Need advice on handling L4-L5 spinal fusion with Type 1 diabetes

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swkath505

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:confused: Hi. I am brand new to your forum and seeking advice on issues to be aware of and how to prepare for managing the pain and recovery I anticipate having from a spinal fusion this coming May 2008. PLUS, I'd love to know if anyone else out there in my position also is dealing withType 1 diabetes like me.

I was diagnosed with DDD and mild to moderate stenosis (lurabar) and spondylolisthesis (L4 onto L5) just over a year ago. Then, my butt and leg pain got so bad from the nerves being pinched that I could barely walk. So in May 2007, I underwent a partial laminectomy on my right L4-L5 vertebrae. Much (but not all) of the pain was helped by this surgery, but I really suffered because I got very ill for several weeks from taking pain meRAB I couldn't tolerate at all--oxycodone and hydrocodone. My first doctor and his staff just kept telling me to take these drugs--despite daily episodes of violent vomiting. I had to take myself off these drugs--cold turkey!--because I knew something was hurting me but I didn't know then (being in a fog from the pain and recovery) just what it was. It took me all summer to recover. Then, just 3 months later, the same pains all appeared on my left side!

Finally, I think I have a good neurosurgeon, but I am petite and REALLY worried about pain management following the fusion I've scheduled in May. Can you tell me whether one type of "hardware" being used for fusions is considered better than any other? My dr. plans to use a titanium cage. Any recommendations on what to do (or ask for) from my doctor and his P.A.? Do I need to get another opinion on fusion? I don't think there are really any other viable alternatives out there . . .

Thank you. Being so new at this has been very difficult, but I've already been helped just reading some of your posts! Looking forward to hearing back from many of you and hope those recovering from surgery are doing well.

kathy
 
Hi Kathy, and welcome to the board!

We're not doctors, but we all have back problems of various types, and many of us have had fusions. We can share from our own experiences and try to answer whatever questions you have.

As far as the pain meRAB, there are others out there. Make sure your doctor knows the reaction you had last time. I'd put that at the top of your list of questions. Ask him what alternatives are available for pain control. Some other questions you might want to ask: will he use BMP (a protein matter that helps to stimulate bone growth), will he use your own bone from your hip or donor bone, will you have a brace after surgery, will you have a walker, are you allowed to go up and down the stairs, how long to not drive, how long for your husband (if you're married) to "leave you alone", will he use staples or stitches, and will he approve temporary handicapped parking for you (look at your local DMV's website for the forms -- it's very helpful when you need to be able to open the car door wide to get in and out).

I don't think they use much other than titanium anymore. When I asked my doctor what kind of metal I had in me, he said it was mostly titanium. I guess there are bits and pieces that aren't, but I don't know what from the x-rays. It all just looks white.

I don't have diabetes, but I do have a son who's a type 1, and we've been told that if he gets a major illness, to just keep testing regularly even if he isn't eating at all. You know that anything out of the ordinary, like illness or surgery, can affect your glucose levels. How was it last time? Did your levels get off very much after surgery and during recovery? Did you feel like you had it somewhat under control? I know type 1 is completely different from type 2, so I really hope you find another type 1 you can talk with. My son gets so frustrated when his grandma, who's a type 2, tries to "help" him to take better care of himself by eating right, etc. She just can't get that he isn't diet controlled. He thinks he has it easier than type 2's because even though he has the more serious type, he can eat whatever he wants. He just takes whatever insulin he neeRAB to cover it. I know there are some type 2's here on the board (and I'm not saying that what they deal with isn't serious), and I hope some will chime in even though it's different. There are still some similarities, too. (You all have sore fingertips! Except my son. He hasn't tested on a finger in two years except at a doctor's appt!)

Read the sticky at the top of the page called "post surgery tips." It has a wealth of information that will help you prepare. My best tips: get a satin-type bottom sheet for your bed and slippery pj's. You'll be able to turn sooooo much more easily, without nearly as much pain. I took off the top sheet, though, and put the cotton one back on. The satin one slid out from being tucked too easily, and I couldn't get it back myself after surgery. And get yourself a good quality grabber tool. You'll use it regularly! It will be worth it's weight in gold your first day home!

I would get a second opinion for your peace of mind. You have a few months yet, so you have time. Are you comfortable with the doctor you have now? That's very important, to have a good trust level with him. But I would still get a second opinion anyway, from a doctor is a different group.

I hope this surgery will be exactly what you need and that you'll be back to your old self after some recovery time.

Take care,
Emily :wave:
 
Hello Kathy,

I had a fusion at L4-5, using a cage and titanium hardware 5 weeks ago today. I too have spondylolisthesis and stenosis. My doc used BMP and the bone that was removed from the laminectomy, which is supposed to have a higher rate of fusion than donor bone.

I think you are correct in that fusion is the next (and hopefully last) logical thing for you to try. I doubt getting other opinions will result in other options for you. If you are curious, you might look for an orthopedic surgeon who specializes in the spine, and who has fellowship training in spinal surgery and consult with him/her for a "second" opinion.

I was so determined to avoid surgery that I consulted with 8 different spinal specialists. They all told me that I needed a fusion...so then it was a matter of making a decision based on other things. In my case, the neurosurgeons I consulted with, recommended fusing more levels than did the other surgeons.

Emily covered many of the other tips that are so helpful. I followed her advice for my surgery and I was totally prepared for my recovery. The tip about the satin sheets is very helpful. You don't have much strength when you first try to turn over and the sheets in the hospital feel like velcro. Going home to the satin sheets made such a difference.

You have plenty of time to prepare for your surgery. Please keep posting with your comments and questions.
 
Emily: Good advice which I appreciate! Thanks for getting back to me. I will be deciding who to see for a 2nd opinion--probably someone at UCLA Spine Center or Cedars-Sinai. And what a reason/excuse to get satin sheets! That sounRAB funny, but it's something I'd never have thought of . . .

kathy
 
The sheets were the best tip I got off the board, too. It never would have occurred to me, but in the hospital it was so difficult to try to turn over. I felt like I was attached to the bed with velcro. When I got home to my nice satin charmeuse sheets, it was so simple to move in the bed...took no energy at all. When I slept in the bed the first night home, I almost launched myself completely out of the bed when I turned over the first time. So, do be careful.;)
 
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