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Met with the NS today...3 level fusion vs. repeat Micro-D

FarmgrrlFFarmgrrl Posts: 146
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
I finally had my appointment with the NS today. He reviewed my films, listened to my history and did a pretty thorough exam. He is offering me two options: we can do another discectomy or just skip that to a 3 level fusion from L3-S1. He feels that I have some significant changes on my MRI compared to the last one (it was actually in Dec '07 3 weeks post-op). Along with that I am continuing to have back pain as well as my obvious reherniation...he feels that I have enough instability to warrant the fusion.

He is however leaving the choice to me. He encouraged me to do my research (I've been doing nothing but that for two months LOL) and even to seek a 2nd opinion if I want to.

I felt pretty dumb when I got home because I really was just expecting him to want to do a repeat discectomy. I wasn't prepared to ask him any questions regarding fusion! I did ask him about recovery times & my concerns regarding my job.

I'm thinking I need to gather my thoughts & my questions and make another appointment just to get my info straight before I can make a decision.

I talked to my parents and my boyfriend (he was at the appt with me) and all three think I should throw in the towel and go for the fusion. I honestly have been dealing with back pain issues since I was 16 years old (my disc issues started at 24); I am getting ready to turn 33 in March.

I think I'm in shock right now, I never thought I would be faced with this decision even though he told me this would be coming down the pike two years ago when I had my Micro-D. I know something needs to happen, my pain relief was short-lived from the combo of the 2nd ESI & Medrol dosepak...its been creeping back up since Thanksgiving.

How did you decide? Would you go for a second opinion?

I feel completely dumb-founded. I can't even cry.

Thanks for reading,

P.S. Any thoughts on stem-cell therapy? My dad was asking me about this too...


  • Yes I would definitely get at least one more opinion...and if it were me, I would go to a fellowship-trained orthopedic Spinal specialist for one of those opinions. I found that there was quite a discrepency between the specialties.

    You want to be absolutely certain that you need three levels fused before you move ahead. The more levels involved, the less the rate for success...so you want to be certain there are no other options than a three level fusion before going ahead with it. This is kind of the end of the road as far as spinal surgery goes. It's not like a discectomy where it can fairly easily be repeated.

    Some surgeons are doing combination surgeries where they replace a disc and fuse the others, or there is a more flexible fusion that is being done, if instability is not one of your problems.

    Stem cell procedures sound very promising but are not far enough along quite yet. I did read about some doctors doing a procedure though where the center of the disc is injected and "puffed up" rather than being removed. I'll see if I can find the article....

    Just remember that unless one has done quite a bit of research or participated in a board such as this, people do not realize that fusion is a BIG surgery and should not be entered into lightly. It is very important to realize that it will not restore the patient to the way he/she was prior to injury or onset of pain. It is done for stabilization and pain relief, but it won't turn back the clock! Most people who understand this concept end up satisfied with their results. People who expect to feel like "they used to" are often disappointed.

    Take your time in reaching a decision. Turn over every stone so you know you have examined all your options.


  • Christine
    I know how you are feeling. I am on the fence about a much smaller surgery. All day each day I change my mind many times.

    Gwennie is right. You need to understand the honest outcomes of each procedure. THe biggest complaint that I see here is people who expected more from their surgery than they should have.

    You may also want to speak with a psychologist who specializes in surgery candidates. Your hospital should be able to recommend someone. This might help you to accept what the future may hold for you.

    My motto is hope for the best and prepare for the worst. Please keep sharing. Maybe something someone says will strike a note for you.
  • I knew something wasn't right about my microdiscectomy and when I went in and heard revision surgery, I thought ok.

    I never expected on my 'real' 2nd opinion to hear the word fusion. My husband thinks I should go for it but it's not him and I don't think he fully understands the potential risks. But what he did agree to and keeps encouraging me is to get enough opinions until I find a doctor I'm confortable with.

    So since I struggled finding a neuro surgeon until 12/15, I made some other appts while I waited. I have met with a total of 4 doctors (including my original surgeon) and 2 said revision and 2 said fusion. Of 1 of the fusion doctors, he said at a minimum, he'd recommend a hemi-laminectomy and explained why.

    I found that while the appts cost me co-pay of $30, it's a drop in the bucket to get me the information and finish my research.

    I'm seeing 2 neuro surgeons before making final decision. One that is a little older and I lucked out and got in on a cancellation this week instead of having to wait and the other in 2 weeks. I now have a list of questions beyond to fuse or not to fuse. I have other options to ask about and then I have more questions about the fusion approach, pain management philosophy, pt approach, hardware questions, and long term success since I'm only 40.

    I think you have to set up a 2nd and possibly 3rd opinion.

    FOlks here can help you figure out what to ask.
    If you aren't sure at a doctors office, I sometimes ask "well, doc, if you were me what would you ask? If I was your wife or child what would you recommend?"

    Good luck and stick around. You have a big decision but you aren't alone.
  • SpineAZSpineAZ WiscPosts: 1,084
    I agree with maybe a second opinion with a Orthopedic Spine Surgeon.

    Also know that you can do well with a fusion early in life. Mine was in my 20's and it improved my life a ton!
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Thanks guys! I knew I'd find help I needed from my fellow spineys...when I first posted I was 24+ hours of no sleep, had to work all night Sunday then stayed up for my appointment. I managed a nap so my head is a bit more clear. :)

    I have found an ortho group, all of their spine surgeons are fellowship trained. I'm going to call them in the morning to set up an appointment for a second opinion. Once I set up that appointment, I'm going to make a 2nd appointment with my NS. There is also another NS group I'm considering for a 3rd opinion if needed.

    I'm getting ready to sit down and start writing down my questions. As Gwennie suggested, I need to find out if fusion is necessary at all 3 levels. I know L4 & L5 are my most troublesome levels but I'd like to preserve as much motion at L3 as possible. I have a real concern about that especially considering the nature of my occupation.

    I'm also thinking that I may need to reconsider the nature of my job if fusion is the choice I go with...I love, love, LOVE bedside nursing with the kids but maybe I need to just take care of the babies (i.e. newborn nursery, NICU). That's something I need to discuss as well with the surgeons.

    I know that I'll never be the same, even with the 'broken' back I've had half my life. Something has to change though. I had a 6.5 cm tumor removed from my liver this past June (had 1/3 of my liver removed) and no one knows why I had it. Typically, its seen in women taking hormones (i.e. birth control), which I don't take (only for 2 months a long time ago). Otherwise, I had a 1 in 1.2 million chance of developing it. The only thing that sticks out in my mind is that repeated doses of steroids I've taken since '01 for my back issues. This may have contributed to it, who knows? Never mind the damage of the Tylenol & Aleve. Sorry if I'm rambling but can I keep taking meds like this???

    Thanks for the help & suggestions, keep 'em coming. They're keeping me half-sane at this point!

  • Well I made a follow-up appointment with my NS for Dec 3rd, this upcoming Thursday. As I mentioned above, I wasn't prepared for what he said, so I'm going back to see him armed with my questions this time!

    I also made an appointment for my 2nd opinion with an ortho for next Friday, Dec 11th. When I see the NS I have to sign a release so they can fax my records to the ortho. I'll be seeing him with my MRI in hand. Do you suggest I bring both my current MRI and the CD of my MRI from Oct '07 for comparison purposes? I forgot to ask them.

    I also have an appointment to see my PM doc tomorrow to give her an update on the outcome of the NS appointment. I want to see if she's willing to try me on another nerve med besides Elavil b/c my numb areas are now starting to burn and it hurts! Everyone has to wear shoes & socks and its driving me crazy, especially at work now.

    My 4th appointment (yes #4!) is in the process of getting set up because this month is my 6 month follow up to my liver surgery. The part that scares me is that I've been having similar pain in my abdomen as pre-op, hoping to chalk it up to IBS symptoms due to nerves. Oh yes, I get to have another MRI!!! I should buy stock in Phillips or GE at this rate. ;)

    Whew...$180 in co-pays coming up plus $150 for another MRI. It looks like a lean Christmas this year for sure. I'll be maxing out my out-of-pocket with the insurance company (I don't know if that should scare me or comfort me? LOL)

    Now, I have to really sit down and start writing down my questions...this is the tough part!

    Thanks for reading!
  • Just think of it all as a Christmas present for your future! You don't want to make the wrong choice, or at least, an uninformed choice.

    The surgeon that did my second surgery has a standard procedure. When he meets with a patient the first time, if he recommends surgery, rather than going into it then, he has the person make an appointment for the following week and come back with spouse, friend, another person. At that point, he explains more about the surgery he is recommending and goes into all the details. He realized early on that when people heard the word "surgery" their minds just kind of shut down and they do not absorb anything beyond that point. So he has then come back for the full explanation, with another person who can remember what the patient forgets. I thought that was a good idea.

    Even when I go in with a long list of questions, the conversation inevitably takes a change in direction...we cover other things and on the way home, I always think of two more things I need to know! C'est la vie.

    Good luck with your homework. It is a big decision.
  • Making progress...

    Saw my PM doc this morning. I'm starting Neurontin tonight for the nerve pain. Chantix for the smoking and she also placed some accupuncture stickers on my earlobe to help me with quitting. (I have no choice at this point, I'm headed for surgery either way).

    I asked her for her input about the fusion idea and if it really was necessary to do the 3 levels. She agrees with my NS on this because the load that L3-L4 would have to bear would be too great having both L4-L5 and L5-S1 fused. She said the stress will be less, or more evenly distributed, at the upper levels. Its hard to explain it but it makes sense to me.

    I asked her for suggestions on who to see for a 2nd/3rd opinion...she gave me a few names. She told me she would lean more towards having a NS do the surgery. I'm still interested to see what an ortho has to say. The ortho name she gave me (doc A) is different from the one I made the appointment with (Doc B), she didn't have many positive things to say about Doc B. Apparently, Doc A is pretty good, is conservative in his treatments and created one of the cages used in fusion. I'm gonna have to call and change my ortho appt. She also gave me the name of another NS so I'll be calling to see how soon I can see him too.

    Gwennie, it is an unexpected gift I guess! Hopefully one that continues to give in a GOOD way LOL We bought our Christmas tree and all the trimmings last night and it felt good to distract myself for a little while listening to Christmas music and decorating with friends. :)

    Gotta run...off to have baseline labs drawn to check liver and kidney function before starting more meds! Then to my mom's to run more errands and have dinner. Another welcome distraction :)

    Thanks for reading!
  • Christine -

    just checking, but have you also had a discogram done? It was crucial in my surgery - would have had the wrong disc worked on, the NS was going to wait a year for the 'not-so-bad' disc, but the discogram showed that it was the main pain generator.

    Of course, if you are having all 3 done, well then that kind of takes care of that.

    Regarding the L3 - if it's not done now then it WILL take on all the load from the lower 2 fused discs. My NS says that it's not a matter of IF but WHEN it'll go. I still ended up with only 2 levels fused though.

    Best of luck!
  • Hi,

    No discogram done yet, its one of the items on my list though. It might be a moot point but I'm planning on asking the same questions from both surgeons.

    Unfortunately, my appointment with my primary NS was cancelled today due to him getting stuck in surgery. They at least rescheduled me for tomorrow.

    I have an appointment next Thursday with a 2nd NS. I'm thinking I may just seek the 2nd opinion of the NS and trash the idea seeing the ortho. I guess I just have my own personal bias but I guess I just prefer neursurgeons LOL

    I also had a problem picking up my meds yesterday (e-scripts) but it got straightened out. I now have my Neurontin in hand! Unfortunately, my new pharmacy plan doesn't cover Chantix! I simply didn't have the $$$ to pay $147 out of pocket, but I'll get it figured out.
  • RangerRRanger on da rangePosts: 805
    Sounds like you have really done your homework. From what I have read I believe you are making a wise, well informed decision. With your good attitude, the support you have from family and friends, you will do well.
    Take care and the best to you!
  • Glad you updated this thread.
    I'm still deciding on a L5-S1 fusion or revision microdiscectomy.

    I have decided I am switching to a neuro surgeon.
    I come to tears thinking of a fusion and just don't think I'm in enough pain to warrant a fusion. But I do understand the risks of a revision surgery failing as quickly . . .each surgery introduces a new level of risk of infection and additional scar tissue.

    But I also know that a fusion is permanent so the other part of me says try the revision surgery. I've been doing a ton of reading and I swear that every other day I find something that supports 1 option and something that supports the other.

    I think it's worth meeting ortho-spine doctor.
    It was the ortho-spine person that explained to me why he thought I should consider a fusion. He took the time to explain both options.

    I went to another ortho-spine guy who said fusion but said at minimum hemilaminectomy. The Neuro surgeon (independent) that works with him said it is up to me but he feels I will be happier with fusion results longer. He did agree that it is likely I will need another one in the future though.

    I'm driving myself a little nuts but worth it since I do not feel settled with either decision right now. I'm meeting another neuro surgeon and getting an opinion from a Spine Clinic (won't list name since I don't think we are allowed to) that I get through work "free".

    I guess I'm trying to figure out what pain levels were people in to push them into fusion?

    My husband's cousin had a cervical fusion twice but they are way different. He said he woke up and his arm/neck pain was gone.

    I guess my back/leg pain just isn't like that where I would know instantly. It really is dependent on weather, how active I am, how well I slept.

    I wish I had a crystal ball.

    But thanks to this board, I have realized it is a HUGE decision.
  • Do you know what type of revision surgery you would have? Would it be a micro-discectomy or possibly something else? Did you see the last neurosurgeon yet?

    I guess if I were in your shoes and were able to function to some extent with the pain you currently have, I would put off fusion for as long as possible.

    The reason I say that is because minimally invasive surgeries are just in their infancy -- like the way hip replacements were 15 years ago. New developments are happening quickly, new technologies are in the pipeline, procedures with stem cells are being experimented with and going into human trials. So the longer you can wait, the better chance their might be for a less invasive procedure.

    But you should be ready to make a move (know which surgeon you'd go with)in case you would develop bladder or bowel problems indicative of cauda equina syndrome. Other than that, or pain you just can't deal with any longer, you shouldn't require fusion at this point. But, you don't want to leave the nerve compressed too long.

    I waited over three years before agreeing to fusion. I just kept thinking I wasn't "that bad". But my nerve pain got to the point where I couldn't stand and I was driving to my mailbox to collect the mail because I couldn't stand the pain to walk more than a few feet at a time. I finally realized my world was becoming smaller and smaller...and I had no other options than fusion. I probably should have done it sooner!

    Take care,
  • Thanks Ranger,

    I'm trying to learn as much as I can, its just in my nature! Like I said, I was taken aback and totally not prepared to hear that he thought I needed a fusion.


    I totally understand what you mean in making this decision. Talking with my PM doc, she helped me feel better about the fusion idea because honestly I walked out of my NS office thinking he was a little crazy for suggesting fusion over repeat micro-d. She pretty much said that if my NS felt I would last a good 10 years with the Micro-d he wouldn't be suggesting fusion. She's thinking that he feels I wouldn't last maybe 3-5 years and I'd end up right back in the OR for fusion anyway. Of course, I'm going back to my NS to hear that straight from the horse's mouth.

    I know I need surgery no matter what. This is totally affecting my ability to perform my job as well as my quality of life at home. My leg pain is coming back and its getting worse everyday. My foot and leg feel like I've been burned by boiling water and I'm altering my gait even-more because it hurts to flex my foot while walking. Like you said, each surgery means more scar tissue... I also don't want to keep chasing my symptoms with more and more meds.

    On the other hand, my pain is tolerable but that's just for right now. I almost feel like I need to trust my gut instinct and do the fusion rather than taking the 'easy' way out with a repeat-Micro D. For now, all I can do it continue to do research and ask my doc(s) many questions as well as my fellow spineys!
  • You may find that the discogram is not necessary. It is not a test that is done routinely, and best avoided if not absolutely necessary.

    I'm glad the surgeon's office could reschedule you right away.
  • Overall, it was definitely a positive experience.

    I went through my list question by question, although I totally forgot to ask him about stem cell therapy to actually heal herniations (heard about it from a news story my dad sent me)

    So, his plan is to do a 3 level TLIF from L3-S1. He does feel L3 would just cr*p out on me quickly if we don't fuse it too. For the graft he said he would use a combination of the bone he remove to access the space (my lamina) as well as either bone marrow aspirate from me and/or Osteocell (concentrated stem cells), he's not a big fan of BMP b/c of potential complications.

    He expects the surgey to last about 5 hours, 3-4 days in the hospital. As far as pain control, 2 days with the PCA then transition to oral meds. Oral meds would be Percocet for a few weeks then to Vicodin then Tylenol and Robaxin for my muscle relaxer.

    Basic PT in the hospital then start outpatient PT at the 6 week mark for 6-8 weeks with aqua therapy if needed.

