A Flick Of The Switch - A Schwannoma Diary (#16).

I'm home now. 

It's been five days since my surgery and four days since my Medtronic Intellis spinal cord stimulator was switched on for the first time. On Wednesday at midday, my medical technician visited me at my bedside and programmed the stimulator in a process that took roughly fifteen minutes. 

That's all. I know right?? 

And it was cool in that all she used was an iPad with a nifty user interface and a handheld device - similar to the one I now own - to send a series of commands into the stimulator, then tweak them so that I would feel the electrical impulses in the right area - namely my left lower back, left hip and left leg. The sensations were strange to say the least. I equated them to being zapped by an electric fence when I was a kid at my uncle's dairy farm, but much more entertaining. After the initial flurry of shocks and zaps, which took place while the technician was establishing the programming parameters, the impulse settled down, becoming a ever present buzz that rose and fell rhythmically.

I'd had a rough sleep on Tuesday night after the operation. I think that was due to the post anaesthetic fog and the inevitable pain from the surgical incisions. I have a cut in my thoracic spine, which feels like I've been kicked in the back and ribs, while the cut on my buttock makes finding a comfortable position when sitting or laying down difficult. 

The first thing I noticed after the switch on - my hip pain virtually disappeared. Instead of the ache that would usually have me struggling to move, the buzz from the unit had taken its place - and it was pleasant! The pins and needles that I usually experience often come in random bursts throughout my leg, ranging from an unpleasant popping and fizzing to an intense burning that can and has lasted for days at a time, they have been replaced by the rhythmic tingle from the stimulator. So the early signs are really promising.

I came home on Thursday and began to reacquaint myself with a familiar environment.

Working with the handheld device has been an interesting dance. It requires some playing with in order to find the best current for a given positions. I find going from a standing to a sitting position, I have to adjust the intensity of the electrical current, otherwise it can be overpowering. The ideal range when standing seems to be around 2.3 to 2.6 mA (milli-amperes). When sitting, I'm finding that I have to dial it down to between 2.0 and 2.3 mA. And when laying in bed, depending on what side I'm on (I tend to be a side sleeper), I find that sometimes I have to dial it up and sometimes I have to dial it down. Laying flat tends to push the paddles against the spinal cord - as does sitting taller - which they say is a good thing anyway.

The rules, if there are any, seem a little rubbery. For now, it's been good to discover and learn what works and what doesn't. I will meet the technician again in the coming weeks to make some adjustments and add some settings to the handheld for me to play around with.

While I heal, I have to stay out of the swimming pool. I'm not happy about that, given the progress I'd made leading upto the surgery. I was achieving 1km distances in around 24 minutes, which I thought was pretty damned good. The most important part of the healing process is ensuring that the leads and paddles don't move while the fascia and muscle layers knit together. Fortunately, I won't need to wait as long this time around.

All in all, I'm in a good place. I feel positive. 

DFA. 

MacArthur Park - A Schwannoma Diary (#15).

It's a strange experience being a "guest" in the place where you work. Even after a few times, I've never entirely gotten used to it. The faces you see every day...it feels like they see you differently. Maybe they do. Maybe they don't. It's just a feeling.

I was whisked through to radiology as soon as I checked in to undergo the pre-operative mapping X-Rays of my thoracic spine. This is so the surgeon has accurate images of where she needs to enter in order to place the paddles onto my spinal cord. I have a whole bunch of writing and drawing on my back where the radiographer labelled everything. I'd take a selfie, but it's a bit hard and I don't really want to.

I'm waiting now. There's an hour to go before the 2pm list begins. I know I'm third on that list so I'm thinking it'll be around 5pm by the time I go under. I have a nice room with a window that looks over some cloisters. They remind me of the cloisters I wrote about in "The Recipient" so that's nice.

My daughter Lucy made sure she packed her multicoloured Llama into my overnight bag this morning. She said it would bring me good luck. When I dropped the children off at school this morning, her bottom lip bulged and I saw a tear. I thought I saw a tear.

I panicked this morning because I didn't have an anaesthetic song. That's a song that you take in your head to the pre-op area - one that's supposed to keep you calm, maybe inspire you. I recounted in a previous post that I got the idea from Michael J. Fox who took Pearl Jam's "Given To Fly" with him into one of his surgeries. 

I have Jimmy Webb's "MacArthur Park" stuck in my head. I didn't necessarily want it, but it's there and I guess it'll do. There is only one version of MacArthur Park that is satisfactory to me though...

