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Dear Christi and all,

Christi is absolutely right. Fusion surgery is up there with open heart surgery. Think of the ricter scale of surgeries and fusees are up there!

For those of you interested read on about the hospital stay and procedure.

The surgery itself is a painful procedure (though once again this is an individual thing). Though it is worth it, really it is. For me the basic run down was this:

The day before: I was admitted the day before my surgery at 2pm. On this day you spend the whole day seeing an array of different people for pre-op testing. The physio( will teach you how to get in and out of bed after the surgery. She will also show you the technique used for turning you in bed - i will explain later), the resident doctor, the radiologist, the anesthetist, perhaps the surgeon (i didnt), the guy that takes blood samples (cant remember their name), the nurse (who does an ECG to test the strength and rythum of the heart) etc. From midnight no food or drink is permitted.

The day: My surgery was scheduled for 11 am. At 9:30am the nurse came in and with her she brought some special antiseptic body wash which you are to totally shower in as well as the stockings you will wear for the majority of your hospital stay (to avoid blood clots) and the gown you will wear into theatre. At 10:30am the anesthetist comes down if you have asked for a pre-med to calm any nerves (i requested this because i do not like needles). The wardsman came down at 11am and i was transfered from my bed into the theatre bed. I was given a cap to cover my hair with and the anesthetist gave me a top up of the pre-med ( i am fairly sure the pre-med is valium). From this point i remember nothing at all even though i was awake when i went into the theatre.
The surgery took 2 surgeons 4 hours to complete. Before starting you will have ECG plugs attached to your chest (4), the anesthetic drip in your hand (1) as well as the drip to medicate and provide saline (nutrients) (1). As far as i can tell the surgery was performed with me laying on my stomach (being a PLIF). An incision about 15 cms long is made from around the L4 to the S1. The spinal muscles including the latimus Dorsi, erector spinae and spinal extensors and stripped of the spine so that surgeon has a very good view. First I had a laminectomy (removal of the disc between L5 and S1). The surgeon at this point may need to drill and larger canal for the nerves to pass through (if nerve impingement had been an issue). Small 'teeth' or spacers are then inserted into each end of the L5 and the S1 so that once the bone graft has been placed between the two vertebrae, the surgeon can then push the two vertebrae together and the 'teeth' or spacers will submerge into the graft material. The bone graft was taken from my hip (internally) and mixed with packed cells of my own whole blood (which i had donated 2 weeks before). Both the bone used for the graft and the blood can be your own or they can be arranged from a blood and bone bank (though the success rate is higher when materials come from your own body). Once the L5 and S1 are in alignment the surgeon inserts titanium screws (4- two in the L5 and 2 in the S1) along with rods running parralel to one another to secure the screws. At this point the surgeon may take an x-ray to ensure the instrumentation is in place. I was then sewn up using around 25 staples. At this stage 2 drainage tubes were inserted at the L1 level as well to drain blood and other fluids from the surgical site.These are sewn in place and will come out at about day 3. A catheter is inserted. The surgeon then places a epidural at the L1 level to reduce the pain on waking up. Another drip is inserted into your arm for morphine. This will remain in for the duration of the time you are in intensive care or for about 2-3 days, the morphine stays in for about 4-5 days. A dressing is then placed over the area and off to recovery.
I woke up in Intensive Care. I felt no pain for around 3 hours after i woke up. Too drugged up from anesthetic, epidural and morphine. Most will have a relatively uneventful stay from here on in, it is very individual. Every hour you need to be moved from laying on your right side to laying on your back to laying on your left side. This occurs for the duration of the hospital stay and indeed should be adhered to on leaving hopsital. This is the most painful part of the stay.The procedure at hospital is: from the side you are laying on two nurses will roll you onto your back. Breathe in and take a big breath out as you roll onto your back. The nurses will then come to the side of the bed which you are being rolled to. They count to 3, on 2 take a big breath in and on 3 they roll you as you breath out as smoothly as they can. To be honest this did hurt a lot but then you are in heaven as changing sides often feels great once done. You are propted up with pillows so you stay on your side without holding yourself there. Each day the radiologist will come and x-ray your lungs to make sure they are recovering ok from the surgery. This is done using a mobile x-ray machine. A film is slid under your upper back and the machine placed over you. This too is uncomfortable.
I am hazy about my hospital stay because the morphine does this. I was in intensive care for 3 days and 2 nights and i hardly slept a wink but you'll catch that up later. When i was transfered into the general ward and had my own room things got better. The first few days are the worst. Just get though them, it can be done and is worth it.

Day Two - i began to eat. Of course you are flat so its hard to eat but only yoghurt at this stage anyway. My mum and dad came in a lot and they would slowly feed me more foods as i felt up to it.

Day Three- Epidural came out. This is not painful because the whole area is still numb from the epidural even after it comes out. The drainage tubes come out and the holes from the drainage tubes close up on their own. The incisions are cleaned and re-dressed. self administering medication drip of morhpine is attached and you have a little button you press to administer the morphine as its needed. Down to the ward, finally you'll get some sleep.

Day Four- Catheter came out. The first day i got up. I was assisted by four physios as well, you're a little unsure, sore and unstable. All it takes is practice thats all, and above all do exactly what they say. They tell you to relax so do it, i didnt and it hurt more. Basically the procedure for getting out of bed is this: On the side you are facing try and get as close to the edge of the bed as possible. Use your arms to lift your upper body at the same time you lower your legs to the floor. Remember from now no bending or twisting for atleast 6 months. Stay straight and tighten your tummy muscles to help you. The stronger your arms and legs before the surgery, the easier it will be for them to support you when trying to get in and out of bed.

Day Five - the physio will visit you to teach you about are for your spine at home and some exercises you can do in bed. By this stage you should be showering and going to the toilet on your own as well as sitting in a chair to eat.

Day Six - home time a day earlier than expected.

Ok, i have to go to bed, its 12 pm in Sydney and my back is wanting to know why i have been sitting for so long.


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