Hi-Ho, Hi-Ho - It's off to the Big City I go...

At long last, I have returned to the office! Life is back to normal and I am back in the swing of things. Well...sort of. But first a bit of nostalgia for all - click here: 'http://www.youtube.com/watch?v=aURThUaRjCc' (Note: RLP check out the security system).

This vestibular/balance disturbance is a beaut, for sure. I was fully expecting that by this juncture the lingering pieces that needed to be sewn up would be. It's that patience thing again and I continue to be humbled by the body's healing process. I continue to learn that there is a process in place and I just need to feed it right, exercise and train it and then let the cell multiplication process do its thing.

As a result of returning to the office, I have had to change my physical therapy routine to once a week. The hours I can get to my therapist, Beth, are a bit limited, especially when commuting to NYC and back is taken into consideration and I just cannot rush myself - when I do the whole balance/throbbing headache/fatigue thing sets in and I know that's my brain telling me to stop pushing. Rail commuting has taught me to become so much more aware of what is going on around me then I have ever made note of before. Let me tell you, the upper level of Grand Central Station is one heck of a bees' nest of activity - the proverbial excess visual stimulation mother ship. When balance and the requirement to think about getting a fix on the horizon is not critical to your stability, that over stimulated environment is another one of those great big city experiences. However, when those criteria are critical to your stability, that tumult of activity is outright unsettling and threatening.

So by necessity and logic my work day for now is going to be somewhat limited. I am commuting after and before the major rush hour time frames which is translating into about a five hour day at the office. I am really working on the issue that starting with this schedule is okay - the years of putting in 10+ hour days is hard to shake and dealing with the emotional component of not really 'working' is truly hard for me. I am part of a vibrant business partnership and my desire to contribute as an equal once again weighs on me. My colleagues have been great about this and there has not been any issue - that still does not mean that my own determination to be a active, vibrant part of what I have missed out on over the last 10 weeks is easy to put aside.

The reception I have received from clients as I have been speaking with them has been very heat warming. The expression of concern and welcoming back has almost been overwhelming. One of our clients, who has been a dedicated rader of the blog, blew me away this week when she thanked me for putting into words in my last blog a series of feelings and emotions she too has been feeling but had not found the words to put it all together. If I ever get these published, EG, you get a dedication for sure.

We had our daughters and their significant others with us last weekend and our daughter Lauren and I had a wonderful talk about my tastebud issues and what she herself had experienced earlier this decade. Lauren was stricken with Bell's Palsy in July of 2000 while she and our other daughter Joanna were in France. The girls had just graduated high school and were traaveling together with the plan that Eileen and I were going to be in France near the end of their trip and the four of us would do Paris for several days together before leaving for home. The details are not as critical (other than our friend and family otolaryngolist, Barry Kent, came to our rescue as we negotiated with the doctors at the American Hospital and had Barry on the phone at the same time) other than the fact that the impact on the facial nerve and tastebuds is very comparable to patients so affected by AN surgery. Lauren is even more beautiful today than she was then (yes, I am partial) and despite the fact that the 'minimal percentage rule' once again kicked in on our family (Lauren was stricken again on the same side with Bell's two years later - that's only supposed to happen in less than 5% of the cases) we shared our experiences of what it is like to experience normal taste on one side of your tongue and mouth and have this constant bitter metallic taste in the other half of your mouth.

To the unaffected this may not seem like too big of a deal, but we're talking even the presence of your own saliva or a sip of water creates the same reaction as a wonderful bottle of St. Emilion. It permeates your daily life and the reality is, compared to most other maladies most folks would ask what the big deal is. I think the best answer I can offer is that it is a constant reminder that all is not right yet, and although I have other things to remind me that I have had this surgery, this one is just (literally and figuratively) in my face (in my mouth) constantly and there is no escaping it - for now.

