Slate has an article about anesthetic awareness today. "Anesthetic awareness" is when you are under general anesthesia, but accidentally awake, just unable to move. This can happen because patients are given a paralytic in addition to the thing that makes you unconscious. So, were the unconscious-making thing to fail, you might be conscious and unable to let anyone know.
It's the stuff of nightmares, obviously.
I felt sheepish asking about this, but before my surgery I did ask the anesthesiologist, "How do you know I won't be awake and just not able to say anything or move?"
I got the reassuring answer that I would not personally be receiving any paralytics, so if I were to wake up, I would in fact be able to move. This is because, since they were operating near my spine, they were going to hook electrodes up to my skull, arms, and legs, and pass signals in both directions (brain to limbs, limbs to brain) and see if they were received. There are minor risks from this procedure, he told me, but it greatly reduces the risk of spinal cord injury, because they can see right away if what they are doing is affecting your spinal cord.
I have no memories from my surgery at all. Of course, I suppose it is possible that I had some kind of experience during it and simply can't remember it, but I'm going to assume I was really out. It doesn't matter at this point, at any rate.
Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts
Wednesday, November 28, 2007
Thursday, October 25, 2007
The Surgery
On August 29th, I had ACDF surgery - anterior cervical discectomy and fusion. In this surgery, which is to handle a badly herniated disc, they go in through the front (anterior) of your neck (cervical), remove one of the discs that acts as a shock absorber for your vertebrae (discectomy), replace it with a piece of bone (like a shim), screw the vertebrae together using a titanium plate and screws, and then hope your vertebrae will grow together with the bone shim (fusion).
The pain I've been dealing with on and off since 2003, and which was really terrible starting in January of this year, is 95% gone. I'm no longer taking any pain meds - not the gabapentin that I'd been taking since March, not even tylenol.
The tiny bits of pain I do have seem unrelated to anything that I do, and that itself is a huge relief. For years I was careful about how I moved my neck, how I held it, how I slept, etc., knowing I could easily trigger a flare-up. Right now I'm being careful because I'm still healing from the surgery, but nothing I've done seems to make anything hurt more.
It's too early to know for sure whether the fusion itself is succeeding, but the success rate among healthy young people (at least based on the control group of one study) is about 98%, so the odds are in my favor.
The surgery itself was pretty easy. I was miserable in the hospital afterwards (a ton of anxiety), but I never had much pain afterwards.
I am really glad I did that.
The pain I've been dealing with on and off since 2003, and which was really terrible starting in January of this year, is 95% gone. I'm no longer taking any pain meds - not the gabapentin that I'd been taking since March, not even tylenol.
The tiny bits of pain I do have seem unrelated to anything that I do, and that itself is a huge relief. For years I was careful about how I moved my neck, how I held it, how I slept, etc., knowing I could easily trigger a flare-up. Right now I'm being careful because I'm still healing from the surgery, but nothing I've done seems to make anything hurt more.
It's too early to know for sure whether the fusion itself is succeeding, but the success rate among healthy young people (at least based on the control group of one study) is about 98%, so the odds are in my favor.
The surgery itself was pretty easy. I was miserable in the hospital afterwards (a ton of anxiety), but I never had much pain afterwards.
I am really glad I did that.
Thursday, August 16, 2007
Surgery Update
I emailed all of this to my mom, but here's an update on the surgery I'm having in 13 days.My surgery is two weeks from yesterday - August 29th. I had my pre-op appointment Monday and they went over everything.
Well, first this horrible nurse talked to me. She was friendly but useless, and didn't talk to me like my surgery was a serious thing. She usually works for a different surgeon and she came in not knowing anything, and asked me what kind of surgery I was having and when. I guess it was lucky for her that I knew, huh? She told me some wrong stuff, like that I wouldn't have a bone growth simulator (I will) and that I shouldn't take ibuprofen for six months after - she denied that the other NSAIDS (aspirin, naproxen) were included in the ban, but my surgeon confirmed that they were later.
Then I talked to the resident who works with Dr. Patel (my surgeon) and he was cool.
And then I talked to Dr. Patel himself, and he went over everything again. And then to another nurse who actually gave me her direct line (unheard of at this place) and was pretty awesome.
