Ready to roam the hospital corridor

Now that my neurosurgeon has removed a significant amount of my pituitary tumor, screwed the front of my skull back into place, and properly stitched the skin around the side of my face together; I feel like a new woman. Either that, or Frankenstein. I think it merits super powers or something. So far though, I haven’t noticed anything extraordinary.

On August 25th I went in for my supra orbital craniotomy. The operation lasted three hours. Amelia, who went through the CNA training course with me, was my CNA again. She took care of me when I was admitted for my transsphenoidal surgery in May. Brent was great at keeping me company. Dr. Florman suggested he bring the girls to see me before my face started bruising up. I guess he thought it might scare them. It was nice to have them there, and they were great, as usual. My friend Maggie came to visit me several times. She helped teach my CNA training course, and she also works with me in the cardiology unit. She made me a delicious strawberry shake and got the girls treats as well. She is awesome!

Maggie and the girls

I slept a lot and quickly tired of lying in bed all day. The nurses were good about keeping the morphine and other pain medications coming. One of the doctors came in and removed the drain from my head. It didn’t hurt much, but I began to feel fluid coming out of the hole and dripping down the side of my face. His expression and response were that of surprise, concern, embarrassment, or a combination of the three. He said, “Um, just a minute,” and promptly ran off. After cleaning up the leak he sealed it off with a big glob of glue. The technology these days is amazing. ;-)

The physical therapist came a couple days after surgery to assist me in walking. She got me a walker with wheels and helped me shuffle down the hall. I was a bit unbalanced and dizzy. I think the double vision and lack of depth perception I was experiencing had something to do with it. Brent asked the PT if we could put tennis balls on the feet of the walker. He’s such a comedian. :-) She wanted me to get a walker to bring home with me, and have a PT come to the house to assist me. Uh…definitely not!

Brent loves his iTouch. The girls like the games on it.

I had several medications temporarily added to the regular hormone replacement medications I am currently taking. I believe the anti-seizure medication played a big part in the headaches and nausea (and what comes with it) I experienced the entire week and a half following my surgery. Also, perhaps I overdid it with the oxycodone, especially as I wasn’t eating much. I recently saw my endocrinologist though, and happily discovered that I do not need to add to or increase my current hormone replacement medications.

Dr. Florman did an excellent job, I think. He did not shave any hair, and the scar is neatly hidden behind the hairline around the top right side of my face. I ended up with a swollen black eye, which took a couple weeks to heal. When I was able to get out of the house, it seemed that I kept getting sympathetic looks from people while Brent would get dirty looks. One of our friends suggested he wear a t-shirt that reads “I didn’t do it.” :-D

My eye 1 1/2 weeks after surgery

Once again, I’m incredibly thankful for Brent and his loving support. He took more than a week off work to stay home and take care of me. He was vigilant and diligent about keeping me from doing anything I wasn’t supposed to (like getting out of bed). When I tried to do anything the least bit strenuous, he would warn me, “your face is going to fall off!” He took fantastic care of me and the girls. The girls were also wonderful and understanding. They’re such troopers!

I started back to work 2 1/2 weeks after my surgery. After trying out a couple six-hour shifts, I went up to my usual twelve hours. I’m feeling good, and keeping up with my 16 credit hours of school as well. I have an MRI scheduled for next week. If the tumor is safely removed from the nerves, I will then go talk to a radiation oncologist about having radiation therapy. Hopefully that will cut down future surgeries and significantly increase the time between each one.

The transsphenoidal operation I had this past May was unsuccessful in removing the tumor (a macroadenoma) from my pituitary gland. According to my MRI, the tumor had moved up, and Dr. Florman, my neurosurgeon, wasn’t able to get to it through the nose.

We previously discussed having radiation therapy to slow down the tumor growth. However there is a risk of damaging the surrounding healthy cells and nerves. The optic nerves in front of it are especially sensitive. Dr. Florman strongly recommended that I have a supra-orbital craniotomy so that he could effectively remove enough of the tumor to allow for safer radiation therapy. Before agreeing to this type of surgery, I decided to get at least one other opinion. I saw Dr. Christensen, a neurosurgeon in Lewiston, Maine, who concurred with Dr. Florman. He held high regard for Dr. Florman and believed him to be the best for this particular surgery. I was discouraged that I really do need to undergo the surgery, yet I felt reassured that I am in good hands.

Dr. Florman explained to me the operation process, complete with the drilling, and insertion of plates and screws. It made me a little apprehensive, I admit. I am scheduled for surgery this Tuesday, August 25. This particular type of craniotomy is a subfrontal approach, so no (or very little) head shaving necessary. :-) Oh, and if someone asks me if I have a screw loose, I’ll simply say, “Uh, maybe.”