    I would get fitted for a turtle brace pre-op and of course, wear it anytime out of bed for 12 weeks.

    Follow up X-rays at 6 then 12 weeks.

    I guess this is the normal run of the mill stuff for fusion.

    My only question is, I guess you have to wear the brace even in the shower?

    He really made me feel better about the whole fusion idea. I was almost ready to start booking the surgery right then! LOL I know better though and plan on meeting with NS #2 next week.
  • Gwennie . . .I haven't seen the last Neuro. I go on 12/15 and I was told I could call next week to see if they have cancellations. He works out of a place that has an ADR surgeon as well. I have tons of questions. I know I need surgery for sure. I know I won't get better. I am just in agreement with my original ortho dr in that a fusion is permanent . . .there's not going back. With revision microD (or even Hemi-laminectomy) I feel like I can have a chance. It's why I picked the original doctor to begin with. He and his partner are more conservative surgeons. I think what's scaring me is that some people say "oh with each surgery you risk infection, yadda yadda" but what they don't get is that with a fusion it's basically breaking my bones.

    My husband is amazing . . .he just reminded me there's one more neuroS we trusted from the initial incident that I haven't talked to (I didn't use him only b/c he didn't operate out of the hospital where my primary worked out of). He wants me to pay the money to see him too. He's realizing it's a huge decision.

    I do know I have to be prepared to be with a doctor long term now in case my numbness escalates.

    Farmgrl - you said it exactlyt right. It's what's the lesser of 2 evils. I have a modified gait b/c I lost my achilles reflex and while it's improved, it's not great. I've pretty much been told by several doctors they doubt I'll get my reflex back. I know revision will likely mean another surgery (i.e. fusion in 3 months, 2 years, 5 years, or 10) . . .but a fusion will likely guarantee me another fusion too.

    So it's all about the gamble. Do I gamble on a less invasive surgery to buy me time until technology is better or do I hope the fusion is like some of the people I've talked to that have lasted 20 years.
  • Hey Christine,

    Most certainly 2 docs is well worth talking to given the big jump from a 2nd micro to a 3 level fusion. Wow! I never did the revision micro on mine. After the accident the surgeon put me in PT and on meds. It never got better. Last month I had enough and the neuro I was seeing told me the disc was pretty much gone. I did MRI and discogram. Single level fusion.

    On my AxiaLIF the surgeon also used stem cell. I put in the info in my update on my surgery. Like yours mine will not use BMP ever again. He uses Trinity Evolution with some of your bone and blood.

    You already how I did with the meds. I hope you stomach them better. It would make the first couple of weeks more bareable.

    The turtle brace is not bad if you get one like they set me up with. It's a full brace with aggressive adjusters. The big plastic shell slides in the back. So you can work your way down from the hardshell to just using the brace without it. It has a small backing built in. Riding in the car at first have that hard shell on helps. Watch out for speed bumps!!! They hurt... You don't wear the one I have in the shower. I didn't sleep in mine either.

    On the Chantix. Remember way back when we were both getting ready for our 1st microdiscetomy? Couple of years ago. Well we talked about the Chantix. I dd it. It stopped for a year. Then made a stupid mistake and started again. 2 months later I took what was left over from the original script. Barely a months worth. Took them again and stopped again. It's been 9 months or so. So basically almost 2 years now of no smoking minus that lapse. You can do it!!! I wish I still had some left I'd send them up to you.

    Good luck with the other appointment.

  • Hi Graham,

    I'm feel like I'm leaning 75% toward fusion & 25% towards the repeat Micro-d. You're completely right, 3 levels is a big jump! Its pretty intimidating and I'm a bit scared of the idea of any fusion, really due to the pain! Of course, there's the 'forever' part too!

    I did pretty well after my micro-d with Percocet, not so well after my liver surgery. Really I think it was the IV pain meds that messed up my gut and lead to all my nausea and vomiting. I definitely made sure the surgeon had a bowel program plan in his head, don't ever wanna go through that again if I can help it.

    I wasn't sure about the brace. I was trying to find a pic to send to my dad and came across a few sites. One had info on how to apply one and it mentioned wearing it in the shower so I was just wondering about that.

