Re-Admission

I was third in the queue when I arrived at the hospital. I was also sobbing hysterically. I was dressed in blood stained shorts and T-shirt with no toiletries, just a bag with my pills and discharge letter in it. The lady second in the queue waved me ahead of her. Hunter ward had called A&E to let them know I would be arriving. I gave them the pager number Hunter ward had provided and was then ushered through to the cubicles.

It did not take long for an A&E nurse to fetch me despite the hour. She got me to lie down on the most uncomfortable bed ever. She examined the dressing and then ran off. A doctor (I assume from A&E) came in whilst she was gone and got me to explain what had happened. He told me that someone from the spinal team would be down to see me shortly. The nurse came back part way though and took off the dressing and cleaned the wound so that the doctor could take a look. They then left me alone.

I'm not sure how long it took, but a lovely lady from Orthopaedics arrived and took a look at my back. She was also the first person to ask me about my mental state in detail and agreed that it was most probably the codeine that I'd had an adverse reaction to. She explained that she wanted a more senior member of the spinal team to take a look at my incision. I didn't really get why at the time.

A few minutes after the Orthopaedic surgeon left, the head of A&E came to speak to me. He was unaware I had already been seen so I had to explain what I'd been told. He had a very gentle, reassuring manner about him.

I can't remember who told me but some time later I found out that they were re-admitting me. I was told that I would be admitted to the Critical Dependency Unit (CDU) until they found me a bed on the ward. I was not to move around whilst I was there. I started crying again as I was scared and alone. It was hours before porters arrived and wheeled me into CDU.

Hunter Ward (Part Three)

I was to spend a total of seven days in Hunter Ward. The reaction to codeine was awful and really messed with my head, even after the nausea and other physical symptoms had gone. I was in a cleft stick regarding my bleeding right incision. The nurses wanted it to close as they were concerned about the risk of infection. The surgical team were happier that it was leaking as it was better for the blood trapped during surgery to evacuate rather than staying in (a haematoma) providing a route for infection and, possibly, leading to further surgery. I was subject to endless blood taking. I think the lab technicians must have been heartily sick of checking for signs of infection by the time I was released.

Washing was restricted as I needed to keep the dressing on the open right incision dry. This meant I could not wash my hair as I was not allowed in the shower. I can not tell you how revolting it felt. I'm normally prone to the dry frizzies but by day seven, it looked like I'd tipped a vat of oil over my head and encouraged my hair into clumps that stood out at all angles!

The nursing staff were avoiding getting trapped into the 'what does it look like' conversation. My friend Jimmy popped by after visiting a relative and kindly took a look at my wounds for me. Apparently they did not look 'too bad' but were about six inches long instead of half inch. He also counted my staples for me. I had seven in the left side and fourteen in the right. I am glad that the staples did not give me too much discomfort as the wounds shrunk widthways as they closed.

I  had several false starts regarding discharge. My right incision would dry up for just long enough to convince the staff I could go now go home, only for it to suddenly flood again. It was to be day six before they made a firm decision I could go.

Day seven was a complete muddle. I was not the only one scheduled for discharge, nor was I the only one due to take their first shower. There must have been three of us in my bay alone who were to take a first shower and get discharged. It was just after lunch by the time I got my turn. I was left alone in the ladies' wet room. This made the whole thing so much more hard work. I am very short sighted. I was still unable to 'read' my body properly. There was nowhere to put down my wash bag that would have been accessible whilst standing so I had to perch on a shower stool that was set a little too high for me. To say I was a nervous as a long-tailed cat in a room full of rocking chairs was an understatement! I was so exhausted by the time I'd washed that I had to ring for a nurse to help me finish drying. I'd more or less drip-dried by the time she got there. I just could not reach my feet.

I collapsed on the bed until a nurse came to ask me if I'd been signed off my everybody at about 2pm. How should I know? I didn't know who had to sign me off! Eventually they were happy for me to go. I was issued with pain killers, including the wretched codeine, and a slip of paper with the ward phone number on it. No spare dressings, no post-surgery booklet, and no tips on how to care for incisions I couldn't see let alone re-dress.

