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Your surgeon will almost certainly run a series of tests to examine your overall health. For instance, patients with diabetes or high blood pressure have additional risks from surgery, and the surgeon needs to take that into consideration. The tests may include an MRI, an EKG, x-rays, blood tests, urine tests, and probably a normal physical from your primary care doctor. None of these tests is anything to worry about, but they do often require their own appointments, so be aware of that.
He or she may ask you to consider donating your own blood (known as “autologous” blood because it came from you, as opposed to a donor) to minimize or eliminate the need for a transfusion. Your family may also get tested to see if they are compatible donors. I believe you have to weigh at least 80 or 85 pounds to be allowed to self-donate, and there are certain waiting periods between donations and before surgery. Talk to your surgeon about the timing. You may need to do it at the hospital, or your surgeon may send you to the local blood bank to donate to yourself. If you do choose to self-donate, remember to get plenty of iron, either from your diet or from supplements.
About a week before surgery, you will probably have a final check-up, last-minute lab tests, and meetings with the surgeon, nurse, anesthesiologist, and so on. These lab tests are important because if you have any kind of infection, anywhere in your body, the surgery will probably be postponed. Otherwise you run the risk of the infection spreading elsewhere in your body, and that can get extremely dangerous.
Click here for a printable list of questions to be sure to ask when you meet with your doctor.
Don’t smoke!! Smoking is probably the single worst thing an otherwise healthy individual can do to hurt his or her chances of successful fusion. If you live with a smoker, you might consider asking them to try to quit, or at least not to smoke around you.
Take care of yourself:
You will recover faster if you are well-rested, well-nourished, and in the best physical condition you can be.
This sounds strange, but perhaps the most useful kind of exercise for you before this surgery will be quad strengthening. You are not allowed to bend over for a while after surgery, so you will find yourself doing a lot of squatting instead. This will be much easier if you go into it with strong quads.
You will need to be able to move around safely, easily, and without tripping on anything.
Make sure you can easily access everything without lifting more than five pounds.
Especially for people whose fusions are higher up, patients sometimes complain that a lot of looking down (e.g. reading on a desk) makes the top of the fusion sore. I actually found this to be more of a problem before surgery than after. Either way, a dictionary stand or other method of propping up textbooks was very helpful. I also made myself a slant board for the writing components of my homework, so that I wouldn’t have to look down flat at the desk so much. (My “high-tech” slant board: an empty two-inch binder with a big alligator clip on the side to hold the paper in place.)
It's good to stock up on frozen and canned meals for convenience, as well as basic groceries and toiletries, to avoid having to go shopping for a while.
Tell the doctor if you get any kind of illness, rash, fever, etc., or if you suspect pregnancy, ten days or less before surgery.
Get your house ready, and make sure you have everything you need for your hospital stay and at home afterward.
If you have any homework over the summer, finish absolutely as much of it as possible before surgery. You do not need that stress while you are recovering, and it will be a few weeks before you feel up to even thinking about it anyway.
Scope out exactly where the surgery unit is in the hospital before the day of the surgery. Actually walk there -- do not simply rely on the map, no matter how clear the map may seem. You do not want to get lost that morning! (My mom and I got lost inside the hospital looking for the surgery unit that morning. An employee ended up having to escort us there.)
That is up to you, obviously. If you work, you will have to arrange time off. For students with summer vacations, summer would clearly be the ideal time. My summer was nine weeks long. I had the surgery at the end of the third week, which was perfect. I had time to get a lot of my summer homework done beforehand, to relax a little with friends and to recover from end-of-the-school-year stress. It also gave me six weeks afterward, which was the minimum allowed by my surgeon before returning to school. (In other words, I would have had to start school late if I had had the surgery any later in the summer.) When school did start, I had enough energy to comfortably make it through the day. Every case is different, however. You need to think about how fast your curves are progressing, and talk to your surgeon. Can you safely wait until summer, or should you do it now? Could you at least try to incorporate Christmas or Easter break, so that you miss less school?
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Click here for a printable list of things to be sure to remember.
