Cerebral Shunt

Cerebral shunt well over one year now, sometime between 2022 and 2023, during this time frame I have documented her progress or failures in the hope that this on-hand observation will benefit anyone who has a loved one, going through the same journey, yes sir it is a journey at that and quite an adventure.

Another Birthday for Therese

When I left off Therese was nearing her 77 birthday, about three months shy of her 77 birthday, I had just taken her to see her physician for a six-month check-up, her x rays showed significant progress, and the surgery which was done to her head had been properly heal, this is a blessing indeed from Jehovah God

EMOTIONAL SUPPORT:

the most important weapon you will have in this venture it is emotional support. Whether you know it or not if you are caring for someone with hydrocephalus you are not alone there is an institution that you can reach out to for help, but the most important is the family and emotional factors for you and the family must be considered that is why sharing the responsibilities is recommended and needed. Regular feelings with your doctor will help them provide the best professional guidance for you, while the help of relatives and friends or other professional help may be necessary for moral support and what is best for the patient to accomplish this goal. Therese is gradually showing signs of loss of interest in our quality time together, she rather spends most of her time sleeping, She is having difficulties moving her right leg when walking, Therese's shunt is placed on the right side of her head. I will be updating this blog four months from today. Well, I thought I would have more to tell you, I thought Therese would decrease in capacity and worsen to the point of taking her back to the hospital, but that is not the case here, she shows me that only God can heal, yes readers and friends health-wise, she is just like you and me with her ups and downs, next month will be the anniversary of the shunt placed in Therese's head if the Lord is willing I will get back to telling you about her progress, may the Lord bless you all, continuing observation on her progress I have to report that Therese is doing quite well health-wise, however, she is deteriorating in her mental capacity, some of the new things portrayed at this time by Therese are. Her memory is failing she periodically stares into space while eating her meals She keeps the utensils that she has in her right hand, right next to her mouth, without any motion at all. She pokes at the food item on her plate repeatedly before scooping it into her mouth She is not articulate and soils her dress due to incorrect mouth motion Sometimes which is very rarely she gets irritated with herself but shoves off the attitude when someone approaches her with loving tender concern and care. Her sleep pattern is off, she may lie on her bed motionless for hours without napping, and only fall asleep during the wee hours of the morning. She drinks less fluid of any kind, and refuses to eat anything after dinner, but enjoys a cup of beverage tea or coffee. But her smile is still to die for, those small inheritances that she now portrays can be overcome with constant vigil care, and a calm approach to each situation, in my opinion for someone living with a tube in their head, it's not normal and will not function normally, so precaution and tender loving care is the key to each symptom and each day of her life events. I begin each day with a routine and stick to the schedule as best as I can, I suppose to each one of you your schedule routine will be different, so it is pointless me telling you what to do in your present situation.

CHECK YOUR CHART:

Make sure you comprehend the conversation regarding what is being done to the patient with the attending physician, and check your health chart, In my case, I don’t know what the doctor meant when he wrote she can follow up on a p.r.n basis, we never discuss that, but it is written in her chart below is the information imputed into Therese chart, once again I believe it must be an oversight on the part of the attending physician. You saw NATHAN T ZWAGERMAN, MD on Wednesday, July 20, 2022. The following issues were addressed Post surgical presence of cerebrovascular fluid drainage device and IVH (extravehicular hemorrhage FAMILY EMOTIONAL FACTORS Firstly have regular check-ups with the neurosurgeon this will help ensure that the shunt is working correctly, and progress is on track freeing you to live a normal lifestyle. Hydrocephalus requires long-term follow-up care so it is important to have regular check-ups, Therese attending physician dismissed her after the first follow-up without scheduling future care, the neurosurgeon needs to monitor your patient's progress and make a test for any changes that may indicate that there is a shunt malfunction. After the patient's discharge, there will be a transition back to your health care team, and attending medical check-ups is recommended, Physical and occupational therapy may speed the recovery and further enhance the patient's health, since this is all about Therese you need to know that Therese had her share of therapy done at home by a private company, after the completion of the schedule seven visits her therapy is being done by me her husband. I have cared for her those last six years and now well into her tenth month of living with a shunt, so many strange and unusual happenings with Therese prompt me to record her daily life, seeing such signs as walking difficulties, poor bladder control, and progressive dementia, all of this can be slowed down given the proper care,

