Tuesday, April 18, 2017

Insurance; Infusion site, Conf. Call (Insur Co heads, Team). new Neurosurg. Appt.

Earlier today, after what felt like a mad dash to get my infusion going (my Nurse was amazing!) and things settled I had a Conf. call with the Dean Insurance Med Team as well as my Case Manager from Genzyme called so we could talk ahead of the conf. call.
Altogether there where  6 people from the Insurance Company as well as my Case Manager from the Biotech Company (Genzyme) that markets the Enzyme infusion drug I receive every wk. If I remember right it was the overall Insurance Company Medical Director, the Infusions Medical Director, the Pharmacy Director (all for Dean Insur.), my Insur. Case Manager (for Dean), my Case Manager for Genzyme as I mentioned above and admittedly I am forgetting who the 6th person was from Dean. Impressive though that all these people took the time to call in and talk to us!

Non-the-less as Amy, my CM said to me when we hung up from the call and she had called me back (on her day off no less, I am blessed to have her on my Team!) she has been on a lot of these types of calls with other of her Genzyme Rare Disease Pts and never before has she been on a call where so many from the Insurer took the time to familiarize themselves with the case  or the history. For that I was and am very grateful. All seemed to chime in, answer my questions and bring up very good points or things they are working to have in place. Although it's very likely it will be denied at the very end of the Conf. call (about a 1/2 hr in length) my Dean (Insurer) Case Manager (CM) mentioned I can request a new Prior Auth (PA) be done (I have) to request re-approval at FMLH to continue infusing there. This likely will be denied given Dean's push to bring Pts in-network, to their sites but then she also mentioned we can write up and submit a "appeal" to any denial if we wish.

Ultimately although yes I do wish my infusion where staying at FMLH as they have experience and have been able to manage my (especially) cardiac-fluid issues without needing to stop or miss any infusions I can understand why it is a huge benefit even to us Insur. plan holders to go in-network for the infusion as the cost savings to Dean each wk is very significant (roughly $42,000 now a week at FMLH where it was roughly $13,000/wk when Dean paid for the drug before it shipped/I infused). I'll also still be able to get it out of network when in-pt say if at UW or CHW.

I guess if I'm going to find any light in this (believe me I'm really not, I really don't want to change sites, the drive to FMLH is MUCH easier than is the drive to the Fish Hatchery site every wk) but my PCP works at the FH site so if there where any issues other than the 3mo span she'll be off (maternity leave) starting around July she'd be able to (her words) come over/help manage any issues.
On a different note (sorry this is ending up a lot longer than I thought) Peds Neurosurgery called Monday and a new Appt is set for a few wks from now w/Dr.Iskandar. I am not entirely sure what she meant but seems he's reconsidering/maybe has something else in mind (maybe she meant he wanted to re-test the shunts again? I'm not to sure, I was driving when the Secretary (Anna) called though I did pull over). Anyways so any prayers appreciate that goes well.
I think I may have wrote about it in the last post but he emailed me he was reconsidering the ICP Monitoring which I agreed with. Thinking about it since then I think even if we did do this him and I have to have an agreement what #'s range he would be looking for to in-fact show 1 of the shunts isn't working (which the shunt taps seemed to show). I and Dr.Bragg know well what (very small, very low) range I feel best at but I'm still uncertain if Dr.Iskandar completely gets this.


Will update sometime soon.
Hope everyone had an Happy Easter! He is Risen, He is Risen indeed!



Thursday, April 13, 2017

Is it really have to be this hard? Shunt frustrations

Why does life as  a Rare Disease Pt have to be so difficult? Why do some Specialists who are good at their fields have to be so dense to the not straight fwd/not as simple' aspects of rare disease issues?

