[Spinal Fusion / Lumbar] Lumbar L5/S1 ALIF/PLIF Fusion

[Nairek]

PART 1

Tuesday, January 20th, surgery day. I had maybe 1 ½ hours of sleep between being nervous and my dog Peanut howling and falling over in her crate. As an elderly dog, she has been suffering from dementia and gets confused very easily. I decided to sleep on the couch to comfort her so we could all get some sleep.

The alarm clock went off at 30 a.m. and both my husband and I woke up to take care of our girls (a Beagle and a Treeing Walker Coonhound). After they were fed and walked, I left a note for my friend on what I needed her to do to look after the girls for me. I already had my bag packed from the night before since we had to catch the first train out of Poughkeepsie at 4:15 a.m. to make it to Lenox Hill Hospital by 60 a.m.

As we got closer to NYC, the reality of the surgery began to finally hit me. I tried so hard to keep the water works from flowing but the truth was I was scared. My husband kept telling me that everything would be fine and that this is what we have waited years for. And even though I could have appealed my insurance company’s decision, I decided that I couldn’t wait any longer and moved forward with the fusion. He reassured me that I was not making the wrong decision. I’ll post about that in another thread.

We took the #6 Lexington Avenue Local and arrived at Lenox Hill Hospital by 68 a.m. and went up to the 10th floor and waited only 10 minutes before I was taken in to pre-op. Dr. Bitan’s staff must have had me pre-registered already which was awesome. In pre-op you have the usual change into a gown & give them a few “samples” for various tests and so they could type my blood in case I needed a transfusion. The nurses kept telling me to relax and all I kept thinking was how can I do that knowing I’m about to be sliced, diced, and julienned?

I first met with Dr. Rizzo the anesthesiologist. He explained to me exactly what he would be doing in the OR. That there wouldn’t be any surprises. He explained that he would be “hooking me up” to a machine that will monitor my nerves so that they can avoid the prospect of nerve damage during the surgery.

Dr. Hannon peeked in as well. This time he had a full beard going on which he didn’t have when we met with him on December 18th. When we met with him back then, both my husband and I were extremely impressed with how he explained what his part of the surgery would entail. He was very thorough and answered every question that we had. He is also a very funny person who really seems to enjoy what he does. When he popped in that morning, he was all smiles which was a huge comfort to me. At least he was in a good mood before the surgery.

Dr. Bitan then arrived and said that we needed to talk about a few things before the surgery began. Basically, he stated that since I couldn’t get approved for the ADR surgery, we didn’t have the opportunity to discuss the changes that had to be made with the fusion which he apologized for. He informed us that he would need to make two incisions in my back so that he could insert two screws to stabilize the hardware. I looked at him and said “Wow, I wasn’t expecting that. That really sucks. But if this is what you need to do for the best outcome, I trust your decision and let’s do it”.

Dr. Bitan also mentioned that he had a medical student who was interested in watching the surgery in the OR and he wanted my permission. My husband said “as long as it’s lookie and no touchie, we are comfortable with that”. Dr. Bitan confirmed the student was only to view the surgery, nothing else. So with that being said, we were OK with it. I joked with him why on earth would this student want to watch something so gross and he said I don’t know I tried talking him out of it as well.

I then joked with Dr. Bitan and asked him if he could do a tummy tuck while he was down there. He looked at me and said “Oh, you wouldn’t want me to do that. I’m not good at those. Ask Dr. Hannon”. So I did, he laughed. Hey, you can’t blame a gal for trying right?!

After all of the new consent forms were signed, it was time to go off to the OR. As they were rolling me down the hall, I kissed my husband goodbye and held back the tears. As they rolled me further down the hall in the wheelchair, there were several times that I thought of jumping out of that chair and running away from the OR. It reminded me of my wedding day in a way (Not that I wanted to run from the altar). The reality of what was coming hadn’t hit me until I entered the OR.

I was wheeled in at 7:40 a.m., 10 minutes later than when my surgery was scheduled to start. I remember Dr. Rizzo said something about giving me relaxing medication and then the lights went out.

