My shunt tubing is causing a lot of abdomen pain!

Hey Manda
My name’s Merl. I’m a member of the modsupport team here on Ben’s.
I too have a vp shunt and I’ve had a few issues with the shunt tubing and the valve along the way. As it sounds you are finding out, for some of us they are not the most comfortable pieces of equipment. I must also say here 4 months is still fairly early on in your recovery, it can take a while to get used to it because, let’s face it, it’s a foreign object in our body.

When they first inserted mine I went to pick up my hospital bag, the tubing rolled over my collarbone. It was the first physical thing I’d done and the sensation was like someone ripping my flesh as the tube moved. The whole length or the whole shunt train needs to be able to move with the movement of our body. There can be an issue known as ‘adhesion’, where the tubing gets stuck in the tunnel under the skin and when we flex those adhesions can pull and sometimes dislodge (or rip) from being stuck.

Yes, an Xray will show up the shunt tubing, but it may not show up any cyst present. An abdominal CT scan or ultrasound would show any changes in abdominal structures. I say this because One day I ended up in the ER. The ER dr ordered both a CT and an Xray. Radiologist decided only to do the xray and I was returned back to the ER. Well, the ER Dr wheeled me straight back to radiology and proceeded to rip shreds of the radiologist, explaining that she needed both scans to get a full picture of the abdomen. Her language was rather direct/short 'I’m the dr, you’re the photographer. You take the pictures. I tell you which pictures to take…" Let’s just say the radiologists ego was severely wounded that day, but the dr got her scan.
A brain CT or an MRI will show raised ICP as brain structures are compressed and the ventricles expand as the pressure rises.

Merl from the Modsupport Team

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Hi Moltroub, my husband reached out to my surgerical nurse as I was in so much pain and the head nurse spoke to the surgeon on my behalf. He suggested giving it time and scheduled a phone consult (due to covid) the following week. By the time I spoke to him 8 days later, the pain had subsided and I felt a bit silly so I agreed to wait and see. All was fine for 2-3 weeks but then last weekend, I experienced the exact same excruciating pain again, this time in two places (my neck and side stomach).

I am caught a little between a rock and hard place because when I am experiencing the pain, the last thing I want to do is get up and go to the emergency wait room. But then when the pain subsides, I feel like it isn’t a big enough deal to bother my surgeon about. The surgeon said he has been putting in shunts for 20 years and hasn’t had a patient experience this before so I am just trying to figure out what it might be so we have a starting point what to look for.

Hi Merl,

Thanks for your feedback. I have an mri scheduled in a couple of weeks. Would this show anything or should I specifically request a CT scan as well? The pain I am feeling is intermittent. Often, I am just sore (along my neck, back, sides) but other days, the pain is excruciating and it is difficult for me to even change position in any way. It feels like severe cramping you might get if you ran a marathon without stretching and I almost feel like my insides are twisting. After an episode, I also experience increased pressure in my head. Does this sound at all similar to a cyst or does it sound more like adhesion? Or something else?

My surgeon hasn’t had a patient describe pain like this before so I am just trying to figure out a starting point of what to perhaps look for.

One other small thing (not sure if this is indicative of anything) but the lump on the back of my head (where my shunt is located) is also perpetually sore. It is bearable pain (feels similar to a bruise), but it’s persistent.

For background, my staples were removed in September and according to the nurse, my scalp “healed very nicely” so I don’t know why it continues to be sore. I can definitely live with the soreness and mention it only in case this has meaningful explanation that could be tied to the shunt pain.

In any case, thank you everyone for all your help and support. It is so comforting to talk to others who have gone through the same! :heart:

Hey Manda,
“I have an mri scheduled in a couple of weeks. Would this show anything or should I specifically request a CT scan as well?”
An MRI is a more defined type of scan, more precise than CT and would show a cyst.

“After an episode, I also experience increased pressure in my head. Does this sound at all similar to a cyst or does it sound more like adhesion? Or something else?”
This really is something only a trained medical professional can answer and I certainly ain’t a Dr.

Now, in saying that, in my experience, fluctuating symptoms are my ‘new normal’. Head pressure? that’s normal for me. Chronic BAD headaches, those a normal too. Some symptoms are manageable, but some are FAR from manageable and I simply never know what today will bring. I too have had the dr’s tell me ‘the cause of your continuing pain is nothing we have done… …It must just be YOU’ like I choose to be in agony or my ‘favourite’ line said to me by a nurse ‘Ohhh, it can’t be THAT bad…’ and the frustration with it all, be that symptoms, be that dr’s or be that with self is HUGE. This all adds to my stress and the medicos are ultra fast to label it all as ‘stress related’. GGGggrrrrrrr. No wonder I’m stressed… …I have to deal with dr’s.

