My First Angiogram Experience

I don't know about you, but angiograms scare the heck out of me. But then again, I am afraid of everything. If your doctor ordered an angiogram, please have it done because if I can do it, anyone can do it.

What To Expect

The angiogram room is extremely cold, has tons of hi-tech gadgets, a cath lab, monitors and lots of fuss! It truly is straight out of a sci-fi movie. A catheter is inserted into an artery in the leg or arm through a small incision in the skin. It is an uncomfortable feeling upon insertion and removal I must admit. But it doesn't last long. Using x-ray guidance, the catheter is navigated to the area being examined. Once there, a contrast dye is injected through the tube and images are captured using x-rays.

Take a peek at this short video which explains what to expect during your angiogram:

The halo was the most uncomfortable part of the entire procedure for me. I'm a person who fidgets a lot and I don't like feelings of helplessness. This was definitely one of those moments for me. They screw this contraption to your head and attach it to the table.

Yes, your head is literally pinned to the table and you cannot move. They will give you a sedative to help make this process a little more bearable. I have had four angiograms and all I can say is that I will never get used to my head being put in a cage and pinned to a table. But...that's just me. Did you ever see "The Jackal" from the movie Thirteen Ghosts?

Speaking of ghosts, the side effects of the drugs may give you hallucinations. Imagine lying there on the operating table and suddenly finding yourself floating inside your garage at home? I remember hovering above my car looking at paint buckets lined up in front of my garage door. Was my subconscious telling me that I needed to finally put the paint to use that I bought six months prior? Perhaps. Meanwhile, I'm just floating around in my garage, like how did I get here? I asked the neuro-team, "Why are we in my garage? How did you get me home so fast? Are we painting my house now?" And they just laughed and laughed.

Did you have a hallucination while undergoing your angiogram? I love hearing about these moments. Some of us have some really good ones! Feel free to share in the comments below!

Arteriovenous Malformation Diagnosis - The Day My Life Changed Forever

I remember it like it was yesterday, January 3rd, 2012. For a little over a week, my PCP left several voicemail messages after I had an MRI to assess a concussion I sustained the previous summer. The messages were vague but marked urgent. I had an MRI the month before and nothing was found so I didn't think anything of it. But this MRI was different because it was ordered with contrast, something my PCP had to literally fight my insurance company to cover.

And before I proceed, let me stress the addition of the contrast made ALL the difference in my diagnosis. Over the course of a decade, I received countless MRIs to assess the source of my chronic migraine, neck pain and dizziness. Not one of them revealed anything. Add contrast, and it's like watching invisible ink appear before your eyes. My advice, DEMAND IT.

At approximately 6:30pm, my PCP and I finally connected on the telephone. And I then I heard the words that no one wants to hear, "You have a brain tumor".  The good news? The tumor was benign. The bad news? It was an arteriovenous malformation located on my occipital-temporal lobe. They also found another 7cm benign tumor in my cervical spine called a hemangioma, running from my C3 to C4. Inoperable, but the doctors were certain that it was the brain tumor that was causing all of my symptoms. They wanted to handle that before moving on to the spinal tumor. I was urged to see a neurosurgeon within the week.  The appointment was already set, my medical records were already sent, all I had to do was get myself to the appointment. I didn't quite understand the diagnosis so I proceeded to tell him I had to work the day of the appointment and couldn't make it.

He said, "I don't think you understand the severity of the situation."

I said, "Wow doc, you sound pretty serious. You're scaring me."

He answered, "You have a 4.6mm arteriovenous malformation on the occipital-temporal lobe of your brain. It is severe and can cause a massive stroke at any moment. You are 68% risk of a massive stroke and if left untreated, could kill you. You need to undergo brain surgery as soon as possible." At that moment, I had dropped to my knees beside my bed in shock.

