Superior Canal Dehiscence Syndrom: Three Months Post-Op

Three months ago to the day I had a middle fossa craniotomy. I feel 80-90% better which is realistically 99% better with pickiness. Time and doing my exercises will improve me above and beyond to 100 or a 110%.  My skin feels entirely new and I am sifting through what was me because I had a hole in my head compared with what is actually me. Crowds no longer bother me. I think I need to start attending music festivals. Or maybe one of those mass of people all dress up as the bunny rabbit or zombies. I have a lot of digesting to do and a lot of it is happening quietly or in conversations with friends not online. Those of you who check my blog do get this super secret reward though for the three month anniversary of my surgery: the steampunk fairy tale version of what happened that day!

An Entirely Elaborate and Fictional Account of My Surgery

The Middle Fossa Craniotomy as Done By Dr P Ashley Wackym

Told Mostly in Lies by Rebekah Golden

Many strange adventures led to the day Dr P Ashley Wackym cut open my head. Soothsayers were consulted, insurance approval required, and most importantly both he and I required preparations. For him preparations involved twenty five years of surgeries involving the cochlea, eighty of which involved the rare condition vexing me known as Superior Canal Dehiscence. For me preparations involved two dreadful months of waiting as well as a lifetime of leaping into situations so the decision, as a wise man said, felt like a “a no brainer.”

The landscape of this story is my head, my literal head. A layer made of skin then muscle, nerves, veins, arteries and hopefully not too much fat. I had shaved the surgery side of the head in spite of Dr Wackym’s insistence it was not necessary. I knew it would allow for better pictures later. My mother and I both love to take pictures of our stubbed toes, bruised knees, and healing sutures. Beneath the skin, muscle, etc, lays bone. Inside the bone is a brain carefully concealed in a placenta like sac called a “dura.” Also inside this bone, commonly referred to as a “skull,” are all the workings of the ear or at least those inner workings not related to the ear that sits on the side of my head.

The ear is made up of all sorts of trumpet like tunnels and drums. Hidden away behind these trumpets and drums is the cochlea and the semicircular canals. The size of a dime, never touching air, never seeing daylight the cochlea and semicircular canals live a life rich in sound and gravity. Mine were about to be disturbed.

Actually mine had been disturbed for a while. One of the three semicircular canals, the “superior” one, had developed a small hole in it. This not only effected my balance, as the semicircular canals are the gyroscope of the brain, it also is the equivalent of opening a window into traffic during a concert hall performance. The performance is everything outside you want to hear like birds and speech and spousal snoring. The traffic is everything inside your head like your pulse, your eyelids popping open and shut, eyes moving, your brain swishing around or just your own voice so overpoweringly loud you wish you’d just shut up. Obviously this needed to be fixed.

Due to the enormously normal size of my brain Dr Wackym had to shrink it prior to surgery so he could have a better access to underneath it where the semicircular canals lay. To begin with he needed to see the area to make sure the hole didn’t have any friends hiding nearby.

Ideally a shrink ray gun would have been used but that would have shrunken my whole head not just the brain inside. Chemicals such as salt and steroids were the actual tools used to shrink my brain. I assume these were given to me after the “relax and just enjoy it” drugs were sent into my system via IV needle. I have a faint memory of saying hallloooo to the surgery team including Dr Wackym but no memory after.

Wait. Stop the story. If I was unconscious then how can I describe my surgery? Through an elaborate device called imagination peppered with some faintly remembered descriptions the good doctor provided prior to the event. It’s lies, all lies. Trust me.

As in most civilized countries I’m sure the incision site was swabbed with either Vodka or Everclear. My surgery took place in Oregon so I will assume Everclear. Everclear holds the place of local hard liquor with highest concentration alchohol and most stupid acts associated therewith. I am sure if my grandmother, descended from Russians, were alive she would have insisted on Vodka.

The incision itself is in the shape of a backwards question mark from forehead to ear. A backwards question mark is an excellent shape for many reasons, one of which being that if it is accidentally drawn like a regular question mark (?) then obviously someone had been dipping into the Everclear and the surgery would need to be postponed or a pinch incisor brought in. Or is it incisioner?

Once the first layer, the layer above the bone and muscle is cut into it is then pulled back and attached to the forehead with double sided sticky tape much like the type used in scrapbooking or photo albums. This is one indication of a high quality establishment. Lesser hospitals use safety pins or bubble gum. If you are about to get this surgery be sure to ask how the flap of skin is held back. I never did and am just grateful that my imagination tells me that one of the nurses was an avid scrapbooker. Bubble gum sounds so unappealing. And what flavor?!

Muscle is also cut with less complicated pulling back. Probably just hair pins or something similar. Then the bone was exposed and Dr Wackym used an ancient trepanning hammer to tap a two inch square out of my skull with an assistant standing by with a tiny little Dust Devil vacuum sucking up all the bone dust. The vacuuming made it so dust would not fall into my brains causing itchy “sand in my pants” dreams for the rest of my life.

