My AVM Blog, or "Do you want brain surgery Paul LaMarr?"

My AVM Blog
or
"Do you want brain surgery Paul LaMarr?"

My intent with this blog is to leave a bread-crumb trail and shine a light ahead for those that follow me along this adventure through the US health care industry to the fun side of invasive brain surgery. Information-imparting and reassuring for those facing it in the future, but with a positive and pleading-free flight to a happy experience with brain surgery in a health care system gone completely awry, that would do service to Monty Python. Also, for family and friends to check from time-to-time to see which square the dice roll has landed me on today.		My name is Paul and I am a 65 year old mostly retired man with a recently discovered AVM, (cerebral ArterioVenous Malformation). Divorced years ago, I live alone with my two dogs, about an hour and a half from Dallas, near a lake surrounded mostly by retired folk. My three children are grown with busy lives rearing my grandchildren and pursuing their careers; the nearest two living about six hours away. Having spent most of my adult years in Dallas my medical support is still there. I have always had some back and neck problems and have just lived with them except for some traction therapy for my neck about 1982.
BLOG FORM Most recent happenings first. I don't have time to live my neuroses and yours.		STORY FORM In the order it all happened. Your life is so exciting I don't want to miss a bit.

Most recent first to check for the latest happenings. Click STORY FORM above, if you want this in the order it happened.

August 8th, 2006, Tuesday. Brain Surgery is a piece of cake. I recommend that everyone have one.

I left the hospital today and am staying with friends, Linda and Shirley, in McKenny. I am in great shape, with truly no brain deficit, and almost no pain. With two successful artery embolizations last Wednesday, and clamping and removing the fistula last Thursday, my brain plumbing is permanently fixed. The only scar I will have is covered by my hair, from ear to ear. For the first time in my life my heart isn't overloaded and my brain is being properly oxygenated. I feel like I have won the lottery.

I'll be home in a couple of days and will try to get this all written up by then. I thank all of you for your love and concern.

Just so you can get a feel for my condition on post-op day two.
I'm much less swollen now, and will post another picture Thursday.

August 1st, 2006, Tuesday. The Brain Surgery Saga. You should click here and read about the truck that left me looking like my picture above.

So here we have exactly why the wrist watch is more popular wearing apparel today than the grandfather clock!

July 28th, 2006, Friday. Just so that you don't think this diary is broken I am posting an update with some priority news. This coming Monday, (the 31st), Charlie has scheduled 10:30 AM to give me a final hairstyling before sending me off into the unknown land of head-shaving for utility, instead of fashion. We will both quake at the thought, sharing a bottle of wine as she makes divine pronouncements over my curly golden locks. I'm sure we will hug before she sends me away with perfect quaff, nails polished, and smelling for all the world like a high-Franc French whore run amok in East Texas. The dogs will probably not recognize me.

And this same coming Monday afternoon at 2:30 PM, April, at April's Pet Place, has scheduled the Dog-Boys for the same fashionable dunk and clip. Chaucer will have a little anti-anxiety pill about an hour before and another as he arrives. He can be afraid of those devil clippers, ya know. It will be nice to spend the evening with them clean before they move the next morning to the Hotel de'Jones for the duration.

July 26th, 2006, Wednesday. This afternoon my daughter and I had a wonderful conversation. Since the treatment procedures are conditional, depending on the outcome of the preceding and actually low risk, they will stay home and wait at each stage for me or my doctor to phone them with the daily progress reports. I'm not nervious needing support and there is truly nothing they can do here. If something should go a little off-track, and they feel the need it only takes an hour to fly-in and gather for incantations and incense. I mean: My God, does Starbucks need three additional yuppies sitting around bemoaning dad's prognosis over lattes?

AVM Animation. I found a good animated explanation of what this AVM thing is about. You have to select the topic on the left and click the play button. Click here.

July 14th, 2006, Friday, 10:17 AM. Telephone call from Linda Mitchell, Nurse Coordinator from University of Texas Southwestern Medical Center, calling to tell me that Dr. White does not want to start any neck therapy before my surgery. If I'm in much pain he says we can start some hypersteroid medication. "hyper?" I decline, content being Blanche's grandson, not wanting to look like her. I'm not in that much pain.

So I asked my remaining Blanche questions:
2. Should I be storing blood? Nope, no need. They don't anticipate much blood loss during surgery, she says.
3. Will they do embolizations over several days?
4. Why does Radiology insist that I have a driver for Post embolization?
5. Shall I rent an apartment near the hospital for the month of August for recovery/out-patient therapy?

