Me, Myself, My Brain & I

I had been waiting for a call from the neurosurgeon’s office (Dr. Nelson) for quite a few weeks and the phone finally rang yesterday morning.

One of my first questions was why this was necessary, given that Dr. White and I were fully aware what direction we needed to move in. The person on the phone told me that Dr. Nelson meets with all of his patients before scheduling an SEEG, so that’s what we were gonna have to do.

Dr. Nelson works in three different locations in my area: Woodbury, Plymouth, and St. Paul. That last one is the closest, so I said I’d like to schedule my appointment there.

“Well, he only works there one day a month.”

“Oh, no…”

Mind you, that was my inner voice speaking, but the person on the phone might have been able to hear what I was thinking if she’d seen my face. Instead, she explained that he was working there tomorrow [Thursday] and had appointments available at 11:30 and 2:30.

My wife and I drove to St. Paul and got to the office a little before 11:30, Dr. Nelson’s assistant brought us into one of the rooms, and we started discussing the situation before she eventually brought in Dr. Nelson for our consult.

What hadn’t occurred to me up until that point was that Dr. Nelson isn’t part of Minnesota Epilepsy Group—he was working at the John Nasseff Neuroscience Specialty Clinic, so he wasn’t part of that earlier surgical conference, he hasn’t been given a lot of information about me, myself, my brain, and I… so I filled him in on the details as best I could.

The SEEG will give more specific information than the MSI, so they’ll spend some time figuring out exactly where the sensors will need to go (where to put them to get through the skull at what angle, etc.), then I’ll spend 7-10 days in a hospital bed and not be allowed to move a whole lot… I’m hoping I’ll be able to get up and use the bathroom instead of just shoving a bedpan under my hospital gown, but who needs dignity, amirite? He said they’ll put some cuffs on my legs this time to make sure I don’t develop a bunch of clots again, but probably put me on a mild dose of a blood thinner for safety’s sake.

But he didn’t know that I only took a blood thinner for three months after staying in the hospital before. He didn’t know that Dr. White and I already talked about different types of surgeries. He didn’t know that extraction had already been ruled out because it can potentially cause some damage in the process. Given that the problem is in the language center of my brain and I’m currently employed as a proofreader (eyebrows go up, eyes get bigger and “Ohhh…”), I enjoy reading and writing in my free time… my quality of life would diminish significantly if something went wrong, so yeah, that type of surgery is off the table.

Before I can be admitted into the hospital, Dr. Nelson needs to make sure that he’s available, that Dr. White’s available, that the special room in the hospital for SEEG testing is available… so it could take a few months for everything to get in order. He said it might be 2-4 weeks before I hear back from his office, so I still have some more waiting to do, but when I get that call, we should be ready to put my hospital stay for SEEG testing on the calendar. (If that testing is supposed to fall over the weekend of July 26th, which is when my wife and I have tickets to see Nate Bargatze performing standup at the Xcel Center… how badly do I really need to have surgery?)

Yep, that was the message I got on Friday.

I spoke to Dr. White last Thursday, he said he’d take care of getting things scheduled at the hospital for my SEEG, so I figured it was just a matter of time.

I couldn’t remember if he said I should call in a week for another update, so I figured that even if he hadn’t, a call couldn’t hurt. I’d rather make the call when I didn’t need to rather than not bother to call when I should have.

I called to ask for an update, they passed the message along, and I got a call back later in the day.

Next week, I’m supposed to get a call from the neurosurgeon’s office (finally!). So from the time I spoke to Dr. White, it’s taken the neurosurgeon’s office a full month to contact me. But it’s not to put me on the schedule for seizure monitoring at the hospital!

Nope, his office will be calling to schedule a consult.

Why? Seriously, why?

I’ve accepted the fact that I’m going to have brain surgery. I’m not sure how long ago that was, but it’s been a while since we determined that medication is no longer a viable option. I expected it to take longer for my case to be presented to the surgical conference at Minnesota Epilepsy Group, but instead of weeks after talking to Dr. White, it was the next day (February 4th). Like I said before, it happened fast.

A full month later (which is very not fast), I’m not being scheduled for what will likely be the final test before surgery. No, I need to talk to the neurosurgeon first. This talk apparently isn’t something that can be done while I’m in the hospital for testing, so the current “God knows how long” timeline looks like this:

A month after the surgical conference, I’m getting a phone call to schedule a consult with the neurosurgeon, then I’ll need to wait for God knows how many weeks until the consult, then God knows how many more weeks until the SEEG… if the neurosurgeon comes to me during the SEEG to say he wants to do additional testing, extending the timeline for God knows how many more weeks until the next test(s) and then God knows how many more weeks until finally performing brain surgery… if those sensors are anywhere near a part of my brain that activates when I’m angry, they’re gonna think I’m having a massive seizure.