That lump that’s perpetually sore, is that the ‘shunt valve’ you are talking about?
A shunt is made up of 3 parts The brain catheter (or The Ventricular catheter), the valve and the distal catheter (or Peritoneal catheter). This valve does a couple of things. 1)It regulates the cerebral spinal fluid (CSF) pressure in the skull and 2) prevents fluid flowing back from the peritoneal into the skull. The valve is rather spongy bulb and can be pressed on or ‘depressed’. Then as the valve reservoir refills the bulb returns to its normal inflated size. The scalp skin over the valve can be rather sensitive too. Normally that skin sits smooth with the skull and now it has a foreign object (the valve) underneath it and this certainly can feel like a bruise, but eventually, it does settle. The ‘lump’ is still there, it’s just sensitive rather than sore. It just takes time to settle.

The healing of the scalp (or the skin) often heals OK, but the skin is on the outside and is not a good indicator of what’s going on inside.

As for the wound sensitivity, that is normal. It took around 9months for that sensitivity to ‘normalise’ with me. I say ‘normalise’ but I think I just became more accustomed to it. In really basic terms, they cut my scalp, cutting the nerves, then they stapled it all back together but in doing so those exposed nerves are right on the scalp surface and are EXTRA sensitive, like WOW sensitive.

Now, speaking of ‘sensitivity’… Once you have been down this neurosurgical route you become SUPER aware, SUPER sensitive. Every twinge, every ache and we’re asking ourselves ‘Is something wrong?’ and I can tell you, that’s normal. My wife became extra alert, she would watch me like a hawk and she could read all of my body language. As much as I tried to convince her all was OK, she could see, something was wrong. Even years later she can still read me better than I know myself. “I’m okay, I’m okay…” “No you’re not, look at your eyes…” And she’s right, my eyes are a giveaway.

What I now look for is a progression of symptoms. A headache, that’s normal. My right eye closes up, that’s a bad headache. Then my face droops, that’s a bad sign, then my whole right side gets a severe case of pins’n’needles, Painful pins’n’needles. It’s then time for me to act.
Now, these are my signs something is wrong and you too will learn your signs. Your signs maybe totally different, but if you ever see a progression of symptoms. Act.

Look, I’ve lost count of how many times I’ve gone to A&E, for them to do their scans only to send me home. But by the same accord, I’ve ignored symptoms, ignored symptoms and ignored symptoms only for the neurosurgeon to rip into me for not following through as there was a genuine issue. In my humble opinion, if you think it’s necessary, then act.

Merl from the Modsupport Team

Manda, it’s really great that your husband is helping you with calls to the surgeon. I can’t tell you what a relief it is to have a great caregiver as well as the support they bring us.

Like Merl’s wife, my BH knows me better than I know myself. So please be alert to the anxiety your husband has…it’s pretty much a reflection of where we are in the moment.

While I don’t have the experience with shunts that you, Merl and others on this site have, I can honestly say that nerves take a good while to repair themselves so you many be feeling that process. It can hurt at times and it can feel weird at times.

I feel that even if your surgeon has done this for 20 years, we are all different. Your surgeon needs to be opened to learning and my guess the surgeon is, but at the same time wants to calm you down. If you feel that you’re not being heard, please tell him so. Open communication is the secret to good health care and all other relationships in my opinion.

I can certainly understand not wanting to go near an ER during a pandemic! I feel the same, so much so that I refused to use my Epi pen last month, or maybe the month prior. I was telling the RN that gives me my allergy shots about my reaction and she asked if I used my pen. Aghast, I said a resounding no! She asked why and I responded I would have to go to the ER. Our area has been hit really hard and we are one of the highest in our State per capita.

With all that, I am going in for a procedure tomorrow morning and have to stay one night hopefully. It will be the 4th repair for a ruptured aneurysm. We discussed in depth my likelihood of rerupture (is that a word?) and my level of activity. Both are high enough that my surgeon suggested she try using a stent or two.

Like Merl said, we have to listen to our bodies. No one, not even our surgeon’s know it as well as we do. So talk to your surgeon or someone on the team, that’s what they are there for!

All the best,
Moltroub

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I am familiar with tearing scar tissue. It can be extremely painful. But it subsides over time.

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