"Not to worry, Blanche," she says. [Well, she didn't really say Blanche.] When I check in Wednesday morning, August 2nd, for the first embolization, they will keep me until I am fully reconstituted, retreaded, repaired, and reinvigorated. She says when they discharge me I will be a fully functional humanoid; walk enabled, talk enabled, tooth brushable, shoe tieable, functional. Able to tend my own keep, but should be conservative for a couple of weeks, like no house cleaning or heavy lifting. Hell, I don't clean houses or lift heavys now.

And no driving for a couple of weeks. I will stock up on snails and blueberrys before checking in, and arrange for daily Fajitia deliveries.
Oh, I will survive! Did you think I'd lay down and die? Oh no not I. I will survive! Sorry, Gloria.

So Here's The Deal My Cheeky Monkeys!

Tuesday, August 1st. Visit for some pre-op blood tests, etc.
Then leave and go home until the next morning.

Wednesday, August 2nd. Check in at 6 AM for some embolization.
No big deal! Very similar to the angiogram two weeks ago. I stay conscious, have some valium.
Just uncomfortable all day from the groin puncture. I really won't feel like having visitors.

Thursday, August 3rd. About 7 AM some open skull brain surgery.
Then a couple of vein snips. Then close. OK, Who's hiding his skull cap?

No big deal. Low risk. I'll probably be semiconscious for the day.
I will try as hard as I can to respond "Rosebud" if they try to rouse me. (Marie's suggestion).
Please don't come. You can't do anything. I'll post a phone number for progress info.

I really don't know when I'll feel like entertaining. But please don't feel a need to show up,
because I'll feel like crap for a few days. I'll blog it when I start getting lonely.
Then you can bring some dancing bears.

I suspect I'll be in the hospital about a week for my skull to knit a bit
and blood to quit dripping in my eyes, before I roller blade home.

What if my personality changes after my brain has some elbow room?
What if I change gender prefs? Oh Darn!

Rosebud!

July 10th, 2006, Monday. Sherry Reed, Neuroradiology, didn't call today, but in the mail I got the following letter from her:

UT Southwestern Medical Center
Dallas, Texas

INTERVENTIONAL PROCEDURE NOTICE
FOR
ZALE LIPSHY UNIVERSITY HOSPITAL
5151 Harry Hines Blvd
Dallas, Texas

July 6, 2006
The following has been scheduled for you:

Presurgery Testing: Tuesday, Aug 1, 10:30 AM. (Then go cool your heels somewhere until next morning).

Embolization: Wednesday, Aug 2, Arrive 6:30AM. (Someone must drive me home afterward. Here we go again).

No mention of scheduled brain surgery the next morning. (Soon we will get this all nailed down a bit firmer).

etc.

[They just don't know Yet that I'm Blanche's grandson, that I have The Blood, and we will discuss these things until they see it My Way!]

I do have a few other questions when I next talk to Linda Mitchell, RN, Clinical Nurse Coordinator, Neurological Surgery:
1. How about some neck therapy during the three weeks until my procedures?
2. Should I be having blood drawn and stored for use during the surgery?
3. The doctor told me that they may do embolization over several days.
4. Why does Radiology insist that I have a driver for Post embolization, Wednesday night, if I'm scheduled for surgery the next morning at 6 AM?

July 7th, 2006, Friday, 2:37 PM. Awakened from my mid-afternoon nap, on the telephone was Linda Mitchell, Nurse coordinator from UTSWMC, calling to tell me she has arranged my surgery schedule. Wednesday, August 2nd, at 6 AM is my check-in time for the first embolization attempt. And if embolization can not fix it then exposed brain surgery will be the following morning. I will have a pre-op visit with the anesthetist the day before on August 1st, and Sherry will call soon with the time and instructions for this.

July 6th, 2006, Thursday. I awoke about 6 AM and had coffee while I filled out new patient paperwork for my 12:15 PM appointment for X-rays followed by a 1:15 with a neurosurgeon at the University of Texas Southwestern Medical Center, (UTSWMC). The paperwork was about as long as the name. After filling the car with fuel I started for Dallas at 8:30 AM. I called last Monday to pick up actual film of my angiogram this morning at Baylor main hospital, (and a CDROM of my sonogram). After I parked and found the Image Archive again, it only took about 30 minutes at Baylor main. Then over to Central Expwy and up North to the Baylor North Image Center for actual film of all the MRIs and the CT I have had there. I called them yesterday and ask them to create it. The film was ready for me, but I didn't see Rudy's smiling face today.

I decided that Northwest Hwy to Inwood Road was a good route to ply. But when I got to the UTSWMC complex, It was only 10:45 AM. It is so hard to pre-judge traffic, especially when making several stops. Traffic has been unusually light today. I drove on up to the Starbucks on Oak Lawn and had a cappuccino while I started typing up todays entry. The valet parkers at the Aston Building were quick as bunnies. I still arrived half hour early to the 7th floor Radiology department, where I was instructed to go. But there was no X-ray order for me because I had so many scans in the last two weeks.

