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Where do I begin? (Read 5578 times)
opal
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Where do I begin?
Aug 12th, 2004 at 9:45am
 
Hi all,

Don't know where to start!  My hubby suffered a cerebral hemmorhage 17 years ago at age 37; coma for 10 days, and a-gram afterward diagnosed moyamoya and he was transferred to a big teaching hospital once stable.  He had surgery to cauterize the vessel that ruptured and came home 6 days later.  6 mo. later, he had another a-gram and was told everything was fine and we were sent on our way.  Hubby has been followed by a local neuro ever since.  Discovered high B.P. a few years ago and has been on meds for that, which we thought was controlling it.

Almost 3 months ago, hubby suffered a brainstem stroke and it was pretty touch and go for awhile.  He was in ICU for 6 days and then off to rehab.  No ability to swallow, (G-tube inserted), totally lost equilibrium, slurred speech, double vision, left sided weakness, etc.  I can say now, that he is coming along very, very well, is on a cane, swallowing has mostly returned and the other symptoms have disappeared.  The drs. tell us now that the stroke was totally unrelated to moya moya; that it was a result of years of hypertension/smoking.  Am happy to report that he is now a committed non-smoker, but a hell of a way to get here! 

17 years ago, I thought I had a grasp on moyamoya, but now I'm totally lost. 

Hubby's memory (short term) is bad, really bad.  He has word finding issues at times, and can't remember an appt. time to save his life.  His MRI (post-stroke) shows possible old high frontal lobe infarcts;  chronic white matter changes, and mild generalized volume loss.  Hubby is in a bit of denial that there's ANYTHING wrong now, and I'm not in a position to question his neuro without hubby's knowledge.  Neuro has said tho', that the carotid arteries are almost completely sealed off, but that he gets ample blood flow to the brain from vertebral arteries (hence, the brainstem stroke).

I'm not even sure of what the questions should be, but anyone have any words of wisdom? Suggestions, comments? 


Seriously, I'm at a loss to know if his future is as uncertain as it seems?

Opal
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srkm5482
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Re: Where do I begin?
Reply #1 - Aug 12th, 2004 at 2:16pm
 
Dear Opal,

I would begin with prayer....the Bible tells us we are not to worry about anything (I''m guilty!), but to take it to God, with thanksgiving.  I do know that , in our case, God already had many things in the works before we even knew there was anything wrong with our son.  God is on the job 24/7!  The bible also says that in this world we will suffer and have sickness and misery, but we do NOT have to endure it alone.  As I look back on our weeks in the hospital, I realize that when I took Kyle around the hospital floor in that Lil' Tykes wagon, there was only  one set of footprints in front of that wagon and it wasn't mine!  I am still in awe at the peace God gave me after my request.  It was indescribable.
Please know that you & hubby are in our prayers that you will recieve peace of mind and guidance on his treatment.  Please keep us updated on his condition.

Sincerely,

sue
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« Last Edit: Aug 13th, 2004 at 3:54pm by srkm5482 »  

Sue (Kyle's mom)
 
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STrantas
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Philadelphia, USA, usa, 490, 122, PA, Pennsylvania
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Re: Where do I begin?
Reply #2 - Aug 12th, 2004 at 4:04pm
 
Opal -

Have you only seen one neuro this whole time?  Is he familiar with MM?  Sounds like you need to get a second or third opinion with a MM specialist.  MM is a progressive disease and speaking with a specialist in MM is so important.  Meanwhile, read as much as you can on this web site.  There is a lot of information and a lot of people's stories here.  Good luck!  You and your husband will be in our thoughts and prayers.

-Shari
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A smile is contagious...start an epidemic!
Dr. Scott did my surgeries - 12/29/03 and 1/5/04
STrantas http://www.facebook.com/home.php?#!/strantas?ref=p STrantas  
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Nancy_N.
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Jasper, USA, usa, 436, 230, GA, Georgia
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Re: Where do I begin?
Reply #3 - Aug 12th, 2004 at 6:40pm
 
There are many people on this site who have been told to not have surgery or wait to have surgery and have gotten a second opinion only to find out that surgery was needed almost immediately. Please read some of the old posts and get a 2nd opinion the surgery will change his whole life. You only get one chance at life you may as well do the most for him that you can, I wouldn't want you to be sorry that you didn't later, all they can say is no its not needed. There are some good MM specialist listed here on the site. Good Luck and keep looking for the right answer that you really feel comfortable with. Our thoughts and prayers are with you both.
                  Nancy Smiley
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Mar
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Re: Where do I begin?
Reply #4 - Aug 13th, 2004 at 3:07am
 
