Posts Tagged ‘back pain management’

kathleenmosko@gmail.com              Twitter     @KathleenMosko

Hi Everyone!

Hard to believe it’s no longer January! GEESH! The older I get the faster the time goes! The holidays were a blurr since being sick right before Christmas and losing our family Therapy bunny, Skittles, 3 days after Christmas. His bonded mate, Candi, has been just as lost as I’ve been without him, and she and I have taken some time to get to know one another again without him around. It’s been painful to watch how lost she is, it’s sad, just very sad.

Anyway, I’ve had this to do for a while but I never realized how much had piled up for this post or how long it’d actually been. I must apologize and then I thought no, I had some living to do, as you all have, and this website in an extension, not an appendage of me and mine! LOL I have several irons in the fire, one very big one, and several small ones and a couple medium-sized ones so it’s no wonder time has just flown! I really do love being busy… although, I finally learned how to take time to stop and smell the roses… they’re wonderful to smell!

Well, I went back to October and looked at my analytics to see what questions you folks were seeking answers to. I can’t believe I let it go that long! Hmmmm. I’m gonna break it down for ya into the different surgeries, first the XLIF, then the total hip and lastly the ACDF. There’s a reason the ACDF will be that last one. It’s because I’m still having some issues with mine and I’ll be doing these topics in separate posts but want it close to this one so you can have the information all together, sorta… LOL I am always surprised at some of the questions, some are similar to ones already asked and answered in my other posts, but I’ll answer them again here just in case I put a little different twist on it that might be beneficial to you in a way I didn’t cover the last time.

SO HERE GOES – XLIF FIRST!

Q: ARE THERE ANY PROBLEMS WITH AN XLIF?    A: The short answer to that is, probably not. The XLIF can be explained that it’s the procedure used to get the doctor into the middle of your body with the least amount of damage to other tissue, muscles and maybe even organs. The XLIF is a procedure or technique designed to get access to the spine. What a doctor does once he’s in the middle of your body at the spine is different than that. There are several procedures available to your doctor to fix any number of problems once he gets in there and sees what’s really happening. I happen to have the good fortune of my doctor being the leading neurosurgeon in the US who not only sees your spine in 3D once he’s in there, it has been told to me he can actually envision in his mind what may be going on in the interior of the spine as well or 4D. Most doctors only need the 3D version for their work to be successful. There are few questions you may want to ask the physician doing your surgery. One, is he NuVasive trained? The reason I share this question is because NuVasive docs are trained on cadaver bodies in an intensive, extensive lab environment. They also are trained to use an advanced version of neuromapping, much like an EEG only MUCH more sophisticated. This is where wires are hooked up to your legs at critical spots and held into place with a plastic sleeve. While undergoing the operation, the doctor is trained to utilize this neuro aide so he can tell exactly what nerve is being touched, drastically reducing the chance of further nerve damage. A doctor who uses this pretty much knows exactly where he is in your spine. One other question you may want to ask is how many of these procedures has that doctor performed. I know that everyone has to start somewhere, but I was one of the last of my doctor’s first 1,000 patients. He’s now working on his second 1,000! In otherwords, he’s had plenty of experience before doing mine! That is not to say all other doctors are not as good as mine, yes, I am partial, but there are plenty of really great neurosurgeons who do excellent work.  Problems arising after an XLIF procedure are usually from some other complication such as drug interactions, body systems malfunctions, or some other unknown at the time of the surgery that manifests itself post-op. The choice of your physician is a determinant here as well. I personally wanted a neurosurgeon, hands down, no ifs, ands, or buts. That being said, I know there are many orthopaedic surgeons who have gone through the NuVasive training and are well qualified to do the XLIF procedure.

