Round 5

Well, Michael "Ali" Moyles has been through four rounds and gotten up every time -- tomorrow starts Round Five! Cancer has knocked me down three times, and I've gotten back up, then radiation and subsequent infection, and again I came back strong -- tomorrow, Round Five (reconstructive surgery) begins. I'm ready for it.

Pre-op started on Tuesday. The appointments were long -- over five hours' worth -- but we have a clear road ahead. I spent most of the time with the neurosurgeon and the anesthesiologist, who will be the most critical players in tomorrow's "game". There were a few amusing moments -- first, the EKG showed that I have "sinus bradycardia" -- as some of you other marathoners may know, this simply means my heart doesn't have to beat very often. With a resting heart rate around 44 bpm, I guess the EKG was a bit concerned. Second, my body type -- that is, part wookie -- wreaks havoc on EKG leads, which never stick. Fortunately, I have good veins (large and easily accessible). The nurse politely told me, "The problems you cause in EKG you make up for in labs." In other words, I'm hairy but have good veins. Nice!

Bottom line, everyone is comfortable and confident, and I think the team is the best available. There are three primary concerns:

1. Infection. Apparently, about an hour of the operation is actually replacing the plate, the other three or four hours are all consumed by "infection avoidance" -- sterilization, cleaning, and making sure the plate, sutures, screws, and other items are properly positioned and so forth. The sutures will be internal to minimize the opportunity of bacteria getting under the skin through holes (from staples or stitches). External will be steri-strips only. These surgeries have an extremely high rate of infection...by far the biggest hurdle.

2. Fluid. The body's natural reaction to a foreign body (like an acrylic plate) is to surround it with fluid, much the way an oyster responds to a grain of sand. So, they expect that there will be significant swelling after surgery -- if it's a knee replacement or something else, the swelling eventually just goes down...but they can't afford to let it swell since it's the skull. Therefore, I'll have a drain (like a shunt) placed into my forehead to help drain any excess fluid that builds up around the plate, potentially increasing cranial pressure. The bad part here is that I have to remain in the hospital until the drain is removed and the fluid buildup subsides -- probably at least 2 - 3 days, not the overnight stay I was hoping for.

3. Seizures. The foreign material, the cranial swelling, and pressure differential caused by sealing the brain inside the skull again all create a high risk of seizures. I've never had one and have proven amazingly resistent to seizures, so let's hope that trend continues. I'll be on some pretty powerful seizure suppressants after surgery, which should help.

If we can sidestep those three landmines -- infection, fluid buildup, and seizures -- then I should be in fine shape. I'm second on the schedule Friday morning, with an 8:30am showtime and 10:00am surgery time. I should be in the hospital about two or three days, just long enough to get past the window where infection or dural tears could cause major complications.

Pooh will be keeping up the blog and Facebook regularly...and if past battles are any indication, we all know who's going to win this round. Float like a butterfly...