Monday, August 15, 2011

the post-op rundown (LONG)

I confess...I've been playing with the contents of a "real" post-op post in my head.  Which totally means I'll miss something.  I'm going to share this on a health bulletin board with a back forum so it may include details my usual visitors aren't as interested in but that might help a future patient.

I'd been struggling with back pain for years and run through more moderate treatments like epidurals (seriously, not sure mom-hood is in my picture, but I'm not doing that again without getting a cute baby in return) and stints with two physical therapists.  An MRI, a bone scan, and a discogram (not fun but not as scary as Google had me fear) pointed to the L5/S1 disc as the culprit.  This is a pretty common trouble point and takes a LOT of one's body weight.  The initial diagnosis had been an annular tear but that was "upgraded" to degenerative disc disease ("DDD") by my latest doc.  I'd been sent to this guy by Doctor Dad....both are neurosurgeons in the same practice and this guy is pretty much a spine expert.  This meant a 2+ hour commute but definitely meant I got stars by my name both in the office and the hospital (I was on a "spine" ward).

I went in for an Anterior Lumbar Interbody Fusion ("ALIF" for the in-the-know crowd) on Monday 8/8.  I'd had 5 surgeries before but all were on the minor end and none involved a stay at the hospital.  I got more nervous as it approached but the pain also got worse by the day which ensured I wouldn't back out.  MM and my father checked me in (my step-mom joined later) and my mom and step-dad arrived just a bit before they put me under.  I'm terrified of IVs but they did a decent job (and waited till I was under to start a second...though that confused me when I woke up since I wasn't aware it would be there).  MM and Teddy were with me till I was asleep.

The hospital staff get MAJOR props for the fact that Teddy was there when I woke up.  Yes, I'm 33 and wanted my Teddy....he's always good to squeeze when pain hits and just is comforting.  That may have been standard fare since I was clearly terrified before, but I'll admit special treatment when Doctor Dad came to see me in recovery  Usually, guests aren't welcome there but he visited and asked that MM be allowed to come back.  Seriously, MM gets a Best In Show ribbon for the recovery room time.  Due to delays in discharge (they keep spine patients grouped so I needed a room on a specific ward), I was in the recovery room for FIVE HOURS (should be more like one).  MM refused an offered chair till they brought it anyway.  He held my hand and stroked my hair (Dr. Dad was thrown by the request to "pet my head"...that's when he suggested MM would be better).  MM told me he loved me every 15 minutes and told me I'm beautiful, impressive when you have wires everywhere including oxygen and a catheter.  MM never left my side.  I told him he could go (and send a replacement) so he could sit more comfortably and play online or something but he refused.  I imagine we made a sight as I was a bit out of it and he got so tired he was resting on my bed rail.  Although it was NOWHERE near as serious, I was reminded of Robin Williams in Good Will Hunting saying the staff knew visiting hours didn't apply to him .

After five hours, the recovery nurse said a room was open.  The Ward folks wanted to wait to give me a nicer one (as they do for any friend or relative) but luckily the recovery nurse stepped in and said they should ask and I took it in a second.  Honestly, I could care less that it wasn't the largest room (like most on the ward, it was private), I just wanted out of recovery.  They wheeled me up (MM followed) and the four parents joined soon after. The rest of that day is fuzzy.

My Mom & stepdad came the next morning (Dad and stepmom waited since they had the post-discharge shift) and stayed all day.  Props for sitting in uncomfortable chairs for hours on end when I was hardly interesting.  While I'm still not a fan for myself, their Kindles definitely helped.  I did have a catheter that was removed on Tuesday (not nearly as terrifying as I imagined).  That did mean ringing an aid every time I needed to move and learning the "log roll" technique for getting in and out of bed (fall to your side, prop up on elbow, drop legs, push to seated).  MM (who stayed till mid-afternoon) showed off his experience at such things (he has ailing parents) with quite the skill at helping me swing my legs to bed.

PT made a quick visit with the basic BLT rules on bending, lifting, or twisting for many months.  I knew I was in bad shape when this didn't make me want bacon (though I was thrilled to be upgraded to broader liquids and get tomato soup at dinner).  I also got my brace and a visit from the respiratory folks with a breathing "toy" to help build back my lungs. 

