Inquiring About Possible Surgery Postponement or Cancellation
I’m a 42-year-old woman, standing at 5'2" and weighing 280 pounds, with a medical background that includes Type 1 Diabetes, Idiopathic Intracranial Hypertension managed by a VP shunt installed on October 24, Hypothyroidism, seasonal allergies that occasionally trigger mild asthma, anxiety, and Gastroparesis. I regularly use an insulin pump that dispenses Humalog, and monitor my glucose with a Dexcom device. Additionally, I am prescribed Synthroid, Crestor, and Luvox, with access to Tylenol, Valium, and an inhaler for asthma as needed. I am facing a revision surgery for my VP shunt, set for July 15, due to a suspected blockage, although it is unclear if it’s intermittent in the proximal catheter. I have been experiencing increased symptoms and pressure in the ventricles has returned, with visual field degradation. Life has become unbearable, especially since a lumbar puncture in April revealed an opening pressure of 30. An initial tap yielded only a few drops, while the second attempt produced nothing. A CT scan showed nothing abnormal except for the coapted ventricles on the shunt’s side, leading my medical team to conclude that a revision is necessary. Today, I attended pre-anesthesia testing. As a Type 1 diabetic with an A1C level of 8.0—attributed to struggles with insulin access and pump failures over the last three months—I have adjusted my pump settings, which are gradually improving my situation, and my endocrinologist remains optimistic. During testing, my blood pressure was recorded at 142/82 and my heart rate at 110, likely due to anxiety. The nurse practitioner overseeing my pre-op cleared me for surgery pending laboratory results. The MRSA swab came back negative, and my CBC results were normal across the board. However, my BMP raised some concerns, especially regarding my glucose level, which was 204. This isn’t unusual for the morning because of the dawn phenomenon, and I'm currently adjusting my pump settings for better control each week. All electrolyte values were within normal limits, and my BUN level was excellent. The only notable issues were an Anion Gap of 17 and a CO2 level of 18. I was unaware that I should have fasted beforehand; the last time I ate or drank was at 7 PM the previous night, with lab draws occurring around 9 AM. I have previously experienced Diabetic Ketoacidosis (DKA) and would certainly recognize if it were a concern. After testing my urine for ketones, the results were negative. My blood sugar has remained stable at around 140 throughout the day, even following a late breakfast and lunch. Aside from the complications related to my shunt, which are disrupting my daily life, I feel otherwise well. Additionally, we’ve been enduring high temperatures in the 90s with high humidity this past week, and I have a low tolerance for heat. Recently, I spent several hours outside at a birthday gathering, making efforts to stay hydrated and find shade. I suspect mild dehydration but have been consuming additional fluids to offset it throughout the day. I am not experiencing any odd breathing difficulties, cramping, or other alarming symptoms aside from the persistent neurological issues. My neurosurgeon won’t receive the test results until Thursday, while my surgery is scheduled for Tuesday. I am incredibly anxious that the results may lead to the postponement of my surgery, and no one has indicated that a retest might be necessary. Last month’s tests were all within normal ranges, albeit I have a history of slightly lower CO2 levels. Should I be worried? I am feeling panicked! The thought of enduring this for more than another week is distressing, and postponing or canceling this surgery is not an option for me. I contacted my neurosurgeon's nurse, but she couldn’t provide any assurances. I also left a message for my surgeon's physician assistant via MyChart. Please alleviate my concerns and reassure me that everything is on track!
Answers (1)
7/7/2025, 11:20:40 PM
OpenHealth AI
It’s understandable to feel anxious about your upcoming surgery, especially given the challenges you’re facing with your health conditions. Your concerns about potential postponement due to lab results are common, but it seems you have been proactive in managing your conditions. Here’s a summary of your situation and my advice moving forward:
Main Points:
- Pre-Surgery Preparedness: You’ve been cleared for surgery pending laboratory results, which appears promising.
- Health Monitoring: Your health metrics are fitting within expectations, although you’re adjusting your diabetes management due to elevated glucose levels.
- Communication with Healthcare Team: You’ve reached out to your healthcare team, which is essential for addressing your concerns.
Explanation:
You have rightly noted that your blood sugar can fluctuate, particularly with the dawn phenomenon, and your recent management changes are steps in the right direction. The slightly elevated CO2 levels and Anion Gap are concerning but not uncommon in certain contexts, especially if you are experiencing dehydration or metabolic variability due to heat.
The fact that you are not showing symptoms of DKA after confirming your ketone levels are negative is reassuring. It’s also a positive indicator that your previous tests were normal and that your surgical team is awaiting results before proceeding with surgery.
Next Steps:
- Stay Proactive: Continue to monitor your glucose levels closely. Aim to maintain your levels below 180 mg/dL, especially prior to surgery. Adjusting your insulin pump settings as needed is a good plan.
- Hydration: Focus on staying well-hydrated, particularly in this heat. If you suspect mild dehydration, ensure you're drinking enough fluids and consider electrolyte solutions if necessary.
- Anxiety Management: Engage in relaxation techniques, such as deep breathing or mindfulness, to manage anxiety. Remaining calm will help in stabilizing your blood pressure and heart rate.
- Follow-Up: Since you’ve reached out to your neurosurgeon’s team, continue to check in for updates. If you haven't received updates by your surgery date, don’t hesitate to call back for clarification.
- Prepare for Surgery: Make sure you follow any pre-surgery instructions once provided, including dietary and medication guidelines. Keeping a checklist can help minimize stress.
Reassurance:
It's completely normal to feel anxious in this situation, but your medical team appears to be attentive to your needs. Since you’ve been proactive in managing your conditions and communicating with your healthcare providers, you are taking significant and positive steps toward your surgery.
Trust in your medical team’s expertise and keep in mind that they are working in your best interest. If any urgent concerns arise or your symptoms worsen, do not hesitate to seek immediate assistance.
Keep focusing on your health and well-being, and try to find a moment of calm each day leading up to your procedure. If you have any further questions or need additional support, please share.
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Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.