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Overview

Four years ago, Laurel was diagnosed with a stable, unruptured, fusiform brain aneurysm on her middle cerebral artery (MCA) in the area above her right ear.

Procedures for removing aneurisms in the MCA are performed by choking the aneurysm off with a microsurgical clipping technique, performed via craniotomy, while most others can be treated using a coiling technique which is performed using a minimallly invasive endovascular method. The methods are significant to us because Laurel's aneurysm, being located on the MCA, makes it a poor candidate for use of the endovascular method.

I'm going to be updating this article day-by-day. Please check back often!

January 28, 2018

We are preparing for a trip to Florida tomorrow. We're not visiting Disney World or even going on vacation. And we're not bringing kiddo with us. It's a getaway for two... to the Mayo Clinic.

The Mayo Clinic was Laurel's choice of medical practice for taking care of her aneurysm.

I think it's fair to say the discovery is what really pushed Laurel to have the vertical gastric sleeve surgery in 2016. The resulting weight loss resolved a number of problems that would have added certain risk to the procedure we're preparing for in the coming week.

For my part, I am working very hard to convince myself that we are in the place we're meant to be in right now. Faith in that notion ought to relieve me of the stress I'm feeling.

January 30, 2018

The Mayo Clinic in Jacksonville is comrpised of three interconnected buildings. One can walk from one building into another and never really know one had changed buildings. The Cannaday and Davis buildings contain clinics and administrivial functions, and they are on opposite sides of the Mayo Hospital building.

We arrived in Florida on Monday evening, and on spent most of Tuesday moving from clinic to clinic as directed, often repeating information we'd told the previous clinician. We started in the Cannaday building, where we met Laurel's physician and talked strategy.

We also found at the time that Mayo never received the image files from our local hospital. This, in part, is what put us on track to schedule a diagnostic cerebral angiogram.

The angiogram is essentially comprised of a probe, which gets inserted into the body, a dye, which gets injected into the body, and a large machine which captures images from the probe's point of view. At least, that's how I understand it. The angiogram was itself a surgical procedure, albeit a minor one.

UPDATE:
All work and no play makes Jack a dull boy, and Jill a dull girl. We're in Florida for goodness sakes. We're looking to spend at least a little time in the sun. So earlier in the day we got a recommendation for a seafood place, and tonight we visited. I give you the Safe Harbor Seafood Company, right on the water.



The blackened Dolphin and blackened Trigger were outstanding. The conch fritters were a trip back in time for me.

January 31, 2018

We reported to the Mayo Hospital at 6 AM on Tuesday morning and, due to unforseen circumstances, didn't actually have the procedure until close to noon. The angiogram took about an hour and a half. It still ended up being a very long day.

We spent the evening just laying around watching TV and ordering in. We ordered from an American gastro pub and the food was awesome. Laurel got caught up on all the grease and carbs she'd been missing, and we slept pretty well.

Perhaps part of the reason we slept so well was the phone call we received from the neurosurgeon's nurse — we were able to schedule the craniotomy for next Monday.

February 1, 2018

Today is Wednesday. We slept in until 9 AM — even after having napped for a little while the preceeding evening. We've a consult scheduled with the neurosurgeon for early this afternoon.

The surgeon told us a little bit about the craniotomy, and the risks involved. The plan is for an incision behind the hairline beginning above the ear and extending upward toward the top of her head, then basically folding the skin forward to expose the bone. (My palms are getting sweaty as I type now.) There were two considerations he pointed out:

• There is a network of nerves that seem to originate from the area of the ear and radiate forward to the face. Among these is a nearly invisible nerve which connects to the muscle used to raise the eyebrow. If the nerve crosses the "fold" of the skin, it is possible that the ability to exercise the eyebrow muscle may be temporarily retarded after the surgery. Think of it like what would happen if you were to fold a garden hose over onto itself.
• There is a muscle attached to the skull called the temporalis which protrudes downwards from the skull and wraps around the jaw, at which point it's known as the masseter muscle.
  
  
  Image credit: Duke University
  
  The neurosurgeon explained he would have to make a split in the temporalis to get to the bone beneath. A byproduct of the incision is some affect the act of chewing, probably until the muscle heals.
  
  There's also some concern about the split causing atrophy of the portion of the split closer to the face as a result of decreased blood flow, which could result in a minor disfiguration near and behind the zygomatic process, which is the portion of the skull at your temples. The neurosurgeon characterized this as happening to most, but cosmetically noticeable in some.
  