I honestly don’t remember how long I’ve worked with my current one: Dr. White. And that in itself should say something.

When I was diagnosed with epilepsy back in the summer of 2000, I became a patient at Minnesota Epilepsy Group. Dr. Gates (who for some reason got a real kick out of calling me “Dude”) might have worked with me for a very long time if he hadn’t passed away due to a brain tumor.

I think Dr. White may have been my doctor after that, so we may have been working together for over 20 years. We’ve been working together since before he started working in Minnesota. (If I remember right, his contract with his previous employer had a non-compete clause in it, so even though he was working with Minnesota Epilepsy Group, he spent a year working in an office that was just over the border in Hudson, Wisconsin.)

And when I say “working together,” that’s exactly what I mean. Dr. White provides his input, I provide my input, then we come to a collective decision. He’s very knowledgeable when it comes to brain surgery and I don’t remember how long ago he brought it up as an option. I told him that option was on the table, but it was on the back of the table—I wanted to exhaust my medication options first. He completely understood and accepted my decision. He would still tell me about surgical options from time to time, not to push the issue, just so I’d have the information in my head instead of reaching the point of no more medications and then he drops a bomb full of surgical information in my lap, leading to a brief period of full-blown panic before curling up on the floor in the fetal position, weeping silently.

After the surgical conference two weeks ago, he said I should call yesterday to get an update and find out what kind of progress he was making. I called in the morning for two things:

1. What’s the update?
2. I still hadn’t received a call from the neurosurgeon’s office about scheduling my stay in the hospital for the SEEG.

The person at the front desk was going to try to get Dr. White’s assistant on the line so she could talk to me. While I was on hold, I got a call from… Minnesota Epilepsy Group.

I didn’t expect to see that name on my phone’s caller ID, but I answered and it was someone checking in to ask how I was doing, was everything okay, etc. I gave her the same information about getting an update from Dr. White and no call about the SEEG. (During that conversation, the person on the other line from Minnesota Epilepsy Group hung up… oops.)

Later that afternoon, I got a call from Nicole, Dr. White’s assistant. She told me there were two reasons I hadn’t received a call about the SEEG, concerns they had about previous health issues that they thought might need further discussion or possible testing:

1. I had pneumonia in my left lung.
2. I had a pulmonary embolism in my right lung.

Those two things were the holdup. And I was pissed.

Why? Because they were both extremely likely a direct result of my last stay in the hospital for seizure monitoring.

We found out about both problems during different visits to the ER just a few weeks after I got out of the hospital. The pneumonia was likely due to a grand mal seizure and some stuff came up out of my stomach that was quickly inhaled into my lungs. Not only did they find the pneumonia, but after admitting me into the hospital, they eventually discovered a bacterial infection, fluid around my lungs… I was in rough shape.

As for the pulmonary embolism (a blood clot in the lung), during that next stay in the hospital, they scanned my lower legs, then asked if I had any pain down there. No… why? Because they found a lot of clots in my lower legs. As it turns out, when you spend a week and a half in the hospital with a bunch of wires glued to your head and the only times you’re vertical is when someone is there to watch you walk to the bathroom and back (maybe a handful of visits to a chair about ten feet away from the bed as well), the blood in your legs doesn’t move around very much. Guess what happens when blood doesn’t move? Clots. And one of those likely escaped from one of my legs and ended up in my lung.

So I was frustrated that my last stay in the hospital for seizure monitoring was the reason why they were hesitant to schedule my next stay in the hospital for seizure monitoring.

Of course, there’s no point in getting upset with Nicole—she was just passing along the information. I just explained my frustration and she said she’d pass it along to Dr. White. He’s on call this week, which means the clinic will give him Monday and Tuesday off… it was Thursday and I might not hear back from him until Wednesday. Another source of frustration.

But less than two hours later, I got a call. I looked at the caller ID… Dr. White. Nicole had told him about our discussion, so he wanted to call me back as soon as he could. I absolutely want them to be thorough in this process, take precautionary measures… safety is important when it comes to brain surgery, you know? But the fact that the only time those issues have actually been issues were immediately after being in the hospital… so he decided that we should get me on the schedule. It’ll likely be a few months before they’ll be able to get me back into the hospital, which is plenty of time for them to do their due diligence.

Has any progress been made since Thursday? I have no idea. Do I feel better anyway. Absolutely. When the current information is “You’ll eventually get a call from the neurosurgeon’s office for scheduling”… I don’t like floating in Limbo, not knowing when or if something will happen. When the current information is “Your doctor is going to get you on the schedule”… I’m comfortable knowing that it’s now just a question of when.

So to Dr. White, thanks for your call and thanks for understanding. I appreciate the fact that you listen.

I think those two are my current options for covering up what’ll likely be a bandage on the top of my head sometime in the near future (I’m assuming the hospital won’t use spackle to plug up the holes in my skull, then staple a wig onto my head, but I’ve been wrong before…).

