Author Topic: AN Story from Perth Australia  (Read 4475 times)

Johno

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AN Story from Perth Australia
« on: September 19, 2007, 05:16:07 pm »
Hello to all in this forum.
I found it while doing research on AN over the last couple of weeks. I was almost relieved to find I am not alone in having had one of these things and that there is a strong support network out there.
About me: 40 yrs old perpetual kid, happily married father of a 5 year old girl and 3 year old boy. Healthy and positive type, I consider myself an average Aussie Bloke who values mateship, hard work and not taking one's self too seriously. Work in the mining industry in Western Australia as an environmental advisor in the majestic outback spending most of my time “out bush� teaching rough Aussie miners to be as green and eco-friendly as I can make them. I was only starting to slow down now from a hectic and adventurous life when a new one started weeks ago.
My hearing in the right was bad for years which I put down to the mining industry and an earlier career in the Army, a year ago I got off a flight and found I had suffered significant hearing loss. The mine site nurse put it down to fluid on the drum and sent me away with sudafed and some alveolation exercises. Several months later a scheduled hearing test picked up profound loss or about 85% on the year before. I put in for a compensation claim against noise induced hearing loss and they started test after test to see if I was really deaf and why it had happened. The decision to send me for an MRI was a fluke as the ENTs had decided it was already a middle ear fistula caused by the flight. My complaints of vertigo and "stuffiness" in the ear had my GP worried and he refered us for an MRI. The result revealed a 4cm AN that reminded me of one of my kids Mr Potato Heads.
Had no idea what that was except it was some relief to me and my wife to be told "benign".
That was four weeks ago.
I was very lucky to get one of the best ENT surgeons in Australia specializing in AN removal, Prof. Marcus Atlas. His demeanor on meeting put me at ease straight away. Unfortunately he was not keen on "wait and see" and advised getting it out right away. I was impressed by the MRI because it looked like the AN was shouldering my brain stem to one side like it wanted it out of my opposite ear! It seemed pretty clear to me I was very lucky to get it identified when I did given that I'm often in remote locations and could have suffered a Hydrocephalus or stroke at any time. Time Bomb is the word that comes best to mind.
Dr Atlas cleared us to fly to work and I had the unique opportunity to inform my boss that I'd need time off to get an egg size tumor cut out. They were and remain very supportive, sometimes working for these big multinational mining companies pays off. I even learned of others working in the same company who had had ANs removed and made full recovery.
I expected the date to be set for late September or early October this year which would give me time to prepare and sort out stuff like life and pay insurance and focus on getting mentally and physically fit for the operation. As it turned out I didn’t have weeks and the surgery was booked for 10 days later on September 3.
The reactions of friends and family was as I wanted, good humored and supportive. They joked that years of bizarre and college kid behavior coming out of me was probably due to the AN. I pointed out to my wife all the years she had been cranky at me for not listening, seeming inattentive or forgetful had probably been unknown symptoms of a deeper problem now known to us as a AN. She didn’t buy it, but I laughed I would milk the situation at home for every cent worth. Making light of this situation helped me deal with the AN and the gravity of situation. For example, I should be in South Africa right now on a holiday I’d been preparing for all year. A best mate from Cape Town is getting married this weekend and although we talk via email often we have not seen each other in ten years and this was to be a big reunion as well. The plan was for me to fly to South Africa on the 15th for his bachelor’s party and stay for ten days getting in the wedding on the 22nd. I was gutted when Dr Atlas dismissed any plans of travel due to the risk of something going wrong. Despite having had the AN for years it was prudent to treat it as life threatening. My wife put the skids on the trip immediately and I cancelled the ticket and called my mate. I had to laugh when I told him that you can always plan on an unwelcome brain tumor to dash one’s best laid plans. Karma.
The morning of the Op I was nervous but felt very calm. The day before had been hard as it was Fathers Day and I had felt more tired than usual. One of things I know realize about AN is that is saps energy. For over the last year I used to get very tired through the day and struggle to stay awake in the early afternoon in the weeks prior to the Op. I also felt depressed because in many ways I felt I'd been cheated by fate. If the next day proved to be my last I would never get to say the things I wanted to say to my wife and kids and everyone that meant something. Being Fathers Day certainly made it worse but I refused to say good bye to the kids early the next morning before going to the hospital as I had already decided there was no way this was going to nail me.
I think the last thing I thought about before going under general in theatre later that morning was how the two surgery nurses looked like they belonged on TV. One had a goatee with a surfie bandanna and the other was a swarthy looking italian with black eyes.
My next memory is seeing a light and hearing Dr Atlas saying "Big Success". My next real coherent memory other than "John...Babe..." and "Can you open your eyes, squeeze my hand?" is Pavarotti. I could hear Pavarotti on a TV and knew in my comatose he had died. If I have to put music to AN, it will probably be O Sole Mio.
I remember the pain arriving like a late night express and the nurse there to take it away and I remember trying to call out for help as I opened an eye, saw the world do a sick tilt and realized I was going to vomit everywhere. They had warned me I would awaken with balance totally out. Other than that I was pretty well out till Thursday, four days later and once they cut the bladder and walked me to the toilet I realized I badly needed a wash and a shave. I also felt weak but probably more alive than ever before.
I was consciously aware that something was missing. Something that had been wrong for a very long time was gone and with it all the associated years of emotional baggage. It was like waking up in a cage to find the door has been left open and the guards have all left. This is what it was like for me on a physical and psychological level knowing the AN was gone. I didn’t need to look at the row of staples around my right ear to know I'd been separated from some parasite that had been like a monkey on my back for years. I also felt the real high of someone who knows they have been through something and survived to be handed a fresh deck of cards. Every bite of finger fruit, sip of lemonade and breath of oxygen felt great. The sheets under my fingers felt different to like I was feeling the texture of linen for the first time. Everything felt different.
