Katie's Surgery with Dr. Pimenta, Brazil (Cervical and Lumbar)

**WPKat** · 03-22-2010, 08:57 PM

Katie asked that I update the Forum on her progress.

She feels badly that "almost every single patient leaves the hospital within two to three days, and I've been unlucky enough to stay longer on a weekend when they are not normally in."

Aside from a couple of painful complications, I told her that she is doing excellent considering that she had both her cervical and lumbar regions operated on - one right after the other - and that she should not compare her progress with the other patients. After all, her surgery was about as major as it gets. She is strong lady with a big heart who is quite an inspiration for the rest of us!

I have taken bits and peices from what both Katie and her husband wrote, which I hope is not too confusing and does justice to her story without invading too much of her privacy. Hopefully, she will be back on the Forum and updating her progress any day now.

March 20 (Day 6)

My energy level was very high this morning with very little pain, but I am wiped and sore from about 3 pm on. But the good news is that it is all surgical pain, pretty much and should continue to lessen every day. I go up and down in energy levels depending on time of day.

I honestly felt like running, jogging a bit down the halls but thankfully restrained myself at least for now.

The sorest part now is my throat; having trouble eating or drinking a lot, but again that will pass. But considering all the beating this old bod has taken, it is a bit of a miracle that I can get out of bed let alone walk the halls and outside for at least a couple of hours a day all told.

I am sort of amazed myself at how well I am able to get around. I am able to walk with no extra help at all and feel that having minimally invasive surgery had a big hand in it.

She did 6 laps on this day!

My husband has read a bit and thinks this is because of the minimaly invasive XLIF approach using the EM monitor to avoid touching the nerves in the psoas muscle. My fusions were simply the insertion of a spacer in the disc space. There are no screws or rods. The bone graft was made using cells from scraping the vertebrae and combining that with a growth medium in two holes in the spacer. There was no bone taken from my hip. This means that the following occurred: the surgery removed all my presious pain and no new pain was introduced except for the three incision sites. Look at the PEEK cage on the nuVasive Website.

The hospital seems to be reducing her morphine quite a bit by extending the 4 hour interval to 6 yesterday, this caused my wife some pain. She has reduced her total meds considerably!

We really thank you all for all your kind words, thoughts and prayers.

March 21 (Day 7)

Today started extremely well as my wife felt better than ever. We were able to sleep in and then had a relaxing morning. It is gorgeous today ... it was both pouring rain and full sunshine at the same time! The heat and humidity is about the same as a July day back there, but this is supposed to be getting into the 'cooler' season.

Still trying to get used to the food. The meat is very salty, and there is an abundance of sauteed cucumbers, tofu and local fruit like mangos and papayas. The oranges and limes are fresh as are the pineapples. Very tasty compared to home, the pineapples at least. My wife cannot eat any meat here because of her throat.

I tried to swallow something and it got caught in my throat, so I had a strong cough. The pain was excrutiating and I felt nauseous. The nurse gave me IV medications plus my regular dose of morphine.

I would love a massage, especially on my neck. It is very stiff and sore with an incision there too on the left side about an inch above my collar bone. I hope that one heals very cleanly with little scarring.

My shoulders are so sore, just tension I guess and I asked my husband to find out about a massage as soon as possible. I have an incision on my left side, another on my neck just to the left of center about the same size and one on the right front for my L5/S1 fusion. So I am pretty carved up and it is starting to seize up a bit.

Not able to walk as much today but still did about 10 laps of the ward.

Katie, you walked 4 more laps than yesterday!

A lot of things are different here, but not for the bad. The hospital, while very old, is spotlessly clean. And the patient/staff ratio is quite high.

March 22 (Day 8)

This morning my wife woke up in a lot of pain and trying to get the nurses to understand completely our piglish and sign language needed us to ask for someone to speak english. There has always been someone here that could help and it took only a couple of minutes to locate someone from elsewhere in the hospital. Her incision pain is still too strong.

I was up till past midnight with some bad pain from the choking incident. My back muscles joined in by starting to spasm, but I got some muscle relaxants and that started settling. I had to start wearing the back brace last night for support after the choking incident.

The previous back pain is completely gone!!! I am on half the morphine as before, because I don't need as much!!!

Please update the forum for me for now till we get to the hotel with internet connection.

**Carson** · 03-22-2010, 11:08 PM

Originally Posted by WPKat

The previous back pain is completely gone!!! I am on half the morphine as before, because I don't need as much!!!

Wow. That is unreal to hear. And thanks for posting WPKat

I know it's never a cake walk and lots of recovery ahead but man oh man is that inspiring for to hear. Glad she's well and feeling good to type much less report such improvement

keep at it, Katie!

**Cindylou** · 03-23-2010, 04:17 AM

I got a nice, newsy email from Rob, Katie's (Sue) husband yesterday myself. Being ever the computer challenged one, I don't know how to put it on here.

But Kat's post pretty much sums it up. They are reducing her morphine quite rapidly, which is of some concern, especially when they are a little late bringing it. But all in all, she is marching along like the trooper she is!! We love you Katie!!!!

**ajj1001** · 03-23-2010, 04:50 AM

Originally Posted by Cindylou

We love you Katie!!!!

Ditto

**KenG** · 03-23-2010, 10:33 AM

I sent email to cheer her and ask her how she is doing and received reply from her husband yesterday.
I thought she had two approaches lumbar and cervical. but I was wrong. She had XLIF and Front approaches for lumbar. I'm ashamed I didn't know that. It must be one of biggest surgery and I am relieved it is great success.

