Tuesday, February 03, 2009

Got a few AVM posts... no pics... I am sorry.

About AVM
I met Dato' Dr. Hj. Fadzli Cheah Abdullah during CNY in my hometown. He is my neighbour's husband's uncle. He is a neurosurgeon who has his own office in Ipoh. I had the chance to show him Mel's brain scan report. He told me that is AVM. He also gave me his contact number, once the angiogram report is out, he is kind to give me second opinion about Mel' case. Thank him so much.I heard about this before, one of my colleague Becky's boyfriend has the same problem.

The different between two of them is Mel's AVM is inside the brain and Ah Teh's AVM is outside the skull.Because of this I have done some research at google about what is AVM.Arteriovenous malformation

An Arteriovenous Malformation is often referred to as an AVM. It is a tangle of abnormal blood vessels (arteries and veins). AVMs can occur anywhere in the body; however brain (also known as cerebral) AVMs are of special concern because of the damage they can cause when they bleed. They are very rare and occur in less than 1% of the general population(1). AVMs that occur in the covering of the brain are called dural AVMs. The cause is not known. AVMs are thought to be due to abnormal development of blood vessels during fetal development. An AVM is not inherited or infectious. An AVM is not a cancer, which means that it cannot spread to other parts of the body. Brain AVMs have usually been there since birth. Dural AVMs are an exception in that they may be caused by injury. AVMs can occur in people of any race or sex in almost equal proportions.

Signs and symptoms

Symptoms of AVM vary according to the location of the malformation. Roughly 88%[citation needed] AVM are asymptomatic; often the malformation is discovered as part of an autopsy or during treatment of an unrelated disorder (called in medicine an incidental finding), rarely its expansion or a micro-bleed from it, could cause epilepsy, deficit or elicit pain.

The most general symptoms include headache and epilepsy, with more specific symptoms occurring that normally depend on the location of the malformation and the individual. Other possible symptoms include:
Difficulties with movement or coordination, including muscle weakness and even paralysis; vertigo (dizziness);
Difficulties of speech (dysarthria) and communication, such as alogia;
Difficulties with everyday activities, such as apraxia;
Abnormal sensations (numbness, tingling, or spontaneous pain);
Memory and thought-related problems, such as confusion, dementia or hallucinations. Treatment options Available There are several options available; the nature of treatment offered will depend on the size and location of the AVM. Your neurosurgeon will advise you of the most suitable options.

Embolisation: is a technique which involves injecting liquid glue or coils into the AVM, using a catheter similar to the one used for an angiogram.

Radiation/Stereotactic Surgery: is also known as Gamma Knife Surgery. The treatment involves narrow x-ray beams being focused on the AVM in such a way that a high dose is concentrated on the AVM with a much lower dose delivered to the rest of the brain.

Surgery: is the traditional technique used to remove an AVM. It is often referred to as a craniotomy. This procedure is carried out by a neurosurgeon who will remove the AVM under general anaesthetic in theatre. Observation: can be used as a fourth option and may be recommended if the neurosurgeon feels that treatment cannot be offered safely or when an AVM is discovered in later life.For more information about AVM, please refer to the link below:




Let's talk about compassion.
I've gotten a couple of comments in the last week that I haven't published. Both of 'em came from women (or a woman, posting as two) who claim to have kid(s) with AVMs on their faces; both of 'em took me to task for a lack of compassion. Apparently, I'm supposed to have compassion when I'm posting here, about my patients, and the doctors, and my nutso coworkers. (I should mention that both comments were personally abusive and name-calling, which triggers the auto-dump feature on the Nurse Jo Robot. That's why they're not here.)
Normally, criticism doesn't bother me. Blame it on the codeine, 'cause I'm gonna answer my critics:
Lady (or Ladies), you don't want me to have compassion on this blog.
Why not? Because, if I'm compassionate here, it means one of two things:
1. I've not used up all my compassion on my patients.
2. I'm drunk.
Let's be real, People: You don't come here for compassion and warm fuzzies. It's like the man said--come for the stories, stay for the snark. And, honestly, who wants to read me tear my heart out over patients that've torn my heart out?
I could talk about walking down the hall with Darlene, her arm around my waist, as we discussed the best way to tell her eight-year-old daughter that Mom wasn't going to live much longer. I could talk about Velma, and how she cried about having to go to hospice, because her mind was still there though her body wasn't. Or I could tell you about Ben, who told me frankly over dinner that he was damned ready to die, but was holding on for the good of his wife and kids, who weren't ready to let him go yet.
But you don't want to hear about that. Nor do you want to hear about the 13-year-old girl with the horrendous congenital AVM that would likely kill her, whose toenails I painted the night before she went into surgery (all but one, so they could put a pulse ox on in the OR), so they'd be pretty for the surgeons. You don't particularly care about the fifteen-year-old boy whose Moya Moya had so screwed up his brain that I was the only one who could get him to consent to surgery, and only then after coming in early and rocking him on his bed like a baby. And I'm certain, as the mother of an eleven-year-old with an AVM, that you don't care about the time I summoned up all the crappy, rusty Danish I could muster to help comfort a dying woman who couldn't remember that she wasn't at home, in Copenhagen.
You'd rather hear the snark, and read the snappy lines. I don't blame you. If my working life were snappy lines and snark, it'd be something for ABC or FOX to run in a half-hour between family comedies. It wouldn't be what I live every day, where real people hurt, and die, and sometimes don't die...and those of us who are living are left to pick up the pieces.
This is an important point for those of us who blog, and those of us who nurse: People will criticize you for not being the constant comforting angel that they think you ought to be. To hell with them. The important thing is that you do what you are meant to do for those people who find themselves in your care.
That means you won't always be unsnarky when somebody wants you to be. You may not always want to talk about work when you get home. Sometimes, if you're a bit under the weather or a little too far into your cups, you might surprise your drinking companion with some heartbreaking story. The important thing is that when it counts, where it counts--with your patients--you aren't holding back.
I spend enough time questioning whether or not I did what was best for my patients. I spend hours after every work day going over every. damn. thing. I did. and trying to figure out if there were a way to say it better, do it more gently. In the middle of my day, I am a nurse. When I come home, I am a blogger. If the nurse part bleeds into the blogger part, it means I'm not doing my job--either job--well enough.
And so, critics, up yours. It's a shame you didn't read farther or dig deeper. I'm sorry for you, and I'm sorry for your kid--but I'm not sorry for my patients. What they get is the absolute best of what I have to give. What the blog gets is the cynical, tired leftovers.
Would you rather it be the other way 'round?



Hi... Umm my Mother has 3 brain aneurysms and an AVM, looking for a little help...
Hi,My Mom on labor day of 2008 had a brain aneurysm bleed. She was life flighted to University hospitals in Cleveland Ohio where they coiled 2 of the aneurysms, her recovery was very fast and she was out of the hospital withing 3 weeks. They took care of my mom's AVM(its like a tangled mass of veins in her brain) on December 5th 2008 in a 2 surgery process. This was by far the worst experience of my life, after the first surgery my mother did not recognize any of her family and acted like a small child. They took her in for the removal of the AVM on December 6th and she came out much better than the first, she knew her own name and most of her family. But our last trial was an aneurysm that had not burst that needed to be clipped. This surgery was scheduled for January 5th 2009, this surgery seemed to be the easiest of them all... but after my mom had recovered she was different, it was like someone else was in her body. My mom was my best friend and now she won't even really talk to me, she is more irritable and just all around unpleasant. She used to be everyone's best friend! She usually worked seconds but now she wakes up late and goes to bed early! I don't know what to do! Its ripping my family apart. I was wondering if anyone has had an experience close to this? I hope with time she will become more of what she used to be, but I don't know what to think. Please someone help.

help if you can... click here


That's it... I am at work... so I have to make it short.
Good bye for now.

1 comment:

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