Here's some stuff I learned.
I'll have a collar (brace) for six weeks after the surgery. The company that fits them will call me and arrange to come out and meet me at my house or whatever two or three days before the surgery, and I'll get the fancy collar then. I'm supposed to wear this all the time. But what Dr. Patel told me - which was really nice to learn - was that plenty of surgeons do this exact surgery and don't ask their patients to wear a collar, so it's more of a precaution than an absolute necessity. I'll wear it anyway, but this should cut down my paranoia about it. (I'm really paranoid about my head breaking off after the surgery. I mean, not literally breaking off, but the idea is for the bones to fuse, and I'm worried about that not happening. The resident told me that the success rate for healthy young people is 98% for this, so my odds are good. I wonder what the other 2% do wrong?)
I'll also have a bone growth simulator, which is like a shock collar that I'll wear a few hours a day for . I've been told that it does not hurt, which I assume is true.
I was worried that I might have to stop taking the gabapentin before the surgery. I don't really notice if I miss a dose, but if I miss two doses, I have really intense pain in my tricep for a while. (The tricep is the back of the upper arm.) I hate that a lot. But Dr. Patel said he wants me to take the gabapentin straight through the surgery, and continue taking it afterwards, and then wean myself off of it over time as the nerve heals. So that's good.
I couldn't get a consistent answer on whether to stop taking the Pill. (Ed and I use the Pill and condoms, so stopping the Pill doesn't really change much.) The only issue there is that it increases the risk of blood clots, and that's one of the major risks of surgery too. (I'll have special hose on after surgery and I'll wear those for a while afterwards - I'm not sure how long, but a week?) Dr. Patel said not to worry about it, his resident said I should stop taking it, and the bad nurse said I should ask my ob-gyn or gp. I'm going to stop taking it. We don't have that much sex and we do use condoms already anyway (not that we couldn't start if we didn't, but since we already do it's even easier) and I am really anti-death.
Having surgery is like having furniture delivered in this one way: you call the day before and they tell you what time to show up. They schedule a few for the same day and they can rearrange the schedule at the last minute. At least it's not a "window", though in practical terms I guess once you show up, there's no absolutely guaranteed time that they do stuff. You know how doctors are. (The bad nurse kept apologizing about not being able to tell me right now what time to show up. I wanted to say "It's ok, I'm taking the whole day off, it really doesn't matter.") I can't eat any food starting 8 hours before the surgery, but I can have clear liquids (including gatorade, water, coffee without cream, clear juices, etc.) until 2 hours before.
Mosch can go with me into pre-op, where I meet with the surgeon again, and the anesthesiologist, and get blood tests, and have an iv put in, and stuff like that. (This is the part I'm nervous about. Pre-op.) Then when they take me into surgery, he goes into the waiting area. They'll give him a pager so he won't feel like he can't leave. I'll be gone 2-4 hours, but the actual surgery part of the surgery only usually takes about an hour.
If I were adamant, I could theoretically leave the hospital the same day, but they like to keep you overnight to make sure you don't have problems with breathing or swallowing. (Since they operate through the front of the neck, there is a possibility of damaging your windpipe or esophagus, though the resident assured me that all of these things, including major nerves, are "in the same place in every patient" and so this is not too likely.) I'm cool with spending the night. I'm not that big a fan of choking to death at home. (Of course, just being in the hospital gives you some chance of getting an antibiotic-resistant infection or something too. But this is a very new and fancy hospital and hopefully they know what they're doing over there.)
Of course they want you up and walking around as soon as possible after the surgery - this is to help prevent blood clots - and the next day, you can go home as long as you are walking, peeing and pooping, breathing fine, and eating and drinking. I'm supposed to have some soft foods at home because my throat will be really sore, as though I had a tonsillectomy.
Mosch is planning to spend the night at the hospital with me. Ed is going to come with us (according to the current plan, anyway) and wait with Mosch, but Mosch will drive him home for the night. I hope Ed will come over the next day, when I'm home again, and help me if I need anything (while Mosch sleeps). I trust Mosch more at the hospital than Ed, because he has more experience being an advocate for a patient in the hospital and he knows me and my preferences really well. Also it's a lot to ask from a boyfriend of 3 months.