Now, I was again an hour and a half early, for my 1:15 PM with Dr. Jonathan White. At the 4th floor neurosurgery waiting area I was told that Dr. White would see me before lunch. All right! A karma reciprocal, I'm convinced. I chatted for just a few minutes with a nice lady who was on a post op for her second tumor removal. I was shortly taken back to a large pleasant exam room with lots of windows looking out to the green treetops. The exam room has several very good colored bass-relief diagrams of the human brain identifying its lobes, plumbing, neuron bundles, and function areas. I studied it for not enough time when Resident Dr. Talmadge Trammell came and introduced himself. We discussed my symptoms, and I told him of my Keflex quandary and he waved at the exam table. I leapt upon it and bared my groin to yet another palpation. He declared my groin a Keflex-need free zone. I am so pleased. As I re-swathed my nakedness, we discussed my concern about tactfully expressing my desire for Dr. Samson to do any surgery I may need. He said that I should feel perfectly comfortable discussing this with Dr. White. That Dr. Samson had trained Dr. White, and Dr. Trammell had heard him say that he would have Dr. White operate on him if he ever needed. Also that cases in the department are not done in a vacuum but are thoroughly discussed by the doctors.

I have to say that Dr. Trammell is a very personable, bright, and attractive young resident, and that if his surgical skills even approach his people skills, that he is going to be, or already is, an awfully good surgeon. And besides he has great ca'boy boots. (Well, they all do, of course. It seems to be a nest of booted brilliant people gathered to do physical brain rearrangement. If they didn't have societal sanction, it would be worrisome.)

In a few minutes Dr. Jon White came in. [expand from notes]

I AM STOKED! I know I'm getting out of sequence here, but I met with Dr, Jonathan White, "my" new vascular neurosurgeon, and he said my situation should not be difficult. Linda Mitchell, RN, clinical nurse coordinator, is scheduling a first embolisation as soon as it can be arranged. Dr. White said that I may not require exposed brain surgery if the embolising locations can be reached to close the necessary arteries by internal catheter. And even if they can't be reached or closed, the necessary surgery looks to him like it would be mostly external to my brain, (although, inside my skull). All DAMN FINE NEWS. Schedule this as soon as possible I request.

Afterwards, scheduling, I tell Linda that the only time I have blocked is a July 12th appointment with the neck ortho. Then we ask if they can't also do my neck at SWMC? Dr. White walks back and asks for my c-spine films. Then said, "Yes, we will also treat this here, you can cancel your orthopedic consult. Very cool! He says he thinks we can handle it conservatively; therapy and injections. I mention my disinterest in spine surgery, considering my mother's ten major back surgeries. He smiles and tells me, "The Bible says, 'Back surgery begets back surgery.' "

AND NOW FOR TODAY'S REALLY GOOD NEWS... My favorite little Mexican Restaurant here at the lake has just reopened after remodeling. Their sizzling Fajitas are where I got my adorable 194 avoirdupois pounds, and how I plan on keeping them. So this evening I treated myself to a large sizzling plater and am miserably stuffed as I'm typing this. - smily face - Did I mention food being the central focus of my post-cigarette life?

July 5th, 2006, Wednesday. Just let me tell you about today! Like I mentioned Sunday, my GM doc has been closed since June 30th, so this morning I called his office to report all that has happened in the last five days; the switch from Dr. Samson to Dr. White, the forced rescheduling of the orthopedic surgeon, my swollen groin puncture with its eventual sonogrammed diagnosis of lymph nodes, and the bothersome Keflex prescription. So shortly after giving all that to Sheryl she called back, and I can't quote exactly, but the relayed gist of Terry's message came across something like, "Tell him he is an idiot and should have started taking the Keflex last Sunday. Why does he think they gave him the prescription? He probably has a hospital air borne resistant staph infection (MRSA) in the puncture site that would have been stopped in its tracks if he had started the Keflex when they gave it to him but now he will probably die a terrible death from an exotic flesh eating bug before sundown tonight." [Again, there may have been some hyperbole in there.]

Actually, I was there and remember the discussion when they gave me the Keflex 'script, so I try to have that re-related to Dr. Watson. A couple of minutes later, I reconsidered the potential wrath I could be in for, and leave Sheryl a message to just tell the doctor that I am starting the Keflex immediately. Too late! She called and relayed his instruction to, "do whatever I want with the antibiotic!" Golly he seems pretty stressed for just returning from a five day holiday, but I am grateful for his professional restraint in not mentioning shady places. Once again, I'm pigeon-holed as a difficult patient that attempts to self-prescribe. I need a couples counselor to "get right" with my General Medicine doctor! I really do need his expertise and judgment these days and I try hard to be a good patient, but we just aren't clicking lately. Maybe I should make an appointment and discuss it with him. -grin- Better! I'll print and fax this blog entry to him. That ought to fix everything right up. Ya think, Paul?