I became aware of the right side of my face and the numbness there. The neurosurgeon and literature I’d read had warned me that palsy was a given but would most likely be temporary. I tried to smile in the mirror and was confronted with a pirate leer that reminded me of the Wiggles character “Captain Feathersword�. I said to the mirror “Ahoy there� and realized I sounded like Captain Feathersword too! Great, atleast the kids will be happy Dads a pirate. My biggest concern was the double vision and lack of function of my right eye lid. I still have it 16 days later and have to cover one eye to work on this computer. More about my post op condition below.
I saw the family everyday, sometimes twice a day and having them there even when I was too tired to speak was the best medicine I could have had. I felt closer to my family now than ever before. It was like layers of insulation and filters had been removed from my heart and eyes and I could see them crystal for the first time and knew how much I loved them and how I thanked god to be given more time with them. I made an oath to myself to be a better father and husband and never to take my family for granted or let life let me forget that they are the most important thing. I tell my wife and kids I love them a lot more now.
My wife told me how great the kids had been through the whole thing. Kids are so much more resilient and understanding at a deeper level than adults. My daughter had lost her first tooth and had sent it to the tooth fairy with a wish for Dad to get better and come home. Friends came to visit and with each one I felt a luckier and luckier man and extremely grateful to my surgeons and to god fro this gift.
I’m not a religious person and don’t care much for religion having been bought up in an ethnic background where religion has been the root of hundreds of years of bitter war. I do believe in a higher power or law that is at the centre of the universe and something we can only imagine at. My best word for it would be love or “peaceâ€?. You can feel it when in the wilderness with your mind clear of all thoughts. I do believe that there is a plan for each of us and the way we live our lives is central to that and judged. I do believe that death is not the end and that the afterlife is something wonderful, like going back home to a mothers arms. My experience has reinforced this instinctive belief and I’m not surprised to say that any fear I had of death is gone. Its been smudged out and I feel like a kid who no longer fears Jack Frost or the Christmas Goblin. I also believe that fear is the most destructive emotion especially when it defeats reason and love. I realized that so much of my being prior to September 3 had been dictated or influenced by fear. My relationship with my wife (which had been rocky for months), my attitude to the kids, (which had been selfish and sometimes harsh) and my relationship with people at work (which had been often dictated by politics and personalities). I decided to immediately reject fear in all it forms and be free of it. It was easy like turning off a switch or saying no. I now feel empowered and more assertive than ever before.   My troubles aren’t over yet so this is very helpful, more on that below.
I got back home a week ago and its been great. Mostly have spent it hanging out with the kids, resting and writing emails. The sense of euphoria along with the palsy, dry eye and double vision is still there. I don’t mind my physical limitations at the moment though it does worry me about how long before I’ll be able to return to work given that I’m exposed to dusty environments and do long days when on the mine site outside and in front of a PC. I probably sleep 5 -6 hours a day compared to the 9 hours I needed to function normally pre-op. My mind is constantly active, I read and write a lot (holding one eye) and have busied myself organizing a road trip in South Africa for next February with my father in law. I have also started making myself useful around the house with the housekeeping, though my wife insists I leave it. I’m hoping to return to work in the office on the first and fly back to my normal job on the 12th. This will depend on what the doctors say and how my eyes go.
Yesterday I had the last of the staples and stitches removed and saw the eye doctor who told me that one of nerves was bruised and as a result causing double vision. It would rectify itself with time. Today I have a meeting with the Neurosurgeon. The main issue is an uncontrolled discharge of clear liquid, like water, from my right nostril when my head is forward. I reported it while getting the stitches out and was nearly kept at the hospital because of the concern I’m leaking brain fluid and could be at risk of infection including meningitis. They couldn’t decide because noone could get a hold of the neurosurgeon and Dr Atlas is overseas and in the end decided to release us and hope to get it sorted today. I will post an update on this potential complication and welcome any comments.
The experience is not something I wanted but I’m glad it happened as it has had a profound impact on the way I look at my life and family and god. Four weeks ago never heard of AN. I was half deaf, unsteady at times and always complaining of fatigue and thirst. All these I put down to hearing loss and a hectic family and work life. I was also not a happy man and was preoccupied with negative thoughts and ideas rather than looking for solutions and opportunity. Life was an effort and I was probably the luckiest guy I know. Getting diagnosed with the AN was almost a relief. It explained many of my problems and bought me and my wife closer together as all the other petty stuff just paled into insignificance. I became acutely aware of how precious my time with my family was and how much opportunity I had missed with them over the years. It was sobering and humbling.
One thing I’m glad I didn’t do was agonize too hard on options of intervention. I studied science so I’m perceptive to objective argument based on evidence and reason. Surgical removal with total loss of hearing in the right and risk of palsy was clearly my best option given the size and location of the AN. My hearing was stuffed anyway so no real loss. As it turns out my hearing is better now than before. Because the tumor is gone, sound travels to the other ear via the affected one unimpeded. I looked Dr Atlas up on the internet  and was impressed, he has removed hundreds of AN no problem. My reading was limited to medical websites and journal articles, I avoided reading depressing testimonials of people who now suffer after AN removals. I tied to focus on being positive and getting through this.
Thanks for letting me share my story. I don’t think its over yet and I will be back to update. Please don’t hesitate if anyone has any questions.

