I first met Dr. Ecker on December 3rd, 2010. In all that time and the different medical procedures we have been through, I don’t believe I have ever hugged him. Yesterday I broke that patient/doctor barrier and gave him a very warm, tight embrace.
Twelve years ago, he picked up my aneurysm story where Dr. Kwan left off four years prior. Aneurysm #1 ruptured in 2006 and is the problem child. Even after 16 initial coils, blood was getting back into the aneurysm. Dr. Ecker has been trying to improve the situation and produce favorable results with several attempts. Two stents and 4 more coils later, we might be at a turning point in our professional relationship with this pesky bugger.
As noted in my previous post, I was thrilled and emotional to hear how well the flow-diverting stent deployed back in April was doing. I certainly was relieved, but until I saw the images and spoke to him in his office after he had a chance to review everything again, I still wasn’t celebrating to the point of calling it “done”.
Seeing the images yesterday was remarkable! The areas where blood was previously getting into the neck of the aneurysm had almost disappeared and the artery where the flow-diverting stent was placed inside the older stent had conformed to the shape of the artery. This is EXACTLY what the hope was. Success!
Because this particular procedure, placing a stent inside another stent, is not a common practice, Dr. Ecker felt a follow-up MRA in three years would be best and I agree. Although we’re all thrilled to see how it’s taking shape after 7 months, giving it sufficient time for healing was recommended. THEN if it continues to look good, we’ll look at it every five years.
Below are a few photos I took of my images on the doctor’s computer screen. They aren’t the best, but I tried to indicate where things are for my readers. The two images placed side-by-side were backwards on his screen showing the AFTER image first, then the BEFORE image after it, so I had to cut them apart, flip them and I tried to keep them around the same size for scale. Hopefully, you’ll get the idea. And yes, I DO know I should have added another “m” for the size of my aneurysm. Don’t @ me. It took me a long time to get these images right and I’m too tired and busy to change them. 🙂
Raw image comparing the aneurysm and artery prior to flow diverter deployment and after Indicating the location and size (approx. 1/2” in diameter) of the aneurysm, which is currently filled with 20 coils (not visible).LEFT: Showing the area of blood that has been developing over a period of years into an aneurysm already susceptible to rupture. RIGHT: Now showing a reduction in size of the bloody area and a clearly defined artery.RIGHT: Showing the relative location of the flow diverter placed within the older stent in the artery.
Yesterday was my 12th cerebral angiogram in 16 years. That’s a lot of images, a lot of stress, many procedures, successes, and even failures. Brain aneurysms don’t care what else is going on your life…they show up whether it’s snowing or not.
It was snow that greeted Dave and I yesterday morning as we were up before the sun rose to hit the road to Portland, a 60 mile drive south. Thankfully, we drove out of the snow about a quarter of the way there as a driving rain greeted us at the door of Maine Medical Center.
When multiple members of the hospital staff remember you from previous visits over the years, that should never be a good thing, but it is what it is in my case. I supposed it’s a comfort to see familiar faces who know my story.
Down in radiology, I was prepped for the procedure, hooked up to an IV, and answered everyone’s questions. Dr. Ecker came in to greet me and indicated he was excited to see how the flow diverter he deployed back in April was doing. Well…yes, I was too! He even opened up the images from the procedure on the computer in the prep area to view them with me and Jack, the PA, who has assisted Dr. Ecker with several of my other angiograms. Again…they know me here.
The procedure itself went very well. No issues and no pain or major discomfort. I was a good girl and didn’t move this time as some lovely classical music accompanied the staff in the endovascular suite.
While still on the table and hooked up to everything, Dr. Ecker said that things looked great, then he said “What Eddie Kwan started 16 years ago, ends today!”. Dr. Eddie Kwan was the doctor who performed the original coiling on my ruptured brain aneurysm in 2006 with 16 coils.
“What Eddie Kwan started 16 years ago, ends today!”
Dr. Robert Ecker
At first, hearing those words brought tremendous relief and joy, then I saw the last 16 years flash before my eyes in a rapid succession of images…the fear when it ruptured, the loss of my husbands niece, the loss of my sister…my second brain aneurysm, the clipping, the recoiling, the stents…all of it in a millisecond of memories and feelings indelibly etched into my heart, brain, and soul.
