Stents & Socks

FYI: These posts are half typed and half using the terrific keyboard dictation feature.

My family is the type that can find humorous moments during the darkest of times. Some may call that inappropriate, others may call it a coping mechanism. In our case, I believe it is the latter.

Like when we were at my grandfather’s funeral in an outside room waiting for the service to begin. My mom was using some Binaca Breath Spray, which was very popular at that time. However, she didn’t have the spray in the correct direction and instead of spraying inside her mouth…the spray went all over her cheek. My sisters and I saw it as it happened and we all got the giggles.

When my father almost died from a ruptured intestine, my sisters and mom and I spent over night in the hospital waiting room. To pass the time we counted ceiling tiles. Then when we knew he survived the surgery, we needed to stop at a store to get “supplies” to go to a hotel. Things like saline solutions for contact lenses…underwear, etc. We were so tired it was like a very slow march of zombies. As we caught the reflection of ourselves the glass of a display case…we got horribly silly. Awake for 24-hours was not. a good look.

After my father passed away many years later, my mom and I made our first public appearance at our church’s Maundy Thursday service. Mom wasn’t looking forward to all the sympathy faces and comments of expression from people, so our plan was to arrive late and sit in the back, but there were no seats available, so we had to sit closer to the front. One of us sang something “off” in one of the hymns and we got the uncontrollable giggles. As we were both trying to hide our giggles, the obvious shaking of our shoulders probably made it seem we were both crying…and that WOULD have been appropriate since my dad has just passed. Nope…we were giggling.

Well, long story short….I think my family of angels (dad, mom, and both sisters) had some fun with me on Wednesday after I was admitted to the hospital for my latest brain procedure: inserting a flow diverter/stent inside my existing stent.

After checking in and walking down to the radiology department, I felt something hitting the back of my knee/calf. My rain jacket wasn’t long enough to hit that area and I couldn’t figure it out. Turns out it was something INSIDE my pant leg – a SOCK that hung on in the wash apparently. I’m still shocked I didn’t notice it before leaving the house, in the car, or the walk from the parking lot to the hospital

I couldn’t believe it. Too funny and something my family would do. I promptly extricated the offending sock from my pant leg and handed it off to Dave where it kept it for safe keeping. It surely helped lighten the mood.

I’ve been to this area of the hospital many times and I was SO glad that Dave was allowed to come in with me this time. We arrived promptly at 11:45 and proceeded to the pre-op area where I was asked more questions and prepared for ROUND 4 on my original, biggest brain aneurysm.

As usual, the staff at Maine Medical Center were top notch. Highly attentive, hard working, and kind. I met with part of the team that would be assisting with my stent placement and we made sure to mention I had a history of becoming quite nauseous. They promptly ordered up a nausea patch and gave me pill as well. I can happily say both were highly successful.

Part of my team was Jack, who is a PA and Dave and I were happy to see him. He has attended our brain aneurysm support group many times in the past and I was happy to see a friendly face. He explained the procedure to us again and that he was very confident we’d get it all done today which helped ease my anxiety. And I was anxious….more in previous days than today. Having a stent placed inside of another stent wasn’t something I had heard a lot about it.

IV’s were set up, my groin area was shaved, I gave Dave a kiss, and off I went to the endovascular radiology suite. It’s a bright and busy area with a fantastic team of technicians. I was quickly put under and my next memory is of waiting up in the PACU (Post Anesthesia Care Unit.) recovery area hearing Dr. Ecker’s voice saying the procedure went very well. I guess Dave saw me briefly when they were moving me there, but I don’t remember

Afterwards I had to lay flat for two hours to avoid any issues with the groin incision site. Then another two hours in recovery. During the wait, my main nurse was able to take a much-needed 30 minute break. Elaine was filling in for her. While reading up on my case, she noticed I worked at Johnny’s and mentioned how much she “loved their magazine”. It gave me great pleasure to tell her I was the one responsible for the layout. She said she’d tell people she met the person who does the catalog.

Dr. Jack came by to check on me and talk about the procedure. He said the flow diverter placement went very well and there were no issues. Also gave me a brief cognitive exam and was pleased. I was finally able to eat something. I ordered up an egg salad sandwich that hit the spot and didn’t cause any nausea, thankfully.

My throat was very sore and my voice was raspy due to the intubation/breathing tube they inserted during the procedure. I didn’t have much pain, just discomfort at this point. As expected, the groin and head were the main offenders.

Even though Dave was allowed in the hospital, he was not allowed back to see my in the PACU. So, I called him on my cell phone. By the time I was transferred up to a room on the sixth floor neuro ward, it was 8pm and visiting hours were over. So, I wasn’t able to see Dave again that day. He ended up driving back home. I called him several times in the evening.

This area of the hospital was once very familiar to me. I spent almost 20 days here after my ruptured brain aneurysm in 2006. It was called the 608 ward back in the day. It was not my favorite place. Noisy, chaotic, and crowded. Since a remodel a few years ago, is it now a quieter, less chaotic place with private room and strong sliding doors. I felt like I was in a the Plaza compared to those days.

Once I got settled in and introduced to the crew assigned to my corner room, Brittany and J.J. I was starting to feel some pain. I ordered up a hot black tea with a Tylenol chaser. As long as the Tylenol took care of the job, I did not need the stronger pain meds that were offered.

The tea really hit the spot, but the caffeine may not have been the best choice at 8:30 in the evening. In addition to the offering of tea, the lovely compression wraps were also slapped onto my lower legs to help alleviate the development of any clots and keep the circulation flowing. I have a love hate relationship with these things. I know they’re needed, but they make sleeping difficult as the wraps expand like blood pressure cuffs every 30 seconds and they’re wired up to the end of the bed, so some movement is restrictive. I’m a side sleeper and they just weren’t playing nice.

I was still hooked up to one IV pumping fluids into my body, but hydration wasn’t an issue today. So, at some point during the night, due to my successful urination visits, the nurse removed that IV. It felt great to have the arm free again.

I had a surprise visitor at 9pm — Dr. Ecker! I never saw him prior to going under in the operating room but I did remember hearing his voice afterwards. He and Dr. Jack both went to speak with Dave after the procedure which I know Dave really appreciated. The docs mentioned it was a good decision to have the procedure done after getting in there and really seeing what was going on. Dr. Ecker explained to me again that he felt everything went very well, BUT that we’d discuss it in more detail on our follow up in two weeks. I will also be having an angriogram in 6th months to make sure everything has healed as it should. It was great to see him and I appreciated him coming to check on me at that hour. It was his birthday today as well.

My discomfort in the bed continued and I got very little sleep overnight. Brittany was terrific and I had some pudding early in the morning for my next round of Tylenol. They performed neuro checks every four hours. With the usual “what’s your name”, “where are you”, “smile for me”, “stick out your tongue”, “raise your arms”, “touch your nose” and some strength test with my arms and feet. I passed them all with flying colors. I even got the date right after midnight.

Sometime after 3am, I was able to finally sleep, but then was awakened at 4:30 to go down for a CT scan. I knew they were going to do the CT scan, but wasn’t expecting it quite that early. They had a wheelchair all ready for me and I was whisked down for the scan and 10 minutes later I was back in the room on the 5th floor.

I was wobbly on my feet and there were some sensations visually that were bothering me. Then right after the scan, I got an ocular migraine. Thankfully it lasted the usual 30 minutes and didn’t develop into something more. Perhaps the contrast die from the CT scan triggered it..or it was just…you know…my brain was fiddled with earlier the previous day.