I don’t remember going into the recovery room. They let my husband in to see me for two minutes and he noticed that I was wheeled in to recovery at 2:45 p.m. The entire time of my surgery, no one came out to tell my husband what was going on. As Dr. Bitan was leaving the OR, he was dialing my husband’s cell number to let him know that everything went well and that there weren’t any complications. By this time, my sister and brother in law arrived to keep my husband company which was great since he was all by himself. We were initially told that the surgery would be about 4 hours long. I was in surgery for close to 7 hours.

I slept most of the time in recovery and was in a lot of pain during that time. I was finally brought up to my room at 70 p.m. and just kind of lay there semi-conscious. After 30 minutes, I asked the nurse if my family was still waiting for me on the tenth floor. Sure enough, no one bothered to tell them that I was moved to my room. Thankfully I had an hour with them before visiting hours were over. The incision on my stomach had a “medicine ball” attached to it which infused pain medication just under the skin of the incision which helped a great deal with the pain. The two incisions on my back though were extremely painful which was made worse by the fact that I was laying on my back.

The first two nights, the hospital couldn’t control my pain. It was so bad that I was moaning and almost in tears for the first two days and nights. And while the surgery went well, this was the beginning of some very scary events which we were not prepared for.

I don’t recall if it was the first or second night I was there, but there were issues where my blood pressure and potassium levels were too low. This was complicated by the fact that my blood oxygen levels were not normal and I was suffering from a rapid heart rate. I was kept on oxygen for 3 ½ days and my heart rate remained tachycardic and at one point was beating over 150 bpm.

I had been on a dextrose based IV drip which was then changed to a potassium based drip. When that wasn’t enough to bring up my potassium level, I had 3 infusions of potassium back to back to bring my levels up. I couldn’t understand what was happening to me. The potassium burned through the IV line. I felt like my hand was on fire. The nurse told my family that there wasn’t anything that they can do to ease the pain and that I had to have the infusions. And while all of this was going on, they had to cut me back on the pain meds because now my blood pressure was dropping. I recall that at one point it was 94/53. I finally broke down that night as my husband was leaving. I kept apologizing to him and telling him I was scared and that I didn’t mean to scare him. He felt like he was abandoning me for leaving but he needed to go home to take care of our pets who are basically our children. It was such an emotional rollercoaster which neither of us could control.

The second night, things got even more insane. I was receiving morphine injections in my shoulders to help deal with the pain when my blood pressure allowed them to do so. The injections only helped me for 20-30 minutes at a time. The doctor had ordered an EKG since my heart rate was so erratic. I remember a doctor had come in and asked what the results of the EKG were and I told him I didn’t know since the tech just walked out without saying anything to me or my family.

I had finally fallen asleep again when another patient stated flipping out and went on a rampage at 30 a.m. The RN’s & NA’s had been very loud at night. This particular night it sounded like they were having a party outside of my room. Maybe this is what set this patient off. I couldn’t see what was happening since I had the curtains drawn closed in my room. This guy was yelling “call my wife” and “call the police. I know what you were doing in the empty room down the hall”. I was in such pain but I feared hitting the call bell for help because I knew the staff had their hands full with this patient. I also feared for my safety and I didn’t want to bring attention to me in case this guy was running through the ward.

Thankfully, after an hour, things settled down again and going forward, nights were much quieter there. I had called for more pain meds but was told I had to hang on and since they couldn’t get the right dosage to help me, they would have to call a pain management doctor to help me. I told them “YES! Please call the pain management doctor”. I was so annoyed that they didn’t do this sooner since I had my own doctor for this!

[Nairek]

Part 2
The morning of day three, Dr. Hoppenfeld came to see me. He commented on my noisy neighbor and when I told him what happened the night before, he was shocked. So he ordered me a regimen of pain meds to help control my pain as well as a sleeping pill so I could try and get some sleep at night. The same day they started with the colace and laxatives to help me along in “that” department. The gas pain was excruciating! My intestines were still pretty sleepy and I was beginning to suffer from distended bowels. If I was able to double over from the pain, I would have. It was that bad.

