Dr. S’  new favorite neuroanatomical term is “parieto-occipital sulcus”. It just rolls off the tongue and leaves a smile behind, doesn’t it.  The parieto-occipital sulcus is a groove that separates the parietal cortex – underneath the upper wall (Latin paries) – from the occipital cortex – (Latin, behind the caput or head). It is depicted as a red line in the accompanying graphic. You can’t see much of it on the outside of the brain, it is more pronounced on the inside of each hemisphere.

While Dr. S reluctantly came to see the logic behind removing Kristine’s lesion, the question was always how to get at it.  Visions of Indiana Jones slashing through the jungle with a machete to find the cosmic -jewel came to mind.  The recently available option of using a thin laser-tipped probe to drill down and zap the tissue seemed attractive, but not without risk.

But no, based on the MRI imaging, the surgeon devised a plan to run along this sulcus, minimizing the going through brain tissue that was so anxiety provoking.  Dr S refers to this as minimally invasive brain surgery, when it’s being done to someone else.   Internalize this graphic & you will understand that super cool stripe under Kristine’s hat.

Let’s reflect on that.  Fifty years ago, one could have an X-ray film.  Thirty years ago, a series of X-ray based CT slices.  I suppose the surgeon would just open you up, takes a look around, and decide what if anything could be done.  The mathematics of 3D image reconstruction and  computational power to execute it all came along in our lifetimes, as well as understanding and harnessing the physics of spinning protons.   Now the well-studied and well-equipped surgeon pulls this stuff up on the screen and says “Ah, follow the sulcus and we’ll be in the right neighborhood”.  I don’t at all take it for granted that our collective brain should be potent enough — especially considering its extensive library of failings — to assemble all these components and in so doing be able to look in on itself.

Dr S notes that “sulcus” can translate to “furrow”.  That could be like the furrowed brows in evidence around town over the past few years, or the furrowed fields of this place we  call home.  I suppose a deep enough furrow qualifies as a “rut”. In this case, the rut could be “Ah, temporal lobe epilepsy, best practice is to chop the temporal lobe, hippocampus &c” — which replaced an older rut of “medicate to the point of disability”.   Granted, these are science-based, but that also means it takes more and better science to find better ruts.

Anyway, it occurs to me that by following the anatomical rut, the surgeon was freed from the conventional-wisdom rut, and given the outcome so far, one can only be Thankful for every person and institution that made that a possibility.

Naturally, the term “temporal lobe epilepsy” associates to things like language and spirituality. But like so many things, the hidden is of great interest. In this case, on the side facing in, normally out of sight, lies the hippocampus. I did not know until reading that early anatomists debated: seahorse? silkworm? I’ve always been partial to seahorse males, being such attentive dads, but I have to agree, it looks more wormlike, unless you fuss with it.

The hippocampus is central to the process of forming new memories. A very enthusiastic temporal lobectomy can take out the hippocampus. For the archetypal if extreme case, read about “HM’s brain” http://en.wikipedia.org/wiki/Henry_Molaison. As it turns out HM’s brain was also studied at the Martinos Center, our favorite research facility on the planet, before heading off to Calif where it is said to have been misplaced. That funny story triggered sharp inhalation when we realized the medical kinship of HM and KZ.

The hippocampus talks to the rest of the brain through the fornix. The apostle Paul warns against fornication,but as I tell my Sunday school students, that only means standing under an arch (fornix).  Ok, and prostituting yourself. Especially in the temple of Aphrodite. It stands to reason that removal of or damage to this structure would be de-fornication, which would have the same end effect as removing the hippocampus.

One galling thing I learned in Boston was that there is something about how the hippocampus is constructed that makes it prone to generate seizures. In addition, apparently repeated seizures can damage the hippocampus over time, making it more epileptogenic, forming what I suppose to be a positive feedback loop. This might seem to lead to horrible choice, but the standard of medical care to maximize probable effect is resection; though not on both sides like HM.

The gift from the Spokane neurologist for several hellish days of  worsening health and extremely well-instrumented convulsions was making plausible that the source of seizures was in a different vicinity than presumed.

The gift from the scientists at Martinos Center was magnificent 7-Tesla MRI images revealing at high resolution the plausibility of removing a lesion unwelcome in that neighborhood, while at the same time, as they say “sparing the hippocampus”.

The gift from the brilliant MGH neurosurgeon was the reasoning and confidence and  consummate skill to plan and execute a very delicate surgery.

Dr Sunshine has not made the slightest, even microscopic dent in the question of: These things that have happened – what does it all mean?”, but simply recalls the Mary Chapin Carpenter lyric “life is a gift from the great Unknown, and your job is to receive it”.

Some one asked this question, and it’s a really good question with a complicated answer. During my first post-op appointment with the neurosurgeon, he basically told us that we were going to have to just “wait and see” if, over a period of time, my seizure activity was reduced. Even that is complicated, because I’ve always had both “partial” (“little”) seizures as well as “generalized” seizures. So, it’s an interesting thing to wait and see if nothing is going to happen! My doctor was also clear that, if I had a seizure, it did not mean that the surgery was not successful. After brain surgery, it takes awhile for everything to settle into “the new normal,” so it can take awhile for the “success” to really be determined.

However, in my case, I’m happy to say that, so far, I have had ZERO seizures since I had the surgery. None. Not even the little ones. And, from my own perspective, so far, things feel “different” in my brain. It’s a lot quieter, and I also feel like I have more energy (I know, watch out, if Kristine has MORE energy than before). I guess the way I would describe it is that I think it is an ongoing “drain” of energy when you are constantly having and recovering from small and not so small seizures. Now, I don’t have that drain everyday to every week, as I did before. There used to be these days when I felt as if I was having a “fight” with the seizures, as I attempted to stave them off, and now I don’t have that sense.

