Day 13. Trick or Treat? I’ll Take the Treat, Thanks.

Everybody was decked out in orange and the black yesterday at the doctor’s office. Where else would I celebrate Halloween? 

My mom and I were hoping for a very simple re-acquaintance audience at the new Vascular Surgeon, Dr. Cameron Akbari’s, office at Washington Hospital Center. He is not getting a nickname because my instinct tells me he doesn’t need one, kind of like Dr. Francomano. Dr. Akbari is such a lucky find. Tonight I am trying to figure out how I feel about what happened, and if my legs didn’t feel like a hurricane is exploding the power lines of my nerves everyplace, I would be kicking myself.  Why didn’t I go to him for the last three years, instead of those blockheads at the Johns Hopkins University?

I actually met with Dr. Akbari three years ago because my primary care physician recommended it, since, if the worst happened and an aneurysm ruptured, my doctors at Johns Hopkins would be no good to me an hour away (and that’s with no traffic).  Little did I know at the time that they would be no good to me even before the worst ever happened!

Seeing Dr. Akbari again helped take the edge off my worries; his easy-going, kind presence breaks all the stereotypes about vicious, shark-like surgeons. It was particularly nice to see him when I didn’t urgently need him! But let’s not let denial take over: I was there at the behest of Dr. Dreamboat, the pulmonologist, who wanted someone to have a look at the results of my recent Brain MRI/MRA, which I spoke about in my last post. I explained to him that I had a Dissection in my Carotid Artery, a sort of aneurysm that isn’t as severe as the kind I have in my belly, or the one I had in my leg, yet worrisome nonetheless). I had sent the paperwork in to Fairfax Hospital and called ahead on October 8th to be sure that both the report and the disk with the images would be sent ahead of time to Dr. Akbari, so that he could make a considered diagnosis.

Well, for my first trick or treat of the day, I learned that stupid Fairfax Hospital didn’t send the images of the MRI exam I had while I was in the hospital. Trick. Upon learning I didn’t have the images, most doctors would have sent me home and said, “Come back when you’re prepared.”

STILL, I was capable of explaining the issue, right? I told him I had a dissection in my left Carotid artery, enough information, I suppose, to get the ball rolling.

Meanwhile, Dr. Akbari’s nurses called Fairfax Hospital and got the report. Treat. While we were waiting, he sent me for a sonogram of my carotid arteries, so he could have a more immediate view of the dissection. The double treat was that the result was negative.  Or does that make it positive?  The woman who did the ultrasonography was an M.D., super-competent, so it was one of those (unfortunately) rare times when I was able to feel very secure about the results, which indeed were beautiful.  Not a thing wrong.

“Still, there is one thing that could be wrong,” she explained, as I sat up wiping off the warm sonogram goo from my neck.  There is something so….I don’t know….degrading about those moments sitting up dripping with sonogram goo. It is a feeling, I suppose, unique to those who have had a sonogram of the head, neck, or heart. “The problem is that the Carotid Artery doesn’t just begin and end in the neck; it shoots up into the brain, so if they saw a dissection, it could still be in the brain, and if that is the case, I wouldn’t be able to see it with a sonogram.”  Oh….Trick.

Sure enough, after I returned to Dr. Akbari’s office, he was able to read the Brain MRI report from the hospital. While he was still smiling his dazzling smile, it had taken on a note of the “I’m speaking to an idiot” about it. So he says, slowly “You didn’t have a dissection in the Carotid, Heidi.” Trick. “This is a pseudoaneurysm in the brain. And the trouble is, my expertise ends at the shoulders. For the brain, I have to refer you to a neurosurgeon.

Trick. Trick. Trick. 

Tricks are for kids, aren’t they?  You know the ones I mean, the sweet little ones with the shaved heads who look cute on telethons?  I wouldn’t look cute after brain surgery, with a prickly, shaved, fat head and a moon face.  Good Lord.  This isn’t looking good at all.

 I said to myself, “I’ll take a treat, please, God.”  I don’t want to point out the dearth of treats in my life at the moment, people.  I hate to bitch.  I haven’t been writing about the blood thinner I inject into my fat stomach every morning now and the related side effects that are not pretty in any way at all.  In the way of the North American culture of the 1950s, since I have not had anything nice to say, I have not mentioned a word at all about the blood-related messes I undergo. Use your imagination. I feel like I have a daily visitation of the stigmata.

Here’s the story with the aneurysm.  Turns out that between October 21st, when I posted last on this blog and got it right (about my pseudo-aneurysm) and October 31st, when I went to see Dr. Akbari, I completely forgot my diagnosis. That is, it went from pseudo-aneurysm to dissection in 60 mph or less (this hyperlink has a list of definitions related to aneurysms; to read about pseudo-aneurysms and dissections, scroll down to page two in the file). Perhaps I am being hard on myself to expect to remember the difference. It is fairly esoteric. Yet, I find myself frustrated when I “lose” knowledge I had firmly a few days ago without any awareness of it.  That is particularly troubling because I used to grasp knowledge firmly and have confidence that I never would lose it; it never occurred to me that my brain would turn all hole-y and sieve-like before I even reached the age of 50!