I believe it was the night of day four that I was taken down to radiology to have x-rays taken of my back. It was pretty painful to try & get on the table and to roll over onto my sides but the tech was a really strong man who helped me. I asked the tech if I could see the x-rays when he was done and he was kind enough to let me take a peek. It looked like there were six screws and two plates in my back. It was weird to look at the x-rays and think wow, that’s what I have inside of me now!

By day five I was cleared by physical therapy to go home. I was able to walk on my own with little assistance since day three and I was able to walk up and down two stairs. However, I was told that I couldn’t go home until I produced a “meaningful” bowel movement for them. I was like you have got to be kidding me right? I had been on a liquid diet for five days, so I didn’t think anything would ever happen!

That evening, things began happening and I was in a much better mood. Baby steps I guess but it was something to be happy about. The morning of the sixth day, I was told by Dr. Bitan’s PA that if I could handle solid food for breakfast and lunch, then I could go home that day. I was so excited, that I called my husband as soon as the PA left at 6:30 a.m. to let him know.

Breakfast came and I was so happy to finally be able to eat solid food! I still didn’t have a huge appetite but did manage to eat a little bit and felt so much better. I went for a twenty minute walk after breakfast and was so tired and short of breath afterwards that I had to lay down for a while. Dr. Bitan’s PA came back to visit and we chatted for a little bit. I told him that breakfast seemed to go very well and he told me that he will more than likely discharge me after 20 p.m.

My husband arrived shortly after 11:30 a.m. and I told him the awesome news. When lunch arrived, I was shocked at how much was on my tray and how good it looked. I was even more shocked by how it tasted. I expected hospital food to be horrible but it was surprisingly tasty. Even my husband was like, wow, that’s a lot of food!

After lunch, my husband was helping me to get dressed when there was a knock on the door. It was Dr. Bitan and his PA coming for a visit. (Dr. Bitan visited with me every day except for the weekend. I expected a colleague of his to check in with me, not him. I was impressed by this.) He said he was glad to catch me before I left and that he was sorry for keeping me over the weekend but he didn’t feel comfortable sending me home on Friday like he had planned. I told him I understood with all of the crazy things I had happening to me. It was better to err on the side of caution. There was a lot of happiness in that room and I was glad that there was a noticeable difference in my pain. That’s another post though since I think I may have put most of you to sleep by now.

And now the new chapter of my life begins……….

[daveinaustin]

Nairek,

It was quite an experience you went through! I was another patient who wanted ADR, but was denied by insurance. Hopefully someday, doctors will be able to provide the solutions they want instead of being told what they can or cannot do.

If I read your post correctly, the procedure was in January. How are you doing now?

-Dave

[Justin]

Karin,

Thanks for posting your detailed pre & postoperative experience with Dr. Bitan. It sounds like you struggled quite a bit post-op with your blood pressure and potassium levels.

I've read great things about Dr. Bitan and I was able to meet him in New York a couple years ago. He's truly a first-class guy and a very gifted surgeon.

Like Dave said, how are you feeling these days? I hope your transition to life in Florida has been smooth.

Be well,

[Gilbert P]

Hi Karin

Thank you so much for your story, you made it.

I would like to hear how is life treating you now?

Thanks

Gil

[KBear]

Wow, what a story. I also struggled with low blood pressure, but was still in extreme pain. They kept telling me they couldn't give me more drugs b/c of my pressure. Ughh, no fun, wouldn't wish that on anyone.

[Nairek]

Hi Everyone,

I am taking the lazy way out & am copying/pasting my surgical outcome from other spine boards I have posted on. I should have done this a long time ago but just have been too busy.

So I'll be posting old 's for now & will get some newer stuff posted soon

[Nairek]

So I went for my 2 week post-op follow up last Thursday. I had to ask a friend of mine to go down to NYC with me since family members had to work. There is nothing I hate more than to bother people to accompany me to my appointments.

Anyway, so we took the train down to NYC & then took a cab to the doctor’s office. My friend was uncomfortable taking the subway & I really didn’t feel like getting hit in the back or stomach for that matter. I still have a bit of trouble getting in & out of a car so it was a very interesting ride to & from Grand Central.

