2 weeks

Today is the 2 week “anniversary” of the surgery. I’ve come a long way since then. At this time 2 weeks ago I was still very drugged, recovering from the anesthesia, nauseous, and more than a little cranky that it took them so long to get me into a room from the recovery area.

Let me back up – they had to stop giving me ice chips (soothing to my very sore throat) and pain meds before sending me upstairs. Then there was a wait for the transport person (the guy wheeling my bed). We roll out to the main elevators; there are only 3 in the bank. First one that comes has a wheelchair in it – no room for us. The next one that comes has a bed in it….we’re waiting…waiting…finally I pipe up “this is bullshit” and ask if there are other elevators. My transport guy says something about carpeting and bumps and I say go for it – get me to ice chips and pain meds, STAT! (that last was in my head, actually). So he wheels me over a bump I barely feel, on to about 5 feet of carpet, to a bank of 4 STAFF ONLY elevators; one opens immediately and was empty. Did that have to be so hard?

When I was awakened in PACU I heard my name and in my dream-state had an image of sitting up which I apparently attempted to do before hands grabbed me and had me lie back. I was roughly it seemed to me put through paces – checking to make sure things worked (gripping fingers, pushing and pulling with my arms, raising bent elbows up against force, flexing and extending my feet). A dilaudid haze made the rest of my time a blur; the surgeon appeared for that seemed like seconds – he asked me to say “eeee” to test if I had any laryngeal complications (I didn’t) then must have run out to talk with my Mom and Susan. I say run because from what I hear it was very brief and he said some things he probably didn’t need to (“Not his last surgery” and “I have to catch a plane”). I didn’t pick this guy for his charming personality, however. My Mom did not like him.

So where I am today is pain-free, pain-med free, mostly sleeping normally, and back to driving. I need to post an updated photo of the surgical wound – it looks great!

Holding pattern

No posts for a couple of days as things begin to normalize. There are still parts of the surgery experience I would like to write about and in particular an encounter I had during my post-op clinic visit, but for now I'm relishing some great milestones:

• My problem sleeping was pronounced a 1-in-30 (i.e., common) post surgical "complication" for which I was prescribed a short course of steroids. My airway no longer collapses causing me to snore in scary-sounding snorts and my sleep has improved dramatically (although not entirely normal yet)
• That same day, post-op day 6, I stopped taking the muscle relaxers as I began to wean some of the meds that were ravaging my GI system. Perhaps coincidentally, but probably not, the day I after I started the steriods I was able to stop taking the oxycodone. Since then I've taken tylenol 2 or 3 times. That was a huge milestone, leading to...
• Today, post-op day, 9 I drove myself to the Costco and then later went to a holiday open house. 
• The dermabond glue crust on top of my surgical wound fell off (photo to follow).  It's amazing, really, and makes it even harder to tell that I had surgery.

What I am noticing these last couple of "normal" days is that I definitely wear down. I did a lot of talking  at the holiday party, showing off my pre-decrusted-scar as a badge of honor, and realized that I had to leave because I was fading and had to drive myself home. I also have to be conscious of my activity, which is supposed to be restricted -- no lifting anything over 5 lbs, no reaching over my head, only slow neck rotation supposedly limited only by pain. That's going to be a big challenge as I continue to feel better, as it will be easy to forget at times, but I need to keep in mind the longer-term goal of successful fusing of the bone implant. 

Pre-op holding

I got to wear 2 gowns for about 30 seconds – as long as it took me to cross the hall from the dressing room to the pre-op area. They pointed me to a bed, closed the curtain, and off came the butt-crack-covering gown. This was fine as I wasn’t going anywhere after that, but think of the laundry costs to accommodate modesty…

Smiling at me through a gap in the curtain was Melissa, the nurse in charge of checking me in. She asked the obligatory questions – name, date of birth, what procedure are you here to have, have you removed all of your clothing and jewelry, is there any metal in your body, do you go by “Gary” (for when they yell at me to wake up from the anesthesia)? These are all part of the protocol to make sure I was the right patient in the right place getting the right procedure – and some or all of these questions would be repeated multiple times in different stages of the process. I wouldn’t say it gave me the warm fuzzies but I understood why it was necessary and hoped that if there was a disparity discovered that the person asking would be alert enough to put on the brakes and sort it out.

When I answered “C4-5 ACDF” to the procedure question, Melissa said “don’t tell me you’re a medical professional until after I’ve put in your IV!” but I blurted out that I was a doc. Turns out she did fine in the end.

Around me and across the way were beds filling with patients off to various surgeries. I could overhear snippets of conversations going on discussing the surgeries, risks, conversations between doctors and their patients (You’re having some more hydrocephalus? And are here for a shunt? I hear you got to leave the hospital for a day – where did you go?). These took me back to my days in med school and residency where working in teaching hospitals meant dealing with the sickest of the sick and repeat customers.

Then in wheeled “Miss Lillian” across from me. I could see her since someone in the procession of my surgeon, anesthesiologist, and nurse anesthetist that came through to see me had left the curtain open but I could hear her better – the staff were having to yell at her because she was easily in her 80s and deaf but as she shouted “they made me take my hearing aids out”. “Do you go by Lillian!” the nurse shouted, asking what she wanted to be awakened with. “They call me Miss Lillian!” she shouted back.

Eventually it was time to go – the CRNA gave me 20 mg of versed (related to valium) and I felt it immediately, and we were rolling to the operating room. I don’t remember much after that until I woke up in the recovery room.

