Alive and Well!

Hello faithful readers and supporters! It's me, Mike -- out of surgery, out of ICU, and on the recovery floor. Now, if only I could convince the docs to put me on a regular diet and stop the IVs! Yes, I'm still causing problems...but in a good way.

From what I'm told, surgery went just fine. There were some delays initially, but once surgery started it went without any difficulty. ICU was, as always, a difficult time -- you're disturbed every hour for a neuro exam, and you're hooked up to every machine imagineable -- so sleep is basically impossible, and that's all you really want to do. To make matters worse, I was setting off alarms every few minutes -- if your heart rate drops below 60 beats per minute, or if your respiration rate (breaths per minute) drops below a certain number, it sets off an alarm. As many of my endurance athlete friends know very well, a heart rate under 60 beats per minute is quite common for us -- a resting heart rate of 44bpm, in my case. So, even if I could get to sleep for a few minutes, shortly after nodding off my heart rate would drop into the low 50s or high 40s, acting like an alarm clock and waking me up, not to mention the nurses and orderlies rushing in to see what was wrong. Same thing with respiration rate. Well, I guess I've found the downside of being in shape. All this to say that last night was a very long, very restless and very uncomfortable night...but I made it!

The biggest victory today was the removal of the EKG leads and the Foley catheter. With those two things gone, I actually have freedom to move and walk around...even run, if they'd let me! I'm up on the patient recovery floor now, where I have a TV and my own room, without the hourly wakeups and heart rate/respiration alarms. Much more peaceful and restful. I've spent most of the morning napping, and now I'm in the lounge on one of the computers furnished by the Wounded Warrior project. Yes, I'm on the Wounded Warrior wing again -- these guys are just incredible! I even had lunch next to a guy who had lost an arm to an IED. Please support this foundation if you can, and say a prayer for them. Hereos, every one.

So, the goal is to be home in time for the Duke game tomorrow night at 8pm. Any bets? Also, it looks like I'm teaming up with a few friends for my next race...the details are still in work, but stay tuned! Potentially big news shortly, if we can work it. Stay tuned, and thanks for your prayers! Pictures soon, I promise...

And the winner is....

Whew-what a long day! For anyone who has had a loved one undergo surgery, you know what it's like to "wait" and waiting is what we did a lot of today.

Starting at 730am, Mike checked in, changed into a "beautiful" gown and was sent to the "holding" area. Yes, we were definitely in a military hospital this time. No fluff, no pampering, just "get it done". Once settled there, the doctor came in and told us that Mike's surgery had been bumped (much to his dismay) until noon. We were heart-broken. Mike was hungry, tired and begging for coffee. The neurosurgeon is outstanding and was very upset that the hospital had rearranged his schedule, but he was going to do his best to get Mike in early. With a 3 hour wait looming on us before they even came to get Mike, my dad and I decided we'd venture off for some breakfast of our own. Mike welcomed the quiet for some much needed sleep. We returned right at 9am, to find the "orderly" there to take Mike back to surgery. Great news for us-no more waiting for the day to get started!

Once again we said our tearful good-byes and parted ways. Now mind you, we have been smack dab in the middle of Beverly Hills for all but these last 2 surgeries and believe me, the thought, "Todo, we aren't in Kansas anymore" comes to mind. We headed to the "waiting room", which was crowded, loud and HOT! After two hours, which felt like seven by now, my dad and I headed to the desk to see if Mike's case had even begun yet. 11:45am: "yes, they just took him back"...Great news, again, no more waiting on the surgery to begin...

We decided to go downstairs and walk around. An hour later, while talking over lunch, we see the neurosurgeon walk by. I shouted to him "Hey, aren't you supposed to be in surgery?" but, he didn't hear me, so we decided to "follow" him. The whole time thinking "Is Mike already done? Did another surgeon "open" for him? Has he NOT even started yet?" Very confused at this point, we lost him, so we headed back to the desk. This guy must have thought I was nuts, but he politely told me that "yes, they were still "in" there!" Okay, back to WAITING!

Oh the waiting...sleeping, eating, talking, eating, watching TV, reading, eating, praying. Yes, there is a definite pattern here-eating. I eat when I'm bored and nothing was filling that empty, worrying void. Yes, praying helps, but your mind does these weird things. I was SO tired of waiting...

