Wednesday, January 4th

I’m ready! 

Tuesday, January 3rd

Trying to get it together before the surgery tomorrow.  I have a checklist of pre-surgery instructions:

·      No food or drink after midnight

·      No shaving in the area of the surgery

·      Bathe the night before and morning of surgery with supplied anti-septic soap

I have a small travel bag packed with a pair of PJ’s, and shave kit for Momma to bring when I’m able to get up and move around.  I’ll have family with me before and after the surgery, so lots of prayers and comfort knowing they’re close.

My single largest trepidation is the pain meds.  I have a real problem with aspirin based pain meds and don’t want to go through the nausea again, especially in the hospital!  As for fears of complications with the surgery, I’ve read a lot of good and a lot of bad and don’t want to dwell on the negative, so staying positive.  Got to say I’m anxious to get off the Diamox!

T-minus 18.5 hours and counting!

Monday, January 2nd

Been getting a little nervous about the surgery.  The neurosurgeon gave me a brochure describing the procedure, but it wasn't very descriptive.   So, off to the World Wide Web to get the low down.  This was one of the best descriptions, while not the exact location, it does convey the general procedure well.  This information is courtesy of the Mayfield Clinic. 

What happens during surgery?

There are 6 main steps during a craniotomy. Depending on the underlying problem being treated and complexity, the procedure can take 3 to 5 hours or longer.

Step 1: prepare the patient 

No food or drink is permitted past midnight the night before surgery. Patients are admitted to the hospital the morning of the craniotomy. With an intravenous (IV) line placed in your arm, general anesthesia is administered while you lie on the operating table. Once asleep, your head is placed in a 3-pin skull fixation device, which attaches to the table and holds your head in position during the procedure (Fig. 2). Insertion of a lumbar drain in your lower back helps remove cerebrospinal fluid (CSF), thus allowing the brain to relax during surgery. A brain-relaxing drug called mannitol may be given.

Figure 2. The patient’s head is placed in a three-pin Mayfield skull clamp. The clamp attaches to the operative table and holds the head absolutely still during delicate brain surgery. The skin incision is usually made behind the hairline (dashed line). 

Step 2: make a skin incision

After the scalp is prepped with an antiseptic, a skin incision is made, usually behind the hairline. The surgeon attempts to ensure a good cosmetic result after surgery. Sometimes a hair sparing technique can be used that requires shaving only a 1/4-inch wide area along the proposed incision. Sometimes the entire incision area may be shaved.

Step 3: perform a craniotomy, open the skull 

The skin and muscles are lifted off the bone and folded back. Next, one or more small burr holes are made in the skull with a drill. Inserting a special saw through the burr holes, the surgeon uses this craniotome to cut the outline of a bone flap (Fig. 3). The cut bone flap is lifted and removed to expose the protective covering of the brain called the dura. The bone flap is safely stored until it is replaced at the end of the procedure.

Figure 3. A craniotomy is cut with a special saw called a craniotome. The bone flap is removed to reveal the protective covering of the brain called the dura. 

Step 4: exposure the brain

After opening the dura with surgical scissors, the surgeon folds it back to expose the brain (Fig. 4). Retractors placed on the brain gently open a corridor to the area needing repair or removal. Neurosurgeons use special magnification glasses, called loupes, or an operating microscope to see the delicate nerves and vessels.

Figure 4. The dura is opened and folded back to expose the brain.

Step 5: correct the problem

Because the brain is tightly enclosed inside the bony skull, tissues cannot be easily moved aside to access and repair problems. Neurosurgeons use a variety of very small tools and instruments to work deep inside the brain. These include long-handled scissors, dissectors and drills, lasers, ultrasonic aspirators (uses a fine jet of water to break up tumors and suction up the pieces), and computer image-guidance systems. In some cases, evoked potential monitoring is used to stimulate specific cranial nerves while the response is monitored in the brain. This is done to preserve function of the nerve and make sure it is not further damaged during surgery.

Step 6: close the craniotomy

With the problem removed or repaired, the retractors holding the brain are removed and the dura is closed with sutures. The bone flap is replaced back in its original position and secured to the skull with titanium plates and screws (Fig. 5). The plates and screws remain permanently to support the area; these can sometimes be felt under your skin. In some cases, a drain may be placed under the skin for a couple of days to remove blood or fluid from the surgical area. The muscles and skin are sutured back together. A turban-like or soft adhesive dressing is placed over the incision.

Figure 5. The bone flap is replaced and secured to the skull with tiny plates and screws.

Sunday, January 1st, 2012

Happy New Year!

The good news, there is no news!  Been sleeping well, mild headaches but easily managed without meds.  Still lethargic, still have the loss of appetite, but no changes.

I did speak with the pre-surgical exam doctor and forgot to include the conversation in my last post.  She called to say the increased red cell count was caused by the Diamox, and that she had added a note to my folder that I was intolerant to aspirin based pain meds.

T-minus 68 hours and counting!

Friday, December 30th

Wednesday and Thursday night were both uneventful, no meds excepting the Diamox, so no stomach issues.  Still lethargic, and still have a low appetite.  I weighed 232 pounds on Monday, December 5^th, at the pre-surgical exam Tuesday, December 27^th; I weighed in at 220 pounds.   Heck of a weight loss plan!

I shaved my head yesterday, and discovered it’s harder than it might seem.  I ended up with some nicks, strawberries and bleeding.  I looked on line for information and it seems that this is normal for a newbie to have these problems.  One of the rules prior to surgery is no shaving the morning of.  They don’t want any open cuts that bacteria can get into.  So, I think I’ll shave my head for the last time on Monday just to be safe!

