Airline Travel: When booking your flight, talk with a reservations person and tell them about your surgery and need for a bulkhead seat for all legs of your return flight. That will give you the easiest seats to get into and out of with crutches and the most leg room to reduce the flexion of your hip. If you book these seats yourself you can get bumped from them for “priority” passengers who need them, as an online booking will not ID you as a priority person. Be sure to confirm these seats when you arrive at the airport for a return flight. Also, when you check in for your return flight, ask for a voucher for a wheelchair to meet you at your layover and give this to the flight attendant in the plane. Another possibility is to use the “golf cart” transporters, but they may be difficult to get into and out of.
Housing & Transportation: I had my procedure on Wednesday (hospital check in 9:30 am), so with a Tuesday morning (10:30 am) office appointment with Dr. Gross we arrived by plane Monday evening. We stayed at and recommend the Comfort Inn on Bush River Road Phone (#803-798-5101). This is for several reasons: 1) They have free shuttle service from the airport, 2) will take you back to the airport or car rental facility the next morning (if you do not rent a car upon arrival), 3) have very nice comfortable beds, 4) will come pick you up at Providence Northeast Hospital and bring you back to the hotel on your discharge day, 5) have ADA handicap rooms close to the front desk with elevated toilets (so you won't need a raised toilet in Columbia) and walkers in the shower (much safer than crutches), and 6) shuttle you to the airport the following day for your flight home. They also have an accommodative staff, as Vijay and Nick were very helpful, the usual free breakfast and wireless internet service. My wife traveled with me and she slept in a fold out bed in the hospital, so we only needed a hotel before and after the surgery.
Car Rental: We used Enterprise for car rental as their prices were competitive and they had a drop-off location Northeast and Southwest of the hospital where you can leave the car the day of surgery and they will take you to the hospital for check-in. Be sure to clarify this arrangement when you rent the car. That way you really only need to rent a car for one 24 hour period, to get to the doctors office, drive around for the day and get to the hospital the following day. Your doctor office visit and surgery time may require a different schedule.
Office visit with Dr. Gross: Give yourself 2 to 3 hours as it is a slow process. The office is about 15 minutes from the hotel. Be sure to write down all of the questions that you want to ask or you will inevitably forget some. I expected Dr. Gross to be all business with the number of cases he does and rush through the office check. Instead, he was very personable and went out of his way to explain things clearly, showing models of the components and making sure that every question was answered completely. He showed no inclination to leave the room until I was completely satisfied and he demonstrated his concern for his patients in other ways as well. This is a big plus on top of his knowledge and skill.
Pre-Op in the hospital: After checking you in, they will start your IV and draw blood for pre-op testing. They will try to draw blood from the IV so you only receive one stick. If the person starting your IV causes a lot of pain, ask for someone else to make the second attempt. The IV should not hurt that much and some people are just better than others. Request that they do not start the IV in you hand, wrist or bend of your arm as these areas will be painful and troublesome during your stay.
When they use hair clippers on your leg and butt (guys), be sure you brush off all of the hair that is stuck to your body and they change the sheets on the stretcher so you don't take loose hair into the OR room for your surgery. They will also put a blood pressure cuff on your arm, oxygen sensor on your finger and heart monitor patches on your chest.
In the OR: After hooking you up to heart and oxygen monitors they will have you sit forward on the OR table and give you an injection in your back consisting of several medications. This will be the spinal anesthesia that will numb you below your belly button for the surgery and reduce your surgical pain for 24 to 36 hours after the surgery. I feel like this is safer than general anesthesia as is has the potential for fewer serious complications, and is one of the reasons I chose Dr. Gross. This shot will just be mildly uncomfortable. After you lay back down you may feel an odd sensation as they insert the foley catheter into your bladder, but you will be pretty well numb by this time. Shortly afterwards they will give you drugs to put you to sleep, but will allow you to breath on your own. You will not even know the surgery is going on.
