Cont’d – One of those appointments


Well, you know how Friday went, or rather didn’t go.  Now here’s the rest of the story.

Shunt-o-gram was scheduled for 1230pm Monday.  A phone call from Paul in Nuclear Medicine informs me that Anesthesia had no information or knew about the test being done.  It is rescheduled for Tuesday, the same time.

Another call from Paul shortly after informs me that Dr. Reed (the Dr they want doing this, and frankly me too) will not be in hospital Tuesday afternoon.  Shunt-o-gram rescheduled again to Wednesday for 1pm.

NOW the fun began when we arrived at Nuclear Medicine on Wednesday.

Anesthesia arrived thinking Patrick already had an IV in place for sedation.  We came from home, as outpatient, obviously he had no IV.  There comes the next big undertaking.

It is unbelievable how strong Patrick is! It takes at least 3 to hold him while they try for an IV.  Poor guy has Mom’s veins, so they are small and collapse, which doesn’t help of course. FIVE tries to get an IV this day.  They had one at one point, but they didn’t secure his hand/wrist enough and they tried to inject something to calm him down, he fought and moved and the IV came out.

Finally after getting an IV and using half a roll of tape to secure it to him, we were set to do the test.

The next issue was figuring out where in the shunt the needle should go.

Let me take a short side-track here and try to explain what happens for a shunt-o-gram.

Shunt-o-grams are done in Nuclear Medicine.  It is a sterile procedure and everyone in the room wears masks and such.  The area where the needle goes is shaved down, cleaned and sterilized.  It typically involves inserting a butterfly needle into the reservoir of the shunt (depending on the type of shunt, some are inserted in the programmable area apparently).  Pressure measurements are taken and some CSF (Cerebral Spinal Fluid) is taken and sent off for testing also.

A small amount of radio-active material is then injected into the shunt.  He is then moved under a machine (similar to one used for bone scans).  As it flows through the tubing of the shunt, the flow is watched on a screen and pictures are taken periodically as it goes through.  This screen is a white background and the material shows black as it travels through the shunt.

They are watching that it moves through well and disperses well at both ends.  If you begin to see dark ‘blotches/spots’, it could mean a blockage.

After checking previous x-rays and scans, it was sorted where Patrick’s reservoirs were located and the test began.

Keeping Patrick sedated is another story in itself.  Since last fall, it seems Patrick metabolizes those drugs quite quickly.  It takes A LOT to sedate him and keep him sedated.  For a 14yr old boy who is only 92lbs, it has been taking more than an adult dose to keep him out long enough to do many of these tests.  For this test, 3 drugs were used, the main one being Propafol.  He needed 80mg more than they would normally give an adult (which is 200mg) to get him through the test.  Wow!

Thursday being called in to discuss the test, resulted in finding out that both shunts appear to work, although the left one is sluggish.  Both dispersed, albeit slowly, but they did.  The tubing is intact and in suitable places. (after the shunt-o-gram, they sent him for a shunt series – an x-ray to see where the tubing was and where it ended)

So the question is.  If both shunts are working, his ventricles should be normal size.  If one is working better than the other, then that ventricle would be smaller, but that’s not the case.  ALL of his ventricles are enlarged.

Update:  Patrick was admitted to hospital yesterday (Friday)

More to come…

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