lumbar fusion surgery preparation

I figured I'd finish a post I started two weeks before the first surgery, which I had on March 3. I started this post in mid-February and never finished. So I removed some of the references to time frames so as not to confuse anyone. I decided I'll write this as "here's all the stuff I had to do pre-op."

It seems like just yesterday I made the decision to have lumbar fusion surgery. But before I knew it, pre-op preparation was upon me. And now both surgeries are over and it's been almost seven weeks!

I started preparing probably about the second week of February:  everything from grocery shopping to cooking to blood work.

A couple weeks before surgery I headed out to the grocery store and the warehouse club to stock up on stuff like paper towels, toilet paper, and other stuff I hate spending money on; I'm so glad I did considering the COVID-19 pandemic that started taking off right around the time of the first surgery. Had I waited to get these items when we actually needed them, I'd be SOL on toilet paper. I also grabbed some ingredients so I could make up some casseroles and other meals to freeze. I'm made a Shepherd's pie; taco bowls (those are already made and are in the freezer); a ground beef base for sloppy Joes; and a huge batch of seasoned rice in the Instant Pot.

I also bought some items I figured I'd need after surgery:  a raised toilet seat attachment (turns out I didn't need this); a shower seat; a handheld shower head, which I installed myself; and two grabbers so I can pick up things from the floor and pull laundry out of the washer and dryer (these things are SO worth it--you'd be amazed how many things you drop after surgery!).

I had my first pre-op appointment mid-February. The nurse practitioner was really nice, and it turns out she's had back surgery, too, so it was helpful to hear about her own experience. She took my vitals (BP and lungs were good!), weighed me (I've gained 34 pounds in three year...not a surprise since my eating has been crap, but I still didn't like hearing it), and ran down a big list of medical questions. She answered some questions for me and really made sure I felt like I was being heard. She also went over pre-op prep, the hospital stay, and recovery afterwards. I have to say, although I knew going into this that recovery would be long--six months to a year before the bones are completely fused--it was tough hearing her say it out loud. I was told that my back will be my "newborn baby" for the next six moths to a year--no "BLT."  That means no bending. lifting, or twisting. She said I'll need to learn how to do everything from getting dressed and undressed, getting into and out of the car, picking things up, and pretty much anything else that would normally involve bending, lifting or twisting. In hindsight, it's really surprising how many things involve twisting and we don't even realize it at the time. She told me to bring clothes to the hospital so they can teach me how to dress and undress in this new way. She also said that once I get to my hospital room after surgery, the physical therapist will be coming later in the day to start PT...the SAME DAY AS SURGERY! I couldn't imagine how that was going to go, but it turned out that all I had to do was show that I can get in and out of bed without twisting (the "log roll"), walk, and do a few stairs.

The following week I had my blood work done. In the same appointment they did a nasal swab to test for staph, MRSA, and all the other nasty stuff that can run rampant in a hospital. They also blood-typed me since I'm new to that health network.  Then they took a urine sample. (That's always fun. I just love peeing all over my hand while I try to "do a clean catch midstream.") Then it was on to the EKG.

Next was the general surgeon. He's the one who works with the orthopedic surgeon to pave the way for access to the spine, as my surgeries involved placing a metal plate and screws on both the front and the back of the spine. He told me what he's going to do, which was basically, "I go in through the abdomen and move all your guts to the side, and you'll have a six- to seven-inch scar."  Pretty much in those exact words, too.

My last appointment was with the pain management doctor. I thought it would be to talk about post-op pain management, how they'll wean me off the meds, etc. Nope. It was just to say he's now handing me off to the orthopedic surgeon for pain management and hopefully I won't need to see him in the future, which obviously is the point of surgery. Normally I'd be thrilled with an appointment that literally lasted about three minutes, but I felt a bit let down, as the doctor was running about 45 minutes late.

So, that was it for doctor's appointments and lab work.

The remainder of my time was spent cleaning the house and preparing for my cousin to visit, which unfortunately didn't happen because the timing of the visit was right when Amtrak was cancelling train routes. That's OK. I'll see her at some point once COVID-19 is over and things start to return to normal. 

second surgery done! now, on to recovery.

It's been over three weeks since I've had the second surgery, which was March 17 (first one was March 3). Time to finally finish this post, which I started almost two weeks ago. (I can't sit for long periods of time yet.) And since it took me so long to get around to finishing it, it's going to be long! I also plan to do another post about recovery in general. Hopefully it doesn't take me quite so long to get it done!