I think that I am getting over the mourning of the loss of my hearing. I have to otherwise it is going to get in the way of my moving on. I can remember reading a story years ago about someone who had gone to bed as a sighted person and woke up blind. The concept was so beyond my ability to truly appreciate what the writer was trying to evoke from the reader. I probably was way too young to consider vulnerability of that dimension. Well, truthfully, I have a long way to go yet in what I expect to be my life's journey, but I am certainly not too young to now understand the loss of a valuable sensing mechanism literally in a matter of hours. I am looking forward to what the technology of the external implant could do for me and I have decided that unless there is some unforseen reason that prohibits me from having it installed, I will be doing it. In the meantime I am getting to used to noisy restaurants and the cacaphony of sounds that I struggle to process.

I have been neglectful in not previously expressing my undying love and admiration to the one person who has put up with all of this and me - my wife, Eileen. In well over 36 years of marriage, bringing up three fabulous children (and still one very missed dog), caring for ill and elderly parents and careers (and the thrills and chills of my life in corporate America), we have sat by our mutually respective hospital beds after major surgeries and tried to imagine our lives without each other. That just didn't seem like a possible or probable outcome. So even when I decided to give her an extra bonus this time around when I was readmitted to the hospital with leaking cerebral spinal fluid, and she was convinced by others that I was not going to die because of it, she is still here putting up with my yet not being quite the same person I was before. But she is unflappable and continues to be supportive, caring, loving and concerned for my improving health. Yes, there are times that I probably think that she is being a bit too protective - but consider the alternative and that would not be her - and that among many other reasons is why I love her as much as I do. And most days she is still the girl I first met in 7th grade (frightening, isn't it? -not so much - really!). And so to the love of my life I just simply say, I Love You and thank you for all that you do to make my life special.

See you around the campus.....

The Wisdom of Roseanne Roseannadanna Was Right....

For those readers of a certain age, you may remember the very early years of "Saturday Night Live" when the wonderful commedienne Gilda Radner (as news feature character Roseanne Roseannadanna), would turn to Jane Curtin, the news anchor and state assertively, "Well, ya know Jane there's always somethin' ". She then would invoke the wisdom shared by her father: "It's just like my daddy would always say. Every night when he would tuck me into bed, he would say, "Roseanne Roseannadanna, if it's not one thing, it's another."

Perhaps not a deep Proustian thought - but a life's perspective none the less.

So let's start with the understanding that the opening statement is not a foreshadowing of changes in my status and progress. I can report that the Vestibular Rehabilitation Therapy ('VRT') is progressing well as I begin the third week of it this week. The process is all about eye and proprioception development and training to create normalcy in my balance and movement. My therapist says she sees improvement - I continue to feel frustrated by not being able to feel as I did before the surgery.

Just so I make sure that I clarify how much I am grateful about, I know that I am incredibly fortunate that besides for the initial setbacks of contracting pneumonia and the CSF leak, and the curent loss of half of my taste buds (that's related to the facial nerve - and the only facial nerve issue I have had), this has been a recuperation that has gone well. I have no paralysis and suffered no other impact other than the loss of my hearing in my left ear.

I think that the larger issues for me are going to be hard for many to grasp. I do not feel right yet. What does that mean? It means that I fall into a hazy state without much warning other than a lot of visual stimulation taking place. It means that unexpectedly the incision site will begin to throb. It means that, while much further and fewer between, I still get a throbbing headache - especially at night. It means that anyhing that involves the normal fast movement of my head creates a 'horizon moving' event - things like swimming the crawl stroke, crossing the street, walking down the steps, reading and watching TV - you get the idea. I know these things will get better, but no one can commit to how long that will take. It could be two more weeks and it could be several years.

You know when the nature of your illness is not visible it seems to be harder for people to grasp that all is not a-okay. If I were in a cast, if there were still bandages around my head or sutures in my scalp, the visual would set up the expectation. When you outwardly look healthy, it's a whole other dynamic and curiously, the expectations of your stamina, ability to interact and participate in social settings changes completely in the eyes of most people. After all as a society, we are constantly taught that if you are 'dressed' for the part you are ready to perform the role. Well my friends, I am here to tell you that is not the case. My personal challenge is to be honest about how I feel in certain situations and to follow through accordingly. However being of the personality to want to please people incessantly, making decisions based on how I feel is a challenge, but something I must continue to work on.