Lainie181818

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Re: AN Story from Perth Australia
« Reply #1 on: September 19, 2007, 05:52:14 pm »
Hi Johno,
Welcome to the site. I had AN mid fossa surgery 18 months ago and life is starting to get back to the "new" normal. I am no surgeon but it sounds like you have a CSF leakage and should see the Dr ASAP. If you type in CSF on this site on the search bar, Russ describes the symptoms. This should help. We are all here for you, relax as much as you can you will exhaust yourself very easily. The recovery is a very long and frustrating period. Between us we have tons of suggestions and answers to your questions. My eye started to blink and tear and I also had fluid coming out of my nose. I went to the emergency room and the
Dr put some of the liquid on a test strip, they can tell you straight away if it is CSF or not. In my case it was not, but you need to check it out. Let us know how the recovery is going. And sorry that you had to make it to this websight.
Lainie.

Desilu

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Re: AN Story from Perth Australia
« Reply #2 on: September 19, 2007, 06:08:50 pm »
Hi Johno,

What a story! I think many of us come to a new realization of what is really important in life and what is not when we have to deal with an Acoustic Neuroma.
We tend not to take things for granted like we used to. It's unfortunate that we have to experience something like this, but I think in the long run, it makes us a better person than we were before. I'm glad that you had and still have a positive attitude about your situation. The healing process takes time. Don't push yourself to hard. I had delayed facial paralysis but it was only temporary (about 7 weeks). Definitly get the CSF leak checked out, it could be serious. I pray that you have continued healing and make a full recovery. Please keep us posted on your progress.   Ann
HEI July 26, 2005
5mm X 8mm Left AN
Middle Fossa
Dr. Brackmann & Dr. Hitselberger

