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Lumbar Drain
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| This is the dressing and where the lumbar drain enters my spine. You can also see a white (and red) safety valve just below my waist. |
Before I tell this story I want to catch-up anyone who hasn’t been reading along in this blog. At this point I had a lumbar drain in my back so that they could keep the pressure from building in my brain. They were draining off 10 mL of spinal fluid every hour, but this is dangerous. If something happens that too much fluid drains I could get sick, have migraines or die, if I lost too much. Also, as you read in the last post, infection is a very big concern when they keep a hole open in your spine, so I have been nervous ever since my surgery. My nightmare night-after-night had been that the nurse had left my drain open or it had come loose and I was dying!
Alright, so now with the story:
On Thursday evening my wife went for dinner with her sister and I was sitting in bed with my iPad and decided to check facebook, twitter, email, etc. Since I was having some trouble with diarrhea because of the antibiotics and the many laxatives they had me on (to combat the pain meds) I asked the nurse to put an absorbent pad back on my bed.
Now, if you are laughing at me a little you have to understand that, at this point, I have two sets of monitors hooked to me, sequentials on my legs, a very important tube connecting my lumbar drain in my back to that machine, and, often, an IV. Also, I’m a fall risk so I’m not supposed to move without someone helping me…and it sometimes takes a few minutes before anyone answers my call button (let alone how long it takes them to unhook me and get me to the bathroom). So having bathroom troubles isn’t an easy thing. It was very likely that I was going to leave a pretty big mess.
Back to my original story: The nurse put a pad on my bed, but I’m tall and it wasn’t positioned quite right, so I remember sitting in bed and scooting about (the nurse supervised) and I pulled the pad up under me. I worry that I might have unintentionally and unknowingly pulled something loose at that point, but we’ll never know. The nurse left and would come back later with my meds. I remained in the same position checking facebook on my iPad. When the nurse came back with meds about 30 or 45 minutes later I was having a queasy stomach and felt a migraine coming on. It should have hit me then that something was amiss. I told my nurse that I had an unset stomach and a migraine coming on. My nurse left and later, I’m not sure how much later it was, (I was having a major migraine by then) I felt something wet behind me. I put down my hand into a bed full of spinal fluid. It still took a moment for me to realize what was happening. I looked down to see what had spilled and couldn’t find the tube for my lumbar drain. Once it hit me, I was utterly terrified by what I was experiencing.
I pressed the call button immediately and tried to turn up on my side the way I had lay the other night when he re-did my dressing. Luckily the unit secretary answered the call right away and I called out that my spinal fluid was leaking out. I don’t know how she made sense of what I was saying, nor do I know how my nurse, Sean, made it to my bedside so quickly, but it was his quick thinking and steady hands that were able to pull the bandage away and find a tube to clamp off.
The nurse came back and told me he had paged the surgeon and he waited, pacing (and freaking out a little), with me in the fetal position and blanket over my head (trying to keep dark because of the migraine I was suffering). There were many nurses and others (interns?) in my room by now. I could reach my phone so I called carrie to tell her that she should come right away. I lay there and finally worked up the courage to ask the question I needed so badly to ask, “If I lost too much spinal fluid to survive, would we know it already or will we find out later?” One of the nurses replied, “I don’t know, we need to wait for the doctor. The surgeon arrived and explained that to help alleviate my migraine I need only to be laid out flat. The migraine subsided a bit as he raised the bed to table height. I told him I’d just had work done on the dressing the night before and he responded that he was the one who had done it. I told him, “Then, doctor, you have seen my ass two times more than I would like!” (Which did illicit laughter from him and the rest of the room)
He said that I am young and healthy and since I was still alive and conscious I would likely be alright. He later told Carrie that if I were elderly or obese or otherwise in poor health I would have likely died from loosing so much spinal fluid.
So, as be began to work on me, my wife arrives on the floor. I know this because I could hear her voice raising as she tried to get past the nurses. To Carrie’s chagrin the room was already sterilized and they would not let her in.
I laughed a little and told the surgeon to watch out. I explained that Carrie, if she feels I was in danger and he was keeping her away from me…I explained that she would probably let him have it. After a moment of silence I said, “but don’t worry, I’ll remind her that you and this nurse just saved the life of the man she loves.”
As Carrie continued to try to get in, the surgeon leans over and says to me, “That is true love. We have a hospital full of people who don’t have visitors, but you have someone fighting to be with you and to advocate for you.”
