Monday, December 27, 2010

The Complete Guide to Spinal surgery from a Patient's Point of View, The End

Many people spend a lifetime with back pain.  It is the #1 cause of absenteeism from work and one of the main reasons that employees seek disability.

I have been fortunate to have had excellent surgeons.  I researched and educated myself as best as I could so that I could understand what was happening to my body.  I am also fortunate that I live in New York City and have the greatest advantage of some of  the best hospitals and doctors  to choose from.  Anyone undergoing spine surgery should seek out the best possible surgeon and hospital.  There are many ways to do that.  The Internet can provide you with lists of hospitals and their rankings.  Hospital websites also contain departmental information where you can find a list of their surgeons and specialty.  This information will give you the doctors credentials, area of expertise, schooling training etc. 

Many patients have successful spine surgery while others do not.  I am now 2 weeks post op from surgery.  I still have pain, muscle spasms, and am limited in walking and sitting.  I am still on pain medication.

I do not know the outcome of this surgery.  I can only put faith into the hands of my surgeon, nurses and other personnel that got me to this point.  Time alone will give me the answer.  My goals are simple, I just want to walk again and perform my daily tasks without pain. 

Without the help of a loving family, who was there for me along the way, I could never have done this.
I hope that this blog has given some inside look to this experience and I hope that it has given another "back patient" some answers.

Sharyn B.

The Complete Guide to Spinal surgery from a Patient's Point of View, Other Stuff

Many people undergoing spinal surgery will do so for any number of reasons.  I have degenerative disc disease, spondylosis and stenosis.
Surgery in 2005 was a laminectomy, performed entirely from the back (posterior) where they removed bone from inside the spinal canal to open it up to remove the pressure on the spinal cord.  There was also a cyst that had formed which was also removed.  This surgery was a "piece of cake" when I look back retrospectively.

Surgery in 2006 was called Anterior/Posterior approach Interbody Fusion.  This was performed from the front (thorough the belly and the back) as well as the back.  This is the most difficult recovery.  There is a 6 inch incision in the abdomen as well as 6 inches in the back.  The loss of stomach muscle makes it very hard to get in and out of bed, a chair, etc.  Kind of like having a C-section and a back surgery in the same day!   This approach is sometimes necessary because the surgeon wants to view the spine from the anterior view (frontal view)  There is no scar tissue formation from the frontal view.  I find it amazing that they actually move your intestines and other organs around in order to view the spine. 

This most recent surgery December 2010 was called a XLIF with posterior approach.  The surgeon  enters through a 3 inch incision along the side just above the pelvic bone, after which they then approach from the back.  My surgeon claimed that the recovery was faster.  In some ways it is.  Definitely better than a full frontal incision.  The side incision is very painful but easier to move around.  I was up walking 3 days after surgery. 

The decision on the type of surgery needed is one that you will discuss with your surgeon.  I cannot stress enough the importance of getting several opinions.  I consulted with 3 surgeons on my diagnosis and options of treatment. 

Prior to surgery,  a patient will most likely try every option available to him/her before deciding on surgery.  I sought  intervention from pain management, trying physical therapy to pain injections (I have had epidural blocks, caudal blocks, facet joint injections).  Injections can get you through a few months in order to buy time in order to seek opinions and make a decision.  Injections are not a cure and may not help everyone.

Sunday, December 26, 2010

After the Surgery

When you first return home or if you go to a sub acute facility, you will be extremely limited. 
At home, I had everything arranged (at least as much as possible) in order to make things easier.

I had a supply of sweatpants and T-shirts stacked up with underwear and socks.  It is impossible to open a dresser drawer and get things out, so keeping a supply of your daily items within easy reach is essential.  You will not be able to wear your jeans.  They will just be too tight along you incision area.  Stick with easy  loose pants and tops.  Your custom brace (which you will get in the hospital and wear for about 6-12 weeks) will feel more comfortable with a T-shirt under it.  Don't even consider sneakers, you can't tie them anyway.  I wore slip on sneakers or if the weather is cold, a pair of fleece lined clogs.  Works very well, no bending to get your shoes on or off.  A tight ski parka will probably not fit over your brace either, use a larger coat or borrow a friends that is 1-2 sizes bigger. 

I organized my hallway closet before I left for the hospital.  I put some towels within easy reach, soap, toilet paper, etc.  You will need to be able to reach this stuff.  There may be times that no one else is home with you and that extra roll of toilet paper inside the vanity is not within your reach.  Get a grabber thing.  You know that metal contraption with a handle that enables you to pick things up.  It works most of the time. 