Relax! Enjoy yourself as much as possible. Go to a movie. Go shopping. Do whatever makes you happy.
If the hospital is far away from home, you might consider taking a hotel. My mom and I both stayed overnight the night before because we had to be at the hospital at 6:30 (eek!) in the morning. She stayed there at night for the rest of the week I was in the hospital. She found that the peace of mind that came from being close to the hospital outweighed the cost of the room.
You will probably be told to have dinner before 6:00 pm, and to stop all water and everything at midnight. When they say “stop everything,” they mean it. No gum, no lollipops, no water, nothing. Not so much as a TicTac. It’s okay to brush your teeth, but don’t swallow your toothpaste. If you cheat, they will postpone the surgery. It’s for your own safety -- if there’s anything in your stomach, there’s a chance the anesthesia will cause you to throw it up. I know it’s a really gross idea, but you can then inhale it, and the stomach acid will really chew up your lungs. It’s a very dangerous situation, but you can avoid it by doing as you’re told and stopping everything at midnight.
Shower in the morning with antibacterial and/or deodorant soap, such as Dial or Zest. The surgeon may give you special pre-surgery soap to use.
You will probably need to arrive at the hospital several hours early. They will take your vital signs -- heart rate, blood pressure, temperature, etc. -- and then give you a gown and socks to change into. You may be asked to shower again with the pre-surgery soap. You and your parents will fill out more forms. (There is an unbelievable amount of paperwork before and after any surgery!) When it’s time, the nurse will take you from your waiting room to the operating room, where you will be put under general anesthesia. You will probably fall asleep on your back. Your parents may or may not be allowed to wait with you until you fall asleep.
You will be under general anesthesia for anywhere from two to nine hours. Don’t be surprised or worried if it takes longer than expected. The surgeon will probably keep your family informed with updates via the receptionist in the lobby where your family will be waiting. Check with your surgeon for your hospital's specific procedures. For more advice for your parents, see Mommy’s Page.
You will probably wake up on your back. You will probably be in the PICU (Pediatric Intensive Care Unit) for one to two days, just as a precaution. They will be able to monitor you more closely there than they can in a regular room.
In many cases, surgeons take the bone graft from protruding ribs to help correct the “rib hump” caused by rotation. This was the case with my surgery. Beware: it is worth it to have the rib hump taken care of, but those rib slices hurt a lot! They took a one-inch-long slice out of each of four of my ribs on the right side, so in essence I had four broken ribs for a while. It hurt to breathe for the first two days or so. After I got home, it was the ribs that bothered me, not the fusion. I don’t want to scare you, because it is worth it, but just be aware.
Activities and Visitors
You will sleep a lot, so don’t worry about bringing a whole lot of things to do. For me, a personal CD player and a coloring book were plenty. When you’re not sleeping, you still will not have much energy, so except for your parents, you really will not want any visitors. Ask them all to wait until you have been home for a week or two. (Have them at least wait until after you have showered!)
Moving, Sitting and Walking
To help prevent bed sores (and general soreness from being in one position too long) you will periodically turn from your back to your side, or your side to your back. (The nurses will help turn you in the beginning.) Remember that you are not allowed to twist at all, so to turn you do a “log roll.” Your whole body rotates as one entity, as if you had no waist or hips. To sit up, you log roll from your back to one side, then push up gently from your side to a sitting position. For the first week or two, you will probably need help doing this. Click here for a diagram of how to log roll.
On about the second day, they will ask you to sit up. It will be one of the weirdest things you have ever felt. It’s not weird like poking at Jello is weird. It’s weird like someone made a puzzle out of your insides and didn’t put it back together correctly. It’s so weird that your body doesn’t quite know how to handle it. I felt stiff, dizzy and somewhat queasy. Don’t worry, though, it gets easier after a couple of tries.
Probably later that day or the next day, you will be asked to stand up. That’s even weirder than sitting. It’s a similar sensation, but more intense. My legs felt like jelly, and my head was spinning. Standing soon gets easier too. You will be walking around by about the third or fourth day. Your body’s equilibrium will have to readjust to being taller and straighter, so they may give you a walker to use in the hospital for added safety.
