Pushing Through Pain

Today marks THREE weeks since my surgery. Spinal fusion is an extremely invasive procedure with a long recovery. Muscles are cut, screws are drilled into the spine, nerves are irritated and the skeletal system is realigned. If you watch an actual video of this type of surgery, it looks very brutal (yes, I watched real videos before both of my surgeries and it looks almost like they are working on a car or some type of a machine with all of the drilling and chiseling). Also, bone graft was harvested from my left hip. They basically scrape the bone from the hip and that is what hurt the most during the first 2 weeks. Swelling and inflammation can cause nerves to be compressed, leading to more pain. The lack of movement of the spine can also cause increased stress on other joints, such as the hips. If I sit too long, I get stiff and if I walk too much, I get sore. I am increasing my walking each day to help with the stiffness. I will be starting physical therapy soon with a focus on core strengthening to support my back.

During this critical time in my recovery, I cannot bend, lift, or twist. I have to keep my back straight and wear a brace 22 hours a day. I even have to sleep in my brace. I have to sleep on my back all night and I cannot turn to my sides. It’s not comfortable, but I’m getting used to it. It can take a while for the bone to actually fuse together and I have to be careful not to damage that process. I have to wear a bone growth stimulator over my brace for 2 hours a day to help promote bone healing. Failure to fuse can cause a whole new set of problems that I do not even want to think about.

My recovery is going more smoothly than the first one and I am learning to cope with my temporary limitations. My amazing husband has played an important role in my recovery process and I am so thankful for him. I also think that my fitness level prior to surgery has proven to be beneficial in my recovery process. I was already walking half a mile on the treadmill 10 days after surgery. The doctor said I should be back to normal around 6 weeks post-op, but I will still have to wear a brace for a couple of months as the bone continues to fuse. 

Here is a quick overview of my first three weeks after surgery:

Week 1- The WORST week. If you can make it through the first week after spinal fusion surgery, you will feel like you can make it through almost anything. It was absolutely awful.

Week 2- Anesthesia has worn off and the soreness really sets in. Still very bloated and swollen. Walking helps, even though it hurts. Each day gets better.

Week 3- Feeling MUCH better, but still tire easily. Can definitely feel if I overdo it. 

Side view of my titanium spine.
Everything below the break is new hardware.

Recovery

The actual surgery was the easiest part of this journey because I don’t remember any of it. The difficulty comes when you wake up and begin the recovery process. I remember waking up, but not being able to see what exactly was going on around me. I could hear the nurse moving around and other people nearby. I remember talking a lot, but I don’t really remember what I was saying. I do recall asking several times when I could see Matt (my husband). They kept saying that I would get to see him when I wake up more. The next thing I remember is being brought to my room. I finally got to see Matt and my family and friends that were there.

Inpatient Hospital Stay

The first night, I did not feel a lot of pain. I was connected to an IV pain pump that I had to press every 10 minutes to release the pain medicine. During the night, one of my nurses removed the pump because my blood pressure and heart rate kept dropping. They switched me to oral pain medicine and I began feeling the soreness. Bone graft was harvested from my left hip and I could definitely feel the soreness from where the bone was scraped. The first time I sat up, I felt awful. I was stiff, dizzy, and nauseated. It was difficult to sit up because I couldn’t bend my back or use any of my back muscles. In order to get up after spinal fusion surgery, you have to rely on your leg and abdominal muscles (good thing I ran a lot before surgery).

Once I was a little more coherent, my anesthesiologist came to my room and informed me that I took a long time to come out of the sedative they gave me. He said some people lack an enzyme to break down that particular type of medication. They use some sort of paralytic to place your trachea tube and nerve monitoring stimulators. Most people come out of it in about 5-7 minutes. He said I was paralyzed for close to an hour before I came out of it. They provided me with some information on it in case I ever need anesthesia again.

My Graduation Ceremony

The next couple of days involved pain, headaches, light sensitivity, nausea, vomiting and walking the hospital halls. My husband stayed with me in my hospital room and slept on the couch beside my bed. The Friday after my surgery was my graduation day. I graduated with my M.Ed. in School Counseling. I had to miss my graduation ceremony, but I was able to put on my cap and gown to walk the hospital halls. My mother-in-law and father-in-law brought me a graduation gift and some decorations to put in my hospital room. It was nice to have my own little ceremony, even though I wasn't feeling well that night. 

The third day after surgery was my worst day. I was dizzy, nauseated and very weak. My blood work showed that my hemoglobin levels were very low. I lost a lot of blood during surgery and continued to lose blood over the next couple of days through my incision drainage tubes. The doctor ordered a blood transfusion and it made me feel much better. The transfusion took most of the day and I was released the next day.

