Friday, December 12, 2008

The Pre-Op meetings

Yesterday (Thu) I met with all the Pre-Op people including the surgeon.

First was the MRI. I was a little early and the nurse lady didn't mind. She took me to the changing room and had me get in a gown and pants. The cheap scrubs looking stuff. She didn't seem to be in a good mood and after I spilled my coffee in the dressing room, she was down right rude - even though I offered to clean it up....

Then I waited. This was the worst part. While waiting I had time to think about what I was doing and why. Why! Why couldn't I be one of the ones that medicines worked for? How embarrassing - I know it shouldn't be, but it is. And here I am waiting for someone to put wires into my brain in order to 'give me energy'. It was very depressing thinking about it. I can't explain it well but I'm sitting there persecuting myself for having to be there. Yeck.

The MRI itself wasn't much. They gave me earplugs, situated me and turned it on. I had previously decided I wasn't going to open my eyes. I've never been claustrophobic but I figured why chance it. When the lady announced I only had 4 minutes to go, I decided I'd look for a little bit. Nope - still not claustrophobic. I noticed they have a couple little mirrors right above where you can see the people in the control room. That was kind of interesting watching the people. I expected to see them highly captivated by the images of my brain flashing before them. Well - nope on that too. They seemed to be visiting about nothing in general.

I changed my clothes and they gave me my 'films'. I understand the whole MRI idea - thin slices of my brain - 20 of them per large page. But there are like 16 pages - with the 20 pictures. That's a whole lot of brain slices. (I'll try to scan a couple in and post them... LOL... That'll make this blog more interesting).

Now off to the surgeon. I had made my list of things to make sure we covered.
  • Story
  • Hair
  • Implant
  • Drive
  • Strenuous activity... (wink)
  • Death

The Dr was very personable. My "administrative contact" had warned me that he would look young, but he was very experienced. I didn't think he was that young and he first started by asking about my depression, then warned that he wasn't a psychiatrist.... "Good", I commented, "I was hoping you were a brain surgeon". He chuckled. (I'm still not sure why he went that direction). He ran through the procedure: I'd arrive at 7:30. 2 hours of prep. My person (or people) could be with me for the prep. They would shave the area - unless I preferred to do it myself before coming in. "Most of my patients just go ahead and shave their hair themselves and come in completely bald".

"Well, um, ok..... I won't be, but that's one of my topics", I warned.

They will attach a metal frame around my head, which will attach to my skull about forehead high, in 4 places. The anesthesiologist will numb those areas, but it will hurt some and be sore later, he warned. (Another blogger mentioned the frame he was subjected to had plugs that went into his ears and was quite uncomfortable. I asked about that and the Dr said they use a different one. He didn't think his was any more comfortable as no matter the frame, it has to be attached securely).

With the frame attached, they'd do another MRI. (Which has made me wonder WHY did they do the first one? Nothing in my brain is going to move around - and even if it did - why bother to have an MRI today and then another one right before surgery? I didn't ask). The new MRI would be used to identify exactly where they were supposed to put the wires (electrodes).

He reviewed that although using the device and procedure for depression was new, installing them for Parkinson's has become very common. He has done about 175 of them. After the MRI, they'll anethesize me but I can be awake or asleep. I chose awake - as much as possible. I dunno why - cause it's my fricken brain maybe?

They cut an incision between 4 & 5 inches on my scalp then drill 2 nickle size holes and put the wires in. Once they get them in exactly where they want, they'll plug the holes with some caps. Then they'll probably knock me out (anesthesia-wise) and put in the 'generator'. It'll go under my collar bone and he offered that if I shot a rifle or shotgun, he would recommend putting it on the left. If I drove a lot, he would recommend the right. Hmmmm..... time to jump in I thought.

"I'd like the generator implanted as deeply as possible. I'd prefer it didn't show". He examined me briefly and said he would put it as deep as possible but that I didn't have much fatty area to work with. OK, I probably haven't mentioned that one of my depressive symptoms is that I don't get hungry very often. Left to my preferences, I'd be at least 20 pounds thinner. I'm below average anyway - I just don't get hungry often. I can lose 5 pounds a week without thinking about it. So - I actually FORCE myself to eat breakfast. I try to eat an extra something with my sandwich at lunch and as for dinner, well, glad I have my kids 3-4 times a week. Not much of an appetite. With not much body fat, he doesn't have much to work with. Dang it. I love swimming - especially with MY kids - who I'm not telling about the procedure.

He finished up with saying the operation would take about 4 hours and I'd stay the night in the hospital. He asked to make sure they had given me the forms for identifying who he 'could' talk with after the surgery - HIPPA laws and all that.

My turn: "I need a cover story to tell my friends why I have a bald head". He looked puzzled. "I haven't told many people I'm having this done. Only my closest friends know how much I suffer. I can put on a great mask. Only 2 people know I'm having the surgery. Not even my kids.... so use your imagination." He still didn't look too sure of what I was asking.

The lights went on in his eyes. "I guess I'll suffer a sub-dural hematoma thing", I said.