You will have to ask your surgeon what he or she will prescribe for you, but I had a “spinal morphine” during surgery. It was supposed to last 24 to 48 hours, but since my body has always metabolized medicine extremely fast, mine only lasted about 12 hours. Unfortunately, they couldn’t give me anything else until 24 hours because of the risk of overdose. Needless to say, the interim was not fun. If you know yourself to metabolize medication rapidly, you should speak to your surgeon ahead of time. I don’t know if they can do anything differently, but it’s worth asking.
Tubes, Monitors and Wires
You will wake up with at least one IV (intravenous) line in to provide fluids and medication during and after surgery. There may also be a pulse oximeter. That’s the clip on your finger that makes sure the hemoglobin in your blood is doing its job of delivering oxygen everywhere. Until you can get up to go to the bathroom yourself (two or three days, probably), you will also have a catheter. Whatever you do, don’t pull on that catheter tube! You will seriously hurt yourself.
In terms of pain control, you will probably be given a PCA (patient-controlled analgesia). This is a machine which dispenses pain medication (such as morphine) to your IV at the touch of a button. The machine has a little computer in it so that you cannot overdose yourself by accident. This more frequent dosing allows you to keep pain under control better than pills can. You may also be given a patch (like the nicotine patches smokers use when they’re trying to quit) that will deliver a constant, low level of pain medication for several days. (Again, for me, this four-day patch lasted two days.)
If you need pain medicine, take it! Don’t try to be tough or heroic or anything like that. Just push the button or ask for the pill. It is enough work just sitting up and walking around when they ask you to; you really don’t want to have to do it all while you’re hurting a lot too. It is also much harder to control pain once it gets bad. When you’re starting to get sore, take something. It’s not going to get better by itself.
I know it’s not a pleasant topic, but constipation is something everyone has to consider after surgery, pain medication, and inactivity. Morphine, Vicodin, and others can be very constipating, so as soon as your pain is somewhat under control, consider asking if there is a less-constipating medication available. To help avoid any problems, drink as many fluids as possible, and move as much as you can bear. Walk when possible, and when you’re in bed, bend your knees, slide your heels up to your hips and back down, roll your ankles, shrug your shoulders, roll your head, etc. Even if you have a low appetite, which is quite common after surgery, be sure to consume lots of fiber. Laxatives like Colace or Ducolax can help. After you get home, if you have no action for several days, your stomach gets hard, and you are nauseous or vomiting, go to the emergency room immediately.
Everybody is unique. Different medications work for different people. If you’re having a problem with a certain medication not working, even after you get home, speak up! The doctors and nurses want to help you, but they can only do that if you tell them there’s a problem. For example, Vicodin didn’t do a thing for me except make me sick and give me hallucinations. By speaking up, I was able to get a different prescription. (Actually that one didn’t work either. Ultimately, Tylenol did the trick.) Some people are nauseous from the anesthesia. The nurses can give medication for that too, but only if you tell them you’re nauseous. Don't worry about being a pest; you have the right to be as comfortable as possible.
All patients, but especially younger patients, need to have a parent or other close family member present at all times to be an advocate and companion. (The doctor says this is optional, but in reality, it’s mandatory.) When you’re worn out and hurting, it can be hard to speak up for yourself. Also, your parent or other relative can help with simple things like turning, going to the bathroom and getting drinks of water, thus freeing up the nurses and getting you more immediate, personalized care. Going through surgery is also a real emotional roller coaster, and it’s critical to have someone to talk to. It’s best for the companion/advocate to be someone to whom you are very close. Remember that this person will probably be helping you with bathroom trips, so a family member of the same gender is recommended. All this is not to say that you cannot be your own advocate; indeed, you are your most important spokesperson. The parent is there for added support, and as an authoritative voice for younger patients. (I was seventeen at the time, so the nurses listened to me pretty well, but when I had my appendix out at age thirteen, I noticed that they were much happier to speak to my parents than to me.)
