Ketchup or mustard on an elephant sandwich?

 I've been told that I can be very verbose and long-winded in my writing. Very recently, I sent an email trying to "fix" that problem, and one of the people who always says that replied that it wasn't a complaint, it's just how I am and she recognizes emails from me by being so long.

So, TL;DR (or BLUF): I'm having brain surgery again. In 5 days.

A year and a half ago I mentioned that "something" was back with Sylvia. The end result of that was chopping my serial MRIs down to once every 6 months instead of every 2 years. So from May 24, I then had one in December '24. The earliest we could schedule after that was August '24, so it was more like 8 months instead of 6.

There was something wrong in August. Sylvia had doubled in size. But "doubling" is a relative term, since 2 times virtually nothing is still virtually nothing. 12 years ago, she was the size of a grape. December of '24 the remnants were the size of a grain of rice. By August, it was about the size of TWO grains of rice. So that's really not much.

My case was presented to the Brain Tumor Board at UCHealth Anschutz. Everyone there agreed with a treatment plan of continued observation and monitoring, while doubling the frequency of MRIs to every 3 months. Something else that was noted in August was that my lateral ventricles were enlarging. In addition to the more frequent monitoring, I started a "headache log." It's had only a few entries, some related to sinus pressure from a cold, but there were some headaches worth noting.

From August, I had my most recent MRI on November 11. Veteran's Day, yay. I went in the tube at UCHealth again and got my scan on. A nice thing about UCHealth is that they typically read and share the results the same day - by that evening, I had the images and the radiology report. "Mass appears stable," blah blah blah. But they didn't say or mention anything about my ventricles, it was all focused on Sylvia. When I looked at the images, I could see that they were even more enlarged than they had been 3 months ago. I'm not a radiologist, but I look at this, and I can see that something ain't right.

(MRIs are shown in mirror image. For all the millions of brain cells and IQ points that went into designing a machine that uses magnets to detect water in your body and create an image, not ONE FRIGGIN' PERSON ON THE TEAM thought to say, "Hey, since the magnets are giving us a reverse image, then in all this image processing software, should we flip it back to normal?" Thus, the left side of the picture is the right side of my head. Up at the top you can see the brighter area that is the titanium plate in my forehead.)

12 years ago, the first thing they did for me was an ETV - endoscopic third ventriculostomy. They poked a hole in the ventricles to allow the brain goo (CSF) to drain. Now, we've reached the point where that hole as likely healed with scar tissue. It was always a risk, but never a guarantee.

I had my appointment on Thursday, the 13th. The PA came in and talked all about how Sylvia was still stable, a little more growth but not much since August, etc. But I virtually cut her off to ask about the ventricles. Here, she hedged - "Yes, they are a little more enlarged, but it's something that can probably wait a while. Eventually we may have to do another surgery but that's probably in the future." She then left, and about 5 minutes later the surgeon came in.

"So, I want to get you scheduled for surgery..."

Huh? What? "How soon?!"

"Nothing too urgent, it can probably wait until the week after Thanksgiving."

Three weeks away. That sounded pretty urgent to me.

In times like this many of us have dumb concerns. Mine rested on law school finals. Yeah, I'm in law school at DU, doing my second year in the part-time program. I had one final on the 7th, two more coming up on the 13th, and 14th. So, we pushed surgery by two weeks.

Well, what is the surgery? There are two options. The first is to do another ETV - it's more invasive to the brain tissue, and it could scar over again. The doc's preferred surgery, and what we're going with, is a ventriculoperitoneal (VP) shunt.

Ventriculo = coming from my brain ventricles

peritoneal = peritoneal sac, the big huge thing in the abdomen housing most of your guts

shunt = shunt, there's going to be a tube running under my skin, in my body, from my brain to my gut. It'll have a one-way valve to make sure nothing goes into my brain, and it will help equalize the pressure in my noggin to where it should be.

I asked about this, and it does not connect to a specific organ like my stomach, intestines, kidneys, or anything. I'm just going to have brain goo going into my abdomen in general, and it gets absorbed there. Your peritoneum just acts like a sponge - and apparently, that includes brain goo.

I have said before that Sylvia is my own personal Sword of Damocles. And it would seem that the horse hair has finally snapped. And the timing couldn't possibly be worse. On November 3rd - ten days BEFORE the news of needing surgery, I was laid off. Weld County has a budget shortfall, and using "last in, first out" my last paycheck comes on December 15th.

Fortunately, ALL of this is covered, 100%, by the VA. Not a dime out of pocket. But, how am I supposed to apply for jobs right now? I'm not protected - they can choose to not hire me if I'm not able to start on the date they want. Hell, an application put in last week might come back with a, "You look like a great candidate, can we interview you on December 16?"

Sorry, can't make it that day. I'm too busy digesting my brain goo.

I'm pretty sure I've put it in here somewhere before, but my Dad often reminds me: "How do you eat an elephant sandwich? One bite at a time."

And that's where I am. One bite at a time.

Study for exams.

Take exams.

Surgery.

Digest brain goo.

Figure out next semester. Figure out job.

It's what I have to do. There's no alternative. The only option I have is to figure out if ketchup goes well on an elephant sandwich. Or should I try yellow mustard?