I had a walker at home as well as a bedside commode.  During the day you can get to the bathroom.  At night it is a very long walk to the bathroom.  The commode can be used over the toilet during the day.  The height is adjustable so that you can have a raised toilet seat.  It's a long way down to that toilet seat, you just don't realize it until you have surgery. 

Sitting at the dining table for meals is sometimes possible,  you'll need extra pillow.  If that's not possible and you must eat in bed, get a over the bed table (like in the hospital).  I used this table for my stuff to keep easy access to it (tissues, water, reading glasses, Vaseline, lotion, medication, note pad, cell phone, etc.)  It is easier for you to have everything at your side instead of bothering a family member every time you need something. 

ADVICE:  you can purchase a walker, bedside commode, bed table on the Internet for a fraction of the price it will cost in the drugstore or surgical supply store.  Four years ago was in rehab, and getting ready for discharge.  The social worker said  "I will arrange for the necessary items to be delivered to your home".
The next day a top of the line walker, a bedside commode was delivered.  Billed to my insurance company for over $600.00.  I needed these items again in December 2010 (I had discarded them never thinking I would need a 3rd surgery).  I purchased the two items over the Internet, no tax, no shipping for $93.00.

Have a supply of gauze pad and tape.  The hospital or rehab may or may not send you home with a supply to cover your incision areas.  If you are sensitive to tapes, buy paper tape.   ADVICE:  I had visiting nurse coming in to do dressing changes for a few days, after that my husband took over.  Talk about it ahead of time, if you have a squeamish partner you may need to make other arrangements (son, daughter, friend, neighbor).

Take your medication as prescribed.  The first week or two after surgery you will still be very sore and have some pain.  Do not be afraid to take your pain meds, it will make your rehabilitation faster.  You will be reluctant to get out of bed and walk if you hurt.  ADVICE:  if you have a sluggish bowel (like me) your first bowel movement will really hurt.  Start taking stool softener the day before your surgery and continue it for up to 2 weeks along with plenty of water.    Use a laxative, if you really need one.  I also advise wet wipes for personal cleaning, plain toilet paper it rough and it will not be easy to reach your backside.  (I used a baby wipe wrapped around a wooden spoon).  Sounds crazy, but it works. 

So, if you plan ahead a little bit, you will save $$, time, and make your post-operative life much easier.

Going Home or Going to a Rehab Facility

When the social worker finally comes into your room an says "tomorrow you are being discharged", you will feel scared, elated, insecure, and happy.

The choice to go home or to  go to sub-acute rehabilitation is a decision that you should make prior to your surgery if possible.  There will be many elements that will be the deciding factor.
After my first surgery, which was a laminectomy, I was ambulatory.  I was in pain, but otherwise I could get in and out of bed myself, get to the toilet, etc.  My husband and son escorted me home.  Getting into our family car however, was not an easy great.  I could not sit without great discomfort.  I actually laid down in the backseat of our car with a pillow at my back so the incision wasn't pressing in.

My second surgery was a spinal fusion.  At day three in the hospital I could barely walk, I was merely able to get out of bed and get to the bedside commode.  Therefore the decision to go to a rehab center became an easier one.  There are different types of rehab places.  Acute and sub-acute.   Acute care means that they have to do everything for you,  you may possibly still have IV lines and drains and be unable to get out of bed, wash and dress, etc.  Sub-acute care, means that you will needs assistance in daily activities but not in everything.  I went into a sub-acute facility near my house.  The food was awful, the nurses were terrible and dumb.  Everyone else there was basically over 70 years of age,  I was 54 years old.  The rehab people did not know what to do with me,.  The first day they had be juggling balls from one hand to the other!   I was restricted in activity so exercises were out of the question.  WE focused on leg lifts, walking with my walker and occupational assistance.  How to put on my socks was a great learning experience.  By the time I left rehab 8 days later, I could walk with my walker,  wash and dress myself.

After three surgeries, I have come to realize that the first few days after surgery on the crucial one.  You must get up out of bed and try very hard even if the pain is at its worse,  During my last hospital stay, the nurses and rehab worked very hard with me to get me to be ambulatory.  If I could get to the toilet myself and walk 30 feet with my walker  could go home.

