Wednesday, December 15, 2010

December is my "Mad World."

It's all craziness over here.
Maybe not craziness.
a certain feeling of ....
needing to recuperate is settling in
And it's not even Christmas yet!

Paul has been having doctor's appointments galore and just two days ago, on Monday, he had an angiogram to take still more pictures of his Arterial-Venal Malformation. The radiologist thought he might be able to do an intervention during the angiogram (funny name for it -- it means to put some sort of coil, "cement", or particle into the vein to stop up the blood flow from going to a place it's not supposed to be going.) However, the situation looked too big and scary to rush into. Dr. Z wanted to make sure he was doing the exact right surgery for Paul (there are a few options) and to make sure he had enough of the equipment he needed to finish the procedure properly.

Paul has three big veins (the size of an adult male's pinky finger in diameter) on one side of his pelvis, and one big vein on the other side of it. This means lots of fast moving blood is feeding an area that isn't supposed to see that much, resulting in an "aneurysm" the size of one of his kidneys. It's huge. Every time a medical professional sees this balloon of blood on an ultrasound or CT scan, they very unprofessionally say, "Wow! That's huge!" and go and get another medical professional to come and look at it -- who then says the same thing.

There are a few options open to him regarding the surgery(ies) that he can have. Right now an expert on Arterial-Venal Malformations (AVM's) from Minnesota is looking at a CD of photos from Paul's angiogram to give his advice to our radiologist and vascular surgeon. Well. Paul's radiologist and vascular surgeon. (I was just guilty of turning this into a we situation -- like when men say "We're pregnant" -- when it is so clearly happening to Paul.)

Another doctor's appointment on Monday will let us see the photos from the angiogram and hear what the expert in Minnesota advises. And then on Thursday, Paul will have surgery (or a "procedure" depending on Monday's outcome). They've also blocked out time on the 30th of this month for another surgery if it is needed.

Procedural options:

1) the radiologist can go up his femoral artery again (like in the angiogram) and push a platinum wire up the catheder. The wire will coil up into a large vein, blocking the blood from rushing into the anuerysm from that side. Then he'll do it again and again in the other veins. (By the way, Paul has more than four, but those are the big ones and Dr. Z doesn't want to cut off all the blood supply to his other pelvic organs.)('Cuz, you know, that could be problematic.)

The theory is, without the blood flow to the balloon, this bubble of blood will clot and then dissolve over time and/or shrink down. This will take the pressure off Paul's internal organs and will not cause him pain and discomfort anymore.

At the same time as the "coil" procedure is happening, Dr. Z will also put in a filter (it acts as an umbrella in the vein) higher up by his lungs. This will be insurance against the hopefully small possibility of part of the "clot" from breaking off and turning into a real blood clot. Pulmunary Embolisms are fatal, dontcha know.

Paul said, "What's the difference from a blood clot getting caught in the filter or the lungs? Both of them block off the artery/vein." Dr. Z said, "If it gets caught in the filter, I can fix that. I can melt it away and remove it. If it goes to your lungs, you die. Instantly."


So we're a little creepified right now.

Option #2) They do the above procedure, but instead of waiting for the aneurysm to dissolve and shrink, once it gets hard like a scab, a vascular surgeon (Dr. S) will go in and surgically remove the grapefruit-sized chuck of pain and repair and reconnect the veins.

They might also do this if we try option 1 and during the "hard" stage (before it gets to dissolving), it just gets way too painful for Paul. His discomfort and pain will get worse after the procedure. We're just hoping that time period is small and manageable. If not ... that's when option 2 would be necessary.

Option #3 isn't really an option right now. Both Dr. Z and Dr. S think it is risky and are hoping to not go there. At least that's my impression. Option 3 would be to forego the coil procedure altogether and go straight for surgery. Just cut the bastard out of there and sew up the holes. This would be scary scary though. Way too much blood. Especially because of the arterial connection. And the aneurysm is very deep in the pelvis. Hard to get to. The combination is fairly dangerous.

Again. Those are my words, but that's the vibe I got from the doctors.

So, we find out Monday which of the options we are going with. Thursday he'll have the procedure, and stay overnight for safety and observation. Hopefully, if all goes way, he'll get to come home on Christmas Eve.

If he needs another follow up procedure -- because the first one is taking too long or something -- he'll go in on December 30th (two days after his birthday and the day before New Year's Eve.)

It doesn't feel like Winter Solstice.
It doesn't feel like Christmas.
I don't feel like celebrating much.
I feel like wishing and hoping and being grateful.
And not taking things for granted.
And not taking people for granted.

Perhaps I'm being melodramatic.
Perhaps this is fairly routine. (His condition is rare, but the procedures and surgeries he'd have are not.) But it's hard to keep my past out of this. My baggage is weighing heavy this week.

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