I’m 5 days from the surgery!

Got my hair cut today!

Wednesday, December 28th

Had a very tough night!  About 4:00 yesterday afternoon, my headache had escalated to extreme, so I took a Norco and took a 2-hour nap.  My headache was still with me when I woke, but was manageable.  By bedtime the headache was again throbbing, decided to take a Norco before bed, as I had no side effects earlier in the evening.  Big mistake!  My stomach was on fire all night, slept in spurts of 25-30 minutes, finally got up at 5:00 to set up.  It’s now 8:15, just had some breakfast and Diamox.  I have to drive downtown to pick up my paycheck, then the laundry and back home before my hair cut.  I still have a slight headache, but will not take any more pain meds.  I discussed this condition with the doctor during my pre-surgical exam, but she didn’t have any suggestions.  On the bright side, I’m now a week away from the surgery!

Tuesday, December 27th

Had a rough night last night.  I went to bed with a slight headache and woke several times, the last at 3:00 am, when I just couldn’t sleep anymore.  I got up at 5:00, but couldn’t have my coffee, as I had my pre-surgical exam this morning.  Got a bowl of Cheerio’s, half a Banana and a glass of juice to make the Diamox go down easier.

Went to Outpatient Processing at St Vincent at 9:45, got my paperwork straight and waited for a nurse, which didn’t take very long.  Got all the questions out of the way and on to the EKG and blood work.  After all the testing, I was told to wait and a doctor would see me.

Doctor came in and reviewed the blood work and said my clotting was normal.  She was surprised that my red cell count was very high, and was last Wednesday when my family doctor took blood for my heart check.  So, the doctor ran through all the possible causes:

·      Low oxygen – did I suffer from sleep apnea, no

·      Kidney problems – no

·      Steroid use - no

·      Heart disease – yes, but no issues

·      Kidney cancer – no

·      Smoking – no

I think it’s the Diamox and the doctor agreed.  It won’t stop the surgery, but she thinks we should follow it up after the surgery.  So, I am cleared for the surgery! 

I stopped by Walgreen’s and bought a Head Blade Razor, and Dick’s for some new Beanies.  I called my local barbershop and have an appointment to get my head cut and shaved tomorrow!  My daughter Gwen is going with me to get some pictures of the occasion.

So, it’s almost 2:00 pm, I’ve got most everything done for today, still have a headache, but it’s manageable without meds!  I can’t wait to get back to normal activities!

Monday, December 26th

Not much to report.  I’ve slept well the past couple nights, no more nausea during the night.  I’ve had some light headaches early in the morning, and after doing too much around the house.  Still lethargic and have little appetite.  A couple new things started over the weekend, tingling in my extremities, and numbness in my face.  I still think this is all attributable to the meds!  I am scheduled for a pre-surgical exam at St Vincent tomorrow, getting closer to my surgery.

Friday, December 23rd

Another good nights sleep.  Had my head on my pillow all night.  Went to bed at 11:00, and went right to sleep.  I woke at 4:45 with a mild headache across the top of my forehead.  Couldn’t get back to sleep, so got up, had some juice and watched the morning news.  Off to work at 8:00, had three stops on the way in.  Worked in production until our pitch in at 12:00.  Had lunch then gathered my database and information I’ll need to work at home while I’m recovering.  The headache left me after lunch and didn't return.

I received a notice from the Brain & Spine Group regarding payment for the surgery.

Your upcoming surgery is tentatively scheduled for 1/04/2012.  We believe the your surgery will cost approximately $10,092.00.  We have learned that your health benefits plan will only cover a portion of our surgeon’s fees.

Based on your benefit information supplied to us from your insurance carrier, we estimate that you will be responsible for the balance of $608.46.  Your insurance carrier does not guarantee payment for this service and this estimate balance will vary based on your benefit plan at the time the claim is processed by your insurance carrier.  Please remember that this is an estimate. You may be responsible for additional amounts after your insurance company processes your claim. All overpayments will be refunded to you within 30 days after your insurance payment is posted to your account.

Our Financial Counselors will be glad to help you arrange payment for your portion of the bill prior to your surgery. Ideally, your portion of payment should be paid prior to your scheduled surgery.  For your convenience, we accept MasterCard, Visa, Discover, CareCredit and American Express credit cards.  If you are mailing your payment prior to your surgery, payment should be mailed to: ______________________, with a copy of this letter.  For questions, you may call 000-000-0000.  We will be happy to assist you.

Following your surgery, you will receive an explanation of benefits from your health benefits plan that confirms our surgeon’s fees. The portion reimbursed by the plan and any balance due to ___________________ that remains your personal responsibility at that time.

So, need to get that paid prior to the surgery!

Also in today’s mail was the Invoice for the ER visit:

Service                            Submitted            Plan                           Co-Pay

                                         Charge                Allowance

Diagnostic                       64.00                    38.16                             5.72

CT Scan                           2,572.00              1,533.68                        230.05

Medical Care                   1,158.00              690.52                           103.57           

MRI                                 3,593.00              2,142.51                        321.37

Prescription Drug            157.60                 93.98                             14.09

Prescription Drug            56.15                   33.48                              5.02

Prescription Drug            50.39                   30.05                              4.50

Prescription Drug            206.40                 123.00                            18.46

TOTALS                          7,857.54              4,685.46                        702.78

I am extremely blessed to have a good medical plan!