At 5:28 PM I got a phone call from Elizabeth, RN, Interventionist Radiology Nurse, at Baylor. She wanted to know my puncture site condition, and also expressed Dr. Hise' concern about me having a neurosurgical consult very soon. I told her the puncture site is identical to Sunday and that I have an appointment tomorrow with Dr. White. (She knew that Dr. Samson is out for July). I told her about my Keflex quandary. She suggested I take the three prescribed caps until I meet with Dr. White, and ask him to examine the swelling. She asks me to call her after my consult with him tomorrow, and I say I will.

July 3rd, 2006, Monday. I called the Image Archive at Baylor Hospital today to arrange to pick up film for my visit Thursday with Dr. White, the neurosurgeon filling in while Dr. Samson is away for July. They say I can pick up the film on Thursday morning on my way to my appointment. We discussed our wonder why doctors are still insisting on film when the images are almost all originally captured digitally. Seems a bit hide-bound to the image archive attendant and me.

I also phoned the Baylor North Image Center to prepare film for me to pickup of the first two MRIs I had there. I'm a bit surprised that the images aren't networked to the main hospital archives, but Rudy said he is happy to print film for me to pickup. I do have plenty of time before my 12:15 PM appointment at UTSWMC, so going both places is no problem.

I got a statement in today's mail from Baylor Hospital for the June 23rd cerebral angiogram. Would you believe $9,644.29? And it says there may be other charges which are not included, ie: "Laboratory, radiology, anesthesia, emergency, and cardiology testing." How Monty Python-esque is that? I'm glad to have Medicare insurance and good supplemental insurance.

July 2nd, 2006, Sunday. This being Sunday and a long holiday weekend, I expected difficulty getting hold of the doctor by phone, but was pleased when I got a mid-morning call again from Nancy asking about my condition. Since the swelling is harder, pulses a bit, is little more painful, and after she consulted with Dr. Hise, I was told to go back to the hospital for a sonogram of the artery in my groin. And what was decided that the happy little elves of mischief are doing to your groin, Paul? Would you believe that three little lymph nodes are doing their job, and trapping some errant germy things that seem to have crept-in with the groin artery puncture? Well, that's what the sonogram found. The two radiologists agree with what Raul Lozano, PA, had first called, "swollen lymph nodes," in Baylor Minor Emergency when he first felt my swelling three hours earlier. I was written a 'script for Keflex to deal with the swelling, if needed, since I live a distance away, and then discharged.

A very happy outcome to a worrisome situation. I'm glad to preserve the puncture site in good shape, since I suspect it will be getting a lot of traffic in the next couple of months. The sonogram was fun and I'm looking forward to getting a disk copy when I pick up the film for my Thursday neuro consult. I'll post an image or two here when I get them.

These are the sonogram Doppler images. I can't interpret them, but suspect CFA is an artery, and CFV and GSV veins.
Below, I think LN means Lymph Node, and V a vein. (Images about quarter size, and these are just 2 of 14.)

I still have one more day on the Flagyl to finish the seven day course. I hope I don't have to take the Keflex for the swollen lymph nodes. I am just getting my digestive system working right for the first time in two months. I would discuss the antibiotic and lymph node swelling with my GM but his office has been closed for the holiday since Friday afternoon and won't open again until Wednesday morning. I did meet a lot of interesting and caring people today, by having to go through the ER at Baylor to have my artery sonographed.

I've decided tonight that if I'm going to blog this saga I will start carrying my digital camera, so you can see what I'm blogging about. I am considering adding an optional, more blog-like most-recent-first format. Use the Contact button below to let me know what you think?

July 1st, 2006, Saturday. Late yesterday, after one week, I noticed soreness and some swelling at the angiogram puncture site over the femoral artery at my groin. It has felt soft until now with no particular pain. Since the printed release sheet says these are signs to watch for this morning I phoned the listed number for the radiologist on call. First I spoke with Nancy, the radiology nurse at Baylor, then Dr. Hise called me back. After some questions about any fever, redness, feeling for pulse in the hard 2 cm wide lump, degree of pain, we decided to watch it for a while before making a trip back into Dallas. He said that blood collecting from earlier leaking, or a "puesdo-aneurysm," were both possibilities.