"No, in case you know anyone that knows their medical terms, you'll have an epidural hematoma. It's not quite as dangerous - much more common - and still requires a hole in your head". He wrote it down for me. Now back to the generator? He came up with nothing. "It's about the same as a heart pacemaker - are you willing to have a heart attack to cover it?", he kind of jested.

Hmmm.... so while they were drilling holes in my head, they ran an EKG and found my heart has an unusual rhythm so they popped a pacemaker in. Um, probably a little much to fathom, but who knows. I need a good cardiologist to give me some ideas. I am actually thinking now of saying something like "when I was in the hospital they noticed an irregularity and I'll have to have it investigated". That may pave the way for me to have a pacemaker put it.

The idea is growing on me, but, like I noticed in the waiting room of the MRI - one of the things I DON'T like about this whole thing is lying about it. I go bezerk when my kids lie - and here I'll be setting a really bad example - in order to save my vain butt.

OK - I digress. Back to the brain surgeon.

I asked about driving and he said 48 hours after. As for strenuous activity - which is what my gf wanted me to ask about.... if you're catching my drift - he said 2 weeks. Ugh. I have been lucky in that my sex drive has been minimumly affected. Actually the more blues I feel, the more drive I seem to have. So now you know - 2 weeks.

And finally, I asked him if he had every lost anyone while doing this. He went back over that he's done about 175 of these. He has had 2 that suffered some hemorrhaging and both recovered well. He hasn't had anyone die. He hasn't had any of the leads break. He said as far as brain surgery, this is about as simple as it gets.

That's why they call it brain surgery, you know, right next to the rocket scientist. Easy stuff.

Ya, right, but it's MY brain.

The Dr did well to answer all my questions.

They let me keep my 'films'. The MRI. So what am I going to do with those? I do have couple of windows in my bedroom that could use some new decor.... just tape a few of these up. Yup. LOL. Now that does bring a smile to my face. Here's my new curtains.... pictures of slices of my brain.

Down to the actual hospital to get all the paperwork done. The research company is footing the bill and the admin coordinator had already given me a letter for them to put on file - so not to bill me. HOLY CRAP - can you imagine getting the bill for all of this? (Actually I'd like to SEE the bill). Then to the lab and draw some blood and take my blood pressure.

For some unknown reason, my blood pressure was a little high. GO FIGURE. I'M NERVOUS ABOUT SOMEONE DRILLING HOLES IN MY HEAD AND WIRING ME UP TO A BATTERY IN MY CHEST. Can't imagine why I'd be nervous. (Sorry - I digress again).

The nurse was very stoic and sterile (pun intended). While in the exam room she asked if I could give her a urine sample & I couldn't resist. She was being sooooo professional. I said "Sure, if you'd turn around - I get shy". She smiled and was very warm for the rest of the time. Humor goes a long way in tense situations. I filled it to the brim - in the bathroom.

Then the anesthesiologist (Dr Sleep). He was a young guy and went through the whole operation thing again. He explained that for depression dbs, the patient is usually out for the whole thing. If the surgeon needs me awake, they'll just give me some oxygen and wake me to the point the surgeon can find out what he needs. I explained the surgeon gave me the option of staying awake - and I would prefer that. Dr Sleep reiterated that there was no reason for me to be awake. I reiterated my preference was to be as awake as possible. HELLO? He acquiesced. I'll have to remind him - in front of nurses or the Dr. I don't trust that he won't just send me night night. Of course with today's anesthesia - well - you don't remember things even if you're awake.

Maybe I should take a movie camera and film the whole thing. Think they would let me? I think if it works - I'd love to have the film.

Finally the last person to come talk with me is the nurse practitioner. She was a little over the top happy. "Hi, my name is .... oh good you're getting a dbs for depression. I really hope this works for you...." but it was that syrupy sweet, not quite genuine voice. Blah blah. We got along but frankly I feel it was more for her benefit than mine. The only useful piece of information I got was that she thought I'd be in the hospital for 2 nights. I need to check with my admin coordinator to see how long the others have been staying.

As the nurse practitioner pointed out, especially since I'm not paying for anything, I ought to stay for 2 nights. Extra care. I can see the point, but I've spent a lot of time in hospitals with my mother, father & sister. The last place on earth to get quality rest is in a hospital!

Finally I was free!!! From 8:30 AM to 3:30 PM. My nervousness was about 1/2 of what it had been. It's not so much nervousness about the procedure as it is anxiousness as to what is going to happen. What if all of this doesn't produce a change? I'll have wires in my brain connected to a battery in my chest with all sorts of LIES about why they are there.

Then again - so what. If it doesn't work - I'll find something else.

Sorry these are so long. I don't know if less frequent but longer posts are better than the opposite or not.

One more note. Besides my best friend in the big city this is happening in, who will be taking care of me - to and from the hospital and probably stay with me the first night home; my gf will take off work to take care of me as well. And, I talked with an old old friend who lives 3 hours away. He and I have shared lots of things. He is OCD and we've often been very frank about what we were experiencing - both agreeing we can't know what the other is going through, but both know how much stigma there is with it.

It was good to tell someone else about it who accepts me. Maybe tomorrow I'll blog about the typical response I've gotten about depression.

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