Friday, August 26, 2016

Pre-op (surgery) update, few other things..

Pre-op Appt was the other day (lol this is ridiculously sad (really sad!) but less than 1.5 wks till the shunt surgery now and am waiting.. picturing the fluid draining off and a bowling ball like weight coming off my head - hoping this helps for awhile again)! My PCP asked if Dr.Iskandar planned to look at both shunts or just at the VPL Shunt which I am not actually sure. I know he showed me on MRI where if he finds an issue he thinks it will be but I have to admit I have wondered some about the LP Shunt to. I have little doubt it's working more just wonder is it working fully?

New Neurosurgeon -
Dr.Simpson asked about the new (apparently now at UW) Peds Neurosurgeon and if I planned to (request) to meet him which I said to her I didn't really know how  to go about this? I worry I'd be burning bridges if I asked to meet the new Nrsgn (Dr.Ahmed) given Dr.Iskandar seems like he's planning to keep my case? Honestly I would just like to the meet the other guy, see his personality. What I REALLY want out of a Nrsgn again is someone that picks up the phone and talks to (especially) my Cardiology Team and who doesn't kind of give the pretense they are super familiar with my disorder when I know they are not.. Or who I tell them something that's well known fact in the MPS Commnunity, that Dr.Bragg, the Nrsgn that referred me to her and drs in our Community all know but then the dr. goes against that in their own notes? I realize this may sound bad to say it like that it's just what any of us in a rare disease communing with a issue that's not all that common to our rare disorder want/wish for.. And when you had a Provider that was pretty phenomenal at communication well it's hard to not want that again1?!?

She (Dr.Simpson), suggested I ask to make an Appt with the new Nrsgn and just gauge his personality, get to know him a little, see if we get along well (does he take an interest in my case).  Per a former Patient of Dr.Bragg's (the Mom's little girl was the Patient) appts are starting to be scheduled with the new guy so I am hoping i'll meet him when in-pt for the shunt surgery? I feel weird about this whole situation as it was originally intended I'd go to the new guy once he got here but then shunt issues sort of got in the way.
 Shoot I even could work with Dr.Iskandar if he'd work with the rest of my Team and I felt a bit more like it was a partnership.. I do appreciate atleast that he's worked with Dr.Bragg (even if I sense it drives him a little crazy I'd kept in touch with her, not sure). I don't know? I just want  a Neurosurgeon again that it's a full partnership... Not one where they say 1 thing to me and another in notes/etc..
So I'm just not entirely sure yet!?!

Cardiology - Surgery (meds, blood thinners)
Cardiology - Lovenox (Enoxaperin technically) right now the plan is Dr.Simpson is talking to Cardiology to find out if they want this injection both the night before and the morning of or to skip the morning of. Given a mitral valve now technically I guess it's recommended the injection be given even the morning of procedures but she's going to find out and let me know and send the recommendations to Neurosurgery. This to... totally something Dr.Bragg would have double checked herself.. I guess it was just the comfort that she wanted to know herself? It's not at all I don't trust my Team b/c I do just knowing everyone communicated was HUGE.

Other meds i'll skip the morning dose of Lasix but take the longer acting Spironolactone to keep fluid off/prevent fluid overload. Per Cardiology and my PCP will do the same as I'd do with Dr.Bragg w surgeries and stop the Baby Aspirin 5 days prior to surgery.

I'll admit it bothers me a little but given the on-going heart issues and Dr.Iskandar being new to my Team/new to MPS that he hasn't said anything about reaching out to my Cardiology Team.
 I know this was a huge reason my Cardiologist liked working with Dr.Bragg (she frequently worked with them, asked their opinion or just kept them up to date on what she intended to do/did they have any concern from heart stand pt.
She didn't always talk to them but if there was a new med or issue she'd reach out and confirm. As any one in our MPS Community knows having docs that do this is HUGE. Dr.Earing appreciated this as well,  I think he just likes to know his Patients Providers are keeping the whole picture in mind and Team player?

Side Note....
Kind of on a side note, I was thinking about this earlier but I fully realize several of my Providers read this blog (not a bad thing I guess, perhaps unnerving bc this is where I go where I feel like I can share what I am feeling about some things but still good I guess for Providers to see inside their Patients worlds outside just a medical appt... Even if I primarily only write about medical stuff here I guess is still another perspective on a Patients life?.. But that said sometimes I am really honest about my frustrations, worries or fears here in ways I don't share elsewhere. I guess read at ones own discretion (if that's the right word to use, not sure)? ... I'm probably never going to stop writing here what I feel b/c this in a way is my sanity (writing).
 
Elmiron, Anti Inflammatory:
 Dr.Simpson and I talked about this med and possible use, about what it does (it is now believed there is an inflammatory component to MPS I, which makes sense really bc many of us w MPS I are originally mis-diagnosed with some form or multiple forms of arthritis and muscle related disorders). She is going to reach out to my Genetics dr. in Boston re dosing as he (Dr.Bodamer) and my Cardiologist (Dr.Earing) have been talking about starting the med for about a yr now to see if it could help some of my issues.
Elmiron crosses the BBB (gets to the brain) and has been shown if I remember right to affect GAG storage which is what we do not break down with MPS I due to the missing/deficient enzyme. Perhaps this could help our Hydrocehaplus/shunt and heart issues some. It does have mild blood thinning properties so that  part would have to be sorted given we already have issues stabilizing INR (currently just doing Lovenox (Enoxaperin) injections vs oral Coumadin for this very reason to provide a stable low blood thinning threshold. We'll see. I LOVE that Dr.Simpson is AWESOME about talking to and working w any of my Providers to sort any given issue out!