I feel so frustrated, actually distressed in a way this past 2 wks. I do not normally experience anxiety much and I have to say I feel distressed. Frustrated that the answer is so evident, the NP got it, Dr.Bragg I think (?) believes its shunt issue (she originally stated she felt a revision was needed not sure now after she's seemed to talked to my Nrsgn. Regardless the shunt taps where very abnormal. My Primary dr. wondered how it isn't clear (that its my "normal" pattern with shunt issues) but this Neurosurgeon seems to have no clue?
Why can't he understand that in my MPS we often have difficult Hydrocephalus that isn't very straight fwd. Yet why also can't there be/or isn't there more drs in the MPS Community who treat this sort of issue-why isn't there more Neurosurgeons aware? Is Discouraging waking up every day feeling like this and little hope. =/

Between this shunt issues, the pressure being so typical to me when shunts not working right (pressure worst at night, early morning, slowly improves as the day goes on till finally about dinner time I feel better albeit imperfect). And then the Insur.-Infusion stuff. It's so tempting to me to just drop my primary insur. and use Medicare as primary thus I wouldn't be as stuck re where I could infuse at and I could stay at FMLH. The local community hospital has no business doing this infusion and the drive to my Primary (whom I really like) is more difficult than is my drive to FMLH/Milw.
 Neurosurgery wise unfortunately there is no good option, the Peds Neurosurgeon that works with mine now (replaced Dr.Bragg) feels the same as my Nrsgn does, that there's nothing he can do to help. Dr.Bragg of course isn't local and for that matter apparently can't treat Adults at her new hospital so seeing her in AZ isn't even an option. That makes me sad (wouldn't be ideal even if could but atleast I'd have an option).

I JUST FEEL DISCOURAGED AND ANGRY AND UPSET. Why does it have to be so difficult?
Sorry to basically just vent,

                     Reminder to myself. There has to be someone who can help, who will help, right? =/ I pray God leads me to whoever this is. =(

Friday, April 7, 2017

Neurosurgery (Shunt taps, clear but not clear result), ERT (Infusion) Changes

     This wk has just been a huge barrel of fun (or b.s, maybe a huge barrel of b.s?)

Peds Neurosurgery / Shunt:
This Appt was no less frustrating then any of the past ones with this Nrsgn have been. On one hand he says himself he has no experience with my MPS and thus the different way it presents Hydrocephalus in my case but then he treats it just like he'd treat any other complex Hydrocephalus Pt. SOOO FRUSTRATING!!!!
The shunt taps done on both shunts at Thurs's Appt showed the VPL Shunt they where only able to get around 2cc's I believe the NP said and she wasn't able to pull anything off the LP Shunt other than there was flashback in the needle (nothing able to be taken off).
I ran this by Dr.Bragg and she raised the concern a shunt revision likely needs to be done. But yes lets confuse the picture even more by repeating ICP Monitoring which won't be clear (b/c my pressure issues even in complete shunt failure aren't normal "high pressures" but is to much for me. And with atleast partial shunt function I completely don't get what the aim of this testing is... If he doesn't fix something after I do not know what I am going to do. I really keep questioning if I should try to get a 2nd opinion from his Partner (the guy that replaced Dr.Bragg at UW-AFCH basically).
This testing is set for a few wks., from now and between this and the infusion stuff I'm not sure which issue is frustrating me more!

ERT Infusion:
I don't even know what to say!?!?! This wk has been so freaking frustrating/stressful/irritating! Not only is my primary insurer trying to switch the infusion I get every wk to a site that has ZERO experience with my MPS I and enzyme infusions in general but these are the same sites that not 3 yrs ago said they could not do it because they didn't have the capacity (experience I guess)?!?!
I am fighting this all the way, I've been working with my Genzyme Case Manager and talking to my Case Manager at my insurer who unfortunately is in the middle as she then acts as my and my Teams voice what our concerns are.
Multiple Providers have told me they do not feel this site, which has no experience should be doing the infusion and my Cardiologist raised the concern they will not have a Geneticist on site. FMLH also has been able to adjust my infusion rates and volume around the cardiac issues b/c they have experience with enzyme replacement infusions in general.
1 of my Providers (whom I love) commented along the line 'they'll only do the infusion if they feel comfortable' which does not make me feel comfortable b/c I do NOT want there to be issues when we have not had any with infusion in years!

Will update sometime soon. Sorry it's been awhile in-between updates lately. I do tend to write a lot less often when I am not feeling great which I am not.