My doctor's words faded off as fear and anxiety took over my thoughts for a few moments. Brain surgery? I have to have brain surgery? What will happen to my children if something goes wrong? What IF something goes wrong? Are they going to cut my skull open? Will I be able to walk and talk afterward? I eventually confirmed the appointment with the neurosurgeon and ended the call. Then, I kneeled and prayed silently for a few moments.  I couldn't speak. I couldn't breathe. My entire body felt hot and I could no longer see past my tears.

It took me a while before I could answer my partner's pleas to tell him what was going on. I almost forgot for a moment that he was sitting on the bed hearing only half of the conversation. What would happen to us? Would he stand by me? What if I end up in a wheelchair? Then I thought about my two sons and what would happen to them. Their biological father was not in the picture. What would happen to them if I died or suffered a massive stroke? How do I tell them that mom needs to have brain surgery and could quite possibly die? What exactly is an arteriovenous malformation anyway? What is a hemangioma?

I... could... not... breathe.

Only those who have been diagnosed with a possible death sentence can understand the overwhelming fear and onslaught of emotions that pour into your mind when you hear that kind of news. It's like drowning with a 100-ton weight tied to your chest. When they say your life flashes before your eyes, they are right. I don't think I slept that night. Or any night since. And this was 8 years ago.

Looking back at this moment as I write this today is very difficult. It was the day my life changed forever. Nothing is the same today as it was back then. When I say everything changed, I mean EVERYTHING has changed. If you stay tuned to my blog, you will learn how my life has changed throughout my diagnosis, recovery, and healing. This is my survival story as an AVM Warrior.

Do you remember the day you were diagnosed? Feel free to share in the comments below.

What Is a Hemangioma? 
Spinal hemangiomas are benign tumors that are most commonly seen in the mid-back (thoracic) and lower back (lumbar). Hemangiomas most often appear in adults between the ages of 30 and 50. They are very common and occur in approximately 10 percent of the world's population. Source: UPMC

Are hemangiomas on the spine dangerous?
Symptoms vary depending on the size and location of the tumor; most hemangiomas cause no symptoms at all. Among symptomatic hemangiomas, the most common symptom is pain at the tumor site, usually in the back. Hemangiomas may also bleed, causing a hemorrhage that can expand and compress the nerves or spinal cord. Source: The Spine Hospital

What is an Arteriovenous Malformation? What is a brain AVM?
Normally, arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain bypasses normal brain tissue and directly diverts blood from the arteries to the veins. Source: American Stroke Association

What are the symptoms of a brain AVM?
Symptoms may vary depending on where the AVM is located:

• More than 50% of patients with an AVM have an intracranial hemorrhage.

• Among AVM patients, 20 to 25% have focal or generalized seizures.

• Patients may have localized pain in the head due to increased blood flow around an AVM.

• 15% may have difficulty with movement, speech, and vision.

Source: American Stroke Association

What Is A Hemorrhagic Stroke?

A hemorrhagic stroke occurs when a blood vessel inside the brain bursts. The bleeding damages the surrounding brain tissue. The brain cells are much more gentle and sensitive than any other cells in the human body. The bleeding increases the pressure applied to the brain cells that surround the bleeding and this is what causes the damage.

The most common cause of hemorrhagic stroke is high blood pressure. Another cause is an aneurysm. It causes the blood vessel wall to become thinner and bust at some point. Stroke can also be caused by the accumulation of a protein called amyloid within the artery walls, particularly in the elderly. This makes the arteries more prone to bleeding.

Hemorrhagic strokes form nearly 20% of all stroke cases. It may occur in all ages and the average risk age is lower than the ischemic stroke risk age.

The symptoms of the hemorrhagic stroke include weakness or inability to move some part of the body, numbness or loss of sensation, decrease or lost vision, speech difficulties, disorientation and inability to recognize familiar faces, sudden headache, dizziness, etc.