June 30th, 2006, Friday. This afternoons mail brought a new patient packet from UT Southwestern Medical Center, and they have scheduled me for an appointment the same time and date as my appointment with the referred orthopedic neck doctor. Also the appointment is with Dr. White, not Dr. Samson as we requested. Since Terry's office is already closed for the holiday and won't be open until the day before this appointment, I'm on my own here. So I started calling and trying to adjust things. I thought that possibly Dr. Samson had quit taking patients. What I discovered was that Dr. Samson will be out for the month of July, and Dr. White is seeing his patients. I decide to keep the new date Thursday the 6th with Dr. White, since the radiologists said I shouldn't delay.

I rescheduled my appointment with the referred Orthopedist for my neck, for 9 AM on July 12th. My research found that this ortho is a conservative doctor and I'm hoping my neck can suffice with some aggressive traction therapy for the time being.

June 26th, 2006, Monday. Driving home from McKenny this morning I stopped by Dr. Watson's for the radiologist's report of the angiogram. It hadn't arrived yet, but I had spent 30 minutes talking with the radiologist Friday and knew his findings. I wanted to cancel my appointment with the neurologist on July 3rd and ask if Terry would refer my case to Dr. Duke Samson, world renowned vascular neurosurgeon, whose research specialty is cerebral AVMs and is chairman of the Neurology Department at UT Southwestern Medical Center. UTSWMC is a huge teaching hospital and medical complex of multiple hospitals, including Parkland, on Harry Hines Blvd. in Dallas.

June 23nd, 2006, Friday. Cerebral Angiogram. Last evening after dinner with my close friend, Marie, at a good little Chinese restaurant in Rowlett, I drove and checked my car with the valet, and checked myself into the Baylor Plaza Hotel. (Only $75 a night, and fairly nice. Not the Trump Plaza, but nice enough). They even had wifi for my laptop, after they added a passworded user for me.

At 6:30 AM I headed downstair for the Day Patient sign in area for my cerebral angiogram. They sent me across the hall for blood tests, then showed me to my room for the day. The radiologist, Dr. Steven Gilbert, came in and introduced himself and said, "You're the left frontal AVM, correct?" Then he apologized and said he had been studying my MRIs, and we both chuckled. We discussed my history, what he was looking for, and what to expect. He felt my femoral artery and foot for pulse. Then my nurse came in and I changed into a gown, locked up my wallet, clothes, etc. The top of my right foot was marked with an X to locate the pulse point there and a couple of pen marks were also placed about an inch apart locating my right femoral artery. She went through some consent forms, which I signed, and she placed a saline IV drip into my left hand.

In just a few minutes a couple of people wheeled my bed down a floor to the test operating room. I was transfered onto a narrow table beside about six large flat monitor screens. A couple of specialty trained registered nurses were hovering around, blocking my head, hips, and arms securely on the table with rolled cloths, covering me, connecting to the IV in my arm, quickly shaving and prepping my upper right groin area, placing five electrocardiogram leads on my chest, and draping me in sterile coverings. They also placed a nostril oxygen supply under my nose and a blood oxygen sensor on my index finger.

I heard Dr. Gilbert enter and say, "Good morning boys and girls." I believe that a bit of tranquilizer had been pushed into my IV line as I was very relaxed but mostly conscious. I believe the doctor rubbed some topical anesthetic over my femoral artery, and told me that it was going to sting. It did, but not terribly, and not for very long. From then on it just got more interesting. I did feel a minor bit of movement at the puncture site, but nothing unpleasant. The large circular drum of the X-ray head was moved over my forehead, but not blocking my sight of the monitors. I tried, but couldn't really see the images or the doctor since my head need to stay still. The doctor made interesting comments telling me in which artery he was placing the contrast injection catheter and expressing that he was pleased whenever he got a particularly good sequence of images showing the AVM. A couple of times he warned me that I was going to feel a quick rush of heat in one place or another in my head. I believe the entire procedure lasted just under an hour.

Front view. The AVM fistula is the dark oval slightly right of center, (which is my left side). (Shown about three quarters size.)
Image is looking straight at us. (See my eye circles?) The supplying arteries go up through the nasal sinuses to the fistula,
then drain into the big vein that buzzes up over the top of my head to the back.
Click the image for a little slide show as the dye goes through.

Left side view. The fistula is the dark oval on the left. This is a side view. (Shown about three quarters size.)
My forehead and eyebrow ridge can be seen on the left. The supplying arteries go up through the nasal sinuses to the fistula,
then drain into the big vein that buzzes up over my head toward the back.
Click the image for a little slide show as the dye goes through.
I think they gave me a little extra splash of nod and the arterial catheter must have been removed as I remember a clamp being tightened onto the puncture site. I was moved into a nearby recovery area where a nurse checked the pulse in my foot and checked the clamp every few minutes. My vitals were being constantly monitored. And at one point he covered my torso with a pre-warmed blanket. So nice. I think I was in recovery about an hour, then the clamp was removed and my bed was wheeled back to my room. I was warned to stay flat and an ice pack was placed on the puncture site. I ate a good turkey sandwich lunch and some juice which was brought in. My vitals and condition were checked regularly for the rest of the day. I was told to drink lots of fluid to clear the contrast from my blood. I do so love using a urinal in bed.