Johno

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Re: AN Story from Perth Australia
« Reply #3 on: September 20, 2007, 12:54:24 am »
Hi Guys,
Thanks for the advice and you are right re my symptom being CFS leakage. I have to go in to get a suture tonight as its started coming out of my head as well as from the nose (gross!). The right side of my head feels like I've got a huge sac of water stuck to it!
What is dissapointing is that the I read about the nose drip symptom  on the web site rather than my own doctor. I was never released home with clear instructions on what to look out for. Forewarned is forearmed.
Have to go back into survgery on Monday to fix the problem. Apparently tissue they put in to stop leakage during the AN removal has probably broken down and they need to replace it which means reopening the wound and another few days in hospital. Bugger!
Too roo
Johno

Desilu

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Re: AN Story from Perth Australia
« Reply #4 on: September 20, 2007, 09:32:18 am »
Hi Johno,

Glad to hear that you are getting the CFS leak taken care of. Hope all goes well for you on Monday.Take care, and take one day at a time. Please keep us posted.  Ann
HEI July 26, 2005
5mm X 8mm Left AN
Middle Fossa
Dr. Brackmann & Dr. Hitselberger

Captain Deb

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Re: AN Story from Perth Australia
« Reply #5 on: September 20, 2007, 01:13:36 pm »
Oy Johno!
Welcome to the site! We has other pirates here as well! Shiploads of 'em! They post on the "Good Morning" Thread over in the Community section. There you will find also one of your countrymen, a bloke named Laz.
 
I was really touched by your post and can relate to the meaning you have found in this experience. My little grandson was born the night before my surgery and I like to think we sort of have the same "birthday" only mine is the "new me." It's like looking at your life with a new pair of glasses. We sure don't sweat the small stuff anymore do we?

Sure hope you get the CSF leak plugged without much fuss--some are easy to fix, some are real buggers.
Best of Luck, Mate!

Be well and sail on!

Capt Deb 8)
"You only have two choices, having fun or freaking out"-Jimmy Buffett
50-ish with a 1x.7x.8cm.AN
Mid-fossa HEI, Jan 03 Friedman & Hitselberger
Chronic post-op headaches
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Jim Scott

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Re: AN Story from Perth Australia
« Reply #6 on: September 20, 2007, 04:36:36 pm »
Hi, Johno:

Welcome to the site and forum.  Your post was both informative and interesting on many levels. 

Your experience relating to the discovery of the AN mirrors my own (see my signature).  Although I didn't share the same personality traits, I was definitely suffering from lethargy before my diagnosis,  It was fortunate I had recently retired because I had steadily (over a period of weeks) lost the energy to do much of anything, including peruse the internet or even watch much TV.  In a 'good news - bad news' context, my sense of taste had been affected by the as yet undiscovered AN and I had drastically cut down on my food intake to the point where I lost 30 pounds...and my gut.  My wife was getting more concerned than jealous at that point and made an appointment with our family doctor for me.  Long story short:  I was wheeled into surgery about 4 weeks later.  It would have been sooner, but just to liven things up,  during pre-op testing a CT scan found a 'mass' on my liver (a large unidentified dark spot).  Cancer was strongly suspected.  My surgery was immediately canceled (by my neurosurgeon, who was very sorry), and I was introduced to a very nice oncologist who immediately ordered a biopsy of my liver.  He told my wife that if I had cancer of the liver, I might have only six months to live.  She later told me that she was scared to death - but she never showed it.  What a girl!


They told us we would have to 'wait a few days' for the biopsy results.  My wife went straight to the oncologist ( a department head) and told him we needed those results now, not in a few days.  He said he would have them before the day was out.  He did.  We received a call from this caring physician at about seven O'clock that evening and we could hear the smile in his voice as he told us that I did not have cancer.  The dark spot was an hemangioma - a benign 'tumor', basically a mass of abnormal blood cells  - and since I was asymptomatic, no treatment was necessary.  My AN surgery was rescheduled.  My wife and I finally exhaled after holding our breath for what seemed like hours. 

