Monday, March 28, 2005
A-Section Page A1
By Becky Bowman
The Enterprise
For the past six months, Tracie Middleton has had a unique request for her fencing buddies.
No blows to the head, she joked at her home last week.
The Vidor resident learned in September that she has a brain aneurysm that can't be treated through conventional surgery.
On Tuesday, after months of waiting, she'll become the ninth person to undergo an experimental procedure at the hands of Dr. Michel Elias Mawad, chairman of the radiology department at Baylor College of Medicine. She's the second such surgery by Mawad for the location of her aneurysm.
If all goes well, Middleton will return to her life without the worry that the bubble in her brain might burst one day.
"I kind of feel like I can start my life over again," she said last week at her home.
Brain aneurysms -- sacs that form in the weakened wall of an artery and can rupture -- affect as many as one in 15 people in the United States, according to information from the American Society of Interventional and Therapeutic Neuroradiology. They occur most commonly in people ages 35 to 60 and are more likely to occur in women.
As many as 15 percent of patients whose aneurysms rupture die before reaching a hospital, according the society's Web site.
To prevent ruptures, doctors previously have used methods known as "clipping" and "coiling" to treat narrow neck brain aneurysms -- disconnecting the aneurysm from the blood flow. They're hoping to use a new procedure that combines the coiling method with a stent, a mesh wire device that steadies the artery, to treat wide-neck aneurysms -- the kind Middleton has.
On Tuesday, doctors at St. Luke's Episcopal Hospital in Houston will thread a thin wire -- similar to a guitar string but more flexible, like a Slinky -- into Middleton's aneurysm until it coils into a ball. They'll then insert the stent in the artery next to the aneurysm to hold the wire in place.
To access Middleton's aneurysm, doctors will use a minimally invasive process of threading both the wire and the stent through her arteries, beginning with an incision in her leg.
The surgery should take only a few hours, Middleton said, and require just a few days of recovery at the hospital. The rest, she said -- including dealing with any ill effects of the surgery -- will be up to her.
Middleton said she wasn't thinking of an aneurysm when she scheduled her September physical. She just wanted to get checked out before switching jobs and, consequently, her health insurance.
But an aneurysm is something she's worried about, and been tested for, in the past. Her mother, Ginny, has had surgery on two aneurysms, including one that ruptured. An aneurysm caused one aunt's death and possibly another aunt's death as well, she said.
Middleton's general practitioner, Dr. Michael Findley, said he felt compelled by Middleton's history to order the test in September.
"The family history was very overwhelming," he said Wednesday. "It's not always clear what to do, but in something that is this strong of a family history, I just thought it was prudent to take the next step."
Getting her test and diagnosis, it turned out, had been easy. But getting the surgery was not.
After the diagnosis, Mawad told Tracie she'd be a good candidate for the new stent procedure. He thought he could enter Middleton in a 30-person study of the experimental stents -- but the study was already full.
"They had just signed up their last person," Middleton said.
So her doctors applied to Cordis -- the company that manufactures the experimental stents -- and to the U.S. Food and Drug Administration for permission to use the device.
Through its "compassionate use" program, the FDA granted permission.
The program gives patients a chance to use a device still in clinical trials when it is "the only option available for a patient faced with a serious, albeit not life-threatening, disease or condition," according to the FDA Web site.
Middleton said she's grateful she's received the chance to undergo the surgery.
"They're not obligated" to offer her the chance, she said. "That's why it's called 'compassionate.' "
Middleton is armed and ready with diagrams and information for anyone curious about what's happening to her. She even had a "Stent Party" recently, where about 40 guests looked at pictures of her brain and used a homemade diagram to "place the stent" in her brain. They also looked at hand-drawn and computer images of how the procedure will work.
Middleton said she threw the party to give friends and loved ones a reason to celebrate after months of waiting for good news.
Throughout the more than six months since her diagnosis, Middleton has kept in touch with friends through an e-mail update system. Her notes often include spiritual thoughts about her condition and the upcoming procedure.
Middleton acknowledged the risks associated with surgeries of all types and also those associated with such a new technique. Brain surgery brings the added risk of effects on her personality, memory or physical functions -- but she said she's ready to deal with that.
"Things change in your life all the time," she said. "You lose abilities. You gain abilities."
Janeal Nielsen, a friend who helped Middleton plan her party, said she's impressed and moved by the way Middleton has turned to her loved ones and faith for support.
"I'm blown away by her," the 29-year-old said Friday. "She's gone through this with such grace."
Middleton said she's also happy to have some bit of "control" over the situation by opting to have the surgery.
"I can face it on my own time and terms," she said.
Reach this reporter at:
(409) 833-3311, ext. 412