Recovering From Brain Surgery

Here are a few really good articles about the horrible recovery process after brain surgery. Isn't the brain remarkable? I'm also going to touch on a few of the items I'm having issues/difficulties with.

My brain after 5th surgery. One side is NOT like the other

http://www.brainline.org/content/2011/07/lost-found-what-brain-injury-survivors-want-you-to-know.html

http://www.everywhereist.com/20-things-you-can-expect-after-brain-surgery/

• When I lean my head forward, it feels like someone is squeezing my head in a vice. There is fluid on the inside and the outside of your brain after surgery. When you bend over, it creates an uncomfortable, painful sensation.  The more I bend down the tighter the vice gets. This makes things difficult - like putting my shoes on, sitting down, and picking things up. A little more than four weeks out and I'm almost able to bend over completely with no pain. I expect in the next week or so this will no longer be an issue.

• It HURTS to open my jaw. I've noticed this in past surgeries and always dread this. They cut the muscles that connects your mouth to your hairline during surgery. Put your finger on your temple and close and open your mouth and you will see what I am talking about. Eating has been fine, but yawning is painful and the dentist today was excruciating. 

  

  No fashion comments - Notice the lean

  
  
  "If your operation was near your temple (between the side of your eye and your hairline), you may find that your jaw is stiff and painful a few days or weeks after surgery. You may find it difficult to open your jaw. This is because the surgeon had to move or cut the muscles of the jaw during your operation. The stiffness gets better by itself in a short time. Making chewing movements or chewing gum helps." http://www.cancerresearchuk.org/about-cancer/type/brain-tumour/treatment/surgery/after-brain-tumour-surgery#wound

• Sneezing and Coughing: I think the body knows that it is damaged. My first sneezes were on 2/28, yes I recorded the date because I hadn't sneezed since my first surgery on 2/2. Oh yeah, it hurt. I was finally able to blow my nose without pain on 3/6. Coughing is a different story. It still hurts.

• Bumps: Driving over the smallest bumps on the road hurts my head like crazy. The drive from Stanford to our house was the worst 22 miles. I would cringe when I would see the car in front of me hit even the smallest of bumps in the road. This subsided about 2 weeks into my recovery.

• I can count the number of T.V. shows I've been able to watch on both hands since my surgery. The effect of the brain surgeries on my attention span is very REAL - it's been getting better with time, but it has been slower than I've experienced with my last two surgeries.  

We had a follow up with my Epilepsy doctor on Tuesday. I have physical, speech and occupational therapies on Thursday and Friday, an MRI on Sunday and Radiation Therapy begins this Tuesday, 3/17.

"Thoughts, feelings and most of the typing by Josh, organization and editing by Fay" 

The Making of The Mask - Pre Radiation Set-Up

Well, today was the start of my radiation therapy. I had to fast for three hours - I ate at exactly 3 hours before and RIGHT after. Fay made sure to pack me lunch.

I checked in and was brought back to get my IV line put in - ON TIME again - awesome. It wasn't like the hospital experience where one nurse missed my vein a total of five times. The nurse today got it on the first try and I was all set to go....then we were told that they were running an hour behind schedule... ugh. So much for on time.

After a few more questions for Dr. Swift, my Radio-Oncologist, and an hour wait we were brought into the Computed Tomography (CT) room where Fay documented the entire process with pictures and some video.


They brought the "mask" out and I was shocked. It was a thin piece of flat plastic about the size of a piece of binder paper. It was placed into a bath of hot water for several minutes and was pulled out with tongs.

The technician then placed the mask around my face and head. Stretching it and molding it around my face. Then attaching the flat piece to the table with plastic clips.

It felt like a very hot blanket on my face. For someone with claustrophobia, it would be their worst nightmare. It's crucial that I don't move my head when I'm inside the radiation machine, so the mask will ensure that I am still.

Before

The plan is to merge, on a computer, my MRI before surgery, my MRI just after surgery and the two CT scans from today in order to identify the exact location and treatment for my tumor. Then Dr. Swift creates a map that the radiation machine uses to "zap" (technical term) my tumor from 360 degrees every day, except weekends, for 6 weeks.

