Friday, March 14, 2014

Revision, VP Shunt catheter, UWHC Sugery update

Surgery started about 10:30-11 this morning and I don't think took very long but to be honest I also don't really remember what time it ended or what time I woke up from anesthesia. For the surgery Dr.Bragg had come by my room up on the floor earlier, before I went down to pre-op and talked a little about what she was thinking and what her thoughts about this issue had been over the past 12 hours or so. She was wavering between a few things but ultimately decided it would be best to go in, open up the exposed area of the incision and re-tunnel the catheter further down and then post-surgery do PCA (pain) pump and antibiotics + send me home on antibiotics.
The 28th, which was our original surgery date to trade out the current bigger sized TPL Shunt (programmable) valve and replace it with the smaller (but otherwise exactly the same minus having a reservoir to tap (draw CSF off of, test shunt function) Codman valve which would be more in-line with the catheter in my back-to-side and our hope is it will be less noticeable when I move, sit back, bend down, etc. I hope!!!
I am praying ever so much God will answer this prayer and this valve will work more finely with my body type, comfort wise! I almost feel guilty admitting I have been asking in my prayers for God to guide Dr.Bragg and myself in this surgery the 28th, that the valve may be more fitting and comfortable.. That surgery b/c it would require both being on my back and (I think) side or stomach to access both incisions for each part of the surgeries will be general anesthesia (honestly makes me feel more comfortable than the very rare occasion we use sedation as I've known to many who ended up trached when sedated surgeries went awry and the Anesthestiologist then couldn't get a secure airway.

Needless worry you might say but in our community, no matter how confident a Anesthesiologist is ones airway can change drastically under a stressful situation and when ones airway is already tend towards being difficult to access... I tend not to worry as much about the things I can't control, I believe you do what you can to prepare, educate and be aware but you can't let "what could be" rule your life. I still believe that applies when it comes to Anesthesia but I do think for airway and surgeries, it's soooo important to reiterate over and over (even if your feeling blue in the face find a different way to get the point across!) as this is an issue that has caused tremendous issues for a lot of MPS I Individuals.
The reason I say any of this is b/c I felt like I was perhaps beginning to perhaps be annoying or something, it's not even that the Anesthesiol made it seem that way but I also don't think he was completely, really getting what I was saying and instead was just trying to placate me; anyone who knows me knows I HATE when people say something they think you want to here! This all said I didn't dislike this dr and have had him once or twice before, more I just wish he would have sat back and listened for a minute or two without clearly already having a response on the tip of his tongue! I did understand what he was saying but I think very few Anesthesiologists understand how from one surgery to the next and back our airways change ie one day is a relatively 'simple' access, the next day may be extremely difficult (Dr.Taylor at CHW pointed this out and explained it VERY well in her experience w/my airway and 2 OHS how different each experience was!)

The Solu Cortef was given 30mins prior to surgery and Plasma (2 bags) which acts as a quick clotting agent to counter act the Coumadin (and high INR) was given as well starting about an hour before surgery and continuing to run in via the Port/second line after I was asleep and surgery started. This is given to bring a to high blood thinner (INR) level down to a safe for surgery range so a patient doesn't bleed out on the table especially in some higher blood access surgeries.
The ice is the best at the moment actually at semi-numbing the surgery incision area, my headaches, un-related to this surgery (but I do think VP Shunt related) have been on and off all day but probably just seem worse b/c of no sleep over night and thus really tired today between not a lot of sleep Weds into Thurs and then no sleep Thurs in to Fri + the anesthesia. Unfortunately the IV steroids probably won't make for great sleeping tonight either as the next post-surgery dose is 12 hrs post-op, so roughly between 10-12pm tonight and steroids have an odd side effect of amping a person up without actually giving you a real energy boost (atleast for me!)
I almost always request not to have the pre-OR rm sedative (makes me feel really weird, makes waking up from actual anesthesia much harder) so when in the OR, on the table while everyone was doing their thing, prepping, confirming information, hooking up monitors, etc. the Anesthesiol. jokingly asked me my MR # (which I don't know), but Dr.Bragg standing to my L piped up and recited it by memory, "b/c I say it so often dictating your notes"! WOW! =) Made for a good laugh while going off to 'dream land'.