Wednesday, March 29, 2017

Exhausting and a little hard.. Shunt stuff. Late Cardiology update

I apparently started writing a update a few wks ago and never finished (see below) so will just tack on to that.
It has been a bit rough of a few wks, not that the past few months have exactly been great but atleast when I had the Spinal Fluid (CSF) leak from my low back (LP) Shunt I had great headache control even though the low back pain/discomfort was pretty intsense any time I was on my feet. That CSF has resolved or healed itself unfortunately now for a few wks and so not only do I still have pretty bad back pain to leg (radiating) pain I now have some pretty freaking (not) awesome headaches that occur mainly at night and certain parts of the day (when pressure is highest). Has stunk really bad!
I have been talking to Dr.Bragg some, getting some advice from her (I miss her so bad, I literally am tearing up just writing this. I miss having a dr. that really listened and thought outside the box. A dr. who realizes my underlying MPS makes my Commun. Hydro just different in some ways than are 'typical' (whatever that is) cases of it. She never gave up and she'd try options like intermittently removing CSF to give relief while we figured things out. Did I say I miss her?

Non-the-less earlier this wk or last wk I emailed my Neurosurgeon (her former Partner) and asked if we could do a shunt tap. check the function of the 2 shunts. I don't know but I do know I feel crummy. Thankfully he responded and agreed we could check the shunts function and see if both are working right.  That is set for next wk. I wish it would be a simple answer! I literally have felt a little depressed some days just from feeling so crappy and frankly uncertainty in answers. I struggled when Dr.Bragg was here, trusting her enough but atleast I knew she wouldn't stop trying to help/figure things out.  Now is just hard.

From a few weeks ago... -  Heart Rhythm Appt
Follow up with Dr.Kovach (Heart Rhythm, CHW) was Thurs an went ok. We opted to add back a low dose (milder) beta blocker, see if this along with the Ivabradine can help calm some of the funny/off heart rhythms. Heart rate itself has averaged (on the past several heart monitors) 80s with some upward spikes in the 100s but overall rate itself is better following the heart ablation in Jan.

Re the beta blocker this was a  joint decision, between Dr.Kovach and myself to trial it. I appreciate my Heart drs. want or ask my input and don't just do something without a joint agreement! I have to admit I may not get this part right or entirely right as I didn't write down any notes and I didn't record the appt (when I do this I delete any recording after I write down any notes) but anyways he mentioned a few options we may have though he's not eager to do/try should we not be able to get these wonky heart rhythm issues to calm with meds. As anyone whose followed this blog knows we haven't exactly had the best of luck with heart meds! That said any further ablations which I genuinely think is unlikely (that we'd try again) but if we did the risk is greater still than the other 2 times. This time especially so b/c we've had a few short episodes of heart block (where the heart stops beating for a brief period or maybe it's that the beats come in a sporadic, inefficient pattern. I honestly can't remember).
   Non-the-less right now it's not on our 'being considered' and I get the feeling is pretty unlikely we'd try again unless things change or got worse.
Will try to update sooner, I genuinely like writing (is easier than talking about how I feel to people and I am glad this blog seems to help so many, who have said as much) but I just don't do it as much when I don't feel good. I guess b/c it's energy I don't really have.

If I sound depressed I promise I am not, just a little discouraged and a little sad and not sleeping to great (I still LOVE my recliner though!) doesn't help.
Thanks for stopping by,


Monday, March 6, 2017

(Cardiology, Neurosurgery, etc) Wonder when we'll figure it out..

Going to try to make this short - I know, stop laughing. =)


Cardiology I had the 48hr heart monitor which I mailed back the other day. Usually takes a wk or so to hear anything. I did have some symptoms during it and in general haven't been feeling all that great for the past few days or week or so so who knows. Between lightheaded episodes (but very odd), heart rate that's a little odd and the low-to-mid back stuff (irritation, radiating discomfort) topped now to with the CSF (Spinal fluid) leak in my low back from the LP Shunt seems like it's pretty much headed. That stinks a lot! Headaches still aren't as bad as they are sometimes, like when the shunts are completely not working but that leak definitely makes/made things much better!