Surgery

My surgery was again scheduled for 7:30 am, which meant being at the hospital by 6 am. No food after midnight, clear liquids only until 4:30 am, and then nothing, not even water, after that. I again missed having my homemade iced mocha latte.

When I got there, admission was pretty fast and they called me into the pre-op area almost immediately after. (Last time they were on Day Two of a new computer system so it took a little longer.) They weighed me and had me give a urine sample to rule out pregnancy. Luckily I remembered not to use the bathroom again before I left the house, so giving a sample was easier this time. Then it was on to the pre-op prep room.

I wasn't nervous this time. I mean, I was on some level--surgery is a big thing after all--but I don't remember actually feeling nervous or being worried. My body would tell you different, though, if you were to look at me or hold my hand. As with the first surgery, I was visibly trembling quite a bit in the pre-op room. Kind of like when you're cold and you shiver uncontrollably. Same thing here, but you're hot and cold at the same time with a bit of nerves thrown in, and your hands are clammy. I seemed to have a little bit of control over it since, when I told myself to stop it, I was able to stop for about 10 seconds or so. Once I stopped actively telling myself to stop shaking, it would start up again. I just kept telling myself that surgery is going to happen at this point whether I want it to or not. I mean, I guess I could have backed out, but why do that? If I want my back to be fixed and I want to not have pain anymore, I need to have the surgery.  There's no other way to fix it; therefore, I have to go through with it.

The pre-op room is where you go to change into a gown (they pump it full of nice warm air!); have your vitals taken; give a rundown of your health, current meds, etc.; have your IVs started; talk to the doctor an everyone else on your surgical team; and generally just wait until it's time. I was in there for about an hour and half or so. With the first surgery it was time spent being nervous, but mostly upbeat. This time, while I wasn't as nervous, it was very uncomfortable physically having to recline on a stretcher with a thin mattress--not good for someone recovering from recent back surgery. Sciatica had set in the Saturday before and it was my whole left leg, from the buttock down to my foot. Since surgery was to take place the following Tuesday, they weren't able to give me an anti-inflammatory meds, which would have helped to calm the sciatic nerve.  Basically all I could do from Saturday to Tuesday is take my oxycodone and recline or lay down as much as possible. Most days it was so bad the oxy really only made it tolerable. (If you've ever had sciatica, you know how uncomfortable it can be. If you haven't had it, it REALLY SUCKS. The sensations range from pain, to throbbing, to burning, sometimes all at the same time, from you butt down to your foot and everything in between, and it can be really hard to get yourself into a comfortable position.) By Tuesday morning I was beyond ready to get into the OR and get the surgery over with just so the sciatica would stop. I told the doctor when he came in beforehand that I want to get to the OR and to knock me out ASAP. He laughed, but I was serious. Having to recline on that hard stretcher for over an hour when I was already uncomfortable felt like torture; I couldn't get comfortable at all, especially because I was still recovering from the first surgery, which made it hard to keep switching positions.

After talking to the surgical team--I had some of the same people I had last time, which was nice--I was brought to the OR. When I got there, it looked different than the last time, but also felt the same. It turned out it was the same room. (They brought me from the opposite direction and it was arranged differently due to the robotic arm and other machines they needed this time.) I remember telling the guy sitting near the OR door when they wheeled me in that the operating table looked like a carnival ride, as the table had curved rails on it. (I was wondering if they would put me under and then move me to the table, or if I had to get on the table myself.  These are the things I think about before surgery, not things like, oh, dying on the table. Turns out they put me under and then moved me. Thank God--I don't know how I would have managed to get on that thing!) While I waited, a nice male nurse talked to me for a bit. We talked about real estate of all things. I'm so glad I had someone to talk to, because the trembling had kicked up quite a bit as soon as they got me into the room. When I mentioned that I didn't really feel that nervous, but was trembling so much, they said it's a fear response: I may not have been actively feeling scared, but I was feeling it subconsciously and my body was reacting. They must have started the sedation soon after, because I remember it stopped quite abruptly without my mind telling it to stop. Pretty soon after that, I was out. In what felt like the blink of an eye, I was in Recovery.

Here's a picture of what the table looked like. Obviously I got this from the Internet. It's not exact, but it's pretty close. I don't remember seeing the black canvas at the bottom. I think it was just the rails on top of the table.

