Wednesday, August 3, 2016

Tom and the Giant Zit

It's actually a bit premature to call it a zit. It could be a malignant zitoma,* but let me be an optimist for once.

[Warning: This gets really gross, but it's what's going on inside my head. Literally.]

As some of you know, I went to meet some surgeons yesterday. Since then, I've gotten a lot of questions such as,"do you have a date for the surgery." (What a silly question! K is always my date!) Anyway, I've tried not to give out too many spoilers. Here's what happened:

K and I drove back in from our Cape Cod vacation to Ben and Jerry's Hospital** (BJH) to meet with a couple of surgeons, the Clivus Dudes. These guys are two outstanding docs who specialize in endoscopic surgery*** of the skull base.  I'm so special, I get to have both of them operate on me at the same time.

They showed me my MRI. It's really unflattering. Radiologically sliced into hundreds of cross sections, I am one ugly guy. To make matters worse, my clivus is a goopy mess. The front and center of the bone have dissolved, and there is a grape-sized blister of fluid on it. This looks to me like a giant zit.

Theoretically, I could take a knitting needle, stick it up my nose, and pop the thing, but the Clivus Dudes want to clean out as much of the diseased tissue as possible, not to mention that they really need to be careful of my right carotid artery, which is right behind it. Then they'll send it all to pathology.

This should actually be a pretty easy procedure from a patient standpoint. Not much harder than a knitting needle. They will have to put me out, and I will be in the hospital for a night or two, but that's kid stuff.

However, in addition, there is a pea-sized collection of fluid (also probably pus) in the area behind my right eye. That's inside the braincase, so it's very creepy. It would be very hard to get with a knitting needle or with anything else for that matter. The Clivus Dudes will leave it alone for now. If the thing on the clivus turns out to be infection, antibiotics might mop it up. Otherwise, someone has to go in there and take it out, and that's a huge surgery. I'm not ready for that kind of fun.

After surgery, assuming this is a zit, I will need to apply my son's zit cream to the area from now on. Not really. I will need lot of antibiotics.

But, after all of that is over, I'll have to think about preventing it from happening again. Someone may have to reconstruct part of the inside of my face. That could keep this blog going for months.

The (first?) surgery will probably take place some time during the week of August 15th. Stay tuned.

*Zitoma is Doctor-Speak for a cancer that looks like a zit.

**This is my nickname for Brigham and Womens Hospital since Brigham's is famous local ice cream brand.

***By endoscopic, I mean that they use tiny instruments and a tiny fiberoptic tube--kind of a My First Colonoscope by Kenner)

By the way, here are some pictures to show what I'm talking about. I have this cheap plastic skull my parents got me for Halloween in 1982. It's not perfect, but it's pretty good for a prop:

This shot is looking into the top of the skull. The skull is facing up and to the left, and the two holes in that direction are the entry points for the optic nerves that come from the eyes. I am pointing to the clivus, which is where most of this is going on (luckily on the nasal side, not the brain side). 

The clivus is the part of the skull that starts from about where my finger is down to the opening at the bottom of the skull where the spinal cord exits. 

My finger is covering the entry point of the right carotid artery. The entry point of the left carotid artery is visible to the left of my finger. These are big, important blood vessels that supply much of the brain, so nothing you want to poke with a knitting needle.

The pea-sized fluid collection inside the braincase is directly above my finger (from the standpoint of the picture).

Below, the camera is looking up from underneath the skull at the roof of the mouth and behind it. I am pointing to the nasal side of the clivus. The hole to the left of my finger is the for a post on which to display the skull. Most people don't have one of those.


  1. Thanks for the helpufl visuals. Question about pronunciation: is it like "Drive us to the clivus" or "Leave us with the clivus"?

  2. Tom - you are a trooper - I enjoy your sense of humor and remember a few years back when we were all learning about the holes in the skull base for anatomy... take care, Gwen