Well, first this horrible nurse talked to me. She was friendly but useless, and didn't talk to me like my surgery was a serious thing. She usually works for a different surgeon and she came in not knowing anything, and asked me what kind of surgery I was having and when. I guess it was lucky for her that I knew, huh? She told me some wrong stuff, like that I wouldn't have a bone growth simulator (I will) and that I shouldn't take ibuprofen for six months after - she denied that the other NSAIDS (aspirin, naproxen) were included in the ban, but my surgeon confirmed that they were later.
Then I talked to the resident who works with Dr. Patel (my surgeon) and he was cool.
And then I talked to Dr. Patel himself, and he went over everything again. And then to another nurse who actually gave me her direct line (unheard of at this place) and was pretty awesome.
Here's some stuff I learned.
I'll have a collar (brace) for six weeks after the surgery. The company that fits them will call me and arrange to come out and meet me at my house or whatever two or three days before the surgery, and I'll get the fancy collar then. I'm supposed to wear this all the time. But what Dr. Patel told me - which was really nice to learn - was that plenty of surgeons do this exact surgery and don't ask their patients to wear a collar, so it's more of a precaution than an absolute necessity. I'll wear it anyway, but this should cut down my paranoia about it. (I'm really paranoid about my head breaking off after the surgery. I mean, not literally breaking off, but the idea is for the bones to fuse, and I'm worried about that not happening. The resident told me that the success rate for healthy young people is 98% for this, so my odds are good. I wonder what the other 2% do wrong?)
I'll also have a bone growth simulator, which is like a shock collar that I'll wear a few hours a day for . I've been told that it does not hurt, which I assume is true.
I was worried that I might have to stop taking the gabapentin before the surgery. I don't really notice if I miss a dose, but if I miss two doses, I have really intense pain in my tricep for a while. (The tricep is the back of the upper arm.) I hate that a lot. But Dr. Patel said he wants me to take the gabapentin straight through the surgery, and continue taking it afterwards, and then wean myself off of it over time as the nerve heals. So that's good.
I couldn't get a consistent answer on whether to stop taking the Pill. (Ed and I use the Pill and condoms, so stopping the Pill doesn't really change much.) The only issue there is that it increases the risk of blood clots, and that's one of the major risks of surgery too. (I'll have special hose on after surgery and I'll wear those for a while afterwards - I'm not sure how long, but a week?) Dr. Patel said not to worry about it, his resident said I should stop taking it, and the bad nurse said I should ask my ob-gyn or gp. I'm going to stop taking it. We don't have that much sex and we do use condoms already anyway (not that we couldn't start if we didn't, but since we already do it's even easier) and I am really anti-death.
Having surgery is like having furniture delivered in this one way: you call the day before and they tell you what time to show up. They schedule a few for the same day and they can rearrange the schedule at the last minute. At least it's not a "window", though in practical terms I guess once you show up, there's no absolutely guaranteed time that they do stuff. You know how doctors are. (The bad nurse kept apologizing about not being able to tell me right now what time to show up. I wanted to say "It's ok, I'm taking the whole day off, it really doesn't matter.") I can't eat any food starting 8 hours before the surgery, but I can have clear liquids (including gatorade, water, coffee without cream, clear juices, etc.) until 2 hours before.
Mosch can go with me into pre-op, where I meet with the surgeon again, and the anesthesiologist, and get blood tests, and have an iv put in, and stuff like that. (This is the part I'm nervous about. Pre-op.) Then when they take me into surgery, he goes into the waiting area. They'll give him a pager so he won't feel like he can't leave. I'll be gone 2-4 hours, but the actual surgery part of the surgery only usually takes about an hour.
If I were adamant, I could theoretically leave the hospital the same day, but they like to keep you overnight to make sure you don't have problems with breathing or swallowing. (Since they operate through the front of the neck, there is a possibility of damaging your windpipe or esophagus, though the resident assured me that all of these things, including major nerves, are "in the same place in every patient" and so this is not too likely.) I'm cool with spending the night. I'm not that big a fan of choking to death at home. (Of course, just being in the hospital gives you some chance of getting an antibiotic-resistant infection or something too. But this is a very new and fancy hospital and hopefully they know what they're doing over there.)
