September 7th, 2012
Appreciating the DASH More than Ever!
We have our digital office with us in Thailand while Loren recovers from brain surgery and “reboots”. We are appreciating the DASH more than ever. We are thankful that we decided to treat this Aneurysm immediately with a leading worldwide endovascular neurosurgeon, Dr. Aman Patel, who since the surgery has become a close friend.
He had a couple of patients come in emergently with bleeding from a ruptured cerebral aneurysm that knew about the diagnosis and chose to not treat the aneurysm at the time of diagnosis. Fortunately, these patients found their way to Dr. Patel in time and he was able to recommend the best treatment to mitigate the result of bleeding and the eventual result was favorable.
Sometimes it is difficult to decide whether to watch and wait or to take the course of immediate intervention. It was only weeks ago when we were in this situation ourselves, so I empathize with the magnitude and complexity of the situation and the decision-making process.
We carefully evaluated the facts of the situation and weighed the risks. We made the right decision and found the right doctor as this was a complex aneurysm and in a dangerous location – and his skill and experience made all the difference. He deserves an Olympic Gold medal on this one.
Loren could have died or have been debilitated never to be the same. The decision was right, the Doctor was the best, and we attracted the right circumstances and energy through visualization, expectation and prayers. However, the best course of action is not simple nor is it clear to many doctors or patients that discover aneurysms. It is a very complex situation with many variables, and the wrong decision can have unexpected and potentially irreversible consequences.
This is one of the best reasons why patients should go to an experienced surgeon and neurological diagnostic team that specializes in the treatment of vascular disorders of the brain. Dr. Patel emphasizes to me that he doesn’t want patients to get the impression that a brain aneurysm could be remedied by rapidly jumping in and getting treated ASAP as an emergency. It is not that simple.
Sometimes it does make sense to watch the aneurysm and evaluate all the risk factors and variables. One solution does not fit all and there is no panacea. Each case is different and unique. There are obvious best practices and clinical probabilities but the permutations of the characteristics and variables are too many to be able to postulate what to do in a chart or decision tree. They need to understand that the decision is complex and depends on a variety of factors and that an experienced surgeon will be willing to discuss all options and plan a course of treatment vs observation.
Those patients that I mentioned above that bled after choosing not to treat did not bleed while awaiting treatment – in contrast to Loren’s situation – these patients chose that treatment course with discussion with their doctors. The question is whether they would have chosen a different course with more information.
Dr. Patel emphasizes that the risk of bleeding while trying to gather information or waiting a short period of time usually carries very little risk – and bleeding during this time period is very very rare. The most important thing to do is get evaluated and have a plan of action. Sometimes it is a fine line between the probability of bleeding and rupture versus the probability of successful treatment and it is a close call.
Experience and careful evaluation of all the variables is required for the best decision. Even then the best decision does not guarantee a perfect result. That is why getting evaluated and then finding a team of experienced experts is probably the most important thing one must do besides being aware of the symptoms and getting the right tests done to determine if one has an aneurysm.
Thank you all. Please watch for my perspective on this in my Blog next week as well as an appearance on TV and Loren’s articles in national publications. I am anxious to actually interview Dr. Patel on this for everyone’s benefit and promise to do so when I get back from Thailand.
However the fact remains that this disease lurks in the shadows of life for many people and they do not know it, and all too often their doctors pass their symptoms off to something else, because the symptoms mimic many conditions. But this is a silent and sudden killer that modern miraculous medicine and experienced surgeons can treat. It is like going to the moon in your brain though the arteries in your leg!
There is a risk, but it is better than suddenly dropping dead. If it burst during treatment — it would have burst soon anyway—so it is better to treat than wait. However, a tricky aneurysm is not something to PRACTICE Medicine on– You want someone who is done practicing and is experienced and confident! We are truly blessed in that regard, and the Neurosurgery team at NY Mt. Sinai were thorough in their diagnosis, assessment, evaluation and plan for treatment. They did not leave a single stone unturned. We are thankful, and now have a better appreciation for the fragility of life.
Make the most of every minute and give thanks to those who dedicate their lives to the advancement of medicine and science!