Wednesday and Thursday went quicker than one might think.  I didn't sleep much, despite medicinal help...the first night I needed an aide's help even to shift a bit).  My Mom came to the first real PT visit on Wednesday...silly woman probably thought she was done watching me learn to walk and climb steps.  They opted to order a walker to help with my shakiness.  OT (occupational skills, not job stuff) went over stuff one never considers like putting on socks, getting in a car, and opening a fridge.  OT seemed never to have gotten my query about avoiding becoming a Sasquatch, though PT helped her suggest Nair (totally failed...darn Italian hair....but a folding chair and trust in knowing I can shave w/o actually seeing my calf did work).  I got stronger and better at my log roll....eventually able to do it myself once I figured out the bed lowering button.

I was discharged around 5 on Thursday and stayed with my Dad and step-mom till mid-Saturday.  Very little has ever been as welcome as the shower when I got there (had to keep the doors open and use my newly acquired sponge-on-a-stick to avoid bending).  Both were helpful nurses and mighty careful of me.  Props to the step-nephews for sharing their "Mimi" time and helping move the stool that served as my table.  I did overdo things Friday simply by sitting too team didn't limit sitting beyond saying to readjust every 30min, but I just underestimated the energy it took and paid for it at night.

MM has the week off and is a patient caretaker, cleaner of spills, and picker-upper of fallen items.  A lot of my pain is at the incision on my belly.  I also have a good deal of spasm-y pain in my back and stiffness all around.  I wear the brace whenever I'm up except for my shower and it will be around for a few months.  I've learned how OFTEN we bend...seriously, I have to go on my toes and pivot at my hips to spit out toothpaste.  I have also learned my years of picking things up with my toes can come in quite handy as long as I bring the foot all the way up to my hand instead of meeting it partway (though bigger things require the "grabby" tool from OT).  I've gotten used to the log roll for bed but need a mental check for a lot of things.  I don't need the walker at home but did take it when we made a store run, partly for the distance but more to alert other people that I need space.   I have a meeting tomorroe and plan to bring it for the same reason....the brace is visible but the walker is more so.  Also, I am struggling already with the food and body demons.  Recovery is SIX MONTHS but I need to remind myself compliance is key to results.

I have a follow-up in a month to check the progress. I was able to avoid a graft so have titanium cages in place of the disc and a protein sponge to encourage the bone to grow. Kinda cool that the surgeon facilitates it but it is really my body that will make the fusion work. The doc, who does multiple disc surgeries a week, said my disc was one of the worst he's seen in YEARS.  This is good on two counts: 1) It is a HUGE amount of validation...both back and endo patients know that people can doubt your pain, the doc was VERY clear it was VERY real and quite bad; 2) It means a great chance that the surgery will be a success since the disc was clearly a culprit and I have good stats (age, size) for recovery. 

Lessons for others facing similar surgery:
  • Tell people, including the nursing and aid staff, how to help you.  No way Teddy would have been there if I hadn't talked about him being a comfort ahead of time.
  • Have them close your room door.  I thought it'd be too dark the first night so had them crack it but there's really never total dark in a hospital room.
  • Compromise with concerned caregivers.  I wanted to shower alone but agreed to an open door and a few check-in shouts. 
  • 5 and 3yo kids are overjoyed to help.  I asked the 3yo to move a stool and then had to let the 5yo re-move it so he could help too :P
  • Tegaderm bandages are easier to pull off than tape (and shower-friendly).  My incision is below the navel so I especially appreciate this at the lower edge where the tape hit "fuzzy" areas.
  • Follow the rules but also know yourself.  My talent at picking things up with my toes make the grabby less essential.  And the struggle to shave was BEYOND worth it in the feeling-human department.
  • Useful things: sponge-on-a-stick (OT gave me one but bought a nicer one), a hospital-like tray table (standing and able to slide under stuff...not the breakfast-in-bed kind), good conditioner, a magazine for the bathroom (TMI, but it took time...), bendy straws, books that are engrossing but not too challenging to read, other books to stack under nightstand essentials to make them reachable


lee said...

Glad to hear that the surgery went well and they think it'll be a success!

Anonymous said...

So glad you came through it in one piece!

Lesley said...

I am glad Teddy was there for you:)
It sounds like you have some wonderful caregivers around you.

Keep up the good healing work.


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