Nothing In My Brain

"I want to show you some beautiful pictures." Those were the first words we heard from Dr. LA in Cleveland yesterday; she suited actions to words and pulled up before-and-after MRI shots from the gamma knife procedure.

As of yesterday's MRI results, there is no swelling remaining in the brain, and all of the targeted lesions were eradicated. There are no new growths present. The procedure was completely successful. It was fascinating to see the images side-by-side. The largest lesion left a hole, literally, in my brain. Thank goodness we have more brain matter than we need ... Dr. LA is thrilled with the results, as are we.

We met also with nurse Shari, who reviewed my labs. Nothing abnormal showed up; my hemoglobin counts continue to hover just below normal, and we'll continue to monitor that as well as some of the other "normally abnormal" counts that I've accumulated over the years. We'll also continue to monitor my liver activity, as anecdotal reports have several Votrient users suddenly developing liver dysfunction. I'll be seeing Dr. LA every three months, and probably will see Dr. G about every 8 weeks, so we'll still be burning up the roads between here and Cleveland for the foreseeable future.

On the homefront: last night Cola suddenly howled, sprang into the air, and raced around the living room, disappearing down the basement steps before I could stop her. She stayed huddled in the basement all night and most of the day today. This was a mystery until I found the yellow jacket in my bathroom. My guess is that she (the Mighty Huntress) found the dratted thing, attacked it as she would any other insect, and was stung. I swatted it with a towel 3 times (each time it started stinging the towel), and finally crushed it with a bottle. I remember stepping on one of those as a kid; it took pliers to pry it away from my toe after I was stung. Poor little kitty!!

So, What Exactly Went On?

This is hard to get a handle on because we all want to put things in familiar context. As Dr. LA said, "Gamma knife surgery involves no knives and no surgery, but those are the terms people comprehend so that's our reference."

To help people understand the procedure, Cleveland Clinic has developed patient resources, including a Gamma Knife Treatment Guide. This gives a better overview of the procedure I went through than I can, but I can add some personal details about what I encountered. I hope the details will be of interest to you; they're certainly of interest to me!

First off: The head frame is fitted with screws directly against the skull in 4 places, very like installing a glass lampshade on a floor lamp. Small plugs (between 1/16" and 1/8" in size) are cut through the skin for direct contact with bone, but there's no penetration into the bone. The head frame in essence allows the patient to become a part of the table during the procedure. The only bleeding I experienced was at the pin site on the right side of my forehead. Given how head wounds can bleed, no surprise that something flowed at the end of the day!

What's so important about being "part of the table"? The precision involved with this procedure is mind-numbing. It takes longer to map the procedure than it does to perform it, for most patients. In my case, the mapping took 4 hours and the zapping took 2-1/2 hours. As Dr. LA and Dr. Sam C both stated, "We're dealing with the brain, not a toe." I am still blown away by the idea of radiation from 192 sources focused on tissue to sub-millimetric accuracy, but if it can be done why demur? So being "part of the table" allows that precision throughout the procedure, and the computer controls allow the team to start, stop and adjust as needed.

I realized part-way through the procedure that "women of a certain age" have a distinct advantage over men during gamma knife: we've all slept on a headful of curlers at some point in our lives, and from that experience we learned how to balance the skull on an uncomfortable surface while relaxing the neck. I haven't slept on curlers since high school over 40 years ago and I still remembered that trick! (Eat your hearts out, guys!)

Stopping and starting the table at will is an advantage for the patient as well. The cylinder is generously sized, the table is comfortable, and the imaging is quiet - no banging magnets, no buzzing, no disruption. I hadn't expected to feel quite so pampered, actually. A nurse was on call for me at all times. About half-way through the procedure my nose started to itch, so I asked that we stop so I could scratch it. That turned into a trip to the waiting room to visit with Saint H and sister/friend M while I retrieved some saline spray and got more comfortable, a little "walkabout" and stretch, and a trip to the bathroom. When I felt ready, I went back in, got repositioned, and continued.

I've given myself plenty of time this week to recuperate. Of all that happened, the most troublesome is the bruising at the pin sites but that's nearly cleared up, and I've had to take some non-aspirin pain reliever from time to time for slight headaches, but that is it.

Who wouldn't like surgery without cuts, bleeding, pain, or recuperation? I ask you!

Surgery in Street Clothes

Yesterday I sent out messages to my "sporadic updates" lists to let everyone know how the procedure had come out, and late afternoon I spoke with my dear sister J. I told her that, on the whole, everyone had complied with my request not to call; I had decided to take several days apart to make certain that I had no headaches, that I didn't overtax myself, that I could adjust to new medication schedules, and get my head wrapped around the whole process, before I settled into visits and talks. She commented, "This all seems to science-fiction! When we were kids, could you have imagined anything like this happening?" And I had to acknowledge, no, I couldn't.

The film Fantastic Voyage comes to mind somehow, with little miniaturized scientists jetting through my head, zapping tissue amidst all types of improbable barriers and dangers. That just doesn't square somehow with being comfortably placed on a table in street clothes, and having someone pop one of my favorite CDs by the Gipsy Kings into the stereo system.

We have friends here who have 25 years of experience dealing with her brain tumors and subsequent medications, surgeries, radiations, and life changes. She's maintained a loving relationship with her friends and her family; she's upbeat, and accepts the limitations that have come with her condition gracefully and inspirationally. Science fiction can't begin to describe how things have changed over the years with treatment options. Even more, science fiction doesn't approach the amazing abilities of the human body and mind to cope.

I'm back to knitting, working my way through small projects. It's a fabulous relief to be able to comprehend my "alternate universe" of stick and string without panic.