Saturday, December 28, 2013

Post-op Info, Plans, up-coming Shunt revisions

Talked to Dr.Bragg this morning, and just said to her how surprised I was by how uncomfortable/how much discomfort there has been since this shunt revision yesterday (Fri), the discomfort is just WOW! She said she wasn't to surprised unfortunately as really this surgery was more in-depth and more manipulating than is a normal, typical shunt revision.
She must have talked to my Cardiology Team as she said they do not recommend the Lovenox injections as a bridge between now and surgery the 14th. Instead they recommended to her I re-start Coumadin today and check-in with them on Monday (I suppose to say when I should next do INR Labs). Due to how high the INR blood level was when I came in they also recommended to her to start back on 5mgs/7 days a week vs 6mgs/7 days a week.
The plan was to release me today, while the head incision is just something incredibly uncomfortable I also am not doing anything else special here so no sense really to stay. I am not sure now though if I will get discharged today or now will it be tomorrow as I am on the PCA Pain pump since surgery and typically the docs like to wean this for 24 hrs before releasing pts. I am not entirely sure what is going on on that front yet.

Regarding Fup as Dr.Bragg goes on vacation sometime this week (I think it is, then comes back the day before my surgery) she wants to keep the Telfa dressing stapled over the surgical site until late next week. I'll fup with one of her NP's then on Thurs or Fri, they will check the site and remove the dressing.
Regarding the upcoming VP and Thoracic Shunt revisions Jan 14th, Dr.Bragg said she would want to admit me the day before again in order to check INR levels, any other Labs and she wants a CT scan to be done in which she uses this 'mapping' to load on to their Stealth Guidance machine in the OR. This machine is then used to help better visualize the small areas she works in and better position the VP shunt especially since she will be going back in to a area she previously had placed a shunt and which we had a lot of placement issues with at the time.

As far as the VP shunt she will use the same type of valve (Codman Hakim) as we've had good results with this minus the catheter wearing down the skin. In the case of the exposed catheter she feels this has to do w the Hakim valve, the skin that grew under the exposed catheter (a phenomenon she said she hadn't seen before) and the tip of the valve originally rubbing against the skin over time wearing it down. The skin that then began to grow under the catheter caused the tip of the valve or catheter (can't remember this part for certain) to be pushed up and in time wear down the skin creating the exposure. This took place over about a 9mo time as that valve was placed last March I believe.
Regarding the Thoracic Shunt she is thinking of using a newer valve her partner has had success with called a 'ProSA' programmable Valve. This is a smaller profile valve that she plans to (I think I remember this right) replace in the same location as the current Hakim Valve but she feels this will be a lot less noticeable with movement or sitting back and thus less uncomfortable. Dr.Bragg did say with this valve it is more of a pain to re-program as it does also require Xray to re-program after imaging (for instance MRI) and she said the re-programmer is different than anything else she has used. When they go to re-program the valve she said it is similar to clicking a pen, the tip has to touch the middle of the programmable valve in-order for proper re-programming to occur. Interesting!?! I just hope this valve works atleast as well if not even better than the Codman Hakim did!
For now I am on 2 IV antibiotics in-patient and will likely go home on the oral versions of these, the one i'll stay on right up till surgery.

One thing i'll have to ask about is if the NP's/Dr.Bragg can work with either my CHW Genetic Counselor or more likely my Genzyme Case Management Team in order to have the Aldurazyme shipped to UWHC that I would otherwise, normally get infused on 1/13 (the day before surgery).

I'll update again when I know something worth updating about,
Thanks for stopping by!


ProSa Valve

1 comment:

  1. Oh wow! So much going on Erica. :( You will be in my thoughts. From the pic above, it looks like you are going with an Aesculap Miethke shunt? If so, while I have heard that they are a pain to program, they also have a much lower chance (than say our Hakims) of being reprogrammed by outside forces.