CT scans are pretty quick compared to MRI's which can last 45 minutes to one hour.  After the mask hardened, the technician left the room for my first scan. Since I was asked to keep my eyes closed, and stickers were placed on my eyelids, I couldn't keep track of time but the first one felt like no longer than 5 minutes.

I was brought out of the device, eyes still closed, connected to the CT contrast material and sent back in the machine for another scan, this time with contrast.

After

It started with a voice, over a loud speaker, saying that the contrast was being put into my veins.  Then, I felt a warming sensation all over my body. It slowly got warmer and warmer and then my body got down right hot! It only lasted a minute or so. It was the opposite of the MRI contrast, which sends a cooling sensation. Then after approximately 5 minutes I was done and the Mask was FINALLY removed!

I was in the mask for approximately 15 minutes. As time passed, I became more and more panicky. Especially, with my eyes closed.  I have no idea how someone who has any difficulty with claustrophobia handles it.

We were then given a date for our first radiation appointment (Tuesday, March 17th), my IV was removed, and I was told to drink eight 8oz glasses of water to help flush the contrast from my body, and we were allowed to leave.

The entire experience was surreal...

"Thoughts, feelings and most of the typing by Josh, organization and editing by Fay" 

Brain Tumor Recovery Progress Report

I'm just past three weeks since my brain surgeries and I continue to improve in all areas. Since I am on short term leave from work, this blog has been a good outlet for me to stay busy.

Homemade torture device

Occupational Therapy: I didn't have occupational therapy this week. Though, at home, I continue to work with the Thera-Putty on strengthening my right hand. It's difficult to explain but I have to think about what movements I want to do. Do this: lay your dominant hand flat on a table with your fingers and thumbs together. Now "walk" each finger out starting with your thumb, then the fingers. I need to concentrate on moving each finger on my dominant right hand. It's very discouraging the amount of thought and energy I need to expend to do this simple process.Think about which finger I need to move, then engage, then focus on lifting it up, engage, move it, etc. See video below.

I've noticed my strength and accuracy getting a little better, I have touch typing back (with errors) but I still have a long way to go. I've also asked my father-in-law to build me my own torture device. I'm happy to report that I no longer drag the nut backwards.

Speech Therapy: Don't my speech therapists look nice - well once we get into what my youngest son calls "1st grade worksheets" (he's in 2nd grade) my therapists become...not so nice.  Just kidding, they are so nice. They are always smiling and always encouraging me but, I still can't stand the work. It's the most challenging of my therapies for sure. More worksheets completed and more homework assigned. Recently, they've started an exercise where they give me 4 words and I have to use them in a sentence and then at the end, recall the original 4 words. A week ago, I wasn't able to retain three words.  As the brain swelling goes down and since I've tapered off of the pain medication, I've noticed an improvement.

My Speech Therapists

Notice the clean face shave - I can finally handle a razor (with two hands) however, it took me quite a long time



Physical Therapy: I had physical therapy today as well. It's amazing how far I've come! I've gone from walking around our house in terrible pain to recently running a mile! The only thing is my head still hurts if I lean forward and I still have a right side droop. If I can get my core muscles back to normal and fix my lean I should be back on track. I'm anxious to get back to running and hiking to stay fit and keep my mind off of all of the other issues that I am dealing with. Including the new wrench in the puzzle, fatigue caused by radiation.

Finger strengthening exercises with "Putty"

State of Mind: I'm still struggling. The surgery and recovery process has been extremely difficult on my mind, no pun intended, and body. Radiation begins soon and I'm really worried about the side effects, mostly fatigue and memory concerns. I know I'm fortunate for someone in my position and have come through five surgeries "relatively OK" but, it doesn't always feel like that... Feeling defeated.

"Thoughts, feelings and most of the typing by Josh, organization and editing by Fay" 

Radiation Oncology Appointment - 3/4/15

The appointment went as well as could be expected. A lot of information, in a short amount of time. Speaking of time, we were called in ON TIME - no waiting!