Neurosurgery wise going off above, I seen my Neurosurgeon today at UW Children's and he is basically at a loss. I said to him the risks of doing more surgery with the LP Shunt may be real (and I know they are to an exent given the stenosis/narrowing and severe scarring) BUT that shunt location right now SUCKS! Now to the CSF leak from around that shunt being pretty well healed makes it all even worse.

I have thought a lot lately about this weird life I live, both normally and so abnormally abnormal. I watch or see people including really my own family, siblings especially going on about their lives, functioning normally, doing normal life things every day meanwhile most or many of my days are spent dealing with insurance stuff, endless medical stuff and all that goes with both of these. Shoot I even fully realize with having my Case Managers at Genzyme and at Dean I think I have it pretty decent compared to many. I think it's just the fact even with these 2 helping (and they do help a lot!) I still have to communicate with them, sort paperwork, deal with scheduling drs. appts., figuring out when f/ups are needed (today's Neurosurgery Appt? I have no idea in hindsight what the plan is other than Xray was done and he wanted to look at some prior surgery notes (for which I sorted through my binder of Neurosurgery Med records and sent this to him and to Dr.Bragg. So much easier keeping copies of all those notes! I called UW Med Records to have a copy of recent spine MRI and Xrays mailed to me which no big deal any 1 of those things but altogether it takes up a lot of time!
I talked to my Insur. Case Manager while still at the Neurosurgery Appt to sort prior auth for the Xrays done (PA is covered for a yr at a time but something was messed up today) and several other phone calls or messages before I'd ever gotten home.
Once I got home? More phone calls, emails, answering messages, editing a document for the interview/photoshoot I did a few wks ago (Levi and the guy he works with do a write up to go with the pics, I somehow messed up the changes I'd made so will have to re-do that in a couple days). This on top of a few 'more normal' things and the day has just been busy and kind of nuts but one of those days you wonder 'what did I do' even though I know I actually did a lot!
Anyways so I guess I've just been thinking a lot about life and trying to figure this LP Shunt irritation/symptoms out and in general pondering life and my life and maybe especially so b/c of watching people around me and how normal their lives seem (even though I realize there are so many whose lives are equal as out of the ordinary as is mine).

Happy 34th Bday I guess and hopefully a year that I in a way is a little less frustrating than this past yrs has been! Was definitely nor all bad and plenty of good sometimes just would be nice if it where a little easier at times! I know if it be God's will we will figure this shunt stuff out, the seeming heart (rhythm) issues and i'll con't to hold my faith, the best I can (failing often undoubtedly) that tomorrow and the next day and the day after that will bring answers and better days. For now I am just grateful to have all I do and even though I don't feel particularly awesome I know I am blessed by those around me whom I love, my Team of Providers and even Providers, like Dr.Bragg whom are no longer here but choose (so much gratitude on my part for her!) to stay a part of my Team and so willingly offer so much help.
 I am grateful for all around me who (to be perfectly honest) sometimes pick me up in a sense when I am frustrated, tired and at times feeling a bit at the end of my rope. I am grateful for all who offer advice and frankly optimism that I sometimes am just barely otherwise holding to (re finding answers).
 I know we've done this so, so many times but even if I felt uncertainty other times atleast I knew in my heart Dr.Bragg would help me figure something out. Now I don't feel that certainty and that stinks. I do think Dr.Iskandar is trying, much thanks to Dr.Bragg for that but I don't think he really gets what it's really like in the harder moments and it just seems or feels like she got it in a way that made even the uncertain, difficult times a bit easier to handle. This all said I'm not giving up, I can't but it does get hard!

Thank you for stopping by, sorry to vent, sometimes it just helps!

                          San Diego, Loma Point Beach (I think that's what it was called) - was beautiful!
Thanks for stopping by and no matter, ultimately I know my God knows the plans he has for me. For that I am grateful.


Tuesday, February 28, 2017

Rare Disease Day - a year ago.. Now vs then

I am not a worrier all that much or the things I do worry about are things that in the grand scheme don't matter that much but 1 thing I do think about often enough and worry about some is (especially when it's something seeming new or uncertain) will my drs. think I'm making something up? Will they (do they?) believe me?
I can't really say why that's something I think about but I do and I guess maybe it comes from all the days when no one knew and from time to time I did get a dr. who in as many words questioned what I said and/or felt.

