 UT Southwestern Medical Center South Campus |
Here is my attempt to recall and paste together many of the little flashes of recollection that I have starting the week of surgery. Going repeatedly in and out of consciousness makes it hard to be accurate and in spite of my strong desire to acknowledge all the wonderful people that helped me I know IÕll miss some. I hope someone will post me when I leave out or misspell someone's name; or get the sequences mixed around. |
 Zale Lipshy University Hospital UT SWMC |
 Forth Floor Neurology Reception  Neurosurgery Reception  Dr. Jonathan White, Vascular Neurosurgeon  Nurse Linda Mitchel, RN, Neurosurgery Coodinator
 Linda removing my staples.
 Linda removing more staples.
 Me impersonating a yuppie at Starbucks celebrating being destapled.
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August 1st, Tuesday, 10:30 AM Pre-Op visit to Zale Lipshy University Hospital. A rushed morning attending to last minute details for being away a couple of weeks, final packing, and getting the dogs to LisaÕs, before the 90 minute drive to the Hospital for Pre-Op. I pulled into the valet parking circle with about five minutes to spare. First to Admitting for my papers and ID bracelet, then up to 2nd floor Pre-Op Waiting. In just a couple of minutes, Beverly (I think) asked me to follow her into a small exam room. She briefed me on what we were going to be doing and said the labs would all be run and evaluated before I left that day to be sure I was ready for surgery the next morning. She took my vitals, filled about five blood tubes, and attached electrodes for a 12 lead electro cardiogram. After that she brought me a cup of very good coffee to facilitate a urine sample. Then started my introduction to the medical teams for histories and their consent forms that would lead me through the next day of angiogram and embolizations. I can not recall the order, but I believe I met with Anesthesiologist, Dr. Steve Ewert, whoÕs smile I came to trust to keep me safe from pain while not killing me with his magic elixir. I also met with several in the Interventional neuroradiology team that would navigate my vascular paths with micro catheters attempting to find, show, and then close the plumbing short circuits on my brain. At the very least I met Doctors Lee Pride, and then Robin Novacavic, and Coordinating RN, Kim Dutton. Dr. Novacavic noticed and ask if I remembered to tell Dr. Ewert that I have a degenerated c-spine disk, (which I hadnÕt). So Dr. Steve came back in to discuss my neck motion range for the airways that would be needed the next two days. He has a good sense of humor and I told him which teeth I would be happy to have crowned in case he felt the need to break a few with the airway, as well as which ones I preferred to keep original. Dr. Pride really explained to me the risks and how he was approaching the embolizations. I told him IÕd like to stay as conscious as possible, but he told me that the embolization glues could be painful, and that the particular artery branch he expected would be most promising was one with a fair supply of sensory nerves. Dr. Novacavic also took the CDÕs of my previous CTs, MRIs, and angiogram for reference and study. All this took just over two hours, so shortly before 1 PM, (lovely lady's name at the front desk) was giving me a day pass to pay for my valet parking. And a week later she would remember my name when I next went down to get my car. First to The Apple store to get a security tether for my laptop, where I drooled over their 30 inch Cinema Displays. Telling myself that If I survived the upcoming week of brain intrusion I would treat myself to one. Then to the Melrose Hotel until the next morning. Marie met me for some cappuccino at the Melrose Library. Late in the evening I had dinner at The Bronx with Jess and served by Scott that is called David. August 2nd, Wednesday, 6:30 AM. Embolization- Neuroradiology- Zale Lipshy University Hospital, My wake up call came at 5:00 AM. I showered, checked out of the Melrose, and drove to the hospital valet parking. Smiling, (valet attendant's name) unloaded my bags and ask how long IÕd be. I told him I thought about a week. It was early and quiet, and he presented a very nice face of the hospital at 6 AM. We had short but pleasantly friendly chat. The plan this morning is to close off as many arteries feeding the AV Fistula as possible. Dr. Lee Pride will thread micro catheters through my femoral artery into a tiny feeder artery. He follows vessels with x-ray while pumping a drop of dye through the catheter to light up his path. If the dye heads straight to the fistula then he is in a good place to close up. If not he will reposition the catheter for another attempt. It is early and a sign says to go directly to 2nd Floor Day Surgery Waiting. I check in there with my ÒAdmit OneÓ orange pass. At 6:25 AM names are called for those having procedures. We line up and are each told which Pre-Op exam room to go to. I am headed for Room #8. Once