Finally, 230pm: "Mrs Moyles?" "Yes". "Let's step out in the hallway..." (gulp-even knowing this is standard) "Mike did great, he's in ICU, awake, semi-alert and almost completely out of anesthesia." WHOA--what a great surprise. The neurosurgeon had decided to wait an hour after surgery to come tell me things were fine due to the high risk of stroke in "head surgery" patients. Mike had not only come through the surgery fine, but was already well on his way to recovery. The "plate" fit perfectly in the forehead and the skin came together beautifully. The crown is a bit higher than it used to be (says the surgeon), but who cares...he's fine! :) He has a pump, to eliminate the fluid buildup. He'll be in ICU overnight and then to a patient room tomorrow and hopefully home on Sunday.

230: We got to lay eyes on him for the first time since morning. What a wonderful sight, bandages and all! Mike was awake (sort of) and talking. As usual, he wanted to be sure that I knew he was okay, so he says..."where am I?" I say "ICU". Mike-"What? They promised me NO ICU" (insert BIG pouty lip). I just laugh and say "oh dear, they didn't tell you that, but you can think that if you want." After giving the nurses some grief over being in ICU and doing EVERYTHING he can to bribe them to get out, he fell asleep!

I saw him one more time before leaving for the evening. Mike was still complaining about being in ICU and desparately trying to get some ice chips. A quick kiss good-bye and a few more reminders from Mike to get him out of ICU and we parted for the evening. Good luck nurses! :)

Oh, and more reason I know we aren't at Cedars Sinai anymore... 830pm: "Hi, this is Mrs. Moyles...how is my husband doing?" "hold on please"...(silence) "Mrs. Jones, he's resting now". "okay, but I'm Mrs. Moyles", "yes, he's resting now, we'll tell him you called-click!" Hmm... sure hope Mike gets the message! :)

We "Thank you" all for the prayers and support! We couldn't have done any of this without God and all of you. I will end with this....

"And the winner is... Mike!" Praise God for being The Great Physician and keeping Mike safe through another trying time.

Good night all and you'll hear from Mike tomorrow!

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...

A Bump in "The Road Ahead."

There's good news and not-so-good news. First, the good news: for those who haven't heard, my scan on the 11th was clear. The cancer is still at bay, I'm still in remission! This is an incredible blessing...perhaps the triple threat (surgery+chemo+radiation) has done the trick. 90 more days, baby!

In the "not-so-good news" realm, the 18th came and went -- with no new forehead. The short version of a long story is that the prosthetic fabricator made the frontal plate out of the wrong material. For those who are interested in the long story...

Here's the original plan:

The image above is from the 1-mm brain scan I had a few weeks ago -- that's actually my skull, you can even see the scar from the bone saw used in previous surgeries. The gold portion is the plate they've created out of titanium mesh. Now, for nearly every cranioplasty patient, titanium mesh is the best option -- lighter, stronger, and integrates well with natural tissues (bone and skin). In numerous consultations with the neurosurgery team, the prosthetic fabricator was able to make a solid case that titanium mesh is the best way to go. Unfortunately, I am not your standard cranioplasty patient. Simply said, titanium mesh is the best way to go, if you never have to remove it. My neurosurgeon here is a fabulous guy and very experienced, and has put many of these plates in -- but, admittedly, has never had to take one out. With my history of tumors and prior brain surgeries, we are realists and understand that (despite the good news above) it is entirely likely that we'll need to go back in at some point to remove additional tumors. Titanium mesh integrates with the healthy bone, and the scalp actually settles into the mesh -- it really becomes a part of your head, which is a great thing for most patients, but not for me. In addition, titanium could mask a recurrence -- since it's metal, it can introduce imperfections and "false positives" into an MRI, and could even mask recurrent tumor tissue. So, for at least a few reasons, titanium mesh is a bad idea for me, and the neurosurgeon has made the right decision to cancel surgery and order an acrylic plate. We're back on the calendar for 15 January, so stay tuned!