Q: WHEN IS A PERSON A GOOD CANDIDATE FOR THE XLIF PROCEDURE?   A: Any number of stars must be in alighment for you to be a candidate such as insurance carriers allowing the procedure, and your body systems all working as well as they can, but from a strictly medical point of view, the doctor makes the final determination about your condition from a series of tests, mostly, at the very least, an MRI. This allows him a peek inside your body and see as to what’s happening in there and what if anything he feels he is capable of doing to fix it. One look at MY MRI’s and my doctor looked back at me and said, “My God girl, you’re a mess!” (those were his exact words) He makes the determination from what he sees internally no just by you coming in with a few old x-rays and telling him you have a pain. He takes many things into consideration before suggesting minimally invasive surgery. Usually he and the insurance company want to see if more conservative non-invasive measures can correct the pain prior to using surgery as a last resort. Some choose not to go through surgery at all for whatever reason, some can’t because of other medical conditions, and still others who won’t give up smoking which pretty much takes back surgery off the table for them unless they quit. (Please referr to a couple of earlier posts about smoking and surgery for more details about this issue.) This is due to the very low success rate of bone fusion while smoking.

Q: HOW WILL I KNOW WHEN IT’S TIME FOR ME TO HAVE BACK SURGERY? A: The short answer to this is, WHEN THE PAIN IS SO ALL-CONSUMING YOU CAN’T THINK OF ANYTHING ELSE! When it taints your thoughts, your sleep, your intimacy, your social and work life, yeah, then it’s time to do something about it. Afterward, if you have the XLIF done, you’ll wonder why you waited so long to have it fixed! THESE ARE WORDS RIGHT FROM THE HORSES’ MOUTH! My circumstances were such that I couldn’t get fixed until I did but I did it as soon as I could! And, it wasn’t a moment too soon! HONESTLY!

Q: WHAT IS THE MORTALITY RATE FOR AN XLIF PROCEDURE?  A: In Dr. Smith’s practice, there has never been a death due to an XLIF procedure. That being said, there are certain unknowns which may adversely affect a successful outcome, such as complications of drug interactions, body systems malfunctions, or some other unknown determinant which causes death post-op. One in particular that comes to mind is MRSA infection. My particular doctor wants his patients in and out of the hospital as quickly as possible and often will perform the surgery on an outpatient basis, greatly reducing the risk of infection and possible other complications. I can only speak for him at this point, so I’m not sure what other doctor’s statistics are.

 Q: IS THERE DEEP TISSUE INJURY FROM AN XLIF? A: I wouldn’t classify it as injury, but there is a certain amount of pain or discomfort from the core muscles being pulled apart in order for the surgeon to get to the interior of the body. That being said, I shudder to think of the pain associated with the actual cutting through of all those muscles in order to get to the interior as is done in the waning traditional procedures. Since the “stretching” is far less destructive, I am perfectly happy to recover from that vs actually having my muscles being cut through!

Q: DOES IT HELP TO HAVE THE XLIF DONE FIRST IF THERE ARE OTHER SURGERIES PROPOSED? A: That will strictly be up to your personal condition and how unstable one area is vs another. Often when a person, especially with a scoliotic condition, is faced with multiple surgeries to correct or improve the condition, the surgeon will take into consideration many factors such as, the area most unstable, lifestyle or activity level of a person’s work, or the acuteness of the pain. There are many others as well, one in particular is if the patient is a smoker. This is a very big issue for a surgeon when making a decision to perform surgery. (see earlier posts on this website for details about smoking) Another consideration upfront is your insurance carrier and what they will allow. If all things are equal and your surgeon is a go… in my particular case, my lower back posed the most immediate of problems, so the XLIF was my first surgery. I have known other surgeons to do a cervical correction first because the neck was more unstable than the lower back. I can’t address the reasoning for this or the particular condition of the patient; not enough information was shared.

Q: WILL A BACK FUSION LAST? A: The short answer is, YES!  HOWEVER! There is evidence that certain activities will aggravate the areas directly adjacent to the fusion causing arthritis or other conditions. A modification of certain activities should be discussed with your surgeon so it is perfectly clear to the patient which activities to avoid and the ones which can be resumed after recovery.

