Brain Surgery

On August 31, 2010, I went into brain surgery.

This is a "delayed" blog post about that.

It got rather long, I'm afraid, which is why it took so long to get up here...

Plus I've been kind of busy until now, where I have a 2-week lull between post-op and Radiation.

But people seem more interested in the actual surgery than anything else, so here is a play-by-play of what I remember from it.


The day started early, with a 5:45am arrival for a brain-mapping GPS MRI scan
and 7:30 surgery. I had been warned I might lose my hands for a week, as they were probably going to "nudge" my motor strip in that area when they cut out the tumor.

After they put all those circular markers on my head, they scanned me, and then I guess dumped a map of my brain to the surgeon's computer.

I was then wheeled into Pre-op which is a fancy word for hallway with curtains.
Felt kind of like being in the wings of a particularly clean Theatre stage for any
Old Troopers. I guess it makes sense for resource management, but it sure doesn't seem very nice. I was lucky not to be too back-logged I guess. I imagine on a bad day, you could end up waiting there for hours and hours.

Dr James P. Chandler

Then started the introductions. I had already met the surgeon Dr Chandler, but was introduced to at least three anesthesiologist including Dr. Koht and his two assistants, and the Chief Resident, Ryan Halpin, who turned out was my "coach" for the surgery (viz) and he seemed to be the one watching the heart and other squiggly lines monitor that I could also see. Though I daresay there were many others monitoring all kinds of stuff I never even saw.

I think I got re-introduced to some doctors/nurses, and I'm told surgery started 2 hours late, but I didn't notice, so maybe that was their plan... Just keep me trying to remember names and faces and distract me :-)

Anyway, they wheeled me in, hooked up an IV or two, and conked me out. They apparently locked down my head and connected some plumbing then, for which I'm quite thankful I was not awake. That probably seems normal enough for any surgery. Then they woke me up, still on the table!

They had me move my fingers around and monitored stuff on their computers to make sure things looked right. They cut open my scalp and chopped a hole in my skull. Did I mention I was still awake?!

So then I presume he moved the protective water balloon brain sac aside, and went in through the vein above that red arrow, or moved some brain bits aside...

Then they had me touch each finger to my thumb and said they were getting signals on that.

Then he hooked up a wire to my brain and made a nerve in my right wrist  twitch at 60 Hz and asked "Can you feel that?" Surreal!

If you've ever gotten a light tremor from house current running through you for a few seconds, it was just like that.  Only direct from my brain. And on purpose.

They also confirmed on some med computer that they were seeing the same signal.

Repeated the process, for my right ankle. Then the left ankle. Each time they asked me "Can you feel that?", and confirmed signal with each other.

They didn't do my left wrist, which was disconcerting, but I'm not sure I was able to voice that concern well.

Then they warned me that they were going to do a few more that I wouldn't feel.

There's not supposed to be any nerves inside the brain, but I WAS able to sense each probe in turn as a sort of cool prick. I told them all about it, apparently in more detail than they required: I believe this was the first time they politely told me to be quiet and focus on taking nice deep breaths.

That would be Dr. Ryan Halpin, the "coach" and I have to say he has the patience of a saint. He managed to put up with me and keep me on task while I was halfway zonked out, which is a miracle.

They ran through all the signals again, confirming I could feel the nerve twitching at 60Hz and seeing the signals on their computers. Apparently "measure twice, cut once" applies to brain surgery as well as lumber.

Come to think of it, counting up MRIs (regular, functional, spectroscopic, and mapping) as well as CT scans and the probes, it was more like "measure 10X, cut once." Same principle at least, but I suppose a factor of 10 for Brain Surgery makes sense.  I mean, tossing a 2x4 out is one thing... :-)

Then Dr Chandler cut out the actual tumor. I think this may have been another time I was politely told to shut up and breathe. It seemed like the actual tumor removal only took 10 minutes, but my time sense wasn't exactly perfect, eh?

