Anaesthetime

Going Under

So I was wheeled into the little anteroom by the operating theatre; the connecting doors were open so I could see into the main theatre room, which was a bit weird. The first thing they do (reassuringly) is to check you're the right person, both by asking you and by checking the ID tags on your wrist and ankle. Then it becomes a bit of a flurry of activity really; you have to untie the hospital gown so it's basically just an extra blanket, make sure your glasses are labelled before they take them off, etc etc. The various anaesthetists and nurses and assistants are really lovely; both times I've had a general anaesthetic, they've done a stellar job of distracting me and keeping me feeling pretty calm about the whole thing.

I had a mask with some oxygen flowing to breathe while they put a cannula in my left wrist. The anaesthetist warned that I might feel a little sting as the anaesthetic was administered, but it was actually surprisingly painful as it moved up my arm. Upon waking up I discovered that at some point the vein had blown, they'd taken that cannula out and put one in my right wrist instead, so I don't know if that would explain why it hurt more than I expected. Equally possible I guess is that it always hurts like that but most people forget once they've been knocked out?

Incidentally, common misconception about cannulae; they're little flexible plastic tubes that sit inside the vein, they don't have needles in - the needle is just used to insert it and is then removed.

Waking Up

I woke up gradually and was fully awake by about half-past twelve; there was a clock opposite my bed. Immediately I took this to be a good sign, as I knew I'd had the general anaesthetic about nine. Given that it would have taken some time to get me into and out of the theatre, that vaguely indicated an operating time of around three hours, which implied there probably hadn't been much in the way of complications like, say, a cerebrospinal fluid leak. Lack of complications is good.

The first thing I noticed, of course, was pain: I didn't have much of it. The second thing I noticed was: there were no bandages in my nose! Last time I had transsphenoidal surgery, my nose was packed with rolls of wadding afterwards, and having it taken out was a pretty unpleasant experience. This time? Nothing. My nose was a little delicate, but it was bandage free and, remarkably, not even oozing at that point. A lovely nurse explained they had filled the wound with a kind of foam, which sets hard and then dissolves slowly. Occassionally over the next few days I would feel it creaking slightly in my head and sinuses, which was an extremely weird sensation but happily caused no actual pain.

As expected, I was really thirsty and my throat was sore from the tube they put down it. The very nice nurse came and asked me my name and where I was, and brought me a cup of water. With a straw. On reflection, maybe I should have remembered that you're not supposed to drink through straws after pituitary surgery, and in hindsight the three cups of water I proceded to drink using said straw may have contributed to the epic nosebleed I experienced some time later once I got back onto the ward. But it's hard to think straight when you've only just woken up...

IMFW: Headache? Painkiller!

If television advertising has taught me one thing over the past few years, it's that headaches are evil red pulsating blobs inside your head, and that if you have one, you can cure it with NUROFEN and that NUROFEN will heal all your achy ills and NUROFEN PLUS is there for when you have an exceptional amount of pain that needs to be killed, because humans are WEAK and liable to developing red pulsating headblobs at any moment.

I think that advert was for Nurofen, anyway...

If actual real life has taught me anything, it's that you should go to the doctor if you have headaches regularly, and also that being allergic to paracetamol is annoying if you're then put on medication which means you can't take aspirin or ibuprofen.

If the BBC has taught me anything this week, it's that painkillers can actually cause headaches, which I had no idea about. We all know you should be careful not to OD on paracetamol (but did you know that paracetamol is actually the commonest drug overdose in the UK, and accounts for a massive 48% of all poisoning admissions to hospital?), yet in fact even at non-toxic doses painkillers can cause what are known as medication overuse headaches. NICE has recently issued new guidance to health professionals in England and Wales on the subject.

If headaches get worse after a couple of months of regular use of painkillers, it's possible that they have developed into medication overuse headaches, and unfortunately the only cure is to go cold turkey and see if they improve - but at first they'll get worse. Also known as rebound headaches, they can be a serious problem, often occurring in people who already suffer from migraine or other chronic headache conditions, and who may have no idea that they're taking painkillers too frequently.

IMFW: Scintillating Scotoma

Up until recently, I had never heard of scintillating scotoma, but my boyfriend is an occasional sufferer - and although that is not so fun for him, it's certainly a handy suggestion for an Interesting Medical Fact of the Week!