So, so far, so good. I try to stay in a realistic place about it, but it does feel incredible to be living in a body that isn’t having regular seizures — when I sleep, little ones throughout the day, and then, the “big ones” that disrupt everything in life.

So that’s the report from inside my brain. I feel great. I am pretty much back to my regular yoga/dance teaching schedule and I can continue to tell that the body memory continues to help my brain and my thought process heal. It’s still very strange to be “inside” a brain that I don’t really recognize as being “my” brain. I found myself longing, the other day, for my “old” brain — the one that was familiar. This new one is fascinating, but sometimes it would feel really nice to have the process of thinking go the way that it used to and not have it feel so unusual, as it continues to feel right now. When it gets to be too much, I just take a nice long nap.

So, over all, things are really, really good, and I continue to just be so tickled that I am alive, waking up, thinking, doing things like going to our daughter’s Parent’s weekend at Whitman College . . . All of those little and big things that make us human and alive.

I can’t say it enough . . . enjoy every minute of it!

I’ve always loved the early morning, and I’ve always liked writing in the morning, so now the blog just gives me a place to do what I already have long enjoyed. Lately, I just feel like I wake, exploding with a sense of gratitude for actually waking up. When you have brain surgery, and they talk you through the process of the surgery, and all of the lines they put in your body “just in case” which is how they describe it to you (meaning, they are tactfully but clearly that they all hope the surgery will go the best possible way, but, from a prepping perspective, they assume the worst, so they get every line in place that they might need, in case it doesn’t go as planned. Now, there’s something about hearing this explanation from a really wonderful and compassionate group but who also could appreciate my own need for no sugar coating that has really stayed with me, even post surgery. It really sunk in, in spite of the anesthesia and all the drugs.

I’m not one that shies away from living with a clear understanding of the possibility of dying — That’s actually been a part of having epilepsy since I first learned of “sudden epilepsy onset death syndrome.” I also do work, that I love, in which mortality is never very far away.

However, on this early Wednesday morning, I’m just wide awake and feeling so thankful for being alive, having a brain that can register the very early beginnings of the sun coming up, that can feel the anticipation in my body of dancing with friends today (both taking a class with Mary Trotter and teaching, later on today) . . . . It’s got me doing a little “jiggle of joy” just thinking about all of it (my Mom would tell you that I’ve always done the little jiggle of joy when I get excited about something).

And now, lets I get too esoteric, my spiritual mentor, Senor the Cat, is bringing me right back to the important things — like that I need to stop writing, because he needs outside, in order to commune with the beauty of the early day.

Enjoy your day, whatever it holds instore!

I believe that I am, perhaps, the most fortunate person that ever got to occupy a body. I got the studio yesterday and there were a whole group of students/friends who came to dance, for my first time back teaching. It wasn’t perfect — right and left are still kind of elusive to me, and then it gets more confusing when teaching and doing “mirroring” when I’m doing things on the left side, but it’s right side for the students . . . and it’s even more confusing, because in Nia, the teacher doesn’t do mirroring, only in yoga. So, you can only imagine the patience of this wonderful group as they hung in there with me, trying to understand what I wanted them to do! And then, there are the words that sometimes just won’t come at all. Like yesterday, I was trying to find the word “swim.” I could find the movement I was looking for, but it was a bit like a group game of charades as they had to come up with the word that described the movement. The bottom line for me was that it was very therapeutic to teach — I can’t tell all of you how much it meant to me just to have you there. It also made me think again about having “A village” to make it through almost anything significant, and I feel surrounded by the love of my village. So thanks for the therapeutic dance yesterday. I’m already excited about the next opportunity!

I continue to have an interesting relationship with time. Like I spend time thinking about what is a “socially acceptable” time to go to sleep or, maybe more important to function as a member of a family unite, to get up in the morning. So I wake up, stare at the clock for a long time in order to understand what time it actually is, and decide if I’m okay to get up or not. Now, you have to understand that my mom has a long tendency of getting up long before any normal human being would consider getting up, so, if I keep up these early morning wake ups, I’m sure Jonathan will probably just ship me to the farm and park me with mom. I’m not sure if she will be up for the 5 a.m. dance sessions — she prefers to listen to the early morning news on the BBC.

I got excited this morning because I heard Jake get up, which meant that I was in the right range for socially acceptable times to get up (because Jake, in general, is more aware of being socially acceptable than either myself or Jonathan). So, I was feeling pretty pleased with myself. But it is funny, I continue to looking at the time and clock and try and really connect what they say to the moment I’m in.

For example, I just realized that the time on my computer was still set to East Coast time, and so I was using that to come up with the “socially acceptable” time to go to bed and get up, not knowing that I was only being socially acceptable in a locale where I happen not to be, at the moment. The bottom line of all of this is that the whole business of time is still really seems kind of arbitrary. It seems worth it to go with it so that I can be on the same “page” with others I love . . . I just wonder when it will feel “real” again?’
It will be interesting to teach this afternoon and see if I can understand the need for the class to end. Right now, my general approach toward dancing seems to be that you should just keep it up for as long as possible, because it’s really fun and it’s what the body is made to do anyway, so why stop? Those of you who come to this class can feel free to gently remind me that it is socially acceptable for classes to end and let people go home, no matter how excited your teacher is to move again!