how do you know?

so far the gist i've got is this:

STA-MCA - direct bypass from outside skull to inside

EDAS - indirect bypass -> arteries are laid on the surface of the brain and left to grow

EMS - indirect bypass -> muscle (and it's bloody supply) is laid down on the surface of the brain and left to grow

i can't remember the names but i've got one (left) completely closed, one on the right almost completely closed and a third (where?) not doing too well.....
people say make sure you have the right surgery for your case but how do you know?

Emily,

An experienced MM surgeon should be able to tell you which procedure is best for you.

I think for many adults, STA-MCA is usually the ideal, because it delivers immediate blood flow, and adults may not grow in new vessells as quickly as children do.  However, not all adults are good candidates for the STA-MCA surgery, and one of the indirect bypass procedures may be a better fit.

If your neurosurgeon isn't giving you good answers about why you aren't doing well after surgery, you might look into getting a second opinion.  At the very least, if a second neurosurgeon with MM experience agrees with what the first is doing, you would know you were doing all you can; however you might end up getting some other treatment options from the second neurosurgeon --- you have nothing to lose 

I'm not sure where you live, but my daughter had surgery with Dr. Steinberg in Stanford, CA, and I would recommend him very highly.  He saved our daughter's life.  Daphne'd had two strokes before her MM diagnosis, when she was 16 months old, and her doctors in Philadelphia did not expect her to live beyond two weeks.   Thanks to her surgeries back in March (and her incredible will), she celebrated her second birthday on October 7th.   ;

Jenny

Jenny

thanks for your replies....
there's two surgeons at my hospital with MM experience, i have an appointment tomorrow so i guess i'll just wait and see what they say.
i think they're a bit unsure what to do with me as i'm an adult - 23, but i'm the size of a child (4 foot 8" ) - and seem to have the symptoms of a child rather than an adult (they described me as extraordinary, hehe, wicked)....
i'll let you know what they say.

Emily:

Good Luck at your appointment. I just wanted to offer one more piece of advice. First of all, I am glad to hear there are doctors in your area that have some MM experience. Secondly, I wanted to ask if you thought those doctors would "consult" with Dr. Scott or Dr. Steinberg about your case. When I had my surgery in 1989, my doctor consulted with Dr. Scott. He was wonderful, and while he wasn't actually my doctor, and didn't actually DO the surgery, he helped my doctor figure out what was best for me since I was "one of the first children diagnosed" in the States.

I aws the first surgery for MM performed in Houston, Texas, which has a HUGE Med. Center. And everything turned out great!

Please keep us all up to date!

Sara

Hi Emily,

I'm glad that you're not putting this off and have gone to see your doctor, Dr. Laidlaw today.  I'm also pleased to hear that he is experienced.  

Looks like his current plan is for you to have 3 surgeries?  An STA-MCA on your left side, then an EDMS on your right, then another bypass along your vertebrae?  I'm just wondering if he gave any time frame for your second surgery?  My MRI/MRA on my other side (left) showed multiple TIA's, and I too am not having symptoms, but the option for surgery is still not up for discussion by my neuro at this time.  

I too was on Plavix but am now on Aggrenox..but I wanted to ask you more about the injections you mentioned you will have to give yourself leading up to your surgery.  I tried googling it, but I couldn't find it.  It really caught my interest.  Is it like a fast acting/short-term blood thinning medication?   Also, I know you mentioned stopping Plavix 3 weeks pre-op, but do you have to also stop taking aspirin prior to your surgery?  I hope you don't mind me asking so many questions...I'm just very interested.

About your hair...don't worry.  I looked quite funny with 1/3 of my head shaved off.  I planned to shave my entire head once I woke up and realized how much was gone...but I chickened out at the last minute.  I personally took a liking for bandanas and probably have one in close to every color ever made.    By the way, I agree with your decision to shave everything off at once. I was told it's better so your hair can grow back evenly...

Last but not least, your post sounds so positive and filled with confidence, which makes me so happy for you!  A positive attitude will definitely help with morale, and I believe very important with the whole healing process!  Keep the positive attitude, Emily!  Keep up that great spirit!  You'll do just fine!  

Take care,
Shan

hey shan. no prob about the questions, i'll try my best to answer them...

No time frame for my second surgery yet, i think that's entirely dependant on the patient, how they recover from the first one and how urgent the second one is. ideally he'd like to give me a STA-MCA for the second one also as that gives the most immediate improvement in blood flow; however, if for example, i don't recover too well from (or my vessels don't "cooperate" well during) the first op, then he'll go for an EDMS for the second one. I may easily recover from a stroke the first time, but a second major stroke could result in permanent damage, etc... That's just an example... Also, right now I need help asap, hence the STA-MCA... if it wasn't so urgent he's probably do the EDMS as it's a less risky procedure.

i was on hepron in hopsital, then switched to asprin and plavix upon discharge. the injections will be because dr laidlaw wants me off plavix asap but with my track record i'll have a stroke pretty darn quickly and it may not be pretty. so (sorry i forget the name) [this drug] must allow my blood to be thin enough to avoid strokes but thick enough to not complicate surgery. i'll get all the details in the next few days so i'll get back to you.

i have to admit i'm quite devastated about my hair.. i have long dreadlocks... which i have been growing to some time and i'm very proud of oh well.. i'll cut them, shave it off and eventually, when this is all over - sew them back on! hehe...

anyway bring on the questions, makes me think about things and keeps me positive also!

