the Lanfords

When we visit Winston-Salem, I take a lot of notes. I ask a lot of questions. And I come home and Google terms and look for images that help me understand what in the world the brain surgeon just tried to dummy down for me. It may not be rocket science, but it is brain surgery. And it’s pretty similar. I think.

I have been schooling myself on the brain’s ventricular system recently, trying to decipher the MRI images and the explanations we’ve been given by Dr. T. One of the things I love most about this doctor is that he takes the time to make sure you I understand what in the world he’s talking about. He’s very thorough and very thoughtful in his explanations. He even takes the time the spell things out for me during his intricate conversations when he can see that I’m struggling with the spelling of pesky little parts of the brain. He is truly as wonderful in the exam room as he is in the operating room.

So, let me tell you what is going on in Chad’s noggin.
I will do the best I can, and I fully admit that I am not a brain surgeon. I do not know what I am talking about.
I did stay at a Holiday Inn Express once, but I doubt that gives me any real authority in an operating room.

Here we have an extracted MRI image from Chad’s latest round of imaging.
Chad’s MRI in on the left, and the image on the right is a random stranger who has beautiful, normal, healthy ventricles.
You can see that Chad’s are…well, quite unhealthy.
You can click the image to view larger.

Chad’s left ventricle is small and almost the size and shape it should be.
The right ventricle, obviously, is not. It’s like a balloon, full of spinal fluid that has no where to go.
Chad’s shunt is located in the left ventricle, and the two should be communicating with each other.

Here is a brief and very condensed version of the function of spinal fluid, the ventricular system & the mesh-like membrane in between the ventricles that I discussed here. **

Cerebrospinal Fluid
Cerebrospinal fluid(CSF) is found within the brain and surrounds the brain and the spinal cord. It is a clear, watery substance that helps to cushion the brain and spinal cord from injury. This fluid circulates through channels around the spinal cord and brain, constantly being absorbed and replenished. It is within hollow channels in the brain, called ventricles, that the fluid is produced. A specialized structure within each ventricle, called the choroid plexus, is responsible for the majority of CSF production. The brain normally maintains a balance between the amount of CSF that is absorbed and the amount that is produced. However, disruptions in this system may occur.

The Ventricular System
The ventricular system is divided into four cavities called ventricles, which are connected by a series of holes called foramen, and tubes. Two ventricles enclosed in the cerebral hemispheres are called the lateral ventricles (first and second). They each communicate with the third ventricle through a separate opening called the Foramen of Munro.
The third ventricle is in the center of the brain, and its walls are made up of the thalamus and hypothalamus. The third ventricle connects with the fourth ventricle through a long tube called the Aqueduct of Sylvius. CSF flowing through the fourth ventricle flows around the brain and spinal cord by passing through another series of openings.

The Septum Pellucidum
The septum pellucidum is a  thin, triangular, vertical membrane separating the lateral ventricles of the brain. It separates the anterior horn of the left and right lateral ventricles. It runs as a sheet from the corpus callosum down to the fornix. When the hemispheres are cut apart, the septum remains on one hemisphere, usually the left.

Whew.
That gave me a headache.
I think it will be helpful for you all me to know when I start talking about this brain surgery stuff again in the near future. But it can wait until after the Thanksgiving holiday. Until then, there will be no more talk about brains, tumors, medications or cancer. Unless I need to tell you something in the event of an emergency.
But emergencies are not allowed in this house anymore without my express permission…so don’t expect to hear anything about the aforementioned crap.
I’m looking forward to writing about some mushy feel-good family togetherness.
Happy Thanksgiving week!

There has been a lot of talk lately about Chad’s head. What’s in it. What’s not in it (largely because he attended NC State…but I digress). I’m KIDDING, all you Wolfpackers!

In the Spring, we finally showed you the MRI images that started this whole journey.
I’ve wanted to show you more, but it’s a little bit of a pain now. When Chad started radiation last Summer, he started receiving all imaging at a different facility than before. The software is a bit different. The images are a bit different. The whole feel is just a little bit different.
I finally put all of the images together, with similar slices, for you to view.
I will warn you that the images started in August of this year are slightly less enhanced. This is due to the subtle differences in the different MRI machines.
I will try me best to walk you through the pictures. You should be able to click the picture for a larger view.

11.13.07
The first MRI. Pretty disturbing. Pretty….yuck.

11.08.08
One year later. Still no change.

02.04.09
Still no change.

08.05.09
The tumor is still there. You’ll notice that you can’t really see much of the cloudy mass towards the middle of Chad’s brain…that’s because there is no tumor there. That’s the area Dr. Tatter was able to safely remove. It’s difficult to see how much/how little was removed because you would need to see all the “slices” to get a real handle on the situation. Just believe me when I say that removing any of IT is truly a miracle. It’s even more of a miracle that Chad is missing a good little chunk of his brain and is, relatively speaking, functioning.

11.04.09
Still there. No changes. That’s good. And it’s not so good. We want some positive change! But we will take no change versus negative change.

Alright. There you have it.
The state of IT, two years later.

And, in case you’re wondering, Chad is not feeling better from the shunt reset. At all. He has noticed absolutely no change, and he should have started feeling mildly better by now.
He is sleeping terribly, even more so than usual.
He is fatigued.
He is lethargic.
And he is just…well, I don’t even know.
It’s hard to say if he’s had a good day or a bad day when every day is the same. Every day he is miserable and hurting.