Finally they started putting things back together. There's a chunk of skull held in by titanium plates and screws (Looking for a pic of these). No MRI or airport restrictions on those, which is nice.

There is apparently some glue in there holding something together as well.  I wonder if they have a $10,000 hot glue gun just like my $20 one at home, or if it's some kind of packet like a condiment they use.

Then the scalp was stapled shut, as you can see to the right:
I kind of expected some stitches, but if I have any, I sure can't find them, even now that the staples are out.


At some point the doc asked for a 1x3, but the nurse only had a 2x2. They went back and forth a few times on that, which was disconcerting. I mean, who cares about the shape of the scar or whatever, but the wrong size screws or plate inside?... I didn't know exactly what stage of re-assembly we were in, so I tried to make a joke about lumber, but it fell flat. Oh well. Tough crowd I guess.

(Weeks later I found out it was just a gauze swab to wipe out some blood or something. Whew!)

They also didn't like when I broke into a song lyric with a trigger word/phrase somebody said; which anybody who knows me is a habit of mine. Guess I don't sing any better while in "twilight" anesthesia. But I only did that once, so that's not so bad! A musician friend of mine tells me she had the whole operating room staff singing with her. That was definitely one of the times I was politely told to shut up and breathe deeply.

Then they wheeled me out to post-op (read: hallway curtains) where I spent 2 hours needing to be there, and six more hanging around waiting for a room, thanks to construction... I've got a few pithy comments about post-op and a certain nurse, but will save those as I've already made this quite long.

Anyway, that's all the bits I can remember from nearly 3 hours of brain surgery. I apologize if it's out of order, or I've managed to completely mess up what they did. All I know is, it was surreal, but they got the tumor out, and over-delivered as my hands worked just fine, albeit with a bit of tingling and numbness now and then. I'm calling it a "win"

Honestly, the only things I could have asked for:

• Advance notice that my main job would be deep breathing.  They had described the finger / nerve twitching process in advance. But perhaps the breathing thing is case-by-case. I probably could have kept more quiet and done more breathing if they had.
• Check that left wrist, or tell me we don't need to.
• Let me know what is going on when the doc asks for a 1x3 and they ain't got it, so I'm not worried about it.

Considering everything else going on, these seem awfully petty!

Brain Surgery Staples Removed

I got my staples removed yesterday, so here's what it looks like today...

So, what I've got going for me:
I'm relatively young, in good health other than this cancer in my brain, and a wild guess estimate is 90% of it was in the tumor they already took out.
I've got just about the most supportive family, friends, and workplace anybody could ask for.

On the downside, if you lump me in with males up to age 90 with brain cancer, my "live expectancy" is a couple years...

 But, hey, let's Do The Math:

A guy 90 years old, already has not much more on "life expectancy"...  There's no numbers I can find breaking it down by decade or anything,  so let's assume it's some kind of curve, and I'm on the right end of the curve.

It blew up fast, over the course of a couple months or even weeks, so there was not much more that could have been done for "early detection".

The docs have caught it in time to get 90% out already, and will radiate and chemo the other 10%.  It will try to grow back, but we'll MRI it every couple months and catch it and chemo it some more, beating it back into submission.  So we have a game plan to keep this under control indefinitely.

Do I expect to make it to 70+, like my dad, as I once did?

No, not really.  I'll give it my best shot though!

Maybe I'll only hit 65, like my Mom.  Still not a bad run.

So what's my "life expectancy"?  I expect to get as much out of it as I can for as long as I can, same as anybody else!

Brain Tumor Pathology

Tumor w/ Surrounding "Bad Stuff" in active tissue

Brain Tumor Pathology
(translated from Medical to English)

Malignant.
Grade 4 (worst)
The surgeon got the main tumor out.
But it's guaranteed to have a splatter effect of Bad Stuff mixed in surrounding brain tissue.
Aggressive radiation/chemo (6wks/6months respectively) will maybe beat it back.
Then, ongoing maintenance of MRI scans every couple months, and chemo when more tumors appear, for life.

