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Archive for March, 2008

More tests: passed

Today was a big day for my future, since it was the first day in 9 days that I was re-measured. I had to get through a variety of tests, and it appears that I have made it, at least so far.

The first test was a CT-Angiogram, where they send in a dye and image it to look at the brain and its arteries. The fun part of this test is the hot-flash. When they dose you with the iodine (or whatever all that was), your body temperature goes up very quickly throughout the chest region, and then it, well … hits the groin area, making that also hot. It gives you good reason to suspect that things are not going right somehow, but then it fortunatley goes away after a few seconds. I’m not quite sure what that has to do with my neck arteries, but I guess we just take it.

Then I had yet another Trans-Cranial Doppler test to look at blood flow in the brains. That seemed to go OK, giving me critical numbers that indicate my arteries are working OK. Then they did some bonus tests. In the first one, they put on a kind of monitor hat, which had the main lasting impression of an indent next to my left ear. Somehow they claimed some time ago that wearing my glasses over my left side might have caused me trouble, but I’m certain it never left a divot. But I guess the numbers were OK.

The other tests were the breathing CO2 test (brain stress test) and also the heavy leg blood pressure test. In that latter one, the legs are both pumped up for about 3 minutes; it sort of feels like your legs are going to explode. The nice thing is when the pressure is released, and the only thing you have to do is absolutely nothing. They just want to watch how quickly the brain re-adapts to the change in pressure. I seemed to do pretty good this time, but the time before the surgery, I was doing fairly badly. I’ll take that as a good sign.

Then I saw the top doc, Dr Sekhar. He seemed happy and had all of my stitches out, and says that all my numbers are fine for now. Still some numbers to keep an eye on, like my right side of my brain, since they’re still counting on some collateral routing of blood to that side from e.g. the back side (I think). He basically has no restrictions on me, while the previous doctors from the other hospital had a variety of restrictions even though they didn’t do anything except take measurements. Kind of funny.

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A Little Review

Yesterday, after 13 days in Harborview Hospital, I was finally able to come home. Yes! I thought I’d give a minor visual tour of the last few weeks. (Click on pictures to see bigger versions.)

Everything started on (probably) Feb 16 when I woke up with a big headache and a droopy left eyelid. That was a day before I was going on my 8th trip to India, and since my health got somewhat better over the next day, I decided to go (bad decision, as I’ve said before). As I had headaches somewhere between half and full time on the trip, I got in touch with my US doctor, and he convinced me to get a head MRI. In India, that’s only $180, and then a visit with a neurologist for $6. Interestingly, they pretty much had the story right, as far as we went.

Here’s the MRI exam room in the Apollo Hospitals in Bangalore. Note the technician’s kid sitting there on lap on this particular Saturday. MRI room

And then here’s a picture where I look particularly photogenic. Headshot

I came back to the US a couple days early, and then started taking tests in the US hospital. On the second day, I took a MRA (magnetic resonance angiogram) which showed the suspected problem with my two internal carotid arteries, which feed the brain. Both had internal tears, which were thought would settle out eventually to a relatively healthy state — plus, a lot of doctors didn’t seem to like mess around in this area. While in the hospital for 3 and a half days for this, I had my first “TIA” — transient ischemic attack, a short-coming due to lack of blood to the brain. In this case it was an inability to write coherently over about a 20 minute period while sending a couple emails. One friend, who received one of these feeble-minded emails, immediately called me up because he (almost correctly) assumed I was having a stroke. The TIAs are like mini-strokes that tend to go away, indicating danger but not necessarily any immediate harm (always hard to tell!).

Here’soverlake bed how things looked in that Bellevue hospital (Overlake). Note a lack of any scars or big piping into my body. I had a nice private room with a pleasant view. Except for that TIA (I had some 6 overall, listed under “Incoherent Count” and one under “Straight-Legged Pain), things were pretty easy. I’m putting this picture as my last rational looking picture for a while!