The transsphenoidal surgery to remove my pituitary macroadenoma went well, and I am happy to be home. Dr. Florman anticipated my hospital stay to be at least three to seven days, but I was discharged after only two days.

Dr. Oppenheim, the endocrinologist following me during my hospital stay, wanted to closely monitor my urine output and my salt-water balance. I stayed in the unit for post-operative and head trauma patients. It was a long corridor of beds separated by curtains. A head trauma patient was in a separate room next to me. She had been there a month after having been in a car accident. The nurse said that being young (early 20s), this patient would recover fairly quickly. She was still confused though, and was constantly yelling out which made it difficult for me to read or sleep. The nurse was kind enough to give me earplugs. :-)

I believe I benefited from having an ENT surgeon, Dr. Makaretz, assist in the nasal portion of my surgery. I was very apprehensive about his removing the nasal packing the next day because I still remember the painful, drawn-out process it had been when my neurosurgeon had done it a couple years ago. But when Dr. Makaretz removed the packing, it was hardly worse than a sneeze! After my first operation I had a cerebrospinal fluid leak which put me flat in bed for a week. Prior to my operation this time Dr. Makaretz took a fat graft from my abdomen to block my nasal sinus in order to prevent the leak. I don’t know how significant the fat graft was, but I did not have a CSF leak this time. When Brent asked why he left such a big scar on my belly, Dr. Makaretz explained that he had to dig deeper because there wasn’t enough fat. Sure, I bet that’s what he tells all the patients. ;-) I will see him in a week so that he can remove the sutures and shunts from my nose.

It seemed strange to be a patient at the hospital where I normally work as a nursing unit secretary. Amelia, one of the CNAs who took care of me, was in a CNA training course with me last spring. This time when she took my vital signs, she wasn’t just practicing on me…at least I don’t think so. :-) I enjoyed visiting with her. She brought me a delicious strawberry milkshake. I knew the girl who brought me on the stretcher from recovery to the unit, and the man who wheeled me down to the car after being discharged. Normally I am the person calling them to transport patients! They were quite surprised to see me on the “other” side.

As a nursing unit secretary I frequently answer call bells from patients. So while I was there in the hospital this week, I had a strange urge to answer the call bell each time I heard it ring. I am aware that the nurses and CNAs sometimes get overwhelmed with excessive demands from some of the patients, and as a patient I did not want to be needy. I think I rang the call bell twice, only because the nurse wanted me to let her know when I was done washing up.

Brent has taken great care of me and spent a lot of time at the hospital. I was glad to have him there and I enjoyed his company. I had a nice visit with our friend Jason, who came by with a beautiful bouquet of flowers. He’s a great guy with an awesome wife and kids. I appreciate all the support, concern, and well wishes from family and Facebook friends. You know who you are! My sister Sara and my mom sent me an awesome care package filled with tissues, lip and face moisturizers, various Jell-O gelatin and pudding, Ghiradelli chocolates, and magazines. Skye, Jenna, and Hayley have been wonderful; understanding, responsible, helpful, and concerned. They’re such great girls!

My nurse Hannah had instructed me not to do anything that would cause any pressure or strain to my head, such as coughing, sneezing, sniffing, lifting, or drinking from a straw. Brent thought the girls should be aware of my limitations, so he gave them a briefing when I returned home from the hospital. He told them: “Don’t make mom sneeze or cough, don’t tickle her, and don’t scare her.” He added “Don’t punch her in the face.” Hayley looked genuinely offended, and replied “But I never punch Mommy in the face!” When Brent told them not to pour hot lava over my head, the girls relaxed a bit and began laughing.

Before Brent left to pick up my pain medication (hooray for Vicodin!), he told the girls to take care of me, watch me closely, and get me what I needed. He instructed them to make me stay in bed. If I got out of bed, they were to tell him and he would get me in trouble. Hayley seemed concerned and asked if he was going to spank me. :-)

I will see my regular endocrinologist, Dr. Bing-You, in a few weeks. After some testing he’ll determine whether I need to increase or add to my current medications. Dr. Florman said that with each operation the pituitary gland will become more damaged, thus requiring more hormone replacements. Sigh…I certainly hope not.

Overall, I am pleased with the outcome of this surgery. I wasn’t in bed at all today. Considering the operation was four days ago, I think I’m doing pretty well! (I may be cheating by taking Vikodin.) Brent said to the girls the other night, “Now girls, Mommy isn’t going to be as smart as she used to be, because they removed part of her brain.” Oops…I hadn’t considered that.

Related post:

One Down, Many More To Go
Kirsten Uhler, Cogitations, March 29, 2009