The surgery was successful and the surgeon was able to reduce the AN from 4.5 cm to about 2.8 cm and this allowed my displaced brain to go back into it's normal position in my skull.  Fortunately, I had no real post-op complications to speak of.  All of my pre-op symptoms rapidly evaporated, as it were.  Radiation (FSR) to kill the remaining tumor was scheduled for three months later.  I underwent 26 20-minute sessions of low-dose radiation targeted at the remaining tumor.  It was successful.  In my last MRI scan, taken in late June, the AN had shrunk to 2.4 cm and showed definite signs of necrosis (cell death).  Now, over a year after my surgery, I'm doing fine.  I just helped a neighbor move her huge TV into her second-floor apartment and then went and hand-washed my car.  I have a slight 'dry eye' condition that annoys me on occasion, but it isn't a real problem.  A few small 'numb' spots remain on one side of my tongue but otherwise, my sense of taste is back to normal, although I've kept the weight off.  My balance is good.  Frankly, you would never know that I had the tumor or the surgery if I didn't tell you, and, were we to meet socially, I probably wouldn't.

I have been a Christian for my entire life and an 'active' church member for quite a few years now, so, of course, I leaned on my faith for courage during this time.  I also received encouragement and the support of many, many friend.  My wife was an absolute rock of support and my advocate all the way.  Like you, Johno, I feel that I appreciate life a bit more now and don't allow petty nonsense to control my thoughts, words or actions.  I think I'm a bit better person than before, and I suspect most AN 'survivors', are. 

I trust you'll continue your recovery at a good clip and be back to work and normalcy, soon. 

Thanks again for your observations.  They are appreciated, I'm sure.  Take care.

Jim



« Last Edit: September 21, 2007, 11:48:26 am by Jim Scott »
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

Crazycat

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Re: AN Story from Perth Australia
« Reply #7 on: September 20, 2007, 06:18:27 pm »
Johno,

    Great story! I know what you mean about the double vision. I had it before surgery and still have it today, although not as bad.
My double vision was at its worst immediately after surgery; in fact it couldn't have been any worse. I had to wear an eye patch for at least three months after. It was so bad it seemed that it would never go away. Gradually, it subsided to a much more manageable level over time. I am now two years out from surgery.

As far as CSF leakage, I don't think I have to worry about that having had a permanent shunt installed. I had hydrocephalus bad along with the tumor. Huge growths tend to block ventricles causing fluid to back up and brain compression.

    My next MRI scan is scheduled for October 5th.

I can relate very strongly to much of what you've described in your post. Nice to meet you!

    Paul
5cm x 5cm left-side A.N. partially removed via Middle Fossa 9/21/2005 @ Mass General. 
Compounded by hydrocephalus. Shunt installed 8/10/2005.
Dr. Fred Barker - Neurosurgeon and Dr. Michael McKenna - Neurotologist.

Samantha n Adrian

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Re: AN Story from Perth Australia
« Reply #8 on: September 20, 2007, 08:22:05 pm »


Thank you so much for sharing so descriptively your AN story with us. I found it to be extremely touching. It made me both laugh and cry and all sounded so very familiar since Adrian has just undergone the same thing with the same size tumor on the same right side around the same dates. I remember hearing of Pavarotti while waiting in the surgical waiting room for his surgery to be over.

Adrian and I have also learned the real "priorities" in life now as well. There is the saying that the sweet just isn't as sweet if you haven't tasted the sour…. and wow how true that is! The things we take for granted on a daily basis.... until it is yanked away and then we realize how much it means to us or how much we depend on it.

Anyhoo.. I want to welcome you to the forum and amvery eager to hear of how your recover goes. Please do keep us updated on how you are doing and I will be thinking of you and your family and sending loving thoughts and get well wishes from here in Florida to there in the down under in the Outback! :)

Sam~
Age 35/ 4cm AN right side, Transpetrosal aproach, 9/6/07
Dr. Loren Bartels - Otolaryngology & partner Dr. Christopher Danner
Dr. Harry van Loveren - Neurosurgeon & partner Dr. Levine
Dr. David Samuels - Anesthesiologist
Tampa General Hopital, Tampa FL
These guys re-assembled Humpty Dumpty!