Hi Opal,

Welcome to our mm family! We may not have solid answers for you, but we can give you our support and friendship and our suggestions based on our experience and research. First I'd like to know, as do the others who posted to you, is your doctors mm specialists, where they deal with mm on a day to day basis? See, that's what we see most of the time here...Where neurosurgeons say, "you don't need surgery", but they do!!! We took our niece to a teaching university as was in your case and were told these were the best doctors in the country, but were told by them NO surgery. We did some homework and read where the ONLY course with mm, is surgery because it is a progressive disease. We then found this website and was advised, as others are advising you now, to get a second opinion with a mm specialist. We then sent her films to Stanford and Dr Steinberg said she needed surgery immediately...it saved her life. We find here too often that if they're not mm specialists, many arn't experienced enough with mm and are risking so much by waiting. That's what our experience has shown us. I'm no doctor or authority and I don't know your husbands case, but you said your husband was diagnosed with mm and then sent home and everything was fine. Well, mm is a progressive disease and perhaps it wasn't fine. See what I mean? They may have been wrong, as we see all too often here. If you read about untreated mm, what happened to your husband is exactly what they say may happen if untreated without the surgery. Again, I'm no authority, but a second opinion with a specialist is what our experience has shown us...it saves lives. Read all you can, it will help you know the right thing to do.

You and your husband will be in out thoughts and prayers and know we're here if you need anything. Please keep us posted.

God bless,
Mar
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CarasMOM
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Re: Where do I begin?
Reply #5 - Aug 13th, 2004 at 7:46pm
 
Opal..."Hi .... Smiley"

If I were you I would go for another opinion because your husband has had a stroke.  Every where I have read if you haven't had a stroke yet...they want to wait and see...seems like it.   My Cara had "spells" thats what they called them...but her first MRI showed not a spot...but she had outside "movements" that were similiar to what my dad had when he had strokes and TIA but in his case isn't MM.   The more "spells" she had the less the "movements" were as she grew older (3.5 years later).  She had all kinds of test too, including MRA and cerebral angiogram....I send films to Dr. Scott in boston and to the MAYO in Rochester (mutual connection  there)...Dr. Scott wanted the "SPECT" exam done as he wanted to see the blood flow.  Dr. Meyer at Rochester said her films may be a VERY early stage of MM but not sure.   The neurologist here says we don't need the SPECT test......long story short...she had another spell that we thought little bit bigger than previous.....was almost end of school year...we decided lets have the MAYO look at her.   They did the SPECT test which showed 80 % reduction blood flow on right side and 30% on left.  They re-looked at the cerebral angiogram from Dec of 2002 and noticed the left wasn't that bad but different from the SPECT which showed the left getting worse.  They highly recommend we do the cerebral angiogram when we got home...I decided to let them do it the next day...which they did along with a new MRI.   BINGO.  The blood flow they saw on the rightside was really from the left.  Right side was 100% occuluded (closed)...and left was getting worst but still only 1/3 occuluded and recommend surgery on the right asap.   That was June 2004....3 wks later on July 14 she had two types of surgeries on the right...and that night had mild stroke on the left....showing that the left is quite fragile and needed surgery.....it will be August 23rd.  they would have moved it up if we wanted....but I wanted Cara to recover and get stronger at home in AZ...and boy has she gotten stronger...one more week of 6 hours of therapies to go...then we return for her left side surgery.   
You just never know....if we listened to only the doctors here in phx...Cara would not have gotten that first surgery.   Seems the more experienced ones in MM do all the necessary testing.
And Cara's new MRI did show spots everywhere...meaning she had been having "TIA's" afterall...and the angiogram showed some MM arteries developing on the left side, too...That confirmed her MM condition where as the doctors in PHX kept saying its a broad spectrum...Cara could have anything...but they were (after 3.5 years) leading close to MM.   I can't even think..."what if I had gotten second opinion sooner???"
Can't hurt to ask...and yes ...only one chance at life...

