Friday, June 8, 2018

The Continuing Story of Joe's Normal Pressure Hydrocephalus...this time at SHANDS

So, here we go again. After the horrible experience Joe had with the last shunt, we were apprehensive about trying this again. After a bit of research, we chose to go to SHANDS, a stellar research hospital in Gainesville, Florida, four hours from Panama City.

The process to get into this hospital is first to get a referral from your physician and then have your records FAXED or mailed to the New Patient part of Shands (352.627.4295 though this may just be neurological). Include the last 6 to 9 months of records and imagery, reasons you need evaluation, insurance information, and your demographics. They will then send the referral to the doctor that is needed to move you through the hospital.

They sent us to neurologist, Dr. Christopher Hess, with whom we were much impressed! Getting the images to Dr. Hess was rather complicated. Of course, the CD would fall out of the envelope I carried with us with the hospital records. So, I had to mail those images after our visit on May 14. I mailed them on May 15 (Tuesday) Priority Mail ($7.30). Records show (KEEP THOSE RECEIPTS!!!!!) that mail reached SHANDS on Thursday, but the "agent" somehow had trouble getting the CD to Dr. Hess. So after a week passed with me calling daily to see if that CD had reached the doctor, I went and got another CD of the imagery and sent it by FED EX ($38.50) overnight. Once again KEEP THE RECEIPT AND TRACKING INFORMATION. Another week passed and they still could not find the CD. I finally contacted FED EX and they started a Trace. FINALLY the person who signed for the FED EX package was located and the CD appeared on Dr. Hess' desk!

Dr. Hess called and told us he concurred with the Panama City neurologist that Joe did indeed have NPH and Joe could now go on to the neurosurgeon. I was thrilled. Joe was losing ground daily. We figured he could go 10 steps and then begin those stutter steps where it seemed his feet were glued to the ground and his mind had to be rebooted. So he had to stop and then start again. He was using the cane and was almost to the walker necessity.

Brandy called from Dr. Roper's office and helped us by making the meeting with Dr. Roper and all the other Pre Op appointments on Tuesday, June 5. His surgery would be the next day, June 6. We felt the surgery was time sensitive now.

We were blessed that my sweet brother, Elkanah Burson, was available to go with us to Shands. It takes three to handle what is necessary. One needed to stay with Joe who was unstable on his feet and his memory was being affected, while the other got the car, carried the luggage in, or many other tasks required with a hospital stay as you can imagine.

Let me mention here the process of acquiring a room in which to stay. I ACCIDENTALLY made reservations through The Ad popped up and looked like I was making the reservation through the official Holiday Inn site. It wasn't and though I thought it was like all reservations and you could cancel if you did not need the room, it was not. So I learned to go directly to the Holiday Inn on University Avenue to make the reservation and then you can get your room cancelled with no charge plus you get the SHANDS DISCOUNT. And there is a shuttle if you need it. It is about a five minute drive from the hotel to SHANDS.We wound up paying for a night we did not use. I won't make that mistake again.

Two nights before the surgery, the patient is to shower with an antibacterial soap and apply Mupricin into the nostrils and repeat this in the morning before surgery. MRSA is in our nostrils we were told and the application of Mupricin helps keep down that infection. That was part of the patient meds the next morning as well.

We asked about antibiotics and surgery and found that Dr. Roper has not found that antibiotics are necessary because of his concern that too many bacteria are becoming antibiotic resistant. The anesthesiologist assured us that he administers an antibiotic as a matter of course with the anesthesia. We trust this team.

The Neurosurgical hospital, located on the Circle of Hope on the University of Florida campus, with which SHANDS is associated, opened in December. Valet service is free to those who have a handicap sticker. The facility is beautiful and the staff expedites everything. I accompanied Joe to the Pre Op. Every nurse and professional that we met were friendly, patient and competent. The picture above is from Pre Op when he was lying down. The picture below comes after a trip to the bathroom with Nurse Catherine before going to surgery.

The surgery took about 2 hours but that was from when he left me. I was able to rejoin him in the Recovery Room where he was chatting about being on the Internet to make a gift to Shands or something somewhere. Fascinating. He told everyone. They took him to get another CT scan and X-Ray and finally we were off to his room in the same building on the 5th floor.

Here we discovered the sweetest, most patient nurses I have ever seen. I guess being on the neurosurgical ward required PATIENCE.

 Joe was supposed to have bed rest at a 30 degree angle for the first 24 hours. After ten minutes he was complaining "I am going to go stir crazy if I have to stay like this. I want to get up. I want to sit on that chair." The alarm kept going off as he attempted to make his escape.

He finally sat up to eat his meal and the incision on his tummy started bleeding. Fortunately not too much, but enough for me to try to keep him down. He ate the fried chicken, I ate the macaroni and cheese. The collard greens got left. And then he started vomiting. They gave him medicine to quiet the vomiting.

Well, that scared me. Would that shake his brain around? Cause another subdural hematoma. Not his concern.

Did it keep him down on the bed?


It was a rough night.

Though there was a sofa that made into a bed and I was grateful for being able to stretch out after the love seat experience at Bay Med, it was hard and the hospital pillows crackled with ever movement. It was hard to sleep there. Joe was miserable.

