Life with a Pain Pump - Part 5
My Pain Pump Surgery & Recovery
My Pain-Pump Surgery
The following account of my pain-pump implant surgery is a broad overview of the end-to-end process, and it should give you a fuller understanding of what to expect if you or someone you care about considers a pain pump to help control pain.
Selecting a Surgeon
Once you have carefully considered the pros and cons of a pain pump to help you control your pain, the next step is to find a qualified surgeon to implant it for you. Your pain specialist can, in some cases, not only prescribe intrathecal medication therapy for you but also implant the pain pump as well. However, given my negative experiences with my three spinal fusion surgeries that left me with permanent nerve damage and with intractable chronic pain, which was the reason why I was considering a pain pump, I decided to only seek a neurosurgeon whose specialty is working in and around the spinal cord and does so on a daily basis. Fortunately, I already knew of a highly qualified neurosurgeon in my hometown who successfully operated on my wife’s spine some years back. So, I asked my pain doctor to send a referral to his office, and an appointment with the surgeon was scheduled.
My Initial Appointment
My first visit with my surgeon was on November 23, 2020. After examining me, he said that I appeared to be a good candidate for surgery. He thoroughly explained the surgical process, including its pros and cons. Like most busy surgeons, he only gave me about fifteen minutes of his time before rushing out to see another patient, which is, unfortunately, a common practice today. My advice is to have all your ducks in a row by making a complete list of your questions and concerns before your initial appointment. Be prepared to “drink from a fire hose” and take copious notes while there because you may not get a second chance. If possible, take someone with you to act as a second pair of eyes and ears to help you remember what your surgeon tells you, or simply record the session with your phone.
My Follow-up Surgeon’s Appointment
Although my surgeon had satisfactorily answered most of my questions during my initial visit, over the next few weeks, new questions arose that needed additional answers. In particular, I wanted to be absolutely sure about the pump’s location, and as this could only be done in person, I requested a second consultation to help me feel more confident about my expectations. Since this device will become a part of your body for many, many years, you should know all that you can about the procedure and the device to make an informed decision and ensure that your expectations align with your surgeon’s. If you request an additional face-to-face appointment, and your surgeon won’t take the time to inform and reassure you completely, I would keep on looking for another surgeon.
Pre-Surgery Preparations
Once you sign off on having the surgery (you will be asked to sign mountains of paperwork—so get used to it!), the surgeon’s staff will work with the hospital or outpatient surgical center to find an available date for your surgery. Once all parties agree to a date, the countdown clock begins ticking.
Eating & Drinking Restrictions: You may not eat or drink anything after midnight on the night before your surgery. This restriction includes food, gum, hard candy, and tobacco products, which are common restrictions for almost all surgeries. The exception is taking small sips of water to take any meds you need. Read the documentation you will be given carefully.
Bathing: You may be asked to shower with an anti-bacterial soap on the night and morning of your surgery to reduce the risk of infection from bacteria on your skin.
Clothing: Wear something very loose and comfortable, like sweats with elastic waist and drawstrings. Putting your clothes back on after surgery, if you wear tight street clothes, will be both difficult and very painful.
Arrival at Hospital: You and your driver should plan to promptly arrive at the hospital at the appointed time. Give yourself some additional time to account for potential traffic or other unforeseen delays.
Surgical Prep: Once your name is called in the hospital’s general waiting room, you will be led back to the surgical prep area, where you will be asked to disrobe and put on a surgical gown. Then an entire army of nurses, doctors, and anesthesiologists will descend on you, poking your arm full of holes and asking you countless questions. For me, the most painful part of the surgery was the two nurses who couldn’t get the IV needle in a vein in my hand, which took several very painful tries. I asked why it was so painful, and they told me it was due to the size of the needle required for anesthesia, but, in this case, I think it was due to inexperience or incompetence. I certainly hope your experience will be far less painful! Once the needle was finally in place, I was given “something” through my IV to “relax me,” according to the nurse. After about an hour or so, I was finally rolled into the operating room.