I thought that I would have to go for x-rays when I got to the office but was surprised when they handed me the pain scale paperwork & said “no x-rays”. I filled out the pain questionnaire for my pain management doctor & was able to say that the surgery reduced my pain by 75% but now I have a “new” pain since the surgery which is quite painful.

I met with my pain management doctor & we decided that I could come off of the Oxycontin (which now I wish I didn’t) & to stay on the Percocet. I explained that the “new” pain that I felt was now in the lower left part of my back & that it felt like something was almost pulling/tearing. He prescribed a Lidocaine patch to apply to the area.

I then met with a rep from Biomet who showed me how to use a bone growth stimulator. As I understand it, I will wear it 24/7 for at least 12 weeks. It wouldn’t be so bad if I didn’t have an adhesive allergy (laughing).

I then met with the man himself, Dr. Bitan. Now when I was in the hospital, I know that I asked a few times if I had staples closing the incisions in my back. I was told on a few different occasions that I did have staples. Imagine my surprise when Dr. Bitan said no that wasn’t the case. All this time I thought I did & thought that was the reason why I had this “new” pain in my back & I was wrong. I swear he must think I’m a loon! I know that I feel like a fool. (Needless to say, when I went back out into the waiting room, my friend was like gee that was quick & I had to tell her that there weren’t any staples. I’m still getting a razzing about it from her & several other friends).

So I said to him, if I don’t have staples tugging at the incision site, then what is this horrible pain that I now have? He told me that the muscles are inflamed in my back & more than likely the pain is being caused from that. So I asked him a few other questions which I received short responses to & more or less was on my way. He is a man of very few words which I’m not use to. Sometimes it is a bit uncomfortable but I know that he’s the best around with spinal surgery so I try to put that aside.

Before I left the office, I got a letter to carry with me so if I set off metal detectors I can prove that I have metal in me. We’ll see if I do in a few weeks when I go to Florida. I also have a card for the bone growth stimulator but I have a feeling that I won’t be able to carry it on the plane with me.

So it was back to Grand Central to catch the train home. My friend teased me that I was a pro at hailing cabs & teased about the no staples thing again when I remembered that I totally forgot to ask the doctor about something. I have steri-strips covering the 2 incisions in my back as well as the incision in my abdomen. I also have 2 lines of suture sticking out about 1 ½ inches from either side of the incision in my abdomen. I have no idea if those are suppose to just disintegrate & fall out, or if I need to have them removed. Does anyone have any experience with this? I joke that if I pull on them hard enough I may just open it up like a dog food bag & have everything fall out. I shouldn’t joke about that though since it still hurts.

OK, that’s enough. I’m supposed to be studying for the notary public exam & not posting on the board. I’ll try to update more often.

[Nairek]

Before I had my surgery, I was suffering a great deal with right leg/foot pain/numbness. When I initially woke up in the recovery room, I was still suffering from pins & needles sensations in my right foot. However, when I woke up a few hours later, it was gone! After 7 years it was finally gone!

The pain that I had in my lower back also feels like it is gone. Since I can’t bend or twist, I can’t say that it is 100% gone as those motions tended to set me off. But I can say that there is a noticeable difference in my back since the surgery.

Unfortunately, I do have a “new” pain in my lower back which is quite troublesome. It is located below one of the incisions in my back & can be extremely painful at times. The best way to describe it is that it feels like a pulling, tearing, burning sensation. The pain feels just as bad if not worse than the back pain I had before my surgery. I mentioned this to my OS & he stated that the muscles are very inflamed in that area & that it’s possible that this is causing my pain. I was prescribed a Lidocaine patch for the pain but it really doesn’t do much for me. Sadly the oral pain meds don’t help much either.

I still have pain in my abdomen from that incision as well. It’s not debilitating or as bad as the pain in my back, but it’s still uncomfortable. I feel like I did a marathon of sit-ups.

The pins & needles appear to be gone from my right foot but it has been replaced by an odd warm feeling which is made worse by walking. I mentioned this to an ortho resident in the hospital as well as my OS & neither could give me an explanation as to what it is. I assume it’s from the nerves being all funky for years. Again, I am hoping that this is something that will go away as time passes.

