Monday, March 16, 2009

An AVM News story...

Not Me... but good.

Earlham Newspaper Article

We were asked to write an article for the local newspaper and I thought it might be a good recap of what has gone on. Obviously it does not have all of the details, but I found it good to go back through the whole ordeal thus far and see how far we have come! So, here it is…

Having lived in Earlham for twelve and a half years, I have come to appreciate many of the benefits of living in a small town. What first bothered me as everyone knowing my business now encourages me, as so many who “know our business” care about what is going on in our lives. Many of you know that my husband, Mike Evans, went to Mayo Clinic for the surgical removal of a large arteriovenous malformation (AVM: mass of intertwined arteries and veins) from the left frontal lobe of his brain. The surgery took place on February 12th, and by medical standards was a success, as the AVM no longer exists.

However, you cannot do such significant surgery on the brain without some repercussions.

Prior to heading up for surgery, we had anticipated being home by February 19th. In our pre-surgical meeting with the neurosurgeon, Dr. Fredric Meyer told us that he expected Mike to come out of surgery with some deficits that would hopefully be temporary but would require inpatient rehabilitation. This did turn out to be the case, with Mike not being able to talk or move his right side at all.

We were relieved when he spoke his first words two days after surgery. Physical therapy started immediately and we were hoping for quick progress. Those of you who know Mike know he is very driven, which we were assuming would serve him well as rehabilitation started.

Unfortunately, things did not go as we had planned. Mike spent seven nights in the neuro ICU before moving to a general neuro floor. After his first night there, he had a seizure do a temperature spike caused by a blood infection. This took him back to the neuro ICU for another four nights so that they could get the 106 degree fever and infection under control. This involved long periods of time on a cooling blanket while covered with ice bags and very strong antibiotics. He was on antibiotics for 21 days and there is currently no indication that the blood infection is still there.

After this time in the ICU, it was back to the general floor to prove he was ready for rehab. On the first night there, Mike was complaining of pain in his right leg which led to the discovery of a very large blood clot. Usually this would be treated with blood thinners, but since Mike had just had brain surgery they did not want to risk a bleed. Instead a filter was placed above the area where the clot was to prevent it from going to the heart or lungs where a clot can be fatal.

After two days he was ready for rehab! The first night he experienced two seizures that were determined to be caused by low levels of the anti-seizure medication. He had a great first full day in rehab, even walking on that first day. The worst crisis was yet to come. He awoke after the second night to have a small seizure, followed by a much larger one. Thankfully I was in the room and was able to call a nurse immediately.

During this seizure Mike coded and the nurses started CPR. Mayo is an amazing place. The neurosurgical fellow was there immediately, as well as a critical care doctor. They got Mike stable enough to transport him back up to neuro ICU. His blood pressure dropped and they were having a hard time keeping the heart beating strong enough to get oxygen to the rest of the body. An ultrasound of the heart showed a large blood clot.

The options were few. We now know that most of the doctors did not expect Mike to live. We believe it is God who had other plans. Dr. Meyer came and told me that he had told the cardiac doctors to do whatever was necessary to save Mike’s life. I signed the consent for open heart surgery and Mike was in the operating room within minutes. The doctor who specializes in this surgery was on call that day and was not already in the middle of a surgery, so he was able to operate immediately. This surgery is only done in two places in the country: Mayo Clinic and somewhere in San Diego. The surgeon was able to remove a 7 cm blood clot from the heart, as well as 20-30 smaller clots from the lungs.

No one knew how long Mike’s brain had gone without oxygen or how far he would be set back. When he woke up, his left side moved normally, which was a good sign that the right side of his brain was fine. We were hoping that the same was true of the surgical side. He started talking again shortly after coming off the ventilator, which was also a good sign. As you can imagine, Mike was shocked to wake up and figure out that he had had open heart surgery. He was not able to fully understand all that had happened until about five days after the surgery. Six days following this surgery, he was back in rehab.

Mike re-entered the inpatient rehabilitation unit on March 4th. There have been no bumps in the road so far. He basically entered at the same point he had after the first surgery, so he had some ground to make up. It has been quite a bit more difficult, given that he is recovering from open heart surgery and has pain from that. He has lost a lot of weight, much of it from muscle loss. Lying in a bed for three weeks is not good!

We are both people who like to do things quickly and rehab is slow. He has been there twelve days and made much progress. He can walk, although he cannot yet lift his leg. His right arm started moving last Monday and he can now lift it slightly. Progress is measured in small amounts. On Saturday he was able to move his toes for the first time. On Sunday he was able put his leg down flat on the bed when it was bent. There is something new every day.

Mike’s speech also continues to improve. He is still having trouble with word finding, but that is coming along better. Last week he wrote a blog post in two hours and this week it took one hour. That’s a huge improvement! Of course, he wants everything back to normal now, but he understands it is a slow process. We are hoping that Mike will be home within the next few weeks. At that point he will begin outpatient physical therapy.

In Mike’s blog post this weekend, he put this Bible verse: “Who has known the mind of the Lord or who has been His counselor? Who has ever given to God that God should repay? For from Him, through Him, and to Him is everything. To God be the glory forever and ever….” We both think that God has kept many things about the brain hidden from people lest they think too highly of themselves. We do not at all understand why all of this has taken place as it has. It is certainly not as we had planned. But we are trusting in God, who understands, and created, Mike’s brain. We give Him credit for keeping Mike safe through all of these complications and we do want all the glory to go to God!



oh my god it is early!
I know that this is a silly statement to thos who are up and moving... and an evan sillier statement for those who get to it by noon or later.

okay enough of this silliness...

Read the stuff above... enjoy... peace out!

No comments: