Upcoming SP surgery - questions

Meg1 · 08-02-2004, 04:32 PM

Next week Dennis (C5/6) is going to have an SP done and I have some questions about the procedure and recovery. I know this topic has been covered quite a bit but I can't seem to find the answers to some of the questions I have.

As a background on Dennis, he was injured July 2003 and has had an indwelling foley ever since. He is riddled with UTIs on a regular basis and as many of you know the meds for the UTI wrecks his bowel program. He also had Leiden Factor 5, a genetic blood disorder that has kept him on Coumadin for the past 10 years. He is anxious to get rid of the UTIs but I think is nervous about the procedure and recovery.

He will have the procedure at St. Barnabus in NJ next wednesday. He was told it would take about 30 minutes with about an hour and a half immediate recovery then several more hours of recovery after that.

He has been seeing Dr. Lindsenmeyer(sp) at Kessler for urology. With EVERY foley change he has pretty severe AD - very high blood pressure, no headache or sweating. Dr.Lindsenmeyer suggested to have the procedure to relieve the AD with every change and the constant grit he has while he has the UTIs.

He went to St. Barnabus last week for pre-op tests that showed his heart rate was low (48) it has been that way more or less since his injury. The anethesiologist is concerned about the heart rate as far as which type of anethesia to use. He is considering a spinal or local. He will decide at the time of the procedure which to use.

He has to get off of the Coumadin and on Lovanox (sp) for the surgery. This switch is always a concern because of blood clots - a nasty side effect of any SCI and the fact that he has the blood disorder to begin with is obviously an issue.

My questions are: Did anyone else who had the SP procedure also have a low heart rate at the time of the surgery? If so, how was it handled? Did you have AD during the procedure? Or soon after? What type of anethesia was used during the surgery? What effects of anethesia did you experience during and after the surgery?

What were the first few days/weeks like after the surgery?

I am sure he has not asked some questions of the surgeon he should - can anyone suggest any questions to ask this week or right before/after the surgery?

Thanks so much. I have been MIA here for about a month due to getting ready for a fundraiser for Dennis, it was July 22nd and a great success, he will be able to have therapy for at least a year paid for and most likely will have the ability to buy some excercise equipment for home use - questions about equipment will come like gangbusters after he has recovered from the SP surgery.

Meg

SCI-Nurse · 08-02-2004, 05:45 PM

Have a plan for management of AD in both the recovery area and when discharged (I assume you are doing only day surgery???). Dr. Lindsenmeyer should probably talk to the urologic surgeon about this.

A spinal would probably be the best anesthesia to prevent spasms or AD during the procedure.

If the anesthesiologist is concerned about the low pulse, he can give a little IV atropine and it will bring the pulse rate up. It usually is not a problem.

If he must be off the blood thinners, then ask about having intraoperative and post-operative sequential compression hose. This will help to prevent blood clots in the legs. Lovenox should be sufficient to replace the coumadin. Restart the Coumadin as soon as they will allow it.

(KLD)

Meg1 · 08-03-2004, 05:15 AM

Having a plan for AD management is a great idea - how do you plan for something like AD during a surgery?

SCI-Nurse · 08-03-2004, 07:59 AM

The spinal anesthetic would prevent the development of AD, which would be the best method. If a local is used, then the blood pressure needs to be monitored and the anesthesiologist and/or surgeon needs to be prepared to give medication (usually nifedipine) to control the blood pressure if it should become too elevated. Post-op is more of a concern if a spinal is used.

(KLD)

ScottS · 08-03-2004, 05:09 PM

i had a spinal for my s/p surgery. no problems at all, and my heart rate is a little low, not under 50, though.

"Today I will do what others won't, so that tomorrow I can do what others can't."

Meg1 · 08-03-2004, 05:14 PM

Thanks Scott. Did you experience much AD before your surgery? Having to do with the foley?