NORMAL PRESSURE HYDROCEPHALUS OVERVIEW

CAUTION PLEASE NOTE. According to the surgeon who operated on Therese this is a progressive scan of her brain To begin with, living with Hydrocephalus, yes that is what it is called, read carefully this is not your everyday illness and recovery back to health is not a walk in the park, recovery from any sickness is never easy but this one is different quite different for you and especially the patient. At the time of Therese's dismissal, no one told me the huge responsibility I would go through nursing her back to health, you are not being told that because you at the time don’t realize you are dealing with a situation involving Hydrocephalus, I have already explained what it means to have this illness, but what I was not told is how this illness affects the patient and what happens going forward in their life, both the caregiver and the patient as well, I will try my best to enlighten you as to the observation in treating Therese for the last six years, After the first three months, your patient will exhibit some kind of behavior issues, this is the reason why I ask you to choose carefully the rehab, come to think of it I don’t believe the rehab is the problem, it could be the finest establishment if you don’t have prior knowledge of this illness you have lost the battle, I believe the problem lies with the staffs who take care of the patient and how much they know about Hydrocephalus. When I say the staff it comes with an explanation, In Therese's case, she has been kicked out of both rehabs that I chose for her, yes they were high-class rehabs Columbia St. Mary’s and Berlin Hospital, but both rehabs found fault with Therese during the seven weeks connectivity she stayed there, eventually kicking her out without any good reason other than she is stubborn and hard to deal with. Therese, her condition started a while back about six years ago December 20th, 2016, when she visited the Beeline Health Physical Medicine N euro Consultant, for severe pain in her head, the attending physician Dr. Brian A Knapp, evaluated her and his diagnosis was that she suffered from Cerebrovascular Accident due to Thrombosis of left Anterior Cerebral Artery. Therese is a patient of Hydrocephalus, before recently I did not know what that is much less knowing my wife is a patient of this illness. However I have taken the liberty to research its meaning, Hydrocephalus is the buildup of too much cerebrovascular fluid in the brain. Normally, this fluid cushions your brain. When you have too much, though, it puts harmful pressure on your brain. THERESE SURGICAL HISTORY BEFORE AND AFTER NEXT SIGNS TO LOOK FOR AFTER A SUCCESSFUL VP SHUNTING Therese Atkins Story DAILY LIFE Folks the illness Hydrocephalus affects the brain of the patient in ways unimaginable, the patient has aggressive moods that develop as a side effect of the Shunt placement, they have short or none at all verbal conversation, and they tend to have memory blockage, those moods affect the communication between you and the patient, but to the patient their actions are normal. Six months later more vivid signs are shown by the patient, depending on which side the implant is placed in the head the patient tends to lean heavily on that side, sometimes they will clutch the head and rub vigorously or they will quench straightening the leg the side of the implant, One eye the one on the side of the implant will water all day long, bowel movement becomes harder to perform, and most time they soil the bed, they are not able to get up and urinate so they come as they please, walking becomes a burden to them so you will need a wheelchair for a short commute. More signs to look for but before we move further ahead if you are the caregiver that action will annoy you because you expect normal behavior, if so please don’t frustrate yourself be patient use your charm instead of your anger. Continue. There will be times when eating and chewing and swallowing their food they do it at a rapid pace, and you have to carefully watch them when feeding them. For reference sake let's say the placement of the VP Shunt is on the right side of the patient's head like it is in Therese's head, you will notice a stiffness in the patient's right arm, and a continuous shaking of the hands this is normal for the patient is an uncontrolled reflects, be patient it stops after a while. During the hours the evening, you may notice the patient rubbing their head it is natural the patient may be having a slight headache, I was instructed to give her Tylenol as needed Therese started showing signs of memory loss, she looks straight into your face but does not comprehend simple instructions, and her reaction is to smile at you, yes she is having short-term memory loss, more like intermittent memory loss, after a long while she regains her composure and performs the instruction as ordered. The very first three weeks after taking Therese home I witnessed quite an episode of continuous vomiting, after every meal Therese would eventually vomit everything, refrain from giving the patient greasy foods, starchy foods like potatoes, red meat, and so