Medical Jibberish...

This post is in regards to the stuff I learned while talking to my doctor in Plano over the phone. It's gonna be boring to anyone, unless you are just into medical stuff LoL. This is actually the email that I sent to my friend, but I thought I would just copy and paste it here so that I wouldn't have to re-type it all. My friend, Suzy, and a friend of hers are the ones who brought these questions to my attention. If it weren't for them, I wouldn't have thought to ask these, and I am so glad that I did, and now when I AM doing my research, things are making a lot more sense to me. So thanks to Suzy and her friend =]

I will be fused from T4-L2 is what they told me, it will be the posterior approach. 11 of my vertebrae will be fused.

They don't use the BMP method unless absolutely necessary, like if I have low bone density [which he said at my age that shouldn't be a problem] or if he has to do A LOT of bone work. [A 'BMP' stands for Bone Morphogenetic Protein and is usually taken out of the hip bone during a surgery through a syringe, and placed into the spine, where the doctor sees fit]

He didn't have access to my bending film [Bending films is where you lay on your back, or stomach, and the radiologist has you bend all the way to the right or left as far as you can, to check for flexibility of the spine] as the computer they were on was being updated, but he said that he would have to get back to me on whether or not they are structural.[Structural curves are more rigid and harder to correct, because the flexibility is lost] He said it depends on my bending films. When I was in there the 1st time, they did the bending films, and I remember Eric saying that my spine was still flexible, that the bending x-rays came out good. I remember that much. Like I said, all I heard that day was that they could help me lol.

When I asked about what he anticipates correction to be - he said he tries to get as a straight as possible, as safe as possible, that the entire time, I will be under spinal cord monitoring, and it will tell them just to how far my spine will allowed to be pushed back into place. His goal is to make me completely straight, but that sometimes it could go from 65 degrees to maybe 15 degrees, which for ME, would be OUTSTANDING! I could live with a 15 degree curve :]. But, he said by looking at my curves compared to others that they have seen, I have a great outlook as far as getting a straight spine. [Because he has patients come in with 130 degree curves that still manage to get almost perfectly straight] He assured me that my curvature, with the range of degrees, is very common and is FIXED on a daily basis. So that was comforting to hear.

Pain relief after surgery. I will be placed on the Duramorph pump that I can release the meds whenever I need it. Then they usually try to get me off of that by day 3 or 4, and onto the Dilaudid and other meds, whatever I need. He said they are very, very aggressive with pain relief after surgery.

My typical hospital stay can be anywhere from 5-14 days. Usually with patients that are my age, we go into ICU for the first, second, and possibly the third day. Then I am moved to PCU for about 4 or 5 days. If I am recovering quite nicely, am able to walk more than 300 feet, can do very simple tasks, things like that, then I will get to bypass going to the rehab facility, and would be sent home. If I do need to go to the rehab facility, it all depends on how fast and well I take on to recovering as to when they would release me from there. The goal is the help me transition from the hospital to the home setting, and it can vary from patient to patient.

Blood transfusion, he doesn't anticipate more than 4-6 units, but said that some patients require less than that, or more than that. Anticipate 6-8 units, but probably, if at all, would need 4-6 units. [Blood loss can be a concern because the bone that makes up the spine is rich with blood supply, and also, when they make the incision, my spine is covered with muscles and tissues. That will be stripped away from my spine so that they have access to my spine. Gory stuff, huh?? Haha!] Note: I wanted to say that they told me that more than likely, I will NOT need a blood transfusion, the units above that he spoke of is what they anticipate, IF I need blood transfusions. Just wanted to get that out there.

Thoracoplasty [This is a procedure where they go in remove several ribs to take away that hideous rib hump] will not be necessary unless my bones are very hard and rigid, and the spine can't go back into place as much as they would like it to, which he said will more than likely not be a problem in my case due to my age. He said that when they straighten the spine, the rib hump will be greatly reduced, [thank God, I hate that thing!] almost eliminated, therefore not needing thoracoplasty. He said they try to avoid it as much as possible, as it makes recovery harder, because it will feel as if my ribs are broken where they had to remove ribs and stuff, and that is very painful! [[Thank goodness, because I read about that, and didn't want it done!]]

His infection rate is very good. The past year, they had two infections, which is exceptional in this field. He said they do A LOT of things to prevent infection. I will be given a body scrub to wash with the night before, Bactroban is used inside the nose, and they wear hoods to prevent infection.

The bank bones they use are also antibacterial. He uses Allo-graft, bank bones. [Which instead of using my bones from say my hip or something, they use donated bone, from cadavers, living or non-living relatives]

He said that the pseudoarthroses [this means that the fusion fails, comes undone, breaks] rate in ADULT FIRST TIME surgeries was, symptomatic about 10-14%, so about 10-14 people out off 100. Non-symptomatic 25 people out of 100, or 25%. He told me that while, this can happen, that the technology and surgical expertise increases everyday, and I can rest assured that I will not have to let this be one of my main concerns, that it gets more and more rare. If it does happen, they will do everything they can to correct and stop the pseudoarthroses.

Revision [Going back in and repairing the spine after a fusion] will only be needed in the case of pseudoarthroses or adjacent segment disease. Like the vertebrae above and below, but mainly the ones below, will have extra pressure put on them, due to the fusion. He said that revision rates can vary from person to person, as it depends on how well they take care of their back AFTER having this surgery. Like using the techniques we are taught in PT. Squat instead of outright bending over, lifting with your knees, stuff we should ALL do anyways, but we don't. If I was extra careful with my back, then I could avoid revision for 30 years, or it could be 15 years, or 10, and so forth. He said that this also varies from patient to patient. That is why, after the first year of surgery, they want me to come in once a year on the anniversary of my surgery, to have x-rays done to check for any abnormalities in the verterbrae underneath the fusion, disk degeneration, ANYTHING out of the norm, so that they can be better take care of me and avoid anything excruciating [[like me not ever checking back in with them and then one day my disks just go out and it hurts like hell, whereas if I had been getting checked on, they could tell me if that was happening or not, you know what I mean??]]

He said that they are hard to get in with, but once I am a patient of theirs, I am a patient for life, and that they will not operate on my back and then send me on my merry way with a pat on the back and "Good Luck" wishes. That they will want to see me every year from now on.

Oh and they use stainless steel instead of titanium. 1/4 inch Expedium (I think) rods. He told me his opinion was that stainless steel was better than titanium because its lighter, stronger and allows for more flexibility, with the hooks and screws.

Then I asked him outright, why the advertisements. :] Aren't you proud of me?? LoL.He said that there is a rule of thumb that medical practices shouldn't advertise. But he said that scoliosis surgery is such a specialized field. That they didn't want to just depend on word-of-mouth, because how many people know someone with scoliosis that is so bad that they are facing surgery to correct it. That they just want to get the word out there, that there is help for adults who need surgery for the first time, and for patients who need revision work because another doctor messed them up, or they weren't happy. He said that almost 50% of his patients are from other doctors, needing a revision.

Now, if any of this doesn't make sense to someone who KNOWS spinal stuff, it could be because he was talking, and I was typing away furiously trying to get all the info I could in black and white! At first I was trying to write the answers. Then I told him, "Wait! Let me get my laptop, I can type faster than I write and my hand won't cramp up!!" LoL.

Then he also told me that he was very happy to see me asking these kinds of questions, that he worries when his patients don't ask questions. He said so many people go into this no knowing much, if anything at all. So I would be one of those if my friends hadn't helped me out.

Ok, enough with all the medical jarbon! =] I am getting hungry and need to eat something!! I will write a normal blog later on probably...

~Adios~