Q: HOW CAN I IMPROVE THE BOND OF MY FUSION? A: The time to do that is long before you need surgery. The higher your bone density the more successful your fusion may be. The number 1 thing a person can do for themselves is if they are a smoker; QUIT SMOKING!!! Exercise is the second. Those who do impact exercises, even the low impact, are in a better position to have a more successful outcome. If that’s not possible, as it was in my case, then doing passive exercises to strengthen the muscles and surrounding tissue of the painful area by doing water exercises is always a plus. Additionally, there is some indication that if you can slow or reverse osteoporosis it would help in the healing of your fusion. CAFFIENE has been linked to the onset of osteopenia (the precursor to osteoporosis) or osteoporosis itself. Some studies have shown that more than 300mg of caffeine, or more than one cup of coffee per day increases your chances for those onsets. Also noted is that fact that several non-coffee related foods are high in caffeine and may also be ingested throughout the course of one’s day adding additional caffeine to their intake. Mixed in with all of this is the lack of Vitamin D which is needed for the body to increase it’s metabolizing of calcium. When a person drinks coffee, it acts as a diuretic which also increases the amount of calcium expelled by the body. Caffeine also interferes with absorption of Vitamin D in the bones. So my take away from this is, eat more calcium and Vitamin D enriched foods, and drastically limit your intake of caffeine. And by the way, that means chocolate too! ALTHOUGH TEA HAS CAFFEINE, IT DOESN’T HAVE THE SAME EFFECT ON THE BODY AS COFFEE CAFFEINE DOES!   GO FIGURE!  (some of this information was taken from my search on the internet)

Q: HOW IS THE BONE HEALED IN AN XLIF SPINAL FUSION? A: Once the doctor implants graft material along with a “growth medium,” it should start to take hold right away. Graft material may come in the form of a non-bodily produced agent or, like mine, was the scrapings off my ribs to insert so it was my own body supplying the material. At about 6 weeks post-op a bone growth stimulator, a simple device designed to send electrical signals to the healing area to increase the rate of stimulation of growth. As one rep put it, If you took the time to have the surgery, and your doctor suggests a bone growth stimulator as part of your recovery, it’s just one more tool in his arsenal to help you heal quicker an more completely. My particular bone growth stimulator was provided to me by Biomet. (go to www.biomet.com to learn more about the science and  how it works. Aslo it gives you questions to ask your doctor about the device.) It’s a little device no bigger than a deck of cards with a case that attaches to your clothing or belt and attached to some wires with patches that have a sticky gel on them that stick to your skin where the doctor wants the healing, not where your scars are. All things being good, the total fusion takes about six months to complete. In the meantime, your body should be pampered somewhat. The surgeon will track your progress by a series of x-rays done at certain intervals of your healing to make sure the fusion is complete. Once the healing is complete, you should be able to resume most all of your old activities. I’m still learning what all I can do that I had to give up for so long.

Q: ONE PERSON ASKED ABOUT HAND PAIN POST-OP, AND ANOTHER ABOUT FOOT PAIN FROM AN XLIF… A: My take on this is that there are other underlying causes to those conditions which can only be addressed by your surgeon. If you haven’t made him or her aware of this condition, please do at your earliest chance. It may be something simple he can address to alleviate the discomfort.

Q: I HAVE PAIN IN MY LOW BACK AND BUTT AREA AFTER MY XLIF. A: This person doesn’t say how long after the surgery so I can only address it from my experience. I don’t recall having much butt pain at all but yes, there was some low back pain. Mainly this was due to a couple of things. First, my muscles were weak from non-use all those years prior to my surgery. Secondly, my back muscles were stretched and I had to allow time for them to work themselves back into place. As I increased my activity levels and my exercise regimine, my discomfort with my low back muscles became a thing of the past. So much so, sometimes I now have to really think hard how much pain I was really in.

Q: WHAT ARE THE NEGATIVES FOR AN XLIF PROCEDURE? A: I will only be able to address this as I know it from my experience with Dr. Smith. As far as I can assertain, there are none. Dr. Smith is very careful to screen his surgical candidates for the XLIF due to their other medical and physical conditions. I spoke directly with Joe, Dr. Smith’s PA to get his perspective about negatives. He shared with me that just on the merit of the condition of the patient and the quality of the procedure, one can expect to have recovery to a greater degree. There are no guarantees with any surgery and there are those cases where, inspite all the best efforts, some nerve damage is irreversable. Dr. Smith has an outstanding recovery rate, far higher than anyone, to my knowledge, performing the surgery to date! (other than Dr. Pimenta who pioneered and perfected the procedure)