See you on the other side...

DFA.

Electric Dreams - A Schwannoma Diary (#14).

I met with my neurosurgeon again earlier this week to review the series of MR scans and X-Rays that I had taken last week of my brain (I have one), my spinal cord and column and my hips. Given that a major feature of my neuropathic pain has been an intense ache in my left hip, we needed to rule out any form of orthopaedic pathology. Fortunately, both my hip joints are in excellent condition so the source of that pain can definitively be sheeted home to my damaged spinal cord.

So, the only thing left to consider was whether to proceed with the Medtronic Intellis spinal cord neurostimulator platform, which I covered in my last post.

We're going to proceed.

My neurosurgeon is confident this implanted neurostimulator will be the best option for me and that I am a good candidate for it. I'm otherwise healthy, have a reasonable amount of physical fitness, thanks to my swimming and, having reviewed and considered the technology for myself, I am mentally prepared to accept the presence of this implanted device in my body.

The biggest risks of the neurostimulator remain the possbility of the leads and paddles being dislodged or migrating, though my neurosurgeon has assured me that she will make sure they are anchored securely. I'll have to watch how I move in the first couple of weeks after the surgery to allow the healing process to further ensure the leads remain locked in place. There's the potential for infection at the wound sites, which is a consideration for any kind of surgery, so I'm not overly concerned by that. My intuition as a Nurse will ensure that I take care of myself. A lesser risk is that I won't adapt psychologically to the presence of the neurostimulator in my body. It has been reported in other patients who have eventually had their devices removed because they couldn't accept it.

As I write this, I feel dispassionate about it. The chronic neuropathic pain I've been experiencing has been so debilitating for me both physically and mentally that I will try anything if it offers a chance for me to escape it. And, being a massive geek for anything technological helps.

Part of me keeps visualizing this as the outcome of the surgery...

(image credit - issam kh).

...when the reality will be much more like this...

(image credit - Medtronic)

...which is still a radical proposition when I think about it for any length of time...like, right now.

It's all happening next Tuesday, August 20th (it's early Thursday morning as I write this). The theatre has been booked. The implant has been ordered. The requisite medical and nursing staff will have been organized - all of them colleagues of mine, which makes this next step in my little journey a bit different.

The Nurse will become the patient once more...

Stay tuned.

DFA.

The Tunnel - A Schwannoma Diary (#13).

No matter how many times I enter into the painfully narrow tunnel of the MR imaging machine, I never feel as though I'm getting used to it. I approach each machine with a similar veneer of defiance that says, "Righto fucker...You. Me. Let's ride" as if I'm goading this big dumb square donut of technology to do something fatal - like throw one of its magnets through its casing at God knows how many thousands of revolutions per minute and cut me in half. It never happens though. MR technology is so well advanced now. Safety protocols are so stringent with these machines. You'd have better luck getting hit by a car than being killed by an MR imager.

Still, when you're in that tunnel, your head secured inside the cage they close over you to keep you from moving around, with those magnets spinning around you, clanging and banging and rumbling. The psychology warfare you have to play with yourself can be considerable - especially if you're not enamoured by confined spaces and bone crunching noise.

I had the preparatory scans of my spine today. These will help the surgeon get a "lay of the land" so to speak so she can best decide how to approach the evntual surgery to implant my spine cord stimulator. Having discussed the technology with the product specialist, its likely that the leads and paddles will be inserted into the spine at the thoracic level - between T8 and T10. The product specialist - who has a clinical background - believes that will be the best place to achieve the best potential for the neurostimulation therapy.

I also had a couple of X-rays of my hips - just to rule out any defect in either of those joints that might be the source of the hip pain I described in my previous post. It's highly unlikely, but you just never know. I can't actually remember if I'd ever had any films taken of my hips previously. I've had so many.

The MR scans were pretty straight forward to be honest. I was in the tunnel for roughly half an hour, during which the radiographer was kind enough to give me a pair of headphones with talk back radio piped through them. The talk back wasn't entirely useful however as it was drowned out by the magnets around me. But I always consider it a nice thought. 

There was a short break in proceedings as they pulled me out from within in order to inject the radioactive dye - gadolinium - into my system. That's so they can take a series of enhanced images that can pick up any anomalies (god forbid another tumour) that may or may not present. Gadolinium is one of those hilarious radio-isotopes that makes you feel as though you've lost control of your bodily functions, even though you clearly haven't.

