I didn’t tell you, did I?

When I was in hospital a couple of months ago, one of the investigations they did was to stick my head in an MRI scanner to see what, if any, damage the Varicella virus had done. Thankfully they found no trace of anything bad.

But

When they looked at the pictures they saw something unrelated that they thought was worth further investigation. A small artery in my brain is a bit swollen. I have an aneurysm. It’s in the “anterior communicating artery,” a small cross link between two arteries feeding my brain. The staff at Southend Hospital who spotted this sent the scans to a specialist neurosurgery unit at Queen’s Hospital in Romford. They sent back a request for further imaging and the day after I was discharged I went back to Radiology for a “CT Angio”– a CAT scan of my head with a contrast medium to highlight the blood vessels. I didn’t like that much; the contrast medium made me feel a bit queasy, but it soon passed.

I was sent an appointment for a consultation in mid November which I duly attended. I saw two consultants. a Neurosurgeon and an “Interventional Neuroradiologist.” There was also a specialist neurosurgical nurse.

They told me I had an aneurysm. No shit. The artery in question is about 25%-30% larger than it ought to be. This is not good. There is a small but real chance of it rupturing in the next few years with consequences ranging from mildly unpleasant, which could mostly get better, through major permanent disability to, well, let’s not go there. Except that I have to.

There are two options. Well, three, but they made it pretty clear that they don’t recommend “conservative management” which would mean having further scans every six months or a year. Their advice was that this was only kicking the can down the road and that sooner or later I’d be faced with the same choices.

Which are: Craniotomy. They remove a small section of my skull, poke around in the grey stuff, and isolate the offending bulge with small clips. Replace the bone and in time it will heal and no one would ever know it had been done. It’s the “definitive solution” but traumatic, painful and with a longish convalescence.

Or, Endoscopy. A small cut in an artery in my groin and they navigate a probe through the blood vessels until they get to the bulge and reinforce it from the inside with a stent. Quick,; in and out of hospital in two days and short recovery. There’s a small (about 1 in 30) chance of it not “taking” and having to be done again. They’ll do scans every now and then to keep an eye on it. The main drawback is that I’ll have to take anticoagulant medication for the rest of my life to prevent blood clotting around the insert. It’ll be a small annoyance for the first six months on quite a strong blood thinner but after that it’s aspirin forever which is fairly benign. They pointed out that a very large number of over 70s take anticoagulant medication without any problems.

I was rather taken aback. Going in I’d kind of assumed that they’d tell me what was wrong and explain what they wanted to do about it. I wasn’t expecting a choice. They said they understood they’d given me a lot of information to absorb and they didn’t expect me to make a decision on the spot. I’d be sent comprehensive notes and contact details for the nurse so I could ask questions. They would be happy to have another in person consultation as well.

Walking out of the consultation in a partial daze I was pretty sure I wanted the endoscopic procedure. Something about having the top of my head sliced off really didn’t appeal.

Then Karen and I stopped to decompress in the hospital coffee shop and by the time I’d settled a bit was leaning towards a craniotomy. “Once and done” and no annoying drug regime.

It was a bit of a wait for the notes but they eventually showed up and I formulated a bunch of questions for the nurse. She sent back a comprehensive set of replies and I spent the Christmas holidays pondering the options.

I went back and forth and round and round and early in January I emailed them asking for the endoscopic procedure. I just couldn’t get past the image, inaccurate as it may be, of slicing the top off a boiled egg.

So then they sent me a couple more appointments. One was supposed to be a phone call but for reasons never explained that didn’t happen, and a couple of days later, an in person appointment in Romford. That was my pre-surgical assessment. Blood pressure, height, weight,etc. A longish medical history questionnaire and then they took some blood,–quite a lot of blood–some skin swabs just in case I was harbouring MRSA and an ECG. I got a short list of instructions on fasting for the day of the surgery, and that was it for the time being. I now had to wait.

I waited quite a long time. Well, I thought it was quite a long time. I had no real idea of how long I could expect to wait. I had a slight memory of the surgeons saying back in November that it wouldn’t be long. Maybe a few weeks. But it got to five weeks and I was starting to wonder.

Then the phone rang one lunchtime: “private number.” Normally I don’t take these but I had a feeling…

It was the hospital. They’d had a cancellation and there was a slot available in two days. Friday 28th.

Did I want it?

Yes, I rather thought I did. A bit short notice but let’s get it over and done with

OK, I was to present myself at the day surgery unit at 7:30 that morning. I should expect to be there for one night, maybe more but at least one night.

So there we are.