The hemorrhagic stroke can be treated through surgery or with medication only. Depending on the severity, treatment includes lifesaving measures, relief of symptoms and repair of the cause of the bleeding. Surgery can help to reduce the brain damage caused by the stroke as well as quicken the recovery. Regardless of the treatment chosen a person who has suffered a hemorrhagic stroke needs a serious long term treatment. Most of the patients need physical therapy, others need behavior modification or family counseling.

There are different types of hemorrhagic stroke - subarachnoid hemorrhage and intracerebral hemorrhage. The subarachnoid hemorrhage occurs when a blood vessel in the area between the brain and the skull starts bleeding. The intracerebral hemorrhage occurs when a blood vessel deep inside the brain starts bleeding. Both types may be caused by structural problems with the arteries such as an aneurysm or Arteriovenous Malformation. The aneurysm is a week area in the blood vessel wall that fills with blood and bulges. High blood pressure or an injury may cause the bulge to rupture and start bleeding. Arteriovenous Malformation is a malformation of the brain's blood vessels. This kind of malformation is usually present since birth and develops slowly with time. It characterizes weak blood vessels that increase the risk of a hemorrhagic stroke.

AVM Surgery

Arteriovenous malformations are masses of abnormal blood vessels that grow in the brain. They consist of a blood vessel "nidus" (nest) through which arteries connect directly to veins, instead of through the elaborate collection of very small vessels called capillaries. Some people are born with the nidus, but as the years go by, it tends to enlarge as the great pressure of the arterial vessels can not be handled by the veins that drain out of it. This causes a large collection of worm-like vessels to develop (malformed) into a mass capable of bleeding at some future time. These malformations are most likely to bleed between the ages of 10 - 55; after 55, the chances of bleeding diminishes rapidly. Before 55, the likelihood of hemorrhaging is between 3 and 4% per year (with a death incidence of about 1%). Once an AVM patient has hemorrhaged, the risk of having another one might approach 20% during the first year, and gradually lessen to about 3 - 4% over the next few years.

AVM s can occur in any area of the brain and can be either small or large. When they hemorrhage, they usually do so with a limited amount of blood, unlike the hypertensive hemorrhages of other stroke patients. The loss of neurologic function depends on both the location of the AVM and the amount of bleeding. Many patients have very small hemorrhages, often multiple. They may display convulsions before even knowing about the presence of an AVM. Some patients suffer from headaches, often unrelated to the AVM which is usually found with a CT scan or brain MRI. In rare instances, children are born with large AVM's and are found to have heart failure because the malformation makes the heart work beyond its capacity.

These lesions are surrounded by a very discrete layer of abnormal, nonfunctioning brain tissue, thus allowing their removal with relative safety to the surrounding brain. This factor is of the utmost importance to the brain surgeon, who can take advantage of this natural separation between normal brain tissue and the abnormal vascular malformation.

TREATMENT OPTIONS

Radiation

If there is a very small AVM, and it is deep-seated in the brain, the patient is fortunate. It is possible to give focused beam radiation to the malformation and avoid surgery. Within two years the malformation will most likely disappear.

Embolization

Larger malformations may be made more surgically manageable with a technique called embolization. With this procedure, an angiogram becomes a therapeutic tool. The interventional angiographer is capable of filling the malformation with agents which help decrease the blood supply to the malformation (coils, glues, plastic spheres, balloons, etc). This makes surgery easier in some cases. The technique has been used as the primary treatment as well and has apparently been successful in some cases.

Surgery

Perhaps surgery is still the best way to go if the decision has been made to do something to eliminate the AVM for good. Surgery cures these lesions by totally removing them, thus disallowing them from ever recurring again. The author's personal bias (quite strongly held) is that most AVMs are best cared for with surgical removal. Even with patients who have large and complex AVMs, surgery provides the cure when the malformation is completely removed.

Benefits of surgery 

A team of specialists in all the disciplines are present to make an accurate diagnosis and arrive at the best course of action to eradicate the disease. Since the success of your surgery is largely dependent on your choice of surgeon, the objective of the doctor is to provide appropriate pre and post-surgery care.