The story of the trepanning hammer and how Dr Wackym acquired it would fill a volume in itself but suffice it to say when he lifted the piece of my skull away from my head all the evil spirits were let out.

If only the problem were simply evil spirits then Dr Wackym could have placed a doubloon over the hole, stitched me up and called the surgery a success. But there was another hole to deal with and he knew his job was not done. He placed my square of skull on a small silver platter and returned to the job at hand.

Though my brain had been shrunk using salt and steroids there is a limit to how small one can shrink a brain withot a shrink ray gun. The result was Dr Wackym had to lift my brain gently up using a silver shoe horn passed down through eleven generations of his family, emblazoned with his family crest, careful not to puncture the dura while moving everything within it. Brain lifted the tiny dime sized cochlea and semicircular canals were exposed.

I wish I could say at this point that he put on special glasses that allowed him to see the smallest details of that tiny object. Actually I guess I could. Instead let me tell you of the giant microscope that was wheeled into the room looking like something an evil villain would have in a James Bond movie. In fact, it was taken from an evil villain on one of Dr Wackym’s adventures but this story is about my surgery not his elaborate life.

The microscope was so huge and so powerful that the heat it emits could fry all sorts of things including eggs as the lab techs proved one slow winter morning between surgeries. Even though it could have fried my brain it is universally acknowledged to be the best tool for the job. As it is also unique to Dr Wackym’s labs it also has created scope envy in many of the good doctor’s peers.

To manage the heat and prevent the microscope from doing harm to my brain a specialist is brought in: the spritzing nurse. To be a spritzing nurse one must be immune to carpal tunnel, ambidextrous, and intensely observant. With a copper spritzer in each hand the nurse carefully irrigates the area exposed to the microscope for the entire surgery. If one needs to be refilled she continues with the other. If someone comes in to interrupt the surgery she squirts them with water and yells “out!” with great authority.

Using a small viewer into the microscope as well as a variety of tiny tools Dr Wackym made his way to my superior canal. Though he can find his way to a cochlea with his eyes closed he acknowledges every brain is different and remains diligent in keeping an eye on the path to his goal. With a tiny tiny mirror very similar to the ones dentists use to see at odd angles into mouths Dr Wackym verified the hole’s location and took a few pictures for posterity (as well as the insurance company.)

Now the fix. He motioned to the assistant who had vacuumed up the bone bits earlier. It wasn’t just to prevent sandy dreams. The assistant emptied the vacuum bag into a mortar and pestle and handed it to Dr Wackym who carefully ground the bone into a fine powder and then created a special cement of my own bone. Seriously cement made from my own bits.

After a saline gel was applied to preserve the natural porous structure of the superior canal the doctor took a tiny tiny trowel and carefully mortared the hole sealing this tiny gate to the hell of hearing within me.

The microscope’s heat helped the bone cement set quickly then was wheeled out of the room back into its vault. The brain was lowered down to sit on the now patched superior canal and the Wackym family shoe horn was removed, washed and returned to its velvet lined case. The piece of my skull was put back in place with the help of some epoxy. Any good wood carver will tell you that kerfing is a natural side effect of cutting pieces and that lost bone dust, now serving a greater purpose, left some space between skull and skull patch. Thank goodness for epoxy.

To ensure that the bone and epoxy held through all my future strange adventures Dr Wackym added a layer of titanium mesh over the skull piece and the skull itself. This reinforces the structural integrity of my head and also makes me immune to alien mind control. Through happy, imaginative, coincidence the mesh is hexagonal much like honeycomb made by the bees I love so well. Sadly anyone else seeing it would think it was chicken wire. Titanium chicken wire.

Early in life Dr Wackym’s mother wanted him to be a tailor and nearly disowned him when he announced he wanted to be a surgeon. In tribute to her he sews up the muscles and skin of all his surgeries himself. Using dissolving thread he stitched a simple yet beautiful pattern into the unseen muscles, happy knowing that somewhere his mother knows he is sewing as well as she taught him even if no one else can see it. For the skin flap, exposed to the world, he used a very neat and practical baseball stitch. This is ingenious given that my head is hard and round much like a baseball. Needless to say his baseball stitch is the envy of the men and women who hand sew every baseball used in the world series as well as crazy quilters like myself.

A heavy bandage was applied and his job done Dr Wackym went home. There were no more adventures that day. Perhaps on his next sabbatical he will acquire some new tool or discuss producing more fabulous microscopes with the panel of SCDS surgeons or study ancient diagrams of cochlea hidden in Mayan temple carvings. December 4th though was devoted to a surgery to fix a woman’s life.

The team took over from there, wheeling me out, waking me up, making sure my vitals were all good. My mother and husband were there for me and first thing the next day my mother started taking pictures of my sutures. At some point Dr Wackym came through to talk to me, though the memory is faint like spotting Santa Claus on Christmas Eve, but I remember asking him about the stitch work and his acknowledgement that it was a baseball stitch. He said nothing more about it or of his mother but I am sure she is proud wherever she is.

Meanwhile I continue to heal and contemplate my own adventures and what magnificent things I will accomplish with my patched superior canal.

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