It was all over in half an hour and I was back on my feet and out., The Radiology Service has a green ethos these days meaning the images will be sent electronically to my surgeon - she probably already has them. I meet with her in a week, by which time we'll pencil in a date for the surgery.

There was a time when I would have been petrified of the tunnel. Now...it's just mildly angst inducing. 

Me 15...

Machine 0...  

DFA.

The Shape Of Water - A Schwannoma Diary (#11).

I saw my neurosurgeon last Friday for my 6 week post operative review. It's kinda hard to believe that six weeks have past since my surgery. Time moves in such elastic ways. 

We reviewed my progress. It's been patchy. I'm not moving freely. Even with the physiotherapy exercises I've been doing, it's hard to loosen up. Walking is a chore for the most part and I can't tolerate walking long distances, say more than a kilometer. It's hard to get in and out of my car, my bed or chair. I experience pain at the surgical site and down into my legs, along with long bouts of pins and needles. Incontinence is still an issue but, so far I've avoided any significant accidents. This requires a regular toileting regime, forward planning - especially on outings - and a keen focus on what my body is telling me. I do get strange sensations, which I've attributed to warnings that I need to take heed of.

With the activity I've been maintaining however, I do believe things are improving. At the very least, I'm coping with them. My neurosurgeon prescribed some new medication that will hopefully, address the pain issues and the nerve irritation that is causing the pins and needles.

The one question I had for her during my review last Friday though was pretty much the only thing I wanted to get an answer for.

Can I get back in the pool?

When I had my original surgery back in 1989, my then surgeon was happy to allow me to get in the swimming pool after a similar time frame. As a result of this, not only did I discover a love for swimming, I became really good at it. So I knew going into this surgery that the pool was going to be my Holy Grail. 

My neurosurgeon this time around prohibited me from going swimming until she had reviewed me. Her primary concern was my wound. She wanted to ensure it had healed properly before exposing it to water and risking infection. I accepted this, but I was disappointed that I couldn't start as soon as possible. 

You can imagine how pleased I was when I put the question to her on Friday and received her answer. 

"Absolutely!" 

I felt like I was receiving a Christmas present - all over again.

The Unley Swimming Pool at Forestville here in Adelaide is a pool I've been swimming at on and off for twenty years. It's an Olympic sized pool and it's a friendly place. After dropping the kids off at school, I headed straight there. After 9AM, the early morning lap enthusiasts and competition swimmers tend to taper off so competition for lanes is minimal. I went for the recreation lane today. 

I had an idea of what I was going to do once in the water but for this first session, I winged it a little. I adapted some of my 'on land' exercises to the water and set about constructing a regimen that ended up looking like this; 

Stationary calf stretches 10 reps x 10 seconds right leg.
Stationary calf stretches 10 reps x 10 seconds left leg.
Stationary side stretches 10 reps x 10 seconds right arm (down right leg).
Stationary side stretches 10 reps x 10 seconds left arm (down left leg).
Stationary leg kicking (against side of pool) 2x 1 minute.
Walking (strides) 25m x 10.
Jogging steps 25m x 10.
Side strides 25m x 10.
Breast stroke (gentle!) 100 meters. 
Cool down walk 25m x2. 

I won't go into deep explanations of each of these, but feel free to ask me about them in the comments and I'll try to explain them if you're interested. 

The session took me about 45 minutes. 

Suffice to say, from the moment I entered the water, I felt amazing! Water and buoyancy affords the body so much freedom of movement and I was able to stretch so much more easily than I can on land. The exercises I chose were designed to achieve both a muscle stretch and a nerve stretch through my lower back and legs and I chose to limit them once I could feel them in my calves in particular. I felt that was good indicator. Curiously, I felt the stationary leg kicks and the breast stroke in my right buttock, close to the mid-line. On land, most of the pain I've been feeling has been centered around my left buttock and sciatic nerve. I'm not sure what the significance of that is but I'll bring that up with my physiotherapist when I see him tomorrow.

Leaving the water after that first session, I felt a little shaky - but it was a good shaky. I felt like I had achieved something important and I felt a rush of endorphins - ones that have been in short supply lately. I'm well keen to do it again. But I know I need to pace myself. 

This is a big milestone for me. Since the surgery, I've been looking towards this moment. I've been thinking about it. Planning (loosely) what I would do once I got in there. I knew it would be good...and it was. 

I love the shape of water. 

DFA.

A Moment In The Air - A Schwannoma Diary (#10).

I can't remember how long it's been since I've been to a beach. 

The sun on my face. 

The sand between my toes. 

