PDA

View Full Version : Surgery on Tuesday--boomergal



boomergal
07-02-2011, 03:06 PM
Just a few more days to go. On Thursday I had my pre-op testing and bending x-rays, and I met with the internist who will be following me in the hospital and with Dr. Boachie. (I saw the HSS pulmonologist earlier in the month.) The fusion will be T2 to T12. Dr. Boachie said that the choice was either the selective thoracic fusion or a fusion down to L4. Because my lumbar curve is very flexible, he wants to preserve the lumbar vertebrae with the hopes that the curve will correct itself (however the rotation in the lumbar region will remain, even if the curve self-corrects). He will know within 6 to 12 months if the fusion needs to be extended. Somehow I had thought that if I needed an extension of the fusion it wouldn't be necessary for years. Although the idea of going through all this again is daunting, if an extension needs to be done I guess I would rather have it done sooner rather than later when I am older and less fit. (I say this now, but ask me again post-surgery and I may not feel the same way, haha.)

Another thing that is a little up in the air: if the instrumentation and de-rotation of the spine don't provide enough correction of my rib hump during surgery, Dr. Boachie will also perform a thoracoplasty. Even if he doesn't need to do the thoracoplasty he will obtain bone from the ribs for the bone graft so that he doesn't need to take bone from the hip, which he said can lead to long-term pain. I hope I am explaining this correctly and using the right terminology. Does using rib bone for the bone graft constitute a thoracoplasty? Or is that term just used for rib removal when it's done for cosmetic purposes?

Dr. Boachie said the surgery will be 3 to 4 hours. Wow! I think I'm getting off easy, it that's the case. I'll be in the hospital for 5 to 7 days if all goes well.
I've arranged for a private-duty nurse's aide for the duration of my stay, but if I don't need the aide for the whole stay I can cancel. One thing I just learned is that if you have the same nurse for over a certain number of shifts (I can't remember what the limit is) you need to pay overtime. That makes sense--I don't know why I hadn't thought of that before. So, I'll just get a different aide, if it comes to that, because I don't want to pay time and a half.

I'm wondering how much the thoracoplasty increases pain and recovery time, and how it affects pulmonary function. I'm guessing that the incentive spirometer exercise is going to be painful. At least I'll avoid the bone graft from the hip.

Well, the big adventure starts Tuesday afternoon (Monday evening if you count the enema as part of the adventure). Many, many thanks to everyone on this forum for sharing your experiences, being supportive, and making me laugh with your great senses of humor.

boomergal
54 years old
T57, L43
surgery sch. with Dr. Boachie 7/05/11
T2 - T12, posterior

golfnut
07-02-2011, 04:05 PM
Boomergirl,
I know this is a tough time, but you will get through it and be on the way to recovery before you know it. From everything I've read on this forum, you have one of the top surgeons. I told Dr. Lenke's nurse to relay the message to him the afternoon before my surgery that I wanted the rib hump gone and jokingly said that I didn't care if he had to saw off a couple of ribs to do it. I guess the derotating of the spine and 6 osteotomies did the trick because I have no evidence at all of the rib hump and he didn't do a thoracoplasty. I hope the same for you. Please post as soon as you are able to let us all know how you are doing. I wish you the best!

Lorz
07-03-2011, 07:28 AM
Boomergal,
My thoughts will be with you on Tues. You really are in good hands. Everyone there kept reassuring me that Dr. Boachie is one of the the most skilled surgeons they have ever worked with. I am glad to hear you reserved an aide, it is reassuring to have someone with you at all times. I did not have a thoracoplasty either, and no longer have a rib hump. He used BMP, donor bone, and some of my own bone. Is he not using BMP with you? He is the expert, whatever he chooses, I am sure is for the best. Best of Luck, and looking forward to hearing from you post-op.

boomergal
07-03-2011, 11:02 AM
Thanks so much for your good wishes. Karen, like you, I'm up for whatever it takes to get rid of the rib hump. (I really enjoyed your swimsuit post--I can't wait to see my new back and eventually go out shopping.) Lori, Dr. Boachie is using a combination of donor bone, BMP and my bone. So far I'm feeling calm and almost excited (I never imagined I would be this calm). I feel very lucky that Dr. Boachie is my doctor and I know he'll do whatever is best.

I'll keep you all informed and I'll get my husband to post, too.

All the best to everyone.

Mary (boomergal), 54 years old
T57, L43
surgery sched. with Dr. Boachie 7/05/11
T2-T12, posterior

Pooka1
07-03-2011, 12:28 PM
Boachie said that the choice was either the selective thoracic fusion or a fusion down to L4. Because my lumbar curve is very flexible, he wants to preserve the lumbar vertebrae with the hopes that the curve will correct itself (however the rotation in the lumbar region will remain, even if the curve self-corrects). He will know within 6 to 12 months if the fusion needs to be extended. Somehow I had thought that if I needed an extension of the fusion it wouldn't be necessary for years.

I am not clear on why Boachie is unsure about whether the lumbar will correct itself. As far as I know, he can determine if the lumbar curve is structural or just compensatory with bending radiographs. If structural it might need fusion if it worsens and that is the 6 to 12 month observation window he is discussing. If only compensatory, it will be much reduced or completely gone on the table and and as seen on first post-op radiograph.

Your thought about many years going by before an extension is necessary relates to folks who have structural lumbar curves that are fused ending at L3 or below that don't include the pelvis. Those people are thought to be in a "countdown" for fusing the remainder of the lumbar. Per testimonials I have read, this countdown can last anywhere between a few years to many years. Linda will know better than I.

