Fighting Back, Part Two: In-Patient Recovery

And reposting Part Two (of Three in the original series), one day before my 1y mark and a few weeks before my next and possibly last appointment with my surgeon.  I plan to do a Part Four shortly after that appointment.
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This is the second post dealing with my recent back surgery (posterior lumbar fusion and laminectomy w/ screws and rods, a revision to a prior anterior lumbar fusion w/ cages).  In addition to updating friends/family, I really hope these posts provide some useful insight to others who are undergoing the same or similar surgeries and/or their loved ones.  The words at the top of my blog page are particularly apt here since the format is pretty darn basic: Nothing fancy, just some thoughts.

This part will cover my in-patient recovery period...I had surgery on Wednesday and was in the hospital until Saturday around 1PM. Here's a link to Part One.

These posts are all just my personal experience and recommendations and thoughts should be taken as such.

Day of Surgery & First Night

• I was the second surgery of the day and got delayed a bit because of trouble waking the woman before me  The wait sucked.  It was early evening when I awoke in the recovery room (and got my glasses!).  It was probably 8:30 before I was taken to my room where my husband, mom, and step-dad were waiting.  They told me the doc said all went well (initial info had been passed to them by a nurse, the doc called and spoke to my husband just as I arrived).  The doc confirmed that he'd seen instability, that was a very good thing since it meant they were tackling what was likely the right problem.  He also mentioned it taking a bit of extra effort placing the screws because my skeleton is quite small...I could have told him that dentists sometimes use pediatric tools and my last physical therapist was fascinated by "the smallest patellas (kneecaps) I've seen on an adult."  
• The first night was LONG.  I didn't sleep one wink.  For most of the night, the nurse was very attentive and kind (she got called away but had been planning to come sit and do her charts in my room to keep me company) although the 12h shift and a rough neighboring patient ("Please, Lady X, don't try to get out of bed" "Please, Lady X, keep your gown on"...) wore on her.  Over the night, there were two hiccups....
• A Bedside Alarm --  The bedside alarm seemed to be for non-urgent matters and I learned that bending my arm too sharply triggered it b/c of the IV placement.  It went off, as it had before, around 5AM.  I knew how to use my call button but didn't press it since I presumed that the alarm would trigger some sort of alert...I figured if no one came there was a mighty good reason why (i.e. Lady X).   Eventually, after a good thirty minutes of an unrelenting alarm noise causing a massive headache on top of everything else, I burst into tears and started calling for someone to help and just make it stop.  A volunteer eventually heard me.  It turns out that alert only sounded in my room and my mostly closed door prevented the staff from hearing it. The nurse was less than kind when she explained this, insisting she'd showed me the call button, which she simply reiterated that when I said I didn't think I needed to use it when the alarm was going off since I presumed it alerted the staff.  She said she didn't want to hear a volunteer found me bawling again...probably well-intentioned but came off sounding like she felt criticized.  Lesson: Press the button, even if you think you don't need to!
• TMI Alert!  Catheter Issue -- Yes, this is TMI, but maybe it'll help someone to share it.....For hours, I mentioned that I felt like I needed to use the bathroom but I "knew" I had a catheter so that shouldn't have been a true issue.  Eventually the nurse did go in search of a bladder scanner that wasn't in its usual location but it was low-priority and she got diverted.  I'm not sure what triggered the eventual response, but suddenly an aide rushed in around 4AM.  Long story short: The catheter wasn't ideally placed and there had been ZEROl output from it all night (which should have told them something!!)...the adjustment led to more than an entire container's worth of output!  Lesson: If you know something is amiss, keep mentioning it even if it feels "silly"...I had mentioned it, but I think I almost dismissed my own complaint.

The Rest of the In-Patient Stay (Days One to Three of Recovery)

• Honestly, I had a good deal of pain throughout the in-patient period and pretty poor pain control, largely b/c of how long I'd been on pain meds and my high tolerance. I also found it incredibly hard to push myself up from lying down and/or sitting.  I worried about doing it without bedrails but found I really did make fast enough progress that I could handle it by the time I was discharged/
• Each day included two visits from physical therapy.  The first time, I just stood and walked across my room and across the hall.  Eventually, we did trips down a couple of hallways and practiced the single step I'd need to take up my stoop at home to get in the door.  I had a walker and usually both a physical therapist and an aide.  
• I also saw Occupational Therapy twice.  They are focused on more general life skills from putting on socks to getting in the shower to using a grabber tool.  Honestly, I didn't need the help since I'd heard much of it after the previous surgery.
• While it has moved into more normal ranges in recent years, I've often had fairly low blood pressure.  I still have it sometimes but I used to feel like the world closed in on me when I stood up.  Although I had high BP before the surgery, it got pretty low in the following days especially on day two.  I had to laugh when an aide dismissed a 90/55 reading and said it was probably an error.  She retook it and got 90/51.  Not surprisingly, I felt like just keeping my eyes open was hard work and even slept through a visit from my husband (he would text me in the AM and come by for a couple hours in the early PM and again post-dinner).
• The hospital had a "Room Service Menu" longer than many restaurants.  I wasn't really hungry, but seeing it by my bed the whole time incited some intense cravings.  Kinda sucked since I was on "clear liquids" until lunch on the last day when I was given a nod to move up to the "Light" listings which meant I got crackers and dry toast!  While I never placed an "order," they still delivered broth every meal...which I never touched but the thought of broth still makes me queasy!!  I mostly had popsicles and water ice.  Lesson 1: Don't look at the menu if you can't have it.  Lesson 2: The meal cart girl had extras of the pops/ices and had better flavors than I got from the nurses!
• By the end of the stay, when they finally unhooked everything (actually, they gradually unhooked certain pumps, my wound drain, etc.) I had a song from Pinocchio in my head: I Got No Strings.  It felt incredibly freeing not to need someone to hold up/move the IV etc and not to have to either have them leave the bathroom door ajar to accommodate the equipment!
• I was terrified to go home.  I wanted home, but I feared I couldn't handle it esp on morning 2 when the doc said I'd probably leave the next day.  I was fine  It wasn't easy (see Part Three!), but I could do it.. Reminder: The docs and nurses really do know what they're talking about when they plan for discharge.