Before your surgery, call your insurance company to find out if you have coverage for a facility.  You should also arrange to visit at least 2 sub acute facilities in the event you need to go to one.   You have to be prepared for any possibility.  Even the biggest, strongest man undergoing spinal surgery has no idea how difficult it will be post op and may need assistance in daily activities.

Friday, December 24, 2010

The Hospital Experience from a Spine Surgery Patients Prospective

Having undergone three spine surgeries, I have experienced different hospital experiences with each. 

My recent hospitalization was a positive one.  The personnel from the admitting office to the transport person who took me outside to my car in a wheelchair' upon discharge; each and every person was professional, courtesy and caring.  My nurses were wonderful, the aides very caring.

My advice:  try to remember your nurses name.  Some hospitals write it on a dry erase board hanging in your room.  It will have the name of the nurse manager, nurse, physician, and aide.  Sometimes I felt as if I was pestering them.  But if you need help,  YOU NEED HELP!  Your family just can't manage 24/7.  

After my catheter was removed, I needed to use the bathroom every two hours.  There was always someone there to help me. 

If something is not to your liking, you need to speak up or have a patient advocate.  You have rights and must not be afraid to express them.  If you truly hate your room, because it is dark or the walk to the bathroom is too far, ask to have your room changed, its that easy.   If your food is intolerable, have a family member bring something in for you.  I would ask for extra juice and Jello since my appetite was poor but I needed to stay hydrated.

Don't bother packing fancy pajamas or robes or even slippers.  It is must easier to be in a hospital gown.
You may still have IV lines or drain lines in for several days.  If any fluid leaks, let it let it mess up the hospital gown.  Easier for your family not to deal with laundry.  The hospital always has gowns and robes, and sock-like slippers with little rubber pieces on the bottom to prevent slippage. 

In the first several days, it is important to hydrate.  Use moisturizer on your face.  Ask your family or nurse to lotion your body.  OH AND BY THE WAY:  have a family member look over your body for excess leftover tapes, chest leads, etc.  I once went home with an EKG suction lead on my back, it was there for 10 days.

A word on hospital room-mates:  you may be in a semi-private room with another patient.  That patient may be quiet and non-inquisitive.  On the other hand, you could get stuck with a loud, intrusive, annoying roommate.  I had a roommate who yelled on the telephone until 11 o'clock for two nights in a row in a rather loud Italian voice.  I rang for the nurse, and they took care of the problem.  The next day she was discharged.  If she had not been, I would have requested a room change.  DO NOT be afraid to request what you deserve,  REST!

Other hospital experiences were less than pleasant.  The nurses were inattentive, rude, and ABSENT!
I could ring for 15 minutes and no once would come in the middle of the night.  My second spinal surgery I was left in bed for 3 days with no one coming to assist me out of bed and arrange to have physical therapy to get me up and walking.  They came into my room on day 3 and told me I was going home the next day!  I  had not been up, still had IV and catheter lines.  I was crying, confused and didn't know what to do.  I was timid, I did not have a family member with me, so I accepted hospital discharge.  I was transferred by ambulance to a sub-acute rehab on a stretcher.  

My very first spinal surgery hospitalization I was placed in a private room in the corner of the unit.  I was left by myself.  No one came in for hours and hours.  I got up by myself every 2-3 hours to use the bathroom.
I was discharged within 24 hours of surgery. 

A word about hospital stays:  remember that everything is not determined by your doctor.  We are at a time where insurance companies make the rules.  After all, they know best.  They know how you feel, they know your ability to walk on day 3, they know how you feel being on Morphine for days and cannot think straight, they know whats best for you.

I have worked in the health care industry for over 35 years.  My opinion of our insurance system is a negative one and I could go on for hours about the inconsistency, the payment determinations, the hospital stay allowances, etc.  But I won't, at least not today.

Thursday, December 23, 2010

Waking up

Waking up from any type of general anesthesia is a terrifying experience.  You feel like you cannot breathe, panicky, cold, disoriented, and just overwhelmed by the whole damn thing.  DO NOT EVER be afraid to ring the call bell for a nurse.  DO NOT EVER feel like you are bothering them, this is their job.   Ask the nurse where you are, what time it is, if your family is there, etc.   Most importantly,  any pain level should be immediately addressed.  If you are lucky (and I really mean lucky) to have a pain pump, just keep pressing the button whenever you remember.

