Wednesday, April 16, 2008

Doctor's Report

We went to see Dr. Oghalai today and got the stitches out. While we sat in the office waiting for him to come in, we came up with about 16 questions for which we wanted answers. So when he came in he started right away looking at the incision to take out the stitches and commented that the incision looked great (emphasis on the great). While he was doing that, Tracy started asking questions. Now, that's a good thing, but it wasn't in the order that I wrote them, so I had to scramble around on my notes to write out the answers. As a result, I didn't get to see him take out the stitches!! What a drag. They came out so fast.
He didn't take the stitches in the ear out. They are made out of gut, so they will eventually dissolve. (I wonder how many other people thought, "Whose gut did they come from?" or Maybe it was cat gut and that's why Tracy wants to be petted all the time. heehee)

One of the questions was whether or not Tracy could go swimming. It's funny because I can't remember the last time Tracy even wanted to swim, but we asked it anyway. Not for another 3 weeks is the answer. And actually, that is the time frame for about anything else like bending down, or any strenuous activity. The numbness in her head and ear (which she says feels like rubber) will go away when the cutaneous nerves grow back or are revitalized. We asked about doing something to stimulate function on the right side of her face. He said there has to be motion before exercise of the muscles can do anything. But we could try massages, lymphatic massage. Some people think it helps, but there is no medical support for it. The facial muscles will return slowly. It is gonna be like watching for your child to take their first steps. I can imagine that some time in the future we will write a blog like, "She moved her right cheek 3 times" announcing it like a proud parent. There is a scale used to rate movement in facial paralysis from 1 to 6; 6 being none. Tracy has been a 6, but today, Dr. Oghalai said he would consider her a 5. He didn't see movement, but he felt that her face looked more toned or taut. It could be just that the swelling is down and we are seeing more of her natural face, but he still put her at a 5.

Now for the fun stuff. We asked about the hole made in her head for the surgery. Does she have a soft spot? Where is it? How big is it? The hole is essentially under or behind her ear. Uhmmm, like if you stuck a pencil in your ear (don't do that!!) going towards the center of your skull. That is what I mean by behind or under, not in back of or below, but towards the epicenter of her head. The hole is a little bigger around than a jumbo egg from the supermarket. So, there is no bone on that part of her head. That is where they put the fat they took out of her belly. They just shoved it into the void left by the tumor. Eventually, the fat will harden up a little, a dural layer will cover it and some scar tissue, which will give it some rigidity, but there will be no bone. Dr. Oghalai pointed out that it is not really important for there to be bone there unless (this is kind of weird, but funny) she got shot by an arrow at that point. There would be nothing to stop it. Well, we're sure gonna be looking out for that! Now, the void is really deep. It goes all the way to the middle of her head, essentially.
We got to look at the post-op MRI and here is what we saw. A lot of you have probably seen some kind of x-ray picture of a skull. There is it's familiar skull shape. You can make out where the eye sockets are and see some bone, and see the two lobes of the brain in the middle surrounding the brain stem, etc. Well, in Tracy's head the left side has a brain lobe in it. The right side has a bunch of fat. It is a large dark spot that takes up the majority of the area on that side of her head. Did they cut out her brain? No, the brain is still in there, but it was compressed, or squished, and it is mostly going to stay that way. For all practical purposes, Tracy really does have a big hole in her head...with fat in it. Does that make her a ... she said it first ... I didn't even think of it ... a ... fat head? Now, the hole is sort of in the shape of an egg, so she could be an egg-head. I didn't come up with that one either.

The pathology report is complete and her tumor is classified as a benign grade 1 meningioma. Benign means it's not cancer. Grade 1 means it is the most benign kind. That is a great thing.

So, speaking of the tumor and its growth, we also saw on the MRI the bits of tumor left in there. Dr. Oghalai pointed out that one part was left in because it was crowded around a major blood vessel. The other chunk was around nerves 9, 10, and 11. Of the most significant was the swallowing ability, which is covered by those nerves. Part of the reason we did not have such intensive rehab (and you know, Tracy has not required any) is because they did not mess with the tumor around those nerves. BUT it can still grow there. If it does and it destroys those nerves or they have to go in there and destroy those nerves to stop the tumor, will she have to have a feeding tube installed and live that way forever? No (this is really cool), they will let the tumor slowly destroy that nerve. WHAT??!!! Yeah, and as it does it, the brain will kind of match it step for step and compensate for what is being lost so that by the time the tumor has done its dirty work and it is time to take it out, Tracy's brain will have all ready shifted responsibility for the swallowing function away from the nerve that is being attacked and established it somewhere else (I assume just on the other side of the symmetrical brain). It's like a chess game or some kind of tactical warfare in a science fiction story. Pretty neato.

Though we don't go back to Dr. Oghalai until July 23rd for another MRI and evaluation, we are not done yet with working on the effects of the operation, or tumor, or whatever. (By the way, of the tumor that was left in there, Dr. Oghalai believes that it will be smaller when we see it in July, because it has lost so much of its mass and nutrition supply.) Tomorrow, Thursday the 17th, Tracy will see an ophthalmologist to see if there is anything that can be done for her right eye. Her vision is blurry and, of course, we have mentioned too many times how much trouble she has with it as it does not produce tears. Dr. Oghalai mentioned putting a gold weight under the eyelid to help it close all the way. Pretty weird. Anyway, I hope the ophthalmologist can help. Dr. Oghalai did say he doesn't want any procedures done on Tracy, however, because he does not want to impede the healing of her brain.

We decided that she can't be at the revival, being that it is outside. Someone smarter than me also mentioned Tracy's vulnerable condition to contagions from crowds of people, like a cold or something. That's something I didn't consider. More than anything though, it would not be good for Tracy to be outside for any period of time.

Ok, lots of words here. Tomorrow, I hope I can take some time to deal with a little more of our heart and daily struggle stuff; to provide some direction for praying.

Gotta go to bed. Everybody keep looking ahead. It's the only way to go.



Anonymous said...


Thank you again for all the time you take to fill
us in on the details--You are a good note taker!

Give your precious wife a hug for me, and I am praying
specifically and daily for her eye.

love you guys,
Susan (TL)

Sandy Bingham said...

A 5 on facial movement--hopeful and progressing!
A 1 on benign tumor grade--Hallelujah!!!

In all, I'd say you're a TEN, Tracy! . . . fearfully and wonderfully made.

With love--SandyB