Friday, March 28, 2014

Post-VP, TPL Shunt surgery-revisions, update

Surgery started a little before 8:00 and I think ended around 11:30 but honestly I can't remember that part very well!?
I didn't hear anything adverse about intubation but Dr.Bragg when she stopped by said her revisions went pretty well with just a small hiccup but nothing that would be a big deal, just took her a little longer on the TPL Shunt valve exchange. There are 2 incisions at that site vs the original 1 she thought we'd get away with but again not to huge of an issue. The area is definitely uncomfortable and sore but that is fairly par for the course with MPS and our thickened skin, muscle manipulation and what she was doing in removing the old valve + replacing with the newer, smaller (more in-line, size of the catheter) valve, both are the same type/brand and this new one remains programmable.

The VP Shunt she said she was fairly certain had occluded, as there was no CSF flow from it or maybe she said there was very little/not spontaneous flow? I can't remember that exactly either but I know she was fairly confident the shunt wasn't working well if at all.
The TPL Shunt she felt was doing well, which I also figured as although I had bad headaches I didn't feel near as bad as I would have when I only had 1 shunt and it would stop working. I also had very little of the autonomic side effects I get when both shunts aren't working well/not draining enough. These are the times I am even more grateful Dr.Bragg thought of and decided to put in that 2nd shunt; even if we've still had our fair share of issues the 2nd shunt and the Codman program. valves have made a huge difference! I am grateful for her persistence!
As far as placement of the VP Shunt Dr.Bragg removed the proximal (top portion) catheter and valve from the R sided incision and using new hardware and the Stealth-robotic guided system created a new incision on the L side, frontal ventricle. She then took this new hardware (catheter, secured valve and the catheter was tunneled on an angle (my description, lol) to re-connect on the R side mid-skull. Total on the VP Shunt there are 3 incisions. She feels the reason this incision kept re-opening is there was likely a low-grade infection under the skin (but not in the CSF so wouldn't show up on CSF cultures) and this in-turn causes the skin to break-down in a process she explained but honestly I can't re-explain! =)

I had a newer Anesthesiologist I've not had before but everything still seemed to go well; no sore throat after and they where planning to follow the same plan as other surgeries (thankfully Dr.Bragg waits I believe to scrub until after I am out and intubated as she has said in the past there have been times she'll tell the Anesthesia Team various things they can try if they are having issues). This time they used the glidescope and for induction (going off to sleep) they almost always these days use the IV drug vs using drug through the oxygen mask as the Anesthesiologist today told me they have better control of airway intubation time (or something like that) and in my case they have concerns with any delays from starting the sedation cocktail to actually getting the airway fully secured (a somewhat lengthy process I guess).

Prior to starting surgery (after I was intubated) Dr.Bragg and her Team typically washes the pts hair (I guess) and this time b/c she was going to have multiple incisions (both sides of my head) she told me when she stopped by this afternoon that she did the small French braid in my hair (she is so sweet) this way I think my hair was mostly out of their way and she has to shave as little as possible for each of the incisions. The braid is tied with some kind of medical type ribbon (I think she had told me one other time it comes on packaging or something) and actually kind of cute. :) I feel soooo appreciative that Dr.Bragg DOESN'T shave very much not to mention ALL of my hair in her surgeries as some Surgeons do!

I'll update when there is something to update about - say a prayer this discomfort improves, OUCH! At the moment I am not sure if the VP Shunt is draining or trying to drain or what but I've never experienced a feeling/pain like what is occurring for the past 1/2hr-ish and it hurts ALOT! =/ Otherwise it is the back incisions/area and the area over the original VP Shunt valve/reservoir (now removed) that feels the worst! Ice and PCA (pain pump) are good and every day will get a little better!
Anyways, thanks for stopping by,


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