Of course they want you up and walking around as soon as possible after the surgery - this is to help prevent blood clots - and the next day, you can go home as long as you are walking, peeing and pooping, breathing fine, and eating and drinking. I'm supposed to have some soft foods at home because my throat will be really sore, as though I had a tonsillectomy.
Mosch is planning to spend the night at the hospital with me. Ed is going to come with us (according to the current plan, anyway) and wait with Mosch, but Mosch will drive him home for the night. I hope Ed will come over the next day, when I'm home again, and help me if I need anything (while Mosch sleeps). I trust Mosch more at the hospital than Ed, because he has more experience being an advocate for a patient in the hospital and he knows me and my preferences really well. Also it's a lot to ask from a boyfriend of 3 months.
Thursday, July 12, 2007
Range of Neck Motion
I've been doing some research into the type of surgery I plan to have. One question that comes up about having vertebrae fused is whether I'll still be able to move my neck all around, or how compromised I will be. (After all, having two vertebrae become one piece of bone is obviously not how the spine is designed to work; the discs are there to let the thing flex.)
Alan Hilibrand has an article in the journal Spine (Jul2006, Vol. 31 Issue 15, p1688-1692, 5p) with this abstract (emphases mine):
Alan Hilibrand has an article in the journal Spine (Jul2006, Vol. 31 Issue 15, p1688-1692, 5p) with this abstract (emphases mine):
This is fairly reassuring. My range of neck motion right now is indeed pretty minimal. I can't look up very far, can't look sideways nearly as far as normal people, and both directions (especially in combination, which is really bad) hurt me. For instance, if I'm in the driver's seat of my car, parked, and talk to someone in the passenger seat for more than a couple of minutes I get a lot of pain.STUDY DESIGN.: Prospective cohort study.
OBJECTIVE.: To precisely measure the effect of anterior cervical fusion on neck motion.
SUMMARY OF BACKGROUND DATA.: Anterior cervical decompression and stabilization procedures are successful in treating recalcitrant cervical radiculopathy and cervical myelopathy. Most assume that these “fusion” procedures result in a loss of neck motion, although changes in overall motion following anterior cervical fusion have never been precisely quantified.
METHODS.: Twenty-five consecutive patients undergoing anterior cervical fusion of ne to four levels underwent cervical range of motion testing in three planes using an unconstrained instrumented linkage before surgery and more than 3 months after surgery. These data were compared with that of 10 volunteers with no prior history of neck complaints. Motion data were compared between patients and volunteers, and between the patients before surgery and at last follow-up, using RMANOVA and Fisher’s PLSD post hoc test.
RESULTS.: Before surgery, the patients had significantly less motion than the volunteers in all directions. Following surgical fusion, patients gained a statistically significant amount of motion in all planes, although they did not achieve the motion seen among the volunteers. Gains in motion were seen among all patients, including those undergoing four-level fusions, and there was no correlation between postoperative motion and the number of levels fused.CONCLUSIONS.: Patients undergoing anterior cervical fusion have diminished neck motion compared with normal volunteers. Following surgery, they may be expected to gain motion, even when undergoing multilevel fusions. However, these patients are unlikely to regain the neck motion seen among normal individuals without neck complaints
Surgery Scheduled
My surgery is scheduled for Wednesday, August 29th. My plan is to return to work the Monday after Labor Day, i.e., September 10th.
Before the surgery, I have a pre-op appointment on August 13th. Also, the company that makes or sells the neck braces (one of which I must wear continually for six weeks from when they put it on during the surgery) may contact me for a fitting. If not, they will fit me on the morning of the actual surgery.
I know it is strange to be excited about going under the knife, and I know I won't enjoy it in the event, and will probably be scared, and the aftermath will probably be very unpleasant, but I actually am excited and happy to have it scheduled. I kind of "can't wait," as silly as that is. It's not so much that I anticipate having my problem solved - though that's certainly the hope based on which I'm choosing the surgery at all. I think it's just the new and exciting proposition of having surgery.
(Yes, I am looney tunes.)
