(2nd Blog Post by “Bert & I” on Behalf of ICU-Resident Ali)
Ali is alive … albeit not presently so chatty!
In ICU one hour after surgery… not so chatty, indeed!
Her 4-hour, triple laminectomy and spinal cord surgery today was concluded at least one hour faster than anticipated and has been judged “highly successful” by her experienced Kunming neurosurgical team. Less than 40cc of blood was lost.
Team Ali on Monday … Dr. Liu + members of his team
Here’s the story of Ali’s day:
At 8:30 a.m. she was moved from her room on the 7th floor of Kunming Tongren Hospital to the operating theatre on the 3rd floor. Ali had fretted about how this transfer would play out, given how large she is relative to the average Chinese, but her anxiety melted when a team of no less than 8 hospital staff showed up to whisk her away.
The Boss ( Dr. Zhu Hui ) to Ali: “FIGHT!”
Words of encouragement from brother Mattias
Ali: “How will I be moved?” Mattias: “Are you kidding?”
Shipping her out to Operating Theatre …
Given time required for preparation and anesthesia, the actual surgery commenced at 10 o’clock and lasted until 2 p.m. All other variables being equal, faster surgery generally offers better outcomes. Confident, experienced surgeons work faster and with less peripheral damage than do less experienced surgeons.
Team Chief, Dr. Zhu Hui: ‘Trust me!’
Dad: “We’ve done our homework. It’ll work!”
While we are happy to report that Ali’s surgery proceeded without complications, this is not to say there were no surprises, because there were, two in particular.
Early in the operation, it was discovered that Ali’s intracranial pressure was extremely high … so high, in fact, that when the Dura Mater was pierced, Cerebral Spinal Fluid (“CSF”) spurted 5-to-6 cm vertically! Evidently this high pressure occurred because Ali’s CSF circulation had been substantially blocked by scar tissue in the ventral sub-arachnoid space … that is, scar tissue from the original injury trapped inside her spinal cord..
While MRI images are not intended to measure fluid pressure, the discovery of such high pressure helps account for at least some of the escalating, severe neuropathic pain Ali has been experiencing in recent months.
The other unanticipated discovery was that Ali’s dorsal vertebral arch (bone) was much thinner than usual – indeed, just paper-thin. It is believed this resulted from the sustained high intracranial pressure referred above, and, obviously, degeneration of such a key structural element had ominous implications for Ali. Now the high CSF pressure is back to normal, and the weakened lamina are gone, having today been surgically replaced by titanium rods and screws.
One other interesting observation as follows: when Dr. Liu made his way round the left side of Ali’s spinal cord to remove tethering scar tissue and to lance the big cyst, he observed there was no pulsation in Ali’s spinal cord. A hour later, after cutting away “very severe” tethering around the ventral side of her spinal cord, Dr. Liu reports that Ali’s cord is now pulsating again with the rhythms of her heartbeat and breathing.
As for the anterior cyst about which Ali has reported so much in recent weeks, this turned out to be as long as the latest MRIs had suggested (longer than 3 cm) but considerably wider than anticipated … suggesting yet another explanation for severe compression of the dorsal root ganglion that channels pain. More ominous still, vertical development of the cyst had reached high enough in her spinal cord to begin impacting breathing function … and, indeed, Ali has reported experiencing difficulty breathing during the past week.
Right now Ali is resting in ICU, attended round-the-clock by a neurosurgeon + dedicated 24 hour rotation nurses stationed at the foot of her bed + a three person team of therapists who constantly massage her legs to prevent a pulmonary embolism. Kunming neurosurgical team leader, Dr. Zhu Hui, insists in sleeping in hospital tonight “just in case” there were to be a complication to which she could response faster in person that by telephone!
Rushing from Operating Theatre to ICU
Ali is expected to be in ICU for two days and then to return to her room on the 7th floor for the balance of the week. She can then recuperate in her nearby apartment, which hospital staff will visit several times daily to check up on her
Dad + relaxed Dr. Liu … 30 minutes post-surgery