WHY? Why did I decide to have surgery?

I have been asked this question many times. Just recently a reader asked again, and I don't think I've ever spelled it out here...so here goes.

My decision to have surgery was by far the most difficult decision of my life. By no means is my explanation an endorsement of surgery or a suggestion to anyone else to have surgery. Surgery is a very personal choice and one that I think warrants much thought. When I was first diagnosed 8/31/09 with a cavernous angioma in the middle of my brain (located right insular cortex/putamen/internal capsule, basal ganglia), I was told by my the first doctor that I had better hope I never needed surgery to remove it because they will never be able to get it out without causing significant damage. The first doctor also said not to worry about it because according to her "angiomas NEVER cause problems." Well, she was wrong in almost everything she told me. I went on to get several more opinions because I had a list of questions and nobody could answer them. I didn't feel comfortable with the opinions and advise I was receiving and as a nurse I had a decent understanding that many of the MDs I saw were blowing smoke...they didn't know what they were talking about....and I wasn't buying it. Basically, I saw doctor after doctor looking for real answers. Meanwhile, I was feeling worse and worse. My choices for doctors were limited at first because I had an HMO insurance plan. Prior to this diagnosis, I was never sick, never went to the doctor, and I wanted the cheapest form of insurance I could get. When you end up with a brain problem, HMO insurance is pretty much a bad idea (I don't want just anyone poking around in my brain...only the best of the best if absolutly necessary, please)...so I eventually switched to a PPO and then I could finally see some real experts and I started to get very different answers. While the first few doctors I saw said no surgery, they also knew nothing...so how valuable were their opinions? Eventually I saw Dr. Martin at UCLA, who has an excellent reputation. First time I saw him, he said I needed more testing, "a better work-up". I saw a bunch more neurologists and went back to him with my list of remaining questions. He seemed pretty annoyed with my barrage of questions and ended up giving me a flip-flop answer to surgery...No then yes, but maintaining that I will more than likely NEED surgery because of future bleeding and resulting worsening deficits in my lifetime. I wasn't sure what to do, but I was finally getting answers. I sent all my "stuff" to Dr. Spetzler and his resident called to tell me that they recommended surgery. My heart sank. I felt sick...now what? I had a lot of knowledge at this point and was hoping he would say, "Let's wait and see." I felt that if one of the best experts told me to wait and see...then that would be it....wait and see. The resident told me that they felt my risk was much greater to leave it than to remove it. Based on my MRI's and my worsening condition I knew he was right, but I was so scared. I had an MRI every six months from diagnosis and each time my cm was bigger and showed new bleeding. One year from my initial diagnosis, my cm had doubled in size to about 4cm.  The growth and bleeding coincided with me feeling more dizzy, more frequent partial seizures, worsening vision to the point I could no longer drive, and a few occasions of not being able to walk. Not being able to walk was really scary as were the seizures. It was becoming obvious that I might become paralyzed because of the surgery, but I might also become paralyzed without the surgery. At first, I was worried that having the surgery might make me worse....but I was getting worse anyway. I began to feel like,"What am I waiting for?" Still not convinced I was making the right choice I connected with others that already had surgery and I sent my "stuff" to more experts.(While no surgery or recovery is the same, talking to others helped me tremendously.) Dr. Samson in Texas has a great reputation so I sent my stuff to him. He wouldn't give me a recommendation unless I was physically in his office and Los Angeles is a long way from Texas...so I never actually got his opinion. I also sent everything to Dr. Steinberg at Stanford, who is also considered one of the best, and he recommended surgery too. I was getting good at asking questions by then, and his nurse practitioner gave me all the same answers as Dr. Spetzler's resident...so I finally felt I was on the right track. All my questions were answered the same...finally!  Connecting with others who had been there done that was invaluable and a big reason why I put my story in this blog. There were so many wonderful people willing to share with me their ups and downs, their personal experiences...I am forever grateful to them for helping me make my best choice and for supporting me from start to finish. :)  The main criteria the doctors gave me for recommending surgery for me were: my cm was big 4cm...since it was so large, the potential for a very big bleed was increased, my cm had a history of bleeding (more than 3 times already) so chances were higher it would bleed again, my age (36 at the time) "young" according to them giving me many years of possible recurrent bleeds without surgery and younger people tend to recover better, I only had one angioma (having multiples changes everything),and they thought they could access my cm without much damage. There was also the added bonus for me, that if my surgery went well I might get to have another baby...which I would love! I believe that my first pregnancy/delivery was the trigger for my angioma to bleed and grow. I knew that I could not consider another pregnancy unless my angioma was removed, the risk of further bleeding and progressive deficits was just too high for me. While a possible future pregnancy was not my only or primary reason for having surgery, I did view it as a possible bonus. Being a mom to Jack and wife to John were my two most important goals. Would I be able to be all I wanted to be without surgery? Long term, would I be better or worse off with or without surgery? Those are the tough questions that nobody can answer. I suspected that the surgical risks they quoted me, 5% chance of all the scary stuff was probably very optimistic..but I wanted to believe I would be lucky enough to avoid all the scary things...especially death. Honestly, I think the surgeons should do a better job of explaining the reality and high risk of brain surgery, especially deep brain surgery. I guess it was their attempt to make me more comfortable with the whole thing. It didn't work...I was terrified, but ultimately I knew it was out of my hands once I decided surgery was my best option. I knew from doing tons of research that my location was terrible. It's a really tough spot to get to and it all comes down to splitting the Sylvian fissure. If that part goes well...hooray!!! If not, ut oh! The brain stem is often considered one of the most difficult locations, but I knew mine was right up there in terms of difficult access, and ultimately that's why my surgery resulted in a stroke...very uncommon for angioma surgery especially with Dr. Spetzler. My Sylvian fissure did not want to be split. There were several blood vessels in the way, so it was either they cut one vessel and take out the angioma or they stop the surgery and tell me, "Sorry, we cut your head open and started, but we can't get it out." They made the executive decision to proceed with the surgery and I am thankful for that.

Some people go into surgery with the expectation that they will not have any new deficits following surgery. To me, that is a naive and unrealistic expectation. As a nurse, I always felt that once you have brain surgery "all bets are off". You might survive but will you be you? I don't remember which book it's from but this line stuck with me, "Brains are not built for service".  Brain surgery is always a BIG deal, and I felt/feel very lucky to be alive and to still be me!!! When I woke up, I was a mess...I knew it...and I was a tiny bit scared...but I was very HAPPY!! I thought I'm alive, I am still me, we can work on everything else, and I still feel that way today.

For me, the decision to have surgery was the right one. Maybe for others, they would have been wrecked by the whole stroke complication. I knew that stroke was a possible risk...while I was hoping to avoid it, I know there were far worse things that could have happened to me. Living with the monster that was in my head and the reality of a lifetime of progressive neurological decline would have been worse for me. I wanted to be proactive about my life and not let this angioma consume me, as it had for the year prior to my surgery. My angioma was growing and bleeding actively for a year...it was horrible!! There were days prior to my surgery when I couldn't do much of anything. Jack was small and just learning how to walk. Some days I would just lay on the floor blocking him and I into a "safe area" and hope we would survive another day. I had surgery ultimately to reclaim my life that I felt was slipping away, and I am glad I did! Please feel free to ask me any questions if I left something out that you are wondering. Best wishes to anyone out there contemplating surgery. I know how hard that decision can be. My advise :get as many opinions as you need from  cavernous angioma experts and then weigh your decision carefully.