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                            Surgery

So you are having Surgery.

Just before.

I am sure that your Consultant will have discussed your surgery with you. He is the only person who can decide if surgery may improve your medical condition, although you have to decide, on his advice, if the time is right for this operation or not. You are the person who knows just how much this condition is affecting your daily life. Once the Consultant and yourself have made the decision to go ahead with the surgery, you will be told approximately when he hopes to perform the surgery. He can only tell you approximately, because you are liable to need a bed in Intensive Care for the first 24 hours and he cannot predict whether or not a bed will be available. This is hard on you, because you will have a lot of preparation to make and sometimes the surgery needs to be postponed as there are no beds available. If you have any specific needs, such as mobility aids, dietary needs etc: please do not hesitate to contact the hospital prior to admission to discuss them with the staff. At this point you will probably be feeling very anxious. Please remember that this is normal. Everybody is nervous prior to surgery and your operation, being where it is, will make you even more nervous. All the staff will be aware of how you are feeling and will try to help in every waypossible.

Admission.

You will probably be admitted 1-2 days prior to the surgery. The reason for this is that any tests that need to be done, such as chest x-ray, blood tests and scans can all be done before the surgery. All the tests that are done prior to surgery are done so as the surgeon knows that you are in the best possible physical shape to go through this operation.
On the day of your admission you will be greeted by the ward staff and shown to your bed and shown around the ward so as you can acclimatise yourself with the toilet, the shower room and the general layout of the ward. You will be given an armband with your name, address, date of birth and your hospital number on it. This is done so as the staff know exactly who you are even when you are sleeping and prevents any mistakes being made.
Your temperature, pulse and blood pressure will then be checked and hopefully they will be all normal. Your weight will then be checked so as the anaesthetist can determine how much anaesthetic he must use for you. You will be shown where the bell is so that you can call a nurse whenever you want to.
It is important that you bring any drugs that you are on at home into the hospital with you. The Consultant and the Anaesthetist will need to know this as the drugs that you are on, may not work together with the drugs that he may wish to prescribe for you. You will be examined by a doctor again, to make sure that you are physically fit for the surgery. Please feel free to ask any question you might have. It is very important that you understand everything that is happening to you, why it is being done and what to expect post-operatively.

Settling In.

Hopefully by now you will have settled into the ward, you know the layout and you understand everything you need to. You will then be visited by the Anaesthetist who will be sending you off to sleep Again, feel free to ask him any questions you might have. It will be important for you to ask him what is his policy for pain relief and nausea relief post-operatively. You can then content yourself to know that if pain or nausea become a problem that the staff will have proper instructions as to how to deal with it for you.
Your Consultant will visit you and once again go over the surgery with you and make sure that you understand everything that you need to. You will then be asked to sign a consent form for the surgery to take place. If you are happy that you understand everything and you have no more questions, then sign the form.
The Nursing Staff will, if you want to, arrange a visit to Intensive Care and the High Dependency Unit for you. All patients who have this type of surgery are sent to Intensive Care for the first 12-24 hours. The nursing care in these units is much more specialised and you can be monitored much more closely there you will no doubt, have questions about your hair. All Consultants differ on this one. Most of the Surgeons only take a strip off right up the centre of the back of your head and some take all the hair off the back your head. Some surgeons like this to be done before the patient leaves the ward and others do it in theatre when you are asleep. Make sure that you ask before the big day so as you know what to expect

The Big Day.