In the Recovery Room: When you wake up, they will be watching your vital signs closely for an hour or so until you go to your room. You are going to feel some degree of numbness below the navel which is normal and you will have minimal pain in your hip area. You will have a foley catheter in your bladder, this will be uncomfortable, but will allow you to urinate freely so they can watch your fluid status. You will also have leggings that will inflate and deflate. This is to help prevent blood clots from forming as your muscles are not working normally due to the spinal anesthesia. They are a bit annoying but will be on for the first day and night, then off the next day. From this point forward you have three leg rules- 1) do not move your leg to the midline (centerline) of your body, 2) do not rotate your toes inward, and 3) do not flex your hip more than 90 degrees. These are essential as they help to prevent a dislocation of your new hip joint (very bad).
In your room: All of the rooms are private, have a fold out bed, and have wireless internet access so bring your computer to help pass the time. The low level of pain is from the long acting narcotic in the spinal anesthesia and the oral and injectable drugs given by Dr. Gross. He really does an excellent job here. Saying this, one of the more common side effects is nausea. Just drink water first and give it some time in your stomach. Continue drinking plenty of fluids over the next few days as it will be very important. Start eating slowly and don't chow down your first meal. You may want to ask for an anti-nausea pill to prevent this from developing, or at the first sensations you have of feeling sick to your stomach, ask for one right away.
The staff is good, as they take care of patients with this surgery frequently and you will have a nurse and a nursing assistant working with you. They work two 12 hour shifts going from 7 to 7. You will wake up with the cool pad over your surgical area that you picked up at Dr. Gross's office. This is your best friend and is part of the pain control. Use it regularly for the next 1 – 2 weeks. The ice in the bucket needs to be changed about every 4-5 hours or it melts and the pad warms up. Sometimes the staff forgets to change it, so if the pad feels warm to you, ring the call bell and they will be happy to fill it up. If your surgery is done before 1 o'clock or so you may have Physical Therapy come and begin your exercises and walking the same day as surgery. You will need to follow their directions at home, so follow their instructions carefully as their information is critical to your recovery.
Guys, your legs will be coated with a surgical soap that has glued all of your leg hair to your skin. This will become itchy and uncomfortable, especially during the night. The staff has a white cream that will melt the soap and free up your hair. If you have a significant other staying with you have them use this with a wash cloth on your legs. If you are alone, have the staff do this. Trust me, you will be glad to do this.
You will have the oxygen meter on your finger, this is to monitor your breathing in case the drugs in your spinal injection effect your breathing. If the machine is beeping with every heart beat, ask them to turn the volume off as it is not necessary. This noise will combine with other factors to keep you awake at night. If your oxygen level drops the machine will sound an alarm and this is all that is necessary.
Pain Medications: The staff will regularly offer you Tylenol for you pain, take them. They have basically no side effects and will be helpful. There will be stronger pain medications for you as well that are related to morphine. You want to take these stronger pain medications before the level of pain increases, or it will be difficult to reduce the pain. Balance this out with not taking them when they are not necessary, as there are side effects that you do not want. One of these is a slowing down of the bowels which are already affected by the spinal anesthesia.
First Night: We were awoken almost hourly after 1 am the first night, and I hope these steps will help minimize your sleep disruptions. The staff will say that their job is to keep an eye on you and not necessarily let you get rest. However, with some coaching you may be able to get them to minimize the wakeups and improve your care. I strongly encourage you to ask your nurse to do the following: at 10:00 pm when you have medications and vital signs due, have them refill your ice bucket at that time. While taking your medications, firmly request that your nurse comes in to check you at the same time as the assistant gets your vital signs at 2:00 am and refills your ice. Ask them to come in for the 6:00 am vital signs and ice refill when the phlebotomist comes in to take the early morning blood samples. It was extremely annoying and unrestfull when their visits were staggered. Their excuse is that they need to check on you, but they can do this in a coordinated manner that provides better patient care.
1st Post-Op Day: First thing in the morning they will take out your foley catheter. It will hurt but only for a few moments. Afterwards, you are going to feel like you need to urinate but it will just be a false sensation. When you do pee, it will hurt again and feel difficult to get started. You may also have some air burp out with the urine, which will resolve after a day or two. This pain will decrease after a few more urinations and it will be normal in a few days. Measure your urine (urinal for guys and hat for gals) for the staff who will be keeping track of this today. I suggest you get up and go to the bathroom whenever you need to urinate as this movement is good for the body. Get up only with help, as there is an increased potential for falling and serious injury this soon after surgery.
