1985, Part II

Well, like most 3 year olds, I was running around crashing into things. From what I was told, my family and I were out of state on vacation. I was running around and crashed head first into the corner of a table. This turned off my shunt. My body went limp and I was unconscious. We returned home to the hospital to have another revision: 

Veronica is a 3 1/2 year old female who did well until recently when she had a VP shunt replaced approximately six weeks ago. The course over the last 48 hours, however, she once again developed headaches, nausea, vomiting and lethargy. Was taken by her mother to the hospital ER where the tap of the shunt revealed no spontaneous flow of fluid out through the Richham reservoir Fluid could be aspirated with a syringe. A CT scan revealed frank ventricular dilation and there fore the patient was taken to surgery this morning for a revision of her shunt. 

DATE: 11/1/85 

PROCEDURE:

 Operating Suite, anesthetized, intubated placed on the operating table in supine position with her head slightly turned toward left shoulder. The right and left sides of the head were shaved, prepped and draped. A curvilinear incision straddled the cornal suture was made on the left side of the midline, carried on down to the skull. 

A single burr hole was placed in the intrapupillary line just rostral to the cornal suture on the left side. A ventricular catheter was placed into the left front horn on a single passage with the return of clear ventricular fluid under high pressure.

The ventricular catheter was connected to a Rickham  reservoir and the Richham reservoir connected in turn to a medium pressure anti siphon containing Heyer Schulte device. The connections were secured with a 2-0 interrupted ieurilon ties. The old right frontal incision was reopened. The Richkam reservoir disconnected  from the ventricular catheter and there was no spontaneous flow of fluid. The holter valve was drained up into the wound and disconnected from the abdominal catheter and the manometrics into the abdomen tested and found to be satisfactory.

The spring distal abdominal catheter was then connected to the multipurpose device and secured with a 2-0 interrupted neurlon tie. The ventricular cathether on the right side was removed. Wound was irrigated with saline and bacatracin solution. The wounds were then closed in layers from inside out utilizing 3-0 interrupted Dexon sutures and 3-0 running ethilon sutures in the skin. Standard dressing was placed on the wound and the child was taken to the Recovery room in satisfactory condition. 

 I remember hearing the surgeon say 'Oh she just turned off the valve, we'll reset it.' Next thing I knew, I was awake in the hospital. 

1985, Part I

In 1985, I was 3 years old and my shunt became obstructed: 

10/9/85 

Postoperative Diagnosis: Obstructed and distracted ventricular peritoneal shunt.  

Operation: Right Ventricular peritoneal Shunt, Removal of Old VP shunt with abdominal alparotomy for removal of abdominal catheter. 

Note:

Patient is almost 4 years old and underwent VP shunting at birth.  She has done well until just recently when she had some headaches and recently had a CT scan which revealed essentially normal size ventricles and intracranial pressure of approximately 200. She was sent home to be watched by her mother and then returned on this date, approximately two weeks later complaining about pain in her head, abdominal pain with nausea, vomiting and lethargy. Richham reservoir was tapped and no fluid could be obtained. 

A shunt series revealed the abdominal catheter was completely contained within the abdominal cavity, Patient, therefore underwent a repeat CT scan which revealed dilated ventricular wire cath and patient was taken to surgery for replacement after removal of the old VP shunt. 

OPERATION:

Patient was brought to the OR Suite anesthetizes, intubated and placed on the OR table. The old curvilinear incision in the head as extended. A brand new burr hole was placed. A flange barium ventricular catheter was placed in to the right frontal horn with a return of clear fluid. 

The old Rickham reservoir and ventricular catheter were removed from the old site and the new ventricular catheter connected to the new Richkam reservoir which was connected in turn to a medium pressure Holter valve (mannometrics tested prior to placement).

A new abdominal incision just below the old one was lateral on the right side of the abdomen. A brand new spring distal low pressure abdominal cathether was brought up to the abdominal wound up to the head by the means of two stab wound incisions and a subcutaneous tunneler device. The peritoneal and posterior sheath were closed with a #4-0 interrupted Nurolon suture except in a small segment in which a purse-string suture was placed around the catheter which was in the abdominal cavity.

The wounds were irrigated with saline and Bacitracian solution and then closed in layers from inside out utilizing #3-0 interrupted Nurgulon sutures. The skin was closed with #4-0 running Ethilon sutures. Standard dressings were placed on the wound.

The child was taken to the Recovery Room in Satisfactory condition.  

I was discharged and sent home. 

I had to return to the hospital six weeks later.... 

 

1982

Time to take a look at previous shunt revisions. Beginning with the first one. I was born three months early in December 1981. I was not expected until March 1982. In May 1982 when I was 7 months old, I had a brain bleed ( which is common for preemie babies) I wouldn't stop crying. My pediatrician couldn't figure out what was wrong. I eventually had a seizure and was rushed to the Emergency Room:

The following is the operative report and diagnosis:

Surgical Operative Note   

Date: 5/7/82

Operation: Right Ventricular Peritoneal Shunt

Post Operative Diagnosis: Hydrocephalus

 Anesthetic: General Endotracheal Utilizing Halothane

Procedure:

The patient was brought to the operating suite, anesthetized, intubated and placed on the operating table.  Head was turned toward the left shoulder. Head, neck and abdomen were suitably shaved, prepped and draped and then a curvilinear incision in the intrapupillary line just in front of the cornal suture on the right side was made through skin carried on down to the skull. 

Small craniectomy was performed. The dura was coagulated and divided as was the pia archnoid. a Rickham ventricular catheter was placed into the right lateral ventricle in a single passage and connected to a standard Richkam Reservoir which was connected and turned to a medium pressure spring distal abdominal catheter.

 The spring distal abdominal catheter was brought by means of a subcutaneous tunneling device down to a skin incision which was made just above and lateral to the umbillius on the right side of the abdomen.

The abdominal incision was approximately 5 cms long. It was made through the skin, carried on down to the anterior rectus sheath and peritoneum were opened sharply whereupon a spring distal abdominal catheter was placed into the abdominal cavity. 

 All wounds were irrigated with Bacitracin solution and then the posterior sheath and peritoneum were closed with a #4-0  suture of neurilon. The anterior sheath as closed with #4-0 dexon sutures and then the subcutaneous tissues and the gale were closed with #4-0 interrupted dexon sutures. The skin was closed in all instances with #4-0 ethilon sutures. 

Standard dressings were placed on the wound and the patient taken back to the Recovery Room in satisfactory condition.  

Dictated by M.D. 

D: 5/10/82

T: 5/11/82 

I am not the first or last person to have major surgery at such a young age. From what I've been told, after I had my first shunt was placed, I was the happiest baby ever. Nothing bothered me again after that. 

The next revision would be when I was three.... 

The Timeline Series is a good review of things that were going on in 1982. 

New Images

I had new X Rays and CT scans done to make sure everything is working. The imaging 

in these scans is different from the ones in 2023. The 2023 X Rays weren't as bright.

X Ray Image of Shunt October 2023

Report below as follows

 

 

 

 

 

 

My VP Shunt X Ray April 2025. 

 

EXAMINATION:

SHUNT SERIES

CLINICAL INFORMATION:

 Baseline shunt series for patient feeling well with vp shunt Z98.2 Presence of cerebrospinal fluid drainage device.

TECHNIQUE:

AP and lateral views of the skull, chest, abdomen and pelvis

COMPARISON:

CT head dated 11/29/2023. Cervical and abdominal radiograph dated 10/18/2022.

FINDINGS:

Right frontal approach ventricular catheter traverses the soft tissues of the neck, chest wall, and abdomen and enters the abdomen with distal tip in the left lower quadrant. No kinking or discontinuity of the shunt is identified. An additional abandoned catheter projects over the soft tissue in the right neck and catheter coursing below the diaphragm with tip projecting over the right mid abdomen as before, unchanged.

*Abandoned catheter refers to the original distal catheter from a 1993 revision that couldn't be removed during the 2nd surgery in 2014. The distal catheter had been in place for 26 years and had fused with my body. Therefore, a new catheter had to be added.

IMPRESSION:

Right frontal approach ventriculoperitoneal shunt without evidence of kinking or discontinuity. Other findings as above.

 

CT Scan of Shunt April 2025. Reminds of my cantaloupe....
My shunt is the little white dot. I'm not sure how they can tell I have slit ventricle syndrome. I didn't have slit ventricle syndrome until my shunt was moved to the wrong side of my brain in 2009. 

11 years and a Blue Octopus

 This week marks eleven years since surviving multiple brain injuries in March 2014. I needed two surgeries to fix my shunt. The incompetent neurosurgeon at the time didn't listen to me when I told him I needed the entire shunt repaired the first time. I had a 2nd shunt revision surgery in May 2014. 

I am both grumpy and grateful. Grumpy like the blue octopus on the right. Like many people living with a chronic illness and chronic pain most of the time...It reminds me of this scene from The Avengers (2012).

My incompetent neurosurgeon reported I only had a stroke. The resident doctor working with him in the Operating Room ("Dr. 2") reported I had multiple brain injuries. Now why would the surgeon only report I had one stroke? Denial is not a river...

Let's look at resident doctor's operative report from March 2014:

Patient is status post VP shunt revision with removal of the left frontal approach ventricular catheter and placement of right frontal approach ventricular catheter with the tip near the formen of monroe to the anterior third ventricle.

There is an expected postoperative pneurocephaly, Interaventricular air within the frontal horns of the lateral ventricle and subcutaneous emphysema within the right frontal scalp.

There is a focal hemorrhage in the region of the left thalmus measuring 7x10 mm at the site of the tip of the prior ventricular catheter.

Acute 5 mm intraparanchymal hemorrhage in the right paremedian pons has developed since 2/22/2014.

The size and configuration for the ventricular system is similar to the prior exam. No hydrocephalus. No depressed calvarial fractures. The visualized para-nasal sinuses and mastoid air cells are unremarkable. 

This critical result value was discussed with "Dr. 2" at 4:45pm on 3/6/2014 with feedback verification. 

Impression:

1. Shunt revision as described above.

2. Focal acute 10 mm hemorrhage in the left thalamic region with a component which may not be intraventricular or intraparaenchymal.

3. Focal acute 5 mm intraparanchymal hemorrhage in the right paramedian pons has developed since 2/22/2014.

"This critical result value was discussed with "Dr. 5" at 4:45PN on 3/6/2014 with readback verification.

Resident Radiologist. Attending Radiologist. Finalizing Radiologist. Transcribed date: 3/6/2014 14:32. Finalized Date: 3/6/2014 17:05. 

While in rehab in inpatient therapy, I learned I had more than one brain bleed while listening to a conversation between my physical therapist and the neuropsychologist. The physical therapist knew I had more than one bleed - My right leg would cross over the left leg. The neuropsychologist was confused by her comment as he said. 'She only had a stroke." (as reported by the incompetent neurosurgeon) Where she replied "No she didn't. She had more than one bleed. I can tell because of how her legs are moving."

When I got out of inpatient rehab and started outpatient therapy I ordered the reports.

In 2015, I made a film about this to spread awareness about hydrocephalus and brain injury. I was also angry about what happened. ( no reason, right?)

My film, Shunt Chronicles My Brain, Art and School (2015) turns 10 this year...

I am not famous, I am a starving artist with a chronic illness. Creating art, reading, and listening to music is just one of many to cope with chronic pain and past trauma. The good news is today, I feel better than I have been recently. That's all I'm saying for now.  My shunt is like an unruly child sometimes...

Like every year, I have a piece of cheesecake ( see right ) to celebrate surviving and not having any additional surgeries since then. This year, I've been shunt revision free for 11 years...

 

 

 

Strabismus!

Recently, I've been playing specific NES or SNES games just for the soundtrack. Like Castlevania II and Megaman X. Also, when I'm not feeling well, it's fun to play Mario 2 just because I can throw vegetables.  I've added board games to my list of things to do as coping mechanisms. The Simon game  is fun ( for short term memory ). The flashing lights on this game may make it not suitable for all people.

This year is 10 years since having strabismus surgery to correct my eyesight after my brain injuries in March 2014. After my injuries, my eyes were crossed and I had double vision for a year and twelve days. I couldn't have surgery to correct my eyesight until March 2015. This was because the surgeon needed to wait a year to see if there is any improvement on it's own before operating.

I was told before the surgery, there would be a chance the doctor couldn't get my eyesight back 100%. That there was also the possibility I would need additional surgeries through the years to maintain my eyesight. Since 2015, I haven't needed to anymore operations on my eye. I do get occasional double vision and my right eye (surgery eye) hasn't drifted to the right in a long time. I am grateful for this.

 I continue to have shunt, scalp and eye pain (needle like pain in eye) associated with both my injuries and unruly shunt.  After my strabismus surgery, the surgeon said to me: 'If your your eye drifts too far to the right and falls out, let us know. That means something is wrong.' Some may find this comment odd, I found it funny.

 

vitamins and then some

 I been prescribed a variety of medications from my neurologist for the chronic pain I have experienced from my injuries in 2014. Nothing worked in alleviating my head and shunt pain issues. I recently started taking an extra magnesium supplement when I have chronic head pain. The pain is from the injuries I had in 2014. In 2009, when my shunt was moved the 1st time - It caused a chiari malformation by my cerebellum. Since then, I get headaches in the back of my head. After my injuries in 2014, I have pain on the top of my scalp (both left and right side).

Taking an extra magnesium was recommended to me after a visit to a local vitamin store. This helps alleviate my the chronic pain in my head. However, it doesn't stop the shunt, distal catheter or occasional nausea.  The pain relief is temporary. I take the extra supplement when I need to.

At least this is an improvement. Magnesium and chronic pain article.

I asked my neurologist for a referral to see a neurosurgeon. I have questions I would like to ask the doctor. I also wanted to establish a relationship with the hospital and get a 2nd backup neurosurgeon. In 2009, I had surgery and my doctor wasn't available. I was given the next available doctor and my shunt was put on the wrong side of my brain. I almost died.

I haven't see a neurosurgeon since I fired the last one in 2014. 

Since it's October and almost Halloween, I decided to introduce my cat to The Twilight Zone. He falls asleep. It's a good distraction from my occasional shunt issues.