  
  Image credit: Wikipedia
  

A note on yesterday's angiogram: Laurel doesn't seem to be experiencing any discomfort today. The incision site (I guess I'll call it that) looks good, and only minor bruising is starting to appear. She was good last night, staying off of her feet and letting me handle picking things up off of the floor. She hates not being able to do for herself, but she's a good patient.

UPDATE:
It's later in the evening. Our appointment with the neurosurgeon ran very late — we didn't actually talk with him until over an hour after our appointment time. During our visit, he answered every question we threw at him, but we came away with a very nice (??) overview of what will be involved with the procedure on Monday.

One other thing we learned was why the CT scans from our local hospital are still important to him: CT scans offer context the angiograms don't. Put another way, the angiograms highlighted the MCA and the aneurysm, but blacked out everything else. The benefit of the CT scans, even though they're less precise, is that they show the MCA and the aneurysm in relation to everything else - the bone, muscle, and other tissues beneath and above.

The neurosurgeon is considering ordering a CT angiogram (CTA) in case the local hospital doesn't come through with the scans they did last August. A CTA differs from a standard CT scan in that the scan includes the injection of a dye to increase the definition of veins and arteries in the image.

The surgeon described Laurel's procedure as a right pterional craniotomy. Google it at your own risk. Also, Laurel's aneurysm is located on her MCA at a position roughly equal to the Sylvian fissure, which is the boundary separating the frontal and temporal lobes of the brain. This is a huge bonus for us, because it means no navigation will be required inside the brain.

One of the things that will happen at the close of the procedure is that they will inject a fluorescent dye into Laurel and monitor her circulation to ensure the clip is stable and that they didn't adversely affect anything else. I likened it to when automotive technicians added a fluorescent dye to the gas in my car, then went under the hood with a black light to look for compromised seals.

Finally, there's an additional side effect to the procedure. Laurel may experience some temporary swelling in her right eye as a result of a pooling of fluids. The swelling will go down.

At this point, we're in vacation mode until Monday morning at 6:30 unless the surgeon orders the CTA; and the surgeon ordering the CTA means they were unable to get the imagery from our hospital at home.

February 2, 2018

Slept in again. We were up late, having driven down to St. Augustine for dinner with friends at the Gypsy Cab Co.

Today is about administrivia: extending the hotel and car reservations and so on, plus picking up a few odds and ends at the grocery store: our coffee creamer supply is critically low.

It's nearly noon, and we've not heard from the clinic. This seems to suggest they received the imagery they were looking for, and didn't order the CTA.

We don't have any big plans for the day.

P.S. - if you've ever questioned the value of the trip insurance offered by the airlines, here's a tip: Laurel bought the trip insurance for this trip, anticipating (correctly) the chance things might not go as originally planned at the hospital. The trip insurance will reimburse us for all costs related to our extended stay. After burning through all of the hotel rewards points I had left, the extended reservation still cost over $2,000. Add to that the cost of food, rental car, and so forth... it's significant.

UPDATE:
We drove to St. John's Town Square this afternoon. I got a great photo of Laurel reclining for a pedicure with a mimosa. Dinner tonight at J. Alexander's. The paneed hake (rhymes with "make") with lemon butter crab sauce was insanely good.

After dinner we walked around the square and did a little browsing.

And our creamer shortage has been resolved.

One last thing for tonight — I went down to stick my feet in the hot tub for a few minutes and came upon a guy drunk on Bud Light who was really touched by the notion that the hotel caters to Mayo Clinic patients. I made the mistake of mentioning Laurel's impending procedure and he offered (several times) to give me his phone number so I could call him on Monday if I wanted to talk. His advice to me was to stay positive and "move on," by which I think he meant to just take things as they come and not to dwell on them. He may have been completely wasted on cheap beer, but that doesn't mean the advice was bad. I thanked him by calling and asking the front desk to look in on him when I got up to our room — I didn't want him alone in or near that hot tub in the condition he was in.

February 3, 2018

The drunk guy from last night was at the hot tub again this morning when we came down for breakfast.

We ended up driving back to the airport to swap rental cars. Our first one was a Dodge Journey, a small SUV. It was a brand new car, but the infotainment center was rather bizarre and it had no back-up camera... it's surprising how much we've come to depend on those things. Our new rental is a Ford Explorer with navigation and a back-up camera. I guess the iPhone interfaces with the infotainment system via an app that has to be downloaded and installed.

All cleaned up and pretty again, we'll be heading out for some lunch at either Taziki's or PDQ, then we'll head east to see the beaches — it may be 60° and overcast, but hey, it's not snowing.