As dawn broke, there was a shift change on the floor and I was introduced to Kellie. Then things started to happen in rapid succession. I called Dave and he was already in the car driving down to visit me for the opening of visiting hours at 8am. I ordered up a tasty breakfast of cinnamon French toast, diced pears, orange juice and hot tea which tasted like coffee. Boooo….

Then Jack came in and gave me even more details of the procedure and to see how I was doing. He drew me a diagram of the anatomy of my aneurysm and to show the funky curves of my arteries. The placement of the new stent fell a little short he said and it may or may not cause some issues later on. I really appreciated him taking the time to explain it all and the drawing he did.

Dr. Jack’s drawing with my text and color embellishments

Then he said the CT scan looked good and all reports back to him via the post-operative staff and the neuro ward crew looked great and that he’d put in the order for discharge. Yay!

The nurse raised the shade in my room. The sun was shining and I was reminded of the bigger, badder world out there as I noticed a window opposite me had a Ukrainian flag and a heart in the window. Yes, I just went through my fourth procedure on this one brain aneurysm, but there were people both sick and healthy around the world in much dyer situations. I am blessed.

I slowly got dressed, Dave went out to pull the car around, and off we went for the hour and a half drive home. The drive pooped me out so we just drove through the drive-thu for a quick meal. I got home, promptly said “Hi” to the kitties and crashed on my own bed for a 3-hour nap. Oh, and I enjoyed a GOOD cup of hot tea.

This is now Friday and I’ve had a slight setback with regards to discomfort, some swelling, and lack of sleep. And now there is abdomen pain I’m dealing with on top of head pain. My groin feels pretty good. Yes, my groin hurts after brain procedures. That’s how they access it.

OH, and when I was being moved from PACU to the Neuro Ward, I discovered I was missing one of the hospital-supplied socks I was given upon entry into pre-op. What was it about socks and this trip? I think it was my family of angels having some fun with me. Well played….well played.

I Am Lit

As I get prepared for my 2-year follow-up MRA this Friday, I was curious to see just how many angiograms and MRA/MRI’s my brain has had since 2006. Thankfully, I was able to get a pretty good handle on that number by simply searching this blog. I was surprised by the number…but not really.

CEREBRAL ANGIOGRAMS

I have had NINE cerebral angiograms which include three treatments that are performed using this same process: my initial coiling, then my stent placement, and recoiling were all performed using angiography.

A Cerebral angiography provides x-ray images of blood vessels in and around the brain, showing abnormalities like brain aneurysms.

PHOTO: John Hopkins Medicine

Typically a catheter is inserted into the femoral artery in the groin and threaded through the circulatory system to the carotid artery where contrast die is injected. A series of images are taken as the contrast agent spreads through the brain’s arterial system, then a second series as it reaches the venous system.

MRA/MRI

I have also had SEVEN MRA/MRI’s. Magnetic resonance angiography–also called a magnetic resonance angiogram or MRA–is a type of MRI that looks specifically at the body’s blood vessels. Unlike an angiogram, which requires inserting a catheter into the body, magnetic resonance angiography is a far less invasive and less painful test.


PHOTO: My brain bling via MRA imaging.

The frequency and type of follow-up procedures I receive hinge on the previous scan showed and what procedure was provided. We’re hoping I can continue just getting MRA’s, but if something unusual shows up, more angiograms may be needed. Angiograms are more invasive and risky, but they are the gold standard for getting the clearest images of my blood vessels.

I am blessed to have had such a great neuro team here in Maine and terrific health insurance coverage through work.

Here’s to more scanxiety.

Two-Year Checkup 2018

I had my two-year MRA last weekend. Another trip down to Scarborough. This time on a Saturday afternoon, which was unusual and nice. Less traffic and great parking! My choice of music was 80’s pop and the whole thing took less than 20 minutes. Bada bing, bada boom. They used a combo of ear plugs and then placed ear phones over that. So, the sound of the MRI machine was significantly muffled. Nice!

