One of the most important questions Deena and I had to ask of the other when we first met was whether we shared the same faith (or if any faith at all.) We could not at the time foresee my eventual cancer or Deena’s cerebral aneurysm. But having a mutual belief system meant that we had a common stratagem which we could fall back on when the road got bumpy (and as we were both approaching the age of seventy, the question was not if we would see health challenges but rather when.) Today, we learned about Omi’s aneurysm.
Economist Adam Smith wrote about an “invisible hand” in the marketplace. Looking back in my life, I saw many, many examples of where I was “nudged” a certain way by a similar such hand. For example, abandoning my short-lived career in logistics and retraining into the medical field in the Air Force when I was in my mid-twenties, and then taking—and later teaching—advanced courses in nursing and medicine to ER technicians and ICU staff. The result was that I could better care for my (now late) wife many years later when she faced multiple health issues. That was then. Today, I’m here for Deena.
The faith that Deena and I share has not immunized us from hardships or suffering in the past and, past being prologue, probably will not as we approach the future. C’est la vie. Christians may love and be loved by their Creator, but they don’t necessarily live charmed lives.
Deena had lost her husband Jim unexpectedly, and he was taken while he was in the prime of his life. Neither of us can understand or explain why. One might wonder where God was when Deena’s husband died? Or the week that my wife suffered multi-organ failure? In fact, God does not heal most people, or even many to my understanding or in my experience. But some people do go into remission from whatever they are suffering from. People occasionally wake up from comas, regain the use of atropied limbs, have malignant tumors reduced in size, recover the use of failing kidneys, survive stunning insults to their bodies from sepsis, car wrecks and gunshot wounds, or from falls, or wild animal attacks. In some cases, many people pray for those with diseases and disorder that they might recover. In other cases, not so and they may recover as well. The Bible says that God rains on the just and the unjust alike (Matthew 4:45.) More often than not, healing today is accomplished through medicine (the Apostle Luke, himself, was a physician.) Certainly, God does not need a physician to remove Deena’s aneurysm, but relying on someone of Luke’s profession is not a breach of faith. We believe that having been forewarned of it, we should use the common sense that God gave us and have it evaluated and treated. In Nehemiah 4:9, Gideon is quoted as saying “. . . we prayed to our God and posted a guard day and night to meet this threat.” Israel was about to be attacked by overwhelming forces. Gideon led his people in prayer, but then did the responsible thing by preparing for battle. Not everything in life is a test where a miracle is the solution. As Freud once said: “Sometimes a cigar is just a cigar.” The same is true of aneurysms. The professional literature tells us that as many as sixty percent of patients have an aneurysm which was not discovered because of misdiagnosis. These are people who sought out health care and medical advice, but ultimately succumbed because the warning signs of stroke were not properly interpreted or ignored. So, clearly, it is worthwhile, even critical, that a person (at least a person with risk factors) knows if he or she has an aneurysm. And that cannot be known without a CT scan or MRI.
When Deena first felt symptoms last Tuesday (restlessness, blurry vision, and a unusual sort of pain on the left side of her head) we checked her blood pressure and it was 189/111. That is well above normal as many of you can personally attest. As I drove her to Emergent Care (EC), I felt in my spirit that this was a warning, and that we should pay close attention to what followed. When she was being triaged at EC, she was asked if she thought this might be a stroke and she replied “Yes!” because her mom had suffered a deadly cerebral hemorrhage at age 45. Her mom smoked and also had hypertension, which are the two major risk factors for aneurysms. Deena never smoked, but she had hypertension nonetheless. So, they called an ambulance telling us they could not provide treatment given the answer Deena provided to them in response to their question. Arriving at the ER in an ambulance meant that Deena only needed to wait six hours to be moved to an inpatient area instead of the ten or twelve hours other patients had to wait to be treated (after triage.) During her wait in the ER, they called her for a CT-scan, an EKG and bloodwork. Had we tried to manage this at home, or on an outpatient basis, her aneurysm would have gone unnoticed, until . . .?
So, we had to wonder why God would reveal this potentially life-threatening defect to us unless it was to prompt us to some prudent action. That begins with prayer as Gideon noted. But that also includes a CT-angiogram and a visit with the neuro-surgeon next month as well. Deena is leaning towards getting the aneurysm removed, rather than living under a constant threat and I fully support her decision. God does not want people to live in fear. Deuteronomy 31:6 says “Do not be afraid or terrified . . .” This phrase or phrases very similar to it appear more often–some 365 times–in the Bible than any other phrase on any other topic! The surgery is safer than ever, but obviously there are risks which partly depend on how the OR team approaches the aneurysm, where the aneurysm is, the age and state of health of the patient, other comorbidities, etc. As far as I know from her CT report and the two neuro-surgeons and the hospitalist who spoke to us briefly while she was in the hallway of the hospital, the aneurysm is at the junction where her right internal carotid artery intersects the Circle of Willis at the base of Deena’s brain (see circled area in yellow on the diagram below.)
Thus, it may involve more than one blood vessel. But we don’t want to wait another year until a CT is repeated in June of 2025. By then, the aneurysm could be twice as large, leaking or ready to burst. Once a cerebral aneurysm of any size bursts, then all bets are off. Deena’s aneurysm is currently 5×7 mm. This, alone, makes Deena a good candidate for an invasive procedure to reduce/remove it.
What we’ve learned about aneurysms
Basically, “the term aneurysm is derived from the ancient Greek word aneurysma, which describes a widening.1” Civilization has known about aneurysms for more than 3,400 years.
In the fourteenth century B.C. the Egyptians . . .treated aneurysms by magico-religious therapies, but the nature and site of occurrence of these lesions are not mentioned nor the term applied to them.”
