I Have Random Thoughts Of Randomness

So, here's a story.

A couple of years ago, my wife got a CT scan for a problem with her collarbone. The radiologist who read the CT saw something else — an aneurysm on her anterior communicating artery, a small vessel that connects the left and right anterior cerebral arteries in the brain.

Further testing showed that the aneurysm was moderate in size — big enough to notice, but not really big enough to worry too much about. We decided that the best thing to do would be to just watch and wait, see if the thing grew and so forth.

Part of the reason that we were more inclined to watch and wait as opposed to treat the aneurysm is because the neurosurgeon we spoke to said that the best option for the type of aneurysm it was was a process called clipping. When an aneurysm is clipped, the surgeon goes into the brain and puts a metal clip around the neck of the aneurysm, blocking it off from the vessel. My wife had a brain tumor removed 12 years ago and wasn't keen on the idea of having her head opened up again. The changes of a rupture were very small, so we were OK waiting.

Another part of the reason we waited was the surgeon said the other option, coiling, wasn't a good option in this case because the aneurysm had a wide neck. Coiling is the default procedure for most cerebral aneurysms these days because it's an endovascular procedure. The surgeon starts in the femoral artery near the groin and works a catheter up to the aneurysm, where he fills the aneurysm sac with coiled up platinum wire. Although not as effective as clipping, coiling is an easier and safer procedure.

My sister sent me an article about a new aneurysm treatment called the Woven EndoBridge (WEB) Aneurysm Embolization System. It's similar to coiling, but uses a little wire mesh that expands to fill in the aneurysm. We asked our doctor about it, and he flew up to the manufacturer with the high-resolution images of several of his patients aneurysms, including my wife's. Unfortunately, it was decided that my wife was not a good candidate for this new procedure, but the surgeon realized that she might be a good candidate for stent-assisted coiling.

Stent-assisted coiling is just like regular coiling except that a small tube is inserted into the vessel to help block off the aneurysm. After some consideration, my wife decided that she wanted to have this procedure.

Last Tuesday, my wife had her cerebral aneurysm treated with stent-assisted coiling. There were all sorts of risks. The surgeon himself said that there was only a 70 percent chance of a complete embolization. Things could go wrong if the stent didn't hold position or any number of other things went bad. However, the odds of a bad result were small, and slightly less than the odds of something bad happening if we continued to do nothing.

The procedure went well — much better than expected, according to the doctor, and was a complete success. My wife recovered quickly, and was able to come home the next day.

Now, one thing the patient has to do to prepare for this procedure is take an anti-platelet drug. Initially, she was given Plavix combined with aspirin. The goal of this treatment is to keep clots from forming in the brain around the stent and coil. It was quickly determined that my wife was non-responsive to Plavix — extremely rare — so they had to switch her to a drug called Brilinta, which is much more powerful and thus also more likely to cause bleeds, which are also not desirable in the brain. We were informed that my wife would need to continue to take Brilinta and aspirin for a minimum of three months, and maybe longer.

Saturday, we were relaxing at home. My wife was tired, and didn't want to go to bed, but didn't feel up to sitting up. I moved a twin mattress we happened to have into the living room so she could stretch out. She put on some foam wedges she uses to elevate her head and knees. About halfway through the movie, my wife asked me to pause. Something didn't feel right. She asked me to help her up, but she couldn't get up. She couldn't move her left leg at all.

While I hoped that her leg had just fallen asleep on her, we called an ambulance just to be safe. They took her into the emergency room where it was determined that she had suffered a very small stroke, and that she had a small bleed near the aneurysm.

The neurosurgeon on call performed an angiogram to get a better look at what was going on. What he found was that a tiny clot had formed on the edge of the stent. It was likely that the clot formed, some broke off and then caused the bleed.

So, there was a problem. They couldn't treat the clot because of the bleed, and they couldn't treat the bleed because of the clot. Anything they tried surgically might well have made matters worse, so they backed out and decided to adjust my wife's medications to address the situation medically. This meant upping the dose of Brilinta a bit and adding a small dose of another blood thinner called Lovenox.

This morning, they performed an MRI to find out the status of the bleed. As it turned out, it appeared that the bleed had stopped and had done only a small amount of damage. The neurosurgeon who did the angiogram expects my wife to make a full recovery.

That's where we're at now. My wife is in the hospital for now. She has regained some ability to move her left foot and is working on exercises to restore it. She is in good spirits and appears generally happy.

I stayed in the hospital room with her last night, which was probably a mistake because I got almost no rest and am exhausted. I've come home tonight so I can get a good night's sleep and be fresh to face whatever challenges crop up back at the hospital tomorrow.

I'm hoping that my wife is able to regain the use of her foot quickly and completely, and that she doesn't suffer any further problems.

I guess we'll see how it goes.