Monday morning

They are operating on about a quarter of Robert's back today. Maybe it's as much as a third. 

The procedure is supposed to take 6 or 7 hours, plus another hour or two for him to wake up from the anesthesia. If all goes well, I won't have any news to report until 5 pm or so.

He is the only surgery Dr. Abbed will do today. We just got him admitted, IV'd up and he's been wheeled off on a rolling bed. I'm spending the day in the pleasant "family waiting room" where they give us caffeine and carbohydrates and wireless access. That's just what we family waiters need.

The best possible outcome is that 6 months to a year from now, he will have less pain in daily life and be able to stand up straighter than he can now. But even if the operation doesn't manage to lessen his pain (which it may not -- the doctors can't promise that) he will still have a straighter back and a more protected, more stable spinal cord. So the game is worth the candle.

A couple of weeks ago I sent an email to our family explaining the Robert's procedure. I'll reproduce it here now as a fact sheet for those who are interested.

Robert's diagnosis: spinal stenosis and degenerative scoliosis.

Why they want to do surgery: Three reasons.

· His spine is so unstable it is not protecting his spinal cord well anymore, and he's at risk for serious spinal damage if he were in a minor accident.

· The deteriorating spinal column is gradually damaging nerves that control functions like balance and walking.

· The problems in the spinal column are causing pain.

Date of the surgery: Monday Dec. 12

What is the doctor going to do?

· Laminectomy -- removing a portion of the spine's structure to create a larger space for the spinal cord and lessen the pressure.

· Fusion -- because the laminectomy removes some stabilizing structures from the spine, screws and rods are used to restabilize the vertebrae. Eventually some of the bony vertebrae will fuse together also to improve stability.

· Insert disk spacer at least one place to improve the "hinge" between his lumbar (mid-lower) spine and his sacral (lower-lower) spine.

Why is Robert's back in such bad shape? Just bad luck genetically. His spine got dealt a bad hand, so to speak. He didn't have an accident, he doesn't have an infectious disease.

Is this a big deal? Yep.

The doctor is operating on 6 or 7 vertebrae. The surgery will take something like 6 hours. The recovery from the surgery is complicated by the fact that they have to cut a bunch of muscles to reach the spine. So the recovery process is not so much recovering from what they do to the spine itself as recovering from the incisions that cut the muscles. This will take a long time. He will probably be walking slowly and not enjoying life much for at least 3 months. At 6 months he may seem normal. It may take 12 months for the full benefit of the surgery to be apparent to Robert.

Will he go into rehab after the surgery? They don't know that until after the surgery. After he's been in the hospital for 2 or 3 days, they evaluate whether he can do basic things on his own: walking, going to the bathroom, bathing. If he can do those things with assistance from me, then he goes home. Some people do go home two or three days after this kind of surgery. If he needs professional help with those things, then he goes into rehab. A lot of people do go into rehab.

Do I know what rehab facility he would go into? Not yet. Have to research the ones that are near us.

Do I want him to go to rehab? Well, yes. Most people seem to think that rehab facilities are great, caring facilities. I would love to get extra help taking care of Robert. So we'll see.

Will we have someone come into the house to help out? If necessary. I'm very open to the idea. Apparently I have a reputation as someone who tries to do things on her own without any help. Not in this case. I will seek out help!

Will Robert be in less pain after the surgery? Not right away. He will be in much more pain because of the incisions to the muscles. But as those heal, he should be in less pain, over time (8-12 months). The pressure on his nerves that causes pain should lessen, and the muscle spasms that are caused by his scoliosis could be addressed by exercise, massage and ultrasound.

Is pain the main reason they are doing the surgery? No. The main reason for doing the surgery is to prevent Robert's basic lower body functions like walking from deteriorating any further. Improving his pain is really a side issue for the surgeon, although he says that 80 percent of people who have this surgery do in fact have less pain once they have fully recovered from the operation.

Are there any special concerns for Robert as a patient?
1) Since he is diabetic, he supposedly heals less well than the average person, but in fact we haven't seen any sign that Robert's healing powers are diminished. He healed very nicely from the neck/cervical spine surgery he had in July, which was a smaller version of this surgery up in his neck.
2) When Robert had the cervical spine surgery in July, he definitely suffered from the "brain fog" that can follow general anesthesia. He was confused and his memory was poor for several weeks after that surgery. That "brain fog" is supposed to be worse as the time under anesthesia increases, so we expect that he will suffer from that confusion even longer this time.

How much time am I taking off from work? The doctor told me to expect to take off at least 2 weeks full time, possibly going back to work part time after 2 or 3 weeks.

How do we feel about all this? Robert feels anxiety and dread and is unhappy that he will be giving up the next 8-12 months of his life to being in even more pain, not sleeping well, and not being able to go out much. On the other hand, he thinks that this has to be done, and he expects that if he does this now he will be in better shape in the future. He is hopeful that he will have less pain when he is fully recovered. And he is very motivated to hang onto those functions that your lower spine controls: walking, balance, etc. Anne feels like this is the right decision and although it will be hard for both of us for several months, the long-term benefit makes it worth it.

I got so much support and kindness from our friends and family over the last six months while Robert was recovering from the smaller neck surgery. That makes us both feel much better about going into this second surgery. We know we have lots of dear friends and loving family to lean on. Thank you for understanding that we are not going to be as active or social for the next few months. It may be hard for me to do things that would have been routine in the past (remember birthdays, go to concerts, cat sit...) Please don't feel slighted if we seem out of touch, and we and we both hope to be back to normal (or better) later in 2012.