April’s Scoliosis Surgery

Hello all,

This is Neil, April’s husband.  April wanted me to give an update on her scoliosis surgery and post-op status.  Bare with my writing, I am not sure I will be as stylistic as April.  So with that being said, I will give you an update and in accordance with April’s wishes, NO SUGAR COATING!

Scoliosis

First off she is fine.  She is healthy and doing well.

Here are some pre-op photos below

Now here is the breakdown of what I know about her surgery: Incision was at 8:30am and she came out of surgery and headed to the ICU at 7:05pm.  During her surgery she lost 7000cc of blood, this is 7 liters. Her body only holds about 5 1/2 to 6 liters of blood.  So most of you are wondering how this is possible?  First of all, she did not just lose 7 liters straight away. She bled for hours during this 11 hour operation.  So as she was losing blood, the anesthesiologist was replacing her blood in a couple different ways.  One way was to give her back her own blood using what is called cell saver.  A cell saver machine is hooked up to the operative suction and basically spins down her lost blood and then they process it and give it to the anesthesiologist to transfuse. April was given back 1200cc of her own blood.  On top of this she was given 10 units of red blood cells (RBC), 8 units of fresh frozen plasma (FFP), 2 units of platelets, 5 units of cryoprecipitate (CRYO, this increases fibrinogen which is what helps your blood form clots), and a couple units of albumin (this is the main protein in blood plasma) and each unit is about 325cc of volume.  This is a lot of product to put into someone’s body, and all of this volume caused some major swelling throughout April’s body.  Since she was prone (laying face down) for several hours the majority of the swelling was in her face and surrounding areas.  Due to the large amount of blood loss and swelling April went straight to the ICU.  Since she was so swollen in her face and throat April was kept intubated and asleep over night.

Intubated in the ICU below scoliosis

After her surgery the doctor came out to talk to me.  I was a little freaked out because before I even spoke with the Doctor I had to watch my wife get wheeled down the hallway into the ICU intubated.  Some may know, but the majority of you probably do not know, that I work in surgery, so of course my mind was racing with all kinds of terrible thoughts.  Luckily about a minute after seeing her go down the hall her doctor found me and talked to me.  She said the surgery went well and she is stable and doing fine.  In my head I’m thinking “fine does not equate to intubated and heading to ICU.”    She said she had lost a quite a bit of blood (uh ya 7 liters is a lot) and she was really swollen and they wanted her intubated until the swelling came down.  Last thing you want to happen is to extubate a patient with a swollen throat and have it swell up cutting off their airway.  So I understood why she had to be intubated and stay in the ICU and I calmed down.  I see people intubated everyday for a living, but it truly was hard for me to see her like that.  The doctor also informed me that there was difficulty putting in her L3-L4 interbody and that ultimately they couldn’t put it in safely due to the location of her nerve root, but that the L3-L4 level was the least crucial of the three levels she needed.  The doctor did say though that April was corrected from about 80 degrees of curvature to now 30 degrees which is awesome, then there was a BUT.  But during the decompression part of the operation, this is where the bone that is pushing on her spinal cord is removed, they somehow hurt the spinal cord.  They know this because during this type of surgery April is connected to what is called neuro monitoring.  Little sensors are placed all around her body and these are connected to a computer that shows a read out of nerve and spinal cord activity.  When the cord was hurt, or damaged, or they just some how pissed It off, they got a reading saying that this area of the spinal cord was not working normally.  When the spinal cord reading finally calmed down, her levels were below base line.  They came back up but never reached where she was before surgery.  Basically this means the doctor was worried she could have spinal cord or nerve damage and they will keep on eye it.

April was extubated Wednesday morning around 8am.  She immediately noticed that her left leg felt funny.  She couldn’t feel her foot and toes on her left side.  She could move everything, but she said her left leg felt like a ton of bricks and was really heavy and hard to move.  Also, she was having excruciating pain in both of her legs all the way down to her feet.  The doctor said this was to be expected because of what happened during the decompression.  April was obviously very scared and didn’t know what it meant. The doctor explained everything, which did not make her feel any better but she at least had an explanation.  Since April was now extubated and able to talk she told me about her terrible early morning.  I was unfortunately not allowed to stay the night in the ICU, well I was allowed to stay as long as I didn’t sleep. I had been up since 4am and left her side around midnight and I was drained and needed to sleep so I found a hotel for me to get a few hours of rest.  When we finally were able to talk she told me how she was awake with the tube in her throat and was trying to tell her nurse that she had to throw up. She said she was banging her hands on the bed and table next to her trying to get the nurses attention and the nurse was just trying get her to calm down and relax.  She was panicking and scared of choking to death, so she was anything but relaxed.  She eventually wrote down on a piece of a paper what was happening, so then the nurse gave her anti-nausea medicine and some more pain meds.  Throughout the day April was fighting pain.  The staff was trying to control her pain but it was tough. April was moved to the Ortho unit in the early evening and has a nice private room thanks to one of the mothers of a student of April’s and we are very appreciative of her help and time. The night was real rough for April.  She woke up multiple times in shaking pain, but by this morning her pain has become much more controlled.

Being extubated

This morning the doctor rounded on April and has become increasingly concerned about her leg.  She ordered an MRI to make sure nothing is going on and hoping it is just an angry nerve root or partially bruised spinal cord that will get better with time.  April today had a physical therapy session where the therapist got her to sit up and stand, even though her left leg is weak and she couldn’t feel the ground with that foot.  It was impressive to see her determined to stand and just grit and bare through the pain.  It is now 8 pm and we are still waiting for her to get an MRI.  So I will have to update again tomorrow.  Sorry this was so long winded, there was a lot of information and it’s not the easiest to explain.