 

And then I got out of the hospital, which started things ramping even more. The first day out I was having some numbness and then a speaking problem, and so we went back to the ER. Sigh. By the time I got into the doctor, I was OK again, so they didn’t know what to do. So they gave me what now seems like clearly bad advice: “You’re getting used to your new body with medicines, etc.” Not what now appears more accurate: your body is shutting down on you. Fortunately, through a friend, I got a connection with probably the top brain doctor in the area a couple days later.

The nice thing about this doctor, Dr Sekhar, is that he seemed to immediately grasp what was going on and unlike all the other doctors, he didn’t seem to have any fear about going in and fixing things up. From our first 5 – 10 minute conversation, he more or less figured out when we were going to have his most likely guess, a bypass operation around one of my brain arteries. Of course he had to do a lot of testing but he was in fact right.

I went into the hospital on that day (Wednesday), and stayed in until the surgery day, the following Monday for the operation, so they could keep an eye on me. I was awake when they rolled me into the surgery around 7:15 a.m., and then I was knocked out and woke up slowly the next day. I think the operation took about 9 hours. Dr Sekhar talked with JoAnn in mid-afternoon, telling her that his job was done — as the main artery grafter (which came out of my left arm). He said that because my brainzombied had been starved for so long, they had to be pretty careful for the next couple days so that I didn’t get too much blood now, for instance. Here’s a nice shot JoAnn took of me during my blissful sleep-off. I do not believe I’m actually awake in this picture, despite what my eyes may be doing. They seem to enjoy giving orders and questions to me, but I don’t remember them later.

The tricky part happened a couple days later. They run these TCD (trans-cranial doppler) tests to look at blood flows in the brain. This caused a little bit of distress, as it looked like they were going to have to do something to bolster the bypass which was now getting close to failing (as an example, when I left the hospital, the blood flow was up by about 7X again). I went in for my 3rd angiogram (complete with that friendly groin puncture), and was awake for about the first half hour. Then they must have decided to do something they didn’t want me to know about, and next thing, I was out again. I woke up sometime the next day, as I mentioned in an earlier post, and fought (unconsciously) with 3 nurses and my wife before they knocked me back out — due to a really uncomfortable breathing apparatus. As part of these tests I got a quick angioplasty to pop open the bypass arteries, and that seems to have collapsed. My numbers are up again and the doctor is happy again.

Hereheadshot‘s how I look nowadays — about 60 stitches in my head and 34 in my left arm for the artery. I’ve had an amazingly small amount of headaches, all things considered. I get some fun shooting pain now and then, and currently innocent appearing chewing gives me some very intense, but relatively short-term pain. I’m sure I’ll have fun with that for a while.  As you can see in the face picture (with the scar from the forehead to the neck) I’m not wearing my left temple in my glasses since there was some concern that my early wearing of that after the surgery may have done some damage — not sure.

I’ve gotarmshot a lot of testing to do, but haven’t had any TIAs since the first surgery — even though my numbers were getting low. I’m down about 10 pounds, but can walk (kind of slowly), and am waiting for my left side of my face to shrink back to normal, which will help me see a bit better, too. Like good kids, mine are enjoying showing my even goofier-than-usual face around their schools. I can deal with that, after having been through what I’ve gone through so far. We are certainly fragile critters, and every day is newly revealed to be the gift I never understood it to be.

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This is Tim again finally — sorry I was a bit under the weather for a few days. I went into the main bypass surgery on Monday, and that seemed to go well. It was done after 8 or 9 hours, then I woke up sometime the next day, although I was responding to questions and commands. Don’t remember any of that, but they say I did it, so I’ll take their word for it.

The docs were pretty happy the first couple days, but then some of the tests showed that blood wasn’t flowing so good through the bypass. They’re blaming me for wearing my glasses — the left side of my face is still pretty puffy, so there’s a good chance that it could have been pushing on the arteries. They had one of those TCD (Trans-cranial doppler) tests to look at blood flow and weren’t happy. So Thursday night, they sent me in for a third angiogram, thinking that they might have to widen out the bypass artery. I was awake for most of the test, and then bonk — they knocked me out. I guess they had decided to do some more drastic work, namely an angioplasty to try to make that bypass artery larger.

