Tuesday, January 24, 2012

Revision # 14 / VP shunt

I'll try to make this coherent - may end up coming back in the next day or two to fix typos.

I wrote in yesterdays update about Dr.Bragg's plan for this surgery (how she was going to move the tip of the catheter from my frontal ventricle to the ventricle at the back of my head) but once she got in to surgery the plans changed. She decided to open up the frontal incision first (originally was going to do this last after getting the other shunt tip in place) and found that the shunt was not completely occluded and was working partially (once again) which she was surprised by given thurs shunt tap and inability to pull any fluid out of the ventricle. Her conclusion was that the shunt from looking at the trajectoy and placement of the tip of the shunt (a CT was done right before surgery this morning) was in less than an optimal position and thus when the ventricle drained the tip would essentially come out and cause issues with further draining. I cant remember exactly how she explained it but it had something to do with that.  In order to place a new valve/reservoir and get the tip of a new cathether in to a better placement Dr.Bragg did say she had to drill away a bit more bone than other surgeries and the incision is somewhat bigger but if it helps i'll deal with it! At the beginning of surgery when she realized the shunt wasnt completely blocked as she initially suspected she paused the surgery for a bit (took about 3 or so hours total for a otherwise relatively simple placement.) and had her partner called (a world renowned  expert on hydrocephalus) in who while he didnt scrub in stayed for the rest of the surgery and they collaborated on how to proceed and placement. She tried to get further pictures for me of the build up within the shunt catheter but these pictures did not turn out as clear as the prior picture she had taken and given me with the scope they use so she didnt keep them. I so appreciate that she keeps wanting to try and help me and that she is concerned about my best outcome (she/they where concerned with moving the shunt tip to the back ventricle if we could get this one to work well given ive already had 1 infection and risk of bleeding would have been greater in the other ventricle.) and that she consistently wants to make sure we are still helping, not harming but also get me feeling better despite all these on-going up and down trials. She's a good dr and I appreciate her honesty, down-to-earth-ness (my own word I know!) and concern about her pts. Even when I may feel bad she knows how to respond and help, not always a common trait in all doctors.In recovery I was upset because I hadnt known why they didnt do what she originally was planned and was scared she changed her mind and didnt want to do anything; she came by in the recovery room and explained it all to me, explained her concerns and that she wasnt giving up on me, we still had options if this didnt work for the long run and she wanted to minimize what we had to do when possible while still giving the best possible outcome. She then said to me if I wanted she could refer me to her colleague or another neurosurgeon if I was discouraged. My response despite my awe at her honesty and concern was simply that she IS one of my favorite providers and as long as she isnt giving up on me, im definitely not giving up on her and really think she is very good at what she does on many levels.

She also for now left the 2nd valve which sits at my collarbone in it's location as when they tested the distal part of the shunt it was draining. She is a little concerned that my skin isnt handling the valve tubing (and connector) but felt that we would be better off not messing with it and if needed that is a really simple procedure to move it back to it's correct location further down on the chest (for those who know where chest Ports are placed the 2nd valve originally sat in that location). Sh also said it's possible at some point we would have to add a 3rd valve to slow down CSF drainage and prevent the ventricle from collapsing  (several other of her and her partners pts have a 2nd and a 4rd valve to). She was pretty confident today's surgery would work and felt like this might be our best outcome yet, I am crossing my fingers!

Anesthesia went ok, a difficult intubation but also not the worst ive had so that was good as it is alwats one of the biggest concerns. The head anesthesia doc wanted a copy of the echo from my Cardiologist before proceeding to surgery (I knew my cardiologist was ok with this surgery and had just saw him last week and emailed with him yesterday) so they managed to get that although the Echo reports are always very different from what my Cardiologist puts in his reports so I personally ddnt think it would be that useful anyways. After surgery I spent the rest of the afternoon with quite fast heart rates (120-130's but normal much slower except for the past couple weeks on and off) which also caused impressive light-headedness that was less than pleasant. Such joys.

I'll update when there's something to write - thanks for stopping by,


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