forth it is better to feed them a bowl of clear soup broth, cereal or pureed mix fruits, Avoid feeding them at night anything passes six is big trouble for you. You will have to stay up late into the wee hours of the morning monitoring the patient in her sleep, that is if you are lucky the patient falls asleep, believe me staying up is better than having the patient choke on the slime that comes out of her tummy. Yes Sir I did have a rough three to four weeks of late-night monitoring. GROOMING: The patient will show signs of vertigo after eight months of living with the shunt it will be necessary to take over the grooming in my case I took over her grooming on week one after she came home, got the necessary equipment stuff like a bath chair, large basin or portable tub, I do not recommend taking the patient to the shower even though you have a walk-in shower, a fall is the last thing you want to have to happen to the patient, then its all over, if you must take the patient to the shower make sure you have the right amount of help to support or carry the patient. In grooming the patient there are some uncomfortable things you the caregiver will have to perform. 1. After every bowel movement wipe out the patient's bottom, and clean it after every sponge bath 2. Brush the patient's teeth after every meal, and make sure you have the patient shake water in their mouth after eating anything, believe me, the patient is not able to empty the mouth of the excess food particles so their mouth cheeks are full of unwanted food, shaking water will clear it out. 3. After every sponge bath and lotion, the patient to maintain a soft skin complexion and avoid bed sores, during the patient's sponge bath make sure to dosh her private parts. 4. Her head is most important first to witness if there is any redness in the shunt area or bleeding, next is to avoid dandruff on her scalp that is to avoid complications and also for comfortable styling. 5. A change of pull-ups would be advisable every four hours and check for any signs of formality or severe order other than urine. This is a small sample that needs to be done to your patient it will help you to make her living as comfortable as possible under the circumstances of having to live with a placement Shun. Make sure the patient is being fed on time choose the right menu and the right diet, but most of all the right time, make sure the patient is changing clothes daily or as needed of course this will eventually mount up your water and gas bill but to your love ones I am sure you will agree its worth every penny. Last but not least you need to follow the recommended doctor checkup that is scheduled for your patient, which I am going to tell you more about after the posted Therese six-month checkup. Therese, her condition started a while back about six years ago December 20th, 2016, when she visited the Bellin Health Physical Medicine Neuro Consultant, for severe pain in her head, the attending physician Dr. Brian A Knapp, evaluated her and his diagnosis was that she suffered from Cerebrovascular Accident due to Thrombosis of left Anterior Cerebral Artery. Therese is a patient of Hydrocephalus, before recently I did not know what that is much less knowing my wife is a patient of this illness. However I have taken the liberty to research its meaning, Hydrocephalus is the buildup of too much cerebrovascular fluid in the brain. Normally, this fluid cushions your brain. When you have too much, though, it puts harmful pressure on your brain. Nathan Zwagerman, MD: Therese Atkins is a very pleasant 76-year-old woman with a history of ACA stroke with residual fourth ventricular IVH, underwent EVD placement followed by a VP shunt placement by me. I last saw her back in November and her imaging was stable. She has no new complaints. She is otherwise in her usual state of health. She has no new imaging to review. In summation, Ms. Atkins is a very pleasant woman who presents today for a follow-up evaluation. At this point, we had a long discussion regarding the natural history of this as well as the options of treatment with continued observation versus intervention. At this point, we will plan on keeping her on continued conservative management. We will plan on getting her back to see us on a p.r.n. Basis. In the meantime, if she has any questions, comments, or concerns, she can contact our office, but otherwise, we will see her back as needed. After reading the doctor’s note above I am sure that you believe what you have just read, well let's put the record straight I am writing this to help enlighten the subject of shunting in general, I do not fabricate, discriminate, or lie to the contrary. Therese has not uttered a word of speech for six years to me or anyone for that matter, most assuredly Any communication on her behalf is being done by myself, however, this is not about me so when I tell you that the statement made above which states that and I quote, we will plan on keeping her on continued conservative versus management, is news to me nothing has been said to me about that except it being written in the doctor note and place in Therese health chart.