Once again I woke up in an Intensive Care Unit, and wasn’t fully awake, but my wife said I was fighting with her and 3 nurses, trying to get a very annoying breathing tube out of my mouth. Finally they cranked up my meds and put me out again. Some hours later I woke up again, tried to to get that thing out of my mouth but by now my hands were tied down. Somehow — and this wasn’t easy — I managed to sit more or less quietly although all my body was intent on figuring how to get that thing out of my mouth. Fortunately, the nurses came along and took the think out before I could go totally crazy.

And that’s been about it. I’m still in the ICU for the last day and a half, and it’s been pleasantly boring. They’re not too worried about me, and for the last several hours I’ve been waiting for a ‘regular’ room to open up. They did more of those TCD tests today, and things look OK. We’ve taken off my left temple from my glasses so there won’t be any bypass artery wipe-out going on. At least that’s the hope. The top doc says I may get out of the hospital in a couple days. Whoopee.

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The Post Op

Well, as you may well know, Tim is out of surgery but still in no condition to type. This may lead the educated reader to guess that this is once again the one and only Brian, but I’d fall into the other camp of treasuring my ignorance and believing that Tim is using his latent psychic powers to type this. Although at this point, you guys probably want to be enlightened as to the condition of our prestigious colleague’s condition:

He’s out of surgery, spent several hour recovering from it, and is now chilling in the ICU. Those of you belonging to the less slang heavy generation may want to visit him with blankets to stop the chilling, but rest assured, he is fine. Well, for a given value of fine. I have been informed that he is in perfect health for someone who just had their skull opened up. Apparently yesterday after the surgery he barely looked like he spent eight hours getting worked on. Today, however, he is sporting a brand new prison scar that ranges from his neck to his skull. With any luck sweet prison tattoos will soon follow, probably of some super complicated microchip.

He had another angiogram so the doctors could confirm that he is still alive and well. Apparently today after that’s done he’ll be moved back up into an actual room, but lets not get ahead of ourselves here. So thanks for staying with us through this harrowing time (with extra harrow!) and Tim should be awake and conscious soon. He’s been really, really tired from the surgery.

~Brian Youngjoon Williams

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Twenty Minutes Left

As you may have guessed, this is not Tim writing this post. As I type, he is still in surgery for (barring any unforeseen difficulties such as death) twenty more minutes. This is his son Brian giving you the familial update straight from the surgery (waiting) room. I could describe the room for you, the constant influx of doctors who call out a last name with dreary overtones and explaining to the uneducated nonmedical people what exactly went right or wrong, or the strangely realistically artificial fish tank that sits over to my left, or the amount of talking that the party rooting for TJ makes (all of it).

But that’s boring.

So I’ll give you the experience I’ve had over the last week since you asked oh so nicely. It was a peaceful day when it started and I was just getting started on my nap. On Wednesday I got a call from my dad asking for my UW netID, the username and password for being a student at UW. Now, to understand why this is important, you must understand that this password controls my academic life in every aspect except learning. I register for classes with it, use it to check my official student email, and access the UW  online library off-campus for the occasional research project. The parents have been after for the past 3 years, believing that they should have access to what they have no business to (except for the shelling out of two thousand dollars, but we won’t go there). So you can understand I was somewhat apprehensive about this question. Tim didn’t tell me why he wanted it, just demanded it. I asked him why, to which he informed that he was “In Harborview” the trauma hospital. This caused a small amount of alarm and he finally got the password.

I got to visit him Thursday where he explained that his episodes had gotten worse. Here I thought that going to the hospital was suppose to make you better! He told me that my password is the only thing that kept him from succumbing to boredom. That’s right medical science! Score one for the creative writing major. But yeah, he’s in overly good spirits even though I’ve spent the intervening two days freaking out. It was fun to watch him converse with a smile on his face despite the whole “neurosurgery” thing he’s about to go through. The usually litany of complaints are ones even he isn’t too bothered by, the smaller room, the fact that he’s spent more time in the hospital than at home since he got back from India, the lack of sleep the doctors let him get, you know, complaints about the fuss we’re making sure he’s gonna be fine.