I am wide awake (but certainly tired!) at 5 in the morning, this Rare Disease Day, many things on my mind and some iffy/odd/weird symptoms occurring (very) intermittently over night and it ALWAYS makes me cringe! I'll wait to say anything, see if symptoms con't or not but to this day I STILL hate calling drs offices, trying to explain something (I will be 1st to say I often struggle  trying to explain symptoms or how I am feeling or if something different what it is exactly. Hopefully in this case the symptoms where just a passing thing!

It is RARE Disease Day (capitalized b/c come on it's RARE DISEASE DAY!) 12 yrs ago this day didn't exist so it's a pretty neat day to me, even if all i'll be doing is driving my sleepy self to infusion, working on paperwork and phone calls and 6ish hours later driving myself home (to hopefully crawl in my pj's and go to sleep I hope!) On this Rare Disease Day I am grateful to have this infusion and even if it's an (basically) entire day 1 day of every wk, week in and week out I am GRATEFUL I have a treatment and to that better treatments are being studied and in studies!
None the less, if you are healthy be grateful. If you know someone with a rare disease, wear your jeans (for genes, the faulty errors for those of us with genetic issues in my case the error falling to a single gene (4p16.3) which was something both my Parents happen to be carriers of)! And if you are like myself walking around with a rare genetic disease well then celebrate this day in some form or another as we are alive and though some or many days may be difficult we've made it so far!


ps a year ago earlier this week., I had heard from Dr.Bragg that she'd accepted the position in AZ at PCH. I can still remember how I felt, how many times my Providers said to me after that (and still say from time to time) they didn't know how to replace her and "there will never be another Neurosurgeon like her". Doesn't mean other drs. aren't good just that she was mighty special for her field!
Reading the various things I wrote that day and the days after was a little heart wrenching (I was so scared, undertain, afraid I think) but I also wrote that I couldn't wait for it to be a year from then honestly for the simple reason that things would be better settled, I'd know who my Neurosurgeon was going to be and almost above all I'd know or have a better idea of what things would be like. I am glad it in fact is a year now! I miss her terribly but she's thankfully has in fact kept in touch.
I'm working w/her former Partner now and though that's not always been the smoothest (I guess she just was a good listener, she didn't try to pretend she understood it all but she learned). - Things will get better with the Neurosurgeon I see now, he's told Dr.Bragg and I he's glad her and I keep in touch as she helps both of us. Above all I get it, he's just a different personality type than she was, but if he tries I can keep on trying to.
 Just forgive me when I get frustrated and when I feel like I'm banging my head on a wall. It's simply b/c I want to sort things out and most of all, above all I just want to feel better (head is pretty good, the leak makes a huge difference, it's the low to mid back radiating pain and the deep-again radiating pain down my R side and at times now when on my feet my L side as well. God has a plan, right?

Another year from now, God willing who knows what will all have occurred, what i'll be up to and what better things may in fact be an option or closer. God willing!
Thanks for stopping by,

ps It may be to late but wear your jeans or wear your blue!

Tuesday, February 21, 2017

Cardiology update, Neurosurgery, WORLD Mtng

Cardiology -
Due to some on/off (but very intermittent and very short lived thankfully) lightheaded/dizzy symptoms that started only in the past few wks or so (though before we restarted the Ivabradine)
Dr.Earing, my Cardiologist is concerned could our having restarted the Ivabradine post this 2nd Sinus Node ablation back in Dec. be causing intermittent episodes with the heart and abnormal pauses.  This concern is because of short episode(s) (ie a short run heart of heart block) I guess they saw on a recent Heart monitor (Zio patch) episode(s) occurring and should I be on this now?
We'll decide I guess based off the Zio patchc(24-48hr continuous EKG, records heart rhythm though 1 done since then was clear.  On the other hand I restarted the Ivabradine before these symptoms started and to heart rate while not drastically slower seems like it's pleasantly different.  Maybe that's a mind game on my part, who knows but even while the lightheaded/dizzy episodes which occur for a few mins. at a time, very intermittently are occuring the skipped or extra beats seem like they are improved. Who knows!

