Not sure what this means

[jackieg412]

Vitamin D levels can be checked. I was told at first to take high doses of vitamin C. So it may depend on the doctor. I believe in the food rich country we live in most good rich country on earth and most people can get their vitamins through diet.
I had the myelogram yeasterday. It wasn't without drama. My doctor did it through my pump but when he cleared the medication from the catheter it gave me too much clonidine and it dropped my blood pressure quickly. It seemed to be cause for concern as I was paid down and an IV started to bring it back up. Right now it is still a little low.
I see the neurosurgeon on Aug 31 and I will know more then.

[titaniumed]

Yes, certain foods are fortified with vitamins but the problem is that the list is so huge. And then the blood testing.....why does this have to be so difficult? At some point, this is going to have to get better. The Theranos story was an interesting story, a great idea, of course their method was not peer reviewed and failed. Frequent repeated blood work is needed for fighting cancers. I started a thread many years ago on this. It would be great if someone invented some sort of blood computer...Prick finger, 1 second to complete analysis on the spot. Highs and lows. (Then it will say "see your doctor")

And how is one supposed to know? I didn't know what was going on with my vitamin levels. My 2nd molar infections were persistent, and taking repeated Amoxicillan is not the greatest idea....especially having hardware. It really was reading through the dental sites that triggered the vitamin D. I knew about it for scoliosis, but then seeing it again in the dental literature, that lit the old lightbulb up. My mouth cleared up almost instantly and my neck is like it was never herniated. All for a $10 bottle of Vitamin D. Now, I am taking 1000 IU daily. I even visited 2 dental specialists along with my dentist, an Endodontist (for 3D root canal x-ray) and a Periodontist and neither mentioned it. I have learned more about bone remodeling from my mouth than my scoliosis.

For 45 years now, the whole scoliosis package for me has been a series of trial and error.....It took me 45 years to get to this point. I wish I had known and tried this 50 years ago.

Your battles with scoliosis and orthopedic matters have been so difficult and I am so sorry. It's just so unfair to have to put up with so much pain...

Ed

[jackieg412]

Well I have a better idea of what will happen in the next surgery. I saw the neurosurgeon yesterday. The revision surgery will take place on October 30. It will be another long surgery. The doctor 's notes are a revision of cervical 4- Pelvis Fusion, Thoracic 1 subtraction Osteotomy.
There is a non fusion about the same level as the wound from last year.
It will be another long recovery but it helps explain the pain and balance issues.
The osteotomy seems very high on the spine. The broken neck can be a factor in this.

[titaniumed]

Well I have a better idea of what will happen in the next surgery. I saw the neurosurgeon yesterday. The revision surgery will take place on October 30. It will be another long surgery. The doctor 's notes are a revision of cervical 4- Pelvis Fusion, Thoracic 1 subtraction Osteotomy.
There is a non fusion about the same level as the wound from last year.
It will be another long recovery but it helps explain the pain and balance issues.
The osteotomy seems very high on the spine. The broken neck can be a factor in this.

Jackie,

Wow....

You poor thing and what can you do? I am assuming they explained everything to you. You have had quite a set of rare technical orthopedic challenges over the years.

The PSO osteotomy at T1 will get your head balanced back to normal. (Chin off chest)

No mention of the scapular fusion while they are in there?

Will they keep you under on ketamine for a few days in ICU? I would think they would have to keep you out for a few days with this much work...

Ed

[jackieg412]

No they are not going to do the scapula fusion while they fix this problem. I think the neurosurgeon is going to have all he can do at that time. Where the nonunion is in the thoracic is so painful and actually looks distorted on the xray. That is why I feel like I'm laying on a ball there. He said he would be reshaping that area also.
The spinal cord stimulator did help some with the pain but of course can't fix the problem.
He also said they would be detaching my head. The car accident broken neck did that also. And when the hardware didn't hold it the head was detached again. I keep losing my head. It would be funny if it wasn't so sad.
He also said something most people don't hear--- that I need to gain weight. That I am too small.
I have started the preop tests and just waiting for the office to clear something up on one of the tests.
I know I will be in the hospital for 5-7 days. He also said that I would need rehab after that. And with the virus times all of it is difficult.
Since it is scheduled for Oct 30, I will early vote.

[titaniumed]

He also said something most people don't hear--- that I need to gain weight. That I am too small.

Malnutrition has been shown to cause postoperative complications, such as infection, poor wound healing, delayed postoperative recovery, and mortality. In the literature, studies have reported malnourishment in 20% to 50% of hospitalized patients.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898673/


Jackie, was there any mention of seeing a nutritionist? I mentioned this in an earlier post....

If not, I would go down to the fruit and veggie section and go nuts. Set up a garden party in your kitchen and eat small amounts "every 30 minutes". Wash your fruits and veggies.