The Surgery: Once in the OR (operating room), the team of doctors and nurses hovered around me like flies on a cold dead fish, which is what I was feeling like at the time! ;-) (Why do hospitals insist on freezing their customers like “patient popsicles?) They continued asking me more questions and generally just trying to put me at ease. It was not long before the anesthesiologist began administering general anesthesia, and I was asked to count backward from one hundred. I think I made it to ninety-eight before the lights went out, and I was under.
I was told later that the surgery took a little over an hour. First, the pump was implanted in my right lower quadrant (RLQ) in my abdomen, just above my belt line. Once the pump was in place, the surgeon began making a path under my skin using a metal rod that he used to snake a tiny tube to carry the medication from the pump. From there, it ran around my right side to the L4/L5 vertebrae level in my lower spine. The end of the tube terminated with a needle, which he placed in the intrathecal space surrounding my spinal cord at the T-6 level, just above where my spinal fusion hardware began at T5.
Post-Surgery & Recovery
Recovery / ICU: When awakened in the ICU, a nurse repeatedly told me to wake up, and then she asked me how I felt. Pretty good, of course, as the effects of the anesthesia had not yet worn off, and I was half incoherent. As soon as I had some of my wits about me, I told my nurse that I didn’t feel any pain in my legs and feet! That was quite a difference from before surgery when my pain level was seven or higher. Overall, I felt pretty good and in not much, if any, pain from the surgery itself. At least so far.
Home: After a couple of hours, I was released from the hospital, and my driver took me home. I needed help getting into my house, up a couple of stairs, and then into my bed (heaven!), where I slept most of the day. Wearing my binder, I could get out of bed and fend for myself from then on.* The next day, I felt much better and moved easily around the house, although I was cautioned to take it very easy and stay on the sofa or in bed for the first day or two. The good news was that my pain levels were very low! *Tip: If possible, I highly suggest having someone who can check on you nearby for a few days.
SP – Spinal Headache: My recovery went well for the first few days until I began to get a headache, which for me is almost always a migraine. The only way I could get any relief from my migraine was to lay prone, the opposite of my usual migraine routine, where I must stand up until it subsides. After a couple of days of nonstop migraine misery, I went to the emergency department of my local hospital, where they treated it with a Toradol cocktail. My doctor called it an “SP headache” for “spinal headache.” It is also known as a “spinal migraine.” After my migraine was mostly resolved, I was sent home, but it returned the next day, and I suffered lying in bed for eight days of almost continuous migraines! If you suffer from migraines, you should have your migraine meds refilled and ready to go after surgery. You may not have this problem, but it's best to be prepared.
Abdominal Binder: You will likely be sent home wearing a big, white wrap-around Velcro binder that can be very uncomfortable at times. However, it is essential to wear it constantly for the next week or ten days. The binder will help keep your pump from moving around until it is stable, as well as help you keep from straining your incision when getting in and out of bed or chairs. It also aids in reducing swelling, also known as “seromas,” as your body adjusts to the new appendage and your surgical wounds heal. I wore mine for almost a week, but I should have worn it longer to reduce the seroma over my pump.
Surgical Pain: After the first day or two, I moved easily, and I had very little pain from the surgery. The scar was pink and healing nicely, according to my doctor.
Post-Surgery Pain Levels: As I mentioned previously, my pain levels were two (2) or lower immediately after surgery. My pain remained low for the next week, probably because I was relatively immobile and inactive. I met with my pain doctor two weeks after surgery, where my pump was drained and refilled by an infusion nurse, and my dosage was increased slightly.
In the next Report, I’ll share some of the preparations you’ll need to make prior to your pain pump implant surgery. This series will then continue with the side effects and results of my surgery. Its outcomes may surprise you!
If you want an even deeper look into the entire story of my Pain Pump experiences, please read my medical memoir, “War on Chronic Pain.”
All the Best!
Franklin
P.S. - If you missed a couple of Reports last week, my apologies! Due to some emergency health issues, I was unable to publish on time. I’m feeling better now, so I should be able to publish on schedule this week, and we’ll wind up this series on life with a Pain Pump.