A pal eventually drove me home after I was let down my my planned designated driver. She could not stay too long so she cleaned up after my cat sitter and then I was on my own. The first problem arose when I realised I could not eat because all the meals I had prepared before going into hospital were at ankle height in the freezer. Fortunately my hose and cat sitter Gary had left enough in the 'fridge for me to fix a sandwich. I had to eat it off the breadboard however as, of course, the plates were also at ankle height in the cupboard!

I pottered about a little, trying to see what I felt okay about doing for myself and trying to work out what I would need help with.

The sofa and TV beckoned about 9pm. My ability to concentrate was still quite limited so I turned off the TV called a neighbour who'd had knee surgery a few weeks before I went into hospital. Best thing I could have done as he echoed that admission and surgery was good but that the discharge was a complete shambles. He also fixed for his wife to come over once she got home as I needed the cat pan changed before I could go to bed. I then realised that I was sitting in a pool of my own blood. I went into complete meltdown.

The doorbell rung. Perfect timing. I rang Hunter ward and rambled at the nurse until my friend took over. She confirmed that the right dressing was totally flooded. The next ten minutes were frantic as I contacted Gary to tell him he had to continue cat sitting, and got into another neighbour's car as I'd been told to go to A&E.

Hunter Ward (Part Two)

The other ladies had warned me that day three would be shit. Day three is when the last of the general anaesthetic and other drugs given during surgery completely leave your system. It is also the day that the drugs given orally reach their effective level in your blood. It tends to make your emotions tank and not one of the patients in my bay had gone through day three without having a least one crying jag. In my case it also saw the arrival of the most appalling nausea and a bad tempered physiotherapist. I'd just been injected with anti-nausea medication when she started in on wanting me to walk up and down some stairs. I tried to tell her I would, just not right now, but she still went on and on. The physiotherapy assistant with her gave me a sympathetic look. In hindsight I wish I'd given in to the urge to projectile vomit over her.

My right incision was still bleeding so I stayed in hospital scrubs. The morning was a bit of a blur as I felt really sick. I seemed to be outside of myself, the world a bit distant. I still went for walks and ate but it all became more disorienting as the day wore on.

I eventually did do the stair walking and was able to explain to the physiotherapist's assistant that I'd been trying to avoid puking over them earlier rather than being uncooperative. She understood but the physio herself still had a face like she'd been chewing wasps when she met us in the test room. I was to find out a couple of days later that she'd had several run-ins with other patients on the same day. I felt like I floated up and down the steps rather than walk on them. I also managed not to swear at the physio when she snapped at me that I was only to use the one handrail (rather than both) as I only had one at home.

I'm not sure but I think day three was when one of my former colleagues and friends popped in to see me on her way from visiting her mother in the same hospital. Jane patiently let me ramble on and on. It was whilst I was talking to her that I realised I seemed to be gabbling and a bit off my tits to be frank. I'm also not sure if it was day three or day four when I saw Mr Muir again. He appeared to be about the size of a leprechaun and floating in a seated position just about the end of my bed. I remember telling him I felt chemically toxic. In fact, I felt like I'd been poisoned! The psychedelic effect was only added to be the fact he seemed to take this completely in his stride and told me that what I was experiencing was completely normal.

Two porters took me down to Main X-ray in the afternoon. I was so glad to be wheeled out of the ward on my bed as the corridors were so much cooler. The accompanying stand-up routine was a welcome distraction. The younger of the x-ray technicians was a bit startled when I pointed out that my consultant wanted my x-rays to be done 'under loading', i.e. with me standing up. Even so, she still wheeled my bed too  close to the machine. It had various bits sticking out all over the place. I was still very nauseous so I really did not want to have to look down or move my head at all really. The technician went to check with her older colleague that the 'under loading' bit was correct. Having checked the sheet, the older lady said, yes, it was. So the younger one added "who's her consultant?"."Oh, it's Mr Mckenna". "Ooh" was the reaction, said with a tone that suggested that this explained everything. I surmise his post-surgery method rather startles some of his colleagues!