Your hip and leg will still feel pretty good, I was amazed at how little it hurt. Stay up in the chair as much as possible and follow the OT and PT instructions for your activity. If you have work to do this is the day to get it done because the next couple of days will be more uncomfortable.
Your digestive system and bowels are going to be messed up with the drugs you have received and this will be a problem for you over the next few days. I did not follow everything here and my abdominal pain was much worse than my hip pain. Don't minimize this complication. Here are a number of suggestions that will help
(http://www.spine-health.com/treatment/back-surgery/preventing-constipation-after-back-surgery):
·
Increase
activity as soon as possible after surgery. Walking is an excellent way to
help bodily functions return to normal, and also helps with healing from the
surgery.
·
Limit use of
narcotic medications (e.g. Vicodin, Tylenol #3, Darvocet, Percocet,
Oxycontin) to just what is necessary for adequate pain control. Narcotics
slow down bowel motility, leading to constipation. Consider switching to a
non-narcotic pain reliever (such as regular Tylenol or extra strength
Tylenol) for pain control shortly after surgery to reduce the risk of
constipation.
·
Begin using a
fiber laxative, stool softener, or combination product after surgery to
reduce the risk of constipation, particularly if one has experienced
constipation in the past.
·
Drink plenty
of water and other non-caffeinated fluids (at least 40 oz per day), provided
that the physician has not restricted fluid intake for another reason. Prune
juice and apple cider (not apple juice) are also excellent natural
laxatives.
·
Eat foods
that are naturally high in fiber to stimulate the intestines. High-fiber
foods include beans, whole grains and bran cereals, fresh fruits (such as
watermelon, grapes), and vegetables (such as lettuce, carrots). Limiting
foods that contribute to constipation is also a good idea, such as cheese,
meat, and processed foods.
·
Eat small,
frequent meals throughout the day, rather than large meals to aid in the
digestive process. (Save some fruit for between the meals snacks)
Even with
doing these things it may be until your 3rd Post-OP day before
you have a bowel movement.
2nd Post-OP day: Your hip is going
to be more sore today, so utilize the stronger pain pills but only as
needed. Be up as much as you can in the chair, take a walk as often as you
can, continue eating as before and drinking lots of water. This was my most
uncomfortable night, from abdominal cramping and pain, not the hip pain. I
did not follow all of the recommendations above and paid the price. If you
sleep on you back, put a couple of pillows under your legs to give you a
little hip flexion to make it more comfortable. If you sleep on your side,
be sure to place a couple of pillows under your operative leg to elevate it
and not allow this leg to approach the centerline of your body.
3rd Post-OP day: Your hip is going
to feel stiff today, but don't let that slow down your exercises and
walking. These activities will loosen it up and help. Other writers on
this website have inferred about the difficulty of their first bowel
movement and this is not to be underestimated. Here are a couple of
suggestions. Sliding your underwear down to your thighs will keep your legs
fairly close together and create more pain in the hip as you sit on the
toilet. For a more comfortable position, and to make it easier to lower
yourself safely onto the seat, drop your underwear off of one leg completely
so you can move your feet and knees further apart. Find a comfortable
position and try to relax, try not to strain, it will take some time and
won't be pleasant. If you feel light-headed lean back and let whoever is
with you know so they can come into the bathroom with you at this point.
People have passed out and hurt themselves.
Flight Home: When checking in to return home,
confirm your bulkhead seats. Allow plenty of time for wheelchair travel and
a full body search by the TSA people. It is going to happen, so just
accept it. Some of the airplanes leaving Columbia will arrive at their
destinations and park away from the terminals and lower the plains steps to
the tarmac. To prevent this, let the flight attendant know that you will
need a ramp upon arrival, and they can make that arrangement. They will not
automatically put together a slow moving person on crutches with the need
for a ramp.
Home: Pretty much continue what you have been
doing. If you start feeling like things are difficult, think of all of the
young men and women that are returning from fighting in the middle east
without legs. Again, this information is from my personal experience (and
hospital experience) and yours may be different. I hope it will be of some
help.