Our prayers are with you.  Keep asking us questions and keep reading back posts...I'm still learning.. Roll Eyes
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Warm Hugs and Prayers, CarasMOM (Carol)
 
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tomg
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Re: Where do I begin?
Reply #6 - Aug 14th, 2004 at 7:37pm
 
God bless your husband it sure teaches me not to feel sorry for my self in comparison.  poor guy and you have been through so much.
     I noticed that you're from Boston,  Please go to see Dr. Christopher Oglvy, neurosurgeon at Mass General.  He's excellent and has lots of moyamoya experience plus the hospital is among the best in the country.
     Keep praying especially to Saint Philomena our appointed patron saint of Moyamoya.
 
     Stay in touch,  Tom Gallucci.
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opal
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Re: Where do I begin?
Reply #7 - Feb 3rd, 2005 at 10:25am
 
I'ts been a long time since I posted my hubby's situation and much has occurred since, both with him and my daughter who has epilepsy, but that's another story for a different board.

My hubby has recovered from his stroke in May about 99%.  He still uses a cane and has some difficulty swallowing, but if that's the extent of his disabilities, we can cope. 

The most important development is that I finally convinced him to make a change in drs. and the neuro he has seen for the last 17 years is no longer.  The new, yet "local" dr. is very well known and has made changes and also repeated MRI to further evaluate hubby's moyamoya.  The upshot of all the testing is this:  eeg was perfectly normal and no need further any further tegretol that he's been taking needlessly for the last 17 years!!!  The MRI show his moyamoya as clinically insignificant!  What a relief! 

I want to thank you all for your words of encouragement and caring.  It was your urging that pushed me to push him into looking for more answers.  We feel blessed that he is healthy and thankful that he's recovered this well.

I'll continue to pray for everyone here and wish you all the best.  I do stop in from time to time and read...

My very, very warmest thanks, Opal
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Mar
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Re: Where do I begin?
Reply #8 - Feb 4th, 2005 at 11:24am
 
Hi Opal,

Thank you for the update. It's so good to hear your hubby is recovering so well from his stroke. You both have been in our thoughts and prayers.

If you don't mind, I have a few questions though. You mentioned that you have a new neurologist, and that he said,
“The MRI shows his moyamoya as clinically insignificant”.
I know nothing about your husbands case, don't get me wrong, but my concern is, the way I understand it… mm is generally a progressive disease (and he was diagnosed 17 years ago?) Also, an angiogram is the only way to actually see the MM vessels. Did your hubby have an angio recently? Does your new doctor have MM experience? The reason I ask you these questions is… We too consulted some very well known neuro’s, in fact they were leaders of the neurological department at a teaching University, but they had little experience with MM. That’s disastrous for a mm patient. I’m not a medical professional mind you, but from what I’ve learnt so far, an MRI is a great diagnostic test and it shows if you had any strokes. An MRA shows any problems with the carotids, but you didn’t mention “Angiogram”, and that’s what concerns me, because from what I’ve learnt the past couple years is, an experienced MM neuro would need a angiogram if they suspect there is an abnormal blood flow in one or more of your vessels. You also stated in your first post that your hubby’s carotid arteries are almost completely sealed off, but he was getting an ample blood supply from the vertebral arteries. The carotid arteries are the main blood supply to the brain. Well, that too has me baffled, because how does this doctor know the blood supply to the brain without other tests, or didn't you mention his other tests in your post?? If your hubby does in fact have MM, the MM vessles can be fragile and weak and bleed, so my concern is that of another stroke or bleed.

Also, I don’t know your hubby’s history or reason he was taking Tegretol, but if he had seizures in the past, we’ve also learnt that with MM and the TIA's associated with it, can also cause seizures. Unfortunately the General medical community doesn’t know enough about this rare disease, and my only concern is that you get the best possible care in treating MM the disease. I mean nothing bad against any doctor.

Lastly, if you don’t mind, I’d like to comment on a statement from your first post, 
“I'm not in a position to question his neuro without hubby's knowledge.”
Well, IMO, for what it's worth, (with this disease,) a MM patient MUST have someone else be their voice!! Distressingly, with MM they may not be able to speak with the knowledge they need to make the vital decisions involved. I say this with only love and concern in my heart from having experienced it.

I’m sorry for the lengthy post, but I had so many concerns and hope I addresses them appropriately.

