Spinal Tap Next Week - A few questions!

Post by **jimmylegs** » Fri Oct 05, 2007 11:44 am

really depends on the doc i would think. i didn't know anything about it when mine got done, but i think the guy who did it would have been lukewarm about talking about it. he wins for health-care-guy-most-likely-to-tell-me-i-need-x-years-of-school-in-order-to-understand.

i'm imagining if it were me with my guy, i would have the printed out big guns in my pocket but only as backup, and i would say, so - tell me how this deal is going to go anyway? and he'd say some kind of spiel, and then i'd say, so what's up with the whole "needle bevel orientation" thing? and then he'd be thinking oh great, here we go... oh that's right, this is another one of those half-baked semi-armed internet patients-who-think-they're-smarter-than-me and then he does one of two things, he pulls out the if you were my sister line, or trots out some long words (which make me laugh inside because either i've read enough to know what he means or i'm close and can fake it, and the whole episode is like a familiar teddy bear at this stage). by this time, i imagine i would have a feel for whether i was in good hands or SOL, and then it would be a judgement call if i felt like it would make a difference to pull out some pics of diff entry angles. and i'd be careful if it's from any source that's making claims but it's not peer-reviewed published info, make sure it's backed up with journal info... and then hope for the best!

ahh, good times navigating the health care system lol!

either way, take good care of yourself after! hope you get away scot-free

AllyB · Post by **AllyB** » Fri Oct 05, 2007 1:19 pm

Hey JL

The Africa Regime worked for me! The 8 hrs, I think, had not only to do with making sure there was no leak, but also making sure that the ventricles in the brain had a good supply of cerebro-spinal fliud post-procedure (the headache can also be caused by that, I was told) - by lying flat, the theory is that the amount of csf is equalised so to speak and the CNS does not miss the volume of fluid taken, and that it is replaced relatively quickly by the body - I was also on IV fluids for the day, and told to drink lots of water (2l I think - it was a long time ago!).

As you know, I have my fair share of Neuro issues, but I must admit he did a great job with this - ansd the 8 hr thinhg worked for me! As an ex RN, I assisted with many LP's and we always had the patients admitted for the day and lying flat, as withdrawing fluid is part of what causes the headaches, not just the leak, so ensuring that the brain/ventricles had no sudden drop in csf pressure because of standing up to quickly afterward.
I trained a long time ago, so this may be rubbish, but it made sense to me, and it worked for whatever reason.
Having goog local really does help with the procedure - I hyper-ventilated my way through it (which was crazy as I had an epidural for my 2nd baby), but I truly felt nothing after the first little "prick" of local - no worse than having blood taken.

Take care PP - all the best - I would suggest that you tell your doc that you are a bit scared of this procedure, so you researched it, this is what you found out, and what does he think of it? That at least opens the discussion.....Bottom line, you have to trust him to put a needle into your spine...Most Neuros are very good at it (just like anaesthetists) as they get lots of practise. If he won't at least reassure you on technique and your gut is nervous and uncertain, think about it a bit more, maybe get someone else to do it - i am not sure it is so urgent that you have to do it NOW! Especially as you have other diagnostic criteria already available - mine was done to rule out ADEM with my first relapse (CIS), then i had a second episode/relapse prior to the results of the csf coming through, then the csf came positive...more lesions on subsequent mri's etc. But my understanding is that it is not always necessary to have an LP...?

Good luck.

Lyon · Post by **Lyon** » Fri Oct 05, 2007 1:44 pm

AllyB wrote:I trained a long time ago, so this may be rubbish, but it made sense to me, and it worked for whatever reason.

No, I'm pretty sure you're right Ally. My father in law was diagnosed with normal pressure hydrocephalus and it wasn't long ago that I was pouring over that information.

I didn't put two and two together until you mentioned it but it does seem that the change in CSF pressure is likely responsible for all the symptoms and the concern about the unsealed puncture is aimed more towards the leakage extending or worsening the problem and possibility of infection.

If someone's symptoms were caused by nicking the spine with the needle, that would be an easy malpractice lawsuit.

Bob

AllyB · Post by **AllyB** » Fri Oct 05, 2007 1:58 pm

Hey, thanks Bob - I will go to bed now actually feeling as if I wrote something that makes sense for a change, instead of my usual drivel! but if you think about it, removing just 10 - 20mls of csf will reduce the pressure, especially if you are vertical immediately afterward, and lying flat until some of this is replaced would reduce the risk of headache (not even a pillow was allowed, and in fact my bed was position so that my head was slightly lower than my feet - one of those fancy tilting hospital beds)...
Leakage obviously would would make the reduction of pressure worse. We use a liberal spray of plastic skin here to minimize infection (along with the usual sterile technique during the procedure) - it is sprayed as the needle clears the skin on withdrawal, and a dressing applied.

How is your father-in-law - what treatment is he getting - I suppose a ventricular-peritineal shunt wouldn't help if there ws no raised intra-cranial pressure?

Take care

Lyon · Post by **Lyon** » Fri Oct 05, 2007 2:24 pm

AllyB wrote:How is your father-in-law - what treatment is he getting - I suppose a ventricular-peritineal shunt wouldn't help if there ws no raised intra-cranial pressure?

Thanks for asking....somehow I KNEW this was going to come up. He died last spring, but he had lived a good, long life. Was 88 years old and he actually died after a couple of massive strokes.