Johno

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Update
« Reply #9 on: September 21, 2007, 07:27:11 am »
Well over the last 24 hours I've been back to my neurosurgeons three times and finally put the CSF scare to bed, for now. My neuro diagnosed the leaky nose as CSF and explained the probable cause as my body having rejected an implant they had put in during surgery. He set Monday for surgery, told me he'd inform my ENT surgeon when he got back from overseas the following day and sent me home after taking a sample of the fluid.
Later that day I felt wetness at the back of my head and realised I was now also leaking from a suture. I could feel a headache coming on and I had the feeling of fullness over much of the right side of my head, like it had self inflated or something. This worried me as the idea of infection and hydrocephalus was something I'd given little thought thinking that the Doctors has managed that while I was still at hospital. My vision and palsy had preoccupied me till now. I called the neuro back and he asked me to come back in. When I got there he found the leak and put a suture on the spot. For his troubles I immediattely had a vaso vagel on his couch while he was trying to put the stitch in! Somehow he still managed to do a good job and I was left to recover with my feet up for half and hour.
Today I went for a CT. The results were encouraging. No hydrocephalus or other problems. The neuro showed me where the tumor had been, the tiny residual left and the mass of imoorted fat that was now putty fill where bone had once resided behind my ear. I could see where the "drill and blast, cut and haul" had happened. It almost looked like underground mining on a microscopic scale. He explained how the tumor had been extremely recalcitrant and very stubborn about leaving during a long and difficult operation. The fact that my facial nerve had been left fully intact was a stroke of luck.
Was wondering if someone could give us advise on posting my avatar. It seems you can't upload jpeg but need to hyperlink from an existing web site. Is that right? What if one does not have a web site?

HeadCase2

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Re: AN Story from Perth Australia
« Reply #10 on: September 21, 2007, 07:56:24 am »
Johno,
 Enjoyed reading your post.  All AN patients can probaby identify with much of what you said.  I hope your CSF leak is soon history.  You may not realize it, but you're doing very well.  Many can't write so cogently so soon after surgery.
 To post an avatar, use a site like photobucket  (http://www.photobucket.com), and then copy the (img) link into your forum profile.
Regards,
  Rob
« Last Edit: September 21, 2007, 08:00:06 am by HeadCase2 »
1.5 X 1.0 cm AN- left side
Retrosigmoid 2/9/06
Duke Univ. Hospital

GrogMeister of the PBW

Johno

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Re: AN Story from Perth Australia
« Reply #11 on: September 21, 2007, 08:59:00 am »
Thanks Rob and Sam
The Doctor said as much about my recovery.
If it was'nt for this surgery on Monday I reckon I'd be trying to go back to work next week atleast on light duties.
I think my thoughts are clearer and less clouded now than before surgery. I'm starting to understand that the tumor probably robbed me of more physical, emotional and mental energy than I realised. I now feel like I've had my RAM doubled.
Johno
 :)

HeadCase2

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Re: AN Story from Perth Australia
« Reply #12 on: September 21, 2007, 11:11:39 am »
Johno,
  It really ggod to hear that you're doing so well.  It also sounds like they have you on steriods, an anti-swelling med.  It has some side effects, like keeping wired enough that sleep is usually short naps, feeling rip snortin' ready to go, and eventually it will make you more ravenous for food than you've ever been.  On steriods I had thoughts like "Must have cheesburger......NOW".
Regards,
 Rob
1.5 X 1.0 cm AN- left side
Retrosigmoid 2/9/06
Duke Univ. Hospital

GrogMeister of the PBW

Johno

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Re: AN Story from Perth Australia
« Reply #13 on: September 21, 2007, 09:37:54 pm »
I was on the roids till the other day and it explains my sleeping patterns and drive which have settled since the Doctor told me to bin them. I know exactly what you mean about burgers. I watched "Fast Food Nation" while in the hospital and all I could think about for a week after was how good a Big Mac would be!
I've lost 8kg since my Op and now are at the perfect body weight for height. Must resist this craving.

Obita

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Re: AN Story from Perth Australia
« Reply #14 on: September 23, 2007, 07:21:17 pm »
Hi Johno:

Welcome!

I really enjoyed reading your story. 

Best of luck to you.  Hopefully, the leak surgery will be a breeze and you can post an update for us soon.

Kathy
Kathy - Age 54
2.5 cm translab May '04
University of Minnesota - Minneapolis
Dr. Sam Levine - Dr. Stephen Haines