20 coils, 1 clip, 1 stent, and 1 flow diverter
After that wonderful declaration by the doctor, a few more images were taken to get a good look at everything else then the doctors left and went to speak with Dave in the waiting room. While the rest of the staff were busily performing their post-procedure routines and unhooking things and cleaning me up, the tears started to unexpectedly flow.
My arms were still hooked up to things and down at my side within the arm guards, so one of the nurses touchingly came and dabbed the tears away from my eyes and face with a tissue for me. They were very comforting, in what was quite a personal and emotional moment for me, and I’m very thankful.
Dave was very surprised and concerned to see tears in my eyes when he joined me in the post-op area about an hour and a half from last seeing me. I assured him they were tears of joy, but he also knew why it was emotional for me because he has been with me through it all.
I was glad to learn what I heard from Dr. Ecker in the radiology suite matched up with what he told Dave seeing how I was a little drugged at the time. The flow diverter (pipeline) did it’s job. It adhered nicely inside the old stent and had paused the flow of blood from getting back into the neck of the aneurysm. He said it was “Done” and I wouldn’t need to go back for five years and it would just be the less invasive MRA scan next time.
The images that were taken yesterday will need to be closely looked at again just to make sure there isn’t anything else we should be concerned about, but during the doctor’s first look on the table, things looked good and it was a great report. I’ll have another follow-up in his office in December.
I pray this is a start of a new chapter in my life where I don’t have to worry about this damn aneurysm anymore. The rest is up to me…live life better and take better care of myself. I am lucky to be here at all.
I am so grateful, thankful, and blessed for the improved medical advancements in treating brain aneurysms and the skilled hands of Dr. Ecker and his stellar care over the last 10+ years. He knows what I’ve been through.
Two Fun Side Notes: Stephanie, my nurse in the pre & post care area is a Buffalo Bills fan and shared photos of her dogs dressed in Bills attire. What are the odds that two Bills fan, in Patriots country, run into each other in the hospital? Then I ran into Sara, our former brain aneurysm support group facilitator on our way out of the hospital. It was great to see her face. Again…they know me here. 🙂
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.
This morning we met with my doctor to discuss the results of my angiogram, his findings, his recommendations, and the next course of action.
FINDINGS:
In comparing the most recent angiogram with the angiogram from 2016, there are “significant changes” in the bloody remnant in the neck of the aneurysm.
This finding gave my doctor “anxiety that it is at risk” of rupturing in the future again.
RECOMMENDATIONS:
Place a flow diverter inside my existing stent to prevent more blood from getting into the neck of the aneurysm.
They may insert and expand a balloon first to push back any “tines” from the original stent to allow the new flow diverter to be positioned better.
The Surpass flow diverter is a more flexible stent that should adhere better to my “ugly” and “challenging” arterial structure around the aneurysm.
It’s an endovascular procedure, so not open head surgery.
Bringing in an additional doctor with knowledge of this procedure and flow diverter to assist if need be.
MY DECISION:
To go ahead with this procedure here at Maine Med.
Will be put on blood thinners (Plavix and full-strength aspirin) the week prior to procedure then remain on both for 6-months after.
Procedure could be as early as March.
There is a good video about administering the Surpass flow diverter on this page, although it doesn’t show it being deployed inside another diverter: Surpass Flow Diverter
I was surprised to read on my blog that I’ve been dealing with the stress of this darn remnant for 11 years now. When the re-coil and stent didn’t do the job, the next course of action would be the stent within a stent. If THIS doesn’t work, there is a possibility we could sacrifice that entire section of artery, but I’m counting on it working so let’s not even go there.
Making this decision with Dave by my side gave me a sense of relief. Relief in knowing I’m doing something about it and there is a plan of action. I have great faith in my doctor and his familiarity with my case, my brain, and this particular brain aneurysm for the past 11 years. I know he wouldn’t make a recommendation unless he felt there was a good chance of success. And so far, he hasn’t been wrong.
Heidi's Brain Blog 