"It Could Be Worse"

When anyone is going through a hard time, it can be hard to know what to tell them. Someone gets a diagnosis of cancer, or hears that a loved one has been injured or killed in an accident - what can you say to comfort them? "I'm sorry"? "It'll be all right"? "You'll come through it"? "They're in a better place now"? What could possibly recognize the shock and the pain someone is going through, the horrible situation they've been cast into?

As an epileptic, probably the least useful such phrase I've encountered is "It could be worse." You tell someone, maybe someone close, about something that's perhaps destroying your life, or maybe only providing a series of unwanted obstacles. Their response? "Well, it could be worse".

"I had a seizure, I can't drive for the next six months."

"Oh! Well, at least you're not in the ICU. It could be worse."

Well maybe this could be worse. (Photo copyright US Navy?)

Well no, it couldn't. It COULDN'T BE WORSE DAMMIT. Thirty years ago I was in college, healthy, feeling like I could do pretty much whatever I wanted and looking forward to a life of staying that way. I was not looking forward to taking six pills a day, getting blood sucked out of my arms two or three or four times a year before mandatory doctor appointments, spending thousands of dollars a year on medication required for me just to function pseudo-normally - and let's not get into the side effects, we've done that already.

I mean, sure. I don't have the brain tumor the doctors initially feared. I'm not going into the emergency room or the intensive care unit once or twice (or more!) a year. I'm not taking four or five medications, I don't need a bed rail when I sleep, I can even drive in reasonable safety. There are loads of other people I know who are worse off than I am.

But "it could be worse"? What does that do for me? I'm not always as badly off as I think I am, but I'm not always as well as I could be either. I don't need to be babied. I don't want to be babied. But my epilepsy is real, and it has real effects on me, and I need you to get that.

Look, I get that you might not know what to say. And yes, saying something is better than saying nothing. Saying nothing at all is just cold. But you want to know what to say? Try these:

"That's rough. Need anything?"
"I hear you. Can I help?"

Just something to let me know that you sympathize, that you're listening, and that you're willing (sincerely) to be there and help out as much as you can if needed.

Life's not usually hard for me. (Like it can be for my friends Daisy and Nichole.) But it can be, and your recognition of that fact is a very basic way to help me, a way to affirm that what I'm going through isn't insignificant and harmless. Could you at least give me that much?

Testing Testing Part 1 - EEGs

As I write this first sentence, I'm in the neuro office waiting for my first EEG since changing my meds. For those of you who don't have experience with an EEG, it's basically an electronic recording of your brain activity. A technician pastes 16, or 24, or more wires onto your scalp and hooks you up to a machine that listens for electricity coming into them from your brain. It can be as short as 20 minutes, or as long as 3 days or more. Mine is going to be an hour. 

(Note: For staffing reasons beyond my control, the exam was in fact a "routine" 30-minute EEG.)

The machine looks a bit like an octopus, with all those wires. I unfortunately didn't get a picture of me with the wires on, but I've always thought the EEG machine itself looked cool.

The Machine. Probably without Florence.

Most of the time, you're sitting (in my case, lying) down with your eyes closed. The doctor wants to get a good picture of your resting brain. I always fall asleep. They do need to try a couple of stimulus situations, though. About 1 out of every 30 people with epilepsy (about 3%) are sensitive to bright or flashing lights. So the EEG tech will set up a strobe light right over your face and strobe the light right into your eyes, to see if anything happens. You do get to close your eyes, but the light is only about eight inches from your face so it doesn't seem to make much difference. Then, they'll have you hyperventilate for two minutes. This makes me dizzy and dries out my throat, but doesn't seem to do anything else. Some people have seizures while they're having an EEG. This is very useful to the doctor, I guess; not so much fun to the patient.

My particular EEGs are pretty boring, mostly. Once a year or so, I go into a room, get my scalp measured and marked off with a pencil (which is painful—your scalp wasn't really meant as drawing paper), get wires pasted onto my scalp, lie down on a hospital bed, and then mostly close my eyes and lie there listening to the tech click away with keyboard and mouse. It's a good thing they want you to fall asleep. But they're the best quick view my neuro has into what's going on with my brain, so I deal with it.

Besides, who would miss a chance to get off work to take a nap?

The Epilepsy Foundation of America has (as usual) a really good quickie discussion of an EEG with more information available.

Pachygyria, Heterotopia, And Other Weirdness

Do you guys know what the brain looks like?

Not this one. Although I do ask, "Gee, Brain, what do you want to do tonight?"

 It looks like a big wrinkled blob of meat:

 

Yeah, kinda gross.

Still, everything has its place and function, and the brain is really really cool when it works right. Which, of course, means that when it doesn't, things can go really wrong. Including having seizures.

If you look at the sliced-up part of the brain there, you'll see that the brain has two kinds of tissue: the inside is called the white matter and the part around the edges is called gray matter (even though it looks pink to me; maybe someone was colorblind?) The bumpy parts on the outside are called gyri and the cracks in between are called sulci. Oh, and the two halves of the brain you can see? They're connected in a few places, the most important being the corpus callosum, near the bottom of the brain right in the middle.