Page, a very sweet CNA, gave him a hot bath and that helped immensely though sleep eluded him until early morning in spite of the hydrocodone and two doses of Benadryl.

Morning came. and by then everyone was convinced that he was well enough to go home.

Did you know that infants cannot leave the hospital until they have urinated and had a bowel movement? It is the same with surgical patients who have had abdominal incisions, apparently. No body functions are sacred in a hospital and proof of activity is welcomed by all. Anesthesia also slows things down.

By 1 PM we were prepared to head out of the hospital and on the road to Dothan.

Let me mention some things that came up during our stay. I mentioned my concern about Janitorial services at Bay Med with cloth mop heads that went from room to room. The Administration word on that? "We contract out our Janitorial services." At SHANDS they use mop covers much like Swiffer mops where they strip the cover off in every room and throw it in the wash container where it is sent to be washed and sanitized (or they thought) perhaps disposed of.

Another concern I mentioned was having seen cell phones carried from room to room. One resident told me in Pre Op that cell phones could not carry pseudomonas or Staph. So I did a Google Search. And told the nurses.

Among the total 664 bacterial isolates contaminating the mobile phones, the gram-positive bacteria were coagulase-negative Staphylococcus (CONS) (255), followed by methicillin-sensitive Staphylococcus aureus (MSSA) (186), methicillin-resistant Staphylococcus aureus (MRSA) (16), Micrococcus sp. (27), Diptheroids (22), Enterococcus sp.(10).
Among gram-negative isolates Acinetobacter species (86), Escherichia coli (15), Klebsiella pneumoniae(20), Enterobacter species (9), Citrobacter species (8), Pseudomonas aeruginosa (6) and Proteus mirabilis(4) were common. [Figure 2].
A total of 16 MRSA were isolated from the mobile phones which were distributed as surgery (3), orthopedics (1), physiology (3) and medical students (9). Out of total 186 MSSA isolated from the mobile phone samples 97 were from the hospital doctors and staff, 16 from the college faculty and staff, 63 from the students and 10 from the public colony.
Among the 94 MSSA isolated from the hand swab samples, 61 belonged to the hospital doctors and staff, 8 to the college faculty and staff, 25 to the students and none in the public colony [Table 1]. A single MRSA isolated from the hand swab sample belonged to the medical students group.

Table 1

Distribution of various bacterial isolates among different groups
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With all the achievements and benefits of the mobile phone, it is easy to overlook the health hazard it might pose to its many users []. 
The constant handling of mobile phones by users in hospitals (by patients, visitors and HCWs, etc.) makes it an open breeding place for transmission of microorganisms, as well as health care-associated infections (HAIs). This is especially so with those associated with the skin due to the moisture and optimum temperature of human body especially our palms []. These factors and the heat generated by mobile phones contribute to harboring bacteria on the device at alarming levels. When we consider a phone's daily contact with the face, mouth, ears, and hands, the dire health risks of using germ-infested mobile devices are obvious []. 
Unlike our hands, which are easily disinfected using alcohol-based hand rubs (ABHRs) that are made available readily across all hospitals and medical facilities, our mobile phones are cumbersome to clean. We even rarely make an effort to disinfect them. As a result, these devices have the potential for contamination with various bacterial agents []. 
Doctors and healthcare staff working in critical areas as intensive care units (ICUs) and operating units are highly exposed to deadly micro-organisms. These mobile phones used by HCWs often become carriers and may serve as vectors and spread microorganisms wherever they are taken along []. Colonized micro-organisms on the devices of HCWs may be transmitted to patients even if patients do not have direct contact with mobile phones []. These organisms if pathogenic can be detrimental to the health of the patients especially those in critical care units and if the organisms transferred happen to be drug-resistant; the situation becomes even more grave as it becomes difficult to treat because of the limited drug options available []. 
HAIs affect more than 25 percent of admitted patients in developing countries. In U.S. hospitals, they cause 1.7 million infections per year and are associated with approximately 100,000 deaths. It is estimated that one third of these infections could be prevented by adhering to standard infection control guidelines []. Multidrug-resistant (MDR) bacteria are commonly implicated in HAIs and can be challenging to eliminate [].

It wasn't long before this conversation spread throughout the Pre Op, I was told. This was not a topic that would be popular, obviously. 
There could be some answers to this. 
  1. Like disposable plastic phone covers that health care providers put on their phones every time they change their gloves. 
  2. Or voice activated blue tooth headphones.  

It is June 8, the third day after the surgery on the 6th. He is taking no meds.  Joe is now happy at home and drove to his coffee group this morning. Later he got a buzz cut like he had at The Citadel so everything will grow out the same time. Dr Roper not only did the head incisions and closure, he did the abdominal incisions and closure. The stitches look clean and neat. Joe was able to shower 48 hours after the surgery with instructions to keep the incisions clean and dry. 
He had a good night's sleep in his own bed with his own kitchen close by. 

I think his walking is much better just a few days after surgery. I am hopeful this shunt will improve his quality of life. 
I asked Joe's nurse Rita if he was their worst patient ever and was told, "No, I have had worse."  
This adventure certainly proved worthy of a segment on the sitcom Lily plans to write someday that she will call  "It's All About Poppy."

We will return in about a month for the programmable shunt. Too much drainage of the fluid initially could cause another subdural hematoma. 

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