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Chihuahua Mama
05-04-2008, 04:55 PM
I'm going to take advantage of all you experienced fusion veterans that have so kindly answered questions over the last few days about what to expect after surgery and would like to ask one more:

What is your first recollection of the exact moment you woke up and just how bad was it? I know the answer to my question is PAIN, but here's what I fear - I had a single level fusion at C6/7 10 years ago. When I woke up, I had over-freakin-whelming pain in my neck and back. Muscles were spasming from my jaw to my ribcage, and I simply could not believe a human being could tolerate so much. As they wheeled me out of the recovery room, the tears were streaming down my face - I couldn't believe how bad it hurt. Even my surgeon asked me "why are you in so much pain"? I felt like kicking his a$$ but I couldn't move at the moment.

I recall that pain and feel like that single moment when I become awake from fusion, that it will be that pain from 10 years ago to the tenth power. Do they give you something while asleep during surgery to help or do you just wake up and feel everything they did to you for the previous 9 hours? This one thing (believe it or not) terrifies more than anything else about this surgery.

Please tell me the truth - I'll take it like a man. Make that a woman - men have never birthed children!

Pooka1
05-04-2008, 05:16 PM
I just asked my daughter (posterior, T4-L1) if she had pain when she woke. She said yes, about a 10 but the nurse immediately gave her some pain meds and she fell asleep. The next thing she remembers is us visiting her in PICU where she felt no pain and wanted to sit up and even walk around. LOL. They must have given her a large dose.

I guess the surgeons don't like giving pain meds until the patient wakes up? Otherwise I can't explain why they would wake a patient knowing they would have 10 level pain. Anyway, it didn't last long per my daughter.

You might want to ask your surgeon about this. If you do, I'd love to know the straight dope on it. If I can remember, I'm going to ask our surgeon this week when we see him for the first check up post surgery.

ps. After seeing my daughter's recovery, I will take spinal fusion over an unmedicated birth.

Susie*Bee
05-04-2008, 05:18 PM
It's kind of hazy... and that's good. ;) But I don't remember any excruciating pain at all. It was more like I was stiff and couldn't move much-- and I think since the pain was evenly spread, and there was so much in the way of drugs in me, that it was more like an awareness of hurt, but muffled in a sense. I don't think I moved much at all for a little bit, but I was ok. It wasn't the sort of pain like what you are talking about. I remember being relieved that it was over-- and that I was "awake" from it! I hope this helps. I really think you'll be ok.

Chihuahua Mama
05-04-2008, 05:40 PM
ps. After seeing my daughter's recovery, I will take spinal fusion over an unmedicated birth.

Haha Pooka - Acutally I DID have an unmedicated birth (think the early 80's and the "lamaze" craze) and blissfully, don't remember a thing. I think that's God's lil way of allowing us Mom's to do the birth thing more than once :eek:

Your daughter has the blessing of being young, but I do appreciate the the honesty - a 10 is what I expect, but do wish it can be reduced to either a 6 or plain ole unconsciousness. Hey, I'm not picky, just don't want to suffer :p

Susie*Bee...I hope for the haze...give me the haze until I can log roll on my own.

Susie*Bee
05-04-2008, 05:44 PM
Hey, c mama, you'll do fine. And I had all 3 of my babies without any medication--and they weren't tiny or anything, ranging from 8 lbs. to 9 lbs. 10.5 oz. -- yes, natural childbirth was the thing then, and I thought it was fine. Hard work, of course, but that's what "labor" means. ;)

BTW-- there is absolutely NO WAY I'd take spinal fusion over natural childbirth. They really don't compare at all--at least in my mind, and I've done both. :eek: One more thing about natural childbirth, at least in my case-- they are not hazy memories, but quite strong and vivid. I remember all 3 very clearly... and the hard work, pain and the euphoria when the baby is born. Very much worth the effort! :)

Pooka1
05-04-2008, 06:00 PM
Haha Pooka - Acutally I DID have an unmedicated birth (think the early 80's and the "lamaze" craze) and blissfully, don't remember a thing. I think that's God's lil way of allowing us Mom's to do the birth thing more than once :eek:

Well maybe it's a matter of mental preparation. I was not intending a new age birth but had one thrust upon me. A twin new age birth. I did no preparation or breathing or whatnot. It was not the experience I had hoped for.

