If I've learned anything during my two years in Aspen, it's that sometimes it's a long, long road...
to get where you want to be.
Four weeks in today. I'm feeling much better but each day, at some point, I get a reminder of just how far I still have to go.
It also just dawned on me that with how quickly everything moved the week of the surgery, many people I spoke to in the initial days after my diagnosis are probably confused as to how I ended up with a craniotomy.
Not to get all Grey's Anatomy on you, but there are essentially three options one has when diagnosed with an aneurysm: do nothing and monitor, have the aneurysm "coiled," or have it surgically clipped shut.
The first option is rather self-explanatory, and was simply out of the question. The two weeks or so we lived with the knowledge that the aneurysm was there were the longest of my life. While the aneurysm has likely been in my brain for the majority of my life, things undeniably change once you're told that it's there; there's this omnipresent awareness of one's mortality. Even though the odds are in your favor that it won't rupture, you're also painfully aware that if it does, your odds of survival are less than 25%. That's no way to live.
Now the coiling is where things get interesting. This is a remarkably non-invasive procedure that involves going in through the femoral artery in the groin, running a small catheter all the way through the body, to the brain, and to the aneurysm, than running a small wire coil through the catheter up to the aneurysm. At this point, the aneurysm is filled with the wire coil, the coil is cut off once the aneurysm is filled, and all is well. The patient walks out of the hospital a day or two later with nothing more than a band-aid on the groin and a headache. While there are small percentage risks of stroke, seizure, and death with the procedure, the recovery time is relatively short since the skull is untouched.
As Lauren and I did our post-diagnosis research, we just assumed coiling would be my answer. Why open up your skull when you didn't have to?
Well, as we continued to dig, we found out some interesting things.
First, because the coiling is such a new technology, the long-term results are still unknown. Would the coils, if properly placed, last 30 years for an active person? There had been studies that revealed that nearly 30% of patients needed to be re-coiled, as the coils had compressed, allowing more blood to enter the aneurysm. Even worse, in some cases the metal coils had actually slipped free and entered the artery itself, causing a stroke.
In addition, the up-keep for coiling is a major pain in the ass. Angiograms (similar to coiling, they go through the groin and administer dye to the brain so they can see the vessels and arteries) are required at the 6-month mark and annually after that. Now, angiograms are an all-day affair, and they carry a small chance of stroke and death with each procedure as well.
So as I waited for the results of my diagnostic angiogram on Thursday, May 8th, I found myself surprisingly scared. Scared that the surgeon would push coiling and that it wasn't necessarily what I wanted.
As the surgeon sat down with Lauren, my parents and I, he explained his findings. Most importantly, my aneurysm had developed a secondary weak spot; a bubble on top of a bubble if you will. This meant that whatever we did, it had to be done in a hurry.
The surgeon then went on to say that based on everything he saw -- size, shape, location of the aneurysm, as well as my age and good health -- he recommended going in surgically and taking care of this thing once and for all. The disadvantage of the surgical clipping as compared to the coiling is the increased risks of surgery and the prolonged recovery from the invasive nature of the procedure. After all, a clipping involves making a large incision in the head, cutting away part of the skull, and placing a small titanium clip over the bulging aneurysm, effectively curtailing any blood flow into the aneurysm and further growth. The advantages? Once you've made it through the surgery and recovered, the aneurysm is, for all intents and purposes, gone forever. You are completely healed, the up-keep is minimal and the threat of recurrence is no different for you than anyone else on the planet. You can return to your normal life -- whatever your normal may be -- free from restrictions.
I was rather surprised to hear one of the few surgeons in the world trained to do both procedures recommend the more invasive of the two, but I understood what he was getting at. If you want to live the rest of your life -- really live the rest of your life -- would you sacrifice three months of recovery time to do it? To just be done and move on and not spend the rest of your days wondering if the quick fix is holding? I think you would.
And so would I.