We're now on what we'd call the second leg of our trip — that is, we've reached the point where our original reservations have expired and extensions or new reservations have taken over. It's why we drove the original rental car back to the airport this morning to exchange it for another.

This afternoon we drove out to Jacksonville Beach. It was probably about the worst day we could have visited: cloudy and super windy.



We spent maybe 20 minutes walking along the beach and immediately sought out a coffee shop to warm up. (We found a Starbucks a few blocks away.)

February 4, 2018

Super Bowl Sunday started out with rain, although it's warmer than yesterday -- it's 66° as of 10:30 EST.

We're planning to hit up a shop or two today — scarves for Laurel to wear around her head post-surgery, and I'm in need of some better footwear (I've been walking about in my slip-on Chucks — great for airport security lines; not so great for all the walking we've been doing).

We'll figure out what time the game is on and order in. I'm certain today is like Black Friday for pizza shops.

I've been noticing that Laurel has been spending a lot of time surfing Jacksonville real estate. Today we spent the afternoon walking through model homes in two separate real estate developments. She wore me out. But we saw two models that were laid out really, really well.

So in preparation for the Super Bowl, we ordered a deep dish pizza from a local place named Siena's Italian Cuisine — we opened the heavy box to something resembling a cheese wheel. They provided a marinara sauce to go over the top. Wow was it good!!

We tuned into only the last couple of minutes of the Super Bowl. I had been following along via intermittent queries to Siri while Laurel watched every episode of Worst Cooks in America — it's funny how every television we own or watch for an extended period seems capable of only receiving the Food Network and the Travel Channel. Anyway, we caught the last couple of minutes when it was looking like the Eagles might actually pull it out... I'm glad Philadelphia is bringing home the Lombardi Trophy, and that the Patriots seemed professional and gracious about the loss.

February 5, 2018

5:15 came awfully early this morning, following an uncomfortable night before surgery. Laurel was wheeled into the O.R. at 8:30 AM on the dot, with a little pain medication in advance to help with anxiety. It seemed like the decision and all it entailed suddenly left the realm of academic exercise in the five minutes before she left. And in a way, I'm very grateful — I had been the one doing all of the crying up to this point.

I'm crying because they're cutting my beautiful baby's head open. I know they're doing a good thing — although I still can't quite let go of how close the call was between operating and leaving it alone. When it's over she's going to have screws and fancy washers holding a baseball-sized piece of skull in place, and her face will have been peeled back and sewn back together. She will be bruised and swollen and scarred, and we've been told about the weird noises she'll hear from the air that got let in. Nobody wants any of this for a loved one. The notion of this is making me cry now — how will I ever keep it all together when I see her this afternoon?

I'm back at the hotel now. I've eaten, had a little coffee, and have the A/C working a little overtime to make up for whatever got changed yesterday — the room temp was part of the reason sleep was evasive at times. I'm going back to bed now to try to catch up on some of the sleep I lost earlier.

UPDATE 1:
12:30 PM EST. No word yet from the hospital, but that's to be expected. After making the previous entry I texted a few of Laurel's friends directly and took a nap for a little while. Just got up and made a little food. I figure I'll get cleaned up and head back to the hospital in a little bit. 1:30 PM EST will mark five hours.

I anticipate the next word I'll hear is that she's out of surgery. I think their practice is they take her back to ICU and do a few things (basically, this is recovery) before I'm invited back to see her — so I won't get to see her right away once she's out of surgery. BTW, recovery in ICU is standard operating procedure (forgive the unintentional pun) for craniotomy patients.

UPDATE 2:
12:54 PM EST: I just got a call from the hospital. The news is, "Things are going well," and that the surgeon "is currently working under the microscope."

As with many things about this trip, the message was a little vague. I guess the second sentence means they've begun work on the aneurysm. The poor volunteer who phoned me is a guy sitting at a desk someplace — he's got no direct knowledge, so... *shrug*

I really liked the first sentence, though.

UPDATE 3:
2:39 PM EST: Hospital reports "the aneurysm has been clipped and secured." We're now at hour six of the procedure; I assume this report means they're testing and getting ready to close. Next call I receive from the hospital should be the neurosurgeon.

UPDATE 4:
3:40 PM EST: Neurosurgeon reports surgery went well; ran long because the aneurysm was nestled up against the frontal lobe, so extra time was taken to maneuver in to isolate the aneurysm. Two clamps were used to cut off the blood flow, and her vitals were constant and good throughout.

I was STILL on the phone updating everybody when I got the next call...