I have had the natural one level lumbar fusion I spoke of elsewhere, I've had toe nails ripped off from being stepped on by horses, I've had a ruptured ectopic w/ massive blood loss, and appendicitis pain for several days prior to surgery.
(ETA: posterior tibial tendonitis in one leg and a broken toe)

All of those combined simply can't compete with several hours of the worse cramping I ever felt, EVERY FEW MINUTES and knowing it was coming every few minutes and not knowing when it would end. I have since been campaigning for the inclusion of unmedicated birthing in the Geneva Conventions against torture. :eek: :D

I realize many women disagree. I agree to disagree with them. :)


Your daughter has the blessing of being young, but I do appreciate the the honesty - a 10 is what I expect, but do wish it can be reduced to either a 6 or plain ole unconsciousness. Hey, I'm not picky, just don't want to suffer :p

You know, I wouldn't worry too much about my daughter's report... she did not mention any pain waking up until I just asked her. She did not mention it in the PICU at any point as far as I know. So it couldn't have lasted too long like, say, in an unmedicated birth! <insert Sam Kinisen scream!>

Best of luck.

Singer
05-04-2008, 07:21 PM
I worried a lot about this too, and asked the anesthesiologist about it right before surgery. I was especially concerned that I would wake up entubed and panic, but he said they would keep me in a "twilight state" until they took the tube out, and even then I would wake up only gradually. There truly isn't any one moment that you wake up, fully conscious, aware of pain or any other sensation. It's all fuzzy and the pain pump does a really good job of controlling pain. I think the most disconcerting thing about early post-op is the helplessness -- I just couldn't move because I was so stiff.

I was never really aware of serious pain until they had me sit up the day after surgery -- now THAT hurt. ONce they switch you to oral meds, it takes a bit of tweaking to get optimum pain relief. Dilaudid was like a miracle drug for me -- I kept making them give me shots of the stuff after I got off the pain pump.

The main thing is you really don't remember much of it afterwards, and while it's happening you're too drugged-up and out of it to care.

malka22
05-04-2008, 07:53 PM
C-Mama: Simple solution: Ask for Methadone to be given intravenously in the OR when the fusion begins. My daughter just underwent fusion surgery & her surgeon gives Methadone, as described above, to all of his patients. It;s a very long lasting drug (24 hrs) & it gets you through the trauma of when you first wake up, as well as the 1st night. By the time it wears off, you will then be on Basal IV Morphine, as well as the PCA Morphine pump. Things are different now then they were 10 years ago. The anesthesiologists are life savers, in the pain dept. Ask for the above & you should be fine. In any case, go over the anesthesia plan in advance, so you will be sure to be covered...painwise! Good luck!!! There's no reason for you to have to suffer.

rosie1108
05-04-2008, 07:53 PM
I remember being really thirsty, and asking for lip balm. The only thing I remember was asking the nurse what seemed like 10 times for lip balm, and she put some on me, then I was happy. She also started feeding me ice chips. I don't really remember pain, it was almost like I was immobilized. My family told me later that iIf i did move my arm or my head, it was really slow and robotically. I had a morphine pump, and the nurses pushed it for me every so often. I think I had been awake for a little while when my husband came in, I don't really remember that so much, but I remember my sister being there, and she was feeding me ice also.

She said that I was talking really slowly, and I kept on picking at my lips and wanting more lip balm. The only thing I actually remember even somewhat clearly was the next day. I was still in the pre-op/ post-op recovery room, they didn't have a room for me yet, and it was a weekend so there were no surgeries scheduled. Anyway, after I had been feeding myself ice earlier when I was by myself, my sister came back, and I made her scoop my ice, then, in a very drugged up and matter of fact manner- I said to her: "what you don't know is that I can do it myself..." So, pain or no pain, at least I was still able to irritate my sister!!

As for having pain, I mostly just felt like I was in someone else's body, that I really didn't have control over anything- especially scooting around, sitting, rolling over, etc. I didn't really start noticing anything until the next day when they moved me to a transport bed (ouch), then to my room's bed (ouch). Just lying still all medicated when I woke up was fine, as far as I can recall...