08-02-2004, 04:32 PM	#1
Meg1 Senior Member Join Date: Sep 2003 Posts: 225	Upcoming SP surgery - questions Next week Dennis (C5/6) is going to have an SP done and I have some questions about the procedure and recovery. I know this topic has been covered quite a bit but I can't seem to find the answers to some of the questions I have. As a background on Dennis, he was injured July 2003 and has had an indwelling foley ever since. He is riddled with UTIs on a regular basis and as many of you know the meds for the UTI wrecks his bowel program. He also had Leiden Factor 5, a genetic blood disorder that has kept him on Coumadin for the past 10 years. He is anxious to get rid of the UTIs but I think is nervous about the procedure and recovery. He will have the procedure at St. Barnabus in NJ next wednesday. He was told it would take about 30 minutes with about an hour and a half immediate recovery then several more hours of recovery after that. He has been seeing Dr. Lindsenmeyer(sp) at Kessler for urology. With EVERY foley change he has pretty severe AD - very high blood pressure, no headache or sweating. Dr.Lindsenmeyer suggested to have the procedure to relieve the AD with every change and the constant grit he has while he has the UTIs. He went to St. Barnabus last week for pre-op tests that showed his heart rate was low (48) it has been that way more or less since his injury. The anethesiologist is concerned about the heart rate as far as which type of anethesia to use. He is considering a spinal or local. He will decide at the time of the procedure which to use. He has to get off of the Coumadin and on Lovanox (sp) for the surgery. This switch is always a concern because of blood clots - a nasty side effect of any SCI and the fact that he has the blood disorder to begin with is obviously an issue. My questions are: Did anyone else who had the SP procedure also have a low heart rate at the time of the surgery? If so, how was it handled? Did you have AD during the procedure? Or soon after? What type of anethesia was used during the surgery? What effects of anethesia did you experience during and after the surgery? What were the first few days/weeks like after the surgery? I am sure he has not asked some questions of the surgeon he should - can anyone suggest any questions to ask this week or right before/after the surgery? Thanks so much. I have been MIA here for about a month due to getting ready for a fundraiser for Dennis, it was July 22nd and a great success, he will be able to have therapy for at least a year paid for and most likely will have the ability to buy some excercise equipment for home use - questions about equipment will come like gangbusters after he has recovered from the SP surgery. Meg

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08-02-2004, 05:45 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,523	Have a plan for management of AD in both the recovery area and when discharged (I assume you are doing only day surgery???). Dr. Lindsenmeyer should probably talk to the urologic surgeon about this. A spinal would probably be the best anesthesia to prevent spasms or AD during the procedure. If the anesthesiologist is concerned about the low pulse, he can give a little IV atropine and it will bring the pulse rate up. It usually is not a problem. If he must be off the blood thinners, then ask about having intraoperative and post-operative sequential compression hose. This will help to prevent blood clots in the legs. Lovenox should be sufficient to replace the coumadin. Restart the Coumadin as soon as they will allow it. (KLD)

08-03-2004, 05:15 AM	#3
Meg1 Senior Member Join Date: Sep 2003 Posts: 225	Having a plan for AD management is a great idea - how do you plan for something like AD during a surgery?

08-03-2004, 07:59 AM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,523	The spinal anesthetic would prevent the development of AD, which would be the best method. If a local is used, then the blood pressure needs to be monitored and the anesthesiologist and/or surgeon needs to be prepared to give medication (usually nifedipine) to control the blood pressure if it should become too elevated. Post-op is more of a concern if a spinal is used. (KLD)

08-03-2004, 05:09 PM	#5
ScottS Senior Member Join Date: Aug 2003 Location: CA Posts: 376	i had a spinal for my s/p surgery. no problems at all, and my heart rate is a little low, not under 50, though. "Today I will do what others won't, so that tomorrow I can do what others can't."

08-03-2004, 05:14 PM	#6
Meg1 Senior Member Join Date: Sep 2003 Posts: 225	Thanks Scott. Did you experience much AD before your surgery? Having to do with the foley?