UPDATE 5:
5:20 PM EST: Laurel is out of recovery and ready for me to come visit!

UPDATE 6:
9:00 PM EST: Laurel is resting comfortably for the moment. She’s got all of the symptoms we were told to expect—- headache, pain in the jaw muscles on the right side, and pain probably from swelling behind the right eye — but nothing more (apart from a touch of nausea, which is common in craniotomy patients). Pain management has made her sleepy.

And I am thankful.

She was a little bit of a jerk when I got there — she demanded her lip balm and then basically told me to shut up when talking to the nurse a few minutes later... so I sat quietly for a few minutes until she asked for me again. I sat with her there for a few hours, in the dark, feeding her crushed ice as she'd ask for it.

She looks good — as good as a woman whose head is wrapped in a bandage can, I guess. Her right eye looked a leeeetle droopy, but I'm not sure if that's just the effect of the bandage or not. No bruising or swelling that I could see, but it's possible those may set in overnight.

Drove back to the hotel, made myself a bite to eat. Started considering this evening's entertainment options as I was typing. I could write some code, but I think I might hafta sugar up to do it. Maybe I'll browse some new books on my Kindle or just surf the Chive for a little while... I could use some funny.

UPDATE 7:
11:50 PM EST: Ended up playing a few hands of solitaire and watching the latter half of Doctor Strange. The hospital scenes read differently now.

Tomorrow I plan to sleep in, shower, eat, and head back to the ICU. Perhaps I'll bring the laptop along and bang out some code.

February 6, 2018

12:30 PM EST: Laurel is recovering well. She's eating, drinking, walking, and using the restroom with assistance. Pain management still keeps her sleepy. Some bruising happening on the right side of her face; her jaw is still sore, and she still has that headache. By all indications, her recovery is progressing very well. She's already had an IV removed, and she'll get her bandage taken off this afternoon. Apparently the hospital has a fun selection of hats from which she may choose... she's looking forward to it.

She was moved out of ICU and into a room on a different floor late this morning. She's sleeping again now. Lunch today is a mango smoothie with protein powder added, and chocolate pudding. Her choice.

I didn't exactly sleep in this morning, but basically everything else went according to plan.

So far today I got to speak Russian and Tagalog in addition to English. Such a win.

Yesterday was pretty frenzied with constant updates — basically every call I got from the hospital became about an hour of some combination of calls, writing update texts, an update post to Facebook, and updating the site. I took the call from the surgeon while I was in the car, and pulled off of the street. I sat there for an hour. I expect that updates will be far less frequent from today forward — particularly the urgent messages and calls. I'll still respond to queries as I can.

UPDATE 1:
1:35 PM EST: Bruising is really becoming noticeable around her right eye. She's been asleep for about the past 45 minutes. I've been silently working through 4 oz. of steamed broccoli for most of that time.

UPDATE 2:
10:40 PM EST: Laurel's bandage was removed late this afternoon — at least, most of it was. Beneath the bandage is a... honestly, I don't know what this thing is. I would have expected it to be gauze... it's where gauze would go over the sutures, along the seam where the skin was cut. Only it's not gauze. It might be a pad from a 3M Tegaderm dressing, but with the transparent adhesive removed from around it.

When the bandage was removed, Laurel complained of her hair being "matted" in the back. As best as I can tell, perhaps a drop of glue fell on the back of her head. So, doing the math (read: I'm completely reaching here), perhaps whatever that long strip is was actually glued over the shorn skin. I heard the nurse mention that someone was going to remove the remainder of the dressing tomorrow, and to shampoo her hair.

I had been worried about the reveal... worried about how I would respond. I snapped a couple of photos for Laurel to see and she wasn't exactly elated with her current look. But I'm following Phillip's advice, and just "[being] positive and moving [forward]."

Thank you, Phillip.

February 7, 2018

Got in a little late this morning, wrangling coffee and iced tea as ordered.

I struggled into the room to find Laurel awake and without the remaining dressing. A short while later she was escorted into the shower.

When we left last night, we'd requested a different anti-nausea medication that Laurel knew worked well for her. Sometime in the night it must have been authorized, and I was overjoyed to see her eating applesauce this morning.

A nurse came by a few minutes ago and mentioned there's talk of releasing her today. Personally, I think I'd rather she stay through to Thursday. She's barely eaten in the past couple of days, and at this point she's eating applesauce. I guess I'd prefer she have a little more nutrition under her belt before we head for the hotel.

She's sleeping again. I'm sure the shower really took it out of her.

UPDATE:
3:30 PM EST: Lots of sleeping happening, but in the breaks she's using the toilet, and going for walks.