    You did really well with the smoking! Congrats! Unfortunately, I relapsed just over 2 months after surgery. At the time I had to pay out of pocket for it so I took if for two months, my downfall was being around other smokers at work! The second time I attempted it was with my liver surgery and insurance covered it. I only lasted about 2 days...this time I had many smokers around me. I have two weeks of Chantix that expired in June and then another two weeks that is good...the expired pills should work (if anything,they may be less effective). It stinks the new plan doesn't cover it, I just think its crazy that they don't.

    I'll keep you posted on the next appointment!

    Z06 said:
    Hey Christine,

    Most certainly 2 docs is well worth talking to given the big jump from a 2nd micro to a 3 level fusion. Wow! I never did the revision micro on mine. After the accident the surgeon put me in PT and on meds. It never got better. Last month I had enough and the neuro I was seeing told me the disc was pretty much gone. I did MRI and discogram. Single level fusion.

    On my AxiaLIF the surgeon also used stem cell. I put in the info in my update on my surgery. Like yours mine will not use BMP ever again. He uses Trinity Evolution with some of your bone and blood.

    You already how I did with the meds. I hope you stomach them better. It would make the first couple of weeks more bareable.

    The turtle brace is not bad if you get one like they set me up with. It's a full brace with aggressive adjusters. The big plastic shell slides in the back. So you can work your way down from the hardshell to just using the brace without it. It has a small backing built in. Riding in the car at first have that hard shell on helps. Watch out for speed bumps!!! They hurt... You don't wear the one I have in the shower. I didn't sleep in mine either.

    On the Chantix. Remember way back when we were both getting ready for our 1st microdiscetomy? Couple of years ago. Well we talked about the Chantix. I dd it. It stopped for a year. Then made a stupid mistake and started again. 2 months later I took what was left over from the original script. Barely a months worth. Took them again and stopped again. It's been 9 months or so. So basically almost 2 years now of no smoking minus that lapse. You can do it!!! I wish I still had some left I'd send them up to you.

    Good luck with the other appointment.

  • Christine,


    Here is the brace I have. If you look at the back. In the middle is a big plastic panel (it has the yellow dot in it). That panel is inserted into the brace. You wear that to get major control of your back. You remove that big plastic panel later. Then behind it is a smaller less rigid plastic panel. The brace has pull straps to tighten it up good and snug. So you can get support but freedom to move. Doc told me to pull the big plastic part out after a few weeks and get used to less support. Make my muscles start helping. I was told not to wear it in the shower at all. I suppose I could. It is washable.

    I'm surprised you got Percs after the micro. I got Darvocet and was told that was enough for a micro. I did fine with it. You will need and want the Percs if you do fusion. It will hurt much more than a micro. I won't BS you on that. I understand your fear. You are trading more pain now for less to no pain over the duration. The trade-off is worth it to me, but it has to be worth it to you. The AxiaLIF is supposedly less invasive. Yeah right. Those pedicle screws and rods are no joke. You'll sleep a lot at first anyway. My body just shuts down after surgery.

    Don't worry about those Chantix that expired in June. They'll work just fine. Mine were expired and they work no problem. It's not the pill, it's you. You have to want to stop that bad. A 3 level fusion should be more than enough reason. That is a lot of fusion. You need to do everything to enhance your ability to fuse. You need to being your A game girl.

    I can't believe anyone who has insurance can't get Chantix covered. That is stupid. Smoking is about one of the worst possible things you can do. Causes so much damage. The company I work for is self insured. They cover it for anyone with no questions asked. They are 100% dedicated to help make everyone non-smokers. They are smart enough to see the long term.

  • Wow Graham, your brace looks so much smaller than what I'm imagining my surgeon wants me to use. He told me that it would go all the way up over my breasts! Thank goodness its winter time!

    I got Percs after my Micro-D because I told my surgeon the worked really well for me in the hospital. He tried to get me to just use the Vicodin he'd prescribed a month before my surgery but I kind of pushed him on the Percs. I'm the kind of girl that like to have options...especially with pain control! I took my Percs for a about 10 days post-op. I don't think I could have just taken Darvocet, they never did a whole lot for me. I took them after my gallbladder surgery in '03 and I just called them Tic-Tacs LOL

    I think I may have just have a low pain tolerance. After my laporascopic (ha!) liver surgery, they had to keep me in the PACU for an extra hour because I was hurting so much. All I remember hearing was somebody (I guess the anesthesiologist?) saying "start her on a Dilaudid PCA". I don't remember moaning or screaming in pain. I was on that PCA for 3 days! Then again, that "minimally invasive" surgery lasted for 5 hours and they pulled the liver tumor out through about a 4 inch incision just above my pubic bone, just like a c-section. There was lots of manipulation in my abdomen, I was very bruised and swollen so I guess that explains a lot!