JamieR
05-04-2008, 08:00 PM
Honestly, the first time I remember waking up, I was already in the ICU. I don't even remember much about the first day but the couple of times I do remember waking up, I know I was not in any pain. The nurses really did a great job of keeping my pain under control. Plus I had a pain pump so that really helped. Just like Susie Bee said, I was really hazy and so out of it I don't think I knew much of what was going on for a while. My parents said that the doctors came into ICU and asked me all kinds of questions. I got every single one of them right and I don't remember a thing about it!!

loves to skate
05-04-2008, 08:12 PM
Hi Chihuahua Mama,
I just dug out my operative report. My Dr. told me about this ahead of time so I would know what to expect. After stitching up all of the layers of tissue including the skin, a field block with 0.25% Marcaine with epinephrine was administered to the area followed by the steri-strips, dressing sponges,etc.
This blocks the pain for several hours after you wake up. So I had no pain when I woke up from the surgery. I just couldn't figure out where the heck I was. The ceiling didn't look like my bedroom ceiling at home, so then I remembered I had just had surgery and I'm alive, praise God. Like Singer said, the serious pain hits you when they come to get you up the first time, so if they give you a heads up, then you can hit the pain pump. Also she is right about the oral meds to get them tweeked. Make sure the nurses explain to you what your options are for oral meds. At one point, I was asked if I wanted one or two of the short acting oxycondones. I thought I could get along with just one. What they didn't tell me was that whether I had one or two, I couldn't have anymore for 3 hours. I always asked for two after that because I was in a great deal of pain after about 2 hours with just the one. :mad:
Just make sure you ask your Surgeon if he uses a local anesthetic after the surgery before you have the surgery. I would hope that any humane Dr. would be doing that in this day and age.
I'll be praying for you. Sally

vndy
05-04-2008, 09:17 PM
I remember VERY little - it was all fuzzy. I know I was a bit belligerent, asking for my family again and again (I had been taken from my boyfriend quite abruptly, and my parents got stuck in traffic and weren't there beforehand). I remember being told it went well, was shorter than expected, and I wound not need to wear a brace. According to my mother, I just replied to every question with a soft, high pitched "yay."

Don't freak yourself out too much. you'll be great!

Suzy
05-04-2008, 09:23 PM
That is the first thought I had when I woke up. Then I saw my Dad walk past my bed looking for me (I was in recovery with others.) and I whistled our family whistle. He turned around, with a grin. I have no idea why he didn't see me I must have been swollen like many have said they were and I wasn't recognizable :eek: ! When I woke up next I was in my room. I was a bit uncomfortable but mostly stiff feeling. My Dr. was very adamant in letting me know that pain can be controlled. If I needed to have something different all I needed to do was ask. (If what I was on wasn't working.) The only real pain I had was when my morphine pump jammed and went without for a bit. Then I still only hit about a 7-8 on the pain scale. I could still see straight but my teeth were starting to clench and I was tensing up. I remember telling a nurse to figure it out faster or they were going to owe me Botox to get the furrows out of my forehead!

sccrm08
05-04-2008, 10:08 PM
I can only remember two things from being in Post Op after surgery, and both times it was the same thing. I remember all kinds of alarms going off and hearing a women saying "shes not breathing". I could not wake up and I don't remember anything else until I was in ICU after 10pm (which my husband said is about the time I got there), I woke up and asked him what went wrong and he said he didn't know that they weren't saying anything to him and I told him I thought I had stopped breathing twice. He then went to the nurse and asked her and she came in and explained to us that I was given too much medication in Post Op and I had stopped breathing twice and now would have to go 24 HOURS with NO Medication. This was the worst experience of my life. The pain was horrible all I remember after that was begging for medication, passing out and having someone stand over me telling me to take deeper breaths. It took 2 days in ICU before the pain even started to get under control. I'm happy to say its now a distant memory but I won't ever go into a surgery without worring about this again.

Linda W
05-05-2008, 09:39 AM
Dear CM,

To be honest, I was more afraid of waking up DURING surgery than after surgery! I had the same wonderful anesthesiologist for both surgical dates, and I made sure that he understood my fears and concerns. I'm happy to report that I peacefully sleep through both surgical days. The first memory I have after the first day of surgery was not until I was in a regular room -- no Recovery Room or ICU memories at all.