1/2 banana, 10 blueberries, 1 strawberry, 5 raspberries, 1 yogurt, 1/2 carrot, slice of apple, pear, orange. You get the idea. Peanut butter, oatmeal, granola, almonds, etc etc.

Stay away from the inside of the grocery store. Shop only the outside isles. No chemicals, no trans fats etc. Stay clear of the bad stuff.

I used whey protein powder smoothies in my post recovery, but I would start right away with jamming the nutrients before you go into surgery. The smoothies are great, store in fridge and re-blend in 5 seconds. You need protein for healing. Sliced roast beef is an easy way to get protein. 2 seconds to protein.

Think nutrition! Before and after surgery. It's so important. Remember I forced myself to eat....sometimes we have to do this.

Your going to be bone on bone on that T1 PSO (Pedicle subtraction osteotomy), so you have to fuse. Your T6 also needs to fuse.

There is some information on Cervicothoracic PSO's online for Kyphosis and AS (Ankylosing Spondylitis) patients. Lower cervical and upper (high) thoracic. All of this was non-existent years ago....Dr Bridwell has contributed quite a bit in this area. The earliest history on PSO I saw was from 1963. Other osteotomies were performed in the 1920's, 100 years ago.

Detached sounds scary. What was said about hardware removal? Everything? All of it?

Ed

[jackieg412]

Thanks for your post Ed. They are always informative.
My blood work came back as boring as any one wants. The only issue was a slight low red count and that is normal for me. He checked a lot of different things. I know he said to try to gain weight but I have not been a person that gains weight . I have twins and even with a twin pregnancy I only gained 22 lbs.
I will concentrate on nutrition because I am well aware about weight loss after this big of a surgery.
He will not be removing the fusion below t-10. While that surgeon created an extreme lumbar curve it will stay. I think it would be way too much to remove it..
He will be removing the cervical and thoracic hardware and replace it with a smaller type.
The screws in the cervical are almost through the skin and can't stay like that.
He said I would have a cervical collar for 3 months. Thank God he didn't say a halo.
With the following day being Halloween I could be part of sleepy hallow.
All I keep thinking is here we go again.

[titaniumed]

I will concentrate on nutrition because I am well aware about weight loss after this big of a surgery.

Well, it's not so much about the weight ... it's more of a balancing of your biochemical makeup to promote arthrodesis or fusion. Also, the ability to fight off infections, and heal. (in a nutshell) Helping or assisting in all ways possible to help your body to heal.....We also have to do our part and not solely rely on our surgeons. It's a 2 way street, and we do all the hard work. I know you understand, but I am posting in general again.

People that let themselves get rundown for various reasons are susceptible to disease. Young people that party like rock stars during pandemics are a great example. If they don't get COVID, the white staph infection lines in their throats can eventually show up. (smug face) If your 19, and have staph and partying, your partying too hard. I had this happen to an employee. You know, no sleep and plenty of alcohol... Lunacy. I have driven several of my employees down to ER over the years for various non traumatic reasons. (Usually on a Friday night)

I wonder if we are in constant battle with infections. There has to be a reason for the fatigue. Its hard to just chalk it off to the ageing process. Young people have the cell re-generation process in full gear and as we age, this process slows down.....and the recovery process from our multi-level scoliosis surgeries takes everything we have which is so taxing on us. I am not sure if blood tests can answer all the questions....and if the scientists really know why our problems happen, its best to be in the best shape possible going in to surgery, and in our recoveries. Diet, or proper diet is something WE can control to help our surgeons accomplish what they set out to do.

In the video below, you can have a year old fusion bridge through a cage viewed from a CT, and unless the flexion and extension views are done, your not going to know if your fused or not. Its why I took things so easy during my recovery.... Fast forward to 17:15
https://www.youtube.com/watch?v=MkIz...enceFoundation

Of course, this is one case example....and we are all different. All of this wondering why pseudarthrosis happens, and why infections happen. Why pseudarthosis happens on specific levels when we have 15 levels done. ??? Is it the motion? The bending, lifting and or twisting? You can see the evolution and specifics of hardware, PEEK, Ti, coatings, allograft, autograft, and BMP used in different forms on different levels in this video. We make our own BMP's ourselves....its used to accelerate the fusion process and is carefully analyzed.

I don't know what it's like to wear a neck collar...and of course the specifics of it's removal....Let us know. I think that your testimonials are highly valuable as are other members here on the forum. It's a shame that many members heal, do good, and move on and don't post anymore. I hear about these things a few years later when they call me with good news. This happened here recently, Dr Bederman gets 2 thumbs up for Southern California members! 2 heavy duty cases to boot.

Your description of your T6 infection, "laying on a ball", had me stopped there for awhile. Are you on antibiotics? Are you going in for antibiotic injections? I am not sure how long a person can go with something like this.....Its sounds terrible. My prior tooth infection experience was incredibly painful. INTENSE acute pain. (but not now) The vitamin D had helped out considerably....

