A new port catheter

Tonight's surgery went well. Susan went down to the OR shortly after 6pm for her procedures to implant a new port catheter and internalize her shunt, and returned to her room about 9:30.

I had a call from one of the vascular surgeons just after 7pm who said an ultrasound showed the veins near Susan’s neck on either side weren’t viable, so they’d need to implant the catheter in her thigh. The surgeon I had spoken with for consent said that might be necessary as a last resort.

I was sad after speaking with the surgeon in OR as I thought how awkward and difficult it will be to lower Susan’s pants every time someone needs to draw blood or infuse meds. I then became angry to think she’d had a perfectly good catheter in place before it was cut accidentally. Susan's been through so much.

I lifted it to the Lord and rested a while, waking up with a phone call from the vascular surgeon again. She said the procedure was done, Susan was doing well, and the neuro team was about to come in and internalize the shunt. She also said they went ahead and placed the new catheter near her neck on the left side – they’d discovered that thigh placement would be upstream of her IVC filter for blood clots. They found the upper vein on the left side of her neck to be just fine. What a relief. My prayer went from petition and waiting to thanks. God is good in attending to these details.

It’s been nearly a month since Susan’s hospital stays began. I wish she were strong enough to come home; but she’ll need time in acute rehab – hopefully now without being disrupted by any setbacks. We’re arranging to transfer her back to Long Beach tomorrow, so that’s one step closer to home. Thanks to everyone for praying tonight and to God for answering.

Successful surgery

Susan's surgery concluded a short time ago with no complications. The neurosurgeon quipped it was boring, which is certainly better than the alternative. She's doing well and will return to her room in a while. We thank God for a smooth procedure and everyone for your prayers.

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In surgery

Susan went to the OR a short while ago for surgery to plant the VP shunt and should be back upstairs by 3:30 or 4pm. She had nausea and vomiting earlier but was better after meds. She's really sleepy and didn't need any pre-op narcotics. I didn't either.

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On stand-by

Susan rested well overnight and is on stand-by for surgery. The schedule is fluid; but they're looking at an OR opening around 1pm.

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Prepped for a VP shunt

I just signed the consent forms for Susan’s procedure tomorrow to have Dr. Bergsneider implant a VP shunt. The staff did a few more pre-op tests since yesterday, including a lumbar puncture to draw cerebrospinal fluid (CSF) and check for infection (it’s negative). Since her procedure is being added to a full schedule, the earliest we’ll know the timing will be 8am. When an operating room becomes available due to something like a no-show or medical complication, the team will swoop in and get started. We’re likely to have about an hour’s notice any time during the day.

Meanwhile, Susan is stable today but weaker in her right arm. It’s really a flopsy item now. Her mood is mellow and pleasant. She’s great at just going with the flow. She’s getting a lot of rest and is eating well. I’ll help her get a good run at dinner since she’ll be without food or water after midnight.

The neurosurgery resident gave me the run-down – bear with me since I geek out on Susan’s medical stuff. The big term is a ventriculoperitoneal shunt, but VP works fine for me. It involves one tube or catheter connected to the brain cavity, another connected to the abdomen, and a small pump in between.

They’ll make an incision in the scalp and drill a small hole in the skull over the right side of Susan’s brain to implant the tube in her ventricle, which they’ll run under the scalp behind the ear where they’ll locate the pump. The pump is a small device that can be adjusted magnetically from outside the scalp. Susan’s version will be MRI compatible.

They’ll connect the peritoneal tube to the pump and guide it around the neck and down the chest wall, under the skin between the fat and muscle layers. They’ll make another incision in her abdomen and connect the tube so it drains into the peritoneum, which is a membrane that covers abdominal organs and is a conduit for blood and lymph vessels and nerves. CSF can be drained there and safely absorbed. Thus endeth today’s lesson. Please don’t try this at home.

The VP shunt replaces Susan’s LP (lumbar-peritoneal) shunt she’s had since late 2007, which will now remain in quiet retirement. LP shunts drain CSF more generally from the spinal column that connects to the brain, so having the VP shunt provides more strategic placement and drainage. Like any plumbing, the goal of a shunt is to flow easily for a lifetime; but sometimes proteins can build up and clog the lines. That may be what happened in Susan’s case.

There are some risks to this procedure for Susan, so we appreciate your prayers. Aside from the usual risks for infection with surgery, general anesthesia for someone on long-term steroids can be complicated. Since steroids artificially substitute what the body would produce, there’s a risk that adrenaline normally kicked in to maintain blood pressure during the stress of surgery may not happen for Susan. The surgery team is aware of this complication and will be prepared to handle it.

We’re not really worried about these risks in particular or worried in general. We trust God completely with the outcome of surgery tomorrow and Susan’s brain tumor journey overall. That said, we welcome your prayers. Our desire is to see God’s purposes established in and through our lives in whatever way that pleases him. This was a point of breakthrough in Susan’s spiritual walk during the time before cancer came into our lives. She surrendered to God with the desire that he use her life to bring glory to him.

By the way, that doesn’t mean he zapped her with cancer – the Living God gives good gifts. But it does mean he’s welcome to use any circumstance of our fallen world to demonstrate his grace in our lives. Approaching six years in brain tumor world, that grace with his peace and a host of other gifts have become fused into our experience for good. We own them. We love him for it. 

This is the precious product of going through hard stuff with an expectation that such seasons can in fact be fruitful. It’s his grace that even gave us that expectation in the first place. We still don’t know what it all means exactly, but we’re confident in God working it out. My spirit sings “He can work it out.” Can I get an amen? We have the greatest guide and companion imaginable. He made us and we are his.