After the second day of surgery, I remember people calling my name and asking me to open my eyes. My memory is struggling to open my eyes for a moment and thinking this must be the Recovery Room because I could not speak and that there was way too much light, noise and confusion. I caught a quick view of my husband and Dr. Rand and that was it until I woke up in the ICU the next day craving ice chips and feeling like there must be a huge magnet under the bed because my body felt so heavy.

My experience is similar to Sally's, another of Dr. Rand's patients, who I have had the pleasure of meeting post-op! The pain block that Dr. Rand used to flood the surgical site was very effective. My recall is fuzzy on the pain pump, but I do remember using it prior to PT visits.

Good Luck,
Linda W.

CStadler
05-05-2008, 10:52 AM
I don't think you should have ever felt that type of pain. I remember feeling like I was laying on something when I first woke up but no pain.
It doesn't sound like they were managing your pain very well and you should have said something, if of course you could talk. I remember with my first surgery one of the night nurses decided to let me sleep instead of waking me for my meds. I woke up in so much pain that I could hardly breath or talk. They had to restart an IV and it took 4 hours before they could get ahead of the pain again. Do not let it get that bad. I was told to never let the pain get past 4 or 5 because it is so hard on you.
Talk to your surgeon and remind him what that pain was like when you woke up and then they should re-evaluate the amount of pain meds they will give you.
I hope it goes better this time. Carol

geo
05-05-2008, 07:18 PM
I woke up without pain, pretty aware of what was going on around me, enough to ask for my family, but totally exhausted to the point of not even wanting to answer yes or no questions. My nurse let me know that I had a painkiller applied directly to the incision area, so I shouldn't feel any pain there until possibly the next day (and I didn't). The most pain I felt in the first few days was when they had to pull me further up the bed because I had gotten too close to the bottom and couldn't incline myself. That hurt! But otherwise, the morphine pump was excellent, and the real pain didn't come until switching to oral meds, and then later when I went off Oxycontin too fast (to a much weaker painkiller).

I remember being amazed at the effectiveness of the pain medication, because that had also been one of my big fears.

Chihuahua Mama
05-05-2008, 08:39 PM
I was just telling one of my family just how much I was reassured after reading all your responses, nitty gritty and all. That's what I love about this forum, you all tell it like it is.

I'm just not going to worry about this anymore. It's time to move on to the next thing I intend to worry about. :rolleyes:

BTW, I'm not quite ready to put my name on the surgical calendar yet, but unofficiallly, it's in June.

Thanks again :)

Theresa
05-05-2008, 10:27 PM
I don't remember the waking up on any of the surgeries!!! When I realized I was awake on the first surgery I felt like I was laying with bricks under my back. It was actually the gauze pads along the incision! My family tells me I kept saying that I hurt but luckily it wasn't until a week and a half before I realized I was awake. The second surgery I woke up when I was already in my room, just a couple of hours after surgery. I had an awful headache. The last surgery I woke up about on day four. I don't know what they give me but it is great!!!!

For the record, if I had a choice I would do both of my kids birth's again before I was to do another spinal fusion. I had both of my kids natural, no meds at all, (Epidural????? What's that?????). My daughter was born forehead first, very longgggggg back labor, she was 7.6 and 19 1/2". My son seven years later was 10.3 and 22". I was up that same day walking back and forth to the nursery.

txmarinemom
05-10-2008, 12:05 AM
I'm going to take advantage of all you experienced fusion veterans that have so kindly answered questions over the last few days about what to expect after surgery and would like to ask one more:

What is your first recollection of the exact moment you woke up and just how bad was it? I know the answer to my question is PAIN ...

Chi Mama, I had NO pain when I woke up: I even called a few people from here from my room just a few hours after they released me from PACU (I was there maybe 30-60 minutes).

I woke up in my room, STARVING, with a caffeine headache asking for my cell phone. The people I called from here can vouch I was FINE.

I've also given natural child birth (GOOD GOD, not by choice - labor was too quick) and that was FAR more painful than the 24-48 period after fusion.