I was in the hospital for 4 days after my surgery. Right before I was discharged, my surgeon came by to visit me. He said that he could not be more pleased with the surgery and that everything went great! My recovery process is now continuing at home.The dizziness and nausea lasted almost a week and I'm still dealing the stiffness and soreness. It takes time to recover from this type of surgery and I will get there soon. 

Blood Transfusion

Going Home

Brace Yourself: Spinal Fusion #2

The week before my surgery, we drove to Houston for my pre-op appointment. Our first stop was the Spine Associates office. I had an EKG to check my heart and a physical exam to clear me for surgery. Next, I had to go to the hospital for blood work and a chest X-Ray. The hospital was able draw blood for my blood work, but they said I would have to come back to have more blood taken for the blood type and cross. The type and cross is done to make sure you receive the correct blood if a transfusion is needed. The last stop for the day was to go get fitted for my brace. I was told that I would have to wear a brace for 3 months after surgery, so I asked if they could make it pretty! They brought me some color samples and I chose a brightly colored pattern for my brace.

On the way home, I began thinking about the robotic surgery and wondering why I had not gotten any information about it. I called the surgery scheduler and she informed me that the hospital I am going to does not have the robotic arm at that site. My doctor performs surgeries at a few different hospitals and the only one that my insurance would cover is the one without the robot. At first, I was really upset to hear this because I knew that the robotic procedure helped to reduce many risks. I got over it and just moved forward with the surgery.

The day before surgery, we drove back to Houston to get my blood drawn for the type and cross and we stayed in a hotel close to the hospital. I was so nervous the entire day before surgery. Every time I would think about it, my stomach would turn a flip!

On the day of surgery, I arrived at 5:00am to get prepped. I changed into my hospital gown and the nurse tried to get my IV started. I am a big baby when it comes to needles. The thought of having screws drilled into my spine does not freak me out as much as needles (I know, that is weird). The nurse tried twice and blew two of my veins because I was so tense and I was crying. She had another nurse come try because she did not want to poke me a third time. They usually don’t let family come back until the IV is going, but the nurse called for my husband to come into the room to calm me down. He held my hand while they tried again to place the IV and it helped.

Before Surgery

Over the next couple of hours, I sat in the pre-op/holding area and waited my turn to go back. I had several doctors and nurses come talk to me and ask me questions. I spoke with my surgeon and he informed me that he would not have to remove all of the hardware I had put in during my previous surgery. He said he would just remove enough of it to make room for the new hardware. I also spoke with the anesthesiologist and the doctor that monitored my nerve functioning. He put wires around my hands and feet and explained that he would have needles in my head, hands, and feet to monitor my spinal cord and nerves while the surgeon worked on my spine.

Waiting to be brought back to the operating room is absolutely terrifying. They finally gave me some medication through my IV to begin the sedation. I told my husband goodbye and they wheeled me to the operating room. I remember telling them, “I’m not asleep yet” as they brought me to the operating room. The nurse said that I will go to sleep soon and that’s the last thing I remember before waking up in the recovery room.

When Life Throws A Curve

I have been doing fairly well, but I have been experiencing some minor pains here and there. I had not been checked in 8 years, so I made an appointment back in August to get a check up. I was expecting to hear that everything was ok and I'm just worrying for no reason, but instead I was told that I needed another surgery. I cried for two days after that appointment. My first surgery was so traumatic and the thought of going through that again was overwhelming. I pulled it together, stopped feeling sorry for myself, and finally just accepted it. There are so many people out there with health problems that are much worse. I am dealing with something that can be fixed.  

Reviewing my X-Rays with the doctor

The doctor said that this surgery should not be as bad as my first one. In my first surgery, most of my spine was fused. The bottom section was left alone because the curve wasn’t significant and they already had me under anesthesia for 13 hours. I do remember my first surgeon telling me I may have to be fused all the way down in the future, but the future seemed so far away. My recent X-Ray showed that the unfused portion of my spine has progressed 10 degrees in the last 8 years. So even though the top is fixed, the unfused portion is still progressing!

My choices now are either do nothing and let the curve continue to progress or go ahead and do the surgery before it gets worse and before I have children. The curve progression and shifting can eventually affect the part of my spine I already had fixed. My first fusion is basically sitting on an unstable foundation. 

I will have all of my hardware removed during my next surgery and I will have new rods and screws put in to fuse the rest of my spine. The screws that I have now are large for my bones and an MRI showed that they are sitting very close to nerves. Once the bone is fused, the hardware serves no purpose. They don't usually remove hardware unless you need additional surgery. My recent CT scans showed that my first fusion was successful, so it is safe to remove the hardware. 