I spoke to Dr. White (my epileptologist) yesterday about the surgical conference and he told me that it went well and there was basically universal agreement that the eventual result of brain surgery will be some sort of device inside my head, most likely an RNS (responsive neurostimulation) device.

But that’s not the next step. Because RNS is supposed to affect a very specific area in the brain—the area where the seizures start—they need to do a different test to find out exactly where that area is.

I’ve had several EEGs (electroencephalograms) done in the past, the most recent during an extended stay in the hospital for seizure monitoring back in September 2023. As soon as I arrived, they glued a whole bunch of electrodes to my scalp and began monitoring my brain wave patterns. They tapered off my medications fairly quickly to try to induce seizures, which effectively induced seizures fairly quickly as well.

For context, the seizures I typically have these days affect my left temporal lobe, the language center of the brain. Thus, when I have a seizure, I might stop speaking mid-sentence because I don’t know what I was about to say—the words are just gone. If I’m trying to listen to something, whatever’s being said doesn’t make sense. If I’m trying to read, same problem. Language is basically out the window. After maybe 30 seconds, I’m okay again. I might need a little help remembering what I was saying, but if there are no words being spoken at that time, you might be standing next to me and never know anything happened.

It was only a few days into my hospital stay when I got a call on the hospital phone. I answered and didn’t recognize the voice. I couldn’t really tell what the voice was saying, but I tried to respond to whatever it was saying (I’m told it was basically gibberish). It wasn’t long before I realized that the person I was speaking to on the phone was my older brother. When the call began with gibberish and ended with “Love you, bud”… you can imagine why my wife was spooked. And what showed up on the EEG?

Nothing.

The area where the seizures start is too far away from the surface of the brain, so the sensors on my scalp couldn’t detect the abnormal brain wave activity. Thus, when I head back to the hospital in a few months (I don’t know exactly when, it hasn’t been scheduled yet), we’ll be doing a slightly different test: an SEEG (stereo EEG or stereoelectroencephalography).

Instead of gluing the electrodes to my scalp, they’ll be inserted deeper inside the skull and thus be able to detect abnormal brain activity a lot more accurately. Not just detecting the activity, but where the activity originates. Since the RNS device sends a little electrical charge to the brain to stop that activity before it becomes significant and turns into a seizure, finding that origin point is kind of important.

And so after my stay in the hospital, I’m going to have at least a partially-shaved head (I think I’d prefer shaving all of it rather than having a weird bald spot right in the middle, but that’s just me) and some small holes where the electrodes were inserted. Call it vanity if you want, but I feel like I’ll want to cover that space up while the spackle dries underneath the bandage, thus begging the question: A ball cap, a fedora, or do I need to go shopping?

I honestly didn’t expect this to happen so quickly.

I’ve been a patient with Minnesota Epilepsy Group since 2000. After talking with my current doctor about the lack of remaining medications and potential surgical options, he explained that they have a weekly surgical conference and present one patient’s case to the entire staff. After hearing all of the information, everyone gets their input and the collective decision is what’s presented to the patient. My previous understanding was there was basically a queue, multiple patients in line ahead of me and it could be a while before they would discuss my case.

Instead, I spent about an hour on the phone with the doctor on Monday afternoon clarifying as much information as possible, making sure everything was accurate for his PowerPoint presentation the next morning.

So yes, I became a case study yesterday. And my one big request to people at this point is that you continue to call me Shawn, not “48-year-old Caucasian male.”

This title seemed a bit unwieldy—it’s a lot of letters to type—so when choosing the web address, I shrank it down to the latter two items: “MyBrainandI.com”.

So after coming up with the title for this blog, the big question is “Why?”

And it’s because it felt like the right thing to do. Like something I was supposed to do.

I have epilepsy.

Most people have probably heard about cancer and COVID and beheadings before, but what’s epilepsy?

That’s where I come in. My first seizure was in 1991, but it’s possible to have a single seizure and that’s it. As a precautionary measure, a doctor had me start taking an anti-seizure medication right away.

If the medication continued to prevent seizures, you wouldn’t be reading this, but it didn’t. I started having seizures maybe five years later (I didn’t realize that’s what they were at the time) and I was officially diagnosed with epilepsy in 2000.

It’s been a long journey since then. Different kinds of seizures, different kinds of medications… and now I’m out of medications. Everything that’s available either doesn’t solve the problem or has side-effects that would make the solution worse than the problem.

Thus, the final way to prevent seizures (aside from beheadings) that will be happening sometime in my near future is brain surgery.

So I’m sharing my epilepsy journey with all of you. Seizures, medications, brain surgery… all of it. Providing a personal perspective to information that you might only read in a textbook from all four of us: my, myself, my brain & I.