Regards,
Pam

Karen Ocker
05-10-2008, 10:01 AM
I had NO pain after the anterior approach- 1st stage revision because they put in epidural pain killers. The next week I had the posterior correction part and it was no longer possible to reach the epidural space because I was fused to the sacrum. I remember a lot of pain in the step-down unit. The nurse said I was not allowed any more medication for another half hour. I demanded they contact the anesthesia resident on call and she gave me dilaudid IV--mercifully. After that I was able to have adequte pain relief at all times.
It helped having private duty nurses who could go out and bug the staff when the time came.
It is NOT necessary to have so much pain. Demand to see the pain people on staff if necessary.

txmarinemom
05-10-2008, 10:54 AM
... It is NOT necessary to have so much pain. Demand to see the pain people on staff if necessary.

Chi Mama (and anyone scheduled for surgery), the best thing you can do to control your pain post-op is make a visit with anesthesiology part of your pre-op hospital workup.

Set up your pain management plan (and backup plans) *before* surgery to ensure you're as comfortable as possible afterwards.

Karen is absolutely right: There are aggressive options available, and no need for excessive suffering. Make sure your pain management plan is documented for the nurses and other hospital staff so there's no delay in getting the meds you need. One thing you really want to avoid is letting the pain get out of hand ... it's tough reigning it back in.

Remember YOU - as the patient - are in charge of your care, as well. As Karen said, you're well within your rights to make demands (it's a bit more desperate when you're already in pain, I know).

Get all this lined out prior to your surgery, and hopefully you can avoid finding yourself in that situation.

Best regards,
Pam

Chihuahua Mama
05-10-2008, 05:12 PM
the best thing you can do to control your pain post-op is make a visit with anesthesiology part of your pre-op hospital workup.

This is great advice. And, Karen, I'm going to remember that little tip - I can't imagine some nurse, after the surgery you just had, would have the audacity to tell you to "wait". Good for you for taking matters into your own hands.

I just wish I had some decent pain medication now - I'm having an awful day, in a lot of pain. Surgery can't happen soon enough.

Chihuahua Mama
05-10-2008, 05:30 PM
Make sure your pain management plan is documented for the nurses and other hospital staff so there's no delay in getting the meds you need.

Pam, so then when you meet with the anesthesiology (sp) dept., you can make requests? I'm not sure how the mechanics of having a pain management plan works...do you have them outline what is standard procedure then ask questions/make requests?

txmarinemom
05-10-2008, 05:59 PM
Pam, so then when you meet with the anesthesiology (sp) dept., you can make requests? I'm not sure how the mechanics of having a pain management plan works...do you have them outline what is standard procedure then ask questions/make requests?

Chi Mama,

One of the things that terrified me going in is I have a HUGE tolerance to pain meds. I mean huge to the point the doses I require would knock someone 3x my size OUT. For days, perhaps.

In addition to this quirk, I had MRSA in 2001, and *always* demand Vancomycin during/post-op.

I discussed both these issues several times with my surgeon, and he was the one who set up my appointment to meet with the Anesthesiology department at Methodist when I went for my pre-op.

I discussed what worked for me and what didn't for prior non-scoli surgeries, and during the 4 years I tried to alleviate the scoli pain with a pain management (anesthesiologist) specialist. If you don't have that background to reference, ask him for HIS standard protocol first. While a hospital pain mgmt team will ultimately devise a plan/send up the drugs, your doctor needs to be on board and write out the orders for your chart.

Remember, things also have a way of getting minimized/shuffled around/etc. I made it a point to remind my surgeon of what we'd decided at every visit.

If yours hasn't suggested it, just explain your concerns to him and tell him you'd like to meet with the hospital anesthesiologists and devise a pain management plan. Ask him (multiple times to make sure ... you're paying enough to be a pain in the a** at times) if he's reviewed it - and make it the last thing you ask him ("is it in my chart??") before they knock you out.

Yeah ... it's probably overkill, but there really IS no overkill with this.

Regards,
Pam

Chihuahua Mama
05-11-2008, 12:55 PM
I too have a high tolerance to meds, but probably not as high as you...which is why I wondered what everyone experienced. I will be asking and looking for an appt. with the anesthesiology (sp) people as well, and will certainly talk to the doctor about it. Thanks so much for the heads up.

You're so right about how things manage to get shuffled around - conversations happen but no one notes it - next thing you know you end up with Nurse Ratchett telling you to wait until dosing time...I think not! I'm awfully good at being a pain in the a$$ - this time a necessary skill.