Wednesday, 18 January 2012

Normal is Good

Good evening all,

I've just realised that I haven't even blogged since I had my shunt surgery! That is a real shame as I have been feeling nothing short of 'euphoric' (as reads the 'side effects' section on Wikipedia for Dexamethosone) and it would've been nice to have captured some of those feelings. Although I am now quite glad I haven't, as I would've been forced to see how fake those feelings were and how much of a nutter I've been for the past week! Luckily common sense has told me that the feelings were probably not all my own, so I've kept a lot to myself. But to give you an idea - mentally, I've run the NYC Marathon, thus qualifying for the Boston Marathon, I've single-handedly packed up, moved and re-decorated our new house and driven the Audi more than my OH finally. In reality, I have just about ventured to the ladies. And haven't managed to write 3 blog entries which is what my head's been telling me. Apologies.

I have however read 2 very inspiring books this week though, that I would highly recommend to everyone - Lance Armstrong 'It's not about the bike' - brought me to tears and Matt Long 'The Long Run' - both incredible human beings who have fought battles tougher than anyone should ever have to injure. Although I'm a bit behind the times with these titles, so I'm sure people are very familiar with them already. The Lance Armstrong book in particular has also cemented my total respect for Nike - the way such a huge, global company stood by one young man (and continues to) is incredible.

But back to my little old story about the LP Shunt and Steroids... They started me on the steroids when I went back into hospital the last time around - unbeknownst to me and boy did they make a difference and fast. Testamount to that fact is that I had no idea what they were and a matter of hours later I felt better. They give steroids in this instance to reduce the swelling and inflammation (for me at the back of my head), which makes operating more simplified and the chance of infection reduced and there was me thinking they were just doing me a favour after all I'd been through - "She's been through enough, that one!"

I had been warned by a fellow Chiarian (hey we have a name!) that when she was given these steroids for meningitis which she experienced 6 weeks post decompression surgery, that she was up the next morning making everyone in the ward a cup of tea and toast! I thought she was wildly exaggerating, but honestly, they very quickly make you feel amazing - not something that can be sustained obviously but great while it lasts.

So when I went in for my surgery after 5 days of being on the steroids, I felt pretty good. But let's not be under any false impression, without the steroids the swelling would've continued and brain damage would have ensued, I don't want anyone getting the wrong impression or anything! I only say this as I was heard trying to bargain with my surgeon "but the swelling has gone down a bit, so maybe we could just leave it for a few weeks?" For all of you that thought I was brave, a classic example of me trying to get out of it!

Coming out of the op, I have to say, I felt immediately better - I've never come out of an op like that before (this is my 5th, not that I am boasting or anything). I know some of this was a false sense of wellbeing because of the meds, but the release of pressure I felt was incredible. I recovered really well in the hospital for the next week, continuing on the steroids, I was a lot more mobile than I imagined I would be.

The shunt surgery felt easier than the first surgery for a few reasons I think. When I went in for the decompression surgery, I didn't feel unwell really (apart from the A&E admissions) so it was hard to get my head around letting someone open up my brain and operate when I didn't feel I had any symptoms. Obviously the Syringomyelia is the serious symptom (more on that later), it's just that I hadn't been aware of it physically. I only had the MRI as evidence and that's quite difficult to rationalise. When I went in for the shunt surgery, I'd been feeling really unwell for weeks so logically it made more sense. And the decompression surgery is a bigger surgery and naturally more scary of course. So I felt incredibly grateful that actually the week I was in hospital I wouldn't say I was in pain, I know now that's because it was managed for me, but like I say I am grateful for that.

Those few days in hospital, reading inspirational books and being 'euphoric' did have a profound effect on me though I have to say. And seriously it wasn't all down to the drugs. The gratitude I have has been overwhelming at times. I have had such fantastic support both medically and personally, I couldn't have asked for more. I'm starting to see copies of the costs of my treatment and it blows my mind. I appreciate now that we have been through a lot (and I count my family in this of course, watching all these events has possibly been more traumatic than going through it first hand) and I recognise that for what it is. The whole thing has changed me and my perspective on life - how could it not really. I hope the feelings of gratitude and pure happiness at being alive never go away. I never want to take being able to go for a run for granted again. God, being able to get out of bed in the morning is a gift. I'm finding it really hard to articulate this part of the story because there aren't the words, it's a feeling and an experience, but I hope to live my life in a slightly different way as a result.