If you are like both my daughters who only have one structural curve and it is in the thorax and the fusion ends at L3 or above, you are not expected to need any more fusion in your life per our surgeon. The wildcard for you is whether your lumbar is structural. You might want to ask Boachie that specific question. Based on what you have written about his saying you might need extension down the road, I am guessing he thinks it might be structural. Or not! All cases are different.


Does using rib bone for the bone graft constitute a thoracoplasty? Or is that term just used for rib removal when it's done for cosmetic purposes?

Thoracoplasty is the rib removal as far as I know. The ribs grow back, hopefully in a better configuration, per what I've read.


I'm wondering how much the thoracoplasty increases pain and recovery time, and how it affects pulmonary function. I'm guessing that the incentive spirometer exercise is going to be painful. At least I'll avoid the bone graft from the hip.

Relatively few folks get thoracoplasty in the US per my understanding. My one daughter was very rotated but the pedicle screws, along with surgeon skill, removed most of it. There are folks from other countries and even a few from the US who did have this procedure and hopefully will say how painful that was if they can separate it out form the fusion surgery.

Good luck. You have hit upon the way to go into this with confidence and that is KNOWING you have a great surgeon. That's what got us through the first kid's surgery. What got us through the second kid's surgery is seeing the quick recovery, great cosmetic results, and most of all stabilization of the straightened spine on the first kid.

You will get a great result also. :)

Sharon

Doodles
07-03-2011, 03:51 PM
Boomergal--
You have the right positive attitude and sounds like you have reached that rather calm feeling before surgery. Best wishes and lots of positive prayers and thoughts coming your way. Janet

kennedy
07-03-2011, 04:44 PM
good luck on tuesday

mabeckoff
07-04-2011, 02:23 PM
Good luck tomorrow

Melissa

MomtoM
07-04-2011, 02:59 PM
good luck to you tomorrow!

loves to skate
07-05-2011, 06:13 AM
My thoughts and prayers are with you today.
Sally

bamboo
07-05-2011, 07:25 AM
positive thoughts for you today! Good luck!

peachrush7
07-05-2011, 06:49 PM
Hope your surgery goes well and you have a smooth recovery! We're all rooting for you!

djkinkead
07-05-2011, 07:53 PM
Boomergal, saying lots of prayers for you!

boomergal
07-07-2011, 09:50 PM
My wife's surgery went smoothly and swiftly on Tuesday. No rib bone had to be used. After three hours Dr. Boachie came out into the family atrium waiting area and showed my daughter and me the before and after X rays on his Blackberry. Wow. What a difference!
The last two days of recovery have gone smoothly as well. Lucidity, walking, and digestion are all improving. The staff has been caring, friendly and professional.
It sounds like my wife will be released on Sunday or Monday. She can update things here after she gets home. (I had a longer version of this post and lost it. Grrr.)
Thank you all very much for your kind comments and good wishes. All the best to all of you waiting for procedures and all of you recovering from surgeries.

mabeckoff
07-07-2011, 09:59 PM
Glad that all went well

Melissa

Doodles
07-07-2011, 10:32 PM
That's wonderful news. I hope recovery continues to go so well. Janet

JenniferG
07-08-2011, 04:18 AM
Great news!

golfnut
07-08-2011, 04:58 AM
Thank you for posting for Boomergal. It sounds like she's doing great and has a good correction.

Lorz
07-08-2011, 09:56 AM
Boomergal,
So glad to hear your surgery went well, and your recovery has been smooth thus far. It is always good to hear another one has made it safely to "the other side" Looking forward to updates when you feel stronger!

Karen Ocker
07-08-2011, 10:27 AM
Thoracoplasty is the rib removal as far as I know. The ribs grow back, hopefully in a better configuration, per what I've read.

Relatively few folks get thoracoplasty in the US per my understanding. My one daughter was very rotated but the pedicle screws, along with surgeon skill, removed most of it. You will get a great result also. :)

Sharon
I asked for the thoracoplasty because I had a very deformed, pointed yet, rib hump from the ~ 100deg thoracic curve as a teen. That particular surgery in 1956 did little for that hump. At age 60 I asked Dr. Boachie for a thoracoplasty. With my aged spine and long standing hump simply reducing the curve wasn't enough. A section of rib of or of several ribs is removed, the bone is then used for the fusion. The breached ribs are sewn back together. A total rib is not taken off the spinal column. I do look better but my right shoulder blade still protrudes some because that part of the upper thorax is a dangerous place to cut ribs. The hump much below the shoulder blade is almost totally gone. The recovery was very paonful but sleeping with ice bags in that area really helped. This also affected my breathing capacity in the long run.

Another reason not to let curves get too large.

Doodles
07-08-2011, 12:02 PM
Karen--
Interesting info on thoracoplasty. Just wondering...was it worth it? Would you do it again? Thanks. Janet

Karen Ocker
07-08-2011, 01:20 PM
Yes because I look much better, my back lines up with chairs and clothes fit and look better than before.

Doodles
07-08-2011, 01:55 PM
Thanks, Karen. I think it's worth considering. Janet

judyat60
07-08-2011, 02:45 PM
just saw this…glad to hear from your hubby things went well and you had good correction. I hope recovery goes as well.
I have my first appt. with Boachie on Monday, my fourth (and last, I hope) consult.