After spine surgery, and I have had two which required a pain pump,  I was not shy about pressing that button.  Spinal surgery HURTS!  Do not let anyone tell you differently.  Use it religiously for 24 hours.  After that, you will feel a bit more awake and can judge your pain level yourself and are more aware of your body.

I had a pain pump, an I.V. line in each hand,  a drain or two coming out of my spine,  inflatable compression cuffs on my lefts and a catheter.  That's a lot of STUFF!  I honestly don't know how a body handles all that stuff but it does.

 If you feel like to have to urinate,  it is because of the catheter.  If that continues, tell the nurse, they will check the bag and check the lines,  sometimes you might be laying on one of the lines and don't know it.  Nurses do not check for everything.  My I.V. lines were put near my wrists making it nearly impossible to bend them without it hurting.  I should have spoken up to the anesthesiologist and tell him to place them higher up on the the top of the hand.  You will need your hands over the next several days and when I.V.s are in an area which interferes with movement it makes it worse.

I had CPAPS (little tubes in your nose that provide oxygen) in my nose for several days.  BEST ADVICE: pack some saline spray and Vaseline to take with you to the hospital.  My nasal passages got so dried out after 2 days that my nose was bleeding.  Using saline spray several times an day and putting Vaseline up there will really help.  The nurses and your doctor will never tell you this. 

If you are prone to cold feet, have your family put some socks on you.

Operating Rooms

Before you  go into any operating room NEVER, NEVER let them take your eyeglasses away.  Wear and old pair if necessary, you don't need 20/20 vision to go into the pre-holding area or the operating room.  If you have not signed a consent for surgery at your surgeon's office, they will coming looking for you while you are laying on a gurney in the holding area.  They will put the consent form in front of you and ask for a signature.  Hence, you will need your glasses.  Then when they wheel you into the operating theatre, you are sometimes still awake and are able to see the anesthesiologist and discuss your anesthesia with you.  You will certainly want to see to whom you are speaking with.   So let them take your eyeglasses at the very last minutes.  Most likely they will be put with your things and they will be with you in recovery.  But if not, bring an old pair that you can afford to lose. 
It is Sunday night December 12th, and I just finished dinner with my husband of 32 years and our two grown children.  My bags are packed and I'm ready to go.......but I am not leaving on a jet plane....tomorrow is my third spinal surgery in 5 years. 

I arrive at Hospital for Joint Diseases NYU Medical Center in New York City and check into the admission office where all the usual stuff about name, birthday, next of kin and the infamous while plastic  bracelet securely around your wrist.  This becomes your identity.  It really helps because in a day or two you WILL not know who you are and you are most likely to forget your  birthday and recall one  that's not even close to your own. 

I then proceed downstairs to the Second Floor where an array of medical staff eagerly awaits me so they can begin THEIR DAY.  I am given a plastic bag and instruction to to into the changing room, put all of my personal belongings into this bag.  Put on a hospital gown, a cap, a robe, and a pair of paper shorts.  OH no, back up a bit, I forgot the white compression stockings!  Those go on first.  They are 5 sizes to small and take 5 minutes each leg to get on.  They are taut, heavy elastic and hurt.  Then I put on hospital booties.

I am ready.

how this all started

In 1975 I tumbled down a mountain while skiing.  Thinking it was nothing more than any other fall, I got up and continued skiing.  By that night, I developed back pain and within two days I had sciatica and pain runing down my left eye.  I couldn't stand, sit and walking was painful. 

I treated myself with pain medications, heat wraps, Ben-Gay, hot showers, etc. with no resolution.  After one week I consulted an orthopedic physician.  I was diagnosed with a slipped disc at L-4-5. Living alone was not an option, so I moved back to my parents house  for complete bed rest for 6 weeks with traction belt around my waist with 3 lb weights hanging off the end of the bed, Valium and pain medication.   I was 24 years old. 

The Complete Guide to Spinal surgery from a Patient's Point of View

Today is Thurs 12/23/2010.  My name is Sharyn and I have just undergone my third spinal surgery.

After laying in the hospital for six days, I actually starting thinking about doing a blog about spinal surgery.  There are many web sites and spine forums out there, most of them give a lot of good information, but I found that most of them are written in the negative.......all the bad things that happen, all the pain and suffering associated with undergoing spinal surgery.  So, I decided that I would start a blog with perhaps a different viewpoint of trying to focus on the positive and trying to put  my personal experience in writing in order to help others.