I'm glad to hear all went well!
An acquaintance of mine in the Swedish Parkinson's association once asked me
if I knew the true meaning of "DBS".
- "Dey're Boring into yer Skull!" ["Dom Borrar i Skallen"] ;-)
Take care,
John
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Ämne: Awake while head drilled
RLMedia
You're awake and they're drilling your head
Posted in Parkinsons' Related, Published Articles by rlmedia on February
11th, 2008
Published in The Georgia Straight August 16 -23/ 2007
Who's going for takeout?" I wise-cracked while lying immobilized, scalp
peeled back, brain exposed, after just having my head cored like a bowling
ball!
I'm awake, and in an operating room at the Vancouver General Hospital.
My slightly exasperated neurosurgeon, Christopher Honey, tells me to chill
out as some of the other medical personnel present turn away and suppress
their laughter.
This false bravado is my way of dealing with the trauma I am
experiencing from the Deep Brain Stimulation {DBS} surgery being performed
on my cranium. Within the next few minutes my guardian angel nurse - who has
been holding my hand and doing her best to keep me engaged throughout this
seven-hour- ordeal will be dabbing my eyes as I switch gears from exchanging
friendly banter with her and the anesthesiologist to crying uncontrollably.
This particular crying jag has been brought on not by the recognition
that DBS surgery could really enhance my life and ease the burden of
Parkinson's disease but by my realization those evil regimes and their cruel
henchmen have been doling out similar operations without local anesthesia on
innocent men, women, and children since the beginning of time. These
conflicting thoughts concerning the good, the bad, and the ugliness of man's
inhumanity to man may have reduced me to tears. Indeed, having one's head
drilled while being awake is not a procedure I would want even my worst
enemy to go through.
The doctors assure me that this part of my surgery won't hurt a bit due
to the local anesthesia. However, I'm also advised to keep my mouth ajar
when the drilling starts and not clench my jaw, unless I want to grind my
molars into dust. For over two weeks after the surgery and my jaw still
ached when I yawned.
Trust me, you do not want to ever feel the vibrations of a drill
digging dig deep into your soul or recall the smell from your smoking skull.
Even some of the veterans of the operating room looked away or found
something else to occupy them when the drilling began. It was one of the
toughest days of my life, and no amount of reading up, talking to, or
listening to any others can prepare you for your date with DBS.
On the other hand it was also one of the most fascinating days of my
life, as I listened and watched . Honey-the only neurosurgeon in B.C. who
performs this type of surgery- coax, cajole, and lead his team of about 10
medical personnel through the procedure. There is no doubt about who is in
charge here. It's Maestro Honey. Here is a man who loves his work, and even
though he has performed this type of procedure over 300 times, you can tell
by the tone of his voice that he is engaged as he alternately lectures,
explains and guides his charges during the long seven- to eight- hour
surgery.
Honey, who's 45 but looks younger, is a former Rhodes Scholar and a
director of the World Society of Stereostactic and Functional Neurosurgery.
If ordinary surgeons were NASCAR drivers, he would be Formula One. On this
day he has neurosurgery fellows from Mexico, England and Egypt observing and
assisting him throughout this procedure.
Deep-brain-stimulation surgery isan operation during which electrodes
are implanted in the brain and an electrical signal is used to shut down the
region of the brain that causes unwanted symptoms. In people with
Parkinson's
disease, normal movement is replaced by unwanted tremors, rigidity, slowness
of movement and loss of balance. DBS surgery involves the drilling of two
quarter-size holes on each side of your skull. Two electrodes are implanted,
the effects seen on the opposite sides of your body.
The electrodes are then attached to a stimulator [similar to a
pace-maker] buried underneath the chest skin that can be turned on and off.
Surgical operations once caused permanent lesions in the affected areas of
the brain, but since the late 1990's this procedure has been supplanted by
deep brain stimulation, which has the advantages of safety, reversibility,
and adjustability.
Only ten percent of Parkinson's patients meet the criteria for DBS. I
was considered a good candidate for DBS because I have had Parkinson's
disease for over 10 years; still respond well to levodopa and other
anti-parkinsonian medications; still experience wide swings between feeling
good "on" and feeling awful "off"; display medication induced uncontrolled
movements called dyskinesia; am in good general health and have a good
support network of family and friends.
My date with destiny starts at 5:30 a.m. with a shower, and at 6:30 the
porters arrive to wheel my bed to the CT lab for the mapping of my brain.