Aneurysms were first mentioned in the Eber’s Papyrus (written 1550 BC.) The great Roman physician Galen was the first to define and describe the disease, as he treated gladiators under the Coliseum in Rome and saw many aneurysms caused by trauma.
Causes of aneurysms
Smoking and hypertension are the main causes of aneurysms followed closely by trauma and hereditary. The role of nicotine in cigarettes is still uncertain:
There are multiple hypotheses about the mechanisms through which smoking can lead to vascular inflammation, hemodynamic stress, endothelial dysfunction, and, ultimately, wall weakening and rupture. Cigarettes are composed of a mixture of chemical substances that release a bunch of harmful toxins when burnt, which can enter into the bloodstream and lead to many vascular adverse effects. To understand it more clearly, we can analyze the impact of cigarette smoking on each stage of the development of aneurysms, such as its formation, growth, rupture, and, eventually, its recurrence.
The sheer force of blood driven though delicate blood vessels by high blood pressure can destroy them, particularly in the eyes, the kidneys and the brain. This is why hypertension is called “the silent killer.” Trauma (such as being driven against a seat belt in a motor vehicle accident can cause aneurysms in the arteries of your shoulder) or abdomen as can infections cause aneurysms as well. Then, there also seems to be a genetic predisposition.
Dr. Alejandro M. Spiotta of the University of South Carolina Medical Center notes speaking of the role of one parent or sibling with an aneurysm to another:
It’s really if you have two first degree relatives, but in my practice, if you have one and you are the second person, we’re not waiting for the third. So, if your mother and your sister had an aneurysm for example, we want to get you screened, we want to get all of your siblings screened and your children screened. I even go to aunts and uncles. And that can be by way of a CT angiogram, a CT-A or an MRA[Magnetic Resonance angiogram.] We’re not waiting for a third. And the big thing that I go over with patients is that I may be discussing you and now you are my patient, your family members are not my patients, so I cannot order that imaging study on them. So, the onus is on you as my patient to call them and say ‘Hey! I’m the third person down with an aneurysm and my neurosurgeon you all need to get screened.'”
Gender also plays a strong role with more aneurysms in women than in men. And these women are generally postmenopausal. This leads some investigators to wonder whether hormones such as estrogen play a role. However, women of any age can develop an aneurysm given the right causal factors (such as smoking and hypertension.)
Signs and symptoms of a cerebral aneurysm
The most common site for an aneurysm in the body is on the aorta, the great vessel that exits the heart with oxygenated blood. The second most common site is the brain. While there are different areas of the body and different types of aneurysms, I want to focus on the brain in this post to avoid confusion. And while there are many useful Youtube videos on aneurysms, the “go-to” resource for aneurysm of the brain is the Brain Aneurysm Foundation.
On the Brain Aneurysm Foundation’s website, you’ll learn that people with an unruptured aneurysm have the following signs and symptoms:
Blurred or double vision
A drooping eyelid
A dilated pupil
Pain above and behind one eye
Weakness and/or numbness
Once the aneurysm has ruptured, addition signs and symptoms may be present, including”
Sudden and severe headache, often described as “the worst headache of my life”
Nausea/vomiting
Stiff neck
Blurred or double vision
Sensitivity to light
Seizure
Drooping eyelid
A dilated pupil
Pain above and behind the eye
Loss of consciousness
Confusion
Weakness and/or numbness
If you experience any of these, you should have it evaluated immediately (STAT), even if it takes a 911 call.
Afterword
While our county has a teaching hospital with a good track record in aneurysm repair (according to our family doctor), Deena and I are considering traveling some distance from home to one of the top four or five treatment facilities in the country. Conventional wisdom says that if you need a major operation, you should choose a hospital where the procedure is a routine one, that is performed quite frequently. That way, you not only have skilled neurosurgeons but you have a more than competent OR team, post-op team and recovery team. Then, too it never hurts to get a second opinion. This is not unusual in medicine and doctors are quite professional about it.
FOOTNOTES
1Krajíček, Milan, et al. “ANEURYSMS.” Cardiovascular Surgery, Karolinum Press, 2014, pp. 219–35. JSTOR, https://doi.org/10.2307/j.ctv371cpm7.17. Accessed 12 June 2024.
P R O G R E S S N O T E S
I’ll start this post, but I’m hoping that Deena will put much of it in her own words.
June 20, 2024 (R):
We went to the Department of Neurosurgey with a folder with well more than a hundred Magnetic Resonance Imaging (MRI) photos of her cerebrum from 2015. Dee had this done in Texas when she lost most of her sense of smell. We’re not expecting the 2015 MRI to show an aneurysm, else the radiologist in Texas would have caught it. So, her aneurysm not very old as far as aneurysms go. We also submitted a narrative summary of what we want the doctor to know. She has several risk factors, including lifelong hypertension, a mother who died at 45 from an intracranial hemorrhage and a brother who had a cerebral aneurysm, himself. Our summary also included symptoms that might be useful to the surgeon. At the very least, the 2015 MRI is a baseline moving forward. It was a relief to visit the Neurosurgery office to see where we’ll be visiting for her appointment, just nineteen days from now.
June 22, 2024 (S):
Deena has an appointment to see her eye doctor in the next week or two. She has intermittent issues with bluriness and she is more photophobic (sensitive to bright light) than ever. The results of her eye exam when contrasted to the ones in the past might indicate if there is a problem brewing, and her surgeon would welcome the test because regardless of the findings, it would be another piece of the puzzle. Sometimes there is a collapse in a person’s peripheral vision and changes in the pupillary response.
June 24, 2024 (M)
Wrote a post today called Synchronicity that describes some of the recent events that are preparing Deena psychologically and spiritually for surgery should that be necessary. Meanwhile, we continue to make arrangements in our affairs to prepare for any eventuality.