Dr.Kovach (my Heart Rhythm dr.) responded to an email I sent him updating on this all and he thought perhaps if symptoms kept on he'd want a 30day Heart monitor to see about any episodes over a longer period. I don't f/up with him until I believe May so we'll watch to see how things play out.

The Echo done at this last episode  showed a very slight improvement in the Mitral valve gradient which not significant but it puts the new valve back in the mild range vs. being moderate stenosis so if that where to stick (stay improved) that wouldn't be a bad thing!

Peds Neurosurgery F/up - few wks ago -
I seen Dr.Iskandar a few wks ago  which wasn't particularly useful (not the right word but can't think of what word I'm looking for)  and honestly the Medical Assistant had called a few days prior to confirm the Appt and say something about I'd need to schedule an MRI after the Appt (I forgot to ask Dr.Iskandar about that but assume he changed his mind as he didn't mention anything re doing imaging before next fup). This MA said he was planning for a 3mo f/up after the Appt. LOL, To that I just thought to myself  'so why am I going to the Appt if he has a plan in mind?' Needless in fact not much came off the Appt., I'm tired of saying over and over what an impact this is having on day to day life so was pretty quiet needless at the Appt though I made sure to emphasize to him this insn't normal, this isn't even entirely what Dr.Bragg and I dealt with after her and I 1st surgery together (symptom mirror then some but not all that much anymore. Hard to explain the difference).
Something I did realize just the other day, though of course several days after the Appt. is that a few years back Dr.Bragg had moved the Lumbar Peritoneal Shunt to drain from the Thoracic (mid) spine versus where it was in the lumbar spine and at that time I had virtually the same symptoms I have no including radiating leg pain, hip and significant low back pain and started in just 1 leg but spread to encompassing both legs after some time though 1 leg at that time always remained worse than the other to as it is now.
The only way I realized this was an old blog post, written about this same issue a few yrs (from this very blog =D ) was it showed up in my facebook timehop (a daily thing that shows up with memories from that same day the past 5-6 years). Needless I asked Dr.Bragg about this and she to felt I should mention it to Dr.Iskandar as he from what I remember placed the LP Shunt so it starts in my low back but the tip ends up in my mid (thoracic) spine now to.

Gawd I hope he will listen!!!!! Hi Secretary when I had called to make the f/up Appt last wk made an Appt for 1mo from now not the 3mo Dr.Iskandar had recommended and she just said if by some chance things are improved (that would be AWESOME!) then I should just call her back and she'd reschedule. Hey, can we can hope but I appreciate she also is insightful!

WORLD Meeting - Injectable anti-inflammatory study.
Otherwise I was in San Diego last wk for the yearly WORLD Mtng., which is 1 of my favorites to attend and was good. A few studies either started or will be started including one looking at a arthritis (and several other indications) injectable drug which is being studied by an Endocrine dr. formerly of UofMn and now at Harbor UCLA in CA. She's helped my Endocrine dr. and I a few times and a genuinely nice doc.
Last summer or so they did a small study with this drug of which I had been asked if I would want to participate but there was a lot going on here with heart and shunt stuff so I chose not to. Things now are a tad smoother so I have already talked with this dr. more, sent her several test results they'll need when looking at if Pts (myself) qualify and b/c they just got a new round of funding (yay to the Foundation I work for!) she expects they may be up and starting again in May. She'll keep me updated which I appreciate (b/c I know these docs and doctors in general have a lot else to do besides just update interested Pts like myself!
This would require initial travel to CA at study start and then any addt;l travel if there is any I believe is limited to the end. I may not be remembering that completely correct but I know the weeks during after initial enrollment they mail the drug to Pts.