Ganbare Katie !

I am looking forward hearing from you but for now,take your time for recovery. Let's go

together.

**WPKat** · 03-23-2010, 11:43 AM

March 23 (Day 9)

It is now day 9 post surgery. My wife is in pretty good shape this morning and looks 10 years younger!

A little later ....
A bit of a setback ... some back pain is back, but unlike before surgery when Katie laid down, the pain is not subsiding after she lays down. We believe the cause is most likley coming from the seam on her back brace that she is wearing.

They continue to reduce the morphine significantly, which has had resulted in some very unpleasant side effects. They are substituting another pain killer by injection, but it isn't quite enough.

Last night, our friends arrived from Canada. My wife has known them since highschool. She had a big cry of joy and relief and then had an opportunity to talk and relieve her english starvation. It is great to have them here to help relieve the cabin fever that Katie is feeling.

This morning the bandages came off. All the incisions look very good. The neck incision is especially nice looking and well hidden in a natural fold in the skin. There are no signs of infection and some yellow discolouring that is continuing to fade.

Katie started physiotherapy yesterday and is enjoying the stretching exercise. This morning she did a check to see how well her balance has improved. Before surgery, Katie was unable to walk a line toe to heel or walk on her heels or toes. She demonstrated her inability for Dr Pimenta last Monday. Today we checked and she can walk a line and can practically run on her toes and heels.

The last part is excellent news!

**Justin** · 03-23-2010, 08:38 PM

Originally Posted by WPKat

The previous back pain is completely gone!!! I am on half the morphine as before, because I don't need as much!!!

Originally Posted by WPKat

Katie started physiotherapy yesterday and is enjoying the stretching exercise. This morning she did a check to see how well her balance has improved. Before surgery, Katie was unable to walk a line toe to heel or walk on her heels or toes. She demonstrated her inability for Dr Pimenta last Monday. Today we checked and she can walk a line and can practically run on her toes and heels.

**rose** · 03-23-2010, 08:44 PM

Katie's lumbar surgery was a non-invasive which gave her a positive and faster
recovery. She is still in the hospital and not gone to a hotel due to her bowel
movement and the withdrawal of her medication.
Hope she will be moved soon. Tomorrow she will see Dr. P for a final.

Below is her explanations.

"Rob has read a bit and thinks this because of the minimaly invasive XLIF approach
using the EM monitor to aviod touching the nerves in the psoas muscle. My fusions
were simply the insertion of a spacer in the disc space. There are no screws or rods.
The bone graft was made using cells from scraping the vertebrea and combining that
with a growth medium in two holes in the spacer. There was no bone taken from my hip.
This means that the following ocured: the surgery removed all my previous pain and no
new pain was introduced except for the three incision sites."

Look at the PEEK cage on the nuVasive web site.

**jss** · 03-23-2010, 09:09 PM

Katie,

Sounds like a lot of "two steps forward and one (or two) steps back". It sounds like the recovery is so far "par for the course".

Praying that the recovery continues!

Jeff

**WPKat** · 03-24-2010, 12:40 PM

March 24 (Day 10)

In taking on the responsibility for keeping you up-to-date on Katie's progress, I hesitated to post certain details that I thought might invade her privacy or that she might feel embarrassed about. I wrote to her about it and she gave me the "go ahead to fire away" with the details of one of the primary reasons she has not been discharged from the hospital yet.

As many of you know, whenever you have major surgery, your intestines often go to sleep. You are put on high powered pain medications and muscle relaxers that have significant constipating side effects. In addition, you are not particularly hungry and often do not want to eat much right away. The combination of these factors (as well as others) may cause unpleasant and painful complications when the intestines stop working as they are designed to do.

In Katie's case, her GI track does not want to cooperate and work on it's own without a great deal of help. Her intestines and stomach are quite swollen ... pushing on her newly operated on lumbar spine and is the mostly likely cause of her lower back pain.

They put her on medication and the methods designed to move things along, using most of the methods that many of the forum members privately suggested to Katie, including the drugs and two enemas. The second one did work somewhat three days ago, but she doesn't know if they will try that again today.

An interesting sidenote is that her husband mentioned that his extremely regular system is way off schedule too, probrably caused from the very different food ... so that could be a simple explanation!

It is always a good ideal to do whatever you can to help yourself as well. Unfortunately, Katie has developed many food allergies that prevent her from benefiting from a high fiber diet. Prior to surgery, she discovered apricots helped her combat the constipation brought on by taking opiate pain medication and muscle relaxers. Her husband found a store in Brazil that carries them and he brought them in for her.

They have significantly reduced her pain medications in an attempt to resolve her compacted GI tract, but this has caused her to go into withdrawals and along with it ... nausea and vomiting. Thankfully, she has adjusted and the pain medications she is currently on are providing just enough coverage to make it bearable.

Although normally on the low side, Katie's blood pressure (BP) has been steadily climbing. After extensive precautionary cardio testing done because of her family history, her resting BP has been 86/65 while her normal historic rate has been 95/65. Last night her BP was 138/90 and this morning it was 144/100 just upon waking. She doesn't know if the saline IV fluids are a contributing factor or not. She certainly hopes so since then it could be easily remedied. Obviously, the doctors are keeping a viligent eye on her blood pressure and will take immediate action to bring it under control if necessary.

She cannot be released from the hospital before they are able to get her GI track working on its own and may call in a specialist with the "know how" to take definitive action to resolve this very unpleasant and painful condition.