A second opinion offers a second chance

What should have been a relaxing evening at home quickly turned into an emergency trip to the hospital that set off a period of fear and confusion for nurse Kailey Ratcliff. From receiving a discouraging diagnosis at a small hospital in a Houston suburb to undergoing a successful craniotomy at Baylor St. Luke's Medical Center (BSLMC) in the world's largest medical center, Ratcliff's road to recovery would not have been possible had it not been for a trusted referral from family and the optimism of her Baylor College of Medicine and BSLMC care team.

A night of uncertainty

"My husband and I were sitting on the couch when suddenly the right side of my face started twitching uncontrollably, and the right side of my body went numb," Ratcliff recounts. "It lasted for a few minutes, and I'm a nurse, so I immediately thought I was having a stroke."

Like many others, Ratcliff and her husband live in one of Houston's rapidly growing suburbs and decided to rush to the nearest hospital. After undergoing the usual workup, including a CT scan, Ratcliff and her husband waited. And waited. The couple waited nearly four hours before hearing from one of the doctors that Ratcliff's imaging showed "a spot" on the left side of her brain.

The news yielded more questions than answers and more anxiety than assurance. "It was just very scary to be told I had a spot on my scan, but to not receive any more information. In that moment, they didn't really explain that I had suffered a seizure."

While Ratcliff felt cared for and attended to during her stay, the prognosis she received was disheartening. "They weren't sure what was going on. The neurosurgeon I initially talked to said that whatever it was, it was inoperable, and they wanted to do radiation. It was overwhelming trying to take in all this information."

A second opinion

After a week-long stay in the hospital, Ratcliff was discharged and she and her husband immediately began trying to get a handle on the situation. Fortunately, a family member mentioned her case to their doctor, who in turn recommended Dr. Omar Tanweer, director of cerebrovascular and endovascular neurosurgery at Baylor College of Medicine. "He said that Dr. Tanweer is a fantastic neurosurgeon."

Ratcliff recalls her first visit with Tanweer. "It was a telehealth visit, and he took the time to review my scans and answer any questions I had. He told us early on that radiation was not the treatment he recommended, and I was flabbergasted to know that was the route we might've taken."

Tanweer explains the role a second opinion played in Ratcliff's case.

"Very often patients turn to Baylor College of Medicine for second opinions, especially when told treatment or cure is not possible. In these cases, it is best to evaluate the patient from a fresh lens and perspective without being biased from prior workup. This may involve ordering new and additional studies or asking questions that were not asked before."

After ordering another MRI and diagnosing Ratcliff with a cavernous malformation, a clustering of tiny abnormal blood vessels surrounded by normal brain tissue, Tanweer determined surgery was Ratcliff's best option. He also enlisted the help of another Baylor expert - neurosurgery chair Dr. Ganesh Rao.

"Dr. Rao had the experience in the type of surgery I needed, the awake craniotomy," Ratcliff explains.

Tanweer describes the shared effort between himself and Rao in Ratcliff's care. "Collaboration is key in practicing cutting-edge medicine. Dr. Rao is one of the world's most renowned experts in performing awake brain surgeries. Knowing his expertise, I approached him to see if we could apply those techniques for a creative solution to her problem. After that, it was extremely smooth and seamless to achieve a great result in her case."

Ratcliff expresses her gratitude for how quickly both surgeons and their teams mobilized and how thorough they were. "It was amazing how quickly they got me in, and they answered every question that I had, alleviating every concern I had. To go from being told that my condition was inoperable to then hearing I needed brain surgery, it was a lot to take in, but they were very calm and reassuring."

A difficult decision

While Ratcliff trusted the opinions of the Baylor neurosurgery experts, the prospect of having brain surgery was not something she readily welcomed. However, when her symptoms began severely interfering with her life, she knew she could not postpone surgery much longer.

"I was having seizures multiple times a day. I wasn't able to drive; my seizure medications were continually having to be increased. It was about quality of life."

Then, one hot Texas day in July, Ratcliff experienced her worst seizure yet. The seizure lasted nearly an hour, during which time she lost her ability to speak as she felt her airway tightening.

"In my head, I was screaming to my husband to call 911, but I couldn't verbalize it. I ended up passing out. EMS came and took me to the hospital. That was the big turning point."

A calming reassurance

When Ratcliff decided to proceed with surgery, Tanweer and Rao were ready to get to work, and once again, they offered their calming reassurances.

Ratcliff recalls arriving at Baylor St. Luke's Medical Center the morning of her surgery. "I was a bundle of nerves, but while I was in the staging area, both Drs. Tanweer and Rao came and checked in on me. I remember them saying everything was going to be okay, and their reassurances helped ease my mind as I was wheeled into the OR."

At a crucial point in the surgery, the moment arrived that Ratcliff had been most apprehensive about - being woken up mid-operation.

"They had me perform certain tasks, [and] answer questions. I had to move my hands. They wanted to make sure they were being as precise as possible with what was being removed."

"We perform an awake craniotomy to identify parts of the brain that supply critical functions, including speech and motor function," Rao explains. "For Mrs. Ratcliff, her cavernous malformation was adjacent to a part of the brain that supplies speech function, which we didn't want to damage, so we had to find a way to take out the lesion while preserving speech function."

In addition to ensuring that Ratcliff received the utmost care, her team also saw to it that her loved ones, who were anxiously awaiting updates, were also being tended to. "My husband remembers Dr. Tanweer coming to speak with him during the surgery and informing him that everything was going smoothly and that I was doing well. He was comforted to know that Dr. Tanweer made it a point to come talk to him himself."

A second chance

Ratcliff's operation was successful, and she was discharged after a brief two-night stay in the hospital. The weeks and months following her surgery included various follow-up scans and visits with her medical team to ensure she was healing well. With time, she was able to reduce her seizure medications and pursue a dream she and her husband had paused due to her condition - starting a family.

"I'm pregnant now," Ratcliff happily shares more than a year postoperation. "Prior to everything happening, my husband and I were getting ready to start a family, and then, of course, everything got put on hold. Having the surgery allowed me to come off one medication that my OB told me I could not be on if we wanted to try getting pregnant."

This joyful news could not have been possible had it not been for the second opinion - the second chance - Ratcliff's team at BSLMC gave her. "I can't help but compare the experience I had at the first hospital with my experience at Baylor. I didn't feel that connection at the first hospital the way I did with the team at Baylor and Baylor St. Luke's. I'm so grateful for Drs. Tanweer and Rao and their teams."

With her care team's support, she and her husband now look forward to this exciting new chapter in their lives. "We've overcome this huge hurdle, and I feel things are falling into place now."

Learn more about cerebrovascular neurosurgery at Baylor Medicine or call the Department of Neurosurgery at 713-798-4696.

By Cristina Flores, communications associate with the Department of Neurosurgery

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