Good news on the lumbar. You have enough on your plate.

Ed

[jackieg412]

Ed I'm glad your teeth are doing better. The infection in a tooth is very painful. And usually the treatment works.
I agree that being as healthy as possible is giving the patient the best chance of a good outcome from surgery. This whole surgery thing is getting old.
I have a copy of the surgeon's office notes.
From the notes: the myelogram shows a solid fusion except at T6-7 , where the instrumentation was removed. The cervicothoracic instrumentation is prominent. There are 50 degrees hypnosis between C7 and T6.
I offered her a revision of her C4-pelvis fusion,re-artrhrodesis and a T1 period subtraction osteotomy. I explained her deformity is very complex and surgery carries an elevated risk of mortality and morbidity.
I explained this is a very large operation with real risks of serious problems.
Now on that discussion I also remember the problems Susan had with the high kyphosis. It is very big decision. It needs a lot of thought.

[jackieg412]

By the way Ed your message box is full. Later I will try your email

[titaniumed]

All better now! (smiley face)

However, e-mail is best...

Ed

[jackieg412]

Ed i noticed you spoke of the biofilms that can form on the hardware. I know I have titanium rods and the rod color is green.
I think it tells the type of rod. The neurosurgeon that will do this next surgery asked me to get a copy of the hospital records on the type of rods. I requested it and have a confirmation that 71 pages were faxed to him but I don't know yet if it had the information he wanted.
Apparently it is important. I was told to bring the explanted hardware to him if we can't find out the information.
Now another wound is forming . I noticed a Redding area that seemed to go away. But last night I checked and it is back. The strange thing is it is right above the other one and in the same shape. It looks like a nike swich. It is soccer but in that shspe. Almost matches the other one that is healed.
I guess I have to call him tomorrow.

[titaniumed]

They can anodize titanium with an electrolytic process. Similar to anodizing aluminums. Some of it is penetrating, and can offer anti-galling and surface fatigue strength. Anodizing offers protection of the surface, and they can do any color. They can even do swirls of multiple colors. Hardware companies will do colors on hardware for identification... for example 5mm screws might be green, 6mm screws might be blue. Anodizing is NOT a painting or coating process.

My hospital reports do not state what alloy is used on my hardware, it just states Synthes "Pangea System" On the Synthes web page, it states that they use the alloy Ti-6Al-7Nb. Synthes was absorbed by Johnson & Johnson years ago. J&J has enough money to just about absorb anything.
https://en.wikipedia.org/wiki/Ti-6Al...0Ti%2D6Al%2D4V.

If one doesn't know exactly what material was used on their hardware, a sample can be sent to a lab for a destructive analysis.

I have done this in the past....Also worked with a large amount of metals and plastics over the years. Machined huge amounts of Ti-6AL-4V which is probably the most common titanium alloy. Most was for for Shilling Robotics in Davis, Ca. They make underwater ROV remote operated vehicles that go deep in the ocean. Like 2 miles deep to work on oil platforms. Titanium's best qualities are its anti-corrosiveness. It will outlast 316 in salt tests. It's expensive. I would buy a 6" bar 12 feet long and at that time approx 15 years ago that bar was around $10,000....so no mistakes allowed. It's not easy to machine and has its own set of rules.

Also worked with PEEK for Coherent in the Bay area. They make lasers. It's a super expensive polymer. Looks like white plastic.

I attached a photo of a pedicle screw below. Notice the head is green. That dull grey coating on the threads I have no idea what that is. That biomedical science is changing and advancing every day....

You have another wound forming? I can't believe you are waiting....When is the wedding?

I would call your doctor first thing in the morning. You do have someone who can take you right?

Ed

[jackieg412]

I do have my hardware that was removed. You are right it is color coded. I know the screws are spinecraft and rods are titanium.
I called surgeon 's
office this morning. My primary care will check the wound tomorrow and send over a picture. It has not opened but the one last year looked similar at first. It is so strange they are in that same unusual shape.After that I will receive further direction and if they want to see if in person I will go on Thursday.

My son tested positive to covid, I am on my 13 th day of not seeing him. He was positive about 5 days after I was there. As a precaution I stayed away from everyone and asked the Dr about tomorrow's appointment and was told to keep it if I didn't have any symptoms and I don't.
My daughter's wedding is October 17. Very soon.
I have no idea if they will proceed with surgery but we have 3 weeks to see if we can take care of this wound. I don't imagine it is real easy to bump up an 8-10 your surgery. And if we don't move forward, it appears that I will just keep having problems. ?????

[titaniumed]

Jackie, I would definitely have that red spot looked at as soon as possible....not sure what they can do, but your spine or neuro surgeons also need to know about this....they might order some new blood tests. Frequent blood tests are super important.

I have seen in the news that they are now recommending Vitamin D for COVID....
https://www.bumc.bu.edu/busm/2020/09...d-19-patients/

Deja Vu ?

Ed