The sea breeze. 

My dog is just as struck by the beauty of the Adelaide beach on which we sit. I've let him off the lead and he's galloped across the sand, his floppy ears flailing like sails. He's snapped at the air like it's some sort of treat. 

On the beach, I can stretch my legs. I can stride a little bit, even though the pins and needles keep reminding me that they're there. I can accept the pain because where I am feels so bloody good! 

There's a young Dad frollicking with his infant son near the edge of the foam as it races up the sand. The boy squeals with joy and it's hard not to smile. Right now - I get it kid. 

To sit on the sand with a straight back (because I *have* to keep a straight back) and look out over the jetty. To marvel at just how wide open everything is. The sun and the light! The air! The breeze on my face! 

I've been surrounded by the four walls of my house for far too long.

I almost don't care that I move like an 80 year old. That I probably should have taken some pain relief with me. That there's not a toilet close by.

I can see a kiosk nearby. 

You know what? I'm gonna treat myself. Yes I am.

DFA.

The Approaching Storm - A Schwannoma Diary (#9).

See...that's the thing about Schedule 8 analgesics. They're all well and good when you're on them and they are giving a nice little analgesic high. You feel good, existing in a state where you're pain free and can function *almost* normally.

And then the wall rushes up. You slam into it and you realise it was all a fallacy.

No matter how diligent you are in weaning yourself off them, reducing the doses every few days and adjusting, there is always a drop off once the final dose has been taken. And it's a big drop off. I encountered it yesterday when I entered the first day without having the narcoticanalgesics available to me.

The pain in my legs was breath taking. Every step I took was a punishment. And not only was there the pain of impact - from taking a simple step - it was accompanied by a lingering bout of pins and needles, lasting anywhere upto an hour once I'd completed a single instance of walking. An electrical storm in my legs.

Any activity is a war. Finding a comfortable spot in bed or in a chair. Having a shower. Even toileting is a fucking to do.

I'm getting frustrated. I'm getting angry. I'm weeping alot. It takes everything I have to erect a veneer so that no-one sees. I'm a shitty builder.

I am able to get some respite from it with Paracetamol and Ibuprofen taken together. But they aren't all that effective. Everything is hard. Even showering. Even toileting.

We're entering a phase of recovery now that isn't going to be pleasant. I have to ride the wave of withdrawal and hope that this will settle in a few days. I have to be patient when pain and patience are the worst of partners.

I have to rely on myself now and I'm not very reliable.

DFA.

Scars - A Schwannoma Diary (#8).

They're a curious thing. Scars. 

Some are easy to see. They're in your face, confronting. They challenge you to consider them. 

Others are deeper. Hidden from view. Covered up to protect others from having to deal with them. 

To those who bear them - they mess with your head, your heart. 

They are uncomfortable. They are painful.

They are functional. They are protective. 

Scars are a curious thing. 

DFA. 

Goodnight Marcella - A Schwannoma Diary (#6).

DFA.

The Alabaster Elephant - A Schwannoma Diary (#5).

My wife bought me an elephant yesterday. We stopped by an Oxfam shop in town during a last minute excursion to finish up our Christmas shopping.  

It's a small carved elephant, one with an even smaller elephant inside it's body, which you can see through the intricately carved lattice work on its flanks. It has its trunk turned upwards, a sign for good luck, according to Hindu culture. It's hand carved, courtesy of some sort of co-operative in India that provides these and other trinkets to the Western market, with proceeds from each sale going back to the individual artisans who make them. 

I've long been fascinated by elephants. Their intelligence, their gentleness, their strength. I've even had the privilege of riding an elephant. It was a few years ago now, during  a trip in Thailand. It was one of those experiences that seemed a lot more special than it probably was. I had a moment with this animal. It wrapped its trunk around me and wasn't going to let me go in a hurry. I had thought we'd bonded. It was probably trying to squeeze the shit out of me.

Where am I going with this...

I've packed that elephant into my suitcase for tomorrow. I don't even know if I'm superstitious but, I figure, it's worth a shot...the whole good luck thing and all.

I've packed my pyjamas. A couple of pairs in fact, along with some loose clothing that won't be too hard to get into. I've put in my tablet and my Bluetooth keyboard. I might get some writing done while I'm recovering...I probably won't. I've put in my copy of Dostoevsky's The Brothers Karamazov and Solzhenitsyn's The Gulag Archipelago - another gift from my wife. My sponge bag. Some L'Occitane products. I have standards.

