I started writing this blog in 2013. In the spring of 2013, I started a Master's degree in Social Work. Because of what happened with my shunt in 2009, I decided to stay 1 to 2 months ahead of my homework assignments out of paranoia. This way, if I needed surgery and/if would be out of school for 3 weeks I would at least be caught up by the time I returned to school.
In August 2013, I was standing up and felt a vibration throughout of spinal cord and head. I almost fell on the floor. This only happened once. The vibrations in my head continued though...
I saw Dr. I and told him about this and he said the following:
'"If it continues to happen in December, we'll fix it."
Now he was having me do a X Rays like every three months. I'm surprised I didn't glow green from the radiation.
At that time I was starting to loose my appetite.
Anytime you have a lack of appetite and vibrations in your head and you have a shunt it is a medical emergency. Why? Because it means the shunt could be broken.
I had more tests done and Dr. I didn't know what to do.
In the middle of February 2014 I had an MRI because things were getting worse. The radiologist had mentioned there was a 5ml stroke developing on the right side of my brain. I didn't know this at the time.
When I saw Dr. I again at the end of February, I had insisted that I needed surgery.
VB:" I need to have a full revision. It's suppose to go on the right side."
*I had never had this thought prior to seeing him, I just blurted it out. I suspect it was divine intervention or my late grandmother whispering in my ear or something...
Dr I - "It is on the right side."
VB: "No it isn't. You need to fix that."
Remember, in 2011 Dr I had moved the valve to the right side and left the distal catheter on the left side.
Dr. I - "I've done a million of these surgeries and I know when shunts aren't working."
VB: "I'm sure you're very good at what you do. I've had this in my body since I was a baby and I know when it's not working and you need to fix it."
More divine intervention.
Dr. I - "You could have a stroke."
I realize now he was saying this because of the MRI results.
VB - "That's the risk for any surgery."
Dr. I - "Ok. We'll schedule surgery for March 6."
My mother and I had brought in my x rays from 1995 (I was 14 at the time) We wanted him to see them and as soon as we mentioned this he said:
Dr. I - I don't need to see those."
VB and Mom: "What do you mean?!''
Dr. I - "I don't need to see those."
He literally put his hand up before we even took the x rays out of the envelope. Prior to the use of digital imaging -You were given the actual X Ray images on large sheets.
Again, I realize Dr. I ( Dr. Incompetent ) didn't want to see them because had we been able to compare the 1995 images to the February 2014 ones it would have been obvious something was wrong.
When I was being taken into the operating room on 3/6/14 - I was talking to Dr. I for a few minutes asking about what everything looked like. He was confused as to why I would be curious about this. ( I didn't tell him or anyone I was making a short film about my shunt.) Next thing I knew - Everything went black.
I suspect my shunt stopped working at that moment.
Operative Report
Date of Surgery: March 6, 2014
Preoperative Diagnosis: Ventriculoperitoneal shunt failure
Postoperative Diagnosis: Ventriculoperitoneal shunt failure
Anesthesia: General Endotracheal Anesthesia
Estimated Blood Loss: 25 mL
Findings: Opening Pressure approximately 15 mm of water.
Complications: None *This was not true as we will see later..
Procedure:
The patient is a 32 year female who presents with signs, symptoms and radiographic evidence of slit ventricle syndrome. The patient had had increasing headaches and unchanged ventricular size on CT imaging. The patient underwent ICP monitoring and was found to have no elevation ICP verses headaches. Given these findings, it was recommended that the patient undergo exploration of her VP shunt under presumed diagnosis of a partial proximal obstruction.
Anesthesia: The patient was sedated and intubated without difficulty by the anesthesia service. Eyes were taped shunt after ointment was applied to prevent corneal abrasion.