Last week I ventured into the Big City to take care of a few errands, including getting my shaggy locks trimmed (no need for the guffaw at this point). My keenest observation was the speed at which many people move at during the course of a regular day - a speed far faster than I am ready for. Admittedly this has me a bit concerned. The train was fine - a concern before last week, but I have that under control. Walking with others who are not used to my pace is another challenge - especially in NYC. (That one takes me back to my childhood walking with my 6'1" father who insisted that I learn to walk at his pace not he walk at mine - I usually met him at our destination at a slightly later moment.)

Well as my philosopher designate R.A.D. offered, there will always be something else that will appear on the horizon which we will need to contend. I think that is just to make sure "he/she" knows we should be paying attention and constantly making sure our checks and balances are in check. On the other hand there those events that truly test our emotional, physchological and physical wellbeing. Before the discovery of my tumor, I believe that I truly subscribed to the belief learned on the school playground many years ago - (and the great song lyric as well) - 'pick yourself up, brush youself off and start all over again.' What I have learned is that sometimes you just don't want - or even still - cannot and then you run this huge risk of getting stuck in place. The getting stuck one is the factor I fear the most - and I think most of us do. I think most days I am making the best effort possible to get myself more acclimated to normal movement and functioning - I read longer, walk a bit longer, drive a bit more, and prove that I can get back on a step stool and change a light bulb without falling flat on my face.

I do not know how you package all of that and sell it as the recuperation survival kit. I am inspired by those who have far more difficult situations with which to contend. I am inpsired by folks in their eighties and nineties that insist on maintaining a dignified and active life style. These folks should be our real heroes - dealing with physical adversity or aging and being really cool with it and doing all that only their physical limitations stop them from doing.

See you around the campus...

Maybe it was a good idea not to take up tightrope walking after all....

It seems unbelievable, but today marks the eighth week since the surgery. What an odyssey. Well, to mark this auspicious occasion I started a specialized round of Physical Therapy today known as "Vestibular Rehabilitation Therapy". In normal people speak that means that I am embarking on nudging the educational process of my brain along in processing where exactly Terra Firma is supposed to be.

I have noted in earlier writings that this experience has taught me that the brain is one heck of a machine. I am continuing to find it more and more fascinating how the brain processes and delivers information, but as importantly, how it learns to compensate for deficit performance when something goes awry.

What I have principally learned about this part of my recovery I owe to the Acoustic Neuroma Association, a fabulous advocacy and educational organization established for the purpose of providing ongoing information to the acoustic neuroma pre and post operative community. Their website is 'http:www.ANAUSA.org'. They have produced a series of pamphlets on all aspects of AN treatment for those who may be reading the blog and are seeking additional information.

Under normal balance conditions, we process information for balance through three separate systems: the Vestibular System, Vision, and Proprioception (there's a new one for you crossword puzzle folks). I am really going to try to keep this as simple as possible -really - no, really.

When all is hunky dory with the vestibular system, information about where up is and where down is processed by the vestibular nerves. The nerves, sending the data to the brain, in turn sends signals to the hydraulic system in both inner ears. This information is like the way the flaps (ailerons to you aeronautic techies out there) work on a plane. For an airplane to turn right, the right flaps go down, the left flaps go up and off you go. Now imagine that the hydraulic lines are not functioning on one side and you try to turn the plane. Oops - it just is not going to happen (don't you just hate when that happens?). Well the same thing happens when the vestibular nerve function no longer operates in the human head. You literally wind up with the room spinning because there is information only being transmitted on one side and the brain has no idea which end is up. Additionally, it is the direct connection from the Vestibular Nerve to your eyes (sending your eyes in the opposite direction from the head at the exact same speed)that aids the brain in processing of things appearing stable. What does begin to happen is that other tools, normally considered by the brain to be secondary tools, begin to kick in.

That takes us to the other two systems. Vision normally reinforces what the vestibular system has told the brain. If the vestibular system is not working, your vision begins to kick in as part of the primary information source to the brain. And if you are not good at processing information such as the horizon moving towards you, for example when you are moving quickly, or if you spend too much time looking out the side window of a fast moving train or car, you will develop motion sickness because your brain is just not getting a fix on where the level horizon is. Vision however, is of little obvious use in the dark or where there are no fixed straight objects to fix a focus on. Which is why should you get out of bed in the middle of the night you will initially have difficulty with your balance until you can fix your adjusted sight on an object in the room.

Proprioception refers to the sensor function provided by the joints in our ankles, knees, hips and spine and the information send back to the brain regarding the alignment of the bones of any or all of those joints. There are also sensors in the balls and heels of our feet that help in sending information as to which direction our body is leaning. This will be impacted on whether the surface is firm or soft - hard floor or plush carpeting, for example. For people who have poor vision issues, getting information from their spine or derriere if they are sitting or laying down will give them a sense of stability.

On a priority basis, the vestibular system will always be correct. That information will be backed up by the other systems. The fly in the ointment is when the vestibular system is not working properly and the brain becomes truly confused in attempting to calculate where the horizon should be. Here is what is so fascinating. When the vestibular function in one ear stops functioning, initially the brain continues to accept the data sent by the good ear only to interpret the information as the whole world spinning (going back to our airplane flap analogy, think one set of flaps working, one not, and the plane spiralling). Generally speaking, this is not a good sensation and tends to limit an individual's mobility. But the brain (being the clever machine that it is) does something very interesting at this point. It will at some point shut down the vestibular function on the working side, enabling the vision and the proprioception systems to provide the primary data.

And that brings us to where I am at this point in the recovery process. As I mentioned at the outset of this posting, the physical therapy process that I have begun is designed to train my brain to accept the primary information for balance from the so-called secondary systems, so that eventually, the vestibular function in my good ear will be turned back on and will work in coordination with the other systems.

If you think it takes a lot to understand all of this, you should try living with it. I am finding that the more activity I can find for myself that forces the use of my vision and proprioceptive systems to keep me vertical is a good thing. Whipping my head back and forth is still not a good thing to do so I think I will be staying clear of attempting to cross Broadway at Times Square for a while yet. I got to hit some golf balls today at the local driving range and while the follow through with my swing had a bit of an impact on my stability (that's carefully worded "is that guy over there drunk or what?") I did squarely hit the ball and was not totally dissatisfied with the results. Frankly, the most difficult part was the follow through and bringing my right leg into position which in essence leaves more weight on the left leg and had some curious impact on staying steady. But I will go back in a few days and do it again just to keep working at it. In the meantime, please refrain from commentary on the form - give a guy a break - I mean I did not fall over once.

There is still some fatigue plaguing me. It is manageable and I am practiced on how to pace myself. Napping is not a considered option as I do not want to mess with the yet fragility of my nighttime sleeping cycle. Headaches still arrive occasionally - Monday's first PT session brought on a dusey upon awakening on Tuesday morning. There is still an occasional twinge of pain that comes from the incision site every so often - I have written that off to nerves and tissue mending and getting reconnected. Admittedly it's a little weird but no one told me this was going to be quite the same thing as recovering from a splinter removal.

Hearing is at this point is what it is. I am yet investigating the BAHA device and gathering some additional information to make an informed decision. As it stands now, larger groups are troublesome and larger venues are plain annoying and for me worth avoiding at this point. The tinnitus is now with me for over a year. I wonder if it stops would I miss it? I think not, but at this point it keeps me amused when I am alone. In a group setting it is a true annoyance. I think that getting back to the office is going to present its own challenges with the activity that goes on in our practice throughout the day. Granted this is a realistic concern, but not one that is insurmountable. I do think being medically designated an 'SSD' - 'Single Sided Deaf' person on the cusp of my 59Th birthday has been a little bit of a smack on the side of the head, but we will get used to how to work around this and get a good handle on how to work with it.

At this point I believe it is fair to state that Phillipe Petite anf the flying Wilendas need not worry about any potential competition from me in challenging the high wire accomplishments for which they hold records. I am going to keep on staying stable while working on step ladders and changing light bulbs in high hat fixtures around the house for now and see where that takes me.

Oh - no one has asked, but I have passed the half way point in Middlemarch by George Eliot. I am loving it and only wished that I understood all of the 19Th century references to the subtleties of British upper middle class life in the English countryside. The current goal is to complete it before I return to work. I wonder if the insurance company would alloy that as part of the evaluation of my progress?? Hmmm.

See you around the campus....