I'm scared. More than I've ever been. This is real. This is real? Surely there's been a mistake. The scans are wrong. They got the wrong patient. The tumour belongs to somebody else.

Fuck!

There's no mistake. 

This is real.

My kids are fighting over some Christmas paper. They're screaming at each other. Meanwhile, the dog is whimpering and whining, wanting to be fed. The TV is too loud. Builders working on the house next door are using an electric saw, a nail gun. My son is trying to follow the cricket, demanding quiet.

Inside my head...silent chaos. A thunder storm of fear that seems more suited to a 15 year old boy than a forty...something...year old man. I'm standing on the edge of a volcano, looking down into the maelstrom. 

I've take the alabaster elephant out my suitcase. I'm holding it in my hand.

The elephant seems calming. They are a calming animal. 

Aren't they?

DFA. 

A Parasitic Relationship - A Schwannoma Diary (#3).

I think I'm entering a phase of being angry now. 

I met with my neurosurgeon this afternoon to review the MRI scans that were captured over the weekend. 

They established the geography of the space occupying lesion at the base of my spinal cord. Even on the scans, it is a parasitic looking little shit. In fact, it's not so little. It's something in the order of an inch to an inch and a half in size - a dark, lobulated mass that is being fed by a rudimentary blood supply and, most likely, my cerebrospinal fluid - the fluid that bathes my spinal cord.

My little parasite - not the circle, the thing in the circle.

The theory goes that this tumour is one that has degraded over time. It started out as a healthy (???) schwannoma but some where along the way it degenerated into this cystic lesion. There's still a lot that is unknown about it. An MRI will give you good images and you can make certain assumptions about the make up of the structure and tissues featured in them. But they're assumptions. Guess work. Estimations.

We won't really know the composition of this thing until it's removed from me and it can be examined. 

I want to anthropomorphize it - to give it an evil agency so I can justify being angry and hateful towards it. 

But it's not evil. 

It has no agenda. I mean, it couldn't even grow properly, like a normal tumour would. It's a pathetic reject - a retarded tumour. It's just there. A stupid genetic abberation of my own making.

I can't sustain my anger. I end up feeling empty, perhaps a little bit guilty.

My retarded tumour.

The surgery has been set for next Tuesday, the 18th of December. I will undergo a laminectomy whereby the surgeon will re-enter my spine through the incision that was made 29 years ago. There's a lot of old scar tissue from that original operation that may or may not cause some problems. Scar tissue is not forgiving. I'll be under an anaesthetic for 3 - 4 hours. It could be less if my surgeon can get in there without too much trouble. Then, I'll stay in the hospital for 5 - 7 days.

That's where my stomach drops. Having to tell my children was crushing this evening. Christmas Day won't be the same. I won't even be home for it. We won't be able to observe our little traditions. Worse still, our planned interstate vacation looks unlikely to proceed. This is particularly upsetting. I haven't seen my parents or my brother for 8 months. There are old friends I haven't seen who I was looking forward to seeing. I haven't reconnected with home in all that time and it hurts. Some people don't understand how much it hurts.

I've noticed something about hospital forms - they never allow enough space to write your email address. I always end up squashing up my writing to make it fit. I'll have to bring that up with someone I reckon. 

DFA.

Billy Idol In A Tube - A Schwannoma Diary (#2).

If you've never had Magnetic Resonance Imaging (MRI) performed before, it's a difficult experience to distill into a basic description. Having thought about this over the past few days, I think the best way to sum it up is in two words - a peaceful panic. 

I consider myself a veteran of the MRI machine, having undergone more of them than I care to count over the past twenty or so years. So, I no longer experience the crippling claustrophobia I felt when I first entered one of these machines back in the 90's. That's not to say the feeling is totally absent. I mean, I still lose my shit if I get tangled up in a sleeping bag, so I retain a certain, unhealthy fear of tight spaces. The MRI and I have, somehow, come to a mutual understanding. We don't fuck with each other.

Entering the two foot wide tube on Sunday was kind of a mundane exercise - if you could call it that. I went into this scan with a clear sense of the objective. We were to map the tumor sitting in my spinal cord in preparation for surgical intervention. Knowing this, and having the clinical knowledge that comes from over 20 years as an Intensive Care Nurse, I didn't feel a great deal of anxiety. 

Once my entire body was delivered into the entirety of the machine - then, it was a case of, "Oh Shit! I'm in this confined space for at least half an hour and I have to lay completely still."