I know, rambly as always!

(Image by Andres Moreno)

Fighting Back, Part One: Overview of the Surgery and the Pre-Op Period

As a general rule, I don't intend to re-post entries from my prior blog here at HSG.  However, there are exceptions to every rule...  I'm fast approaching the one year mark from my second back surgery and I have a check-up with my surgeon in early June.  After that appointment, I intend to post an update but it feels like it would be ungrounded without first sharing the earlier stages of the journey.  So, with acknowledgment to myself and my other blog, here's part one:

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I intended to write, both on the blog and for myself, during my recovery downtime but that hasn't materialized.  Part of the issue is that sitting is hard on the back and so I'm in bed much of the time and only using my tablet instead of my laptop -- I'm a slow enough typer normally, let alone on a smaller touchscreen!  Still, I want to have more of a record of this recovery and also want to share it for anyone who might be looking for firsthand accounts of spinal fusion surgeries...so, I'll compromise with a throwback to my beloved bulletpoint style posts that may take a bit to complete but hopefully will cover the surgery and the early weeks of the recovery.

Since a single post was becoming unwieldy, I'm going to split this up a bit.  I'll add in links to the other parts once they are complete but here's a bit of rambling on the procedure and the pre-op timeframe...

Note: These posts are all just my personal experience and recommendations and thoughts should be taken as such.

The Procedure (copying myself from Facebook)

• This will make more sense in combination with the links below (obviously generalized so may include irrelevant pieces or miss important ones) -- My surgeon did a posterior (i.e. from the back) laminectomy with fusion (much bigger endeavor than w/o), the term "PLIF" is often used for Posterior Lumbar Interbody Fusion.  The doc used pedicle screws and rods plus a bone graft of “locally harvested” material taken from the earlier in the surgery.  It was complicated since I had a previous surgery at the same level from the front (anterior, ALIF) using two cages plus bone morphogenetic protein (supposed to encourage bone growth).  We believe the area never fully fused leaving instability that caused pain.  The underlying reason is basically unknown…they’ve referenced “degenerative disc disease” (read: bone broke down and no one knows why) and also “failed back surgery syndrome” which pretty much means what it says! 
• Here's a short animated video shows a procedure much like mine; 
• This page has lots of words but more info than most;
• This page provides an overview of fusion (as one person said in an online discussion about a procedure akin to mine “[t]hink of it as fusion being the primary surgery with laminectomy just a part of the process”;
• One more link with a bit of detail on the screws 

Pre-Op

• Background: Many years ago, I waited much too long to speak up about pelvic pain..as in I was put in a cab and dispatched to the doc after passing out at work.  By then the pain was bad and no longer confined itself to my period and when I finally did seek help it felt pretty urgent.  Despite both the doc and I "knowing" it was endo, they ran through tests for a number of other possibilities first since endo is a surgical diagnosis.  Finally, we were ready for what I "knew" was the procedure that could diagnose and even help treat the pain.  The date was set...until I showed up to the pre-op with a "little" congestion and found out it was walking pneumonia!  That meant a heart-wrenching delay and means I freak out a bit about pre-op issues.  
• Before this surgery, I needed a clearance from my general practitioner and a bunch of tests.  I was worried but I "passed."  
• The week before surgery I felt kind of weak and had cold symptoms.  It isn't the right response, but I didn't say a word and figured I was fine as long as I didn't have congestion or a fever on the big day.  As a kid I'd get strep throat without the slightest temp rise and my norm is closer to 97.6, a degree below average...still I felt like I might have one about 5 days out (I refused to check).  So I held my breath when the nurse took my temp in pre-op and my heart stopped when she voiced the read-out "One hundred even."  Thankfully, and perhaps b/c they didn't know it was more equivalent to a 101 in someone else, they still allowed me to go ahead.
• One of the many reasons I like my surgeon is that when he stopped by my pre-op bed (side note: it was in a little bay with a real door and this odd toilet that folded into the wall!) he gave me a hug and told me he'd pray for me.  It seems standard for the surgeon to check-in, but this truly made me feel like he cared.  Despite not being a religious person, I truly do appreciate prayers and I also appreciate any sort of thoughts/energy/wishes that people put out there.  I will admit, as another aside, I told people that for the day of the prayers/wishes/vibes/energy should all be directed towards the doc to guide his hands...my "part" would come after.
• I'd had surgeries before and knew I couldn't wear my contacts.  The staff seemed a bit befuddled by me refusing to just send my glasses with my husband.  I knew I'd be in recovery for an hour or so before I saw my family when I was moved to a room.  I couldn't imagine the added anxiety that not being able to see would bring.  I pushed and, despite insisting patients couldn't take anything with them, they eventually agreed to have my glasses travel alongside me.  Absolutely worth the push (though truly surprised that I seemed to be the only person who made the request)!

(Image by sportEX journals)