 Botox
Otherwise I had 3mo botox today, which at the last Appt we had added an area more central so do shoulders, neck and mid/mid-low back area and while that newer area isn't particularly comfortable getting injected it all works so well! I really do need to go back to PT sooner than later to help overall leg/hip and the muscles that control posture but the botox does work well!

Hydro Association (1 day) Conf. - Phoenix, AZ
Lastly I both know an MPS Family that goes to the hospital Dr.Bragg is now at (they are seeing her next wk) and a few months ago met on fb another shunt Mom who was moving to AZ (not an MPS Family) and I follow the PCH/Barrow fb page (actually kind of an interesting page, they do a good job updating and interesting Hydro pieces here and there).  Anyways it turns out PCH is collaborating with the Hydrocephalus Assoc to host a 1  day Hydro Conf.
http://www.hydroassoc.org/event-view/hydrocephalus-education-day-phoenix-az/

I'm not yet sure if i'll go or not but the Foundation I work for has offered to send me if I do chose to. This is in Oct so not the greatest timing what with Sunday School starts back up in a few wks (Sun after Labor Day), the shunt surgery is the 6th (not a huge recovery) but then we're also doing the Heart Ablation procedure in-pt at CHW again so likely another Sun. I'd miss of SS topped by there's another Sun. in late Sept. i'll miss.

This all said other than is EXHAUSTING traveling (but maybe i'll be in the (atleast from shunt aspect) feeling better mode so that would help? Would be fun to see friends out there and Dr.Bragg's new hospital.  I'll likely decide sometime mid-Sept so we'll see?

In any case, thanks for stopping by,

Erica


 
 

Thursday, August 18, 2016

Appt, Heart Rhythm Team.. Take 2 Heart Procedure (sinus node. heart rate)

This update shouuulllddddd be shorter (but then again I say that and usually end up not being)!

Heart Rhythm Appt. Take 2 (t-minus shunt surgery 1st)
Anyways saw Heart Rhythm doc today and (atleast I was somewhat surprised) he is recommending once we get through this upcoming shunt surgery to re-try the Heart Ablation study (with same idea to try and kill/deaden abnormal (scar?) tissue creating abnormally fast rhythms from the sinus node.

The Sinus Node is the hearts natural pacemaker so is same risks as last time (biggest being the ablation causes to slow of a heart rate which in turn require a Pacemaker) but Dr.Kovach and Dr.Earing (my Cardiologist) feel the benefits out-weight the risks and especially since (as Dr.Kovach put it) they did a similar, less intensive approach last month and it did slow heart rate for about 8hrs.



Why the initial (Ablation)  response?
I can't remember if he said why he thought we would have gotten that initial benefit (besides I jokingly said to him our heart issues are a bit like the shunt issues - we get good results then back slides again to not being effective/not working well enough, lol my body just likes to stay it's status quo I think.. Change? Why would we want to give this girl's body permanent, effective change?! Is how I imagine my body, lol if it could have conversations with itself).
He just commented, as 1 of several comments (but the only I remember) that this area they ablated last month "woke up" after about 8hrs. His hope is if he goes in this time I think he said using 3 cathethers (but not absolute on that part) and he plans to insert one of the catheters in my neck via an artery to get a different vantage point/possible treating point that might give them more efficacy. I cant say I got all of that absolutely right other than I remember the "woke up after 8hrs" (I remember lol) and his mentioning approaching this via both groin and neck this next time.


Shunt surgery 1st... Heart Ablation to follow..
He asked that once the shunt surgery is done and I am released/feel up to it I let him know and contact his Nurses so they could initiate getting the next EP (Heart Rhythm) study set and scheduled.  He asked right away about the shunt stuff and was happy it was being done though he to understands this like the other shunt surgeries likely won't be a long term fix either to our on-going shunt problems. It more he'd like to wait to do this procedure till after the shunt surgery "so you can lay more comfortably flat and isn't as miserable after for you for the procedure and post-recovery" (indirect quote).
I am game with that as last time my Anesthesia dr (as I've mentioned before is the same Anesthesia (airway) dr whose done all 3 of the Cardiac procedures and the 3 Open Heart Surgeries in the past 3yrs) opted to do sedation for the 4hr period in order I would be able to lay flat (I still am amazed by that,  I totally would have said I was awake after). Is so weird the things we don't realize!



So in any case i'll let him and his Nurses know once the shunt surgery is over and they'll work on scheduling/coordinating it. Kind of craptastic this all ends up falling just as the Sunday School year is about to start gearing back up! In any case will figure it out as necessary and if both the shunt and the heart surgery and studies help improve symptoms then bring it on I guess.

Pre-op is mid-next wk for the shunt surgery, will update sometime soon. Thanks for stopping by,

Erica