Appointments at Stanford

My friend, Rosemary, along with Mackenzie and I left on Sunday. We drove to Rosemary's parents' house in Santa Rosa. We also stayed their Tuesday night after my doctor appointments to kind of break up the long drive home as well. Her parents Rudi and Carole have a beautiful home in the hills above Santa Rosa that they had built themselves in the late 60's. They are wonderful people and I enjoyed visiting with them and their hospitality. Mackenzie enjoyed her stay as well.

Monday we drove down to Palo Alto and checked into the motel. I had my CT scan at 4:40. I thought they were not going to be using iodine contrast but they decided to at the last minute. It worked out alright with Mackenzie and nursing. The CT scans were fast and a lot quieter than MRIs.

Tuesday morning while getting ready to go over to Stanford for my doctor appointments I felt a funny tightness/soreness in my left cheek. I also had a metallic taste in my mouth. I finished getting ready and we headed over to Stanford for my appointment with Dr. Harsh, the neurosurgeon. We arrived early and I had to fill out a long questionaire. I got about half way and they called me. I barely finished the questionaire in the exam room when Dr. Harsh came in. He said sorry to keep you waiting. I don't even think it was 12:30 yet which was suppose to be my apointment time. This guy is on the ball. I know he won't be late for my surgery.

We talked a bit and he pulled up my MRI and CT Scans. I told him about what had happened that morning with my cheek and the metallic taste in my mouth. I also told him about how I have been hearing my pulse really loud in my left ear all the time since September 5th. He wrote this down. Then he said most likely I will need the plate to stabilize my neck. He pointed out to me on, what I think was, the CT scan films where the top two vertebrae on my left side are basically gone. However, he does like to do a wait and see approach. The surgery to remove the tumor will take about 12 hours like last time. He prefers to do that part and then put me in a collar to help support my head during recovery. Then take a look, in I believe, a week and see how my neck is doing supporting my head. If the muscles are spasming without the collar and I cannot handle it they go in again and put the plate in. He said putting the plate in is no big deal. I think he said a couple hours with four small incisions. I forgot to write that part down. He did mention that the plate will mostly make my head fixed. I won't be able to turn my head much to the side or up or down. I will have to turn my torso to turn my head. This was a little hard to take but I realized it basically turns me into John McCain. Regardless of your political leanings he has managed to climb the ranks and become his party's candidate for president. So, I realized it won't slow me down that much. He also mentioned that I will be needing to have a tracheotomy, to help with breathing, this time and a tube down my throat to help me get nourishment. He said, you probably had that all before. I told him that I hadn't because the doctors said I was "young" and could handle it and my recovery would be quicker without it. He said well now you are "old" so I will need them. I want to add here that the spirit of his comment was light and humorous. But, I still may have the last laugh, because when I mentioned this to Dr. Jackler and his sidekick Dr. Monfared, in my afternoon appointment, they said I would not need all these tubes. They said since my nerve damage for swallowing and such is old and my body has already learned to compensate I will not need these. Dr. Monefared also added that our birthdays are only 3 months apart and we are not "old." I like Dr. Monefared. I must say it is a little funny having one of the guys doing this the same age as me! I am getting older even if I am not old yet. At my pre-op appointment on the 30th of September I am going to make sure that Dr. Harsh and Dr. Jackler are on the same page when it comes to the tubes or not.

I saw Dr. Jackler with Dr. Monefared in the afternoon. They pulled up my CT scan and I told them also about the new symptoms I have been experiencing. They said these are signs the tumor is growing. Though they reassured me about not needing the tracheotomy and all they did change their tune a little bit from my first appointment with them in August. Dr. Jackler said that it is likely they will need to move my facial nerve again and that there is the possiblity of having to take it. My first appointment they felt pretty confident they would be able to go in well behind the facial nerve and not even disturb it. But, with the CT scan info along with the new symptoms that started that morning in my cheek and that metallic taste in my mouth that there is evidence the facial nerve has come more into play. If the facial nerve is moved I will experience the facial paralysis on the left side temporarily and it will have to slowly recover like last time. They did say, in no uncertain terms, that should they need to take the facial nerve that they will not leave the left side of my face paralyzed. There is a lot they can do these days with rerouting nerves and stuff. He said we'll crack open a bottle of wine and celebrate if it doesn't need to be moved at all but that I will not remain expressionless on the left side forever no matter what they need to do. Dr. Jackler also said that the amount of surface that the tumor covers next to the brain is pretty extensive and that they may take it out in two surgeries to lessen the chances of a cerebral spinal fluid leak and bulging under the skin that can put pressure on the incision site. He said that will be a decision made during surgery. It depends on what they find when they open my head. I told them about Dr. Harsh's wait and see approach with the plate for my neck. They said that was fine and that they then could probably do the plate and the vocal cord enhancement at the same time. That part sounded cool.

SUMMARY:

So, the tumor is going through a growing phase again. It looks like there is a small chance of having just one surgery (remove all the tumor) and a quick procedure later to fix the vocal cord. A better chance of two surgeries. The first where they remove the tumor and then the second where they put the plate in and do the vocal cord. And there is also the chance of 3 surgeries. Two would be to remove the tumor and then the third to do the plate and vocal cord. My understanding is the surgeries would be days or a week apart. Basically I stabilize from one and go in again. I will check that at my pre-op appointment. I'm sure a lot depends on what they find when they are in there and my condition during and after surgery.

I came home to find that my previous surgical records have arrived from University of Nebraska Medical Center. I am going to scan and email them tomorrow to Stanford. Dr. Monefared gave me his email address. I read the records over. It is a blow by blow account from the time I was wheeled in to be sedated. It was very interesting to read the account of what was done while I was out. The good part was that my body tolerated everything well and there was no unexpected issues that had arose during surgery. They told me that before but you never know if there was really some minor issue that they just forgot to mention.

Well, I am finally feeling a little tired. I am going to try and get a little more sleep. Later this morning I am going to the blood center to donate a unit of blood for my surgery. I have never given blood before. They said get plenty of rest (I tried for an hour to fall back asleep after Mackenzie awoke at 3 am), drink lots of fluids, and have a good breakfast. I then go next Thursday and donate another unit.

Good night.