Real Time Reflections from Five Years ago #16

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“All the sudden I could bend my right knee in bed yesterday!   And  I could raise my arm about 12 inches…12 inches more than yesterday! ” Mike

Picture to the left is of Golgotha, “the place of the skull” in Jerusalem, one of two possible sites where Jesus was crucified. Karla and I had the opportunity to visit Israel in February 2011.

March 14-15th, 2009

Karla (Saturday March 14, 2009)

As I was driving into Rochester at 8:30 this morning, I received a call from Luke asking where I was.  I told him I was almost to the hospital and he said that he was already there!

One of the missionaries we support is briefly back from Paraguay and really wanted to see Mike.  So a group of 3 adult (although I did ask them how old they are) men and Luke arrived at the hospital at 6:30 this morning for a two hour visit.  It sounds like they had a great time, although Mike may need to recover from all the laughing!  His chest still hurts quite a bit when he laughs.  They also used all his best words for the day.  I’m hoping I get some after he has a nap!

Mike had a great day yesterday.  I was able to attend most of his therapy sessions.  It is amazing that physical therapy works.  I still don’t get it.  They started by telling Mike to look at his hand and think about moving it.  Then they had him move his left hand while they move his right.  Eventually he was able to move on the right.  It makes no sense.  That it is pretty much how everything has worked.

Yesterday he was working on walking from side to side.  He held onto a windowsill and a bar and moved both directions.  In the morning, the therapist had to help his right foot move.  In the afternoon session, she didn’t.  I am definitely going to have to research this to figure out how it works!

Several people have expressed concern over his hand not working as well as his leg.  He was up and walking on March 4th and his arm did not start to work until March 9th.  We were told that usually the leg works first and then the arm, and this is the pattern that Mike has followed.  So, while others were worried about this, I was not.  Of course, we don’t know what the final result will be, but progress usually continues through the first year following AVM surgery….

Next week will be the first week that Mike has a full slate of therapy.  They held off on some of the non-essentials (recreational therapy) to give him time to heal from the cardiac surgery.  He still has pain with laughing and some movements, but is doing much better in that area.

I am hoping to get some good talking time in today!  He only has two therapy sessions today, so hopefully he’ll be more awake.  I am heading home tomorrow to spend a few more days at home.  Mike may be posting sometime this weekend, so stay tuned!

Mike’s post from March 14th,2009 (first post post-open heart surgery, which was on Feb. 26th. I posted once on Feb. 24th after the brain surgery and blood infection, naively thinking that that would be as bad as it would get. Ha!)

  • “Thank you to all of you who have joined us on this roller coaster ride.  Strap your seat belts on and join in the great adventure!  I am eternally grateful for every last one of you!  After all, if the prayers (of just one) righteous person are powerful and accomplishes much, then there is surely much more power in the prayers of many.
  • The brain is more than just a machine that one turns on…it is a vastly complex interworking of muscle groups, neurons, etc.  that I think God largely hides from man.  The intricacies of modern science have allowed access to all of the major organs of the body…except the brain.  “Who has known the mind of the Lord or who has been His counselor?  Who has ever given to God that God should repay?  For from Him , through Him, and to Him is everything.  To God be the glory forever and ever….”
  • Progress is being made every day.  All the sudden I could bend my right knee in bed yesterday!   And  I could raise my arm about 12 inches…12 inches more than yesterday!  Various leg motions heretofore unrecorded, practically dry my tears.  It’s about getting systems working again.

I had an unexpected visit today from 4 friends and my 16 year old son (son is included in friends) who left Earlham today at 3:30 A.M.! (posting took 1 hour).”

Mike’s take on this post. What was I thinking when I wrote that the brain had muscle groups? I was a biology major right? Well, tonight five years later, I checked it out. And it turns out that my original statement is not that far from reality. No, of course the brain is not a muscle. It is an organ…a very important one.

And actually there is a physical connection between the brain and muscles. It is called the neuromuscular junction and chemical exchanges that happen at this junction are the key to our ability to move. However, it is like a muscle in that the more individual parts of the brain are used the larger it will become. London taxi drivers for example have very large hippocampi because that is the part of the brain that deals with spatial mapping. Also, like muscles, the more one uses a particular part of the brain the more blood is pumped to that area to provide energy. The more you use it the better it works.

One scientifically oriented site I looked at today suggested thinking of your brain as a muscle. So I guess technically I was not correct in suggesting that the brain is a muscle, but it is intimately related to what any individual or group of muscles does.

I also continue to stand in awe of the human brain. It is an amazing three pound organ that God has uniquely given the capacity to adapt and rewire itself, even into old age. Brain exercises are important!  As I read my own words from five years ago “Progress is being made every day.  All the sudden I could bend my right knee in bed yesterday!   And I could raise my arm about 12 inches…12 inches more than yesterday!” Prior to March 13th, I had never moved my leg or raised my arm at all. Unless you have experienced a temporary or permanent paralysis in a part of your body you cannot understand what a joyful moment it was to comprehend that some movement was returning! It was invigorating. I hope that you will never be able to relate.

I was also surprised by some early morning visitors yesterday five years ago. My son Luke and three other friends from Earlham stopped in on this Saturday morning and stayed for nearly two hours. It was a great visit and a good surprise! I remember it well, because of the ruckus in the room early on a Saturday morning.

It was good to laugh although it was also physically painful. I think it was worth it. To see my son Luke and company just made my day. Then as quickly as they had appeared they disappeared…for another four hour ride home.

I hadn’t intended on putting Karla’s entire summary of the events thus far, but I thought she did such a nice job summarizing the saga in this article for our local newspaper, the Earlham Advocate, that I decided to include it in its entirety. And again I would reiterate what Karla mentions in this article regarding the support we received from the Earlham community and church.  It was great. After returning home, Connie Ramsey quietly drove me to my outpatient rehab appointments at Methodist Hospital in Des Moines several times a week for the better part of three months.