Below are some answers to some of the major questions that were asked in my Radio-Oncology appointment.

Dr. Swift

We will be using Intensity-Modulated Radiation Therapy  (IMRT) for 6 weeks, 5 days a week. I guess tumors stop growing on the weekends?? (Thanks Julie)

The beams of radiation will rotate around my head, 360 degrees, and every beam is slightly different. The focus being on the tumor and little surrounding area. After the initial 30 minute treatment visit, they will then last about 15 minutes. The actual radiation treatment, once the beams are on, is less than 2 minutes. In addition, I will meet with Dr. Swift once a week so he can check in to see if there are any problems.

What side effects can I expect given the location of the tumor, type of tumor and amount/duration of treatment?

Short Term Effects:
Fatigue, possible patchy hair loss, nausea, sore skin, possible headaches from swelling. If I develop headaches, I will be put back on steroids to control it.

Long Term Effects:
Two long term risks were mentioned:
*Possible new tumor (about 15 years on average) could be a benign or malignant brain tumor (1/300)
*Less than 1% chance of needing surgery to remove healthy cells that were damaged by radiation.

What is the sum of radiation that I can expect over the course of my treatment?
The dose is unknown until mapping and CT scan are complete. But for my type and grade of tumor, the dose range is 54-60 unit gray.
A personalized mask will be made (see picture) to ensure I do not move during treatment. I have an appointment to have this done this Friday, March 6.

 


What did the Tumor Board recommend?
Everyone at the Tumor Board agreed with being as aggressive as possible so that we stop the tumor from growing into some very critical areas (motor cortex) and we can prevent serious, permanent long term deficits.

Damage to the Hipacampas?
The Doctor said that they try to spare it if they can. He said that the location of my tumor is above it and not touching it. Therefore, in my case, radiation will not involve this part of the brain.

Will radiation cause difficulty in future readings of my MRI's?
All teams are familiar with reading MRI's of people who have had radiation. No concern.

What, if any, impact will it have on my seizures? Radiation treatment can cause seizures. However, since I already have a history of seizures (I am currently taking two anti-seizure meds) it would be impossible to know if the radiation treatment was the cause.
The ultimate goal is to be taken off of all seizure meds after treatment is completed.

All in all, this was a very informative discussion and I'm proceeding as recommended.

Tumor Location - Click to enlarge

"Thoughts and feelings by Josh, organization and editing by Fay"

Radiation Concerns

I'm feeling very nervous that radiation might impact me more than I expected. Especially, after talking with a family friend whose husband just passed away from a brain tumor.

She was more than generous to take time, even though she is going through so much, to talk with me about some things that she wish she had known before her husband started radiation. She gave me some really good information and good questions to ask the doctor. I'm so thankful to her for our talk.

There are a lot of factors that come into play - there are more than 120 different brain tumor types, different grade levels (how aggressive), types of radiation, amount/length of radiation, and the location of the tumor in the brain that effect treatment outcome.

After learning more about it, I'm really apprehensive about starting radiation therapy. I'm anxious about tomorrow's meeting with the Radio-Oncologist.

Up and Running

So, I attempted to run today. The plan was to run/walk for 1 mile just to get a new baseline. Of course it was dependent upon how I felt. It's only been a few weeks since my brain surgeries so I told myself I would take it slow - that went out the window. My headache went away in the first 100 meters so I was able to keep running for the mile.

Results of my track workout: 1 mile in 8:51 minutes. While this is far slower than I run, I was happy with the result. I was expecting somewhere between 10-12 minutes with a combination of walking and running. I was dragging my foot occasionally around the track so I expect I wasn't running straight the whole time.

Also, my max heart rate is 180 and I was running at 182 so I won't be pushing myself that hard again for quite some time.

Fay took a picture of my "lean". As you can see, I'm pretty crooked. My body is leaning and it's most noticeable in my elbows. My left elbow is more than an inch or two above my right. I still have some work to do!


On Saturday, I continued to work on my memory and played some brain games with my niece Lola and my oldest son, Dylan. Dylan is so helpful, too helpful - he won't let me do or lift anything around the house.