So, here we go again! Surgery #2 is coming up quick! I go next week for my pre-op appointment. Instead of a 6 month recovery, I'm looking at a 6 week recovery. Thankfully, technology has advanced quite a bit in the last 8 years. My doctor will be using a robot to assist with my surgery. It actually seems pretty cool! Check out the video below. 

Spinal Fusion #1: May 31, 2007

Spinal fusion is a surgical process in which the vertebrae are fused together with bone graft to heal into one solid bone. The fusion helps to correct and discontinue any further curvature of the spine. The rods and screws are put into place to hold everything together until the bone fuses. A blood transfusion is usually required due to massive blood loss during this type of surgery. The 3-D animation below illustrates the process of placing the instrumentation. Once the instrumentation is in place, the doctor applies bone graft so that the fusion can take place. 

My Surgical Process

My first surgery took place at Texas Children's Hospital on May 31, 2007. I was 21 at the time and engaged to be married the next year. My mom and my husband (who was my fiancée at the time) took great care of me during my difficult recovery. I was the oldest patient at Texas Children's because my surgeon actually worked at Baylor and Texas Children's Hospital. He preferred to do my surgery with his colleagues at Texas Children's, so he was able to get me in even though I was technically "too old" to be there.

My surgery took 13 hours. They gave my mom a pager to call for the nurse anytime she wanted an update. In one of my pre-op visits, they did an MRI and found that I had a tethered spinal cord. This had to be fixed before they could begin the fusion. So, the first hour or so of surgery I had a neurosurgeon working to untether my spinal cord. The next 11-12 hours I had two orthopedic surgeons straightening my spine. 

But wait, there's more... 

Bone graft was harvested from my own rib. They went through my back to break my rib and they ended up accidentally puncturing my lung during that process. I had to have a general surgeon come sew up my lung toward the end of surgery. Bone graft is often taken from the hip or from a cadaver. They chose to take from my rib to correct my rib hump that was beginning to form as a result of the scoliosis. When the spine shifts, it also causes the attached ribs to shift. This can cause a noticeable hump on one side of the spine. Taking from my rib helped to correct the rib hump and improve my posture. 


In summary,  I had neurosurgery, spinal fusion surgery, a broken rib, and a punctured lung all within that 13 hour process. I lost so much blood during surgery that I had to have a blood transfusion. I knew this ahead of time so I donated my own blood prior to surgery and my father-in-law donated for me as a back up. I was also told that they invited the medical students into the operating room because they got to see something during the neurosurgery that they only see in textbooks. I don't remember what that "something" was, but I'm sure it is somewhere in my 57 pages of medical records from that week. 

My After Surgery X-Ray

Recovery

I had to stay in the hospital for a week. They tried to get me up and walking the next day, but I could barely sit up without vomiting. This was due to the anesthetic wearing off and I was on some very heavy pain medication, including a morphine pump. I had an allergic reaction to the morphine, so they decided to take me off of it a couple of days after surgery. That was a bad idea. 


I believe my exact words were, "WHERE IS MY PAIN MANAGEMENT TEAM??? THEY ARE NOT MANAGING MY PAIN!!!!" When they took me off the morphine pump, I was screaming and in so much pain that I had every doctor on that floor in my hospital room. My screaming could have been translated to...Um, HELLO PEOPLE?! IN CASE YOU FORGOT, I JUST HAD MY SKELETON REALIGNED AND IT LIKE, REALLY HURTS!!! PLEASE, DO SOMETHING! They decided that the rash I developed was preferable to the pain, so they put me back on the pump and gave me several other medications to calm me down and ease the pain. Words cannot even describe the pain level I was experiencing at that time. 

My nurses had to come into my hospital room to turn me every 4 hours. I had to lie on my side, then my back, then my other side. My mom had to continue this when we got home. She had to set her alarm during the night to wake up every 4 hours to turn me and give me my medicine. I could not even go to the bathroom or take a shower by myself for a long time. My weight dropped because I did not have much of an appetite for a while. I weighed 88 pounds at my lowest and I did not look healthy. I am thankful that I had my mom to take care of me during my recovery. She passed away from cancer 3 years ago and it has been an adjustment to life without her. I miss my mom very much, but I now have an amazing husband that will take care of me during my next round of surgery. He proposed to me 2 months before my first surgery and he was there for me throughout my surgery and recovery process, even before we were married! I am extremely blessed. 

"I will sing to the Lord, because He has dealt bountifully with me."   

Psalm 13:6 

The doctor told me that it would take about 6 months to fully recover and that was an accurate estimate. Over time, my pain subsided and I went through physical therapy. The physical therapists were intrigued to see my progress after having such a major surgery. Many years ago, scoliosis patients were put into a full body cast after surgery. Spinal fusion surgery has come a long way and so have I! I have run multiple 5K races, 10K races and two half-marathons. I hope to run many more in the future.