Days three and four I had the most appalling craving for a chicken mayonnaise sandwich. So much so that I nearly kissed my friend Mary's feet when she brought me one in. The hospital food was great. I just had this awful craving. She sat and chatted to be for quite a while then pointed out the window and told me she was not surprised I felt weird. Mary eventually had to explain that it was the night of the full moon and commented that of course a white witch like me was bound to feel strange.

It was something more than that though. I was on high dosage of paracetamol and of codeine. I'm not sure at what point the nursing staff figured it out, but it would appear I shouldn't be allowed anywhere near codeine. It had been causing the nausea, the hallucinations and the sensations of non-existent constipation and period cramps (yes, that good!). Once my mental fog cleared a bit, they explained that it's not uncommon for people to find that they can't take a given pain killer in large amounts. I was told that I would seem to be at the extreme end of the codeine sensitivity however and to make sure to check anything I took in future for codeine as an ingredient (e.g, cough and cold remedies).

I refused all further offers of pain killers for the next twenty-four hours and only resumed the paracetamol as a precaution.

Hunter Ward (Part One)

I woke early on the first day after surgery. I felt very hot and thirsty and a bit cramped up at the foot of my wrinkly bed. The oxygen enabled me to breath very well though; my perennial sinusitis dried right out. The 'obs' nurse took my stats and got me to breath deeply for a few breaths. Then came the first of numerous pain killer pills. I took them even though I was pain free as I'd been warned not to wait to be in pain before requesting medication.

My neighbouring lady asked me how I felt. We chatted for a bit then a nurse asked me if I felt able to get up. I was delighted to be allowed to give it a go as I needed the bathroom again. I was very cautious at first as I couldn't really tell what my back was experiencing so it was difficult to assess how much of any movement was too much. I'd had concerns prior to surgery that 'wiping' might be an issue if I wasn't allowed to bend. As it turns out it wasn't but it did require a bit of trial and error as the arms on the over-toilet commode limited knee spread!

Breakfast was a joy as I was ravenous by this stage. I took care to have the healthy options of porridge and fruit juice with some brown toast to follow. I was keen to avoid to gloop issued to other patients to aid 'going'. Strong pain killers have a tendency to 'back one up', hence the gloop.

I was visited by a couple of members of the spinal team later in the morning. They got me to roll over onto my side to check my wounds. I was told that they could see the incisions through the dressings. When I saw a pack of these later, I saw that they were composed of a bi-layer of transparent plastic with a blue honeycomb sponge sandwiched between. I was then asked to roll back onto my back so that they could check my reflexes. I flexed toes, then ankle, and then rotated my feet. Yes, I could feel being tickled by the plastic stick, there, there, and there. The senior surgeon commented that he was surprised at the amount of motion I had and that it normally took most people several days to regain full sensation in their lower limbs.

That afternoon, I stood chatting to a fellow patient for longer than I've been able to stand in the last five years. Standing still had been the most painful posture prior to surgery. I'd considered it a good day if I'd managed three minutes without wanting to kill someone for keeping me waiting. That afternoon I managed twenty minutes before even feeling tired. I was delighted once I realised and reflected on the fact that I'd also been able to walk further than in the last five years and that my posture felt NORMAL!

I was grateful later that I'd obeyed my surgeon and got walking as soon as possible as it let me know that surgery had been the right option. I'd been able to judge my corrected posture, my mobility, and had eliminated worries over one of the possible complications, that of permanent urinary incontinence.

...ooOoo...

The heat of the ward, the constant need to drink and the endless trips to the loo, and the general noise in the unit meant I go no sleep on day one. Day two was hailed by the arrival of the dreaded butt and lower back swelling. This was not painful per se but did result in some very weird sensations. I was both numb yet fizzy and any movement carried the risk of intermittent sensations like having your butt pinched. It also revealed that my right incision had been bleeding. Bleeding enough to cause my previously sterile dressing to lift off my skin. It was re-dressed and a blood sample was taken to check my blood count and to look for signs of infection. One of my consultant's registrars, Mr Muir, was called to take a look. I only realised much later that he was trying to assess whether I was losing spinal fluid. If I had been, it would have meant another trip to the operating theatre for a procedure akin to applying a puncture repair patch to a tyre. Thankfully this was not required.