Had I been older or in worse shape, had I not realized the fluid was leaking out, had my nurse not been so quick…had the night not gone just as it did, I might not have survived that night. The recurring nightmare I’d been having all week came true, but because of an excellent nurse and just a short time later an excellent surgeon, I was put back together and my wife and I were able to see one another again. By the time the surgeon finished it was well after 1:00am. Carrie, again, stayed the night. I mean, it really wasn’t a choice, at that point. I don’t think anything could have moved Carrie out of that room that night.
So, Wednesday evening I was introduced to my new nurses and was settling into my space (my wife was actually the one doing the ‘settling,’ I was doing the ordering). Finally my wife left to go to her parent’s house and get some sleep and I laid back and fell off to sleep. I woke up needing the restroom, so I sat up on the edge of the bed and got ahold of my urinal. Something didn’t feel right though, when I pulled up out of bed. I put my hand behind me to feel the lumbar drain and I felt a string (It was later confirmed that this was the smaller tube from the lumbar drain that should have been under the plastic dressing). I called for the nurse.
Now, before I explain what happened, I have to tell you that, every since the surgery I had been paranoid about that lumbar drain. Every 5 minutes I was asking the nurse to check that the drains were turned off or that the dressing was alright and not leaking. I think most people can understand how I would be a little paranoid about this thing I didn’t expect, didn’t want, and this thing that can kill you…
So, back to the story! I called the nurse and said the lumbar drain dressing didn’t feel right. She said, “I’ve found someone more OCD than me, I think!” I said, “Yes, but will you please look at it?” Of course she was glad to look at it and came around behind me with her little light… She ended up leaning in really closely to the dressing, because I could nearly feel her breath on my back and from back behind me she quietly said, “I need you to stay very still and I’m going to call the on-call surgeon.” I asked if everything was okay and she said that she didn’t know, but she didn’t think I was in any danger if I just stay still. She hustled out of the room and I could reach my phone so I called Carrie and told her something was up. She didn’t arrive until everything was finished.
It was a very simple procedure. The surgeon did a great job simply re-dressing and re-sterilized everything and since we became aware, right away, that it was exposed I was never in any serious or imminent danger. Once everything was sterile and under a plastic dressing again, I was ready to go back to sleep.
It was a very simple procedure. The surgeon did a great job simply re-dressing and re-sterilized everything and since we became aware, right away, that it was exposed I was never in any serious or imminent danger. Once everything was sterile and under a plastic dressing again, I was ready to go back to sleep.
Carrie stayed at the hospital the rest of the night, since it was after 2:00 a.m. by then!
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| the lumbar drain in Scott’s back. |
I’m exhausted, but I’m feeling pretty well right now, tonight. I thought I would blog a bit and, as I looked back, I realized that I’ve never actually told “the story” of what’s been happening, really, since getting to St. Louis.
So, first recap of my last surgery:
I had a benign (didn’t know that for sure till it came out) tumor in my cerebellum. They came in from my neck; cut my neck muscles away and held them away from my body; and cut out a piece of my skull. They next opened up the dura (sp?) which is the membrane around the brain and then used probes to go into my cerebellum and resect the tumor which was in the left hemisphere of the cerebellum kind of near to my spine. Then they closed the dura and skull (which I don’t remember how they explained it, except we now know they use titanium screws to put the skull back and once everything was put back into place they used staples to close the incision which was several inches up the back of my neck.
Now, I recovered pretty quickly for the first few weeks and then had setbacks with a couple bouts with -what we thought was- flu. Even after the flu, I felt as though I had progressed, but starting about two weeks [before I ended up back in the hospital] I began having more bad days than good. We’d always had bad days and good days, so, until we had the benefit of hindsight, we didn’t realize things were actually getting worse.