I guess that's not as bad as the old school movie "Go home and die" answer, but I think these days it's about as bad as it gets folks...

On the other hand, the oncologist said that the odds of hearing benign were in the realm of "case study in a journal".  I do wish they had just told me that weeks ago. I've been living with a false hope of hearing "benign" and on the hook of not knowing for weeks... Oh well.

I'm staying as positive as I can, but I'm in for a rough ride, and that's the breaks.

Thanks for all your prayers, support, and donations.

I'll try to post more on Friday 9/10. Tomorrow 9/9 is a CT scan with some kind of plastic fencing mask to map where the tumor used to be married with the old MRIs to program the linear accelerator for the radiation treatment.  Or, at least, that's my layman's understanding of what the doctor said...

I think I get my staples out of my scalp tomorrow too.  That's good, as the changing Autumn weather is making them hot/cold expand/contract in an annoying way. That probably sounds silly/petty in the grand scheme of things, but there it is.

Anyway, expect silence Thursday 9/9 from me, almost for sure.  I don't think they let me use my laptop from inside a CT scanner :-)

I also want to thank my employer, Rasmussen who have bent over backwards throughout this ordeal to keep me "employed" and "current" in insurance coverage. I don't know what I'd do without them. If you are looking for a good place to work in the online education industry, check out the openings and tell them I sent you:
Rasmussen Employment Opportunities
They've done right by me, that's for sure!

SEO For Beginners

You're probably even more tired of my posts about Brain Tumor/Surgery than I am, so I'll go off on a "rant" on another topic :-)

I still need to draw your attention to that Donate button over there... Okay, done.

A Beginner's Guide To SEO:
#1: CONTENT IS KING
Put content on your site that people want, and make it easy to find/browse in your own navigation.
If you have content people WANT, and people can find it, and search engines can read it (don't bury it in Flash) then you're all set.
If not, you have no "game" and all the SEO in the world won't do squat for you.

#2
Follow some common-sense basics like using HTML/CSS properly, with valid markup, and a good TITLE tag matching an H1 tag relating to what's on the page.
Put your important content first in the text, and use CSS to position it where you like.
Try to use a decent domain name that you can shout to a roomful of drunk people that they'll remember, maybe, the next day.
Even if your target audience is NOT rooms full of drunken people, it's still a good metric for the domain name.

#3
A META Description is good, if it matches the page/site content, and provides a consistent "brand" (theme/mission/image) you want to promote. You'd have to ask some Marketing drone whether it's a "brand" or an "image".
META Keywords haven't been used by any major search engine in years: Anybody who says different is stupid or out-dated. Or both.

#4
Don't try to "game" the system with techniques that misrepresent your content. As soon as the search engine makers figure out what you and all the other idiots are doing, they DEDUCT points for it, and you lose, Game Over.
Unless they just ban your site completely from the results, in which case you've just wasted your oh-so-precious domain name. GAME OVER!!!

#5, #6, #7, #8, #9: See #1

#10
After you have done that, worry about tweaking the so-called SEO junk to improve your site that last 1%.
Image ALT keywords, re-positioning

PS
I believe most SEO "experts" are charlatans, and I refuse to label myself an SEO expert.
Make of that what you want...

Brain Surgery Survivor

I made it!
Even have fully functional hands.
I feel about like you'd expect when somebody cuts a hole in one's head... :-)
Thanks so much for the prayers of any flavor and donations.
Followup appointments next week are still in pencil due to doctor schedule conflicts, but at lest one of them should tell me something some time next week, regarding malignant/benign and grade/scale or whatever.
Had a screamer on the same floor last night, so didn't sleep much...
Very tired, so I'll end this post here.
Just know I'm alive, and recovering, and will know the Real Story next week...

[EDIT: 2010-09-11]
I added this photo from my sister's phone.  Those white circles were some kind of GPS markers for an MRI mapping that lets the surgeon match up the brain images of the tumor with what's actually in my head.
Had I only known in advance, we probably could have gotten my brain on Google maps! :-)