On November 14, 2013 we met with Dr. Kris Smith to discuss
options for surgery for Breck. He stated
that based on the last Selective WADA test and the group conference that Breck
is a definite candidate for “Amygdalohippocampectomy” surgery. Say that 3 times fast. What that really means is that they will go
in and remove the left hippocampus (about the size of your pinky finger) along
with a small section that is attached to the hippocampus (about the size of
your thumb nail) with is called the Amygdala.
Recap:
We have a hippocampus on each side of the brain. A left and right one. The Hippocampus is responsible for retrieving
memories. Not storing them; although
they can store temporarily short term memory.
Because there are two of them that are connected if one isn’t working
the other can compensate and work for both.
The last Selective specialized WADA test they numbed the left
hippocampus to see if the right one could do the work of both. Breck scored 15 out of 16 correctly showing a
very high probability that her memory will be ok with the left one removed.
The amygdala is attached on or near the hippocampus and is
responsible for giving us some emotions tied to our memories. From my reading it seems the emotions
dissussed are more the fear or feelings to help in a safety response
situation. Such as walking in a forest
and seeing a coiled object --- you would immediately freeze and think snake…
how to move quickly or run… This is very
interesting to me. Nowhere can I find amygdala
and pleasant feelings discussed. For example
– think about how certain memories almost still feel like you are there. Or a song that brings back a flood of
emotions or memories of people and places.
Well, Dr. Smith talked to Breck about the feelings she has before a
seizure – the ones where she feels them coming on. There is fear, anxiety and a sense of dread
centered around this. He explained that
is why they remove the amygdale --- to help minimize these feelings especially
when the seizures should be non-existent.
I didn’t think to ask how that works when she still has the right amygdala. I wonder if the feelings are stronger because
the seizures start on the left side? All
I remember is him saying that the brain will take awhile trying to figure out
what happened or where the hippocampus went and that she shouldn’t have those
same Auroras. Breck seemed really ok
with that part of it.
Here is a diagram showing where these two
parts/pieces of the brain are located.
Concern:
Breck expressed her concern with having complications with the last two
procedures. She wanted to make sure Dr.
Smith would have every precaution or added staff needed to keep her safe during
the surgery.
Answer:
To this Dr. Smith tried to reassure her that in reality this is the
safest of any surgeries she could have.
The others would remove more of the brain and have more risks. Even the further testing would have required
more entries – incisions into the brain with multiple risks each time. He also stated that her complications came
from the angiogram – entering through the artery in the groin and going up thru
her veins and main artery.
Surgery: Possibly Dec 16th or 18th... just one month from now.
This surgery starts with a small incision over the left ear… looked as
if about 2 inches in length if I were to guess.
She will not even have her head shaved.
Dr. Smith said he may have to shave a very tiny amount but nothing that
will be visible or noticeable afterward.
Then they will go into the brain, under the temporal lobe and back up to
remove the hippocampus and amygdala.
Recovery:
She will be in the hospital for about 2 days at least and then be able
to come home and rest. She will have a
follow up appt in a week and be released to light activity. Dr Smith said she would have a headache and
general soreness for a few days after the surgery. This is normal and is usually controlled
reasonably with pain meds. He suggested
she not be in school for at least 4 to 6 weeks or to overwork the brain while
it is healing. He does want her to be
active as far as walking. This is the
best way to avoid pneumonia and blood clots – both risks of any surgery. Breck and I talked about easy hikes and
picnics… light reading for pleasure and watching movies – mainly just enjoying
her days. We also discussed how
important good sleep is going to be for recovery.
Other concerns:
I specifically tried to discuss Breck’s low heart rate and the need for
someone to be monitoring and giving her meds to keep it up during and coming
out of surgery. He seemed to agree. I also pointed out that perhaps her last
seizure came from the meds wearing off and Breck not having enough time in recovery. I will be stressing that some more --- I
believe the timing of the meds wearing off happened to be around the same time Breck started
moving and heading down to the car last time. That could be why she “tanked” and caused the seizure. I don’t remember Dr. Kris Smith saying much
other than agreeing that it could have been a good explanation.
Lastly I wanted to post a picture of Breck’s brain showing the
damaged hippocampus. This picture is as
if she is looking at you. So what you see on
the right side of the picture is the left side of Breck’s brain. There inside the purple dots are both the right
and left hippocampus. Her right one is
clearly bigger and more “plump”. On her
left side you see more “white” surrounding the shriveled hippocampus. This
white area is empty space or space filled with Fluid. You can see why they say the left is very
damaged. Just an interesting
picture.
Questions:
How much does the amygdala control? Will Breck “feel” differently? Even tho she still has her memories and can be retrieved – will she feel less or nothing at all with certain memories? Will she be able to feel past memories – such as an amazing birthday or vacation times? How does that work?
Will her personality change? Will this affect her “moods”? Do people have depression after surgery?
One of Breck’s main questions --- what precautions are they going to take exactly to assure her the safest surgery?
I am sure more questions will arise as we get closer to the day. Moving forward in Hope… smiles
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