I need to do a little bit of grocery shopping this afternoon, because I'm running on low on supplies at the hotel. I'll probably take off in about 45 minutes to do that — hopefully by doing so I'll avoid the rush hour mess on San Pablo and Beach Boulevard. I'll grab some dinner in the room while I'm out and come back for a while this evening.

February 9, 2018

Laurel was discharged from the hospital yesterday. She ate some dinner last night and ate some breakfast this morning. She has three medications -- one of which is for the prevention of seizures (another standard operating procedure for craniotomy patients). Her other prescriptions (pain and anti- nausea) are further fortified with Tylenol and Advil.

Her swelling continues to decrease — she noted this morning that the FaceID on her iPhone is working again. She's still got a headache of course, though it's not as bad as it was.

February 11, 2018

Laurel's swelling is just about gone — her jaw and cheek are still a tiny bit swollen, and she's still got some color in the area of her temple and right eye.

She had a very active day yeterday. We stepped out of the room for a while and did a little shopping (she drove a motorized cart), and we went out for sushi last night. The roll made her stretch her mouth a bit, and her jaw is sore today (oops). We also stayed up late last night watching the olympics.

Also, she didn't nap yesterday. She finds she's a touch tired today.

Chick-Fil-A's sriracha sauce is not my friend.

February 12, 2018

Last night we went to another spectacular seafood restaurant. Marker 32 served a Mahi Hoppin' John with a beautiful basily flavor that sent me into orbit. The black-eyed peas and rice were a bit heavy - almost mealy - and weighed down the dish enough that I could only eat half. The basil was the perfect introduction for the marinara atop the fish. It was crazy good.

A neighboring table remarked that Marker 32 is known to be second only to Safe Harbor Seafood for the quality of their seafood — and that's because Safe Harbor actually fishes for the food they serve. Looks like we've covered all the bases here!

More importantly, Laurel looked beautiful at dinner. She's got her curly hair arranged around a bandana, and any remaining swelling is imperceptable without careful study.

She completes her anti-seizure medication tonight (she never had a seizure), and she'll have her staples removed on Thursday. At one point yesterday she logged into her work computer and spent some time catching up with one of her peers. I slipped out for a sorely needed shave... two weeks away from my clippers did me no favors. We had a little down-time yesterday afternoon, laying on the bed and watching women's olympic ice hockey (USA beat Finland).

So far today, she's playing on her XBOX. I interpret this as a huge step, because gaming tends to create elevated mental activity. I admit I'm curious to see how long she'll play and how she'll feel when she stops.

February 14, 2018

Laurel continues to improve, though I have noticed she's got some bruising on her throat now, probably from her intubation during the procedure.

Her use of the medication has been declining. We talked about it a bit, and I learned that she's moving away from prophylactic use and toward management-as-needed. I've been meticulously logging her consumption of both the pain and nausea meds as well as her supplementary OTC meds, and all have been in decline over the past two days. She was typically using one of the OTC's at about 90 minutes after her prescription meds; those times have been slipping to two hours and beyond. She's actually run out of the nausea med, but she's getting it refilled.

Last night we had another new dining experience: TacoLu is located just over the bridge toward Jacksonville Beach. They're a casual, Day of the Dead-themed taco joint and bar. Their "$10 Taco" is made with Filet Mignon, but it doesn't hold a candle to The Carne Royale.

Today, Laurel is out getting some "face time" with a beautician while I hang back in the hotel room to have an interview with a prospective employer — my second in two days!

February 16, 2018

Laurel got her staples out yesterday afternoon.

Afterward, we went out to celebrate. Dinner was at Pusser's Bar and Grille at Ponta Vedra Beach. I couldn't have been more excited about this — during my service to our country I was lucky enough to participate in the time-honored British naval tradition of splicing the mainbrace. The restaurant even had a rum tub under glass:

Today was our big day for heading out to the beach. And the weather didn't disappoint.

We're finally coming home tomorrow. We spent this evening in the room having Chinese take-out, doing laundry and packing our bags. We can't wait to rejoin the rest of our family!

February 17, 2018: Home Again

After a long day of travel, we made it back home at about 10 PM. The longest part was about four hours on the aircraft taking us from Dulles: Bad weather was moving in, and we sat in the plane for about an hour and a half before we went anywhere. But we did okay, and got home safe.

We were welcomed home with a small banner hanging in our bedroom and another by the back door — both painted by kiddo. When I got in the door she gave me the biggest hug ever and wouldn't let me go. I won't soon forget it.