Remember how I mentioned a slight facial asymmetry last week? Turns out, it was my body's way of taking me on the ultimate neuropsychological thrill ride.
I don't particularly enjoy carnival rides, especially ones that turn you upside down and spin your world around. I went on one such ride in 1992 at a Desparate and Dateless Ball at the docklands. Hanging upside down in midair, people's loose change falling to the ground in the dark around me, I found myself screaming expletives, and the words "I don't want to die!". One year later, at the Lyon St Festa, I foolishly thought I would be braver if I went on such a ride in broad daylight. Same result, though I deleted the expletives.
Twenty years later, my body has cooked up its own ride, but without my consent. I'm planning to post this about two hours before I get wheeled into an operating theatre to experience stereotactic brain surgery. I will have fasted from 11am, and the genteel bow-tie wearing anaesthetist will have given me medication to help the last two hours go faster (he's a magician, as well as a calming presence :).
At six pm, the neurosurgeon will start operating f to explore or remove a 4cm cystic lesion from the right side of my brain. It's growing about 1cm below the cortex, and he'll be making a vertical incision just above and behind my right ear. Stereotactic surgery means that he will be guided by a computer that allows him to see where he's cutting, to help him cut only what he wants to cut. He describes it as the most important advance in neurosurgery in the last 20 years, and instead of removing a large bone flap to access the brain, there will just be a small incision begin my ear.
The lesion, or explains my facial symptoms, and probably explains why I've started dropping my phone and making typing errors with my left hand in the past couple of weeks. And may also explain why I've found it it difficult to park or tackle intersections while the kids have been talking to me. It is growing near the motor cortex, and because it is occupying space, it is causing oedema (swelling) in the underlying brain tissue, and is pushing the swollen tissue towards the midline of my brain ( the usually straight line between the two hemispheres). I'm so glad it was caught at this stage - untreated, it would have started to cause me headaches, increased irritability, more neurological sigs, possible nausea and vomiting, or seizures. It's not good to drive a car with something like this growing in your head. I'm so glad I didn't have an accident and hurt anyone. And I so don't want to alarm you, gentle readers. I will be fine. I've seen brain surgery many times, and this one isn't going to be a risky procedure. It will just give me something new to recover from.
My neurosurgeon said he thinks it's 85% likely that the mass is a tumour, and 15% likely it's an abscess. I've read that brain abscesses are uncommon in the general population, but are more common in people with cancer -it's possible it started growing during my chemo, when my immune system was suppressed. If it's an abscess, he'll drain it and treat it with antibiotics. If it's a tumour, he'll take it out. In any case, surgery will reduce the oedema, and I'll be in hospital for another 7 days. There is a smaller, different mass in the left occipital lobe, almost arising from the lateral ventricle (a fluid- filled space that gently arcs from the front to the back of the brain). The smaller mass is probably a tumour, and will need to come out later. I asked if it could come out next week as well, but he said (rising instantly in my estimation), that operating on each hemisphere of the brain in the same week would be a taxing experience for my body, and that he'd rather give me a chance to recover for a week or two after the first operation. Initial side effects will include pain over the surgery site, fatigue, and possible headache, but they'll subside in a few weeks, and there will hopefully be limited effects on the left side of my body. Prophylactic aticonvulsants will reduce the risk of me getting seizures after the surgery.
if the lumps are tumours, they would have arisen from micrometastes from my breast cancer. Given that the breast CA was removed in January, I'm hoping there won't be any additional mets in my brain. Removing the lumps, and whole brain irradiation, should take care of them.
I'm pleased to report that, apart from having a large ring-enhancing lesion and surrounding in the right parietal lobe, and a smaller lesion in the left occipital lobe, I have a nice-looking brain. My mesial temporal lobes (housing the hippocampus and other structure necessary for memory) are good and and plump, and there's no sign of cortical atrophy (not that there should be, I'm only 46!!). My cerebellum is looking good, despite some excesses of alcohol consumption in my late adolescence, and my corpus callosum is beautifully shaped, even if I say so myself. My neuroradiological friend in Melbourne said that it's a very healthy looking brain (apart from the trouble spots), and the radiographers complemented me on lying perfectly still for the scans (MRIs are harder to read if the patient moves. I didn't want to make my own images blurry). I told the neurosurgeon I was glad to see I had such a healthy-looking brain, he joked that he thought it looked like it hadn't been used. I liked him even more.
I am so sorry to have to share this news. I've thought about nor doing it, but i dont know how I'lll feel after surgery (probably sedated and dopey). And I could really do with your support tonight.
I don't want to shock or upset any of you, and I know almost exactly what my neuropsychological friends will be thinking. (I'm pretending the scan belongs to someone else. I like diasociation as a defence mechanism too!)
I'll be able to use this experience to help our patients and their families, and to increase community understanding of brain conditions.
I'll be fine. This is just a setback, but it could be much worse. I wrote the following words last night:
Back to 3am.
I'm feeling much lighter after seeing the neurosurgeon last night. He helped us look ahead, and the gorge didn't seem so deep after all.
It's not worth worrying about what might happen. I'm well now, we've found this thing before it did real damage, it could be growing in far worse parts of my brain.
The worst thing about having surgery tomorrow night is that I'll miss seeing the first episode of the new Phryne Fisher series. I could do with some elegant costumes and light-hearted pap around now.
Please don't be distressed or worry too much for me. Focus on sending healing wishes, and imagining me living to a ripe old age and enjoying life and my family and friends. Keep looking forward for me, link your arm in mine as we walk, and don't look down. It's just brain surgery. It's done every day, and my surgeon has an excellent reputation as well as a sense of humour.
With much love to all of you.
