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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for chronic lung disease

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3631 Questions

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Posted on Fri, 26 May 2017 in Brain and Spine
Question: no problem with going under anesthesia with lung disease in order to remove shunt?
neurosurgeon suggest unfavorable outcome.
your opinion please?
doctor
Answered by Dr. Olsi Taka 2 hours later
Brief Answer:
Lung disease increases risk.

Detailed Answer:
I read your question as well as past questions and I understand your concern.

The presence of a chronic lung disease naturally brings about an increased risk for complications from anesthesia both during surgery as well as in the early post-operative period. The degree of that risk depends on the degree of function damage in your pulmonary function tests, but there is no doubt that there is an increased risk.

That being said if there is a certain indication for surgery I do not believe that surgery should be avoided. The issue in your case is that perhaps the neurosurgeon doesn't believe that you need surgery for certain. That is because your opening pressure is not high and you mention the ophthalmologist found no swelling behind your eyes in the nerve. That indicates that there is no increased pressure and surgery may not be needed, observation may be the right approach for now.

I remain at your disposal for other question.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 4 days later
What about the broken shunt in my back? That can't be good for me. What causes the pain in my head, neck, shoulders, numbness in hands, arms, feet and legs.

I have pain when I swallow, elimination but, the gastrointestinal doctors will not do anything because of my terminal lung disease.i occasionally pass blood in my stool. I have been sick since 2012. So, no colonoscopy for me because no Dr wants to put me under anesthesia. I am caught literally between a rock and a hard place. Thank for your help .
doctor
Answered by Dr. Olsi Taka 9 hours later
Brief Answer:
Read below.

Detailed Answer:
The broken shunt in your back in itself doesn't cause any symptoms. The one issue it would cause would be raised intracranial pressure and that in turn would manifest with swelling of the optic nerves and increased cerebrospinal fluid pressure on lumbar puncture. Both those manifestations you say to have been excluded, no swelling noted by ophthalmologist and pressure was normal. Hence no indication of raised pressure.
As for the diffuse pains you describe they may be in the setting of fibromyalgia. Of course spine issues may cause such pain and numbness in the limbs, but I assume the neurosurgeons would already have noted that. There is also the issue of Chiari malformation, that could cause those problems. It is hard for me to say whether any surgery is needed for that without having imaging and neurological exam info, most patients with Chiari malformation do not need surgery, so one has to be sure the symptoms are really related. Not related to the shunt though.

As for the gastrointestinal issues, it's not my area of expertise, but I believe a colonoscopy is not done by general anesthesia, only mild sedation. I think with no intubation involved there isn't much risk, it is a procedure which can be done. Or they could try other tests like contrast and barium ingestion CT scan. If they are not doing it it is perhaps because they do not think it is something serious, the symptoms seem too extensive to be related to a fial issue such as a tumor, perhaps anxiety may play a role in the swallowing problem.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 11 hours later
What are my chances of survival if elect to go ahead with the surgery to remove the lumbar peritoneal shunt?
Good
50/50
Vent
Trach
Not good
Can't say
doctor
Answered by Dr. Olsi Taka 5 hours later
Brief Answer:
Read below

Detailed Answer:
Hello again. I do not think that the answer to the question is as simple as you think it is. Also there are other information which might be missing as we do not have access to your full chart so the responsible answer would be can't say. If I really had to pick one of the other options I would say 50/50.
But that is not the point, even if chances of survival are let's say 80% what you should be asking what am I risking that 20% for. As I said there is not much to gain from revising the shunt, putting it back to function. So you should be asking the neurosurgeon what am I risking by simply leaving it there, after all you've lived with it for 20 years. So why take that 20% risk, if the risk of doing nothing is lower? That is what you should be thinking. I hope you understand what I am trying to say.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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