I showed Lola the 15 different occupational exercises I do with my Thera-Putty which is meant to improve my fine motor skills. Just trying to roll and shape the putty into a round ball is crazy hard, not to mention all the specific exercises I have to do.

I ended the weekend by meeting up with Chris and Julie for a visit and some drinks. They have been absolutely wonderful to our family during this difficult time. Taking the boys out, dropping care packages off, and making us meals.  I don't know how we'll ever repay them!


"Thoughts and feelings by Josh, organization and editing by Fay" 

Perfect Timing

"Hello Josh and Fay - I ran across your blog somehow, I hope you don't mind a stranger reading about your situation.  I just wanted to say thank you.

We have a dear friend who had brain surgery in December (different type than yours) and still suffers from seizures and disorientation.  We don't really understand what she is going through and it's quite scary especially as we are geographically distant from her right now.

So I appreciate being able to read your blog as sort of a proxy to help her through her situation.  I hope your words bring comfort to others going through this, and that they provide a way to help you heal.

Your family is beautiful and clearly they support and love you very much...  And very clearly, you are strong and determined!  Hugs and I wish you the very best in your recovery.  - Jen"
*******

Your message couldn't have come at a better time for our family. We just found out today that I will be proceeding with Radiation followed by one year of Chemo.

One of the reasons I am posting about my surgery and recovery process is to provide insight into what it's like to suffer from seizures and a brain tumor in the most open and honest way (for the internet - anyway) for others to see. I'm grateful that any of my words provide insight into what your friend may be going through. 

I do know that the seizure meds alone are enough to cause MANY issues, let alone the trauma of a brain surgery and resulting impact that may result. 

You are doing the right thing - reading and finding out how best to help her. Please feel free to reach out to me directly and I will answer any questions you (or she) may have. 

I appreciate your email so very much and I wish you and your friend the best. 

Josh

Update & Plan - post by Fay

We met with Josh's NeuroOncologist today.The plan is to do Radiation (5 days a week) for 5 weeks followed up with a year of Oral Chemotherapy (Temodar).

The Tumor Board met today to discuss Josh's case and came up with treatment plan options.

The three options presented to us were:

1. Wait & Watch - follow with MRI in 3 months
2. Begin Chemotherapy for 12 months (a few types to be considered)
3. Begin Radiation and follow up with Oral Chemotherapy for 12 months

Ultimately the choice is Josh's, but it was recommended that we act aggressively and promptly. There is concern because the tumor has grown so close to critical areas of the brain. The idea is to catch/stop the tumor before it grows into these danger areas.  It has started growing down and back (deeper).
Josh is on board with moving forward aggressively.

I'm not sure what he was thinking, but I was completely caught off guard when I heard the Doctor's words.   I felt like I had been punched and knocked down. As I sat there, I concentrated on not crying.
He's just barely through the surgeries and he's struggling through recovery and now he still has to go through this.
I don't know what else to say right now.

Brain Surgery Recovery Report

I do this blog for three reasons. 1. It is a form of therapy for me. 2. To update friends and family on my progress and 3. To share with others who may be going through a similar challenge - An initial diagnosis of a brain tumor, cancer, or fighting thru the recovery process.

I received a call from my NeuroOncologist today. We will meet tomorrow and I suspect that we will review my treatment options that were discussed at the "Tumor Board". While I wait for the treatment options my therapy continues.

Occupational Therapy: Today was the first real day of therapy and was extremely frustrating!! I honestly just want to give up and just use my left hand for everything.  The gross motor skills of my hand are fine, but the fine motor skills of the hand are insanely difficult for me to train.

I was given some "Thera-putty" to use at home which will help to strengthen my hand and fingers.

Today, my therapist brought out a HORRIBLE device (see picture below) for some fine motor exercises. She had me pick up a nut and tighten it in place. This exercise was so irritating because for every turn of the nut my hand would "drag" the nut backwards a half a turn; My hand was shaking by the end of the session.

