Wednesday, April 18, 2012

Revision/surgery #14: Lumbar drain surgery details. Good, Good, Great!!

Surgery being at 12:15 was kind of nice since I didnt have to get up till a bit later and be at my parents house till a little after 9 in order to get to the hospiital at 10:15. The surgery itself even started about 15-20mins early. In pre-op when Dr.bragg stopped by she mentioned she thought anesthesia would probably opt to do general anesthesia with fiberoptic intubation (essentially a camera) given she didnt know if the drain placement would take 5 mins or take a lot longer. Anesthesia opted to do fiberoptic. Dr. Bragg also said she had been thinking about my situaiton alot again over night and this morning (how can you beat a surgeon who cares that much?) and said she would be a little sad if we got a resolution to our on-going issues (but happy to get me feeling better) and said something like it woiuld feel a little strange if I wasnt coming to see her every other week bc she really likes working with me and her nurses really like me. :)  She also said her team and her had definitively decided to have me on the regular neurosurgery floor (vs neuro-ICU) and that when she was up on this floor earlier in the day the nurses had asked her if I was coming back and she told them yes, plus they told her while they hoped we got it figured out soon they also really liked having me. Again how sweet is that???  I thought that was INCREDIBLY sweet and makes me LOVE her even more both as a surgeon and as my provider and a person!! I had a different anesthesiologist and his resident and even though the actual surgery ended up literally being like 5 minutes to place the drain they didnt know this would be the case ahead of time (Dr.Bragg had reviewed previous MRIs and decided to go below my previous lumbar surgeries/scarring vs above it as below is less risky) and so Dr.bragg said they where almost in disbelief when she told them she was done so quickly, not that they didnt want anesthesia to go safely just that we all if in hindsight (which is always 20/20 and we would have had no way of knowing for sure) had known would have done it awake given how easily the catheter went in. .. Dr.Bragg did say both in almost disbelief (bc it has never happened to her before) and excitement that as soon as she got the catheter in to the sub-arachnoid space the CSF (cerebral spinal fluid) literally shot out the top of the manometer/catheter and hit her in the chest all over her gown and when she looked down it had run all down the front of her and her gown and soaked her pants and shoes. She actually thought this was kind of amazing and good bc normally CSF drains relatively slowly or slow enough to get the catheter attached to the needed drain/measuring device. She said this was definitely a clear sign that pressure was obviously to high yet despite the VP shunt and a likely sign we need a 2nd shunt. When she came by she was dry and still amped up about it all which I thought was kind of cool since as she said for once we had a clear cut sign  of where/what a problem is/was as well as she was very confident I would have symptom resolution which I do!!

                                                          CSF Drainage

                                                  External drain placement

All today Dr.Bragg has been draining at 10cc of spinal fluid every hour (the nurse comes in and over about 3 mins they drain CSF which they all comment how fast it flows and quicly that 10cc drains compared to others they've seen) . This drains in to the above bag or essentially like a IV bag and attached to a device that hangs it from the IV pole. She thinks in a day or two she will try draining at 15cc/hour CSF and see if that is even better or if worse we'll go back to 10cc/CSF.  With a lumbar drain and draining pressure she has no real way to know how much fluid to drain so this is a guessing game in a way and she goes with other experiences. The nurse I had today said the most he has ever seen someone successfully drain at was 17cc/hr and he said that was a larger male. She also said if as she further suspects we end up doing a lumbar shunt (the VP will stay in place) then she will likely do a low resistance valve on the LP shunt which just means essentially the CSF has less it has to overcome before pressure builds up and drains. Programmable valves arent a real option with LP shunts so she wasnt sure yet which valve setting we would go with ie low, medium or high pressure setting valve.drainage.  She did say we wouldnt neccessarily have to wait very long to do that 2nd shunt placement if we decide on it. My parents are going on vacation week after next so I hope we could do it soon but will figure that out with Dr.Bragg when we know more about the setting/valve type we'd use. Otherwise it has been lovely to feel better and walk around the floor - albeit a low back pain from drain placement and vision which will resolve in time I am super excited!!!

More soon,


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