February 24, 2011 - Third Time's the Charm?

I had my PATs and also met with the anesthesiologist/
resident for intake at the hospital in New Jersey. I saw my cardiac
doctor for clearance. February 24, 2011, I go in for my third
fusion surgery (this time L1-L2) in six and a half years. I will also
have the old instrumentation removed from the lower lumbar levels
since I'm solidly fused there and since he's there anyway.

I remember waking up from my first surgery back in October of 2004 and
thinking "It's over! I did it!" Sadly, it was not over. Never let
any surgeon assure you that he (or she) can fix you and afterward,
there will be no further problems. Your chances, after a multi-level
fusion, of slipping more either below or above your initial fusion
site is more than 50%. I have always said that I am glad I had my
surgeries because I was in poor shape before each of them. I hurt

and couldn't do much. Same thing before this last one. It's just that

you are never really "fixed" the way you are when you have, say, a hip

replaced. Touching the back through surgery is always dicey and can

lead to other issues later on. I know there will be people who say "Oh,

but I'm fine after my fusion surgery" but they are only a few years post-op.

Heck, some are only a few weeks post-op. wish them well, but I know better.

With fusion surgery, always keep your hopes high, your expectations
low and your fingers crossed.

And find a good surgeon, a spine specialist preferably.

Not Again ...!

I thought I'd check in, update my blog and let you all know what happened at my appointment back in October with my spine surgeon. I had my MRI films from a few months ago and stopped in to get new x-rays before I went up to see him. He greeted me with "You again??" and we both laughed. Then he went off to study what he had, new x-rays and the MRI stuff.

When he came back, I said, "So, what'd you see?" and he replied " It's not good, not good at all." Then he explained to me that yet another level of my lumbar spine (above my last fusion site) is slipping, so much so that I really must consider having more surgery soon. He indicated that although there's no disc herniation at this time at this location, with the kind of friction from slippage I've got - 9 mm - a herniated disc there is almost imminent. He told me to go home, look at my calendar and chose a date.

I don't believe this is happening. I knew something was wrong, but I never expected this. I'm stunned.

Update

Well, I haven't been here in quite some time because things were looking up, the pain was minimal, and it seems I was healing. Recently, I have had some incidents of stabbing pain (not lasting, just surprising!) in the center of my right butt cheek. What could *that* be? Also, I'm now getting cramping pain at the very bottom of my thighs/tops of my butt where the two body parts meet. What could THAT mean? Anyway, I had an MRI of my lower spine done this week (suggested by my PM doctor - if it's anything that needs to be reported to my spine surgeon, we'll go from there). I'll probably see him for an appointment within the next few weeks, before vacation. Keep your fingers crossed, everyone.

Finally, a New "View".

I've been fussing and fooling with my last known CT scan from right after my last surgery in late August of 2006. I finally got it up so you all can see what a VERY multi-level lumbar fusion looks like. Yes, it does look intimidating and like it would hurt, but honestly, it's getting better all the time, pain-wise.

Update

It's Thursday, April 26th and it's time to update my blog.  I'm almost nine months post-op after my last fusion surgery back in late August 2006.  The back brace is long gone, but the opiate drugs remain as lifesavers.  I still see my pain management doctor regularly, and I still need (much to my personal dismay) some drug help with the pain.  There are some days when I feel great, on top of the world and ready to take on anything.  There are other days, though not so often lately, that I feel like I got hit by a commuter train.

Mornings are still rough for me.  Evenings, if I've overdone activities during the day, done too much lifting or moving around, are also rough.  I've found out I can tell what the weather will be because my fusion site acts up when it gets damp or raw.  Winters have been rough and so are rain and snow storms, it seems.  

I've been halfing my Vocodin, taking only 5 mgs as needed.  Some days I can get away with only 15 mgs.  Most days it's still more like 20-25 mgs.  Percocet is far too strong for what ails me now, pain-wise, and I take it only rarely,  but I sure wish I didn't need anything at all.  I guess I have to continue to be patient.  Still, I'm very glad I had this surgery done.  When I think of how I almost couldn't walk at all back in early 2003 at the worst point of all of this, I'm happy for how far I've come.

Three Weeks Today

Today, I feel great! Yesterday, not so good. Saturday, okay. Friday, awful.