I have to get him feeling better. And right now, I think he is leaning towards surgery. I hate to push it on him; I really do. But I feel like we have to try every reasonable thing suggested to us.
Chad & I were discussing this a few days ago & his statement was that he wants a guarantee surgery will fix the current issues. Of course, I would want a guarantee too. But no one can guarantee that. No person, any way. So we have to trust in the skilled physicians that we have been gently guided to — and pray for the best possible long-term outcome.

It’s hard to believe that two years ago, we were told that surgery was not an option and wouldn’t help.
Here we are…three (maybe four) surgeries in one year. The tumor may be “better”, but Chad is not.
Life can be so tricky sometimes.

Chad was discharged Sunday afternoon. We waited for a wheelchair to take him downstairs, but no one ever came. So Chad just walked right out of the hospital. Don’t worry, we had permission.

We got home shortly before dinner time on Sunday. We had to fight traffic in Greensboro, so we were very ready to pull into our driveway as soon as we got into our city limits.

This surgery is a little different than Chad’s previous surgeries – as in, it wasn’t as invasive. Yes, they put a tube in his lungs, which is risky. But they didn’t open up his head at all. That meant less time on the table in the operating room, and a quicker recovery. Chad is doing really well, so tired and sore.
And, unfortunately, the headache is still there.
At this point, we have to give it some time. In a week, if the headache persists, we will be going back to Winston-Salem to have the shunt reset (again) and allow for more fluid drainage. If that still doesn’t help, Chad will be looking at another shunt surgery. We hope that’s not the case, but it is very likely. I don’t want anyone to be caught off guard when we announce another surgery is is forthcoming. We know the headache is a pressure/fluid issue and not a standard headache because the only thing that seems to help is steroids. Chad cannot be on steroids for the rest of his life; they have their own complications.
Again, I hope we are done with surgery for a while — but I don’t think we can ever count it out. If I’ve learned anything in the past two years, it’s that you should always expect the unexpected. You should always plan for it, too.

Chad has declared that he is not going back to work until the headache goes away. I understand, and I’m sure you do too. Currently, he doesn’t plan to go back until the end of the month. That could change. We just have to wait and see.

Thank you, as always, for your thoughts & prayers.

When we first started this whole journey with IT, I was numb.
There. I said it.
I admit it.

I remember chasing thoughts that were running through my head so quickly that I couldn’t catch up.
I tried to push through the emotion because I had to. I had two little girls who needed me to be strong. And I had a husband who needed me to be strong. And I needed me to be strong.

But sometimes, contrary to what some of you may think, I am not always strong.
I have a good cry.
And I move on.
Before IT, I never understood those movies and commercials where women would “have a good cry” and feel better. Crying never made me feel better…until all of this happened. It’s a cathartic release of emotion that does make me feel better, or at least a little more me again. It’s an opportunity to let your frustrations, fear and feelings of inadequacy out. An opportunity to move on, accept the things that are happening (you don’t have to like it – but you do have to accept it!), and make a plan for how you will react when something else happens. And, as we’ve found out, something else undoubtedly will happen.

Nearly two years later, there are still days where I’m not sure what to make of this whole situation.
Some days, I think I have it all figured out.
Other days, I feel like our world is falling apart.
And then there are days where I just want to go back, rewind our life if you will – and other days when I couldn’t even possibly think of doing such a thing.

One feeling that is constant for me is that “everything happens for a reason”. I have always felt this way, even before Chad was diagnosed. But having a terminally ill loved one makes that phrase a little more visceral.
God does not give us more than we can handle, and we are handling things the best we can. That’s all He asks of us.

I still don’t always know what to think of our life with IT.
We think we have IT figured out, and then IT changes.
We think we know what to expect with IT, and then we get new symptoms to report and diagnose.
IT is a mystery. And Chad and I are both exhausted with IT.
We wish we could say we’re done with IT.

While I sincerely appreciate all of the kind words that people bestow upon me, I often find myself questioning them.
What am I doing that is so extraordinary?
I love my husband. And I am taking care of him, and our family, the best I can. I don’t think that’s extraordinary. It’s just what I signed up for when I married him eight years ago. “In sickness and in health…” I truly meant that.

How do I stay so positive?
I’ll let you in on a little secret: I am not always positive.
But I try my best to keep those moments to myself because they do not do anyone else any good.
Especially my children: if they see that I am okay, then all is right within their little world. As soon as I start to crack, they react – and they are instantly upset. My children are resilient little girls; they have dealt with so much and take it all in stride. I am so proud of them for asking hard questions, and even prouder that they have remained their cheerful little selves throughout this ordeal.

“You make it seem so easy – everything you’re dealing with.”
I assure you, it’s not easy. But we both try to keep living, the best we can. Life still goes on. Our children still need to be parented. I still have to make meals. I still have to go grocery shopping. I still have to work. I still have to be thankful that our life is tangibly beautiful. There are many things we have to be thankful for, despite the hardships we face. We are here – together – and that’s all that really, truly matters.

I am very thankful for my friends and family, for whom I do not think I thank enough. I appreciate your kindness, thoughtful words, ability to listen without judgment, and I appreciate your shoulder when I need to have a good cry.

This week, we will travel to Winston-Salem to see Chad’s neurosurgeon after an MRI tomorrow.
Our trip will be one week shy of Chad’s two-year diagnosis anniversary.
It doesn’t feel like two years have passed. It feels like a lifetime.
But we are still here. We are still thankful. And we are still living.