The word scintillating comes from the Latin scintillare - to sparkle, glitter, gleam or flash. The word scotoma comes from the Greek for darkness. So at first etymological glance, it would appear that a scintillating scotoma is something of an oxymoron.

Medically speaking, a scintillating scotoma is a symptom which often precedes the onset of migraine, although it can also appear as an isolated symptom without headache. Wikipedia describes it as follows:

Scintillating scotoma usually begins as a spot of flickering light near or in the center of the visual fields, which prevents vision within the scotoma. The scotoma area flickers, but is not dark. The scotoma then expands into one or more shimmering arcs of white or colored flashing lights. An arc of light may gradually enlarge, become more obvious, and may take the form of a definite zigzag pattern, sometimes called a fortification spectrum, because of its resemblance to the fortifications of a castle or fort seen from above. 

The visual anomaly results from abnormal functioning of portions of the occipital cortex, at the back of the brain, not in the eyes. Symptoms typically appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes, leading to the headache in classic migraine with aura, or resolving without consequence in acephalgic migraine.

Sounds kind of pretty, right? Unfortunately, even if you don't get a headache or other symptoms, it does massively mess with your vision until it resolves. If you search online, you can see a selection of artist's impressions of what scintillating scotoma can look like to sufferers:

Head = achy

I have had such a pituitary headache today! Right in the middle of my face. I'm hoping that's because the tumour is being battered mercilessly by the lanreotide zooming around in my system.

Progress Report

Long time no post! In fact, I returned from my holiday a week ago and have just been lazy incredibly busy and productive.

I am in fact on study leave from work at the moment, so technically I should be drawing a big spider diagram using my favourite set of coloured pens right now,* but as I have one heck of a pituitary tumour headache right now I am slacking off to write this message to my adoring public. Whoop whoop!

It has now been four weeks since my last trip to the hospital, when my endocrinologists told me they would call me in "a couple of days" to arrange an overnight stay filled with fun metabolic tests and delicious hospital food. They have still not called me, although I have called them twice and both times spoken to a receptionist who could not help beyond sending a note to the relevant doctors. I would be less annoyed about this if it weren't for the fact that I have to stay off my medication until they get these bloody tests done and consequently all my symptoms (fast heartrate, shaky hands, hair falling out, etc etc) have been worsening slightly.

The worst of the worsenings has been how hungry I have been getting! Oh my god. It is deeply irritating! I can tell my metabolism has gone up because I am just so darn peckish all the time. It sounds stupid but it's really annoying to live with.

Anyway, I realise that this is basically a super dull post, so I will end it here. Hurrah!


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*Not a joke. I do this.

Headache? Brain Tumour!

So I thought maybe I should write a post about the pituitary tumour headaches that I get. As I have almost certainly complained previously, for many years I never got headaches and then, gradually, I started having them more frequently. Every now and again, right after taking a couple of ibuprofen,* I would entertain the vague thought that maybe I should go to the doctor and get it checked out... and then laugh at myself for being melodramatic. Oops.

Because the thing is, they never happened that frequently. Maybe once every few weeks. I was under the vague soap opera impression that tumours in your head  gave you headaches continously, but apparently this is not necessarily the case! After my operation, I had headaches more frequently for a month or two (not particularly surprising given that surgeons had been rummaging around in there with sharpened implements), maybe a couple of times a week.**

My pituitary adenoma headaches are actually usually pretty similar. Previously, I would get pain all around the edge of my right eye socket, and right at the back of my eye - and it is somewhat disconcerting to feel where your eyeball must be - although since the surgery, it has improved (yay!) - I only really get it in the upper left-hand corner of my eye, which is where the pain used to be worst. I always feel slightly better if I massage that corner of my eyebrow; this has now turned into a habit which I catch myself doing even when my head is not hurting.

But ladies and gents of the internet - fret not if your headache sounds similar, for you probably do not have a tumour in your head (though that does not mean that your headache could not be seriously unfortunate). The Power of The Internet informs me that there are all sorts of different types of headaches even amongst pituitary tumour patients, so pfft, who knows. Just go hassle your doctor about it.

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* Paracetemol makes me cough. Apparently this is odd.

** I wasn't allowed to take ibuprofen due to being on steroids, and I wasn't supposed to cough lots, which ruled out paracetemol. This put me in something of a quandry for painkillers, but as they didn't tend to last too long I am INCREDIBLY BRAVE, I just did without.