But normality is returning in one sense or another, slowly but surely. I came home from hospital on Friday and the staples came out on Monday. I'm now reducing the steroids as instructed and just as fast as they made me feel good, they've made me feel bad. Well, I won't say bad, I should say more normal. I feel like I've had an operation now. I had an uneasy night last night, unable to get fully comfortable and I am stiff when I move. But I'm not complaining. Sore and stiff is normal, I've just had surgery. Normal is good. Thank GOD for normal.

When asked what's been the worst part about the whole experience, it's definitely the pain I had in August, when I was first admitted to hospital. That was sheer agony, more pain than I ever could have imagined in my life. And terrifying as well because you have no idea what's going on (and neither did anyone else at that time). So much so that I actually couldn't imagine anything more painful - that's an incredibly hard concept to explain or imagine yourself and I don't think you can unless you've been through something agonising. Anyway it doesn't really matter actually because everyone feels pain differently and copes with it differently and it's not a competition. I am glad to have been through that amount of pain because I have a better understanding of how I cope with severe pain now. It makes me less afraid of life. We are pretty tough creatures, human beings and I am pleased to know what I'm made of!

So it's no wonder really that today and yesterday I've been bored. Yay for bored! I've been in my pjs because I'm not allowed to shower now the staples have come out, there's nothing on telly, I've read all my books, I'm bored of Gossip Girl (I know, how can this be!) and now the excitement of food is even wearing thin...

Actually, I need to pause for one second to talk about this... can I just say I have been eating the most amount of food known to man! Apparently that's the steroids too. Thank goodness I had lost so much weight from weeks of sickness otherwise I'd be the size of a house by now. I have literally been a total glutton. It's been fun but it can't go on! While I was in hospital (the private one) I was eating: toast, poached eggs, grapefruit, cereal, coffee and juice for breakfast, followed by a 3 course lunch and 3 course dinner, plus an afternoon snack of Ryvita and cheese, bags of crisps, fruit etc. I was like a woman possessed when my OH came to visit "can you get me some food?!" every time. Texts throughout the day with more food demands. I was having proper cravings for really specific things. I suppose a bit like being pregnant, I'd have probably murdered for Tyrells Sweet Chilli crisps at one point. It is passing but it's not gone yet - for lunch today I ate: oven chips topped with about a pound of cheese and 2 packets of Uncle Ben's Vegetable Rice. OMG what is WRONG with me.

Paella for dinner, cooked by the hubbie! More rice, more carbs and there will definitely have to be a dessert as well...

So what's next? I am going to gradually heal from the shunt surgery and give the system a chance to regulate the new pressure over the next couple of weeks (repeat after me Sarah, I must take it easy!). Then I'm going to start my phased return to work - the thought of being well enough to work again is v exciting; I will never moan about going back to work in January after Christmas again! Then in about 5 weeks time I will see my neurosurgeon for my post op check up - he will check the progress of the Syringomyelia, which hopefully will have started to shrink and then we can really start to move on. Wow that's a dangerous paragraph planning it all out like that, but you know what - whatever happens, it's going to be OK. It'll be what's meant to be and we'll deal with it as it comes. I just wanted to put some hope and positivity out there!

Oh and more good news - I am reducing my over-active thyroid meds! Hey life is pretty good.

Lots of love,
Sarah x

P.S. Any suggestions on boredom busters, please let me know! Bare in mind I've been off work for 10 weeks now!

Sunday, 8 January 2012

And So 2012 Begins...

I actually wrote this at the start of the weekend but didn't have chance to publish. For some reason, on the morning of the op, with 10 mins to spare before we have to leave the house, I feel the need to get this out there. As I already told you, I'm a shocker for 'lists' and this is one of the only remaining things on my list.

So, Happy New Year...

I hope you all had good ones. This year, we sat in and watched Jules Holland. It was calm. Well, for a bit anyway. The only New Year's Resolution I made this year was: No More Dramas. Sadly, that has already been broken, but through no fault of my own (as kindly pointed out by a close friend), so I guess that doesn't set me up for bad karma for the rest of this year, as if I needed that. Let me fill you in.