 Of course, they do give you a panic button and headphones - mainly to block out the frightening sound of the magnets circling at insane speeds around your body - but also to pipe music or radio talk back of your choice into your ears as a measure of comfort. I chose the broadcast of the Test Cricket between Australian and India at the Adelaide Oval but the radiographer had a difficult time actually finding the station. For several minutes, I had FM radio blaring Billy Idol's "Hot In The City" in my ears. As I was feeling an uncomfortable warmth in my pelvis (real or imagined), I thought the song was appropriate.

Somehow, the radiographer fiddled with the dial and, like that first bit of radio static you hear on Pink Floyd's "Wish You Were Here", the Cricket broadcast was eventually found. 

Recently, I have been using a meditation app called "Calm". Like the many guided meditation apps that are available at the moment, this app focuses on the breathing as your centering strategy, while voice guidance - provided by the wonderful Tamara Levitt - lulls you into a state of relaxation and...well...Calm! throughout each, roughly 15 minute session.

This method of breathing and focus came in handy while I was in the machine. I found I was able to push away the chaos of the magnets spinning around my body, assaulting my tissues with their insane fields of energy, and find a state of being that helped. The claustrophobia - the panic of feeling claustrophobia - peeled away from me and, funnily enough, even the sound of the magnets became a tool with which to enhance my state of calm. Of course, the cricket helped as well. 

Not Billy Idol though. He's a tool. 

The set of pre and post contrast images, focusing on the lesion in my spinal cord, were good images. At first there was a little confusion because the tumor didn't take up the contrast as readily as was expected (tumors are inherently vascular). It has become cystic, space occupying, which accounts for the leg weakness and pain, the urogenital dysfunction and my lazy bowel, so it has to be dealt with sooner rather than later. 

I meet with my Neurosurgeon tomorrow to discuss the results and go to the next stage.

(image credit - Getty images.)

Emotionally, I'm ragged. I'm at war with my thoughts - my anxieties. Knowing I have this parasitic "thing" within me does not encourage good tidings. I can't plan anything - certainly around Christmas or beyond. At a time of year where everything is insane and people have to think 12 steps ahead, I'm forced to live day to day. Plans I've made with the family have to be held in stasis until we know more and I feel a pressure cooker of expectation. Most of this of course, is in my own head. I don't want to let people down - most of all my kids who, at this time of year are filled with Christmas butterflies. And time always moves slowest when you don't know the answers to their questions.

I'm also asking the question, why did this thing come back? That has been playing on my mind more and more and, of course, that can't readily be answered. I know I shouldn't ruminate over that too much because there's no use in it. It came back and that's all there is to it.

I listened to Joe Rogan talking with Jordan Peterson over the weekend and they were talking about the nature of struggle. Peterson was saying that struggle is an inherent part of human nature - of being - and it's how we approach the struggle that determines our character. I'm trying to approach all of this with strength and focus. It's elementary really. This thing has got to come out. I've got to accept the struggle and navigate the path through it. 

I've got too much living to do. 

DFA.  

The Twenty Ninth Year - A Schwannoma Diary.

Where to begin with this...

So...I've had to digest a lot of news in a short space of time this past week, so my thoughts are a jumble. I'm probably going to struggle to express myself coherently here. But, bare with me. Okay?

There's a background to this story that I'll relate to you in a potted form. It's a story that began back in 1989 when I was 14 years old. 

I was a reasonably active kid. Good at swimming, average at football. Decent at cricket - though nothing to write home about. I was always a little clumsy, uncoordinated. I had a terrible drop punt and I used to trip and fall over myself a bit. It was embarrassing sure, but I didn't get too worried about it. My Star Wars game was always better than my Australian Rules game. One morning in late May, during a junior football match, I suddenly collapsed and was rendered unable to walk. After a flurry of medical examinations and a series of scans, I was diagnosed with a tumour in my spinal cord - a schwannoma. It was growing out of the spinal cord itself, it's parastic tissue intimately emeshed with the cord. It was to turn my teenaged life upside down for the next two years. 

I had two operations back then to remove the tumour and clean up some scarring that caused some issues afterwards. I had to re-learn how to walk. I had to manage a few functional issues involving my bladder and bowels and I somehow had to navigate the psychological comprehension of a traumatic experience that upended my adolescence.

I was told at the time that this tumour was a fluke - a once off. Owing to its slow growing nature, there was zero likelihood of this thing ever returning in my lifetime. Aside from a few functional issues, I should be able to lead a normal life.

Twenty Nine Years later...

