The Nitty Gritty

With surgery around the corner and in preparation for the procedure, we have been learning more about the risks and all that this entails.  A number of people have called to ask questions concerning specific details, so I figured that I may as well write a blog about it so that I will not have to continue retelling the details.  By the way, Sandra and I would both want to say a huge “thank you” to so many friends who have been an amazing support and an encouragement this past week while we have been processing the news – so thank you so much!!! With that said, allow me to explain by answering the 7 most commonly asked questions – this past week… (Don”t read if you don”t want the nitty gritty of the surgical process – just meant for those who asked for more information to pray with specificity).

 

1. When did you find out the news?

We always knew that there would be a precautionary follow up to the news last summer, since the doctors wanted to make sure there was no more growth.  While we did the initial follow up MRI back in early February, we only heard the negative diagnosis this past Monday.  That”s right, on April 1st, I received the call! I so wanted the doctor to conclude the news with a rousing, “April Fools!” but it never came. (Although if it had, that would have been an entirely different story about the demented prankster surgeon.)

 

2. If the doctor pronounced that this was “not an aneurysm,” what on earth changed?

Great question…  Last summer, when I was diagnosed with the aneurysm after a brief, yet unrelated onset of Bells Palsy (praise God, since that”s how we discovered this), an MRI revealed an aneurysm off of my carotid artery, behind my right eye.  After follow up scans were performed, it was decided that they do an angiogram, (procedure in which a catheter actually takes images from inside the artery to get a better idea of what surgery would look like). At that time, the neurosurgeon saw a small vein coming off the back of the bubble like aneurysm.  The presence of a vein on the back of the aneurysm, technically speaking – means that this is no longer an aneurysm, which is why he pronounced this is  “not an aneurysm!” The reason being, that the vein in this location relieves the pressure of the blood that is being routed into that area, in theory, keeping it from growing any larger. The doctor expected to see everything as it was back in August in terms of the size of the bubble-like area, which would have meant that the vein was relieving the pressure, therefore, it would still not be an aneurysm. However, that was unfortunately not the case.

 

3. So what is the situation or problem now?

The problem they discovered was that the aneurysm had more than doubled in size. The doctor did two MRIs and one CTA scan to confirm the results, and in doing so concluded that although there is a vein off the back of the aneurysm, it is obviously not working hard enough to relieve the pressure, which is why the area has doubled in size, and now requires surgery.

 

4. What are the surgical options?

There are essentially two choices for surgery for people who are blessed to find an aneurysm before it ruptures (I mean that in all seriousness, since most people never even know that they have one until it is too late). The first is the old school method of clamping the aneurysm. This method is done with open head surgery and requires going straight to the area and putting a clamp on the aneurysm to stop any future growth. The pros of this method are that if successful, the follow up is not until 5 years later since it is found to be extremely thorough. The cons are the fact that risks are elevated any time they actually need to open your head and operate on your brain. In addition, there is a week of recovery in the hospital and then about a month following with what the doctor referred to as “the worse headaches of your life,” due to the brain swelling from surgery.  Lastly, this procedure will leave a large Frankenstein like scar on my bald head – yikes! (However, it is the opportunity for a new program character – I just don”t want to be type-casted. You need to be able to laugh at times like these.)

The second method is referred to as coiling. This method is preferred to the other by three different physicians that we consulted with, since it is less invasive and can be performed internally with a catheter from the femoral artery into the brain (how amazing is that?).  However, since my aneurysm has unfortunately grown so big, it will require a stint to hold the coils in place. While there are many pros to this non-invasive procedure with a speedy recovery, the cons have to do with the follow up. Post surgery requires more MRIs and CT Scans every 6-12 months for the next 10 years of my life, to make sure that the coils are holding in place. If the coils slip, the surgeon does surgery again to add more coils until the aneurysm is completely packed tight, preventing risk of rupture. This can take as many as 4 treatments with some patients, but is still the preferred method.

5. What are the risks involved?

Well, the neurosurgeon said that this surgery has a 95% success rate with normal patients (great odds!). However, he then said that my situation was much more complex. The complexity is due to three extra circumstances: The size of the aneurysm, the placement (on a U shaped portion of the artery behind the right eye), and the fact that there is still that small vein coming off of the back of my aneurysm. In other words, regardless of which type of surgery is selected (we are going with the stint and coils), either procedure will end up cutting of that small vein. The doctor said that this adds the additional risk of a minor stroke, due to the vein that will have to be stopped. I asked about skipping the surgery all together and hoping for the best with prayer and he responded, that at the rate the aneurysm is growing, he did not believe that I would be alive in a year without one of the surgeries. An added risk, he mentioned, was that of the aneurysm rupturing as a result of the coiling.  However, the doctor said that for this reason they reserve an ER room for me, so that if that occurs, there is no time wasted getting me across the hall for an emergency surgery and the fact that he is a neurosurgeon also would decrease time for any residual damage.  He mentioned that time is critical if there is a rupture, but with everything in place they are ready to deal with that. Of course I responded, “Well let”s do it ASAP then!” Not that simple…

 

6. So if there is such a rush for the surgery, why are we waiting until the 16th?

Great question – Apparently, since there is a stint required to help keep the coils in place, I need to be on blood thinners for more than a week. You take the blood thinners so that your body does not reject the stint or create more problems, increase risk of stroke or blood clots. In addition, this will require staying on the blood thinners for 3 additional months post surgery and baby aspirin for life.

 

7. How can people pray for our family?

Please pray for a stress free week before the procedure. It is a strange thing for someone to give you all of this news and then say, “Try not to stress out because that is the one thing you don”t want to do with an aneurysm.” Or as the doctor phrased it, “You have a ticking time bomb in your head, so you need you to relax.”  Seriously – that seems like quite a challenge, but in all honesty God always seems more tangibly near at times like these, when you realize you have no control.  Philippians 4:6-7 is also a great encouragement. Please pray for Sandra to also continue to not worry, as well as for Courtney, Murphy, Connor and Hailey. Also, please pray for Murphy, who has requested that his commanding officer allow him to leave the base to be with our family early next week.  Thanks for your prayers, love and encouragement!!!