As you will know from my previous entry, the last time I was in hospital (10-16th Dec), I was diagnosed with 'severe migraines' which as I mentioned I was skeptical of at the time. I should qualify this really. It's just that you often hear people talking about the fact that they get conditions like migraine or tonsillitis or IBS and it turns out to be a bad headache, a sore throat or a regular tummy upset. I'm not saying that about everyone and I know there are plenty of people suffering chronic conditions everyday of their lives, but given the fact that when I get one of these migraines I am paralysed down one side, cannot speak and am in agony that even morphine struggles to take off, I was not very accepting of the diagnosis - simply because of my understanding of what a 'migraine' is. I couldn't see how other migraines I'd witnessed were the same as mine, or how I would get anyone to take my diagnosis seriously that I needed time off work, or that I was hospitalised.

In addition, it just seems odd that I've never suffered 'migraines / severe headaches' before this year and I find it hard to believe all the head pain isn't related to this brain condition. That said, I was diagnosed by a Consultant Neurologist from Queen's Square, so if anyone should know it should be him, so I had been forced to start accepting it.

About 3pm on New Year's Day, I was going up the stairs to get changed to go for a walk with my OH, brother and his gf. When suddenly I got a horrendous pain across my shoulders that went up my neck and head into the are around my wound from the surgery. Over the space of a few hours it crept over the top of my head and into my face as well, but not as severely. The pain rendered me incapacitated for about half an hour and I was in bed in tears. The pain finally subsided enough to go downstairs but not to go out for the walk. Then when I tried to eat dinner, it sounds bizarre, but I couldn't get my mouth open wide enough to eat, so my table manners left a lot to be desired! I also couldn't open my mouth wide enough to yawn and this was causing a lot of pain!

Note: This pain was totally different to my migraine pain / experience. The head pain was in a different place, the pain felt different and there was no tingling/paralysis or inability to speak. So it is possible that the migraines are a separate thing, granted.

Between being in hospital with the severe migraines and the NYD attack, I'd also had some strange goings on and a general feeling that actually I had stopped getting better and actually started to get worse. I had been planning to go back to a phased return to work on 3rd Jan and it just kept feeling more and more unrealistic. Some of these symptoms included:
- Keep forgetting everyday words and finding it increasingly hard to converse with people
- Walking around the house and veering off to the side unexpectedly
- General balance and co-ordination problems
- Cramp like pain in between my shoulder blades
- Continued/increased nausea and vomitting
- Dizziness and pain when moving position
- Sudden head pain when sitting down / getting up / walking / bending
- Unable to open my mouth wide enough to fully yawn due to pain / stiffness

So come 1am on New Year's Day when I was still awake and in agony, I knew it was time to go back to hospital. I just felt like something was wrong. My OH called The Wellington where I had my op and they advised us to go to A&E because they had no Neuro-Dr at the hospital overnight. The last few times we'd always been to the local A&E and although the staff were very caring, there was no designated Neuro Ward/Unit and the knowledge of my condition/s had been very limited and in the end I'd only be transferred back to The Wellington anyway. So this time we went to the Royal Free, which although is still NHS, it has a massive Neuro Ward and my actual surgeon works there as well, when he's not working privately. We were sent straight through Triage - although we then did have to wait 5 hours to go up to the ward, but it was the early hours of 2nd Jan and NYD had been one of their most violent on record apparently. Which you could well believe given some of the people in A&E on 2nd. Plus by then the pain had subsided quite a lot and it was obvious that I wasn't urgent, urgent.

I could quite literally blog on here for a month about my 2 nights in a London NHS hospital, not least about the 'Gruel and Mash' I was given for dinner one night (I was actually thankful that I was being so sick I couldn't eat) or the view of the woman opposite going for a... 'Number 2' with the toilet door open, or the sheer emotional disturbance of witnessing another patient going through 3 agonising Lumbar Punctures (due to an issue with an op that I'm about to have) - however the main point to highlight is that the nursing staff, Drs and Surgeons were incredible - so caring and knowledgeable and easily on a par with their Private counterparts. The only things I would criticise is that they are under-staffed, under-paid and over-stretched, resulting in them not being able to do the best job.

To cut an exceedingly long story short, my Neurosurgeon came to see me on 3rd Jan on his return from the Christmas break and diagnosed a Pseudomeningocele (swelling of fluid collecting at the wound site), which is causing pressure on the head/brain and some of the strange symptoms I've been getting. The last time I'd seen him at The Wellington (when I was diagnosed with the migraines), he had said something about the back of the head being quite 'full' and that he wanted to see me in a month about that. I hadn't even had a chance to make that appointment and hadn't paid much attention to that given everything else (being tested for Epilepsy, Strokes, Tumours etc). But it became clear that one of the things the surgeon checks at your 6 weeks post surgery appt is the swelling to the wound (fairly obvious when you think about it) but I'd never got to that appt because of everything else going on. Anyway he wasn't happy about it and so I transferred back to The Wellington for more monitoring and tests. He warned me that it was highly likely that I would need another operation, known as a 'Shunt'. In the meantime I was put on steroids and more painkillers.

To recap for a second:
In Aug I was diagnosed with suspected migraines and 'incidental' Chiari Malformation
Then in Sept I was diagnosed with Syringomyelia ("but you have no symptoms, which shouldn't mean you need surgery") and Over-Active Thyroid (given meds)
In Oct I saw the Neurosurgeon who told me I did need surgery for the CM and Syringomyelia
In Nov I had surgery for the Chiari, which in turn should treat the Syringomyelia
In Dec I was diagnosed with severe migraines
Then in Jan I was diagnosed with a Pseudomeningocele
I am due a review of my Thyroid meds in Mar
In Jan I will have my shunt op (see below)

Don't worry if you're not following, they're not brain surgeons for nothing, hey!

Basically CM is where the brain sits too low in the skull and in my case blocks the normal flow of spinal fluid. This results in a cyst in the spine (Syringomyelia) or sometimes fluid on the brain (Hydrocephalus). They operate on CM when there is a cyst present or daily symptoms are very severe. If left a cyst will more than likely paralyse the patient, even if they don't get any symptoms at that point in time (like me), usually by the time they get symptoms it's too late to operate, as damage cannot be reversed. So that's what they did, operate on me in Nov. Unfortunately the body hasn't adapted to the operation and still isn't processing the spinal fluid properly, so now it's collecting at the back of my head (and maybe not in the cyst), but of course this cannot be left either as it could result in Hydrocephalus, brain damage or death. So now they have to do a Lumbar-Peritoneal Shunt.

The shunt is a tube that they put into the bottom of my spine to drain away the excess fluid into the peritoneum (abdomen), it will then be reabsorbed by the body and expelled. My NS is doing this on Monday. The op takes about 1.5hrs and I will have 3 scars - 1 down my spine, a 'stab' wound in my side and a scar across my tummy (I think a few of inches). Shunts are permanent, but only last about 10-15yrs, so I will have to have it replaced in time. They can over or under drain, get infected, or slip, so it's not uncommon that they have to be adjusted etc, so it's possible that this is not the last surgery I will need. But that's OK. I'm OK with this, it could be worse after all.

The bottom line is, my body doesn't deal with the spinal fluid correctly. It never has done and it never will, without help, unfortunately. However, the fortunate part of it is that I have an amazing surgeon, I live in a country where although this surgery is quite new in medical terms, it is a well recognised technique and I have amazing healthcare. My family and friends have been nothing short of amazing, with so much thought and support, I have been overwhelmed by the generosity - both in terms of time, messages, gifts and hugs!

I am also incredibly grateful that I have had this experience to a certain extent, because it's made me see things very differently. I have a new perspective on the world that's for sure and things that used to be really important to me, I now know are totally trivial. The most important things to me are the people I love and that are close to me and being a decent human being. That's it really.

So I've been let home for the weekend, before the op, which is awesome. Although this morning started with me having a weird fainting/shaking attack as I got out of bed and me nearly falling down the stairs. My OH managed to catch me before that happened and made me amazing tea and toast! That's one of the most frightening things though, is all these bizarre things happening to your body that you have no control over. To go from being totally in control to totally not, is very strange. But actually, I'm beginning to think maybe it's the best thing for me. I had got quite OCD / timetable-led about life and putting pressure and stress on myself which was totally self inflicted. I don't think it's a bad thing that I realise that perhaps it's not all down to me and I need to let go a bit more!

Bit of a rush to get this update out, but I wanted to share every step of the journey as promised, there would no point if not. I just read this back and I think this doesn't even cover the half of the drama, but those that know me can imagine I'm sure! Just imagine sick, sick, sick and more sick, fainting attacks, agonising pain, tears and general terror. That said, I think I have coped reasonably well, this is my/our life at the moment and has been for 5-6 months. Maybe one day I will go back to work...

Did I mention that we are 2.5 weeks away from moving house / first house purchase? :-)

That's all for now folks, see you post op!
S x