Q: IS IT OK IF I PICK UP SOMETHING WEIGHING 10#? A: Depending on where you are in your healing process the answer is yes, and no! LOL For the first six months of my recovery of the XLIF, I was not allowed to pick up anything heavier than 5#. My son, Brian, jumped at the chance to get me a Coach purse, which I vehemently resisted, until Dr. Smith told me I would have to reduce the weight of my purse. Brian nagged me for two years prior to get me a Coach purse but I kept telling him no. After the Dr. Smith directive, he showed up one day with this 10″x8″x2″ purse. I have had more people ask me why I even bother with such a small purse, and it being a Coach purse and all, so then I have to stand there and explain to them it was Dr. Smith’s fault and what Brian did for me to acquire it! I don’t have a limitation now but Brian spent so much on it, I don’t have the heart to not use it. He’s told me it was ok if I didn’t but, it was such a fun gesture, I can’t put it away. It came in handy after my ACDF surgery anyway because I wasn’t allowed to lift anything but 5# or under then as well. Now it’s just a novelty! A gallon of milk or water weights approximately 8.5 pounds which, at the beginning of your healing will be too much to lift. For a while I suggest buying your milk in half gallons if you want to lift it yourself. And ladies, change the size of your purse!

Q: DID ANYONE LOSE WEIGHT AFTER THEIR XLIF? A: I can’t speak for anyone else, but for me the answer is a big fat YES!  I lost 29 pounds. My doctor of physical therapy told me it was due to muscle mass loss. BELIEVE ME, if I could have gained back the muscle mass without gaining back the weight I would have given up my eyeteeth for the trade! Once you are done with your slow pace and you go back to physical therapy, you should regain most of the weight back. I didn’t take it off all at once and it came back slowly as I increased my exercise program. I have hamstrings now that actually do what they’re supposed to so I’m ok with gaining back the muscle weight. NOW, if I could only lose the fat weight, I’d be in great shape! LOL

Q: I HAVE A LARGE LUMP UNDER MY XLIF SCAR AND THE AREA IS TWITCHING…  A: The lump can be one of several things, a cyst, sometimes caused by trapped fluid or blood, a growth of tisssue under the skin, or it could be the scar, which is what they call keloiding. A keloid is when scar tissue manufactures too much skin to repair itself. It’s more annoying than anything else, and it sometimes makes the scar wider than the original inciscion. If a keloid becomes unsightly, you can see a plastic surgeon to repair it. It isn’t however caused by anything your original surgeon did or didn’t do. It has to do with how your body repairs itself after a wound. In the other instances as cited above, each should warrant a visit to your surgeon to address them so he can assess what needs to be done to correct the lump, if anything. As for the twitching, although it is probably associated with the healing process of the wound itself, you may want to address it at the next regularly scheduled office visit unless you feel it’s so annoying it warrants its own visit.

Q: I HAVE SWEATING POST-OP OF MY XLIF… A: Your body has experienced an induced trauma with the XLIF surgery, although it was a good trauma in order to fix the pain. Some people react differently to that trauma and their metabolism is thrown way out of whack. I too, had the very opposite effect, I sat chilled to the bone though it was 110 degrees outside! (Remember, I live in Vegas!LOL) I would be sitting in sweatpants and a sweatshirt covered with a blanket while the rest of the household members were in shorts, T-shirts and the air conditioning was running! It was a bazzar time for me and my metabolism but it got better as I got further out post-op! I am now back to my “normal” if one could call it that… I can sit in a room in a pair of shorts and the heat doesn’t have to be blaring for me to be comfortable. It’s mostly part of the process. As your metabolism returns to a normal state, the sweats should reduce in occurance. IF for some reason you are having sweats with a fever, by all means seek medical help immediately. There may be an infection which needs addressed STAT! Take your temp and see if it’s normal or if you have a fever, then act accordingly.

WHEW! This concludes catching up with the questions concerning the XLIF PROCEDURE asked on this website as concerns and followups to the different posts. I will return shortly with a continuation of Installment 9 of Questions and Answers to address the ACDF procedure.

In the meantime, you know what to do, take care of you and yours,

hugs,

Love,

Kathleen