Speech Therapy: Memory, picturing scenes/places, naming categories and word recall continue to be a challenge for me. Fay has noticed an improvement, though its not nearly fast enough for me. I know my therapists are there to help me through this, but I can't help but feel ashamed and embarrassed when I cannot provide answers. I'm glad the sessions are only 1 hour because, I leave with a headache every time.

Physical: I'm now walking consistently 5 miles a day, in 1 mile increments, with little to no pain. I'm used to running about 30-40 miles per week, so this is a huge physical setback for me. I need to start some light workouts to strengthen my core muscles. My right side is still very weak and I am still slightly drooping to the right. My therapist has shown me some stretches and says this will improve once I strengthen my core and my muscles loosen up.

It still hurts my head to bend down or lay flat, so I need to take it slow. The fluid and pressure in my brain is still a limiting factor. It's getting better, but slowly.

State of Mind: I have bouts of depression and I'm pissed at the speed of my recovery. I get discouraged and mad at myself for not being able to do and say what I want to.

"Thoughts and feelings by Josh, organization and editing by Fay" 

Post Surgery Check-up: Good News & Bad News

Thoughts and feelings by Josh, organized and edited by Fay.

Well, I received some good news and some bad news today... and waited an extremely long time. What gets me through the wait is knowing that the doctor is taking extra time with people in my situation.

First the good news. The surgery was a success. The grid monitoring that was done proved to be a huge aid to the surgeon in guiding him safely during surgery - though it was a terribly painful and stressful process, it was well worth it.

During my final surgery, they were able to "shock" the electrodes to guide them through surgery to remove as much of the tumor as possible.  In addition they removed a small seizure focus point. The seizure focus points that remain are far away from the tumor site and would have been difficult to track and remove. The other GOOD news is that the pathology of the brain tumor shows that my tumor has remained a Grade 2 Oligodendroglioma - it has NOT upgraded. 

Oh, and my staples are out and I can finally wash my hair... tomorrow! Only about 10 of the 54 staples hurt when the came out. They do not provide pain medicine and the pain was only a few seconds for each one. Also, one stitch was removed where the drain had been placed during the emergency surgery.




Now the bad news: Approx 20% of the tumor remains. It is too deep and too close to the motor cortex to safely reach. This is where the mapping helped, they could see how far was safe to go before permanently leaving me without the use of my right arm or worse. He pushed it as far as he could while ensuring that I didn't come out of this with any deficits. Dr. Chang (picture above) said that the Neurologist who was present during surgery was scared about going any further because when they touched certain areas, my hand and face twitched.

The 80% of tumor that was removed had well defined, clear boarders. The 20% that remains has roots and branches that are not well defined. Dr. Chang explained that the if you picture the tumor as black and the healthy brain as white, the part of tumor that is left is gray - blending or mixing with the regular brain and therefore, inoperable.

My case will be presented to the "Tumor Board" this Friday.  This is when teams of experts meet and discuss patient cases. My Surgeon, my Neuro-Oncologist, a Pathologist and Radiologist will all attend to discuss my treatment options. My latest MRI, day after the final surgery, as well as all of my case notes will be presented. There is some disagreement of treatment plans with a slow growing tumor type. We were warned that disagreements will be had and that I will receive a call with all of my options. We were told that there is no single right answer - there is some controversy over what treatment is best.

Since surgery is no longer a safe option for me, we are looking at chemo, radiation, or the wait and watch plan.

Other items: I am now allowed to lift up to 25lbs - carefully, I've developed a rash caused by one (or all) of the medicines, my brain is still swollen, it hurts to cough, and I can exercise as tolerated. Now that I have tapered off the steroids, as of this morning, I'm anxious to work off the more than a few pounds that I've gained.

My tumor, thankfully, is still slow growing. I've come to know so many families absolutely torn apart by this disease. A family friend passed away just last night and it actually hurts to think of his family...his wife and his two very young kids.

So, while it is hard not to feel depressed, I know I am fortunate.
For now, I will enjoy my first beer with my father-in-law and focus on my recovery.