The first step of my operation involves the placement and fitting of the
stereostatic head frame. This medieval-looking cage-it resembles something
you would see in the chamber of horrors in Madame Tussauds wax museum-is
bolted to my skull at four points in order to immobilize my head for the
duration of my operation. The insertion of the sharp needles hurts until the
local anesthesia numbs my skull, a convergence of state-of-the-art brain
surgery and old fashioned mechanical surgery. The head-frame apparatus will
be bolted to the operating table to hold my head in a fixed position.
I realize that my upcoming DBS surgery means little to the busy staff
performing their daily tasks, but I have made my bed -now I must lie in it!
Marooned in the middle of the hall, outside the CT facility, with four
doctors sticking needles into my scalp and bolting in the anchoring screws,
I get a kick out of watching the horrified faces of the patients, visitors,
and medical personnel who dare to glance my way as they scurry by my bed. I
try to lighten the proceedings with a request for the matching shoulder pads
and a plea to "send me in coach, I'm ready to play".
Next it's into the scanner and its roller-coaster ride, complete with
laser lights and overwhelming sound effects. When I ask the team how many
tickets for another ride someone fires back: "about 5,000".
There are a couple of events that I recall vividly. During a
particularly crucial phase of my operation, I feel a dry tickle in my
throat, and I begin to cough uncontrollably. This not good, especially when
the surgeons are attempting to insert, with millimeter accuracy, an
electrode deep within my brain. The operation comes to a standstill, and
there is a hush in the room. I feel at this point that my life could be in
danger as I fight to suppress my cough. Honey assures me that this is only a
temporary condition and that my cough should subside without me focusing on
it within 15 minutes. Sure enough, 15 minutes later the cough disappears and
the procedure restarts.
After the right side of my brain has been drilled and the electrode
implanted, Honey informs me that it's my turn to contribute to the
proceedings. This is why I have been kept awake: now I must answer Honey's
questions about how I'm feeling. It is also an opportunity for the team to
test my range of motion when the electrical current is applied. As the
current is turned up, a wave of pinpricks flows down my left side. Honey
rotates my left wrist as we engage in a discussion about the looseness of my
wrist joint. After we establish a comfort zone for a full range of motion,
one of the fellows is instructed to turn up the dial to find my top end. As
the current strengthens, I feel my left eye start to twitch and my cheek
tightens around my mouth.
After the first electrode has been set in place, the procedure is
repeated on the opposite side.This is where Honey's skill and experience
shine. He has left it up to one of the visiting fellows to determine the
correct coordinates on the left side of my brain. I hear the fellow call out
the applicable coordinates, but he has failed to take into consideration
that my head has been bolted in at a slight angle to alleviate some stress
on my neck. Honey quickly determines that these coordinates are wrong and
rattles off three different numbers. I am relieved that this guy is in my
corner.
Near the end, while my scalp is being sewed back together, the nurses
begin to cleanup the room. I hear some whispering about the whereabouts of a
surgical sponge. This talk escalates into a full blown search. I listen
intently to this crisis unfolding behind me and finally bid the attending
fellow to stop sewing and come around and get in my face. I ask him point
blank, "Is there a sponge left in my skull?" He calmly informs me using his
thumb and forefinger that my burr holes are about the size of a quarter and
the missing sponge is 20 centimetres by 10. Soon after, the sponge is
recaptured and the universe is again unfolding as it should.
As I drift into unconsciousness for the final hour of surgery, I call
out to all those responsible my thanks and a "See you later.bye, bye." I'm
woken in the recovery room to find I now am the proud owner of a stimulator
embedded in my chest with visible wires running under my skin, behind my
ear, and into the battery pack. After the first night of morphine and hourly
wake-up calls from the nurses to test my vitals, I'm on the road to a quick
recovery. The stitches are out, my body and head are finally washable again
and my locks have been shorn down to a Sinead O'Connor length. I'm back on
my full medications, 23 prescription pills per day
I won't know if my operation has been successful until my brain
swelling goes down enough to allow for the start-up of my stimulator. This
process will start before the end of August and could take weeks, even
months, to test, set the levels and have my meds adjusted to an appropriate
level.
Was it all worth it? There is no guarantee of success, and there were
certainly points in the whole process where I would have gladly opted out.
But the promise and the hope for improvement in the 30-to-70 percent range
were just too tempting to pass up, even after 15 months on the waiting list.
The support I received before my surgery and have seen since has been
very moving. It's the hope of a better quality of life to share with my
family and friends that drives me forward. I'm lucky to have the option of
treatments like DBS surgery, and as I look farther ahead to the possibility
of stem-cell-research breakthroughs, not having or believing in these
options is what would really scare me.
Rayilyn Brown
Board Member AZNPF
Arizona Chapter National Parkinson's Foundation
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