You will be awakened early that morning and sent for a bath or a shower. While you are there the staff will change your bed. When you come back the nurses will do what is a routine check before anyone goes to theatre. They will check your armband, make sure that you have got nothing on under your gown, you have no dentures in, you have no nail varnish on, and you have no body piercings in place. When the checks are all complete they will give you some drugs to help calm you down and assist with the effectiveness of the anaesthetic drugs.
When the time comes for your surgery, you will hopefully be feeling a little sleepy by then and you will be
transferred to a trolley and taken to the theatre. The Anaesthetist will administer the drugs via a vein in the back your hand. These drugs are extremely fast acting and the next thing that you will be aware of is that the operation is over. The operation itself usually lasts about 3-4 hours but this can vary immensely. When you wake up you will be in Intensive Care and you may be a bit overwhelmed by all the tubes beeps etc. but remember they are all there so as the staff can monitor you more closely. You will have a drip in your arm. This is to keep you hydrated while you cannot eat or drink for yourself. You will have a heart monitor on so they can watch your heartbeat and pick up any abnormalities as soon as they occur. You will have an oxygen mask on to keep you properly oxygenated. This is measured by a small clip that is placed on your finger. It tells the staff if you are breathing properly and that you are getting enough oxygen into your bloodstream.
You may also have a catheter in place. This is a fine tube which is placed into your bladder to drain away any urine you produce without you having to get on a bed-pan. You may also have another tube inserted into an artery in your wrist. This is call an Arterial Line and is used to take blood tests from you if needed. It is definitely not used to give drugs through. Once you know and understand what all these tubes are then you should not be as frightened by them.
When you wake up you will be asked how you feel; If you are in pain or feel nauseated, tell the nurse and she will be able to administer some more drugs to help you. The staff will frequently, over your recovery time, ask you questions like,” Can you tell me your name? Can you tell me where you are?, and get you to move your arms and legs and check your eyes with a bright light. This can get quite irritating especially when you have just drifted off into a nice sleep and they wake you up again to ask you what seem like pointless questions. There is a purpose in this. The nurses need to keep a check on your level of consciousness. They need to know that you know who you are and where you are, that you can move all limbs independently and are recovering nicely. One of the first signs that something may be going wrong may come with the pupil response in your eyes and that is why they test it by checking your eyes with a bright light, although this is rare.
Your head may or may not be dressed. Mine wasn't, but some surgeons do dress the wound. The wound will probably have staples in and they will be removed in 7-10 days time. This is not a painful process. The wound for the surgery is usually 4-6 inches long but don't be alarmed if yours is shorter or longer than this as all surgeons differ. Your head will feel very heavy and painful to move but the pain will be managed by drugs until such time as you feel that you don't need them any more. During your time in Intensive Care you will be very closely monitored and it is very important that if you feel that something is wrong you must ask the nursing staff and they will put your mind at rest. Your Consultant and your Anaesthetist will also visit you and when they are sure that you are recovering nicely you will be transferred to the High Dependency Unit.

The next step.

When you are moved in this Unit you will notice that it is smaller and has much less equipment than in Intensive Care. You will still be monitored closely but it is a bit more relaxed in here. You won't be as sleepy today. You will have a bed bath and this will feel absolutely wonderful.
A physiotherapist will visit you and help you to move your head and neck. She will be very gentle with you and you must remember that she is only there to help you because it is very important that your head and neck become loose again and that you get back on your feet as soon as possible. Again, you will constantly be asked those irritating questions but just try to remember that there is a purpose to everything that they do to you and they are not there to annoy you.
Before you leave this unit you will have some if not all of your tubes removed. Your Arterial Line and your heart monitor will be removed. This act alone makes you feel that you are on your way to recovery.

Back to the ward.

After another 12-24 hours you will be transferred back to your ward and hopefully you will be able to get some much needed rest there. The atmosphere again is much more relaxed here. The nurses will continue to monitor you and your Consultant will visit you on a daily basis. Your medication will continue as and when needed. You will not be allowed to suffer pain or nausea needlessly. By this time you will be eating a light diet and be feeling a little better. You will be encouraged to get out of bed for a short time. You should be advised to get out of bed after you have taken your analgesia and your head does not feel as painful. You may feel a little nausea when you first stand up but again this will be well controlled. The physiotherapist will continue to work with you to help ease the tension in your head and neck. By day 3 you will have got rid of your oxygen mask and hopefully your catheter and again, this will make you feel more human.
As each day progresses your mobility will increase and you should feel a lot better, but don't underestimate just how tired you will be even when you have been sitting out of bed for a short time. Bed feels wonderful again when you get back in. I was allowed to shower on day 4 and that was great but I was totally exhausted after it. Once the surgeon feels that you are ready for home, which is usually between day 7 and day 10, you will be discharged into the care of your G.P. and the Community Nursing Service, if required. This will be arranged before you leave the hospital.

At home.

Once you are back at home, common sense should prevail. Listen to your body and what it tells you to do. If it says “rest” then rest. You must remember that everyone is different and some people recover more quickly than others. Some people get complications, although this is rare, and others don't. That doesn't mean that something is wrong with you because you don't recover quickly, it is just that everyone is different. You will need a lot of help from family and friends and take any help that you are offered graciously. Some people are fully recovered and back to work within 2-3 months and others are not.
The most important thing to remember is that you must not be alarmed by the fact that your pre-operative symptoms don't go away quickly. This is normal and you must not compare yourself to others, they are NOT you. Remember your spinal cord has been compressed for years and it is going to take time for everything to settle down. You may be disappointed when you first wake up and find that none of your symptoms have disappeared and in fact you may find some new ones have appeared, but you must not worry. This is just all of your nervous system settling down and it all takes time. Some of your symptoms may disappear very quickly, others may not. The nervous system is such a complex system and nerves regenerate very slowly do don't be impatient. It is also very important for you to have a positive attitude and don't become depressed by the whole thing. You will find that positive thinking will help you a lot. Either way, the surgery that you were so anxious about is now over and you can look forward to the rest of your life hopefully as pain-free and symptom free as possible.

Thanks to Susan Mathews, for supplying the above information, sufferer of these diseases.
 

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                                                                    www.chiari-info.co.uk  Last update..27-01-2010

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