I've documented my recent *exploits* here with my throat - how a dysfunctional branch of nerves in my neck caused havoc with my ability to swallow, speak and breath effectively. Having largely conquered that episode, I was referred to a Neurologist to investigate the underlying aetiology of this nerve dysfunction 

I was concerned there was an inflammatory causative factor for the whole throat thing. Some additional symptoms I'd been experiencing - including visual deterioration in my left eye, a sudden inability to taste or smell, some incontinence and *other* dysfunction - led my neurologist to want to rule out that very inflammatory pathology. We discussed Multiple Sclerosis, even Parkinson's Disease.

I agreed to undergo a battery of tests in order to build a case against these. A series of blood tests, urine, a lumbar puncture, neurological exam, an MRI. I underwent these tests, determined to get to the bottom of this mystery, because I didn't want it weighing on me any longer. This had been two years out of my life, in which - you know - I would've rathered been focusing on something else. 

I'm at a stage in my life where there's not a lot that shocks me anymore. As an Intensive Care Nurse, I've seen a fair bit - maladies, trauma, disease, the expected and the unexpected. 

I received a phone call from my GP last week, requesting that I make and appointment to see her. I sat down with her after a long night duty shift on Wednesday morning.

The MRI scan found a tumour, located in my lower spinal cord - very close to where the original schwannoma had been found in 1989. 

A tumour - that was never supposed to recurr.

I was shocked, stunned, numb.

Remember? This was never supposed to happen. 

Things have moved fairly quickly. I have met with a Neurosurgeon, and we have discussed my options, which I might say, are pretty straightforward. I will have to undergo surgery to remove the tumour. Plans are afoot in that direction and I'll be undergoing a second series of scans later this week to *map* out the exact geography and extent of the lesion. It is growing out of the spinal cord itself, so the surgical team need to know - to the millimetre - how emeshed this mass is.

At the moment, I'm approaching all this with a clinician's mind as much as I am a patient's. It's a confusing state. I've expressed little outward emotion about the diagnosis so far. Rather, I've been digesting the reports and the MRI films. I've mulled over the technical aspects of the prospective surgery. I've weighed up the chances of this thing being a malignancy. By erecting a veneer of distance between the diagnosis, I can keep my emotions in check.

This is not to say that I am completely divorced from them. This recurrence has implications beyond the mere presence of the tumour - implications that I can't bring myself to process just yet. There is, deep down, a maelstrom of emotions.

There is fear. There is disbelief. There is anger.

My mind teeters on the edge of this chaos so I'm doing everything I can to focus on the process dispassionately.

This may seem strange, but I'm more worried about more fundamental things - like, how I'm going to get through the next little while - I mean, it's bloody Christmas. I have to pay the bills, support my family, give my kids a Christmas to treasure - this Christmas is certainly going to be interesting. 

I want to get back on my feet as soon as I can. I can't stay idle. It'll drive me nuts. I can't allow this thing to upend my life again. 

The stakes are too high.

Is this a diary? I think this is a diary. Let's call it a diary.

I can't breathe now. I need to stop writing. I'll talk a little more soon.

DFA.

The Snore Of Destiny - Part Deux.

It's quite a thing to be travelling along, living your life and dealing with the mundane problems of life and then, suddenly, be forced into a sudden left turn that, literally, shakes shit up. 

So, remember that time when I was talking to you about a little problem I had with snoring? You know - when I'd resorted to a handful of "home remedies" in the hope that I could stop this throaty rumble that had people running from me as if I was the xenomorph from the Alien film series?

Well...it turns out that there is a reason for this snore - and it is one that I hadn't anticipated. At all.

I won't go into a long winded recap of the whole snore-fest. You can click through to read my original post and the rather screwy lengths I'd gone to try and stop it. 

After we returned from our family holiday on Kangaroo Island, I'd resolved to give this thing proper medical attention and I went to see my G.P. with the intention of nipping this thing in the bud right away. After examining me and determining that there was no obvious reason for me to suddenly have begun snoring, my GP and I decided to refer me to an ear, nose and throat surgeon. Because I'm *in the business*, as it were, I know a number of fine surgeons in this field. An appointment was duly made.

Upon visiting the ENT surgeon and having the somewhat wierd experience of a camera being threaded down the back of my throat right there in his rooms, a rather alarming discovery was made. It turns out that my right vocal cord is paralysed - specifically, the arytenoid cartilage that anchors the vocal cord to the  result is that during things like speech, breathing or the act of swallowing, the right side of my throat is collapsing inwards whenever the cords come together so that they don't close up properly.

image credit: Mayo Clinic.

