Friday, December 27, 2013

#28 Today's VP Shunt Surgery

This morning Lab-INR was a little high (not sure if it was higher than yesterday's) but the Neuro Team opted to do 2 Plasma bags over a quicker period (1-2 hours verses 4 or more hour infusion) in order to try and bring INR down to a more appropriate-less bleeding risk range for surgery.
The plan is to cover the open incision via (per the Resident) loosening the skin around the open VP shunt site/exposed shunt catheter and try to pull this over and I assume stitch that in place? Sounds a little on the gruesome (skin an indian anyone?) side.. Hopefully the Neurosurgery Team wont need to shave much hair/this loosening the skin wont affect hair growth... I know that's a vane thing to be concerned about but when you have so little control over many things related to your body it is nice to have a few things you can still manage!...

10:00PM 12/26-
So surgery was successful from what I glean from my Dad (talked to Dr.Bragg post-surgery) and the Nurses/Anesthesiologist who all updated me and in the case of Anesthesia stopped by my rm in post-op care. I'll update when I talk to Dr.Bragg in the morning though one thing the Staff and my Dad told me was Dr.Bragg was surprised by and had never seen where an exposed shunt catheter when they go to remove it has skin growing under the catheter (vs over I guess which would keep the area closed). I think they all said Dr.Bragg felt this might have something to do w the underlying MPS but I don't remember that part for certain and will ask tomorrow.
What I do know from Dr.Bragg as she stopped by my in-patient room late Friday morning after her other surgeries where done is that 1. she planned to use the previous VP shunt incision along the valve site (several inches long) and then take the exposed catheter and "under-mine" it by lifting and stretching skin (not sure if I re-explained that correctly), tuck the catheter inside what I think she explained (but again cant remember for certain) a pocket of sorts and then pull the 2 incision sides together and stitch it up. The incision is covered by a fairly large, stapled on Telfa sponge so I cant tell how big the area is.. It does look like they shaved a minority of surrounding hair which is/will be/would be great!
She plans to as I've written here before con't to treat the formerly exposed areas with antibiotics and Jan 14th we'll go back to the OR. Right now she (Dr.Bragg) is considering whether to bridge this next 2 1/2 (ish) weeks with injection Lovenox (is done twice daily) which offers fairly consistent INR level as the med only lasts 12 hrs. Otherwise she will restart the Coumadin, we'll have to con't daily blood draws until INR is back in-range and till I could be discharged.. Per the Cardiology NP getting INR back in-range can be more difficult when Vit K or Plasma has to be given to bring down a pre-surgery, high INR # though I cant remember why she said that was.

When Dr.Bragg does move the VP shunt valve and proximal catheter the 14th she plans to use the same shunt catheter tract (not sure if that's the right word to use) as the areas where the catheter feeds down to my abdomen/'T' connector have worked well and not a lot of options where else we could try. The valve will be at the back of my head again I guess (circa Dec/Jan 2012/'13 when we had bc of the shunt infections moved the VP shunt to a parietal location. I'll update on that down the road.. She plans to use the same Codman Hakim programmable valve (has worked pretty well, not perfectly but when the 2 shunts where working pretty well I did feel a lot better than I otherwise had in a long time! =)

I don't really know much else so will update when I do,
Thanks for stopping by!

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