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Relax and be patient with yourself.
Relax!! Homework is almost impossible for a while, so you must do fun stuff. Do whatever relaxes you, like watching TV, talking on the phone, or surfing the internet. Be patient with yourself. Your body is doing the best it can. You will feel better soon.
Be as active as you can, but don’t overdo it.
Do everything you're supposed to do, and nothing you're not supposed to do.
Probably after about three weeks, with your doctor’s permission, you can take trips out. For the first four to six weeks, you will need to sit in the front passenger seat, with the seat pushed all the way back and slightly reclined, to avoid twisting while getting in and out of the car.
The doctors try to limit your time in the car at first because of the risks from sudden starts and stops, prolonged exposure to vibrations, and potential injury from accidents. Early on, even bumping down a curb has the potential to be harmful. When the doctors tell you to stay home for a while, they really are not trying to put a crimp in your social life; they are just trying to keep you safe.
You can usually drive yourself one to two months after the surgery, depending on your strength and mobility, and as long as you are not on any narcotic pain medications.
Take care of yourself.
Don’t wait for your pain to get bad before you take something. For about the first two weeks (or as advised by your doctor, of course) you should take your pain medications around the clock, whether you think you need them or not, to avoid the “peaks and valleys” that can be very hard to get back under control.
Change positions. Try sitting in a recliner, on the couch, on your bed, and laying down at both ends of your bed. You will be more comfortable and less stiff if you move as much as possible.
If you had ribs cut, hug yourself when laughing, sneezing, or coughing.
I can’t say from experience, but I have heard that 15 to 20 minutes of a cold pack per hour may help.
Aspirin and ibuprofen (known as non-steroidal anti-inflammatory drugs, or NSAIDs) can cause bleeding during surgery and can interfere with the fusion afterward. My surgeon told me not to take any for two weeks before surgery and for one year afterward. Click here for a list of brands to avoid during this time.
I found Tylenol (acetaminophen) to be the most effective pain medicine. It worked even better than the Vicodin or Darvocet my doctor prescribed. Tylenol brand works fine, but Excedrin also makes something called Excedrin: Tension Headache, which is acetaminophen with 65 mg (a cup of coffee worth) of caffeine in each dose to help it “kick in” faster. It is aspirin-free Excedrin, which means that it is allowed, even though Excedrin is on the list of medications to avoid. Be aware that that much caffeine can cause serious insomnia! Also be aware of addiction. If you take this instead of plain Tylenol, you are getting a full cup of coffee worth of caffeine in each dose. At even one dose a day, it is very easy to become very addicted to the caffeine very quickly, especially if you are not usually a caffeine user.
Since you cannot take any anti-inflammatory medicine for a year, it can take a while for things to calm down once you irritate them (i.e. overdo it), so be careful not to get to that point if you can help it.
Keep speaking up!
Just like in the hospital, remember to speak up if your pain medications are not working, and/or if they are giving you side effects you can’t stand. The doctor has many options available for pain control, but can only look at other options if you tell him or her that your current prescription is not working. Again, don't worry about being a pest. If you have to call the doctor with questions every day for a while, that's fine.
Some people tense up because it hurts to move, and then get back spasms as a result of this tension. The doctor can prescribe Valium or something similar to alleviate these spasms. Nausea, constipation, or other problems can also be treated, but only if you speak up.
It is okay to put light gauze over any oozing from the incision, but avoid any cream or ointment! It is important to keep the incision clean and dry.
If you have steri strips, do not remove them forcibly. As they gradually peel off at the edges, simply snip those edges off. If you pull the strips off by force, you run the risk of tearing the incision open. If the steri strips leave behind a sticky residue, your local drug store or medical supply store may have special wipes to take off that goop. It's okay to shower with the steri strips on; just have someone use a hairdryer on your back to dry the strips before you get dressed. (I know it sounds silly, but it works, and it keeps towel fuzz and bacteria from getting in the incision.)