    Were you able to cut your Chantix in half? I know that you have to taper your dose up for the first week and those pills are just so tiny! I'm used to using pill cutters at work and couldn't imagine trying to use one of those, I'd probably crush the darn thing trying. I guess I could try with a sharp knife. I just realized that a friend at work got a script for it in August, well after our prescription plan changed. The medical campus where I work went smoke-free (for everyone, including visitors) in January and of course, there was a big push to encourage us to quit including vouchers to even help your spouse quit. I'm going to check with my prescription plan then with HR & Occupatioal health to check on this. At least I have pills to get started with this. Now I just have to pick my quit date. I'm thinking of Christmas Eve or Christmas...its really the best present I could give myself.

    Speaking of my A-game, I also have got to get started on weight loss as well. I notice that its a topic many people don't talk about on here. I'm surprised that none of my docs have really pushed me on this. When I talked to my surgeon with my mom there, the topic came up of how to maximize success of not just fusing but for the long term...I just blurted out "I've got to quit smoking and lose weight". My surgeon got a smile on his face and just nodded in agreeement.

    I'm thinking I'd like to lose 20 pounds before surgery, I don't know how realistic that is. I know I've gained 10 lbs since this debacle started. I'd like to to chalk it up to the Medrol dosepaks & prednisone I had to take before my ESI's but I know a lot of the weight gain has to do with ME! That 10 lbs isn't helping the situation at all. I successfully lost 47 lbs five years ago using WW so I know the program. I have the tools to lose it, I just need to use them!

    Anyways, I read your post about your 4 week follow-up. It sounds like you're doing everything right for a successful fusion, keep up the good work :) All I can say is you're a lot tougher than me!

    Sorry for the long winded reply. I've been at work all weekend and have had lots of thoughts about this going through my head, just no time to post.

    Take care!
  • Christine,

    There are all sorts of braces depending on how much limitation they want. For me, single level. lower lumbar. He felt that was sufficient. If you look on that same site under other lumbar braces. There is one that is based on what I have. Only it goes further up your back and goes up the front around your breasts. You would look Zena the Warrior wearing it. I'm sure you wouldn't bend at all !!!

    Pain tolerance is all relative. After the micro I took the Darvocet-N full dose for 3 days. Then backed off to nothing by the end of the week. Took Advil the following week. Saved the Darvocet for the couple of times it flared up. Right now I'm taking the Hydrocodone cut in half once or twice a day at most. That might change after PT tomorrow...

    On the Chantix. Yes. Get a pill splitter and you can cut them in half no problem. I tried cutting them in quarter pieces and that was a problem. I weened myself off them too. So I did half/day to start and half/day the last week too. I think for some it is a shock just stopping taking it. Our company went campus-wide smoke-free also.

    Funny I gained 30lbs on Lyrica in a few months. I stopped taking it because my brain was in a fog. My pants wouldn't fit in the waist at all. When I hopped on the scale and saw the 30lbs I freaked. I've been slim all my life. I'm like WTF happened there? Some talk the weight issues in the Diet and Exercise section. You just can't use the work "fat" or they all flip out... I know that 30lbs I got ain't muscle and it ain't feathers. What else could it be??? LOL If you are overweight then you tax your spine. So if you can drop some then all the better for you. No smoking and less weight should help and I think it will help with your mental state. Being in an upbeat mood before surgery is good too.