Anyway, Dr. Akbari gave me the report, which did help me to understand, and when you read the following crystalline prose, you will understand why. This is the  radiologist’s description of the problem in my brain, along with some pictures that should help with the anatomy:

An MRA imaging of the Circle of Willis demonstrates patency of the intracranial Carotid Artery. There is a broad-based outpouching near the junction of the petrous and cavernous segments of the internal Carotid Artery on the right, protruding anteriorly, suggestive of a pseudo-aneurysm.  Mild fusiform dilation of the contralateral internal Carotid Artery is identified on this level as well.  There is also mild fairly fusiform dilation of the cavernous segment of the internal Carotid Artery on the right.

 So, to split hairs, I was right about the dilation — a mild dilation does exist on the right side, but it is only a minor problem as compared with the patency, or the sort of bubbling out, of the intracranial Carotid Artery and the internal Carotid Artery.  But the end of the report (this is always titled “Impressions”) summarizes the “vascular abnormalities,” and then, to conclude, points out “There is no stenosis.”  When I looked up stenosis, I learned how important that statement is: it means there is no plaque in the arteries, no fat in there (no prime rib, no bacon, no cheddar cheese, pork roast, or, most certainly, no turduckey). When that is present (particularly with the previously described vascular abnormalities), the potential for stroke is high. Good God!  That is all I need.

Good luck, meat eaters!

The plan now? I have to make an appointment with the neurosurgeon (after I finally get a copy of the MRI/MRA images).  However, Dr. Akbari wouldn’t let us leave without saying a few words, and when you read them, you will understand why he didn’t merit a nickname:

“You are not a walking time-bomb, Heidi. Listen, I do this all day, and many times a day I tell people, ‘Look this is a very serious condition, and you need to be extremely concerned.’ That’s not what I am saying to you. Believe me. I would say that if it were true.”  I was so grateful for that comfort! “Now,” he added, “that isn’t to say that you do not need medical care. It is important that you see the neurosurgeon to find out whether you need a procedure, or how he wants to handle it, but this is a small thing.”  

Treat. I think.

Frankly, I was glad to take down the Halloween wreath this morning and put away the Halloween socks.  I am hoping that this year’s tricks are behind me and that I’ll be living in Treat City until my birthday….and beyond.

How did you spend your Halloween?

10 thoughts on “Day 13. Trick or Treat? I’ll Take the Treat, Thanks.

  1. Is it wrong that the first thing I want to say is “whatchoo talkin’ ’bout, Willis?” You have the most amazing body vocabulary. And I am so glad Dr. Real Name was able to be both truthful and reassuring. That came all the way through the screen.

    The injections sound horrid. I hope there’s a way to get you out of that routine sooner rather than later. Although perhaps you could do a more fashionable YouTube demo video before you quit, to augment the one you posted. Kudos to the person who performed that generous act, but the outfit is, well, not Heidi-fabulous.

    I saw a movie the other day where Cate Blanchett got her head shaved (“Heaven”: it’s a fable on Netflix. Not a happy fable, but a fable anyway). I thought it was totally unfair that someone so beautiful everywhere else should also have a beautiful scalp. Like, how does that happen? Mine’s all weird bumps. I’d be a phrenologist’s field day. You, on the other hand, could hold on to the bangs. That would be awesome. And I bet you have a gorgeous scalp, too.

    Also, what are we doing for your birthday? onelove…

    • Well, you are so kind, Randi! My head is really all lumps and bumps as well–I’ve often thought it was phrenologist’s dream. I wouldn’t go near it with a razor, unless I absolutely had to (for fashion’s sake, clearly).

      What cracks me up is that both you AND Carlos said the same thing about the YouTube video I found. Hilarious! There isn’t a chance that I would be willing to film my bubbly belly; even if it is bronzely beautiful, it is a roadmap of enormous bruises and mountain ranges of cellulite and rolls of fat. No, no, no.

      As for my birthday…Up in the air. What should we do?

  2. Well, I wish you could eat all the candy corn I would like to shower you with, as treats are yours from now on!!!
    I’m working on yo present mama!!!!

  3. On the more pedestrian side of things… I was worried that the video was you. What had happened to your fashion sense? The injections, however, do sound despicable (and this from a guy who likes getting injections and donating blood). On the less pedestrian side, I’ll drink to dr. Akabari and his assessment: “You’re not a time-bomb.” In a landscape where bad news are the norm, I’ll take every morsel of good news that I get. And I don’t think it is delusional, I think it’s commonsensical. I may prepare for the worst, but I plan for the best and that seems to be the healthier choice.

    I know your family will keep you for themselves for your birthday. But, you’ll have to have another birthday celebration that includes the rest of us. That is a gentle reminder that I want to see you. Plus you’ll get a nice present…

    • I agree with you, Carlos. What a great example of the rosy future this is. I really am not worried about this brain thing. Why bother!?

      And as for my birthday….well, things are up in the air with my family about what we’re doing. Ugh. My brother may be up here next weekend for a family thing (thus, I don’t know what to do about planning a Salon). Not sure. Other than that, I have no birthday plans.


  4. I like how you wrote this with “Tricks” and “Treats”. It’s a great and good news writing!

    It sounds like you’ve met another excellent physician. He seems like he has patience and willing to educate. How are your blood clots in the lungs? Is the heparin working?

    It’s horrible to go through what you are and have been through, especially this year.

    It’s good that you’re “not a time-bomb”!, at least it’s Dr. Akbari’s opinion. Great news is always welcome! Happy Birthday!

  5. Thank you, Edie! I would like to say I lucked out, but I didn’t. This guy was recommended by another doctor. I made him tell me who he would go to if he were in my seat. That’s a good method, if you’re able to do it. Anyway, I appreciate the compliment.


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