THERESE SURGICAL HISTORY BEFORE

AND AFTER

Let me take you through Therese's extravehicular shunt placement, putting aside all reluctant and bad decisions finally on the eve of 9/30/2021 the surgeon performed an extravehicular shunt placement, folks even at this late hour, to be honest, we were briefed by the surgeon what the procedure entails and what he was planning to do to relieve the pressure on Therese's brain, the consultation lasted about twenty minutes, did I fully understood what he had just told me nope, yet to get the ball rolling I nodded my head in agreement. Don’t be like me since this is a true extract of what happened to Therese I will be frank and endeavor to tell you what I think you should do, it is up to you to ahead with my instructions or reject them altogether, but I hope you don’t please read carefully, OK back to the consultation with the surgeon, what I did not know at the time of the consultation with the surgeon was that the whole procedure is base on two surgery to be final. The first one is the atrioventricular shunt placement, which is where a hole is drilled into the scalp to release the pressure on the brain by draining the brain fluid buildup, a tube is then inserted into that hole to extract the build-up fluid, and a dispenser bag hanging at the bedside collects the fluid as it drains from the scalp. Depending on the success of this procedure, the success is measured by how much fluid drains out per their calculations. This may take several days with the patient lying on the bed during the drainage process, sorry to be so blunt but if you are to take anything from this information blog I must tell you what I witness done to Therese. The second step to the first step providing the surgeon is satisfied that the patient is ready to proceed to the next step is the atrioventricular drain placed, it was twenty-five days later this procedure was performed on Therese, and the surgeons were pleased with the drainage and therefore proceeded to perform the atrioventricular drain placed. CAUTION FOLKS … Two operations two different procedures, the first is the atrioventricular shunt placement, in a nutshell, drilling a hole in the head placing a suction tube, and measuring the drainage to a satisfactory limit. The second operation is the atrioventricular drain placed, this surgery operation entails much more than the first to satisfy the first procedure, if it seems that I am going in circles bear with me for I had no knowledge of this procedure and I was not brief about it being done, I knew nothing at the time, however even though I was told it would not make any sense to me, so please right at this juncture make sure you are informed of what will be taking place on this surgery you must do! To be honest you must do it. Pay Attention: I learned later on after researching this last surgery procedure, some important decisions have to be made concerning the placement of the drainage tube, the tube itself what type will be put in, and a whole lot of other technicalities, their decision will be made for you if you don’t intervene, let me tell you there is a lot to know in this juncture, first of all when placing the suction tube it can go into the tummy or it can be left outside, there are several types of the suction tube on the market, please research and make your decision as to which one to use, Therese had I believe a atrioventricular (VP ) Shunt A, what is it? Well, Atrioventricular Shunt 1 People of any age can develop hydrocephalus and therefore require a VP shunt. 2 VP shunt procedure. Doctors typically perform the placement of a VP shunt while a patient is... 3 Recovery. Recovery from a VP shunt placement takes three to four days. 4 Risks of VP Shunting Don’t forget to read up on the risks of VP Shunting Naturally, I did not know that I did not have even a clue even though it was now residing in Therese's head, to make matters worse they did not tell me anything about what I have just told you about the procedure, because I did not ask about the surgery they left me in the dark blind as a bat, so yes here is the question. What is a VP shunt procedure? VP shunting is a surgical procedure that primarily treats a condition called hydrocephalus. This condition occurs when excess cerebrovascular fluid (C SF) collects in the brain’s ventricles. ... Doctors typically perform the placement of a VP shunt while a patient is under general anesthesia. Yes, however, if you have a loved one with Hydrocephalus I employ you to read up on this and look closely for all the signs involved, of course, how could you know those things beforehand luckily for you, you are reading my blog it will help you with some of the answers. OK, it's time to bring you up to par with the procedure done on Therese, what you are about to read is the doctor's general information regarding the procedure done and its aftermath. We will skip this for it has no use to you and the procedure would leave you clueless as did to me, if you ask me what this means I would say it means a successful operation was done on Therese, Successful surgery means to you the caregiver, your work has now begun how will it affect you the caretaker, shortly since I have gone through this trip I will venture to tell you as the patient caregiver what you should do to keep in the loop. After the (VP ) Shunt was placed in Therese's head she spent some time healing at the hospital, during this time frame interval you should decide your next move. Before the patient is released you are given several choices for future care for the patient, continuing therapy is a must, choose wisely where you put your loved one, there is a good reason that I am telling you to choose wisely, in Therese's case my choices were bad ones, keep reading to know why this is so important.