Otherwise I did a photoshoot with Levi of 'Living in the Light of Rare' Foundation, whom photograps Pts, tells their story and has displays of these pics and stories at various Pharma/Biotech mtngs. These are used to raise awareness but also to give Pts a voice. The photoshoot took us to the Bay area of San Diego (about 20-30 mins from our hotel), and various area around there incuding some cliffs (maybe not the right way to describe), Navy ship area and to lighthouse on the Bay. Was fun, exhausting and so well cool! Some of the pics attached either I or Levi took with my phone but he'll send me the ones he took when he has them set (edited maybe or downloaded, not sure). Either way was really rewarding! We had dinner afterwards and he humored me by going to a more basic food place (Cheesecake factory) vs a (I think it was but can't remember for sure) Mexican restaurant (I have nothing against this particular one just didn't seem to have any basic items.
The night before that I'd had dinner with the Foundation I work for and with the CEO and Study Coord. for another study that is on-going using the Aldurazyme (drug I receive every wk) reformulated to cross the BBB. Was informative and interesting as well as the 2 people where extremely down to earth to talk to!

Will keep things updated here on any given 1 of the above on-going issues or study,
Thanks for stopping by,


Monday, January 23, 2017

Shunt / Heart updates

Sorry for not update on recent Appts and frankly life (although I guess I don't often share much about my day to day-fairly boring (but good to me) life! Sometimes I feel like wrting but then I don't actually know what to write about or to be more apt (is that the right word?!) I know what's on my mind but to tired to really be able to put it in to words! That has been the case for sure the past few wks.
Cardiology  / Heart Rhythm
I guess i'll start with the Cardiology and Peds Neurosurgery Appts I had last wk. and see about the rest.
Cardiology was ok, nothing to much as we didn't do an Echo this time (repeat in June), the next heart monitor will be in June as well  with joint f/up Appt with both Dr.Kovach and Dr.Earing, basically to con't to monitor the newest valve (some (moderate) stenosis (narrowing) in the new valve but nothing that my Team seems to alarmed about. We'll also con't to monitor the post heart ablation rhythm and brief run of  heart block episode(s).
 Dr.Earing along (apparently) with Dr.Kovach decided to stop the Digoxin, this having something to do with the episode(s) of short heart block on the heart monitor and if I understand right Digoxin may have some or could have some affect on that area/potential issue? Non-the-less, although I'd love to
I wont complain about stopping it (I take numerous heart meds so one less is awesome!). =) Even with getting off the Ivabradine last month and the Digoxin now I still take numerous other meds for heart (Lisinopril, 2 different meds for fluid (Lasix, Spironolactone) to get fluid off/keep fluid off heart and lungs and baby aspirin +Lovenox injection (blood thinner).  At some point we'll likely re-add the Coumadin, go back to just doing Lovenox before surgeries/procedures.
Needless the 3rd Open Heart Surgery was a year ago, Jan 21. Seems hard to believe at times!
Spinal fluid / Shunts
Our biggest issue here is the lack of spinal fluid in my spinal canal due to the 2 shunts (1 in spinal canal, 1 in my brain), the lack of CSF b/c of these shunts and secondary (per my Nrsgn) severe Arachnoiditis (having to do with scarring I guess) which affects CSF flow and (I guess if I have it right) the spinal fluid (CSF) being less there is less of a cushion to the spine/spinal cord. This scar tissue in turn causes inflammation if I understand correctly which causes more scar tissue.
Lack of Spinal fluid within the Spinal canal due to the shunts and Spinal fluid leak (CSF leaking out due to CSF leak in low back) and aggravated by the severe scarring/narrowing (Arachnoiditis per Dr.Iskandar) could be the  cause of irritation to the nerves this causing radiating pain (and maybe cause of the severe low back pain when standing?).
Needless I still feel the valve and reservoir sitting on my low back (under the skin, located low back) is not helping irritation or inflammation at all.
It's always worst when I am on my feet and is minimal discomfort when I am sitting back either very straight posture (but then very difficult mid-shoulders, a radiating pain).
I could KICK myself for not sticking to our original agreement to put the valve and reservoir to sit on my side, along the LP Shunt again! I HATE this! And the leg/low back pain literally takes my breathe away quite often.
Non-the-less will try to update soon,
Thanks for stopping by,

Saturday, January 14, 2017

Heart monitor ? LP Shunt ? = Watch and monitor/see

Sorry for the last update being so lack of info - not much to say other than I've been home from the hospital now about a wk and honestly hasn't been horrible but definetly hadn't been great either. I stayed with my Parents up till yesterday so a little less than a week and now back at my Apt. Stitches came out Thurs and I f/up with Dr.Iskandar next Thurs.
Shunt wise what to even say? I talked to Dr.Bragg some to ask her about out prior experience with something somewhat (but not entirely) similar and got a little info from her. I appreciate she's willing to help and I appreciate my Neurosurgeon now has said to both her and I he is glad the 2 of us stay in touch as it helps him.

