Scar Tissue

Things always take longer than we wish (including in startups!), and this is especially true of post-surgical recovery. As we heal, our bodies go through a series of stages that can make progress hard to discern.

Thanks to all of you who have been inquiring about how my recovery from major surgery is progressing. In a word, “well!” Or at least as well as can be expected when you have neurosurgery to remove some benign brain tumors (meningiomas) that were causing trouble. One of the great challenges of major surgery recovery is that it takes far longer than one wishes to recover, and most likely, your life will never be the same because, honestly, there is no 100% going back to your pre-surgical state due to the scar tissue that may improve over time but will never entirely go away.

You look great!

Recently I was talking with a friend who also had major surgery in May, and we commiserated about the fact that, as time passes, it is hard for others around us to know that we are still in recovery, especially as the overt scars fade and we seem to be doing all the “normal” things. As we reintegrate into regular life and start re-engaging in an increasingly broad range of activities (for me, that includes starting back to work around a month post-surgery and getting back to horseback riding three months after surgery), it certainly appears to the casual observer like things are getting back to normal. I frequently hear, “You look great!” but I do not always feel great. Yet a medical friend of mine keeps reminding me that major surgery is just that “major,” and our bodies and brains need time and rest while they are healing. For those around us, what is harder to see is the ever-present lack of stamina, fatigue, and pain that persistently reminds post-surgical patients like me that our recovery process is not yet complete. Those gaps between where we are now and where we once were are hard to cope with some days.

Scar tissue is the body’s answer to injury

Surgery is controlled trauma that causes injury even as it seeks to investigate or address a problem, such as removing a tumor, repairing a tear, or excising an organ. The very act of surgery damages the body and requires healing. A natural and essential part of the healing process, scar tissue is a collection of cells covering the site of an injury, internally or externally. While most of us have experience with scar tissue on our skin, scar tissue also forms inside our bodies, including in our brains, and because its composition is different than normal tissue, it does not behave the same way as our original tissue. When you have surgery, you will have scar tissue. How it affects you will vary.

The body heals in predictable stages

Part of it goes quite quickly! The 9-inch skin incision in my scalp closed in 10 days (when my staples were removed), healed from the inside out into a fat scar, and then the scar began “remodeling” as the skin replaced the original “patch” and grew better organized. At 18 weeks, even the formerly fat scar is flattened, fading, and showing signs of hair regrowth. Skin is impressive in its ability to heal! In general, it replaces itself every six weeks! And, although I will likely have some measure of scarring on my scalp forever, it is a remarkable process to watch unfold. I am using my incision healing as a reminder of the stages of healing that various parts of our body go through.

I wish brains would heal as quickly as skin, but alas, such is not the case. The pace of brain healing is not helped by the fact that neurosurgery involves the nerves of your brain and central nervous system, and healing in these types of tissue is notoriously slow. For example, our nerves typically regrow at only one millimeter per month, if they regrow at all. Our blood-brain barrier is designed to protect our brains from foreign intrusion. Yet, just as it resists “stuff” coming in, it also resists “stuff” (like the air and swelling and other “extras” left behind by the surgical process) coming back out.

At 16 weeks post-surgery (notice how everything is measured in time post-surgery!), I had a routine follow-up MRI to assess the healing progress and ensure there were no unpleasant surprises. The good news is that there are no signs of tumor regrowth. The air trapped in my skull is gone, the swelling is down, and I appear to be left with what amounts to the equivalent of “scar tissue” in my brain as a result of (a) having meningiomas and (b) having surgery into the space between my hemispheres to peel them off my nerves and blood vessels and get those buggers out of there. Unfortunately, surgery always results in scarring wherever it is. And while scarring may improve over time, like my skin incision, it never truly disappears.

The gradual process of healing

Now nearly 18 weeks post-neurosurgery, I am well into the exponential decay curve I am using to visualize the recovery process. Immediately after surgery, recovery starts fast with fairly obvious daily progress, and then gradually flattens to the point that improvements become harder to detect.

Part of the challenge and question of recovery is where the body’s gradual healing process will ultimately settle. At this point, change is good because it indicates that healing is continuing. Just like my skin scar went from fat to flat, I must remain hopeful (not always easy!) that the gradual healing of the scar tissue in my brain will also diminish post-surgical symptoms and sensitivities over time. My impatient self wants to be all better yesterday. Still, my more experienced, knowledgeable, and practical advisors tell me that I should expect many more months of gradual evolution, and four months is far too soon to expect my post-surgical symptoms to resolve fully. And, discouragingly, sometimes there is the niggly little worry that full resolution may never happen, and I will learn to live with an entirely new normal.

While there is no question in my mind, my doctor’s mind, or those closest to me that my surgery was both needed and a success, that does not mean my journey is over. When will I get to be pain-free? Six months post-surgery? A year? No one knows, except that it will take a long time for recovery from the insults of surgery, probably longer than anyone wishes. That uncertainty of what my expected “full recovery” will look like (probably not exactly like before the problem that required surgery emerged!) and how long it will take to get there makes the journey difficult.

Is a new normal ok?

Quite possibly a new normal would be ok. Already I am riding my horse. I have taken a cross-country trip. I celebrated my birthday. I am working full-time. My colleagues are glad I am back, contributing my particular skills to our mission. And my husband and I are starting to dream about trips we might take one day. I have many things to look forward to following the year of neurosurgery (my personal name for 2022!). What exactly 2023 will be like and will become remains to be seen; however, occasional discouragement and despair must not take the place of hope and determination to live the best lives we can. Lives filled with service, generosity, and hopefully impact. I will turn my eyes to the future and walk God’s path for me.

For other posts related to my neurosurgery, click on the “Neurosurgery” category on my blogpost site at www.StartupCEOReflections.com.