I was allowed to sit in a chair for a while and brought a cardboard washbowl and cloth so that I could rinse myself down. The nursing assistant helped me to wash my back as I had to make sure my dressings stayed dry. My surgical gown and bed linen were changed. One of the nurses checked my dressings again and told me she wasn't going to tell me what it looked like. I found this rather perplexing as I hadn't asked! I rested for most of the afternoon. I didn't manage to sleep but did sort of hover on the edge of sleep whilst listening to the hiss of my 'boots'.

My rest was interrupted by a brief visit from that day's physiotherapist. She gave me a sheet that basically covered the same sort of leg and foot exercises you're given on planes to prevent DVT. I took one look and understood why my surgeon had said he didn't want me bothering with them too much as the walking was far more important to my recovery in his opinion.

I was still very hungry so ate like a horse at each mealtime. I made sure to ask for fruit as snacks, knowing that I'd probably be very grateful for having it in the small hours. The pattern of ops, drugs, dressing changes, blood tests, and endless loo trips was set. I got to know the other ladies in my bay a bit. No one else was in for spinal surgery. It was all hips and knees. I also met to the night sister for the first time. She was Albanian and had a wonderfully gentle, kind yet naughty personality.

Surgery Day

It was a wintry 23rd January 2012 that saw me being transported to the Royal Berkshire Hospital in Reading to have fusion surgery. I had to report before 7am and I don't *do* mornings. A lovely pal drove me there in her other half's 4x4 which felt safer than a 'normal' car on the icy, slightly snowy streets.

Once there I found out that I'd been bumped out of second place on the wickedly adorable Mr Patrick McKenna's surgical list to later in the day; like nearer 4pm. Fortunately they were happy for me to pop off to my mother's for a few hours and I was given leave to drink water or very weak squash until 2am.

I was signed in once I got back to the Orthopaedics admission list and given a shot of gloop. The gloop was a mixture of pain killer and a drug designed to stop me from fitting on the table. The latter being a distinct possibility due to the surgery being so close to my spinal cord.

Previous surgeries had led me to expect to be taken to a bed for surgical preparation but the Royal's Orthopaedics suite does not work like that. I was led through to a small room with a changing cubicle. I sat down on a bench outside the cubicle and asked the usual questions to confirm ID and procedure. I had two labels attached to my right wrist, one with my identity and one detailing drug sensitivities. I then entered the cubicle, stripped down and get into a cotton surgical gown. The fastenings were down the side but I couldn't reach so had to hold it around myself as I peered around the door looking for the nurse. He had me place my possessions into a locker and then did me up. I went back into the cubicle to wait for a member of the surgical team.

The surgeon again confirmed my details and then got me to turn around so that he could draw on my lower back with a thick black marker pen. He got me to confirm which level of my spine was to be fused and the details of the work to replace the right hand side of my L5/S1 facet joint. I was then led through into an anteroom to the operating suite itself.

Shedding my flip-flops, I was helped onto a surgical trolley bed and released my gown from underneath myself. The anaesthesiologist did most of the talking but it was the surgical nurse who again confirmed my ID and so forth. I noted that the oxygen mask had been massively re-designed since the last time I'd had a general anaesthetic. It was much, much smaller and made of a transparent, clear, rubbery material. It was held just above my nose in recognition of my claustrophobia. The anaesthesiologist talked away my nerves as he placed a cannula with tap into the back of my left hand, taking care to avoid the ganglionic cyst I have near the centre of my wrist.

It seemed to take ages but was probably only a few minutes before I was injected with the anaesthetic which seemed to take me over much more quickly and gently than in previous surgeries.

...ooOoo...

