March 20, 2019

Pre-Op Details

Pre-Op Details

After writing yesterday's post, I realized that I didn't talk at all about what was involved in the pre-op appointments. These sorts of details, in other blogs, have been so helpful to me as I evaluated my options, planned for surgery, etc; and part of the reason I'm writing this blog is to add to that community / repository of information. So here goes:

I had two pre-op appointments, one with the "Preoperative Medicine Clinic" and one with my surgeon.

The Preoperative Clinic appointment was the longer appointment, with more stuff to be done:

  • Blood tests - CBC, basic metabolic panel, blood type, INR (related to coagulation, I think), and something labeled "antibody screen" - no idea what antibodies it was screening for.
  • Staph screening, for both MSSA and MRSA, which they said are carried by about 30% of the population and can cause problems with wound infections. The test involved swabbing a q-tip around the inside of my nose - quick and easy, no pain. I tested negative for both, but a positive test wouldn't be a big deal: they'd require you to put an ointment in your nose for five days before surgery; a positive MRSA test requires hospital staff to wear protective outfits when coming into your room, so that they don't carry it to other patients.
  • Typical questions about my health - liver problems? kidney problems? stomach pain? etc. They asked if I snored (a bit) and if I stop breathing when I snore (nope). They asked if my parents were still alive (yep) and if they had any major health problems.
  • They asked about any implants, devices, etc. I think this is so that they know whether they can do an MRI or not. I'm a bit bionic myself - I have metal bars in my lower jaw from surgery I had when I was a teenager, but I've already had MRIs without a problem.
  • They didn't ask about whether I was prone to nausea from medication, but fortunately I remembered to mention it - they said they'll put a "cocktail" in the anesthesia so that it won't make me sick. Fingers crossed that it works; I dread nausea more than pain.
  • Some simple physical tests - touch my chin to my chest, look left and right and up, can I put my lower lip under my upper teeth. They pressed my fingernails and then watched the color come back - a circulation test, I think.

The visit with my surgeon was in some ways a repeat of prior visits because I brought my husband with me this time. We looked at the super-fancy-hi-def 3D MRI/angiogram again, at how one of my blood vessels swoops down and maybe grazes the trigeminal nerve, but without any compression (hence why we're doing internal neurolysis instead of an MVD).

The surgeon also went over the main risks of the surgery: numbness, infection, CSF leak, and damage to the 7th (facial - motor control) and 8th (vestibulocochlear - hearing) nerves on that side. Since I haven't had surgery there before, I don't have scar tissue, so that last risk is very low in my case. The numbness is not really a risk, it is a certainty, but it will go away in the weeks following the surgery - the risk is of it not going away or taking a long time to go away. I had long-term numbness after my jaw surgery, and it wasn't as big of a deal as I thought it would be - I got used to it, and eventually it did go away. Infection and CSF leak are risks of any brain surgery, and treatable.

So there are risks, but in the scheme of things, not terrible ones. Of course, I may have a different viewpoint if one those things happens. So I guess I'm writing this to remind myself, in case that does happen: if I don't have surgery, the risk of having to increase the med dose in the future, and therefore increase the side effects, is effectively 100%. It is practically guaranteed that the meds, at any dose, will stop working at some point in the future. And then I'd be right back here.