Well, they were. During the week before I went into the ER I had only bad days and ended up nauseous often. Wednesday before I went the ER I woke up throwing up at 5 am and didn’t stop until noon, but by noon I finally got relief and slept the rest of the day. Thursday and Friday were miserable and I still had migraines, but I wasn’t throwing up and we had called the doctors, none of which thought this was necessarily unusual after brain surgery…
But on Saturday I woke up vomiting in the early morning hours, had the worst migraines I’d ever had and it wouldn’t stop and probably wouldn’t have. We called my surgeons around 11 or maybe 1 and they said if it persisted to go to the ER, so around 4pm we headed to St. James OSF Emergency Room. They were very good with us. You can read that account in DAY 1 – The ER In Pontiac
Once we got to St. Louis and were working with neurosurgeons and not just an ER doc, we were still afraid that they would look at us and say, “Um, you just had brain surgery, there’s nothing abnormal, go home and take some tylenol.” Are you seeing a pattern? And by the way I hadn’t been able to keep water down since Friday night and had eaten nothing since then either. They looked at the CT’s from Pontiac and the on-call Neurosurgeon asked us some questions and let us tell the story of how we got there (and listened to our questions, anxieties and fears) and then explained it probably was not a fresh brain bleed like Pontiac thought it was, but there was definitely some fluid and if fluid was flowing in and out of dura/skull around the surgical site, there probably was some bleeding as a by-product of this activity. The migraines, then, were being caused (and then getting better briefly) when that spinal fluid would leak out of the brain membrane and skull out under my skin. The brain, then, didn’t have enough spinal fluid pressure and I’d have migraine and then my brain would produce spinal fluid to compensate, but with more pressure that would all leak out and form large pockets of fluid outside the brain and it would happen all over. He also explained where my other headaches (which I had described) were coming from (with detail) and explained that they wanted to do a surgery to correct the structure of the brain where they had done the surgery in order to make sure the spinal fluid was draining from the gland that makes it, down through the brain as it is supposed to. He used the metaphor of a kitchen sink. If you set it running at a certain speed and have the drain open it will just continue to drain properly, never emptying and never overflowing, but if you stop it up, or somehow open the drain wider, it no longer drains as we want it. We really thought Dr. Beaumont was just great. You can see him, later, shaving my head in this video:
So now, I hadn’t eaten since Friday and it was Monday, so that was really the first thing on my mind. I finally got to eat something! (On Sunday they wanted to wait until the MRI results were gone-over to make sure I didn’t need emergency surgery that night before they gave me food) Now, on Monday morning I got to eat breakfast. It was gross by any normal standards, but when you haven’t eaten in several days, even greasy, rubbery eggs and sausage at the hospital will bring you delight 🙂
Late on Monday morning Dr. Beaumont (that same on-call surgeon) brought in syringes and had me lie down on my side and drained as much of the spinal fluid as he could which had been flowing into other cavities and creating pockets of fluid where we didn’t want them. It sounds as though he drained a whole lot of bloodly spinal fluid.
I still got to have some nasty lunch and dinner and they explained that my procedure would be on Tuesday, sometime. My surgeon was out-of-town at a conference, so I was being fit in with Dr. Dowling (I think he moved / cancelled his own surgeries) to fit me in Tuesday at 1, because he was filling in for Dr. Dacey’s service, in case emergencies like this came up.
The surgery was Tuesday in the early afternoon, but while they expected this leakage had created a bit of damage to the dura as it flowed in and out, they were not prepared for the severity of damage.That spinal fluid had “shredded” the dura all around the incision point. I guess it was far worse than they thought and they had to put in a lumbar drain which had been “a very remote possibility.” It wasn’t so bad that they couldn’t put the skull back together (they said there was an even more remote chance they may have to use a wire mesh), thank GOD!!!
The surgery to correct the structural problems [stemming from the original surgery] was really a repeat of the first surgery, except they didn’t have to go through the dura into the brain. They simply went into the skull, removed it, repaired the dura and then worked backwards repairing structures along the way.
The problem is that, because it was so severe, we could do all this and have all the same trouble, so they needed, in this case, to put in the lumbar drain to keep that from happening. You see, the brain is capable of producing 30 mL of fluid every hour. Well, we don’t want too much fluid pressure or it might seep through the incision site again and we’d have the very same problem.
So they open a hole in my lower back, insert a shunt into my spine with a small tube (looked like a small string) coming out and hanging out of the hole. They they take… welll, I don’t know, think about a plastic sheet a little thicker than a latex glove material, but the same consistency. They took a sheet of that and sealed over the whole hole (with the whole in the middle and then they use those sheets to completely cover my lower back so that it formed several layers and then taped all around (an aside: think about sleeping for days wrapped in plastic wrap. Not cool.
That small tube sticking out from under the “medical grade, glued down, ‘plastic wrap’ connected, then, to a hub which then connected to a thicker tube which ran down to a contraption on a pole. I had to trust the nurses to be attentive and drain only 10 mL each hour. There were several valves which had to be carefully turned on and off, but I became very nervous when we asked about the side-effects. They said it was unlikely, but the possible complications were, if the site became “exposed,” infection; or if too much spinal fluid leaked out there would first be queasiness, then a severe migraine and, finally death. This is what we definitely didn’t want to have happeni!
Well, that gets us through an overview of the first and second, corrective, surgery as well as some of the complications that could arisel
After the procedure Tuesday I did great and that takes us to my mext blog on the day from hell: Wednesday!!!