I woke in the recovery room, unaware of having been wheeled out of theatre (I had been on previous occasions). It was the first and last time that I got to meet Mr McKenna himself. I was tearful on waking. I had expected this as modern generals seem to have the same effect on me that gin does on some women. I had warned Patrick beforehand so he was grinning at me. He squeezed my hand and briefly explained that he'd had to cut bigger incisions due to access issues and that he'd only been able to fuse up the back of my spine, leaving the front of my disc in place. I had been warned of both possible complications ahead of time so was not surprised. He squeezed by hand again and left me. A few minutes later my attending nurse came up and told me it was all okay as I was still crying.

I do not remember much about the next few minutes, just the trip up to Hunter Ward and the transfer to a six-bed sub-unit. The turn into the unit was tight and I was a bit uncomfortable due to the bed being bumped against the wall. Several of the other women in the bay introduced themselves as I was wheeled through to a bed adjacent to the window. I came to appreciate this 'easing of relations' so much over the next few days.

The bed I was transferred into was far more comfortable than the surgical trolley bed but felt extremely wrinkly. My lower back itself was cushioned by the specialised dressings placed in theatre. There seemed to be a lot of hazy fussing around me but I was finally arranged on my back in a reclined position with my lower legs enveloped in softly hissing, hydraulic, foot-less 'boots', and a soft rubber oxygen tube poking up each nostril. I had no pain, just a sensation of sitting on a lop-sided cushion (my butt).

I drifted between the frequent monitoring checks (blood pressure, temperature, blood oxygen saturation) until the demands of my bladder became too much to ignore. By this time the unit's lighting had been dimmed so I guess it must have been around ten in the evening. I called a nurse who proceeded to get me to try to use a cardboard bed pan. The 'log-roll' needed to get on to the pan presented few issues but I simply could not get started. It felt like I was trying to pee out of my ears. Very weird! We decided to leave it a while before trying again. I was told that the anaesthetic stops smooth muscle from working well due to blocking the innervating nerves. This meant that one's urethra does not dilate easily. It also explains why one is asked to cough at many of the monitoring checks as it impacts lung function too.

A second attempt with the bed pan was equally fruitless. The nurse warned me that I might need to be catheterised however she offered to let me try to use a commode placed adjacent to the bed first if I felt able to try standing. I knew Patrick wanted me to stand and to walk as soon as possible after surgery and not fancying having a tube inserted, I agreed.

I had practised the 'log roll' method of getting out of bed before coming into hospital and I'm glad that I did as it gave me a lot more confidence that I would be able to get up and sit on the edge of the bed safely. I was surprised that sitting gave me absolutely no discomfort and that I was slowly able to stand without pain, wobble or other alarms. Lowering myself onto the commode took time as I was terrified I might cock up and end up butt first on the floor.

I could not go at first but using a simple mini body scan meditation and utilising my pelvic floor muscles as a pump brought relief in more ways than one. I was comfortable and knew the surgery had not let me with urinary incontinence.

Once back in bed, I started the first of the pints and pints and pints of water I was to down over the next few days. The nurse plugged my 'boots' back in and told me to try to sleep. I think I must have managed a little eventually but the heat and hissing of hydraulics throughout the unit made that difficult.

L5/S1 Posterior Lumbar Interbody Fusion (PLIF)

Two weeks before surgery on the 23rd January 2013.

I'm finally going in on the 23rd January provided my surgeon is happy with my too high, too erratic blood pressure.

My surgeon has scheduled three hours for the operation (a 'normal' fusion is allocated 2.5) and tells me the average stay is one night (yes, really!) but to allow for up to five. It's scheduled to be done by 'keyhole' methods. Barring complications, I will have several incisions about the size of the end of my little finger in my back and, maybe, my sides. I am getting extra fusion either side of the affected joint as well as the usual one up through the old disc space. I also have to have the two ends of my spine re-aligned before the work for the fusion. I think he will also have to go fishing for broken off bits of bone. He tells me I should be able to walk twenty minutes three times a day by the time I have my six week follow-up appointment. From what I've read, complete fusion can take up to two years to complete all being well.

My blood pressure is within the surgical guidelines now but too high and very erratic so the Doctor put me on calcium channel blockers on Friday. My hospital letter says start any medication four weeks before surgery. They didn't even give me four weeks notice of the surgery! I have to call my doctor tomorrow to make sure that they've faxed the readings to the hospital.