Hi Emily,

Thanks for your post.  I too was on heparin pre and post op, then when I was discharged, I was on Plavix and 325 aspirin.  I had a one time 4 1/2 hr nose bleed once, so my neuro switched me to 81 mg aspirin and Aggrenox and stopped the Persantine, but it looks like my current bleeding time is "disturbingly" normal.  As soon as I do my breast biopsy next week Wednesday and pray that surgery is not needed...then my neuro will change my meds to thin my blood further which is definitely needed!  He, as well as my internist are puzzled as to why regular aspirin combined with Aggrenox (also contains aspirin and persantine) isn't thinning my blood the way it should be.  I've also been referred to a hematologist/oncologist which I will be seeing next week Thursday.  If you can, please let me know the name of the shot you'll be giving yourself.  I'd like to ask about it; although, I am a BIG baby when it comes to needles. 

You have long hair? Okay, I'm jealous.   But like I said earlier, don't worry...we know you're just as beautiful on the inside as out! 

Take care,
Shan

Hi Patti,

Nice to see you on the board again!  It was great meeting your husband and son in Las Vegas, and we were sorry you couldn't be there.

I'm hoping your post doesn't mean that Michael is having difficulties, but thought I should post some of what I understand about direct and indirect bypasses.

Indirect surgery most likely prohibits a future direct bypass because it sacrifices the superficial temporal artery needed to do a direct bypass.  I've also heard that by virtue of doing the direct bypass, the patient benefits from getting an indirect bypass at the same time.

Keep in mind that I'm just a layperson, and my education about the different types of surgery continues to evolve.  This information should be confirmed by a MM specialist.

Please keep us posted on how things are going with all of you.  You will be in my thoughts and prayers.

Warmly,
Jill

I wonder what their reasoning is for taking you off one anticoagulant "as it is close to surgery" and putting you on another.  Is the Clexane somehow safer for surgery?

thanks shan
have my app today, still not sure if they're intra-venous or intra-muscular.. i assume the former...

and yeah em i figured it's because it's not actually a blood thinner, just something that prevents clotting.. are they different? is that what your medical-paragraph meant shan?

Hi Emily,

I couldn't go to bed without trying to find out more info on this subject...so to Google I went...and found this:

What is an anticoagulant?

An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting.

What is an anticoagulant medication?

A drug that is used as a "blood-thinner" to prevent the formation of blood clots and to maintain open blood vessels. Anticoagulants have various uses. Some are used for the prophylaxis (prevention) or the treatment of thromboembolic disorders. Thrombi are clots. Emboli are clots that break free, travel through the bloodstream, and lodge therein.

What are antiplatelet agents?

Antiplatelet agents are medications that block the formation of blood clots by preventing the clumping of platelets. There are three types of antiplatelet agents: aspirin, the thienopyridines, and the glycoprotein IIb/IIIa inhibitors. These agents differ in four ways: the way in which they prevent platelets from clumping, their potency (how strongly they prevent clumping), how rapidly they work, and their cost.

How do antiplatelet agents work?

Aspirin

Aspirin prevents blood from clotting by blocking the production of thromboxane A-2, a chemical that platelets produce that causes them to clump. Aspirin’s antiplatelet effect lasts for days while the other NSAIDs’ antiplatelet effects last for only hours.

Thienopyridines

In addition to thromboxane A-2, platelets also produce adenosine diphosphate (ADP). When ADP attaches to receptors on the surface of platelets, the platelets clump. The thienopyridines, for example, ticlopidine (Ticlid) and clopidogrel (Plavix), block the ADP receptor. Blocking the ADP receptor prevents ADP from attaching to the receptor and the platelets from clumping.

Glycoprotein IIB/IIa Inhibitors

The glycoprotein IIb/IIIa inhibitors such as abciximab (Reopro) and eptifibatide (Integrilin) prevent clumping of platelets by inhibiting a different receptor on the surface of platelets, the receptor for glycoprotein IIb/IIIa. The glycoprotein IIb/IIIa inhibitors that are approved by the FDA must be given intravenously.


I found a list of blood thinning medications, and Enoxaparin is included:
http://www.umm.edu/altmed/ConsDrugs/DrugCats/BloodthinningMedications.html[/color]

So...My guess is that blood thinners and anticoagulants are basically the same thing.  Antiplatelet therapy/medication may have an anticoagulant effect, but aren't necessarily considered anticoagulants.  I could be wrong, as I am not a doctor, but that is what I gathered from what I read.  I will be sure to ask my neuro at my next appt this Saturday...

I hope I didn't confuse you..

[try again!]

yep i'm confused hehe
but i did have my appointment with the hospital today and found out the following...

both are blood thinners

plavix takes a long time to get out of your system (i am stopping today and it will be out of my system in 2 weeks) - my op is on nov 17 (yes!!! i have a date!!)

clexane moves through your system very quickly, basically within a day. so i have daily injections and on my last day, (wed 16th) it will be out of my system by the time they start operating.

the injections will be done by hospital staff (coming round to my house every day) in my tummy (subcutaneous = fatty bits..... pffff what are they saying! hehe)

there we go.... make some sense?

I've edited my original post in this thread and wanted to make sure the information was seen...

DJ wrote on Oct 19^th, 2005 at 8:29pm: