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Seattle Ear clinic has asked that I skip breakfast because the morning testing being done today may make me nauseous. Finally, it’s time, and I gave Gina a hug and walked into the clinic.

I’m actually dismayed that my hearing is improving – it makes my decision to have surgery instead of radiation more difficult.

Then the audiologist takes me to another room, wires me up with a forest of electrodes, and puts me in front of a bar of red LED’s. She runs the lights vertically and horizontally. The electrodes record the motion of my eye muscles as I try to track the single illuminated LED that dances across the bar.

The electrodes itch. They are applied with a slightly abrasive gel that improves electrical conduction.

The next test is for nystagmus – involuntary eye movement. I’ve read about these tests, but I’d never experienced one. The audiologist puts a tiny balloon into my ear, and warm water is run through the it. The effect is unsurprising at first – your ear feels warm! But after a few moments, the heat alters the density of the fluid in the inner ear, causing a powerful and growing sensation of motion.

If you move with your eyes open, your eyes attempt to find and focus on stationary objects that pass across your vision. As you continue to move, your eyes attempt to track the stationary object until it moves from your field of view – then your eyes swing back to direction of motion and lock on the next stationary objects which passes.  You’ve experienced this as a child on a merry-go-round, trying to watch the stationary scenery around the amusement ride.

It turns out that this reaction also occurs if your eyes are CLOSED – your body’s natural visual systems swing the eyes towards the apparent direction of motion, and attempt to lock onto some stationary image even if your eyes are shut. The clinic can use this effect – which is quite involuntary – to measure the remaining function of your inner ear on the side with the tumor.

When the balloon is in my right ear, I feel a powerful rotating motion. The audiogist shows me the scans afterwards – the powerful sensation of motion is associated with a rapid snapping motion of closed eyes. My eyes are trying to track the apparent rapid motion I’m perceiving.

But when the balloon is in my left ear, I feel only the faintest sensation – a gentle floating feeling. The balance organs in my left ear – the semi-circular canals – are working fine but the tumor has so badly damaged the vestibular nerves that the information isn’t getting from the organs to my brain.

The audiologist estimates that I had already lost over 70% of my balance function on the AN affected side.

I have a brief meeting with Dr. Mangham, who tells me that it’s good news that my balance function is so badly disrupted. This means the tumor probably arose from the superior divisions of the vestibular nerve, and slightly increases the chance that the hearing function may be preserved.  (This turned out to be wrong - the tumor arose, as most apparently do, from the inferior division)

Due to some confusion at pre-admission, I ended up waiting nearly an hour in the wrong line at Swedish. Finally, I was sent to a small office for some paperwork and tests.

A nurse performed a simple blot-clotting test. A tiny device nicks your skin inside your inner arm and measures how long it takes for the blood to clot. Papercuts hurt worse. She also took some blood for tests.

The administrator asked for copies of my durable power of attorney (see above) and was pleased that I had taken the time to prepare them.

Finally it’s time to go back to Seattle Ear for the last test of the day. The long delay after lunch has made me late, but I still sit down in the rockeries outside Swedish and contemplate my decision. The dismaying thing about Acoustic Neuroma is that despite how far medicine has progressed in treating these tumors, there is still immense room for improvement. We haven’t reached the point where any doctor can "just make it better."

I pulled out a letter I had written to myself, explaining my decision to go with surgery. As I re-read the letter, I found my judgement sound. I was making the best decision I could for my particular case and with the limited information available to me. And I was making the decision with the full knowledge that in a decade, when more data on FSR will be available, I might possibly discover I had made the wrong decision. Life is full of problematic decisions, isn’t it?

I picked up my belongings and trudged back to Seattle Ear for the final test.

A different audiologist gave me a dose of valium, and recorded the relex reactions of my affected ear when exposed to sounds. Dr. Mangham gave me a few prescriptions: A steroid to be taken prior to surgery to reduce swelling and a mild sedative so I would have a chance to get some sleep that night. Nothing by mouth after midnight.

My brother-in-law, Rich and my friend John Anderson drove me to the hospital. The nurses had me put on one of those silly gowns that expose your backside, and a robe that mostly covered the gap in back. Hugs and drugs and I was out like a light.

I was scheduled to start at 7:30 am, but my plumbing apparently caused some difficulty. Immense exposure to caffeine during college has given me minor prostate difficulties. After an hour, a urologist had to be called in to insert my catheter.

About an hour after that, Dr. Steege came out to speak to my family and told them he had opened my skull without incident, and that Dr. Mangham was working on the tumor. Several hours later, Dr. Mangham came out and told my family he was done and Dr. Steege was closing up. My mother said she wanted to hug him. Dr. Mangham said the facial nerve was perfectly preserved, and that the hearing nerve looked pretty good. He said I shouldn’t judge how much hearing I had left until at least a month after surgery to allow for healing and for the swelling to go down.

For the morbidly curious, here are the details of The Operation.

One of the side-effects of anesthesia can be short-term memory loss. Apparently I asked my mother to come and whisper in my left ear to see if I had any hearing left. I don’t remember asking this at all, but I do remember the result: faint but perfectly understandable speech, like I had cotton in my ear. This sort of hearing loss is completely correctable with a hearing aid, which is a very good sign. However, even this low level of hearing was gone the following morning. Again, Dr. Mangham said I shouldn’t judge how much hearing I had left until a month after surgery

Some people I’ve spoken with have had difficulty understanding why a hearing aid won’t help many patients with partial hearing after AN surgery or radiotherapy. Either treatment can damage the hearing nerve in ways that distort or eliminate the ability to hear certain frequencies. A hearing aid can amplify sound, but cannot restore the ability to hear a frequency you can no longer hear or can no longer hear without distortion. The best analogy I can think of is that eyeglasses cannot restore normal vision to someone who has become blind in one eye.

Swedish has a great television system – right in your bed you get extended basic cable! Another patient told me he had trouble concentrating for a few weeks after surgery. An hour long TV show was too long. I’ve apparently escaped this side-effect: I watched "Men in Black" the night of surgery. (Not to be confused with "Men in Black," a different movie you wouldn't want to see in a hospital!)

I did have one weird side-effect, perhaps from the morpheine.  If I closed my eyes for a few minutes I immediately began dreaming vividly.  If someone spoke to me, I was immediately awake.  Weird, but not at all unpleasant.

Here’s what I looked like when I just woke up.  The day after surgery, I was walking the length of the hallway, pushing my IV tree.  The funny leggings are anti-embolism socks, and they go along with a pair of inflatable plastic wraps which go from your toes to just above your knees.  Every five minutes or so the wraps inflate and then deflate, which is supposed to drive any stagnant blood from your legs and prevent blood clots.  When I got up to use the bathroom for the first time after my catheter was out, I left the wraps lying on the bed.  Even without me inside them, they inflated and deflated, reportedly "moving like some kind of weird animal."

Cathy Alexander, a family friend, dropped by – turns out she’s one of the nurses at Swedish.  My landlord dropped by with his new bride, who brought cookies.   My cousins Chris and Dave Hlt came twice – I think they were there Saturday and Monday.  Dean Baron, an old skiing buddy dropped in.  My parents came by, and my sister even brought my two little nieces by to see me.  My sister just got back from Europe, and to cheer me up, she brought me a selection of naughty kiosk ads from London!

Saw numerous friends including Jeff Aurand and John Klym (Klym came all the way from Houston!).  They’re great guys but they kind of wore me out after a while.  We were joking with the nurse and she threatened to put my catheter back in if we didn't behave.  Notice my defense against hospital gowns:  Hawaiian shirts!  I recommend them highly for any hospital stay.  They’re comfortable, and you can wear them with joggers (a.k.a. sweat pants) instead of those nasty gowns that expose your rear to every passing eye.  Unfortunately, I had to ask John Anderson to rip out the seams on one side of the red shirt so I could wear the IV at the same time as the shirt.  Sunday, when the IV’s came out, I wore the rest of my wardrobe of hawaiian shirts.  I was the best-dressed guy in the ward! (and certainly the most comfortable)

Turns out I’m one of the unlucky 10-15% who get Cerebrospinal Fluid (CSF) leaks.  CSF fluid inflates the meniges (the linings around the brain) and acts as a kind of waterbed for your brain.  The bone around the inner ear is porous, and when the doctors cut away the bone to get at the tumor, the hollow parts of the bone become exposed to CSF on one side, and the middle ear on the other side.  If their efforts to plug the porous bone fail, the patient leaks CSF into the middle ear after surgery.

In my case, I dripped a little CSF from my nose whenever I leaned head and body forward.  This happened when sitting on the john or pulling on slippers.  The nurses gave me a plastic jar filled with little chemically sensitive strips.  When I got a drip, I was directed to drip onto the chem strips.  The strips changed color to show glucose in the drips, which is a positive indication for CSF.

Dr. Steege showed me the fat vials of CSF he’d drawn off – the fluid was the color of creme soda, with a faint pinkish tinge. He explained that my CSF prior to surgery would have been as clear as white wine. The color change was due to blood in the CSF. One thing wasn’t painless – as the CSF pressure when down, I got an awful splitting headache. Dr. Steege explained that this was the result of my brain settling into my skull as the fluid cushion around my brain deflated. What a pounder!  When nurses came to disconnect my IV, and I stalled them until I could hit the morpheine button a few more times.

My neurotologist, Dr. Mangham, dropped by in the evening to see if the spinal tap had stopped my CSF leak. Nope! Scheduled for surgery in the morning.

Dr. Mangham cut a tiny slot in my eardrum, and inserted glue and gelfoam into the porous bone pockets accessible from the other side. He also inserted glue into my eustatian tube, and then glued the eardrum back together. The glue and gelfoam in the bone pockets aids the body in sealing off the leak, the glue in the eustatian tube prevents any leaks from getting into the nasal cavity or sinuses, and the glue on the eardrum is used to close up. Dr. Mangham says the gelfoam should dissolve in a two weeks, the glue in maybe three weeks.

The whole mess packed in my ear creates a slight sensation of pressure and mild discomfort. There also is a noticably greater sensation of numbness around the outer ear canal and the fleshy part of the outer ear. But this may actually be a delayed side-effect of the first surgery, rather than a side-effect of the CSF leak repair.

Roger Black, the poor unlucky bastard burdened with taking over my work at Boeing in my absence, dropped by after working an eleven hour day. Roger gave me a book called "Strange Brains: the Secret Lives of Eccentric Scientists and Madmen."   Hmmm.  Is this a compliment or an insult?  I guess I must have a strange brain if it’s growing lumps. It's a fascinating book: did you know the famed British Scientist Oliver Heaviside replaced all his furniture with solid granite blocks?