Two Weeks Since Brain Surgery

FYI - It takes me hours to type each post and it is a collection of random thoughts that I want to share. Fay spends time each night helping me edit into what you see here....

Still trying to figure out which therapy is the worst...

Occupational Therapy assessment today - Just over two weeks since surgery, I've gone from not being able to use my right hand completely to now being able to actually use utensils while eating. I think it's an improvement however, I still find my right hand laying limp and I've started using my left hand instead. So, I need to remember to challenge the right side.

They tested me on pinch strength and hand strength. As I expected, my right hand was a little less than half of what is normal. So I have a lot of work to do. They also timed me on a  peg game (place 10 pegs in holes and then remove them as fast as I can). My right hand took twice as long as my left. We also practiced opening and closing different sized jars. It turns out that I have already started automatically using my left hand to do these tasks. The therapist told me to make sure I do not do this because the brain can get lazy and then my right hand won't improve. For example, during the test, I held the jar in my hands but used my left hand to twist the jar rather than turn the lid with my right hand. I also took a typing test test. The homework that she gave me was to move a ball (size of a golf ball) from my palm to the tips of the fingertips and back - over and over again.
See below 

Speech Therapy:  My therapists compare it to going to the "Brain Gym".  Fay calls it Mind Therapy. It's still very difficult and probably more frustrating than anything else that I am dealing with. While holding a conversation is generally OK, my ability to picture scenes, describe items or even form a sentence using three related words (and then recall the words) is so difficult. Speech Therapy isn't what you might think. It is not correcting my speech, it is meant to help me formulate thoughts, find words, recall information and communicate what I might be thinking but cannot articulate. For example, they ask me to name 5 things that I would find at a park. I could only come up with slide and swing. Another exercise is when I'm given 3 words and I have to use them in a sentence and then repeat the original 3 words. It may seem easy, but I am really struggling with it. So, I'm given trees, trails and hill. I have to make a sentence and then give them the 3 words.
It will take me quite some time to get my speech back but I think I am on track. Especially after such a short time since surgery and considering all the seizure meds I'm taking.

Physical Therapy: When I was finally up and able to walk, it was so unbelievably painful that it was worse than the pain in my head. I wish someone would have told me that this would happen and I would have known what to expect upon release from the hospital. I only found out today when the therapist told us that the impact of a typical hospital bed stay on muscle loss is typically 3% of muscle mass per day. I was strapped down and unable to move for eleven days. My legs are stiff but with light stretches, so much better.
The other issue that we are working on is my right side drift. I was told that my core strength has weakened and that my entire body is leaning or drooping right. So, besides concentrating on balancing while walking, I'm told to concentrate on straightening up.

Science Daily --> http://www.sciencedaily.com/releases/2009/10/091027162011.htm

As of today, I'm off of all pain medication and have worked up to about 5 miles a day which is great recovery.

Follow up and staple removal with Dr. Chang at Stanford is tomorrow.

Math drills

Progress: only missed 4

Recovery Progress

Recovery is still at a mind numbing, slow and frustrating pace.

Speech: It took me 15 minutes to write the alphabet with a pencil today. The only letters I forgot how to write are a lower case "f" and "k". I guess that is progress. The little one (Hayden) is such a help when it comes to my nightly speech therapy homework.

Physical: The pain in my legs has been absolutely horrible - even just standing straight takes monumental effort. Two weeks of laying in bed caused the muscles in my legs to atrophy. 

I have a slight lean to the right side so I'm supposed to try and correct that which isn't as easy as it sounds. I'm already concentrating really hard on just walking and now I need to work on fixing the right side drift.

Thankfully, the leg pain has somewhat subsided the last two days and I have been able to do some light stretching and walking. It was a nice day out and I made my first "unsupervised" walk around the block! And, I walked around the track at Lincoln High School and went up and down the bleachers.

Spending time with the puppy has been good therapy too.

Occupational therapy starts next week.

I've been slowly tapering off the steroid that helps with brain swelling. I'm so glad I only have four more days on it. I cannot stop eating. Everyone laughs at me when I get to my meal. But, I can't control it.  It's Crazy!