I ran my first half-marathon at forty-nine. I ran my last half-marathon at 51. Between the two, I underwent serious brain surgery.
The physical
At my annual physical, just after my 50th birthday, I complained of constant pressure headaches. My primary physician ordered an MRI (Magnetic Resonance Imaging). The study revealed that the base of my brain had herniated through the foramen magnum by 9 mm. The foramen magnum is an opening at the base of the skull, a passage through which the brain stem joins the spinal cord.
The MRI indicated that I had Chiari Malformation — an extremely rare neurological anomaly that manifests in numerous ways. In addition to the pressure headaches, I often suffered from dizziness, nausea and vomiting, and an unsteady gait that often lead to falls.
One day, shortly after the MRI, as I was running hills to prepare for a race later that month, I fell face first crossing a street. The fall scared me enough for me to pull my registration.
Teaching my American literature course at the university became increasingly more difficult. The nausea made it stressful to be in the classroom, as I constantly feared vomiting in front of my students. When the end of the semester finally came, I thought long and hard about whether I wanted to teach again in the fall.
Headed to New York City
I was referred to a neurologist who suggested I read the medical literature to learn that my condition often warranted surgery, and that she wanted to refer me to a surgeon for a second opinion.
She identified three neurosurgeons in various parts of the country, all of whom had extensive experience performing the posterior fossa decompression,* that could provide relief from my symptoms. My parents and most of my friends lived in New Jersey, so I chose Paulo Bolognese, MD, in Long Island. I sent my MRI to his office. After what seemed like forever, his nurse practitioner called to make my initial appointment.
A few weeks later, a close friend and I met at the JFK airport. We got underway in a car driven by a gentleman who works for the neurosurgical practice. Morris drove us to the Variety House where we would stay until the appointment I had for the next day. We were in Great Neck, New York on a very busy main road, across the street from The Long Island Jewish Medical Center.
The difference trust makes
When Dr. Bolognese came into the exam room he had the disc I had sent previously.
Up on the screen I saw the image of my brain. The doctor pointed out how the base of my cerebellum, which is located at the very bottom of the brain, had herniated outside the base of my skull. We went over some facts about the cerebellum. He explained how this part of the brain is primarily responsible for muscle control, including balance and movement. It also plays a role in cognitive functions such as language processing and memory. He told me Chiari had the potential to become degenerative and could lead to gross motor difficulties.
By the end of the appointment, Dr. Bolognese recommended surgery, and I felt pretty confident when he ordered further testing to guide his surgical technique.
His manner — equal parts scientific knowledge and comedic sensibility — provided the assurance I sought to make a well-thought decision to have the surgery. My constant headaches had greatly affected my quality of life, and I seriously considered the surgery. Then, he spoke with me further with the clearest of diction, as my assurance combined with courage. I would have this surgery, and everything would go exactly as it was planned. In the end, his non-scientific expression of compassion sealed my decision.
He smiled with the kindness of a father.
“Are you scared?” he asked.
“Not with you there.”
The surgical date was set. July 29, 2014.
The hair must go
When the week of my scheduled surgery arrived, my husband and I flew back to New York to spend the day prior to surgery in preop testing at the hospital. I kept wondering whether my memory would be affected by the surgery. Would I be able to run again? Would I be able to continue teaching? I slept only a few hours that night.
Early the next morning, we arrived at the hospital for the surgery. My fear combined with anxiety, as I thought of how new it would be to not have head pain. Nonetheless, knowing my head would be shaved and that an incision would be cut at the very base of the skull unnerved me. The lowermost portion of my cerebellum would be removed, and I wondered how I would feel afterward. Would the nausea and vomiting be any less? At most, I hoped for the alleviation of the constant headache.
After surgery, later that day, Dr. Bolognese came to my room to check on me. He told me everything went smoothly with the procedure. He carefully got me out of bed to take a walk with him in the hallway. When the walk began to tire me, we went back to my room. The next day I climbed a few steps.
If you were a chic stylist, clipping and bobbing my chestnut hair into smooth waves, I would say, “thank-you,” leave you a generous tip, and pop out into the afternoon sun. “Thank you” would convey appreciation for the bouncy light you put in my step. However, for this other kind of artistry you did on my head, a surgical modification of brilliance, I have no words. You touched my brain, altered its shape and position. You opened a door that lead back to the life I loved; then, gently, you took my hand and walked me through those first magical steps to return, back to my real self. For that gift, I will be eternally grateful.
Running alone
November 14, 2014 was an unseasonably cold twenty degrees, with wind chills close to zero. The late autumn sky was a continuous white. That blustery day, I ran for the first time after my surgery. I ran alone. Most of the trees were bare. Wind gusts set the few leaves at the starting line swirling.
A few minutes into the race, the first snowflakes fell until, by the end of the race, it was lightly snowing. I kept a steady pace, and I felt grateful at the end of each mile. I felt some dizziness by the end of mile 12. I had to concentrate hard on my balance to avoid falling. Ultimately, the cold didn’t bother me as much as I had feared. I finished my final half-marathon with my personal best time.
* The most common surgery for Chiari malformation is called posterior fossa decompression. Surgery involves removing a small section of bone in the back of the skull. This relieves pressure by giving the brain more room.
During surgery, the covering of the brain called the dura mater may be opened. Also, a patch may be sewn in place to enlarge the covering and provide more room for the brain. This patch may be an artificial material, or it could be tissue harvested from a different part of the body. Your surgeon also may remove a small portion of the spinal column to relieve pressure on the spinal cord and allow more space. (Mayo Clinic)