Operative Technique:
We first began by disconnecting the valve from the distal catheter. Once this was accomplished, a manometer was then inserted. Once this was accomplished, attention was then turned to the left frontal area, which was then opened sharply with a #15 scalpel blade using a combination of blunt and sharp dissection as well as monopolar electrocautery. The left front bur hole was then identified. The ventricular catheter was then disconnected from the valve on the right frontal incision and minimal CSF was noted to be dripping. At his point, the neuroenddoscope was then brought into the field. The NeuroPEN was then navigated through the left frontal catheter and was found to be stuck; however, the ventricular system could successfully be navigated. Once this was accomplished, it was noted. However, there was slow pulsation of CSF through this cathether. Given these findings, we decided to proceed with a right frontal ventricular insertion using an 8 drill bit, a burr hole was then created in the right frontal region. Once this was accomplished, the dura was then bipolarized and incised with a #11 scalpel blade. The ventricular cathether was then inserted to a depth approximatley 6 cm. Brisk CSF flow was noted upon entry. Next, the NeuroPEN endoscope was then brought into the field adn the ventricular system was navigated critical landmarks including the right sided choroid plexus. formamen of monroe, and septal epllucidum were identified. The cathether was then inserted through the right formen of monro. The third ventricile catheter was left withing the third ventricle.
Next, the programmable valve was brought into the field along with a 10 cm anti siphon device. The valve was then connected to the distal cathether and then connected to the proximal cathether. The shunt was again tapped verifying the patency. The wound was then copiously irrigated with an antibotic solution until clear. Both wounds were then closed with sequential 2-0 Vicryl suture followed by running 3-0 Monocryl suture for the skin. Sterile dressing consisting of Mastisol, Steri Strips, Telfa and Tegaderm and Coban was then applied. All needle counts, sponge counts and instrument counts were correct at the end of case x2.
Admitting Physician: Dr. I.
Signed by Dr. G at 12:15PM.
Dr. I had told my family while I was in a coma in the ICU that when they moved the distal catheter to the right side was when I had a stroke.
This was not true.
Dr. G the other physician in the OR had written the following:
The patient is status post VP shunt revision with removal of the left frontal approach ventricular catheter and placement of the right frontal approach ventricular catheter with tip near the froman of Monroe to anterior third ventricle, there is expected postoperative pneumocrephaly, intraventricolar air within the frontal horms of the lateral ventricles, and subcanous emphysema within the right frontal scalp, T=
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 cathether Acute 5 mm intraparenchymal hemorrage in the right paraedian pons has developed since 2/22/2014. The size and configuration of the ventricular system is similar to prior exam. No hydrocephalus. no depressed calvarial fractures.
Impression:
1. Shunt revision as described above.
2. Focal acute 10 mm hemorrhage in the left thalmic region
3. Focal acute 5mm intraparaenchymal hemorrhage in the right paramedian pons has developed since 2/22/2014.
When I woke up in the operating room, my entire body was stiff and numb. I thought when I died I would go back to a spaceship. (I like science fiction and I think I came from one.) Or I would see a white light or hearing music playing, maybe see a dead relative and there was none of that. I was just in this room with one eye shut closed. My right eye was pointed down and inward toward the inside of my left eye. I was able to move it out a little before Dr I came to me and said "You had a stroke you're going to rehab."
VB: (thinking) What?!
I was still confused about what had happened. I was trying to analyze the situation.
Moments later, my mom walked up to my left side and I told her the following:
VB: Everything is numb. Everything is numb.
Then everything went black (again).
While I was in a coma....I saw all these pretty swirling colors of green, blue, pink and violet. I learned later those were the same colors in the machine I was hooked up to.
Dr. I told my family the following:
Dr. I: "We did what you told us to do. At least she didn't have a stroke in her forehead."
Meaning that he was only following my instructions. Yes, having a stroke in my forehead (prefronal cortex) would have meant I wouldn't remember how to speak.
Why would Dr. I tell my family and myself that I only had a stroke?
I learned while in rehab, that I had multiple brain injuries during surgery...I would have surgery again in May 2014...
