The Family

The Family
For Christmas 2010

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Thursday, April 22, 2010

VP Shunt Revisited

Where to put Nathan's shunt?  That was the $1,000,000 question. 

We had learned from experience, both sad and scary, that Nathan's little body did just not appear able to absorb large amounts of CSF.  Since both the VP and the VPL shunts had failed and with the VA shunt still out of the question, that meant that we were quickly running out of good options, which was more than frustrating. 

Add that to the fact that it had only been another 36 days since the last shunt revision and top it off with how much we were opposed to the shunt back in December and the situation was just becoming more and more and more disheartening all the time

However, Dr. Riva-Cambrin was slightly more optimistic than we were.  He believed that the main reason Nathan's body was having trouble absorbing all of the fluid was because of all of the scar tissue.  And it seemed like a reasonable explanation to us because, well, let's face it: Nathan had a lot of scar tissue!  So the good doctor wanted to give the VP shunt another try, but with a slight twist.

On one of Nathan's x-rays or CT scans, Dr. Riva-Cambrin noticed that there was likely a spot that he could put the distal end of the shunt on the far right side of Nathan's abdomen.  It was a place with no scar tissue -- really the only place on his abdomen that was scar-free --  to impede the re-absorption of the CSF.  It all made sense to us, so we thought we should go ahead and do it.

So Dr. Riva-Cambrin checked with the Dr. Scaife, the surgeon who had done Nathan's CDH repair 7 months before, to see if putting the distal end of the shunt there would be a viable option.  Dr. Scaife agreed that it should work there and agreed to assists Dr. Riva-Cambrin with the surgery, since it was not your typical VP-placement shunt.

So for shunt surgery #3, the first thing they did was to drain Nathan's pleural cavity off the excess fluid.  To do that, they opened up the incision behind Nathan's left ear, disconnected the shunt and basically used the tubing to siphon out about 95% of the excess fluid (that's all he could get out).

Dr. Riva-Cambrin then ran new tubing under his skin, across his chest over to the far right side of his abdomen, where Dr. Scaife made an incision to find a place to put Nathan's shunt.  Apparently Nathan's intestines were jumbled and somewhat "sticky," but unscarred.  Dr. Scaife unstuck the intestines a little and they found a spot behind his liver where they could tuck the distal end of the shunt that looked like it would work perfectly.

As usual, we had been waiting in the Waiting Room during the surgery.  As Dr. Riva-Cambrin walked in following the surgery, the smile on his face let us know that the surgery had gone as well as, if not better than, planned.  Just seeing the smile on his face made Bekah want to get up and dance before he even told us how it had gone.

He let us know about finding the spot behind the liver and how it was about 10 times bigger than the spot he had placed the first VP shunt.  So he and we were all very optimistic.  And by my math, 10 times bigger meant that it should hold 10 times as much and last 10 times as long.  So to me 10 times 9 weeks for the first shunt meant that we should be good for quite a while.

1 comment:

  1. I think you need to publish your story....I get enthralled every time. I love it, but more because I watched from a distance as you guys were going through this. You guys are so brave. God knew what he was doing when he gave you that sweet spirit.