They did install the shunt and although his symptoms never disappeared, he did seem to show improvement for a short time. Shunts in old people tend to quickly plug up in addition to it being nearly impossible to gauge a shunt to exactly coincide with the rate that new cerebrospinal fluid is created.

It was a most ironic situation I'd ever seen in that he detested the thought of being old and feeble. I'd known him since he was 62 and he put a lot of effort into working out, running and eating right.

The irony was in the fact that he spent his last 10 years healthy as a horse but his dizziness and loss of peripheral vision removed his ability to golf, drive or live in his own house. NPH made him lose his will to live but all his healthy efforts left him with a body that refused to die.

In large part that's why I drink, smoke, swear, fight at the drop of a hat, chase wild women and fart in public. I'm completely willing to donate my organs, but when I get done with them the whole shittenkaboodle's going to be wore out and if any good is to come of me they're going to have to grind me up for garden fertilizer.

They say your body is a temple........mine might rightly be compared to derelict inner city crackhouse.

Regardless, we all enjoyed having my father in law around as long as we did and I think he had a few good times along the way.

Bob

AllyB · Post by **AllyB** » Sat Oct 06, 2007 12:48 am

Heya Bob

So sorry about your loss - that is tough, I can relate as both my Mom and father in law passed a few years ago. 88 is a good age though, even if the last few years were rough for him. I am sure it helped him to know he was cared for, but losing independence is a bitch.
Shunts can be a problem, seem to work best on kids/babies, but they still need to be replaced fairly frequently.
I agree with your attitude, no point in burying a pristine corpse - it should have lived before it dies! None of us know when we are going to go....! Good health is important in order to enjoy life, but it should be enjoyed - I'd rather have a great life and die at 60, than be miserable and deny myself any pleasures, then live to 90 (nothing to look back on with glee and delight)! Which is why I believe in chocolate...

Take care

Lyon · Post by **Lyon** » Sat Oct 06, 2007 7:49 am

Nice picture Ally!

Yeah, I think we have a secret society or something going on around here because it's not unusual on this site for someone to come out from undercover and proclaim their love for chocolate.

I LOVE those Cadbury fruit and nut candy bars, but they are hard to find so in a pinch a Chunky will do.

Bob

AllyB · Post by **AllyB** » Sat Oct 06, 2007 8:38 am

Thanks Bob - took me forever to figure out how to do it, but had to keep trying 'cos I was so jealous of Robbie's - his dog rocks! Don't really like pics of myself, but couldn't just post a pic of my boys - although they are total cuties, the folks here might have got a bit nervous about dealing with super advanced 6 & 4 yr olds pretending to be a grown-up... (not that I am that clever or anything, just very literate if I was only 4)?

Cadbury's fruit 'n nut is real easy to get here, but it is a cheap date - the real stuff does it for me - Lindt (swiss chocolate) is sooo indulgent. There, my secret is out, but seems I am in good company.

Cheerio from a self-confessed chocoholic.

Lyon · Post by **Lyon** » Sat Oct 06, 2007 10:56 am

AllyB wrote:Cadbury's fruit 'n nut is real easy to get here, but it is a cheap date - the real stuff does it for me - Lindt (swiss chocolate) is sooo indulgent. There, my secret is out, but seems I am in good company.

Bromley has threatened to send "fine" English chocolates to the people who are nice to him. Although I'm not aware of anyone actually receiving chocolates from Bromley, I do know of one person who actually was able to smell them

viper498 wrote:I know the US postal system stole my chocolate. My package smelled of chocolate, it just wasn't in there.

Bob

AllyB · Post by **AllyB** » Sat Oct 06, 2007 11:04 am

I could be persuaded to offer a similar - er - "service", to the right person, for the right price - being nice to me would be a good start....We get really good chocs here...I await (legal) offers.......Paypal accepted

p.s. Just in case anyone actually takes me seriously here (not sure who will be reading) - I am just kidding (about Paypal anyway!).

Lyon · Post by **Lyon** » Sat Oct 06, 2007 11:12 am

Actually, I think you'll notice that most people have a pretty good sense of humor on this site. Occasionally something will "seem" mean spirited, but for the most part I think it was taken wrong.

Bob

AllyB · Post by **AllyB** » Sat Oct 06, 2007 11:22 am

Thanks, point taken Bob - I am still a bit new, and while I have "chatted" to you a few times and didn't think you would have any problems with my post (being a fellow chocaholic and something of a dinosaur), I suddenly got a bit nervous after I re-read it as I really don't want to upset anyone (being new, haven't got any balls yet), and certainly did not want to be seen as some shyster trying to extort money from sick people...

You never know who is out there, or how you will come accross....
Will try to establish some backbone - I am turning around now so that you can give me a kick in the butt!

Lyon · Post by **Lyon** » Sat Oct 06, 2007 11:52 am

Hi Ally,
We've kind of "hijacked" pookpook's thread, so I continued it under General "Out of Africa".
Bob

AllyB · Post by **AllyB** » Sat Oct 06, 2007 1:19 pm

Apologies for the hijack Pookpook (love the name) and hope all goes well with your lp.

MattB · Post by **MattB** » Mon Oct 08, 2007 7:07 am

My neuro insisted that the spinal went great but I had a headache for a little more than a week after the tap. I layed down for an hour afterwards but drove myself home and went to work, in considerable pain, that night, in the end I think it was a big mistake. I'm not sure if laying down would have done the trick or not but in retrospect I wish I would have.