It’s amazing how your mind plays with your emotions during that period of waiting. Especially when a potential vacation could be derailed if things have changed dramatically and I was told not to fly. A lot was riding on my brain and it had been a longer stretch of time between checkups.

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So, today I finally got the results back and this report was good. Nothing had changed from two years ago and we’ll do it all again in two years. (2020!) I still have that remnant of blood getting in to the neck of my first brain aneurysm, but the fact it stayed the same is good. Do I think I’m free and clear of ever having any other issues? No, but for now…I’ll take it. And I’m glad I didn’t have to endure ANOTHER angiogram. I’ll have to go back and check out my blog to see just how many I have had since 2006.

I’m still a survivor.

Look out Scotland & Northern Ireland! Here we come!

SaveSave

This Year’s Angiogram

I’m seriously hoping this is my last angiogram for awhile. I’ve seen that angriography suite far too often the last several years. However, it’s the best way to see what’s really going on with my pesky vascular system.

As stated in my previous blog entry, this angiogram was to determine if there were any changes to my original 11mm brain aneurysm from last year when it was discovered more blood was starting to creep back into the neck of the aneurysm. Obviously, the 20 coils and the one stent weren’t doing the best job they could be, but I’m still here.

Since there was a chance I’d be staying overnight, I had to go to admissions first and check in, then we went straight to the radiology department. They were quite busy today, although I reminded myself I’m usually scheduled for much earlier appointments. This is the first time I’ve had an afternoon appointment and I was VERY hungry and thirsty after not having anything to eat or drink since midnight the night before.

Upon entering radiology, Dave and I were greeted from a distance by nurse John, who we usually see when we arrive there. It’s a mixed blessing when you’ve visited a place so often you become so familiar with the staff of a hospital. John told my attending nurse that I didn’t need any instruction because I knew exactly what I was supposed to do in here. LOL Yes…pretty true.

The IV was hooked up, more questions were asked, and more instruction was given. We were most curious about the balloon occlusion test and what that entailed.

The BOT is a little more risky and it would also require another port and catheter into my other arm where something would be injected to bring my blood pressure down during the test. I wasn’t looking forward to TWO catheters. Dr. Ecker explained the risks and why they’d keep me over night as more of a precaution. If I was doing great after the whole thing I could potentially go home and not have to stay.

I said my good-bye’s to Dave and was wheeled into the radiology angiography suite. As usual, the teams assembled for every single angiogram I’ve had at Maine Medical Center are top notch and always make me feel comfortable and at ease. Even though I’ve gone through many of these, it’s still a nervous time.

They allowed me to request a music station on their Pandora internet radio that was piped into the suite. I chose 80’s Throwback music. As the doctor walked in he said the music was a step up from the morning sessions. I said “You’re welcome”.

So enough of the pleasantries and on to the drugs, please! I’ve always had some pretty good pain when the catheter in my groin is inserted and I always request a little extra something special. Thankfully, they complied and it wasn’t too bad. They also inserted the IV into my left arm to prepare for a catheter for the balloon occlusion test. That was a little painful as well, but it didn’t last long.

I know many people don’t understand why my groin hurts after having X-rays done on my brain. Aren’t they a tad far away from each other? Well, yes, but inserting a dye into that area gives a direct flight into the brain via one of the main cerebral arteries. I’m not sure why it’s going from the groin and not up higher on the body, such as the neck or chest, but it works, so I’m not going to question it.

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During the angiogram, they take a series of images of the arteries then inject a dye to see exactly where the blood is flowing and take another series of X-rays. When the dye is injected I see a series of small horizontal lightning strikes behind my left eye. It’s brief, but weird. I keep my eyes closed during the whole thing, mainly because I’m dopey and can’t see anything without my glasses anyway, but because there is usually part of the machine directly above my head and there isn’t anything to see anyway.