I wish there was some way to make sure this long recovery had uniform days of feeling good. I'm trying to figure out if it *is* the Percocet that is making me feel so sleepy and low, yet I still need it for the pain, like I had last night. I desperately wanted to watch "Desperate Housewives" last night, but had to go lay in bed earlier than planned after taking a Percocet. I felt better, fell asleep and woke at 3:30 AM to take another Percocet. This morning I feel great. I'm trying to not take as many pain meds, but it's only three weeks today that I had my surgery, and I know the Percocet will be with me for at least a few more weeks, so I have to get used to it.

Thankfully, I have absolutely no pain at all in my legs anymore from the disk problems at L3-L4. I don't have very much incision pain or post-surgical pain there, but when I do, I do need meds for it, plus I can't even take anything less than an opiate because I'm fusing. Curiously, I keep getting a fierce pain right on a palm-sized area of my right outer hip every once in a while when I'm laying down (but not on that side.) The only thing I can think of that it could be is residual pain from the bad disks. My lower back feels great, where the larger screw was put in to replace the earlier loose one. I now know the pain I used to have back there was from that darned loose screw!

Home Again, Again

My surgery was early on the morning of August 28, 2006. I went home from the hospital on September 1, 2006. It was a very rough week.

I woke up after the surgery in the worst possible pain I could have imagined. After my first fusion surgery in 2004, I woke up calmly and peacefully with a pain pump of morphine IV already in place and working very nicely, so I expected the same this time.

That wasn't the case.

My surgeon later told me that I was terribly stressed, and that my body was feeling and reacting to pain even while under anesthesia. I was stressing and had to be stablized before I could be given anything like morphine. All I remember was waking up in so much pain, thrashing around and screaming "Help me! Help me!" like Susan Hayward in one of those old black and white 1950s "B" movies. Then, it was not so funny, but that's what it must have looked like.

I don't know how long it took for them to do what they had to do to get the pain pump in place (I think they also gave me a shot of morphine, but again, I'm not sure), but it seemed like a lifetime. I was taken to a bed in sub-acute ICU that night and stayed there until Thursday. There, I was checked on continually and monitored, much more so than during those first few post-op days after my first surgery. I was moved to a regular room for one day before I went home late Friday night.

Note: I’ve asked my DH about the events of that day, since my memory of it all was not very clear. I remember him being there and then not being there with me. He said he was permitted to stay for about five minutes right after my surgery, but then, the need to get me stabilized was paramount, so he had to wait outside for an hour or so to see me again. It must have been a long day for him.

Just briefly, I have a 16 inch scar now where the old one was. I won't be getting my hardware back. It seems a request like that is just too much for them to handle. I have a wound on my upper lip that may produce a scar from the surgical tape used during the procedure. When they took the tape off, they took the skin with it. That's getting better, though, so it may not be as much of a problem as I first thought.

My surgeon's chief surgical resident prescribed only 4.5 days of low dose Percocet for me when I left the hospital on Friday night. I'm sure many of you all know that a script for opiates should have the dosage and the total amount of pills written on it. This one did not, and when I questioned that (I didn't want any problems with this after I left the hospital) he sent back the nurse to tell me it was “okay.” It was not. Our pharmacist, who is also a neighbor and a long-time mom-and-pop drug store owner in town, had to call to find out how to fill the Rx, because it wasn't written correctly. Of course, he couldn't get through (that's been my main concern in dealing with these folks) and wound up getting a file clerk who was in doing extra hours on a three day weekend! A call in to my regular pain management doctor did the trick, and he saw me a few days later, before I ran out of that initial paltry prescription I was given. Thank goodness for the compassionate doctors.

The rest of my hospital stay was marred with dueling day nurses fighting with overbearing PTs, nurse's aids jockeying for position with wheel chairs and other petty sniping and bickering. I'm sure I just saw what goes on at a lot of big inner city/metro hospitals all over the world, though.

I saw both my surgeon and his NP who removed my staples earlier today, Friday, September 8th. The incision looks good, I’m doing well, and the pain in my thighs from the disk problems is slowly going away, enough so that I actually feel that it might be successful. My surgeon stressed the need for my brace, for taking it easy and he also suggested I use a bone growth stimulator. His NP will be in touch about that.