Training has gone quite well over the past month or so. Those of you who know me are well aware of the fact that these little "bumps in the road" like cranial reconstructions and brain surgeries don't slow me down much...and you may remember from a previous blog that I've decided to specialize in the half-marathon. My goal is to break 1:30 next year, which starts with the National Half-Marathon in March. Goal for this race is somewhere in the 1:37s, around 7:25/mile pace. I'm focusing on the Furman Institute's of Running and Scientific Training (FIRST) half-marathon plan, and it really seems to be working so far. Has anyone used FIRST before? The book "Run Less, Run Faster" is largely based on Furman's research, and I must say I'm pretty impressed. PRs at both 5 and 8 miles just in the last few weeks (36:11 and 59:24 respectively), so it can accomplish some pretty good results on only 3 runs per week.

That's all for now -- of course we thought we'd be in recovery from surgery this week, so didn't make any plans, and will be spending a quiet Christmas at home with Pooh and Monkey. To be honest, I wouldn't have it any other way. Be thankful for life and loved ones today, my friends!

The Road Ahead

Well, I promised an update after last Monday's appointment with the neurosurgeon. Good news -- I'm fully healed, and ready for reconstructive surgery! A concern and a praise at the same time, I suppose...I'm very ready for this whole ordeal to be over, but not necessarily looking forward to another major surgery -- my third one this year. But, if you know me, you know it won't slow me down. Here's the road ahead:

23 November: 1mm-cranial scan. This is like a CT, but a CT is usually done with 3mm or 5mm "slices." To reconstruct a 3-d image of my skull, they need to do one with 1mm slices...that just means a really long CT scan...probably two hours or more. They'll use the 3-d imaging from that scan to construct the prosthetic that will go where my forehead used to be.

11 December: Brain scan (MRI). Remember the "90 Days at a Time" blog? Well, my last scan was 16 September...so you can do the math. We've made it another 90 days in remission, and we need to check again to make sure the cancer is still at bay. This is basically unrelated to the infection and the reconstruction, but a significant event nonetheless.

14 December: Neurosurgery and radiation oncology consults. Basically, appointments to go over the scans and learn the results. Hopefully, we'll restart the 90-day clock!

18 December: Reconstructive surgery. They'll open me up again, place the prosthetic in, "trim to fit," and close me back up. In general, the shortest and simplest of all the surgeries I've had, but there are some potential complications and risks. If all goes well, I'm only in the hospital overnight for observation, and home that weekend.

31 December: The Fairfax Four road race! What, you thought I'd let surgery stop me from training and running? Come on...

So, there you have it! A new forehead for Christmas. There's a song there somewhere...

Race Report -- Richmond Half-Marathon

Greetings bloggers! First, the running news. I've made the decision to specialize -- meaning I've probably run my last marathon. My challenge is to find a distance long enough to satisfy my love for the long run, but short enough that I can still be competitive. I realize that to be competitive at the marathon distance, I need to be in the 2:30 range -- something that is just not realistic for me. However, if I move down to the half marathon, in the 35 - 39 age group, I can place (and maybe even win a few) if I get under 1:30. I think that's well within my ability. So, let it be done -- I'm now a half-marathoner.

That said, today was the Suntrust Richmond Half-Marathon. I had not quite trained as much as I would like -- I ran the Leavenworth Half-Marathon in October with almost no training, then trained about five weeks after that race for Richmond. Still, I as hoping to break 1:40 -- about 7:37 pace. Well...

You've all probably heard of Hurricane Ida. It's been wreaking havoc across most of the east coast, and here in Alexandria it's rained for about five straight days...Richmond too. But, a little light rain isn't much of a deterrent...it actually makes for pretty good running weather, most days. The race started bright and early at 0730 -- parking was plentiful and easily accessible, and only a few blocks from the start. It seemed there were fewer porta-potties than there needed to be given the number of runners, but I was early enough to wait it out in line.

The course was flat and fast...beautiful fall colors, some of the course along the James River, and most of it in either historic oldtown or in one of the many city parks in Richmond. Live music was plentiful, and the water stops were well-placed and well-stocked. Unfortunately, there was almost a complete lack of any fan support -- perhaps because the half-marathon started 30 minutes prior to the full, or perhaps because of the weather, but it was really just a few hardy folks standing on their doorsteps and a couple dozen at the entrance to Joseph Bryan Park.