Do as your surgeon instructs, regardless of what kind of closure device you have. Incision care is very important. One of the most serious complications that can happen after surgery is infection, and the primary way of contracting a post-operative infection is improper care of the incision.
You need to avoid twisting at the waist for a while. This means you need to move with your feet, not your waist. Keep your ears, shoulders, and hips in a straight line.
In the hospital, they had a loose flat sheet underneath me (but on top of the fitted sheet). The nurses pulled this gently to help me turn “like a log” without twisting. At home, we used the same technique for a couple of weeks. After I laid down, I often found that I wasn’t completely flat on my back, so the “pulling sheet” made it easy for my mom to help me flatten out without twisting.
Click here for a diagram of how to log roll.
For the first two weeks or so, you will need someone home with you 24/7. In the beginning, you will probably even need help getting in and out of bed. If you do not have a family member or members who can do this for you, your insurance company or HMO social worker may be able to connect you with someone.
“Reachers” or “grabbers” (long poles that pick up objects with tongs on the other end when you squeeze a trigger on your end) can be useful. If you are going to be alone, it may be wise to get two, so that you can use one to pick up the other if you drop it. (I didn’t use these, but I have heard that many people find them helpful.)
Keep a small basket in bed with you. In the basket, include:
It is okay to call the doctor several times. Don't feel that you're being a pest or a bother. Remember that it is your doctor's job to make you as healthy and as comfortable as possible, and that he or she has a lot invested in your successful outcome. He or she is ready and willing to help you, so don't be afraid to ask.
If you have sutures or staples, you will probably see a nurse in two to three weeks to have those removed.
Expect a check-up with your surgeon around six to eight weeks after surgery, then again at six months, one year, and five years. At each appointment, you will probably have x-rays taken.
About 14 days after surgery seems to be a magic time. You begin to feel dramatically better, with more energy and less pain.
I am told that preexisting leg/arm pain usually subsides gradually, although some people experience immediate relief. A few patients still have chronic pain after they are healed from surgery. If this is you, talk with your doctor. You may be eligible for a pain management clinic or an alternative pain therapy.
Yes, you will be taller afterward, but by how much will depend on the size of your curve and the degree of correction. I grew more than an inch, which meant that many of my tops were suddenly too short, so as soon as I got out of the brace, my mom and I went shopping. On the flip side, a few of my tops that had gotten too tight actually fit again once my "rib hump" was taken care of.
I gave a letter to each of my teachers on the first day of school, explaining what had happened and the few accommodations I would need. A letter offers a discrete, convenient way of communicating with your teachers, especially early in the school year when you don’t know them very well yet. Even if you are self-conscious about telling anyone about your surgery, most teachers will really appreciate being informed of what is going on. Click here to download a copy of my letter; feel free to adapt it as needed for your situation.
It was obviously not comfortable to use a backpack in the very beginning, so I used a tote bag instead. Pretty soon, though, I found that carrying it on one shoulder all the time, even though I alternated shoulders, was more uncomfortable than the backpack. A small, lightweight backpack is best. The fancy kinds with lots of sections are astonishingly heavy, even empty! Also, a smaller backpack will keep you from loading it up with so much stuff.
You will probably have a one-year excuse from PE. This doesn’t get you out of those credits for graduation, but it does require the school to let you make them up in a different elective area.
Your surgeon will probably give you letters allowing you to take medication at school, to have a second set of textbooks at home so you don’t have to carry any, and to have an extra minute or two of passing time if your classes are far apart, since you can’t run for a while.
Absolutely! The surgery was absolutely worth it. It was a pretty horrendous process, especially for the first two weeks, but I would do it all again if I had to. I got my life back. I feel better about myself. I am able to be more active now, six months after surgery, than I was six months before surgery because of the severity of the curves at that point. I know that I will be able to be healthier and more active throughout my life now than I would have been if I had left the curve untreated. Even things I hadn’t really noticed were wrong before, such as breathing and sleeping, are much better now. I know that it is done now, and I can move on. I never have to worry about the curve continuing to grow or interfering with my life in any way. I thank God that I was able to have this surgery.