At 4 PM my nurse got me up and together we walked slowly down the hall and back. I was told that the doctor would visit and discharge me soon. Dr. Gilbert came in, checked my puncture site and then discussed what he found. He said he had been able to map the dural left frontal AV fistula. He said the supplying arteries arose in my sinus area from the external carotid and the ophthalmic supply and went up between my eyes to the fistula. He also said there is aneurysmal dilation of the draining cortical vein flowing into the sagittal sinus. He wouldn't discus how symptoms related to his findings, or treatment options, but did say a management plan would need to be developed by an experienced vascular specialist. He also looked at the roof of my mouth where I reported two past aneurysmic bleeds saying that is near the area where some of the feeder arteries start. After about 20 minutes he wished me good luck and left. I dressed and in a few minutes was wheeled to my hotel room, (with a light boxed dinner). Never in any discomfort, I spent the night and checked-out the next morning about 11AM. I drove North to McKenny and stayed with friends until Monday morning, (only because I hadn't seen them in a while and I was close, not for any need of care).

June 21st, 2006, Wednesday. On my way into Dallas this morning I dropped the dog-boys off at the Hotel de'Jones where they will stay until next week. My first appointment this morning is with Dr. Mark Glover, my periodontist, for a two month post surgical evaluation and a scheduled cleaning. I have called twice to be sure that my 11 AM appointment will give time for me to get to a 12:30 appointment with Dr. Watson, my good GM doctor, just a few miles away. I even called before I made the second appointment. I always try to arrange multiple appointments when they are made weeks in advance, to avoid making a second 150 mile trip. It is amazing how seldom I am able schedule two same-day medical visits. When I get there 30 minutes early and they tell me that an hour won't be enough, so they move my cleaning two weeks hence. Oh well. The doctor starts the post op evaluation and they think maybe they can work in the cleaning before Noon when I must leave. After then waiting a few minutes, they tell me they have made some schedule adjustments, and can do the cleaning at 1:30 PM today if I can make it back by then. I assure them I can. I told the the doctor what a loop the Clindamycin threw me for that he prescribed with my oral surgery two months ago. He said we won't prescribe it again for me. He also says the oral ossiosis and bone graft was successful, and will probably save my lower left molars.

I arrived 15 minutes early at Dr. Watson's offices in Oak Lawn area and they got me right in. My weight was still 194 pounds, (I would have thought some parts would have worn off during the past hectic week). I gave my sample bottles in a brown paper bag to the tech on my way in. Terry reported that my blood panels were all good. Liver function and cholesterol, (169), were good. Terry said that it had been quite a week for me, and that he was anxious to see the results from the angiogram two days hence. He also said that Dr. Lee, (ENT), had sent in a report suggesting I start Xanax for my tinnitus, and start a therapy course at the Collier Hearing Center to teach me to live successfully with tinnitus. (Like I haven't been for five years). I don't think I'll be doing either, I tell him. But I will see Dr. Lee again after we know more about my brain plumbing. He also writes me a prescription for Flagyl, to be filled if my sample results find bacillus difficultus in my gut, (a possible result of the previous Clindamycin). (I'll get it filled but won't start it until I'm back home next week after the angiogram). We quickly discuss the two neuro consults I have coming up, and then I'm out of there by 12:45 PM.

Even in lunch-hour traffic, I have a leisurely drive from the Oak Lawn area up to Dr. Glover's Preston Road and NW Hwy office for my 1:30 cleaning. The cleaning takes about an hour and the tech is nice enough to prepare me a little travel pack of oral maintenance items for my upcoming vacation trip at Baylor Hotel et Hospital.

I put my sparkly clean solid teeth to use indulging in a Cajan late lunch at Pappadeaux' before my hour and a half drive back home.
Remember that great all night bakery and deli that was in this location? Was it called Bakers?
(Last evening I had dinner again at The Bronks with Jess and his friend Bill, and the trivia question was solved. The all night diner was Lucas B & B).