Sunday I visited him again after his “night of hell” which is misleading; hell is more pleasant. He spent the last forty three hours with his leg straight in order to keep from dying. A dismal prospect since I’m as jittery as a jitterbug on caffeine, but he managed it. He looked miserable for which I can’t blame him. Tim has spent the most miserable few days in his life. This’ll teach him to go to India with a saggy face! We spent the time joking around, the classic Williams response to stress, joy, boredom, and everything else. His spirits are surprisingly high despite having to urinate into a little clear jug. We left so he could try and catch a few hours of peaceful rest before they moved him again.

2:49 pm: Joann is crying since Tim is apparently all done. The surgery went well and they are patching up. Or sewing up, who knows. We’ll see how drugged up he is. He’ll probably be totally out of it and probably spew gibberish. So I’ll spend the next little bit drawing mustaches on him or something. Everyone let out a sigh of collective relief, and I almost can’t regret skipping class this morning to come wait for this. Because, to be honest, I wouldn’t be anywhere else. I enjoy making fun of his hospital gown and now he’s got a shaved head. Comedy Gold.

~Brian Youngjoon Williams

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Somehow it sounds kind of catchy. To bifurcate, to split, to fork. Used to be going along with one brain, now you’re going along with a bit different one. Whatever this day is going to be, seems pretty likely it will be noticeably different than the one before it.

Although it’s unlikely, things could turn out really bad. That’s a reason to put up with the aphasias and try to wait it out … maybe the arteries will heal enough, and things will get back in kilter. But my feeling is that the operation is the better bet, and that the bad thing down that other road is the one we want to avoid.

I’m kind of expecting a bit of a headache on the far side of this operation. Seems like something wouldn’t be right it doesn’t happen. (But I won’t complain if there’s not one.)

Haven’t worked out my full-up Bucket List yet. Seems like I ought to have more time for that, but that’s what most people probably say. A few things I’ll be interested to try to do in the very near future. Kakuro (it’s like Sudoku, only I like it better). I’m hoping I still remember the 40 or so decimal places of pi, out of the 100 places I picked up in high school. My current brain would be disappointed if I couldn’t say something in an occasionally humorous way, but hopefully not too obnoxiously – which we hope to just blame on the old one.

I do believe that the Lord God Almighty exists and has his way with us, to the extent that he wants. He seems to give us the dignity of engaging in lots of things – things like medicine, for instance – a remarkable sharing step on his part that he probably does in all areas. We were made too fragile for this place – despite our often great desire, this life is not guaranteed to be all good; that seems to be reserved for someplace else.

But I look forward to see what adventure lies beyond Bifurcation Day. If I know my creator, I’m sure it will be something I wouldn’t have guessed.

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Acts of beauty

One thing that’s obvious about this post, by it’s title, is that it’s not about me. It’s dedicated to a group of my fellow humans that I never quite appreciated correctly before: nurses. Doctoring is a prestigious and valuable profession, of course, but a whole lot of pain and suffering and inconvenience is made a bit better by the good-hearted people who are our nurses. I’ve spent 7 or 8 days in the hospital recently, and while there are undoubtedly some nurses who are themselves somewhat the focus of their nursing, even the worst of these puts up with so much messy life on a typical day in the nursing field that they can pretty much be forgiven all.

Imagine comforting the 76 year old woman, just out of brain surgery, and hopelessly addicted to her jar of Ambien sleeping pills back home, essentially unable to face the night without those. The nurses bottle the Ambien-free message with grace and patiently deliver it over, and over, and over. Or dealing with the elderly man who no one visits in the hospital, but who woke up in there to find he’d had a big stroke. The nurses are certainly 10 million times better off than this guy, but they bring him all of the cheerful moments he gets, they clean him, they give him a reason to be conscious for few moments, so there can be reasons to have even more conscious moments the next day.

My namesake nurse Tim only had to put up with my straight-legged problems, and set himself about making my unintentional stay in his area as nice as it could be, and much nicer than I deserved. Nurse Tim did a lot of little things so that I would have a few incrementally nicer moments. I’m sure he would have been perfectly within his responsibilities to not do all that little extra stuff for me. But I don’t get the impression that Nurse Tim became Nurse Tim to do the minimum amount of things he could for his patients. In that way, he’s a lot like most of his fellow servants.

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