Thursday, July 3, 2014

Neurosurgery Appt

Another Appt w Dr.Bragg, basically there are 2 thoughts going on at the moment.

1. Being Dr.Bragg said she really would like to figure out a way to make the VP Shunt work more efficiently as she feels the TPL Shunt does more of the work and though I am having what we think is the nerve irritation symptoms she does think the TPL Shunt is working atleast fairly well. She commented that she would really like to find a way to improve how well the VP Shunt drains as she thinks that would help us overall.
2. The other problem is the TPL Shunt irritation and figuring out where that is originating from ie is the proximal (top) of the catheter sitting at the bottom of the lung space and thus causing irritation and the intermittent (but really, reallllyyyyy uncomfortable) pinching/poking like sensation or is the distal catheter in the spinal canal the cause?
Based off last weeks MRIs she had commented the distal catheter is sitting closer to one side of the spinal canal than where they would prefer a catheter be (typically the catheter sits more centered) and this could also be the cause of the intermittent but fierce leg-nerve discomfort and sensations at the front and along the shunt catheter.

We opted to do a CT Scan to get a better view of the catheter within the lung space to see where the catheter is sitting.
She had also commented there was fluid within the pleural space where the shunt drains which would be the CSF draining, though this should typically be absorbed vs sitting within the lung. I am not sure if she saw that on the MRIs maybe.
Secondly she thought we should try turning the VP Shunt setting up, see if this might by some chance help the shunt to drain better; I typically do better at very low ICP (intracranial pressure) but this also can cause the shunt catheter to collapse intermittently and thus more likely for obstruction.
She did depress the VP Shunt reservoir and commented this was slow to refill (stayed indented) which is I think why she wanted to try adjusting the shunt setting to drain a little less, see if it might help the shunt overall drain better.
Apparently there is also a reservoir on the TPL Shunt (maybe there is a way to check flow on the shunt but it can't be tapped, I am not entirely sure) and she said this refilled normally, which is atleast good. =)

In my ever brilliance I didn't think to ask her what I should do if the VPS setting re-adjustment didn't help or for that matter even if it did but the TPL Shunt discomfort keeps occurring?
We clearly wouldn't do 2 things at once and per the NP who helped set up the CT i'll call to try and get the results Monday but it just never occurred to me am I supposed to make a f/up appt if things don't improve or would we schedule something for either shunt over the phone?
Argh sometimes I could kick myself for my lack of ability to think quickly on my feet when we are talking about things! I honestly think it is that I am processing the info we are talking about and just need time to think through everything before I can really come up w these (what would sure seem like!) basic but kind of needed questions!
I am sure I can always if need be email Dr.Bragg but would rather not so will see what her Secretary says Monday.
If we did end up doing something to the TPL Shunt due to previous scar tissue from the 2 OHS's she would use the Peds General Surgeon again to help with placement of the catheter.

I guess we'll see how things go and hope something improves!
Thanks for stopping by,

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