I find that a lot of times during the night, when I try to turn over, my legs just decide that they want to stretch out on their own & I can’t stop it from happening. I know that stretching isn’t recommended so soon after surgery but what happens if you can’t stop it from happening? I can feel the stretch in my abdomen & my lower back & I hope that it’s not hindering my recovery. It’s really freaky. I’m hoping that if I try to walk more that maybe it will stop happening so much.

I’m still a little slow with the walking. I usually start out pretty well but slow down quite a bit after about 10 minutes. I have managed to make it out of the house & to a few stores for very short excursions. I’m usually wiped out after those & fall asleep for a few hours so I can re-energize.

A week after I got home from the hospital I was able to take a shower on my own which was really nice. I’m able to get dressed with the help of my trusty “grabber do-hicky” except for putting on socks. I still need help with that.

The other day I spent a little over an hour in the kitchen preparing dinner which I wasn’t able to do before surgery. I did have to pop some pain meds afterwards but it was a huge step for me.

[Nairek]

I had my 6 week post op visit a week & a half ago. Sorry for the delay in the update. I've just got a lot going on along with an increase in discomfort when I sit for too long. I basically have good news/bad news.

The good news is that I had x-rays taken & they show that the cage is right where it should be. It would have been nice if I was able to see the x-rays that were taken but I guess for whatever reason, the doc just doesn't do that. I know, I should ask but I didn't. I just take the word of the doc.

I seem to be doing fairly well since the surgery. The doc seemed happy with my progress. So much so that he didn't prescribe physical therapy & said that I can go back to work whenever I want. Here's the problem though. The new pain that I have in my back since the surgery hasn't let up. As a matter of fact, it's more intense now. On top of that, when I sit or walk for too long, I get a burning feeling in my right foot & pain in my lower left buttock area. Now when I told my doc this, he dismissed it as something that will go away. It's probably still being caused by the muscles in my back being cut. I'm also still dealing with pain/discomfort in my abdomen if anything touches it. I hope that goes away really soon. (It actually bothered me to wear jeans the other day. )

So I went from his office to my pain management doctor's office. I lucked out that I was able to see him that day. It saved me & my husband $60 in train fare

I explained to my PM doc that the Lidocaine patches he prescribed do nothing for the "new" pain. When I showed him again where the pain was, he tells me he's positive it's coming from my SI Joint. Sacroiliitis strikes again! The pain feels like I am being stabbed or like it's a nasty burn. It's gotten so bad that it hurts to sneeze, lift up my left arm, & believe it or not, even a chill will set it off. So it's back to NYC this Wednesday & we're going to try an SI Joint injection on the left side. I am praying that this works. Otherwise I swear I am going to have a nervous breakdown!

I then tell my PM doc about the weird burning feeling that I am getting in my right foot. Now before I had the fusion, that same foot was numb & tingly & all sorts of whacked out. After the surgery I was just dealing with the warm sensations. When I was in the hospital, they couldn't explain why I was having that reaction. My PM doc took a good look at both of my legs & feet & was really quiet. So I asked him if maybe he thought it was the nerves just trying to re-adjust. Dead silence. I'm thinking great, he doesn't know what it is either. So after another half a minute of silence, he says to me don't shave your legs for a few weeks. I just looked at him like dude, you have got to be freaking kidding me right? So I asked him why. He thinks that I may be suffering from Reflex Sympathetic Dystrophy. He said that it happens after surgery & he's not sure if this is something that I have or not but the hairy leg thing or lack there of is a symptom of it.

So right now I'm just kind of at a loss. I'm stressed out. Between the surgery, having to put a beloved pet to sleep, the after affects of this surgery, disability checks not coming in, & the possibility of having to move because "The Evil Empire" (aka my husband's job) is sending his job over to India, I'm afraid that I'm going to have that nervous breakdown that I spoke of before.

I know that I just need to chill out but that's easier said then done. I'm going to shut up now. I just needed to vent. Thank you in advance for understanding.