there a pleasant Nurse gives me a Patient Bag for my street clothes, and a hospital gown to change into. She started an IV line in my left hand, and I got to watch the activity for a bit. A quick parade of doctors moved through, including Lee Pride and Steve Ewert with his syringe of nod. Eventually, all questions answered, there was a general conscious and with a reassuring smile that syringe was pushed into the IV line. Here are some details from this mornings angiogram and embolizations. The procedure's first image is at 9:37 AM and the last is at 1:06 PM. The images look like Dr. Lee Pride had successfully completed two titanium coil embolizations by about 10:44 AM. I canÕt read the angiograms well enough to select which images to show you the two coil embolizations . Maybe one of the doctors will suggest which images show them. An image at 11:10 AM shows he must have entered the left femoral vein and started an upstream attack on the fistula. Inside the veins from my groin to the top of my head he threaded a micro catheter through the stretched vein down over my brain to within a a centimeter of the fistula. There are many images between 11:10 and 12:30 when he must have disappointedly given up his amazing attempt to get into the space needed to seal and avoid any further brain surgery.  In this view of my left side you can see the bright catheter line inside the wide grayish stretched vein threading down almost to the oval shaped fistula on the left. So close. But to try further could have written disaster had the vein been punctured. Knowing when to quit and rely on a following surgery must be paramount. I can only imagine Dr. PrideÕs frustration following this. (Click on image for an enlarged view). Post Embolization Recovery. I think I started drifting back into some awareness in day surgery recovery about 1:00 PM. I canÕt remember the angel caring for me, but I remember he was timing how long he needed to hold pressure on my artery after the catheters were removed. I ask if they didnÕt have clamps and he answered that they thought it more comfortable to just hold pressure for the 12 to 15 minutes required to control bleeding. I think that Dr. Pride told me he would use a French #6 starter and a #5 catheter, but IÕm not sure. I think after another hour I was rolled from Recovery up to Room 502 on the Nursing Floor. David was my Nurse and was so kind and attentive. At one point he ask me about my luggage and said that Day Pre-Op had called and wanted to send it up. David knew that I was scheduled for Surgery the next morning and from there would go to ICU for a day or two before being back on the 5th floor. He said he would have my stuff locked in his office, (he is also assistant floor nursing manager, I think), until I returned. This was a big weight off my mind as I was going to be there for a week or so, without visitors, and the hospital doesnÕt have any place to lock up computers, etc. Some lockers would be helpful for sequential procedure patients like me. I think my daughter, Lorrie, and friend, Marie both called about as soon as I got onto the nursing floor. Oh, and cousin, Patty Lauterbach Stanford, of course. Just after 3 AM my nurses rolled my bed down to CT Scan, where a big young man, (possibly Richard), moved me onto the slide. He laughed that he was hired because he could lift patients. The first CT image is time stamped 3:29 AM. I guess it confirmed that the embolizations were holding and that there was no bleeding so the planned 6:30 AM fistula surgery could go forward. I had complained about the hallway lights while being wheeled so one of my nurses found a cloth to cover my eyes for the return trip to Room 502. August 3rd, Thursday, 6:30 AM. Neurosurgery - Zale Lipshy University Hospital Neurosurgery Team Dr Jonathan White, MD vascular neurosurgeon. Dr Talmadge Trammell, MD Resident neurosurgeon, assisting Dr White. Dr Brian Wohlfeld, MD Resident Linda Mitchell, RN, Clinical Nurse Coordinator, (214) 648-8500 Beth Allen, RN, neurocoordinator About 6 AM I was wheeled from my room to Surgery Pre-Op. Greeted by a friendly guy that could be a poster boy for neurosurgery, with his perfectly shaped and shiny shaved head. I ask him if he was one of the hairstyle selection option models. I donÕt remember his name or classification but he was refreshing and got me water and a swab to rinse my sticky dry mouth. He did some other prep before the room started filling. Next I remember Steve Ewert with his syringe in his shirt pocket. When my time is running out about 35 years from now I hope to open my eyes and see SteveÕs smile, and IÕll know that everything is going to be just fine. He did some line prepping and then Dr. Shamema Karjeker, anesthesiologist arrived. She reminded me of my brilliant neighbor during the 90Õs, Rita. I instantly liked her. She set to work getting her territory exactly as she wanted it in the smallest detail. I had the feeling that to cross her would be at the crosseeÕs extreme risk. They discussed that all were