Unfortunate complications

Another quick update:

Unfortunately, we got some bad news after Dad returned from the second procedure.  The CAT scan showed that there was some bleeding outside of his brain, with a wisp of blood in the brain, that was causing some fluid to fail to drain.  So, they are currently in the process of putting in an external ventricular drain, which will drain the fluid externally (as opposed to a shunt, which is internal and permanent).  They said this is necessary and occasionally one of the consequences of thinning the blood for surgery, and not uncommon.  The real bummer is that he is now expected to remain in the ICU for another week and discharge date will be pushed out until at least then.  As you can imagine, this was disappointing news for all of us, given the positive reports early on, as we were hoping he would be discharged on Wednesday.  The plus side is he should be much more comfortable after this is done because it should take away most of his headaches.

So for now we are playing it by ear.  Erik, Elliot, & I are still planning on heading home tomorrow since we both have to work Wednesday, but will likely be back next weekend.  Please keep the prayers coming!  We hope this is the only complication in an otherwise successful surgery.

Brief Update on Dad

I have finally found some time to update everyone on Dad's surgery.  It will be brief because I am T.I.R.E.D.  It has been a long week, haha.

As we speak he has just been rolled down for his second procedure.  More on that later.

The big surgery took place on Thursday and, thank God, went very well!  This surgery was the first of a two-step process for attacking the aneurysm and was the much more invasive process.  They went in through his skull and swung a vessel down to his PICA to bypass the aneurysm which they are coiling off today.  (If that didn't make sense to you go back to my blog post from several weeks ago where I explain it in brilliant [sarcasm] detail.)  There were no complications, however it did take much longer than anticipated.  We were there at 5:45 a.m. and did not leave the hospital until 11:00 p.m.  The surgery itself took slightly longer than the 4-6 hour estimate and apparently it takes quite a long time to prep and close up for brain surgery, so that accounted for a lot of the time.  However, there was a lot of just waiting for his room to be open up in the ICU where we could see him.  So that was a long day.  But, I am not complaining because everything went so well, and honestly, compared to a lot of the other patients in the neuro ICU, he is in great shape.  He also has/had a LOT of family here for support.  My sister, Danielle, flew in from New York, and in addition to Erik, Elliot, and me his mom, 3 sisters, 3 nieces & a nephew, dad, and several aunts and cousins have been here.  It has been quite a crew and Elliot got to meet some people she has never seen before.

Today's procedure (I say procedure because when I said surgery to a nurse I was sternly corrected that it is "actually a procedure, not a surgery") is much less invasive.  They are going in through his femoral artery (near groin) to do an angiogram plus coil off the aneurysm.  It should take approximately 3 hours, plus a couple hours in recovery, followed by 6 hours of lying flat.  So, he will probably be uncomfortable this afternoon.  They plan on taking out his central line today and he is still on track to be discharged on Wednesday.  He is one hundred times better today than he has been.  When we arrived this morning he stayed awake for 20 minutes talking with us.  He was cracking jokes and being himself.  I can't believe how fast you can bounce back from brain surgery!

Thank you so much for the prayers, texts, and phone calls.  I feel so blessed to have wonderful family and friends.  I especially want to thank my sister-in-law, Krista.  She has been amazing.  She has let us crash at her apartment for nearly a week (and we have made it a disaster zone!), makes us dinner, and has taken time off work to watch Elliot so we can be at the hospital.  I don't know what we would do without her.  Please keep us in your prayers, specifically that this second procedure goes well, that recovery is speedy, and that everyone has a safe trip home.  I will try to update soon about the procedure today.

Update on Dad; The Next Steps

We spent the last few days in Seattle where Dad underwent another angiogram so the surgeons could have a better idea of what we are working with.

On Monday, Dad checked in at the hospital bright and early to get his labs done and then to get the angiogram done.  Turns out he did not need to get there so early because they did not get him in until almost 3:00 p.m.!  It made for a long day for everyone.  It went fairly well after that and the surgeons were able to get very detailed 3D imaging of the aneurysm and the arteries around it.  Dad was left with a bit of soreness in his leg/groin region, where they inserted the the tubes that let out the dye and he had to lay flat for 6 hours after the procedure so he didn't get back to the hotel until around 10:00 pm.

On Tuesday, we met with the surgeons to discuss the results of the angiogram and plan out the next steps.  As we already knew, the aneurysm measures at about 11mm x 13 mm, which is classified as "big".  Unfortunately, we got some bad news.  Based on the type and location of the aneurysm they will not be able to "simply" go in through the groin and coil it off.  They will have to do two surgeries, and the first will be an "open" surgery, where they will actually have to remove a small window of his skull and operate on the surface of his brain.  I have made some sketches to help illustrate what we have going on here:

 Ok, so the sketch above shows the problem.  As you can see, the aneurysm is on the right vertebral artery which supplies the brain stem and the PICA (don't ask me what it stands for, it is an artery, and apparently it is quite an important one).  Coiling the aneurysm does not present a problem to the blood flow to the brain stem (Sidebar: Coiling is the process of putting a coil into the aneurysm that stops all blood from flowing into or out of the affected area.) because the left vertebral artery also supplies blood to the brain stem.  However, it does present a problem with regard to the PICA because the PICA has no other blood source besides the right vertebral artery.  If they were to go in and coil the aneurysm without taking other precautions there would be no blood flow to the PICA and this would almost certainly cause stroke and damage to his balance, speech, swallowing ability, and who knows what else.  So before they can coil they have to do another procedure.

 The sketch above illustrates the procedure.  So what they need to do is find another blood source for the PICA before they cut off the blood source from the right vertebral artery.  This blood source will be a scalp artery that they will "swing down" and suture to the PICA.  This means they will make an incision in the scalp and pick one of the arteries (apparently his scalp won't miss it because there are many redundant blood supplies there), the attach it to the PICA through the window made in the skull.  They claim that it will be very well protected  by the rest of his skull.  The process I just described is known as bypass surgery, and this should take around 4-5 hours and he will do it on a Thursday.

Once the first procedure is complete they will give him a few days to rest up and get more tests done, MRI's and all that, and then the following Monday they will go in and coil the aneurysm.  In this process they will go in through his leg/groin, the same way they did for the angiogram.  Once this is done the aneurysm will be blocked off and no blood will flow through it.  Easy, right?

I was surprised to find out that the hospital recovery time for all this is actually pretty short.  They said he could be released as early as the Wednesday directly following the second surgery on Monday.  Literally less than a week after he has open brain surgery he should be able to walk right out of the hospital!  Amazing!  So, even though this is not the best news we hoped for, I left the hospital feeling confident that Dad was in really good hands with his surgical team at Harborview.  The surgeries are going to take place at the beginning of September.  Please keep us all in your prayers.  Especially Dad.  He is understandably very anxious about having to undergo open brain surgery.  Thanks everyone for the outpouring of love and support.  It really helps!