Labs look good so far, in the past CSF infection has showed up as late as 5 days on several occasions! But as long as CSF cont's to stay clear (would be a good thing on all of our parts, a reason to mini celebrate I think!?) we will be able to wait to completely move this VP Shunt valve (Dr.Bragg plans to also use a smaller profile one than is currently implanted, less prone to breaking down the skin) to the L side during the other surgery for the TPL Shunt the 28th. =) I am celebrating in a joyful way at least that so far all labs are looking promising and that part one of this un-expted surgery for the VP Shunt was a success today! =)
Visitors tonight (my Co-Sunday School Teacher, and the other is my PM Nurse, Evey)

I'll update again when or if there is any news,
Thanks for stopping by,
Erica

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VP Shunt, Admitted to D6-4 (Neurosurg.) for catheter

Just a really quick update (i'll update when I have more information) that while twirling my hair absentmindedly (I was working and finishing up my Sunday School lesson for Sunday) =/ I realized not only did the area around my VP shunt feel damp (I admittedly hadn't even changed out of my pajamas much less gotten through the shower despite it being mid/late afternoon) but the VP Shunt felt like it was really close to the surface, similar to when my hairstylist found it exposed back in Dec.

I know this had to have happened sometime in the last week as Lindsey (hairstylist) even commented last wk that the shunt site looked really good and no catheter was visible!
I rarely use a comb much less a brush in my hair (finger comb it if anything) so that wouldn't be what caused this, I just am not sure what would. =/ If anything the skin must just be tired of having a catheter underneath it and so many surgeries over the past 2 1/2 years? I don't know? =(
I was able to see semi-well enough via a camera pic (hard to bend my neck enough fwd to see at the angle my shunt is in the mirror) that the catheter was in fact poking through the skin again in a semi-small area. Not entirely sure what to do I called Neurosurgery on-call and the Resident paged Dr.Bragg. She apparently had seen a pic I posted on fb as she knew right away when the Resident paged her about me and she told him to direct admit me + to tap the shunt, (draw off CSF) run blood labs, and start IV antibiotics as a precaution. She or the Resident even called admitting to let them and Security know I was to bi-pass the ER and to have them just send me up to D6-4 (neurosurgery) + have a room assigned to me. The Admitting ofc called me shortly after I talked to the Resident to pass along some of this information to. I guess that was a small consolation for having to come back up here? =/?

Some of the very sweet Nurses always make it a little better and one of my favorites got assigned to me, she said to me shortly after I got here "We are always happy when you are here", not that they want me here just that they like having me I guess. :) After a semi-rough wk with some really mean comments from 2 different people (but a TON of really sweet comments ro refute those other 2) Evey's and the Nurses comments really meant ALOT! I always wonder if people know how much their kind words and actions really mean?

On a different note and I don't think related (but I also don't know) for the past few days and especially today I have been having a strong discomfort (but isn't something I would describe as pain) in my mid/upper spine, actually kind of near where the valve is but not centered there) and up to my shoulder/across and goes almost feels like right through my body to my inner core and can especially feel it with breathing. Has been really odd but I have no idea what is causing it/what it would be from! Who knows sometimes!

In any case I have no idea what the plan is, ie the labs look good so far so per the Resident he said Drragg wasn't sure if she was going to do like last time treat with antibiotics for a bit and send me home (would mean I could probably go to Mn for the study as scheduled next Weds-Fri and keep the Cardiology Appt on Tues) + bring me back on the normal surgery date (to change the TPL Shunt valve) on the 28th or will she want to do the surgery sometime sooner while I am still admitted this time? It is an infection risk with the shunt exposed but antibiotics can offer some protection so I am not sure yet!
Stay tuned, will update when I hear from her,

Thanks for stopping by
Erica