I couldn't find an actual picture, but this is what it looks like on an MRI.

Bear with me guys; I know you probably weren't expecting an anatomy lesson but I promise this is relevant.

The brain gets sorted into gray matter outside and white matter inside during about the fourth month of pregnancy, and the gyri and sulci develop from about the fourth to sixth month. The corpus callosum starts developing about the fifth or sixth month and continues at least through birth.

Unless of course you're me. Then things go every which way.

For nearly twenty-five years, nobody could understand why I was having seizures. Then my neurologist finally (FINALLY) said, "Let's have a high resolution MRI and see if we can figure it out."

They stuff you in this for 45 minutes. It makes a ton of noise
and magically sees inside your skull.

When the report came back, I read it before the doctor did (I worked in the radiology clinic, so I could do that :-) ) There were all kinds of words I didn't know: pachygyria, dysgenesis, heterotopia. I was a bit scared.

Basically here's what happened: Before I was born, when my brain was developing, that gray matter didn't make it all the way out to the outside of my brain where it belongs. I have big lumps of gray matter on the inside - gray matter heterotopia. Because all that gray matter is on the inside, the stuff on the outside is thinner than it's supposed to be, and my gyri are spread out wider than they should be and the sulci are shallower - that's pachygyria. Finally, it looks like my corpus callosum did not develop correctly. Go back up and look at the picture. See the bulb at the back and the hook at the front? Not there on mine.

Now most people with these conditions, as severe as mine are, have seizures early in life: as early as age 3, and almost certainly by 9 years old. My seizures didn't start until I was 20. I'm lucky there. And very lucky indeed that I didn't experience the intellectual deficits and learning disabilities people with these conditions nearly always do. My neurologist, when he saw the report from the MRI, said, "Go home and thank your parents for your good genes!" The neuroradiologist looked at the pictures, then looked at me, and said "Are you sure this is you?"

So there are a lot of worse things that could have happened to me, and I am thankful every day that they didn't. I did thank my parents for what they had passed down to me, and I have a lot more respect than I did for my brain, which somehow finds a way to function well above normal when by all rights it shouldn't even be able to get to "normal". I feel better about myself, and about my epilepsy, than I did before I knew what was going on.

About 2 out of 3 epilepsy patients, though, don't know why they have epilepsy, and never will. For you guys, I look with awe at your bravery. I really do. And so should everyone. Something terrible has happened to you, for no apparent reason, with no apparent cure, and yet you find a way to slog along through life; even to be happy and smile. You're amazing, you know? Don't forget that.

And you guys without epilepsy? You're great too. But pay attention to those around you. They may be going through more than you know.

---

I want to call out my friend Daisy Robson, a fellow epilepsy blogger. She's recently been in the ICU and is still recovering from having a hideous lot of seizures. She and her mom, in particular, have really gone through hell in the last week. If you could just keep them in mind; pray for them if you pray. They could use it. Thanks!

Looking For A Neurologist: What We Need From Our Doctors

"Hi! Glad to meet you! I'm Doctor Smith."

I was in the office of my latest neurologist. I've done a fair bit of moving in the last thirty years, and the very first thing I have to do when I move anywhere is set up my doctors. I have to have my medications, and so I need a local prescriber. Neurologists aren't common in all areas of the country (I haven't always lived near a big city), and it usually takes a while before you can get an appointment. Finding a neuro has usually been the second thing I do when I move anywhere, right after finding an apartment.

So there I was in Doctor Smith's office in northern Michigan. He certainly seemed interested, attentive, competent; everything I wanted my specialist to be. But I had seen three or four neurologists in the previous six years. I was used to them being good at what they did. At that moment, I just wanted to get my prescriptions and get out feeling reassured that somebody knew who I was, what was going on with me, and what should be done if there were a problem. There wasn't anyone else who fit that description for six hundred odd miles.

Home was here.

Family was way down here.

A brief introduction, then "I have epilepsy. It was diagnosed six years ago at the University of Chicago. I've been having a few seizures a year, on average."

"Oh? Well, let's see." So, he's going to see whether I have epilepsy? This should be interesting. The standard approach to deciding whether someone has epilepsy, short of documenting multiple seizures, is detecting "epileptiform activity" on an EEG.

This stuff.

But most individual-practice neurologists don't have an EEG in their office; they outsource it to a lab. Doctor Smith started in on what I'd come to think of as "the usual routine".

"Stand up. Close your eyes. Put your arms out in front of you. Touch your nose with your left hand. Now your right hand." And on. And On. And ON. Finally after an hour (an HOUR!!!):

"Well, I think we can say that you have epilepsy."

Oh really, Doctor? It took sixty minutes of testing, using a test that can't actually tell whether there's seizure activity in my brain, for you to agree with something that I already told you an hour ago?

Look, neurologists are good people. They're really important to us. I mean Really Important. Some of them are even epileptologists, specialists in epilepsy. (If you come across one of these guys, don't give them up. They're ACE.) But calling all neuros: I'm an adult. I know what's going on with my body. Can we at least start with the assumption that I know I have epilepsy? Don't look down on me. Work with me. I can help you help me. That'll do both of us good.

And that goes for all you guys too. I love you!