Sunday, June 30, 2013

Quiet Desperation

Despite the somewhat downbeat title, this entry is actually mostly good news – in a world where "no news is good news".

I went to see my neurosurgeon in Boston a couple of weeks ago, had a new CT scan done, and you know how I love sharing pictures of my brain. So, below, I give you those thousands of words, including the radiologist's report for anyone who cares to dig in to the medical jargon. My doctor's general interpretation was that the scans showed no new damage or re-development of the aneurysm, so that's all good. And that the clips holding the neck of what remains of my aneurysm  are still intact (also good). In fact, he said he wouldn't request another of these scans for another two to 2-1/2 years. I have pressed him a bit on the possibility of getting a functional MRI , which would be very colorful and potentially show how my brain has remapped around scar tissue caused by the stroke (which I've recently been amused to learn can also be called a "brain attack"), as well as perhaps showing how brain cells have even regenerated in my right hemisphere (if that's even possible). I would consider it a picture of my New Brain. Insert, "Why, I've got half a mind to..." joke here.

So why Quiet desperation? Whenever I go in for scans like this, I find I have to prepare myself to some extent for bad news and question what lengths I'd even be prepared to go to remedy unexpected problems. Even though I've been feeling fine and didn't suspect any changes, I had to gird myself. If I do have an fMRI performed (insurance has to agree, since it isn't medically necessary), I'll have to do the same, despite the fact that the goal of the scan has more optimistic intent – instead of looking for damage, I'd be looking for healing. But the sword is double-edged – my doctor said he would not normally request such a scan,  because just talking to me about how I feel I'm doing, observing my progress, and noting the areas of my life in which I've returned to some level of normalcy (driving, work) provides a meaningful gauge of how I'm healing. Even the fact that I'm curious about an fMFI, he considers a positive sign. That said, I've been down that road before of expecting better results than I received – most specifically with the neuropsychological evaluation I expected to pass with flying colors but which ended up identifying more deficits than I feel accurately portray my day-to-day performance.

Now to the pictures:

Left is right & vice versa, light grey is healthy brain tissue, dark grey or black is scar or dead tissue, reflection is from aneurysm clips.

Arterial view. The reflection is still clips and what's left of the deflated aneurysm.

Highlights my big nose, the aneurysm clips, and the zipper on my fleece.

Pretty similar but somewhat emphasizes the portion of my skull that was replaced.
My plastic skull.

The Radiologist's report:

COMPARISON: CT head Maine Medical Center 8/7/2012, CTA 6/9/2011
CTA of the head with and without contrast. 3D post-processing of the images was performed, and the post-processed images were used in
There are postoperative changes of prior right frontal temporal craniotomy, giant right MCA aneurysm clipping, and synthetic cranioplasty flap
placement over the right frontal temporal convexity. There is an unchanged appearance of multiple aneurysm clips, as well as calcium from a
collapsed thrombosed aneurysm.
There is unchanged encephalomalacia in the right frontotemporal parenchyma with ex vacuo dilatation of the right lateral ventricle. There is
unchanged dystrophic calcification adjacent to the region of encephalomalacia. There is atrophy of the right caudate and right cerebral
There is no evidence of acute intracranial hemorrhage, new mass, or new territorial infarction.
The ventricles, sulci and cisterns are unchanged in appearance.
Scattered paranasal sinus opacification is present with right maxillary retention cyst The mastoid air cells are clear.
The orbits, soft tissues, bony structures are unremarkable, except for postoperative change described above.
Examination of the aneurysm is limited secondary to metallic streak artifacts from aneurysm clips. There is an unchanged appearance of mild
prominence of contrast enhancement in the area of the surgical clips that may represent minimal persistent flow through the MCA aneurysm.
The remaining arteries are unremarkable, with no hemodynamically significant stenosis or aneurysm identified.
Unchanged findings of right frontal temporal craniotomy with synthetic cranioplasty flap and giant right MCA aneurysm clipping.
Unchanged right frontotemporal encephalomalacia.
No acute intracranial hemorrhage, new territorial infarction, or new mass lesion.
Unchanged contrast opacification in the region of the right MCA aneurysm that may represent a small amount of persistent flow. No other
intracranial aneurysm identified.

The real quiet desperation

In addition to my medical travels to Massachusetts, I also recently took a more spiritual journey to The Bay State – driving to Walden Pond to meet my dear virtual and flesh-and-blood friend, Jeniene. When the park turned out to be closed, except for the gift shop, I think Mr. Thoreau would have been pleased with how we reclaimed our day and let the time carry us wherever it cared. Oddly enough, despite being the Thoreau quote which resonated most with me in my youth, quiet desperation doesn't sell well on a t-shirt, so I instead bought a magnet of the much-more-uplifting but no-less-resonant, "I know of no more encouraging fact than the unquestionable ability of man to elevate his life by a conscious endeavor." Our unexpected change of plans (we were originally going to spend the morning at Walden) led to a serendipitous chain of events as we consciously endeavored to lose and find each other a couple of times but always managed to reconnect via cell phone, including a pit-stop in a strangely-familiar parking lot (my visual memory works!) which turned out to be the location where I married my Best Man (meaning I was the officiant  at his wedding) in 2009 and had a very nice lunch in a pub in Waltham (while she and I have bonded mostly over Facebook, our face-to-face interactions always confirm we have much more in common than illness. So as my first bona fide road trip since getting my license back, it turned out to be the perfect expression of what good things life delivers sometimes when you just let it. That's the "song" I think Thoreau was talking about.

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