Pulmonary, Hand Surgery

INR (blood thinner level) is thankfully low enough for tomorrow's surgery, arrival is 6:30.

It's defintiely been a crazy week since I last wrote last Weds about the Pulmonary Appt.
Friday I started getting the same coughing and side pain and chest discomfort all over again (it had been hugely, vastly improved even over the improvement since the VPS revision) and the cough that was incessant, occuring literally almost from the time I woke up till i'd finally fall asleep. The wknd was more of the same so at first I thought maybe it was just cold symptoms but didn't seem like it as I had no other real symptoms that would have made it seem that. Non-the-less a pretty not that awesome wknd! I did manage to have Zan (my nephew) spend Sat night, we went to Church on Sun (no Sun School during the holidays) and after I went to lunch with some Church friends. Not altogether a pleasant wknd!
Monday I was beginning to feel somewhat better, the cough was easing up and side pain to so I do think it was just the shunt and my body was fiiinnnaaallllyyyy deciding to catch up on absorbing whatever fluid had drained/or was sitting there.
B/c of Thurs's out-pt surgery (3rd carpal tunnel release in L hand, tissue/muscle graft) my PMD was a little concerned so I gave Pulmonary a heads up. They in turn made an Appt for today with Dr.Biller's NP as they where concerned it was fluid getting worse (I had let the Nurse know yesterday when I was talking to her I thought the symptoms might already be starting to improve) so Xrays where re-done and Appt went fine. Same R side lung is reduced breathe sounds but otherwise the Xray looks a little better still than even last wk. as she said the area was expanded and she couldnt really see any fluid I think is what she said.
Maybe it's just going to be a matter of when fluid accumulates I get symptoms and they come and go (damn will that be annoying) I don't know. Hopefully if that is the case it isnt always as bad as this last wknd was!?!?!
Thankfully ERT running at 5hrs does seem to make a difference to, the cough still ramps up some but not as significantly as it would when we did 4hrs.

Headaches have been a little worse in the last 3-ish days but nothing I can't live with yet - mostly the mornings. The NP asked me today how I knew when the fluid was better (I had said something how I figured there wouldnt be much if any change on the Xrays and that I suspected it was improved from the wknd) and I said "Because I have varying degree of headaches", the look on her face was priceless! She in turn responded though, "that makes sense, I wouldnt have thought of that". =) This is just b/c the shunts to tend to drain better the longer I am up, so I typically wake up with a headache but somedays are worse than others.

As far as this surgery I have to give kudos to the Hand surgery Team BUT most especially to my PMD who does seems to be amazing at coordinating what she feels should be done and for reaching out to Providers when she feels we need more information or answers. Thankfully as I wrote at the top the INR was low enough (1.31, they wanted it 1.5 or below today) as otherwise we'd (per Cardiology) have had to reschedule. Per the Nurse in the out-pt surgery Dept. it was written in my Hand Surgeon's notes to give Vit K. should INR have been higher so it seems everyone likes this med except my Cardiology Team!
I asked my Primary dr if she thought there could be periods where there was no CSF in the Pleural Space (I think thats what todays CXR showed or even less than last wk and the area expanded more) or why she thought it might cause intermittent symptoms. Part of her response: "I would expect some fluid in the pleural space from your pleural draining shunt but the quantity is the problem. I am not sure how much is normal and how much is too much. I would say your symptoms should help drive the answer (cough/ chest pain/shortness of breath). Likely too much fluid. I hope that helps."
I'll try to update atleast a short update soon, will be harder since I am L handed and that is what this surgery is on. I know last time the splint was on for approx 3wks (or maybe it was 4, can't remember) due to the graft portion of the surgery. The things I do for various relief on various body systems!
Thanks for stoppingg by,
Erica