In my discussions with both the GP and the ENT surgeon, a couple of things were happening in addition to the snoring that I'd kind of disregarded but were now, with the advent of all this, things that I should have paid more attention to. Over the past few months I'd noticed, on occasion, that whenever I engaged in exercise I would, after a while, find it difficult to breathe and in addition to that, my breathing had become quite noisy. I was producing a stridor. After exercise, I'd noticed that I had the feeling of a lump in my throat without any real explanation. It was uncomfortable but I'd gotten used to it and therefore dismissed it.

And, very occasionally, I'd noticed that I have struggled with swallowing - whereby I have actually choked on small morsels of food that would otherwise be considered innocuous. There have been a few instances of this that have garnered wierd stares and chuckles from my family but they didn't occur so often that we'd conisdered anything untoward about them. All these symptoms have gotten progressively worse in the last month or so and they've been harder to ignore.

So, on the day that I'm sitting in the surgeon's rooms and we're discussing a paralysed vocal cord, two things came up as causators for it - the first being a viral neuritis leading to an inflammation of the nerve that supplies the right side of my vocal cords. The cause for this is generally sheeted home to a viral infection which can be something as general as a flu. 

The other possibility was a lesion or tumour.

Alarm bells sounded in my head on that one as I recalled memories of my experience of the spinal cord tumour that disrupted so much of my adolesence. Whilst I'd been told that the chances of me having another tumour like the one I'd had in my spinal cord was remote, there was always a slight possibility there could be another schwanomma lurking around inside me. 

In light of this, it was decided that I should undergo two tests to bed down what we were dealing with - a sleep study to monitor the severity of my snore and its affect on my sleep and an MRI scan of my neck and chest to rule out the possibililty of a new tumour growing on the cranial nerve.

image credit: Auburn University.

If you've ever had an MRI, you'll know that it is, at best, a disconcerting experience. You are essentially placed inside a tunnel that isn't much wider than the average person from shoulder to shoulder. It is an uncomfortable and claustrophobic environment and moving inside the tunnel is not an option. Furthermore, a series of huge magnets revolve around you that create a noise unlike anything you've ever heard. It's loud and it's a little scary. 

For my scan, I had the additional *delight* of having my head and neck encased in a rather medieval cage, securing me in such a way that even subtle movements of my head were impossible. Scratching my nose was out of the question. For 45 minutes I was inside this machine, completely helpless and at the mercy of noise that would make Darth Vader quiver. 

The sleep study was a world away from that experience and I was able to complete it at home with a minimum of fuss. It's not really worth mentioning to be honest, but here's a nice picture.

The week long wait following the scan passed in a blur and I was pretty withdrawn for much of the time. The thought of possibly having a tumour - another tumour - was breath taking. Recalling those memories as a kid, going through serious surgery was unpleasant to say the least and it was all I could to keep myself from descending into panic.

Fortunately, the MRI was clear of any sign of a tumour. My relief at having dodged that bullet cannot be understated and I almost had an episode of urinary incontinence in the surgeon's rooms. The scan was able to visualize the defect in my vocal cord and noted the swelling caused by the snore and the general irritation of the tissues in my throat. The sleep study cearly showed that the snore accompanying my sleep state was significant though my overall sleep was rated - surprisingly - pretty decently.

So what's the next step?

Well, in a few weeks time, I will be admitted to hospital to have a more thorough study of my throat known as a nasoendoscopy. During that procedure, I'll be anesthetized and the surgeon will examine how the defect with my vocal cord causes my snoring. He also intends to examine my throat further down, to rule out any other causes or problems with my throat that might be contributing to all of this. The bigger part of the surgery, the part that I'm the most nervous about, will involve the surgeon applying a laser to an area of my throat adjacent to the vocal cord. He will, literally, burn it, creating an area of scarring that will, hopefully, prevent the vocal cord from collapsing in, causing the snore and the asymmetrical airflow over my cords that has caused so much trouble for me over the past few months. It will be a little painful and I may have some temporary difficulties with speech and swallowing but the snore will be gone and my wife will want to share the same bed with me again so that's gotta be a good thing right!???

This was a left turn I didn't expect to be taking and I certainly didn't expect that a snore would have a decidedly more complex root cause as mine does.

I get to be a patient. As a clinician - that's going to be a *fun* experience. 

You know what they say about nurses and doctors making the worst patients...

DFA.