Hi William: What a fascinating chapter, both of your life and of your book. Where can I get a copy of "My Second Life"? Carole H. --- William Harshaw <[log in to unmask]> wrote: > Debbie, > > When I had my pallidotomy in Dec '93, as Dr. > Ronald Tasker, my > neurosurgeon, made the lesion in my right globus > pallidus, I could feel the > rigidity leave the left side of my body. It has not > returned. > > I attach Chapter Eight of my book: My Second > Life. > > copyright 1999 The Harfolk Press > may not be reprodced without permission > Monday, November 30, 1998 revise > > Chapter Eight > > NEUROSURGERY > > ... the brain is the most interesting, complex and > wonderful thing in the > universe ... and it's a wonderfully exciting thing > to study and be in > contact with. ... The brain is you, it's not just > biologically or > genetically, it has all your experience, it's you. > -Oliver Sacks > > > > When I returned to the hospital on Tuesday, December > 7, 1993, I was ready > for surgery, eagerly looking forward to the > operation even though I was > apprehensive. Other than my overnight doing the > pre-op testing I hadn't > stayed in a hospital since I was twelve years old > having my tonsils out, and > I enjoyed the novelty. I brought a good supply of > books and music tapes. > Because the operation was unusual, everyone seemed > to want to know about me > and I was being paid a lot of attention. I felt > quite important. > I was sharing a room with a man from Huntsville who > had an inoperable brain > tumour. His wife was with him constantly, and I > sensed, from overhearing the > doctors and nurses, that he did not have long to > live. Even so, there was a > sense of calm surrounding the couple as they > prepared for his inevitable > death. > For the first few hours after I was admitted, I was > too busy having my > medical history taken, for what seemed the nth time > by a nurse and then > again by a surgical resident, and then being visited > by Jan Duff, Dr. Lang > and Esther and Howard to take in the reality of what > was going on beside me. > I dimly recognized that this couple were preparing > for the husband's death, > but there was no weeping and gnashing of teeth; > rather, there was hope. As > the wife left that Tuesday evening, she turned to me > and said, "You will be > in my prayers tonight. God bless you." > She had enough room in her heart for me, when I > would have thought her > whole being would be focused on her husband, on her > family. I was touched > and inspired by her generosity of spirit. > Later in the evening, Dr. Lozano and Dr.Tasker, the > neurosurgeons, came to > see me and discuss the operation. Dr. Andres Lozano > is tall, with > close-cropped black hair and wears plain wire-rimmed > glasses. If anything, > they made him look younger than his thirty-six > years. He had the aura of an > ascetic about him. He was the expert in > pallidotomys, having done thirteen > previous ones at the hospital. Dr. Tasker, known > behind his back as "The > Lone Ranger", and with a reputation for iconoclastic > brilliance, was > Lozano's mentor, having pioneered the thalamotomy, > where lesions are made in > the thalamus, another procedure used to reliving > Parkinson's tremors. In my > operation Dr. Tasker, although the senior, would be > the number two surgeon, > learning the pallidotomy procedure from Dr. Lozano. > With me they were a > "good guy, bad guy" team as they discussed the risks > and potential benefits > of the operation. Tasker spelled out the negatives, > while Lozano emphasised > the potential benefits. > The operation I would be having was a stereotaxic > pallidotomy. Stereotaxic > refers to the finely calibrated metal frame that > would be fixed to my skull > for the operation. It fulfils two functions: it > provides precise three > dimensional co-ordinates for the positioning of > surgical instruments within > the brain; and it is bolted to the operating table, > immobilizing the frame, > and, therefore the head. Pallidotomy refers to the > globus pallidus, > literally "pale globe", a part of the basal ganglia > which is the deepest in > the skull. The pallidus regulates the braking action > of the brain; in > Parkinson's patients the brakes are being applied > too heavily, causing > poverty of movement and clumsiness. (Parkinson > himself had noted that > sometimes, if patients of "his" disease had a > stroke, the characteristic > Parkinsonian tremor was less evident, although > muscle weakness more than > made up for the eased tremor.) In the pallidotomy, > the neurosurgeons make > some lesions on the pallidus which would result in > scarring. When properly > placed, the scars relieve the patient's symptoms. > Stereotaxic surgery dates back to the nineteenth > century when its use was > pioneered by veterinary surgeons. It was not until > the 1930s that the frame > was used for surgery on Parkinson's patients. By > today's standards, these > early procedures were crude, even barbaric. The > procedure was little more > than trial and error and the results were often less > than satisfactory. In > one American case reported in 1951, first the motor > cortex was disconnected, > then other connecting fibres were cut and finally > the head of the caudate > was severed, which finally relieved the Parkinson's > symptoms. It is hard to > imagine that there was much brain function left. > Meanwhile, in the 1960s, the potency of L-dopa > medications became > recognized as far superior to herbal extracts and > their synthetic clones, > and to some extent replaced surgery as a treatment > for Parkinson's. But > L-dopa has its limitations. In my case and many > others, it produces > dyskinesia as a side-effect. As these limitations > became recognized, > stereotaxic surgery was undergoing a revolution in > technique resulting from > the application of computer technology and > miniaturization of surgical > instrumentation. Technology assisted as well in > understanding the geography > of the brain and the specific function of many of > the parts of the human > brain. > As the two neurosurgeons discussed the operation > with me, I realized for > the first time how much responsibility for its > success would fall on my > shoulders. I would have no aesthetic because there > would be no pain. I > needed to be alert and mentally clear so I could > give timely and accurate > responses to the surgeons' questions, particularly > about the location of the > optic tract, a scant one millimetre from the globus > pallidus, and itself > only one millimetre in diameter. Should the probe > damage the optic tract, my > vision could be impaired. If the procedure resulted > in bleeding, a stroke > could result, with all the complications that come > with it, including the > possibility of death. > Somehow, all the cautions and potential problems > that Dr. Tasker discussed > were insignificant when Dr. Lozano described the > potential benefits of the > operation: moderation of dyskinesia, easing of > muscular rigidity on my left > side (the operation was going to be on the right > side of my brain ) and a > lessening of the reptilian appearance my > Parkinsonian mask had given me. Dr. > Lozano had estimated the risk of something going > seriously wrong at between > two and three per cent. The two surgeons were > putting benefits and possible > hazards of the operation clearly so that so that I > would be able to sign a > === message truncated === __________________________________________________ Do You Yahoo!? Bid and sell for free at http://auctions.yahoo.com