pleased I hadnÕt taken my usual blood pressure regulating meds, which would let them control it with the precision they are capable of. I reminded Steve which teeth I was willing to give up for the greater good. Then Dr. Jonathan White, my vascular neurosurgeon, walked up and said good morning. He told me that the CT scan over night showed that the two coil embolizations had been successful and that he had a good plan for the surgery. Probably I had some anti-anxiety chemicals pumping around but I donÕt remember ever feeling safer or more positive. Surrounded by all these compassionate, highly trained, brilliant people all focused for the immediate future on my well being. I wish I could recall whatever good deeds I must have done for Karma to so reward me. My next recollection seems to be just before the angiogramÕs first image at 11:53 AM. August 6, Sunday- (typed during actual time). This has been an unusual day of awakening for me. As I sit here at 8:38 in the evening on my 3rd post-op AV fistula removal day, I am suddenly aware that my tinnitus is not so loud as it has been, and that the ringing component is mostly gone. The buzzing noise is still the major component in my left hearing but it is much quieter right now. I have noticed that the tinnitus has waxed and waned since the removal surgery. I'm suspecting that this may have some connection to swelling but don't actually know. Anyway, I feel very positive about it and am sure it will not get any worse, even it it never completely switches off. My face swelling is quite apparent today, my eyes look small, like a toy doll, and some bruising is showing on my throat below my jaw line. My lower face, mainly jowls look fluid infused and firmly swollen. In fact, my jaw line is so swollen toward the back that my earlobes almost don't show from the front. My forehead is fairly tight, without any deep lines showing. I'm also noticing that the tingling/ numbness/ abnormal sensation on my left side is decreasing now. The nurses tell me that today, 3rd post-op, will be my worst external swelling day, and my face should now start subsiding toward more normal. I am being prescribed a corticosteroid, Decadron, that pass the brain barrier to control brain swelling. This steroid causes my blood sugar to increase, kind of induced diabetes, and the dosage is determined by a blood sugar test that they seem to take about every six hours. Lower blood sugar, higher steroid dose. Of course, the main symptom of the feeling of pressure in my head has been completely gone since I awoke after the AV fistula removal surgery. I am feeling wonderfully positive and fortunate today. I feel like I have won the lottery! For quite a while I have been surprised each night when I went to bed that I had survived the day without a hemorrhage killing me. Now I suddenly have maybe 30 more good years to live that I truly wasn't expecting. Another third added to my life! What shall I do with this extra gift? Indeed, what? August 7, Monday- 7:30 AM. I quit taking any pain medication last evening, and the last steroid for swelling was at 6 AM, and so far so good. Dr. Bryan Wohlfeld and Nurse Beth Allen with the neurosurgery team just came in for morning rounds. They said that I'm probably medically ready for discharge. I requested another day since I live so far and alone. So it will be reviewed I guess. I offered to pay even if insurance doesn't. Marie and Elise visited today and we went down to the Radiology film room to get my image disk. Marie had just had an artery MRI run here at UTSWMC. She brought scan disk so we looked at it on my laptop. She and Elsie left to go see a movie. Then cousin Joe and Darla Dugger popped into my hospital digs for a bit which was very nice of them, I thought. 10:00 AM. Beth Allen, neurosurgery coordinator, just came by and said I have been approved to stay at least until tomorrow. Also, neuroradiology is trying to find the image CDs I brought in and gave to Dr. Robin Novacavic in pre-op; and my nurse, Laura, is trying to get all my new images since I arrived August 2nd, from the image archives. An angiogram before and during the coil placement embolizations, a CT scan that night, another angiogram after the fistula removal surgery, and a second CT scan the night after surgery. I think the embolizations took about four hours, so I doubt that it was all recorded. There was a before angiogram on the 2nd, before the embolization and another following the brain surgery on the 3rd, so for sure there are some images both before and after embolization and fistula clamping and dissection removal. 2:00 PM. Nurse Kin Dutton brought the CDs of my scans before I left. Still under construction. |
June 13th - July 28th Story form Blog form Pre-Op Visit, Aug 1st Embolization, Aug 2nd Embolizations Details Embolization Recovery Neurosurgery, Aug 3nd Under Construction: ICU Recovery Nursing Floor, Aug 5th  Ambulatory Care Center UT SWMC Staple Removal, Aug 15th |
Last updated August 18th, 2006. Copyright © 2006 Paul L. Hathcoat