Thankfully I was in Recovery for less than two hours this time, versus the five hours I was there last time. Apparently they didn't have a lot of orthopedic surgeries scheduled that day and the orthopedic floor was nearly empty. Actually, the recovery room was empty, too--I was one of only two in Recovery when I got there. Last time the room was full.

The second surgery took about three hours. The doctor placed the bone grafts, which they took from my pelvis; removed the temporary metal plates, which were put in place during the first surgery to connect the two vertebrae (L4 and L5) and keep them stable; put in the remaining rods and screws (the first set was installed during the first surgery through the front of the abdomen); decompressed the nerve; and cleaned everything up.

Pain Levels

While I wasn't yet in much pain right after surgery, I was really happy they already had me in my bed while in Recovery, which meant they just wheeled my into the room and parked me. I didn't have to be transferred into bed like the last surgery. My pain increased over the course of the day, which they controlled with oxycodone again. I also got a dose of dilaudid at some point. I also got dilaudid the following morning, because it was time to get my out of bed and moving, which was definitely harder this time. Not terrible, but not quite as easy as last time. When I saw the doctor that morning I asked about my pain levels. He said the anestesia stays in my body for about 24 hours after surgery and then the pain spikes about six to eight hours after that. He was right:  my pain spiked that afternoon right about the time they were sending me home. Thankfully I got a dose of oxy before I left, because the ride home, while fairly unpleasant, would have been much worse. We picked up my pains meds on the way home and I was happy it was again time to take them by the time we got home.

I definitely had more pain from the incisions this time around and it was difficult turning over in bed while I was the hospital. I managed, but it wasn't fun. And I feel like a lot of the pain was also from laying in bed so long in one position, both because of being on the operating table for three hours and also not being able to get out of bed until the following morning. Unfortunately the pain meds really don't help that kind of pain, so I spent my whole stay wishing I could be up and moving around in order to take the pressure off my back and hips.

Sciatica once again set in after surgery (Tuesday, 03/17/20), though this time it happened within a couple days rather than almost two weeks later. It started Wednesday night and was getting worse Thursday. I contacted the doctor's office and they put me on a steroid taper pack (six days of pills totaling 21 pills, tapering down day to day from six pills to one) to control the inflammation, which is what was causing the nerve pain. The leg pain went away for the most part, though my legs and feet still ached from time to time depending on how much I was moving around. I still had the incision pain, though it improved over the course of the week.

I was doing OK until the following Monday, which was about a week after this surgery.  The sciatica started up again and was worse the next day. I suspected this would happen as I tapered down the steroids. Unfortunately I can't take NSAIDs because it will slow down the bone growth, and I need the bone to grow so it fuses together--the whole point of the surgery. I also can't take NSAIDs because I've had gastric bypass, so those will always be off limits to me anyway. I also can't take another steroid pack so soon. I contacted the doctor's office and they put me on gabapentin, which is supposed to help with nerve pain. The only down side is that it takes one to two weeks to be fully effective. I started with the lowest dose, but had to ask them to increase it since it didn't seem to be helping. The higher dose seemed to help.

I'm also using a cooling therapy machine, which is like an ice pack, but it's ice water instead. A cooler holds water and ice, which of course you need to refill every day, and it pumps ice water into the pouch. You just put the pouch wherever you want it to get pain relief. It has a power switch so you can turn it on and off.

It's now been almost four weeks since the second surgery and now I’m left with pain pretty much only when I sit in my desk chair for more than 10/15 minutes, or when I take a car ride.  The car tends to kick up the legs aches and burning sensations in my feet for a couple hours, which is annoying, but thankfully it’s nothing like what I was dealing with a few weeks ago.

They’re starting to taper down the oxycodone this week and it makes me nervous that, in a few weeks, I’ll really have nothing left for pain relief if I need it: Tylenol is useless, as I’ve taken SO MUCH over the last three years for my back pain that it doesn’t even really help a headache anymore, which means it’s not going to help nerve pain; I can’t take NSAIDs because it will slow bone growth, which I need to for the bones to fuse; and everything else is a narcotic as far as I know, which I assume they won’t give me since they’re tapering me off the oxy. The gabapentin I take isn’t fast-acting pain relief–it has to build up in the body and stay at a consistent level to work, and even with that I still get the sciatica.  So what's left if I need it? I have no idea. I emailed the doctor's office today and I expect I'll hear from them tomorrow.