As part of my med-surg clinical this semester I had the opportunity to watch a surgery in the operating room. This OR (operating room) observation day replaces my regular clinical that week. Today was my OR day. I was thrilled when I learned that I would be observing open heart surgery–more specifically, coronary artery bypass grafting (CABG). It seemed appropriate, as I am a nursing unit secretary in the cardiology unit and we are often sending patients down for this procedure. I was excited to witness this complicated and invasive operation.

In a CABG, arteries or veins from elsewhere in the patient’s body are used to graft to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle). I watched the PA (physician assistant) cut open the patient’s legs and use a scope to locate and harvest the veins that would be used for grafting. Meanwhile, the cardiothoracic surgeon made an incision in the patient’s chest, cut apart his sternum (breast bone) with a saw, and proceeded to dissect the internal mammary artery from the chest wall to use as a bypass conduit. Read the rest of this entry »

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! Read the rest of this entry »

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.

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Sometime in early 2005 doctors discovered in me a small pituitary tumor. After a year and a half of drug therapy failed to reduce the tumor it was removed transsphenoidally in August of 2006. My neurosurgeon said it would probably not recur. It has.

A recent MRI scan revealed the tumor has grown to 2.5 cm, which is larger than it was before surgery in 2006. Due to the location of the tumor there is pressure on and deformation of the optic nerve. To check for damage an opthalmologist performed a Visual Field Test a few weeks ago. The results of this test are normal. Vision loss typically begins from each side of the field of vision and leads to tunnel vision and then blindness.

I was referred by my endocrinologist to a neurosurgeon, Dr. Florman. Dr. Florman is very personable and candid. My previous neurosurgeon assured us that the portion of tumor he was unable to remove would be cauterized and, therefore, unlikely to grow. Dr. Florman said these tumors always grow back. This tumor is growing very fast: about one centimeter in diameter per year. At the current rate I will require surgery every two years. Because of scarring and a weakening of the tissues, each successive surgery is more risky than the previous operation.

Dr. Florman advised me to consider radiation therapy after surgery. Radiation can significantly reduce the tumor’s rate of growth which would mean fewer surgeries. Read the rest of this entry »