June 19th, 2006, Monday. Second MRI. I drove into Dallas this morning for another MRI at the Baylor North Image Center. I have gotten to know the friendly staff on first name basis by now. Rudy guided me through the labyrinth to the changing rooms and helped me with the scrubs. He took me to an exam room where I laid on the table while he strictured my arm and coaxed a vein to come up. When he had what he wanted he painlessly tapped my arm for the contrast dye connection. Then to the MRI suite where he and Pam again made me secure and comfortable on the table. He even placed an angular pillow under my legs to flex my knees. The MRI really isn't bad at all. There is a mirror directly above my eyes where I am looking in Pam's face as she sits at the controls, and I have a signaling bulb in my hand to stop and call her. There is an intercom so you don't even have to raise your voice. The tests are broken up and each only lasts about five minutes. Between segments she always asks if I'm doing OK, and gives me a chance to fidget. She tells me the approximate length of the next test, and then we start it. Not bad. The MRI dye caused no sensation at all today. An hour later, with a big smile, I was headed home with a new CD-ROM of this latest scan. There was again a call waiting from Sheryl in my GM doctor's office.

The AVM fistula is at the left side, just behind the sinus at my eyebrow ridge. It is the pea size dark spot. (Image about half size.)

The AVM fistula is the light colored spot, just above my eye, right of center, (my left side). (Image about half size.)
It shows part of the draining vein toward the center. (A bit of a gastly image, isn't it?)
On the left, (my right), just below the eye can be seen a small grey growth, that is unwanted.
Dr. Daniel Clark, radiologist had phoned his MRI reading to my GM's office as I was driving home. Seems I have an AVM, (ArterioVenous Malformation), in the dural tissue at the front of my left frontal lobe. Just behind my left eyebrow. An AVM is a vein node that several arteries feed directly into without any capillaries to slow down the flow or pressure. The pressure usually causes the vein to expand, and can sometimes blow out. This would not be a good event.

Sheryl tells me the doctors have conferred and I am scheduled for a cerebral angiogram for 7AM Friday morning at Baylor main hospital. She gives me a number and says to discuss the particulars with Linda at Baylor. I ask if it involves a femoral artery puncture, and my doctor asks in the background what difference that makes. I say it means I wouldn't be able to drive home. Sheryl says, "ask Linda at Baylor."

After much discussion with Linda, she insisting that someone will have to drive me home, and me insisting they will have to keep me overnight, she mentions the Baylor Hotel on the 12th floor. From this point on, all is duck soup. I make a reservation to check into the hotel Thursday evening, (before 9 PM), will have the angiogram at 7 Friday morning, be wheeled back to the hotel afterwards, and stay until I feel like driving home, probably Saturday morning. I spent the rest of today, (and Tuesday), Googling and reading everything I can find on AVMs and cerebral angiograms.

June 15th, 2006, Thursday. This morning I met with Dr. Dwight Lee, Otolaryngologist, and also had a hearing cognition test conducted by Dr. Alice Wilson, Audiologist. The test reveled that I have a lot of loss in my left ear hearing nothing below about 70 dB. My right ear hears down to about 50dB, but no high frequencies above 2,500 Hz. Dr. Lee's initial conclusion is that I probably have some late impacting scaring from a 1961 car wreck head trauma causing my tinnitus and loss. But he is reserving final judgment until he sees the results of yesterdays scans. He did tell me that the left brain side responds to the left ear, not the opposite side as is the case with most other brain functions. He also confirmed that the auditory nerves connect directly without being routed through the spine, so my hearing loss is not connected to my c-spine degeneration.

I then drove up to the Baylor North Image Center to get a CD-ROM of my MRI and CT scan from yesterday. I merely walked in, ask Rudy for a disk copy. He disappeared for about five minutes and reappeared with the CD. While there I also had copies of the radiologist's report from the scans faxed to Dr. Lee; and was given copies for myself.

When I got back home, there was a phone message from my GM doctor's office manager, Sheryl Webster, so I returned her call. She had the radiologist's conclusions from the scans, (which I had read driving home). The c-spine MRI shows a good bit of degeneration in my neck, both disks and vertebrae need to be addressed.

I think most of us can see here that I have a bit of a neck problem. (Image about half size.)
No wonder my neck is a bit stiff. It looks like my head could break off most any time.
But the real corker is that the CT scan shows what is thought to be a small, (1 cm), meningioma in my left frontal lobe and a similar sized growth in my right max sinus. But he didn't find any signs of aneurysm or bleeding. Both are good news. The radiologist recommends another MRI with contrast to further delineate the meningioma.

So Sheryl tells me she has scheduled me another MRI for the following Monday. She also told me the doctor says not to worry, that it isn't an aneurysm and the meningioma isn't malignant.

I haven't mentioned that in anticipation of this runaway healthcare train, before my appointment last Tuesday with my GM doctor, that I had taken my dog-team to stay at the Hotel and Spa de'Jones, overseen by my good friend and veterinarian, Lisa Jones, DVM. The dogs would rather board at her clinic here at the lake than stay at home, I think. They know their own kennel at Lisa's, surrounded by others of their kind, and have a great acre yard for exercise. It is pretty quiet and boring at home by comparison. Anyway I'll pick them up tomorrow morning to spend the weekend at home with me.

June 14th, 2006, Wednesday. This morning I had an interesting MRI of my cervical spine, (neck), and then a CT scan of my head with iodine contrast through an arm vein. These tests were done at Baylor's new Diagnostic Imaging Center in North Dallas, at Central and Park Lane. This is a really nice place with free parking garage and a friendly unrushed staff. There was no waiting at all. First a little paperwork, then to the dressing rooms with lockers, where I changed into scrub pants. Rudy got the scrubs for me and said I could leave on my knit shirt, socks, and underwear. You just can't be wearing any metal. Then he took me to the MRI where he and Pam helped me get comfortably situated on the sliding table. Pam ran the tests. The MRI took about 45 minutes, (as did the following CT scan), with the tests broken into short segments. Some people are disturbed by being in the MRI tunnel and by the noise. They do give you ear plugs, and a panic switch, but even though I didn't feel particularly claustrophobic, I was glad when the MRI was over. Before the CT scan Rudy took me to another room and put an IV port in my arm for the contrast injection. The CT scan is much more open and less nerve-wracking than the MRI. When the radio-opaque iodine contrast was released there was a quick flush of heat in my head and neck, not painful, accompanied by a strong taste and smell of iodine. It quickly faded. After the CT Rudy guided me back to the dressing rooms where I dressed and then drove back to the lake.

Tonight an internet Helix friend in Australia, a radiologist, Dr. David Gudex, suggested we get and keep a copy of any medical images on CD-ROM, in DICOM format. And download a free copy of the open source OsiriX medical image viewer so we can look at the scans on our own computer.

June 13th, 2006, Tuesday. My semi-annual check-up and blood-labs with my friend and General Medicine doctor of many years, Terry Watson, DO, PA, was scheduled for this morning. I have been taking Lotrel for blood pressure and Lipitor for cholesterol for years, and my good GM doctor watches the test results closely.

About three years ago my weight had slowly crept up, but the scale had merciful stopped at 199 pounds, I discovered on one of my weigh-ins preceding a previous check-up. To avoid adding that last pound to 200, I removed real butter and ice cream from my shopping lists, and slowly reduced to my high school weight of 175. I was happy with that, although, I'm sure it represented a lot more fat than it had 45 years earlier.

Being a heavy smoker since I was about 20, I finally quit in February 2005. During the following 16 months I have eaten my way back up to 194 pounds the scales reported starting out this morning's office visit. Obviously, it is time to quit making food the central focus of my cigarette free life.

Today I reported some symptoms that have developed very slowly over many years, that I have ignored mainly due to maleness and fatalism, I think. I admitted to progressing and now severe numbness on my left side, an awful feeling of pressure in my head when I cough, lift, or strain, recently increasing tinnitus in my left ear, and a very stiff neck.

As my good doctor levitated off his stool in obvious frustration, [that was hyperbole], I also tried to report some digestive problems following a course of Clindamycin with a periodontal oral surgery two months ago. He said we only had 30 minutes scheduled and I would have to come back for the digestive problems, (but he did have a nurse get together a sample kit for me to bring home). He was rightly very frustrated and probably angry with me. He has devoted well over 20 years keeping me healthy, sewing me up when I stupidly cut something, probing in my feet for splinters, and treating one infirmity or back strain after another. There was the feared heart attack in '93 that was fortunately just stress, and lots of other water under our mutual bridge. How could I have not told him about these symptoms? He ask when my symptoms started and I told him I had seen an internist about 1970 for numbness in the back of my hand while driving and it had slowly increased since then. I had first faintly noticed the tinnitus about five years ago.

I admitted that I thought my symptoms were probably due to an aneurysm since there is a family history, (mother and grandfather). I reminded him that I had always argued against an aspirin a day citing my concern of aneurysm. While writing furiously he mentioned his opinion of self diagnoses, and called for another note sheet. During the next hour and a half, he had me scheduled for an MRI followed by a CT scan with contrast tomorrow, hearing tests and an appointment with an ear-nose-throat otolaryngologist the following day, a consult next week with an ortho neurosurgeon, and also with a neurologist. Plus he has me scheduled back in his office next week, ostensibly for a digestive consult.

He said he doesn't think I have an aneurysm, not to worry too much, and that he suspects the ENT doctor can do something to help the tinnitus.

So here we have exactly why the wrist watch is more popular wearing apparel today than the grandfather clock!