Steven Triffletti was looking forward to celebrating the 40th year of his law practice and 25 years as town moderator, a key role in Plymouth’s town meeting government, as he drove to his office one morning in June.
He was certainly not anticipating a date with a neurosurgeon.
When his car was rear-ended, however, the minor accident led to the discovery of a brain aneurysm, a potentially major health risk. After an advanced surgical treatment removed the risk of a rupture of the aneurym, Triffletti now says he looks at his fender-bender on Plymouth’s Long Pond Road as a “happy accident” leading to the elimination of the serious health risk he would not otherwise have been aware of. He believes he can use his story to promote a wider awareness of brain aneurysm and the need for research; one such opportunity is scheduled to take place at the State House on Sept. 25.
Following his accident, Triffletti kept a detailed list of physical symptoms, such as lower back strain and shortness of breath, just as he counsels clients to do after an accident, before he checked himself into the emergency room for a routine exam. The examining physician found no obvious cause for concern, but because of the symptoms Triffletti reported, the doctor scheduled a magnetic resonance imaging, or MRI, test. That scan led to the disturbing discovery.
A bulge or ballooning in a blood vessel within the brain, often described as looking like a berry hanging off a stem, a brain aneurysm is a common condition, according to medical literature. One person in every 50 has it. A brain aneurysm by itself may not produce discomfort, but its rupture would cause bleeding in the brain and a potentially life-ending stroke. A rupture is fatal in 40 percent of cases, and more than half of the survivors of a rupture suffer a permanent disability.
Acting on the advice of his physician brother, Triffletti turned to Dr. Christopher Ogilvy of the Brain Aneurysm Institute of Beth Israel Deaconess Medical Center for treatment. In late July Ogilvy and his team performed a preventive surgery to eliminate the risk of rupture by inserting a stent to “remodel” the artery.
Ogilvy said recently that he placed a “pipeline flow-diverting device” made of a special titanium alloy in an advanced procedure that entered through the femoral artery of the patient’s leg and inserted a catheter into the brain. The procedure sounds to laymen like “turning on a light switch with a rubber band from the other side of the room,” he acknowledged.
But if the brain aneurysm is in a place big enough to permit surgical entry and navigation through the blood vessel, Ogilvy said, the technique has advanced to the point where the surgeons are reasonably sure of success.
“We don’t treat every unruptured brain aneurysm,” he said. “A lot goes into the decision making. The size and location of the brain aneurysm, the age of the patient, general health, the risk of bleeding.”
While it may not always be possible, preventing the risk of rupture is highly desirable. “When they rupture, bad things can happen,” Ogilvy said.
In cases where the procedure given Triffletti is not possible or where a rupture has already taken place, surgeons resort to the more invasive surgery of opening the patient’s head. That was the case when Ogilvy’s team treated the ruptured brain aneurysm and saved the life of Tom Tinlin, then head of the highway division of the Massachusetts Department of Transportation, a recent case that received much publicity because of Tinlin’s position.
Triffletti said he shared his story with some colleagues at work and in town government.
“They are very interested,” he said. “And they find it pretty amazing that I’m back to work so soon after brain surgery.”
Seeking to spread awareness and the need for research, Triffletti took advantage of the previously planned Sept. 7 gathering to celebrate the 40th anniversary of his firm, Triffletti & Costa, PC, to raise money for the efforts of the Hanover-based Brain Aneurysm Foundation.
Triffletti spoke about his experience at the party, attended by 500 people, and presented a check of more than $1,000 to the foundation’s executive director, Christine Buckley. The Plymouth Rotary Club also donated $250 after Triffletti spoke to them.
Buckley said that 30,000 people in this country suffer a brain aneurysm rupture every year, but the federal government spends only about $5 million on research.
“The foundation has been pushing for recognition of brain aneurysm and working on Capitol Hill for more government funding,” she said. The foundation recently awarded $445,000 from fund-raising in 14 research grants.
One of the challenges to treatment is there is no known biomarker to tell people whether they have a brain aneurysm. The only way to test for its presence is an MRI. But you can’t screen the general population, Buckley said, because the cost is prohibitive.
And there are no precise indicators to tell whether a brain aneurysm is about to rupture. Possible symptoms include “the worst headache of your life,” Buckley said. Other indicators the foundation cites include “loss of consciousness; nausea/vomiting, stiff neck; sudden blurred or double vision.”
Besides helping to raise money for research, Triffletti said his experience points to some lessons for those with a brain aneurysm.
“You need to advocate for yourself,” he said. In his case that meant pushing to get an additional scan called a magnetic resonance angiogram, or MRA. “It was a challenge at times to navigate our health care system,” he said.
While he was back in the office a week after surgery, Triffletti said the recovery came with pain and going back to work helped him deal with it. “I powered through the pain,” he said.
He said he was able to taper off pain medications a month after the surgery and resume physical exercising.
“One of my goals is being available to speak about this publicly to increase the awareness that one in 50 people have a brain aneurysm and help improve the treatment through fund-raising,” he said. “I am a survivor and can share my experience. There’s life after brain aneurysm. Don’t be discouraged.”
Triffletti said he’s recently been interviewed on radio and hosted a cable TV show on the subject. He plans to advocate for more funding for research, putting a trip to Washington, D.C., for that purpose on his calendar for next spring.
“It’s my new favorite charity,” he said.
A closer opportunity to spread the word is the “Brain Aneurysm Awareness Event” scheduled at the State House on Sept. 25 from 10 a.m. to 1 p.m.
State officials including Governor Charlie Baker will attend, along with Ogilvy and survivors Tinlin, Boston TV sportscaster Bob Halloran, and Triffletti.Robert Knox can be reached at firstname.lastname@example.org.