Tuesday, December 6, 2011

Shunt surgery: VP shunt revision 3, Revision 13

12/7/11 - 12:10
 Infectious Disease docs stopped by again a bit ago; they'll watch the CSF culture for about 5-7 days and while we all expect/hope it comes back negative (infection under control) if not or if i begin to have negative side effects like bone marrow suppresion they will switch to a IV antibiotic and the antibiotic would be given for longer than the current planned 2 weeks (if negatve). Suprisingly they said that tiredness is a common reported side effect in their pts of zyvox but not reported in literature.

Surgery wenr pretty well with a few surprises but started about 7:30 and finished a little past 10:30. Dr.Bragg started with the LP shunt removal whch she said when she got in to the lumbar portion of this she fiound that the 2 shunt pieces which should have been 1 where disconnected completely in to 2 pices (should have been connected as it was tied off but this area hadnt been worked on since the 2nd shunt revision in august and was initially replaced during the laminoplasty in May. The august revision  was just re-anchoring the catheter as it had come lose in that area. This she said was likely why there was still a small amount of CSF build up but Dr. Bragg does not think this will have any impact on the lower back pain as that she feels is from not enough CSF draining through the shunt. She was happy that the spine tissue was scarred off though so she did not have to mess around in the area of the nerve roots or with the nerve roots as happened during May's surgery. There are 3 incisions from this shunt removal. The VP shunt apparently right before I went to sleep from anesthesia I asked Dr.Bragg if she could in fact move the 2nd valve on the VP shunt although I fell asleep then before she could ask questions or we could talk about it - normally I ask not to have the 'sleepy' IV med right before they take you in to surgery but this anesthesiologist gave it anyways which kind of ticked me off and after I explicilty but nciely explained why I didnt want it.  Anyways so she when they got to that point did move the valve up to my upper chsst and commented how in the other location upper stomach/lower chest the valve clearly moved around quite a bit and she could definitely see why that would have been annoying as itwould rub on the bra line and clothing to.. When she got to the proximal catheter (in ventricle) and 1st valve/reservoir she found that these where once again partially occluded and said that this is probably why my headaches had improved so much but then basically plateaud. If this happens again she is planning to move the proximal catheter to a ventricle with more fluid space that is farther from the choroid plexus (near the front of the head and a coral like material that often gets occluded in catheters placed in the front ventricle. Placing the catheter tip att the back of my head/brain she said would give more space and she could place the catheter further in to the ventricle. In total I have 6 incisions and actually feel far worse pain wise tonight than I did this morning or afternoon after surgery. Sleep has been elusive which is a bummer as I am incredibly tired!!! - update I did sleep on and off for about an hour here and there.

The infectious disease doc stopped by 2x's today and decided that they will cont the zyvox (linezolid) for 2 more weeks with 3 times weekly lab tests as once a person is on this med for more than 2 weeks it can begin to suppress the bone marrow and I have been on it now for 3 weeks already. My labs where low currenly but the docs said it wasnt worrisome at this point and just needed to be monitored closely. If the CSF culture from todays surgery would come back positive they said they'd re-eval the treatment approach but we are somewhat limited in meds as I am allergic to the other 2 oral meds that cross the BBB and help CNS infections. Our hop is though that since ive been on this med for 3 weeks now the infection will be well under control and removing the 2 shunts will prevent a recurrence. (this type of infections act much like scum on plumbing when it clogs - very difficult to get rrid of and would  re-occur if the shunts hadnt been removed which is why shunts are often removed and eplaced with CNS infections.

Im sure im forgetting something so will update soon - thanks for the prayers. Sorry for the typos this is all  really blurry so having a hard time re-checking the spelling. =/
Hoping for sleep,


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