Wednesday, August 4, 2010

Preparing for Spine Surgery

Before embarking on this journey I had spent a great deal of time learning as to what is the best way to prepare for spine surgery, spondy or not. I should be more specific and point out that this is in regards to fusion surgery, where prolonged immobilization is required. Some of these are from my own experiences, while some are from when I worked with post-op patients and seeing their struggles.

While I did not implement all of these, I did many, and it has helped greatly so far (while others I wish I did). The following is a list that I will continue to update as I learn from this experience, and in no specific order. Please also note that this is based and specific for MY experience, and should not be misconstrued as medical advice or the like; consult your doctor for what YOU should do for YOUR procedure.

  1. Strengthen core muscles in the abs and back. They will atrophy during the brace wearing, but having a good set to start with along with good motion will help. Sit ups, pelvic tilts, leg lifts....if you're in PT for spondy you are already doing them most likely.
  2. Leg exercises and stretches. Squats: You will not be able to bend for 3-6 months. Being able to do a full squat repeatedly will allow you to pick up objects and remain functional. Hamstrings: They will be much tighter when you get fixed if its spondy. Having additional room will help big time with walking and sleeping/laying flat.
  3. Lose weight. My favorite is Atkins, with no artificial sweetners. I dropped almost 40 lbs in the 3-4 months prior to surgery. This makes those squats much easier, reduces scarring, lessens the chance of infection, dehissance, less load on new surgical hardware, less chance of complications during and after surgery. This will also give you room to "grow" as you are sedentary for a good while afterwards. However, the week before surgery, eat some good nutritious meals to have plenty of reserves, don't be in a losing mode that final week leading up to it.
  4. Lose the narcotics if you can, or at least cut down. Yes your resistance will build back up fairly quickly once you get back to the hospital, but it will make the immediate post-op experience much less painful. This varies with everyone based on how much you are taking.
  5. Have help. Make sure to have a phone on you at all times. Walking is the immediate treatment, if you don't have a treadmill, have the name of a local cab company or a friend programmed in in case you walked too far. Laps around blocks are good, but quite boring.
  6. Plan to sleep in a recliner and not a bed. It helps spread the weight away from the back incision, and keeps you in a position where the ligaments/tendons in your legs are not as stretched out (reduction will do so greatly). Find a good one and sleep in it a few times before surgery so you know for sure you have a good one. A reclining couch is best so you can shift between laying flat and reclined.
  7. Stock up on Tylenol (acetaminophen), benadryl (diphenhydramine), and ask for a benzo if you're prone to spasm. One of the issues (especially for me) is back spasm, and being immobile along with the inflammation it can be a miserable experience. Valium will help keep them at bay, and also give you some better sleep, not to mention will be beneficial when you're ready to come off the narcotics if you've been on them for a long time. Talk to your doc about it, every case is different and serious withdrawal requires an inpatient hospital stay. Be very careful mixing opiates and benzos--it can lead to respiratory arrest very quickly. The Benadryl will help you sleep when you're down to just nagging pains like I have now. Its very mild--but constant. Making it quite hard to sleep. Tylenol PM is a good mix of the two, but remember, no more than 4 grams/day of Tylenol (including that which is in your percocet) or you'll need a liver transplant.
  8. If you drink, STOP a few weeks ahead of time. This way your body can replenish lost minerals/vitamins that alcohol causes you to lose, and if you are a heavy drinker you won't find yoruself in DTs while inpatient. This happens much more often than people think and is a huge cause of lengthy inpatient stays. Do not drink until fusion is confirmed.
  9. If you're having a fusion and you're going to smoke (cigarettes, cigars, marijuana, chew/snuff), don't even bother going in for the surgery. The odds are good the graft won't take. The biggest contributor to pseudoarthrtis (non fusion) is smoking. It stops the cells that grow bone from "turning on", and you are left with an unfused back for the rest of your life. Quit. There are some great new meds out there that have been quite effective. And yes California residents, marijuana has the same effects as cigarettes on impairing bone regrowth.
  10. Don't take Advil, Motrin, Aleve, or ANY NSAID. Check with your doctor. Common ones are Naproxen and Ibuprofen, Aspirin in high doses also will significantly impair bone regrowth. 81mg childrens aspirin post-op is fine though, since at that dose it only thins the blood and prevents clots, but does not impair bone growth.

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