Earlier today, we made our way to Winston-Salem for Chad’s one-month follow-up visit with Dr. Tatter. Little did we know that we would be checking back into Le Hotel de Wake Forest University Medical Center, in the very same room we occupied this time last month. Fancy that!
After reviewing Chad’s MRI from Monday and talking with us about his progressively worsening symptoms, the decision was made to readmit Chad. As I type this, he is receiving a Vitamin K transfusion as a precursor to a fresh frozen blood plasma transfusion. The term fresh frozen makes me laugh, by the way.
He had a CT Scan a few hours ago, and he will probably have another scan or two while we’re here.
Tomorrow afternoon, Chad will undergo another surgery to place a shunt in his brain.
As we suspected, the intense pressure and worsening headache was due to increased fluid on his brain. After looking over the MRI, Dr. Tatter saw that this issue was due a severe spinal fluid increase. Apparently, when part of Chad’s tumor was removed, it caused an obstruction of the cerebral aqueduct – resulting in an imbalance between the formation and drainage of cerebrospinal fluid (CSF), resulting in a condition called external hydrocephalus.
The brain cannot rid itself of excess fluid, thus the vomiting Chad experienced over the weekend. Steroids were a temporary fix. The fluid is now increasing outside of his brain, around the tissue. The shunt aims to reduce intercranial pressure and relocate the excess CSF to his abdomen, where it will be released through bodily fluids.
At first, Dr. Tatter recommended a drainage point, where he would drill a small hole into the skull and release the CSF build-up. After talking to him about the extreme fatigue (Chad was in bed for a good 10-12 hours a day – totally unlike him and an unexpected outcome) and headaches, he decided it would be best to go ahead and place the shunt immediately. If we had opted for the drainage point as a first line of defense, it’s quite possible Chad would have needed to have the shunt anyway. So, we all agreed to skip step one, and head straight for the shunt.
This throws a damper on our radiation schedule, as the new incision site will need to be fully healed before radiation can begin. If things heal quickly (and we think they will, given the short time it took for Chad to heal from his craniotomy), we should be able to move forward with radiation within 2-3 weeks.
Tomorrow, around 5pm, Chad will undergo yet another craniotomy to place the shunt. It should take about 1.5 -2 hours. He should feel better almost immediately.
We are told Chad will most likely be able to go home by Sunday at the earliest, and not to be surprised if he is here until Tuesday.
Due to the increase of CSF, his brain is under intense pressure. A large part of the diseased tissue was removed, and should have “ballooned out” to fill the void created by the tissue removal. Instead, the pressure is causing the brain to collapse inward, and shift a part of his brain the right. The part of the tumor that lies within the midline of his brain is being squeezed to the right. The shunt should allow for the brain to realign itself almost immediately.
Chad is currently on blood thinners to prevent a recurrence of blood cots he experienced in 2007. Since this surgery was unexpected and there was no time to stop the blood thinners, he is being given a plasma infusion to help his blood clot during the surgery.
Also, I asked about the pathology report from the craniotomy last month. Thankfully, the results came back as expected – a WHO Grade II Oligodendroglioma. However, the sample did show some cells were dividing at a more rapid pace than other cells. What does this mean? We don’t know right now. It does mean that the cells were changing, and probably becoming more aggressive and higher in grade. Thankfully, radiation should kill and/or retard the growth of the faster cell divisions. It also means we were correct to assume that the smaller tumor was killed off via Chad’s 10-month chemo course. Higher grade cells are killed quicker by the form of chemo Chad received. Thank goodness we did the strong chemo in the beginning; we technically have less to worry about.
I will update tomorrow as I have more information.
Thank you, in advance, for your prayers and support.