I am saving up questions for the surgeon. So far, I have
Before the surgery, I have a pre-op appointment on August 13th. Also, the company that makes or sells the neck braces (one of which I must wear continually for six weeks from when they put it on during the surgery) may contact me for a fitting. If not, they will fit me on the morning of the actual surgery.
I know it is strange to be excited about going under the knife, and I know I won't enjoy it in the event, and will probably be scared, and the aftermath will probably be very unpleasant, but I actually am excited and happy to have it scheduled. I kind of "can't wait," as silly as that is. It's not so much that I anticipate having my problem solved - though that's certainly the hope based on which I'm choosing the surgery at all. I think it's just the new and exciting proposition of having surgery.
(Yes, I am looney tunes.)
I am saving up questions for the surgeon. So far, I have
- How do you make sure that you operate on the correct vertebrae? Do you count them or are they each just really distinct to you? (It's not like having your leg amputated where you can just write on the other one with a sharpie ahead of time "NOT THIS ONE.")
- Do they insert the urinary catheter before or after I'm under? (I have anxiety about this.)
Tuesday, July 03, 2007
More Surgery Info
My doctor gave me this link where you can see what he looks like and learn more about this type of surgery. If you click on "patient education" in the sidebar, then choose "spine" and then "cervical" and then the last procedure in the list ("anterior cervical discectomy, fusion instrumented (ACDF)"), you can watch an animated illustration of exactly what the surgery consists of. It starts with a good illustration of what the actual problem is.
Monday, July 02, 2007
Surgery
In March of 2003, for no particular reason, I woke up one morning with a crick in my neck, which then worsened to the point that I had several emergency room visits before being diagnosed with a herniated disc.
Basically, your spine is made up of vertebrae separated by these slightly springy (like a hockey puck) discs. The discs have some kind of jelly-like interior. A herniated or ruptured disc is what they call it when the disc tears and the inside of it pushes out. This can be harmless - some people have ruptured discs and no symptoms - but if the material impinges on a nerve then it can cause numbness, tingling, pain, or weakness. When this happens in your lower back, the result is called "sciatica," and a lot of people suffer from this, but there's no common name for having it in your neck.
It basically sucks. The original thing in 2003 was horrendous, and since that kind of faded I've just been careful all the time, to the point that I feel like people think I am some kind of weird hypochrondriac about it. (I feel like some weird old person who has a trick knee or a hip that aches when it's going to rain or whatever.) It sucks to continually tell people that you can't do some very commonplace thing (turn your head a certain way, sit in some particular chair, etc.) because of your neck.
And it's not black or white. I can do lots of things, it's just that they aggravate my neck, and if the aggravation is bad enough, I get a flare-up.
But this has been pretty manageable until this January, where on the heels of irritating my neck slightly in various ways, I committed the unthinkable crime of sleeping one night on my couch. That started a really heinous flare-up that is still ongoing.
Stupid neck. Bah!
Anyway, last Friday I talked to a surgeon. I already emailed my mom about this, so I'm going to just paste that email into here.
I think I'm going to go ahead and schedule the surgery. They say they are about 6 weeks out in the schedule, but I think I'll aim for mid-September because Barbara is having her hip replacement in early August and it's hard if we're both out at the same time.
The nurse practitioner and the surgeon showed me my MRI and the x-ray they took while I was there on the computer and it's really easy to see how the disc is making my spinal column veer around it.
The surgeon said that I basically have three options:
1. Wait and let it heal on its own. I did this in 2003 and it did basically heal but I've needed to be careful ever since because I always have little flare-ups and now I've got a full-blown breach again.
2. Try a steroid injection. Some people get no pain relief from this, some people get a few hours, and some people get six months.
3. Have surgery.
The reason I don't really feel like trying #2 (the injection) is that it's not pain that's my primary concern. If I just knew I'd have this pain forever, I probably wouldn't have the surgery. What I'm tired of is having to constantly be careful about my neck Every Fucking Day because if I'm not it's going to flare up and be really bad. I'm tired of only have two positions I can lie down in. I'm tired of not being able to snuggle with my boyfriend (and I really do mean "snuggle") because I just can't lie with him in any nice positions.