By Karla on March 15th, 2009

“We were asked to write an article for the local newspaper and I thought it might be a good recap of what has gone on.  Obviously it does not have all of the details, but I found it good to go back through the whole ordeal thus far and see how far we have come! So, here it is…

Having lived in Earlham for twelve and a half years, I have come to appreciate many of the benefits of living in a small town.  What first bothered me as everyone knowing my business now encourages me, as so many who “know our business” care about what is going on in our lives.  Many of you know that my husband, Mike Evans, went to Mayo Clinic for the surgical removal of a large arteriovenous malformation (AVM:  mass of intertwined arteries and veins) from the left frontal lobe of his brain.  The surgery took place on February 12th, and by medical standards was a success, as the AVM no longer exists. 

However, you cannot do such significant surgery on the brain without some repercussions.

Prior to heading up for surgery, we had anticipated being home by February 19th.  In our pre-surgical meeting with the neurosurgeon, Dr. Fredric Meyer told us that he expected Mike to come out of surgery with some deficits that would hopefully be temporary but would require inpatient rehabilitation.  This did turn out to be the case, with Mike not being able to talk or move his right side at all.

We were relieved when he spoke his first words two days after surgery.  Physical therapy started immediately and we were hoping for quick progress.  Those of you who know Mike know he is very driven, which we were assuming would serve him well as rehabilitation started.

Unfortunately, things did not go as we had planned.  Mike spent seven nights in the neuro ICU before moving to a general neuro floor.  After his first night there, he had a seizure do a temperature spike caused by a blood infection.  This took him back to the neuro ICU for another four nights so that they could get the 106 degree fever and infection under control.  This involved long periods of time on a cooling blanket while covered with ice bags and very strong antibiotics.  He was on antibiotics for 21 days and there is currently no indication that the blood infection is still there.

After this time in the ICU, it was back to the general floor to prove he was ready for rehab.  On the first night there, Mike was complaining of pain in his right leg which led to the discovery of a very large blood clot.  Usually this would be treated with blood thinners, but since Mike had just had brain surgery they did not want to risk a bleed.  Instead a filter was placed above the area where the clot was to prevent it from going to the heart or lungs where a clot can be fatal.

After two days he was ready for rehab!  The first night he experienced two seizures that were determined to be caused by low levels of the anti-seizure medication.  He had a great first full day in rehab, even walking on that first day.  The worst crisis was yet to come.  He awoke after the second night to have a small seizure, followed by a much larger one.  Thankfully I was in the room and was able to call a nurse immediately. 

During this seizure Mike coded and the nurses started CPR.  Mayo is an amazing place.  The neurosurgical fellow was there immediately, as well as a critical care doctor.  They got Mike stable enough to transport him back up to neuro ICU.  His blood pressure dropped and they were having a hard time keeping the heart beating strong enough to get oxygen to the rest of the body.  An ultrasound of the heart showed a large blood clot. 

The options were few.  We now know that most of the doctors did not expect Mike to live.  We believe it is God who had other plans.  Dr. Meyer came and told me that he had told the cardiac doctors to do whatever was necessary to save Mike’s life.   I signed the consent for open heart surgery and Mike was in the operating room within minutes.  The doctor who specializes in this surgery was on call that day and was not already in the middle of a surgery, so he was able to operate immediately.  This surgery is only done in two places in the country:  Mayo Clinic and somewhere in San Diego.  The surgeon was able to remove a 7 cm blood clot from the heart, as well as 20-30 smaller clots from the lungs. 

No one knew how long Mike’s brain had gone without oxygen or how far he would be set back.  When he woke up, his left side moved normally, which was a good sign that the right side of his brain was fine.  We were hoping that the same was true of the surgical side.  He started talking again shortly after coming off the ventilator, which was also a good sign.  As you can imagine, Mike was shocked to wake up and figure out that he had had open heart surgery.  He was not able to fully understand all that had happened until about five days after the surgery.  Six days following this surgery, he was back in rehab.

Mike re-entered the inpatient rehabilitation unit on March 4th.  There have been no bumps in the road so far.  He basically entered at the same point he had after the first surgery, so he had some ground to make up.  It has been quite a bit more difficult, given that he is recovering from open heart surgery and has pain from that.  He has lost a lot of weight, much of it from muscle loss.  Lying in a bed for three weeks is not good!

We are both people who like to do things quickly and rehab is slow.  He has been there twelve days and made much progress.  He can walk, although he cannot yet lift his leg.  His right arm started moving last Monday and he can now lift it slightly.  Progress is measured in small amounts.  On Saturday he was able to move his toes for the first time.  On Sunday he was able put his leg down flat on the bed when it was bent.  There is something new every day.

Mike’s speech also continues to improve.  He is still having trouble with word finding, but that is coming along better.  Last week he wrote a blog post in two hours and this week it took one hour.  That’s a huge improvement!  Of course, he wants everything back to normal now, but he understands it is a slow process.  We are hoping that Mike will be home within the next few weeks.  At that point he will begin outpatient physical therapy.

In Mike’s blog post this weekend, he put this Bible verse:  “Who has known the mind of the Lord or who has been His counselor?  Who has ever given to God that God should repay?  For from Him, through Him, and to Him is everything.  To God be the glory forever and ever….”  We both think that God has kept many things about the brain hidden from people lest they think too highly of themselves.  We do not at all understand why all of this has taken place as it has.  It is certainly not as we had planned.  But we are trusting in God, who understands, and created, Mike’s brain.  We give Him credit for keeping Mike safe through all of these complications and we do want all the glory to go to God!”

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