Monday, March 18, 2013

When you're sliding into first...

Oh the life of a two-shunt family.  Vomit, headache, sleepiness, fever... for most of you out there, those would be symptoms of a good old fashioned stomach bug.  For us, that's a trip to the ER and some serious diagnostics to determine if someone has got a malfunctioning shunt.  If you're able to remember back this far, to the first ever NC Slaviks blog post, you'll recall the issues that we used to have trying to decipher between stomach bugs and shunt malfunctions.

And if you're keeping track, Luke and Will last had a shunt malfunction in the August/September time frame of 2008.  That was back when we had three shunt surgeries in less than a month.  Oh the good times.

And in the case that you were wondering, the typical shunt last 5 years.  Awesome.

Luke started complaining on Saturday afternoon that his stomach hurt.  We got home from a lacrosse game, just in time for him to run into the bathroom and puke.  A lot.  He slept for the rest of the evening.  He woke up in the 3 in the morning with a fever and another round of yuck.  He couldn't keep Tylenol down.  Two hours later, he was back in front of the pot.

Unfortunately around this time, he also started complaining of headache.  And then he went back to sleep.  Add it all together, and it sounded to us and the UNC pediatric neurosurgeon that we needed to make a trek into Chapel Hill to get things checked out.

Off we went.  I've learned some things in my years of getting shunts checked out - first I learned that a trip to the ER can be a 12 hour event.  Then I learned that once you're in the ER, if you have a shunt and a suspected shunt malfunction, you don't actually need to see a doctor to order a shunt series x-ray and a CT.  Perhaps that seems a little weird.  To me, its an opportunity to shave 4 hours off of the ER visit.  If we waited to see a pediatrician, they would have wanted us to see a neurosurgeon.  The neurosurgeon would have come down an hour later to tell me that they wanted x-rays and a CT.  And then we would have been at the exact same place, only a few hours later.

Honestly, anyone who has been to an ER knows it is a lot of hurry up and wait.  I'd just prefer to wait less.   So we arrived in the ER, put in the orders for the radiographic tests, got Luke settled, and waited for his puking to stop.  We had been there for less than 20 minutes when they came to get us for the x-rays.  We hadn't seen a doctor yet. 

He braved it well through his x-rays, holding still, holding his breath and counting to 10 like a little champ.  He was a bit concerned about the CT because they wrapped his body with a big Velcro strap to keep him from rolling off the moving table.  But he made it through that well too.

We got back to the room just in time for another round of nausea.  We saw a pediatrician who said that they were seeing a lot of the stomach bugs going around, and that they were going to take some blood and urine to rule out infection or other non-shunt causes.  I was good with this, though I believed firmly that we were dealing with a shunt issue.  I figured a GI bug would have both affected... um... other parts of his GI tract AND being that there are several other people in our house, figured that others of us would have been affected.  But hey, a couple of diagnostic tests are never a bad idea.

The neurosurgeon also stopped in to see us.  He was happy to see that we'd already gotten the x-rays and CT taken care of (little momma pat on the back).  He said that Luke's ventricles (fluid filled spaces in his brain) looked a bit enlarged from the last time he got a CT.  Of course, the last time Luke got a CT was in 2009, and his brain has done a lot of growing in the past 4 years.

But they couldn't rule out potential shunt issue with the combination of all the symptoms.  They thought a shunt tap would be the logical next step.  I had to agree.  As much as I didn't want Luke in pain, the only way to firmly diagnose a shunt malfunction is to stick a very very very small needle into the shunt (through his scalp) and measure the pressure of the fluid in his shunt.  If the pressure was too high, then the shunt was malfunctioning and causing his symptoms.  If the pressure was good, then the shunt was working properly and the symptoms were likely caused by a GI bug.

Before they came back in to tap the shunt, they came in to start an IV line in Luke's hand to give him fluids and anti-nausea medicine, and draw blood.  It has been a very long time since he's been given an IV (like nearly 5 years!) and although the nurse did a great job, this was pretty traumatic for Luke.  He did NOT like that he was bleeding.  And he was fixated on the IV when they were done.

The surprise and the prick of the shunt tap drew his attention away from the IV.  It was very hard to explain to Luke what was happening or why.  We've never actually had the "why you have a shunt" conversation.  He knows that he has a bump on his head, but he hasn't seemed too interested in the 'why' part of it yet.

So while the neurosurgeon waited for Luke's pressure to show up on his diagnostic tools, I tried to keep Luke calm underneath the surgical drape.  To say it was challenging would be an understatement.  He kept trying to grab the needle sticking out of his scalp to stop the pricking feeling.  I kept trying to stop him with one hand, all the while holding his chin still and firmly to the left with the other.

I could tell something wasn't going well though, by the look on the neurosurgeon's face.  He announced that the pressure was a 9 - which doesn't mean much to me except to know that anything above 12 usually means we're headed for immediate surgery.  Then he said that the distal catheter (the part of the shunt that goes from Luke's scalp to his belly) was draining very slowly.  He wasn't sure what to make of it, and went to confer with his neurosurgical team.  He also sent some of the cerebral spinal fluid to be tested for infection.

Luke didn't care too much about the IV after the shunt tap.  At this point, he was exhausted, his stomach hurt, he had a headache, now he was bleeding in two places (not really, but from his 6 year old perspective, you get the logic) AND his head was covered with an exorbitant amount of betadine (the yellow cleaning solution they used all over his scalp before the shunt tap).  Thank goodness there was a NASCAR race on to divert some of his sadness.  Soon, he was asleep.  The fluids and the anti-nausea medicine were making him much for comfortable.

All the labs came back negative.  I waited for word on the shunt.  Finally, the neurosurgeon came back.  It took a while for him to get to his point.  But ultimately what he said was that if Luke's shunt was actually malfunctioning, the pressure in his head would have been a whole lot higher.  The fact that his distal catheter was running slow says to the neurosurgeons that Luke's body may have actually found another path for the cerebral spinal fluid flow - basically that his distal catheter MAY actually be blocked, but it isn't causing Luke any trouble.

So, everyone agreed that there was no shunt issue and that Luke's troubles were the cause of a GI bug.  I never want my kids to have surgery, so this was completely fine with me.  Despite everything that had been done to expedite our ER visit, we were still there for 7 hours.  Luke was happy to get in the car and go home, and was asleep before we pulled out of the parking lot.

He woke up this morning still feeling very tired, but his stomach and headache had gone away.  He spent the day off of school, hanging out with Oma and Opa.  He took a nap, wasn't really hungry, but drank enough to stay safely hydrated.  None of the rest of us are feeling any ill effects, but just to prove the cause of what we're dealing with, Luke's... um... other parts of his GI tract are now catching up.  Hence the immature title of this post.

1 comment:

Anonymous said...

So happy Luke is doing better! Grammy let me know and asked for prayers .... so glad it all worked for the best! You are all truly amazing.... God Bless you.