For the surgery, they go in through the front of the neck. They remove the disc completely, and they take bone from somewhere else in your body (not sure where, but probably the hip or
something) to put between the vertebrae in place of the disc. Then they put a metal plate in the front and screw it on to help hold the vertebrae together. (It's called "spinal fusion.")
It is pretty safe and works for most people. I'd probably go home the day after the surgery and need to take about two weeks off work. I'd wear a neck brace for six weeks to help while the bones fuse together. In 2-6 months the nerves themselves (the ones previously impinged by the disc) would start to heal and that can go on for up to 2 years.
The danger of spinal fusion is that, when that one joint in your spine can't flex, it puts more stress on the adjoining joints. But in follow-ups over 20 years, there isn't an increased risk of needing further neck surgeries for that reason, if you compare people who had this problem and did or didn't have surgery.
Anyway, I'll keep you guys posted, but for now, those are my plans.
Basically, your spine is made up of vertebrae separated by these slightly springy (like a hockey puck) discs. The discs have some kind of jelly-like interior. A herniated or ruptured disc is what they call it when the disc tears and the inside of it pushes out. This can be harmless - some people have ruptured discs and no symptoms - but if the material impinges on a nerve then it can cause numbness, tingling, pain, or weakness. When this happens in your lower back, the result is called "sciatica," and a lot of people suffer from this, but there's no common name for having it in your neck.
It basically sucks. The original thing in 2003 was horrendous, and since that kind of faded I've just been careful all the time, to the point that I feel like people think I am some kind of weird hypochrondriac about it. (I feel like some weird old person who has a trick knee or a hip that aches when it's going to rain or whatever.) It sucks to continually tell people that you can't do some very commonplace thing (turn your head a certain way, sit in some particular chair, etc.) because of your neck.
And it's not black or white. I can do lots of things, it's just that they aggravate my neck, and if the aggravation is bad enough, I get a flare-up.
But this has been pretty manageable until this January, where on the heels of irritating my neck slightly in various ways, I committed the unthinkable crime of sleeping one night on my couch. That started a really heinous flare-up that is still ongoing.
Stupid neck. Bah!
Anyway, last Friday I talked to a surgeon. I already emailed my mom about this, so I'm going to just paste that email into here.
I think I'm going to go ahead and schedule the surgery. They say they are about 6 weeks out in the schedule, but I think I'll aim for mid-September because Barbara is having her hip replacement in early August and it's hard if we're both out at the same time.
The nurse practitioner and the surgeon showed me my MRI and the x-ray they took while I was there on the computer and it's really easy to see how the disc is making my spinal column veer around it.
The surgeon said that I basically have three options:
1. Wait and let it heal on its own. I did this in 2003 and it did basically heal but I've needed to be careful ever since because I always have little flare-ups and now I've got a full-blown breach again.
2. Try a steroid injection. Some people get no pain relief from this, some people get a few hours, and some people get six months.
3. Have surgery.
The reason I don't really feel like trying #2 (the injection) is that it's not pain that's my primary concern. If I just knew I'd have this pain forever, I probably wouldn't have the surgery. What I'm tired of is having to constantly be careful about my neck Every Fucking Day because if I'm not it's going to flare up and be really bad. I'm tired of only have two positions I can lie down in. I'm tired of not being able to snuggle with my boyfriend (and I really do mean "snuggle") because I just can't lie with him in any nice positions.
For the surgery, they go in through the front of the neck. They remove the disc completely, and they take bone from somewhere else in your body (not sure where, but probably the hip or
something) to put between the vertebrae in place of the disc. Then they put a metal plate in the front and screw it on to help hold the vertebrae together. (It's called "spinal fusion.")
It is pretty safe and works for most people. I'd probably go home the day after the surgery and need to take about two weeks off work. I'd wear a neck brace for six weeks to help while the bones fuse together. In 2-6 months the nerves themselves (the ones previously impinged by the disc) would start to heal and that can go on for up to 2 years.
The danger of spinal fusion is that, when that one joint in your spine can't flex, it puts more stress on the adjoining joints. But in follow-ups over 20 years, there isn't an increased risk of needing further neck surgeries for that reason, if you compare people who had this problem and did or didn't have surgery.
Anyway, I'll keep you guys posted, but for now, those are my plans.
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