surgery: yes, that is something we warn everybody with
a brainstem malformation about. Over the
first couple of days, usually the first three days, you can have some worsening
of your symptoms because of the swelling around the area of surgery. That does not mean that they are permanent by
any means, but you can imagine that the normal tissue around where we operate
gets kind of irritated that can cause some symptoms for at least a little
while. However, that does get better
quickly.
I asked what new deficits the surgery could potentially cause: very similar to what would happen from a
bleeding episode. So sensory changes,
weakness on the side of the body, perhaps worsening problems with your speech, or
with your tongue function, or with your swallowing function, but overall I
think the chances of any of that happening are relatively low. I am betting that if Dr. Spetzler were to see
you in clinic and quote you a number he would say you have probably between an
85 and 90% of getting by with no new permanent deficits at all.
I asked when I can put my contacts back in (I hate my
glasses): in recovery as soon as I feel
like it.
Every day that you don’t have surgery is a day you could
have a bleeding episode even if it is unlikely.
If you are from out of state, you fly in and get seen by us
in clinic, you also get a new MRI and that MRI is used at the time of surgery
for our navigation system – that’s kind of day one. You go back to your hotel and then the next
day or maybe the day after that depending on the timing, you come in early in
the morning and that is when you are admitted for surgery and you have surgery
that day. It is sort of an all in one process;
it all gets taken care of within a couple of days.
I asked about Mike staying with me: When people are in the ICU or on the hospital
floor there is a couch in the back of every room and family members are welcome
to stay 24/7, at least one of them. It
can be anyone important to me; they do not have to be family. After 9 or 10 pm it is just one person, but during
the day as many people as can fit in the room are fine.
I think we can do you some good and get this out. There is
no guarantee that your symptoms will improve, but certainly we can prevent them
from getting worse. But there is always a
chance for recovery as well especially since things have been getting worse
recently and not over those last five years there is always potential for
recovery in someone who is young as well.
You come in and have your pre-op and surgery the next day,
so that is two days right there. You
stay in the ICU overnight, that’s another day, maybe two days depending on how
fast you are waking up and everything.
Most people will leave the hospital by a week after surgery. I tell people to plan on being in the Phoenix
area for seven to ten days. Obviously if
you were to have a new deficit after surgery or need rehab or there was a
complication, God forbid (yes he said that), that would put you here
longer.
I asked how much assistance I would need when I go home: I anticipate you would not need much more
than you already do. Again, unless you
were to have some new permanent or temporary neurologic deficit and in that
case you would probably go to rehab, until you are at that baseline level
again. Most people get back to their
normal lives pretty quick.
He does recommend going to dad’s house after surgery for the
help they can give me and Mike.
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| March 14th we are EVICTING Damian!! |
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