Dino Di’Giacomo

Dino’s current troubles began early in November. He was having problems speaking. When he found it became difficult to read he finally went to the VA, they sent him to Rapid City Regional and the diagnosis began.

Dino has three conditions that do not play well together:


An AVM, which he has had for about fifty years.


An aneurysm, likely associated with the AVM.


Atrial fibrillation (a flutter in the heart), unrelated to the AVM and the most common cause of strokes.


ATRIAL FIBRILLATION (my simplified primer)
A-fib is an irregularity in the heart which creates clots, which can cause strokes. Such a stroke is probably the cause of Dino’s current speech problem. Treatment involves anticoagulants, which increase the chance of the aneurysm or the AVM bursting or worsening. However, without treatment, stroke risk increases by 12% each year. The neurosurgeon opposes this option for obvious reasons. He thinks it might be wise to start taking an aspirin, which is safer than the anticoagulants and drops the risk to 9%, still a very significant risk and still increasing annually, so that in four years he will be at nearly 50% risk of stroke.
Clearly there is not a great solution to this problem. 



THE AVM
First, from the net: “Arteriovenous malformations (AVMs) of the brain and spinal cord are tangles of abnormal blood vessels. They can form wherever arteries and veins exist. The ones that form in the brain or spinal cord have the most serious symptoms.”

Dino’s AVM was discovered when he was in his twenties. He fell while hiking and they did an x-ray after the fall, which revealed the AVM. He was not symptomatic until he was in his thirties. Sometime in the 90s he had a serious stroke, attributed to the AVM, which, as you all know, severely damaged his right side. Everything has pretty much stayed the same since then, except of course that his left side has felt the effects of doing all the work for twenty years or so. Through all those years, the medical professionals have believed removing the AVM was too risky to consider.

Today, the neurosurgeon is conferring with colleagues in Sioux Falls about treatment options. He believes it might be possible to remove the AVM. One reason he thinks it might be feasible is that the right side is already pretty much out of commission, so the damage the AVM can do may be much less than one would have thought previously.

If they decide it is a good idea and Dino agrees, it would require a great deal of planning. Taking the aneurysm out is also a possibility; however, it is also possible that if the AVM is removed the aneurysm will go away on its own, so they want to decide about removing the AVM (or not) before deciding what to do about the aneurysm.

SUMMARY:
There are three issues, all can cause anything a stroke typically causes, from minor speech and physical limitations to serious debilitation. All can also be fatal. Treating the afib would adversely affect the other two conditions (because of anti-coagulants). Treatment for the AVM and aneurysm are highly risky, potentially causing all the same problems that the afib/stroke can cause.

Thus, the choices are not clearly defined and so the decisions are not easy. Dino’s language function can probably be improved through therapy. Of course, he gets frustrated when he can't find the words and that probably makes it harder to find the words!

His blood pressure has been a problem—sometimes too high, sometimes too low. He has had some severe headaches throughout this process. 



Dino and Delores cannot express enough how deeply grateful they are to all of you for your love, concern, support, encouragement and prayers. They know they are loved and your support lifts their spirits and gives them strength. Thank you, thank you!

Please see the November 20th update for guidance on calling/visiting. I will do my best to continue putting updates on this site so that Delores does not have to try to get the information out to everyone. Between work, critters, and all this medical stuff, she is plenty busy! Keep sending your messages here. Delores reads the comments to Dino, so it is a great way to encourage and cheer them. Be sure to sign up for notifications!