Weekend Update

2.  Before I came down, as the Brits say, in-bed sick, I made it to my appointment with the new neurosurgeon.  I like him.  He’s a huge Dutch guy.  As opposed to my neurosurgeon in LA, who is a smallish Dutch guy.  Aside: what is it with the Dutch and the brain?  Is there some connection there that the rest of the world is unaware of?  Also, why are Dutch neurosurgeons so, so affable?  They actually have senses of humor.

3. My new neurosurgeon said he doesn’t see any reason why he should be seeing me in the future, outside of a bar for drinks (yes, he did say that).  He said, after looking at the CD-rom of my angiogram, that my arteries are in excellent condition.  No atheroschlerosis (or however you spell it).   He said I was born with the aneurysm and it was just dumb luck that it ruptured and if it hadn’t been for those three iatrogenic infections raging through my body, I would have been home after two weeks and not six in the ICU. 

4. My new neurosurgeon contradicted my old one on two counts:

a. well, actually, he agreed on the first.  Dr. S, in LA, told me once that I was lucky he was on his honeymoon when my aneurysm burst, because he would have clipped me, not coiled it.  My new neurosurgeon (whose name I can’t remember because of all those white spaces from past infarcts) said I was lucky as he disapproves of anyone clipping an aneurysm that can be coiled. 

This is a highly political statement.  The argument goes something like this: Clipping is major brain surgery.  They  open your skull, go in and actually tie off the aneurysm.  It’s done by a neurosurgeon.  In Coiling they send a slinky up your femoral artery into the aneurysm, which causes it to seal off.  It’s done by a neuroradiologist.  With Clipping, they shave your head; with Coiling, they shave your crotch.    Clipping has been the treatment of choice in America, while Europe favors Coiling.  Those who are pro-Clipping say it’s the most effective way of treating the aneurysm.  Those who are pro-Coiling say it’s equally effective and less invasive.  Pro-Clippers say Coiling doesn’t work for all aneurysms.  Pro-Coilers say the surgeons are just protecting their turf.   When I was on the operating table, they had a neurosurgeon on call in case the Coiling wasn’t possible.  It was, they did it, and I got bills for his time for months afterward from the neurosurgeon.  Blue Cross straightened him out, eventually.

b. Dr. S, in LA, says I will have to have another angiogram in ten years and special CAT scans every two years.  My new neurosurgeon says, “balderdash…medical overkill…I’ll see you if you ever need me, but not till then.”

How do I feel about this:  hmmmmm.  Good and not good.  It’s not as if Dr. S in LA was a hypervigilant sort of guy.  He’s always been very ho hummish and you can do whatever-ish.  In fact, I was hoping that the new guy would be a little more rigorous.  But he’s not.  Is this a function of his greater familiarity/ease with coiling????  In two years, I’ll call Dr. S. and ask him why he recommended that I have CAT scans every two years.