First and foremost, the Gribbon and Sheridan families would like to thank everyone for their thoughts and prayers. The outpouring of love has been truly extraordinary.
So, lets start from the beginning…
As I’m sure some of you already know, Gage suffered an aneurysm rupture on Thanksgiving Day in New York City. Within 20 minutes of her collapse, largely in part to the lack of traffic in Manhattan on Thanksgiving, we were able to get her to Mount Sinai Beth Israel for proper assessment.
Following her stabilization and proper evaluation at Beth Israel, she was transferred by way of ambulance uptown to Mount Sinai’s “flagship” location.
Uptown, CT scans were taken of her brain clarifying that she suffered an aneurysm rupture which caused a Hemorrhagic Stroke also known as a Subarachnoid Hemorrhage (SAH). The protocol for an SAH is to first control the swelling and pressure through an external ventricular drain (EVD) and then to prevent any re-bleeding by securing the aneurysm through a minimally invasive procedure called “coiling”. We were informed around 4AM on Friday morning that our all star team of doctors (most notably, Dr. Christopher Kellner) successfully performed both procedures without complication.
It goes without saying that we feel incredibly blessed to have been with Gage when the collapse occurred, that we were in such close proximity to some of the country’s best neurological doctors AND that this all occurred on a holiday when there was no traffic.
With Gage settled into her nook at the ICU, we came to learn that there are two major hurdles when treating a ruptured aneurysm: securing the aneurysm (check!) and preventing vasospasm.
Vasospasm = the narrowing of vessels in the brain due to irritation from bleeding in the brain.
Given the type of stroke Gage suffered, doctors anticipated that she would fall into the 70% of patients that experience spasms after an SAH. While vasospasm sound frightening and very damaging to the brain, our team of doctors and nurses established a plan to prevent and treat early signs of spasm. Some of the management includes: increased blood pressure, an oral medication designed to dilate the arteries in the brain and if both non-surgical methods are ineffective, an angiogram is performed.
Angiogram = A procedure that utilizes a thin catheter that is inserted into an artery in the leg and navigated to the area in the brain that is experiencing vasospasm. Once the spasm areas are identified, the same dilating medicine taken orally is injected directly into the arteries, thus expanding the once narrowed vessels.
For the first week in the NSICU, Gage was responding well to the non-surgical methods of preventing vasospasm. During the end of the first week and into her second week at the ICU, the spasms started to increase in frequency and severity and the doctors recommended that an angiogram is performed. By week three, the doctors had performed three successful angiograms and Gage was responding very well to the procedures.
Unfortunately, all surgery carries risk. For angiograms, there is a risk of a blood clot forming due to potential disturbance of plaque along the artery walls while navigating the catheter through the artery. From the beginning, we were told that the risk was minimal, but unfortunately during Gage’s fourth angiogram on 12/4, that minimal risk became a reality. Three clots were identified, which resulted in a small stroke in her left frontal hemisphere.
Given that Gage was currently in an operating room to treat the initial spasm, the doctors were able to identify and treat the clots quickly. Of the three, the most consequential clot was dissolved and the other two were in areas that allowed the brain to reroute blood flow with little to no damage. When the doctors informed our family of the ischemic stroke (clot induced stroke), we came to learn that she had also experienced a hemorrhagic transformation, which is additional bleeding that occurs when blood reenters the arteries after the clots are dissolved. The treatment for a hemorrhagic transformation? A craniectomy.
Craniectomy = the removal of part of the skull to alleviate cranial pressure from brain swelling.
Given Gage’s age and excellent health before her time in the ICU, the doctors were confident that she would respond well to this surgery and that it would significantly improve her prognosis. Although this is a setback, Gage’s all star team of doctors responded both quickly and efficiently.
Following the craniectomy, we are happy to report that throughout her following two to three weeks in the ICU Gage did not experience any further complications. During those two to three weeks, our doctors' main objectives were to continue to treat and prevent any residual vasospasm and to prepare Gage for transfer out of the ICU and into rehabilitation.
On December 28th, these objectives were met and Gage was transferred to the Kessler Rehab Institute! As some of you may know, this is one of the best facilities in the country. Thanks to the help of friends, we were able to secure a private room, excellent doctors and the best therapists.
A few days into her stay at Kessler, we can say with all certainty that the difference between the ICU and the Kessler Facility is truly night and day. While our family is forever grateful to our team of doctors at Mount Sinai, Gage had out grown the ICU and has transitioned from safety mode into recovery mode. We could not be more pleased with the professionalism, care and service we have received thus far at Kessler and we look forward to a difficult, but ultimately, successful recovery.
So, after reading how this chapter began, I’m sure you’re all wondering how it is going to end. Regarding her prognosis, we can only tell you what we know, which is that Gage currently is experiencing right side weakness and difficulty speaking. With that being said, our doctors have been very optimistic that she will regain most (if not all) of her function. However, given the complex nature of the brain and the variation between patients, we have not received a long term prognosis. Believe me, we have asked every which way possible. We are all eager to get the Gage we know and love back to us and with time and hard work we are confident that we will!
Stay updated on Gage’s recovery by following her Caring Bridge journal!
After a successful three weeks at her TMS “boot camp” program at Mount Sinai, we have decided to extend her program by a month. Her schedule for the next month entails 20 minutes of TMS, 3 hours of speech therapy, 1 hour of occupational therapy and 2 hours of physical therapy.
Thus far, we can noticeably tell that the muscles in her right arm have begun to re-activate. When she began this program 3 weeks ago, her right arm was completely flaccid. Today, she is able to move her shoulder and has slowly but surely begun rebuilding the muscles to activate elbow movement.
In addition to her therapies, Gage has actively been trying to be more independent. Just the other day, unbeknownst to us, she got herself out of bed, made the bed (with the decorative pillows and all), undressed herself and made her way to the shower. By the time my Dad found her, she was wrapping up her shower and was ready to begin her day!
All in all, we view this as a step in the right direction.
Thank you all for your continued thoughts and prayers. We look forward to keeping you updated on her next month of boot camp!
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