I've been imagining all sorts of symptoms since they've been focussing on my BP so much, My lovely surgeon has told me everything I'd ever want to know about the actual surgery. It's been information on what to expect post operatively that's been lacking. My GP advised calling Social Services. They reassured me that help is available if needed. Apparently the post-op assessment by the physio establishes whether I need any and they then call the Social direct. Now if anyone had bothered to tell me that sometime over the last n months, I might have been spared being in an anxiety state for the best part of a year.

My local Lloyds Pharmacy has me signed up for a new service whereby they call folk on certain kinds of medication (e.g. for BP. diabetes, etc) at 2 and 4 weeks after starting them to establish if one has any issues and to make sure I have the information needed to get them addressed. They have also signed me up for home delivery of drugs if I need it. All in all I got a lot of help on Friday. I just need to find a way of decompressing now. One pal is sending me a brief positive vibes message each day, bless her. I am trying to BREATHE lol

Introduction

I was diagnosed with a broken joint in my spine approximately five years ago. My surgeon and I decided to take a conservative approach to treatment and try to suppress the pain and other symptoms I had first. Over the following years I underwent three minor surgeries involving injections into the spine. Eventually, we made the decision to go for surgery. It was at this point that I discovered that (at the time) there were very few personal narratives on the Internet that tell it like it is; there were plenty of horror stories but very few successes. It is now about five months since surgery which is 'early days' but I do consider my surgery a success so far. It should be noted that everyone's experience is different and how similar yours will be to mine is depended on how similar your problem is and that I had a couple of post-operative complications that I hope you are spared.

The following sections of this post are for reference.

...ooOoo...

My Case

Diagnosis:  

Spondylolisthesis L5/S1 (grade 1/2) with:

Bilaterally compromised foramen

Spinal stenosis

Herniated disc

Degraded right facet joint

Cause:

Likely to be previous traumas plus age related degeneration and, possibly made more likely by a the slight lumbar lordosis that most of my mother's side of the family exhibit.

Treatment:

Nerve root block L5/S1

Facet joint injections: L4/L5, S1/S2, & S2/S3

Lumbar Epidural

PLIF L5/S1 + support of right fact joint using MAST

...ooOoo...

Quick Guide

Anatomy:

The top 7 vertebrae that form the neck are called the cervical spine and are labeled C1-C7. The seven vertebrae of the cervical spine are responsible for the normal function and mobility of the neck. They also protect the spinal cord, nerves and arteries that extend from the brain to the rest of the body.

The upper back, or thoracic spine, has 12 vertebrae, labeled T1-T12.

The lower back, or lumbar spine, has 5 vertebrae, labeled L1-L5. The lumbar spine bears the most weight relative to other regions of the spine, which makes it a common source of back pain.

The sacrum (S1) and coccyx (tailbone) are made up of 9 vertebrae that are fused together to form a solid, bony unit.

Definitions:

• Spondylolisthesis - a forward dislocation of one vertebra over the one beneath it producing pressure on spinal nerves.
• (Intervertebral) Foramen - a passage for a spinal nerve and vessels that is formed by notches on pedicles of adjacent vertebrae.
• Spinal Stenosis - condition in which the spinal canal narrows and compresses the spinal cord and peripheral nerves at the level(s) affected.
• Facet Joint - any of the four projections that link one vertebra of the spine to an adjacent vertebra.
• Nerve Root - the initial segment of a nerve leaving the central nervous system.
• Epidural - on or around the dura mater, in particular, (of an anesthetic) introduced into the space around the dura mater of the spinal cord.
• PLIF - Posterior Lumbar Interbody Fusion. This is a surgical technique used to join two or more vertebrae whereby the disc is accessed from a posterior incision. Supplementary bone tissue, either from the patient (autograft) or a donor (allograft), is used in conjunction with the body's natural bone growth (osteoblastic) processes to fuse the vertebrae.
• MAST - Minimal Access Spinal Technology. Uses cameras with microscopes, high definition monitors and other technology to allow surgeons to perform spine surgery with minimal soft tissue trauma.