I don't really know why low back this time is so incredibly painful but then almost as soon as I sit I feel little pain/discomfort. It's not even just like a nerve pain but a full out throbbing, severe pain. Ugh I hope we can figure it out soon (very soon!) or that it just settles!

Heart / Heart Monitor -
I received the Heart monitor  (Zio (Heart) monitor) results from my Heart Rhythm dr. earlier this week and overall seems pretty good results w/a  average heart rate on that 48hr monitor around 86. That's down from 100s so a plus! It's possible we'll still add back a med specific to heart rate (we stopped the very specific Ivabradine after this last repeat-Ablation attempt). It's possible will take a bit of trial and error but something to help overall symptoms which for whatever reason seem like they've kept back up some from the improvements  we had after the 3rd OHS a year ago (albeit not every symptom completely went away after the 3rd OHS/Mitral valve replacement) thus why we tried to manage with meds and get heart rate down after.

There's a potential new issue with heart but something we'll just watch and average heart rate is in the 80s going up to 130s so not to bad compared to prior to Dec's repeat ablation.
For the HR increases he mentioned we could potentially try and beta blocker again (yuck!)  but no matter he'd like to give it a little time before considering restarting the Ivabadine (a heart med more specific to heart rate and heart failure).

The area he had some concern with (an area of heart block) that we've not seen on any prior heart monitors and he's unsure if is related to the ablation we just did or potentially from the last Open Heart surgery a yr. ago. It seems this new area/issue could also be a lesser common link between my MPS, the heart surgeries  (a lesser known or common issue in MPS Pts., doesn't occur from what I think I remember very frequent?) and just hasn't shown up on monitoring before.
None-the-less right now we just watch this "brief heart block" and monitor over time, watch or correlate to any symptoms and may (or may not depending if a consistent issue over time) require a pacemaker.
Heart block from what Dr.Kovach said is a "disruption in the normal communication between the top of your heart and the bottom" so for now we just monitor and watch and hopefully never need a Pacemaker. I know he's talked about it before but I can't even imagine how a Pacemaker, 2 programmable shunts (VPL, LP) work together (I'm sure they can just would be curious when it came to imaging (especially) I guess..

I follow up with my actual Cardiologist (Dr.Earing manages the heart valve and overall heart, Dr.Kovach monitors more the actual heart rhythm) next wk so we'll see what he has to say about it all. Both Heart drs. have kept up on the on-going shunt stuff.

Will try to update after that Appt later this week,
Thanks for stopping by,


Tuesday, January 10, 2017

(LP) Shunt Surgery update, Cardiology next wk.

Surgery itself went fine, I don't remember Dr.Iskandar saying anything much out of the ordinary other than the LP Shunt catheter had worked itself completely out of the spinal canal (where Cerebral Spinal Fluid is in the back) and the CSF was leaking only b/c of the hole in the spinal canal from this initial shunt having been put back in. I still have that leak so atleast head wise feel fairly good.

A relative lack of CSF (Cerebral Spinal Fluid, what bathes the spine) is what's causing the nerve pain especially down my R side and a tad difficult of walking. Sorry for lack of a real post!

I already typed up a post so re-doing this am going to make it VERY short. I f/up Thurs this week and site, where the fluid is collecting will be monitored over next few wks I guess.

I rescheduled Cardiology f/up today so that will be next wk now - following up partially from the Ablation done a few weeks ago.
Will update soon, Sorry for lack of information or real post,
Will try to do a real post after Thurs's f/up or after next weeks Cardiology f/up appt.
Thanks for stopping by,