No problems during the race, but my legs started to get heavy around 10 miles...not sure why, but it made the last few miles some pretty tough ones. I can't really blame the course or the weather, so it was probably just a lack of training, lack of sleep, or nutrition issue. Final time was 1:42:23, about two and half minutes over goal time...398th out of 4578 total, and 45th out of 366 in my age group. Not too bad -- and the five weeks of training since Leavenworth paid off by knocking almost 10 minutes off my time from that race, but still a couple minutes short of my goal. Next up -- the National Half-Marathon, 20 March 2010.

In other news, my next neurosurgery appointment is on Monday (16 November). Hopefully, they'll do a physical assessment and schedule me for reconstructive surgery. I'm really not looking forward to another surgery and another 4 - 6 weeks of recovery, but I'm ready to get this episode over with. Put me head back together, and let me get on with living!

For the "Monkey Fan Club," you'll be happy to know that she is growing like a weed and expanding her vocabulary daily. I'm also afraid she's hit the "terrible twos" about six months early...it's becoming quite a challenge, but an enjoyable one.

Will let you all know the results of the Monday appointment!

90 Days At A Time...

My brain tumor was first discovered almost 10 years ago -- in December 1999. It was a complete stroke of luck, if you believe in such things (I don't, but that's another post). While playing basketball with a city league in St. Louis, I dove for a loose ball and collided with another player, losing consciousness for about 15 seconds. When I regained consciousness, I couldn't move my right arm. An ambulance ride and a CT scan later, I learned that I had sustained significant damage to my C5 cervical nerve, weakening my right arm to the point where I couldn't lift a 16-oz can of soda. I was a Captain in the Air Force at the time, and Air Force policies dictated that I also have an MRI of the brain to rule out any hemorrhaging or potential complications from the concussion. What followed can only be described as surreal.

An MRI of the brain can be an intimidating experience for the uninitiated (of course, I sleep through them now). Your head is immobilized by a plastic helmet, and you are slowly moved into a tube about 24" in diameter. You must be completely motionless -- for about 55 minutes. In my case, there was a small mirror just above my eyes, which allowed me to see out the tube, between my feet, into the MRI room where the technician was sitting. I tried to count the minutes as they crawled by...15...30...40...and about 45 minutes into the scan, a Colonel arrived. Five minutes later, another Colonel. And then another. And another. An hour into the scan, it was finished -- but I was still in the tube, watching with growing desperation as four Colonels pored over the screen where I can only assume my brain was on display. Born in and raised under the care of military hospitals, I knew Colonels were the Chiefs of their various divisions within the hospital -- neurology, neurosurgery, radiology, internal medicine, family practice...who were they? What did they see? After an eternity, the table started to move and I slowly slid out of the tube. The Colonels were gone.

The next day I received a call from a doctor in neurology, who wanted to test my right arm to determine the extent of the nerve damage. He also provided me with a referral to Barnes-Jewish Hospital in St. Louis to see a neurosurgeon. After repeated questions, he divulged that they had "seen something" on the scan, but didn't know what it was. The subsequent neurosurgery appointment confirmed the rumor, but diagnosis remained elusive -- an arachnoid cyst, a birth defect, a hamartoma. A year and a half later, along with second and third opinions at Deaconness and Sacred Heart Medical Center, and still no real confidence in what the thing was. But it was there. And it was growing. And it had to be removed.

Thanks to an article I ran across in Time Magazine and the sheer brilliance of Dr. Keith Black and his team at the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai, we finally got a diagnosis, and scheduled surgery -- going under the knife in April 2001.

That first surgery was followed by serial brain scans (basically MRIs) every 90 days, and for the last eight years, I have been undergoing a similar routine. Life really only exists until the next scan. Is it clear? 90 days of remission. Is there a recurrence? Then the process begins again. Surgery? Chemotherapy? Radiation? You literally learn to live 90 days at a time. Each clear scan is 90 more days of living. 90 more days of running. 90 more days of fighting.

Which brings me to the point of the historic tale. I had another brain scan just a week or two ago, and recently got the results. We're all clear! The infection is gone, and there is no sign of any recurring cancer. No more tumors. The surgery, chemotherapy, radiation, and antibiotics have all done their job. 90 more days, baby! 90 more days...