Please know you, your hubby and your daughter are in our continued thoughts and prayers.

Mar

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sps
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Re: Where do I begin?
Reply #9 - Feb 4th, 2005 at 7:02pm
 
Opal

I have just read Mar's post and second everything she mentions.  I have learn't so much about MM from this website and have been able to help my sister with info and suggestions from other MM sufferers.

Please try and get an angio for your husband, this really is the only way to monitor blood flow in the brain and see the moyamoya vessels.  As Mar mentioned MM is a progressive disease so you must be sure that you are getting all the relevant tests and information.

My thoughts are with you and your husband.

SPS
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MJS452
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Re: Where do I begin?
Reply #10 - Feb 4th, 2005 at 9:07pm
 
Yes Yes Yes. I too agree with the last two posts,, AS WELL as all the others.  My sister has full blown MM. Then we found out my brother has it also. His signs were exactly as you describe. Only,, he blamed his on a neck problem he had. Then he had two TIA's and a hemmorage.  Three---repeat---THREE MRIs did NOT show his real problem. Which was MM.  Only the angiogram did the job.  He also had cat scans,,, scans with contrast,, etc. Smiley I do not know why the other tests do not show MM. But they don't. My sister had a cat scan and MRI,,,, did not show FULL OCCLUSION ( complete blockage on back and full sides of her head). PLEASE,,, speak for your husband!!!! You could always just send what results you have and send them to a another doctor.   What can it hurt??? Maybe he is ok,,, but, for peace of mind, I think I would find out for sure. Sounds like the new doc isn't up on MM either. Many doctors claim to know about it. But that is the problem,,, they just "know" about.   My prayers will be with you. Keep us posted.   MJS
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nikki
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Re: Where do I begin?
Reply #11 - Feb 4th, 2005 at 9:16pm
 
Hi Opal, I totally agree with Mar. In my opinion NO MM is INSIGNIFICANT. I really think,IMO, that you should get your hubby to an MM SPECIALIST. You said your hubby had already had a bleed. I don't mean to scare you but my mom had a massive bleed and almost died as a result. We were told that that she had signs of mm and that nothing could be done(we never even got an actual mm diagnosis). She was treated as a stroke patient and released 4 months later. Needless to say a little over a year later she had another bleed, this one even larger and worse than the first. The way I looked at my moms condition was that if something wasn't done she was just going to continue having hemorages until it finally killed her. Please understand I am not trying to scare you, I just want you to understand the importance of having a SPECIALIST in this disease. I wish you all the luck in the world and we will always be here to support you. Best wishes
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Re: Where do I begin?
Reply #12 - Feb 4th, 2005 at 10:37pm
 
OPAL,                                                                                         FIND A SPECIALIST. DON'T WAIT AROUND LIKE I DID. MY WIFE HAD RECOVERED 85% WHEN THE SECOND BLEED HIT. NOW SHE HAS TO DO IT ALL AGAIN. PRAY, AND I'LL PRAY FOR YOU, BUT FIND A MM SPECIALIST. WE WENT TO DR. STINBURG AT STANFORD UNIVERSITY HOSPITAL, AND IT WAS WORTH THE TRIP FROM ALABAMA. BY THE WAY EVERY ONE RHONDA OR MOMA AS NIKKI SAYS, GOT HER DRIVERS LICENSES RENEWED TODAY.                                                                                          DANNY (NIKKI'S DAD)
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CarasMOM
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My 11 year old Cara has
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Re: Where do I begin?
Reply #13 - Feb 4th, 2005 at 10:39pm
 
Hi Opal...good to hear from you again...but am glad Mar and everyone else responded to your post...your husbands delicate situation deserves another opinion and you would be glad you did.  I know Dr. Steinberg looks at films for others...he deals with MM on daily basis.   I am still recovering from my dad's death....while he did not have MM...he had a heart attack that triggered stroke on his good side of the brain...and his blood was VERY THIN...years of blood thinners...long story...but Saturday morning it happened, Sunday was in coma (blood kept filling the hollow parts of the brain which drowns it out of oxygen)...he passed away on Monday (a week ago)....so when I read your post...I kept thinking of my dad (78)...and how VERY, VERY important that second and third opinions are because you never know.  Will keep you and your husband in my prayers.....CarasMOM
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Warm Hugs and Prayers, CarasMOM (Carol)
 
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