After the initial angiogram, Dr. Ecker compared images taken last year at this time with the ones he just took. He was able to pull them up on the screen side-by-side, then even overlap them. He indicated there was absolutely NO change from last year, which was great news. Then he was questioning if we should even go ahead with the balloon occlusion test at that point since nothing had changed.

The main reason we were going to do the balloon occlusion test in the first place was to see if my vascular setup could even handle such a reversal of blood flow should a I NEED to have something dramatic done to prevent more blood from getting into the brain aneurysm.

Since there didn’t appear to be any immediate need for that, based on this angiogram, we both decided to forgo the BOT this time. I was okay with that. I wasn’t looking forward to more pain, or an overnight stay. However, a part of me was disappointed we just didn’t do it and get it over with now so we’ll know down the road.

Because they had expected to do a lot more, the large team assembled for this big event wasn’t really needed now and the last thing remaining in the radiology suite was the dreaded “plug”, or Angio-Seal™. The angio-seal is a small device that basically closes up the puncture site in the groin. However, since he used a larger catheter for today’s procedure, that larger plug was needed. It can be quite painful, mainly because I’ve been “poked so many times” as he said. Lucky me!

Why, yes…it WAS painful and they had to tell me to calm down, relax, and keep my leg down. I did. Still hurt. LOL The UPSIDE of using the closure device is that I only have to lay flat in recovery for two hours, not four or more hours if they were simply to apply preasure to the site for 15 minutes. The angio-seal allows the bleeding to stop much more rapidly and a quicker discharge from the hospital So, that’s the trade off for the pain.

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The seal is comprised of three absorbable components: a small anchor, collagen, and a suture. The doctor guides the anchor through the hole created during the procedure where it is drawn in against the wall of the artery and the suture and collegian compact to create a secure seal over the entry point in the groin. All three components dissolve and are absorbed into my body in about 90 days. I’ll have an odd bump there for awhile, but the pain should ease after a few days.

The recovery in the radiology department is always long, but it seemed more so this time because they kind of forgot to offer me any food or water. It wasn’t until Dave asked them about an hour into my stay that I got a sandwich and some water. That’s highly unlike that crew and I was a little surprised.

Once they had me up on my feet for a short walking test and determined I wasn’t dizzy or unstable, I was discharged and walked out on my own. The only stop on the way home was at McDonalds for a shamrock shake! ‘Tis the season and it tasted sooooo good.

I developed quite a nasty headache on the ride home and was very glad we didn’t live any further than the 60 miles away we already did. The second I got in the door I had a cold cloth ready, heated my beanbag neck wrap, and crawled into bed for a good 7 hours. All the while keeping a pillow over my groin area so the cats wouldn’t jump directly on it. They did very good….been there, done that and I think they knew mommy wasn’t feeling well and cuddled with me all night.

My sleeping and eating pattern is all out of whack now and my groin is still giving me some pain. I’m pretty tired and not real stable. My head is going back and forth on whether it wants to bother me or not, but nothing I can’t handle. I’ve been in worse pain, been in worse condition, and I’m just lucky to be here.

However, there still is that lingering “issue”. Blood has gotten back into my original brain aneurysm and it’s still sitting there. Dr. Ecker wants me to get an MRA so we have a really good baseline image as it stands right now, then we’re hoping to just have MRA’s next time and not have to go through an angiogram as frequently. I’m all for that. Not that I enjoy MRA’s, but it’s far less invasive than angiograms, just loud and annoying. Then if they notice a change on an MRA, another angiogram will be ordered for a closer look.

I came away from this angiogram with mixed feelings. Yes, it’s great news that things hadn’t changed from last year, BUT there is still blood sitting there in the neck of a brain aneurysm that has already ruptured and we haven’t really resolved what to do with that. It’s almost a deja vu of last year. Something I guess I’ll still worry about until we see otherwise one way or the other. I don’t feel like I’m out of the woods yet from that pesky 11mm brain aneurysm. I should give it a name…any suggestions? (Keep it clean!)