  • Hi Christine,
    as you know, quitting smoking is horribly difficult, but you can do it. I smoked for years and years and that might be why I have my disk problems-smokers are much more likely to get herniated discs. Anyway I have a few tips.
    1. Take some Nicorette gum or lozenge, and when you are chewing it inhale deeply. It will feel just like a cigarette.
    2. Consider how you are feeling right before you are back to smoke a cigarette. Think about what the emotion is. If you are angry, chew some gum. If you are tense, have a drink of water or 10 deep breaths. It sounds hokey but it works some of the time.
    3. If you are really stressed out and have a cigarette, throw the rest of the pack out. If necessary, dump them in water. Yeah I know they cost 10 bucks, you will hate yourself for spending the money but in the end it is worth it.
    It is totally possible to quit smoking. I smoked for a really long time, about 15 years. About a pack a day. If you wait long enough you just don't even think about having a cigarette anymore. It's not even an option, because the nicotine is out of your system. If nothing else works think about your back. Good luck.
    By the way, your neurosurgeon sounds much better than mine. Just wondering-if you live anywhere near New York City please let me know, I'm looking for a new doctor.
    I hope this doesn't sound too preachy. I tried one of those medications when I was quitting, forgot which one it was, but the medication had side effects and I ended up having to do it cold turkey. Actually it was more like warm turkey, because I had frequent slips. Then I would have to throw the rest of the pack away. But now I don't smoke. My back is still a mess though!
  • Just wanted to let you know that I read your repsonses and I will reply soon. Thank you!

    Woke up about an hour ago and I feel like crap. I'm nauseous & dizzy; I made myself vomit once to see if I'd feel better (sorry if that's TMI). This feels like a bad hangover and being drunk at the same time. I'm not sure if its the Neurontin vs. a stomach bug but I'm seeing the 2nd NS today for the 2nd opinion. I can't cancel the appt since his next one isn't til January. My boyfriend is going to drive me as I can barely walk straight without bumping into the wall. I think I have to call out from work tonight.

    I'll let y'all know how the appt goes...



  • For my lumbar fusion my NS only fused the 2 collapsed levels L4/5-L5/S1. He said it would be 10 years before I have problems with the disc above the fusion. I've never heard of fusing a good disc, this is new to me. Good luck with your 2nd opinion, you can never get too many. I got 3 opinions before fusion. Two were the same and one suggested a pain pump or SCS. I'm glad I got the fusion, it has changed my life! I hope your surgery changes your life for the better too.

    Faith M
  • Well I went for the 2nd opinion and he recommended a 2nd micro-d. I told him about my NS giving me the choice of a repeat or to move to fuse and NS #2 strongly advised against it. He reassured me that my NS is a great surgeon (LOL...I already knew that) but his way of thinking was "if it ain't broke, don't fix it" which I totally understand.

    So, I've decided to have the 2nd micro-d. The 2nd opinion pretty much sealed the deal for me but I honestly just haven't felt THAT bad and I felt the move to fusion was a little too quick for me. If I reherniate again then I'll know its time. I really just can't accept the permanent nature of it at this point.

    This time around though I know I need to make changes (and I'm accepting it as fact!). As mentioned above, weight loss & quitting smoking are still on the agenda. I know these are factors that I definitely have control over and I need to do everything I can to know that I've fought the good fight.

    So, I called my NS today and told them to get the ball rolling on this. Their scheduler is going to call me next week to let me know.

    I saw my PCP today and she thinks my dizziness might be a combination of the side effects of the Neurontin as well as some inner ear inflammation from a cold that I caught last week. I walked out with a script for Flonase to help that. I also found out incidentally that my vitamin D level is really low. The bottom range is supposed to be >32 and mine was 6! So now I have to take a vitamin D pill every week for the next two months and get that rechecked at the end of the two months. From what I've read, low vitamin D levels are associated with chronic pain among many other things...

    @Fatih M... My L3-L4 disc isn't really healthy but its not necessarily giving me problems. It does have degenerative changes (its blacked out on MRI). I'm glad fusion worked for you. :)

    @Painfuldya... Unforunately, I don't live in NYC but I used to! Where do you live? I spent my teens living in Bayside/Douglaston in Queens. My sister is still up there and my brother recently transplanted up there from Miami.
    Thanks for the smoking tips, I just have to remind myself that I can do this! Alternative coping strategies are key :) I am in VA so cigs are about 5 bucks a pack here but my siblings are still paying those outrageous prices in the city. (I feel like I'm in the mob everytime I drive up there with 6 cartons of smokes for them LOL.) I'm going to have to keep reading your post in the coming months.

    @Graham... I guess the brace is moot at this point! Thanks much for the info though :) I was at the store tonight and totally forgot to pick up a pill splitter. I was going to nag the pharmacy about the Chantix again but they were so busy I decided to forget it for today. Now I just have to really pick my date, still thinking about Christmas.

    Hope everyone is staying safe while getting their shopping done!

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