Post op day 5

A much better day – almost too good, actually. The paranoid part of me is waiting for the other shoe to drop. Nights are still tough but I rebounded in the AM much more quickly today. Here’s a real photo of me:  (click on pic for full size in a new window for a better view of the scar. Again, thanks to John Blaise for suggesting that I upload post-op scar pics – but if you’re grossed out, you can blame him).

 

 

And here’s a shot of the plate that’s screwed into the bones (click on pic for full size in a new window):

Pretty cool when you think about it. Compared to the MRI I posted to start this blog, there is now a larger and more even gap between the bones. Not as obvious unless you compare it to a pre-op x-ray (not posted) is that the bone spur protruding forward has been removed.

 

 

 

Tomorrow – either an insightful and heartwarming story about something that happened when I was in pre-op holding, or a meta-analysis of why I am unable to write heartwarming stories.

Another crappy night

Here’s an updated photo of my scar (h/t to John Blaise for suggesting I post one)

Bad bad bad night – very little sleep, having trouble with apnea/snoring such that I wake myself up and can’t get into deep REM. Sucks. Vomited after I had some coffee. Still no b.m. since before the surgery.

And yet – now (11:30 AM EST) feeling pretty perky. I do not feel sorry for myself, so neither should you.

Foggy

Bad day today as a result of a bad night, so I haven't been writing as much as I would like. I'm having to stay on top of the pain with oxycodone, and my periods of lucidity come and go. It makes me appreciate all the amazing blogging that Michelle did through her illness and meds (warning -- do not follow that link unless you have a few hours and a box of tissues).

Hopefully I'll have a better night and be able to write more tomorrow. There are a couple of good stories that took place while I was waiting to be wheeled back into the OR, and in the post-op conversation that took place between the surgeon and my family. 

25 hours

That's how long as I was in the hospital -- from the time I arrived to check in until discharge the next day.  Here's me the next morning, a self portait with camera phone -->

It's been a while since I've spent any length of time in a hospital, and I forgot what strange places they can be. I was at Duke hospital but I don't think what I experienced was anything particular to them. 

• We arrived as instructed at 9:30. First stop, registration and check in,then a seat in the surgery waiting area. They give you a pager (disc that lights up and vibrates, like the kind you sometimes get a restaurants)
• Susan asked me if I was stressed (I wasn't; just hungry, since I couldn't have breakfast, and tired  -- no coffee!); she said she wasn't stressed until we got into the waiting room and figured it was because she was catching the vibe from the pretty packed-in group there. I think the loud construction noises and cheap crammed-together furniture didn’t help, that’s for sure
• We sat next to someone that had been told to arrive at 5:30 AM for a 7:30 surgery and she lives 2 hours away. She looked pretty beat
• The pager went off at around 10:40 and it was time to get changed into a gown, booties and hat. They gave me 2 gowns to wear, the first one backward and the second one covering the open back – which came off as soon as I crossed the hall into the pre-op area and got onto the bed.
• This was it – time to say goodbye hug and kiss Susan

Next up – into the OR.

The view from above

Here are more pictures I promised. Both are axial MRI sections, meaning they are shot as if looking down from the top of my head. Put another way, it’s as if you sliced me open at any particular level and look down at my neck. Here is a “healthy” view, a few levels up from where the problem is:

Notice in the center the nice dark circle (spinal cord) surrounded by a white border (spinal fluid). Now for the unhealthy view:

The spinal cord is nearly triangular and the white border is nearly gone.

3 days

3 days until surgery. I had my first anxiety dreams last night, nothing specific that I can recall but more of a "tossing and turning while thinking about it" experience. I'm not nervous, really, but as I get closer and it becomes more real I'm allowing myself to think about the details, what it will be like to get on the gurney in that skimpy gown, get the IV, talk to anesthesia staff...so it's getting real.

What I find as I remind or tell people about it the first time, after going through the why (disability prevention) and the what (cervical stenosis requiring discectomy and fusion) is that I do a bad job of explaining everything. Either that or I'm assuming too much knowledge (a recurrent problem of mine) and using unfamiliar terms which make it hard for the listener to really absorb what I'm trying to convey. So on that note I found a couple of sites that answer a few questions. This one is great, has a number of diagrams and explains a lot with good language. This one is more focused on recovery/rehab which was good for me to read, too since I haven't received a lot of information from my surgeon. I am just as much to blame as I've intentionally avoided that conversation figuring it wasn't an important part of the decision making process (I could be wrong there, but oops, too late) and that I didn't have a lot of control over it anyway -- it's more of a need-to-know.

The biggest issue in the short term is whether I'll be able to be a passenger on a long car ride, 19 days post-op, to Columbus, OH to visit my in-laws for Christmas. I'll find out soon enough.

Beginning

Cervicalgia is loosely defined as a pain in the neck. What actually got me to decide to create and publish my first blog isn't pain, but a condition that is often associated with pain called cervical spondylotic myelopathy (CSM).  This is what it looks like (from the MRI I had at Duke, 6-17-2008). Click on picture for larger image

After visits with 4 doctors, a fair amount of reading/research, and some soul-searching I decided to have surgery to repair this condition to prevent any further damage to my spinal cord that, if it happened, would cause disability in some unknown but unwanted form. 

The surgery is a pretty big deal -- general anesthesia and all its risks, removal of the offending disc, replacing it with a piece of cadaver bone.

I thought a blog would be a good place to scribble some random musings about the upcoming deal, get my thoughts out there (thanks, Andy) and maybe be a good place to connect with friends and family as I go through recovery. 

More fun pictures later!