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Sunday, August 21, 2011

Countdown to Susie's first surgery--neck fusion--it's actually a more complicated procedure now that her gall bladder also has to be removed--for why, see below blog post today

Susie has emailed some of you about her upcoming neck surgery but I wanted to give you my understanding about it.  Since she's having the procedure done on her, it is certainly the case that she is closer to the matter.  However, like a Catholic celibate priest who gives sex counselling to his parishioners, I'll now tell you what I recall Dr. Schwartz explaining to us last week about how he plans to operate.

The purpose of the neck fusion is to regain, through surgeon's handiwork, what God gaveth and that pernicious little road depression taketh away, namely, Susie's excellent health, active life-style, and always-happy disposition.  Yes, I'm sure some of you are thinking at this moment, how is it possible Susie's mood was pretty much always happy, given that she's lived with me for 42 years and I can be such a pain in the.....ask me 'bout my grandson, Liam, who will be three on October 3, 2011.  Well, her mood had been happy, pretty much all the time, before this tragic incident.

In a neck, or cervical, fusion, the neurosurgeon makes an incision either in the front of the neck, or the back, but not both, in order to drill holes in the vertebrae which need to be fused.  The surgeon removes the inter-vertebral  disc material and replaces it with a gray-plastic disc.  The disc has a circle of tiny raised, pointed bumps which, it is hoped, will slightly penetrate the body of the vertebrae, on the top side and the bottom side of the disc, and keep the plastic disc from moving back and forth.  The doctor, who by now in the operation is "little more than" a glorified, over-educated, carpenter, then uses a surgical drill to fashion the holes in the vertebrae which will receive the four titanium surgical screws.  He then inserts the point of each screw into the drilled holes, thereby stabilizing and "fusing" the two back bones together. 

Sounds simple enough, although it does take a life-time of learning, experience, and practice to get to the point where the doctor is cocky-enough to try really hard to do a good job, but also humble and respectful enough about the vagaries and non-guaranteed outcomes that if he needs help when the you-know-what hits the fan in the operating suite.

But there's also one more complexity in the neck operation itself because of a wrinkle in the formerly perfectly healthy, lovely body of my soul mate and wife of more than four decades.  And that is this.  Susie also needs to have her gall bladder surgically removed.  Susie has had, for a number of years, inactive gall stones.  Either the bicycle crash or the very strong medications she had to take to palliate the pain wound up re-activating the gall stones to the point where her liver function enzymes increased to a dangerous level.  "Dangerous" because Susie was not cleared by her GPs, Drs. Schroth and Ameleto, to have the neck surgery until her liver enzymes came down to a reasonable level. 

The reason for that restriction is that after neck surgery, Susie will probably need to be back on some pretty heavy pain killing medications for a while to mask the pain which will result from the neck fusion surgery.  If a person's liver function is already compromised and they have surgery under general anesthetic, adding powerful medicinal pain killers to the body is even riskier when one's liver function is abnormal.  The liver is the organ of the body which filters out what the body considers poisonous, and strong prescription medication is a toxin to the human body.

As some of you have correctly pointed out to Susie in private emails to her, the modern gall bladder removal surgery is a relative piece of cake compared with what Dr. Schwartz is about to do on Tuesday, August 23, 2011, very early in the morning.  Laproscopic surgery is about little-invasive as you can get, except for the fact that, like any other surgery on a miraculous creation like the human body, going in and taking out any major organ is a lot more risky than entering an FDIC-insured bank, drawing a gun, and asking the teller for all her money.  In the latter case, of the armed robbery, as long as no shots are fired, it's unlikely that anyone will get hurt or killed in the process.  By contrast, in surgery we all know what's true, even if we've never read those Informed Consent forms at the surgeon's office, that all bets are off in the operating suite.  Morbid outcomes (i.e. complications post-surgery) are more common (four per cent, Dr. Schwartz told us, sanguinely) than mortal ones (i.e. death during or after surgery; one per cent probability).  If you don't love the patient the way I love Susie, those percentages probably seem negligible. But I DO love Susie in that way, so those numbers, and even the surgeon's apparent calm in the face of those potential calamitous outcomes, leave me, frankly, cold as a cadaver in a dark, metal drawer in the bureau of body drawers in the  CSI morgue.  

But the now-simple gall bladder removal surgery does require something which makes it a more dangerous procedure in Susie's case.  To remove a person's God-given gall bladder, all sentient humans feel the need for general anesthesia.  For the sedation to be safely administered during surgery, "the patient," aka Susie Dutcher, must be intubated, to make sure she doesn't stop breathing during the procedure.  And this is what makes the upcoming neck fusion surgery more complicated.

Intubation is just what it sounds like.  A tube is put the patient's mouth and throat, to insure an open airway during surgery.  So what's that got to do with the neck fusion surgery?  Dr. Schwartz is concerned that the intubation for the gall bladder surgery, which will not be scheduled until sometime after the neck fusion, may twist the fused vertebrae out of their fused position.  Remember, as Dr. Schwartz explained to Susie and me, until the bone cells have a chance to grow around, in, and through the fusion site, and make the surgical appliances in Susie's neck really rock solidly in place, the torque and force necessary to jam the intubation tube down Susie's throat could well disturb the position of the fused vertebrae, one of those "morbid" outcomes which our neurosurgeon Inform-Consented us about.  Just in case the you-know-what hits the fan.

Because of this possible morbid outcome of the intubation for the future gall bladder removal surgery, the neurosurgeon has decided to up the ante on the neck fusion.  He will not only enter Susie's Goddess-like physical integument through the front of her delicate neck, where he will replace the disc and screw the screws, but then he will re-enter The Integument through the back of Susie's neck (a so-called Rear Entry in the Multiple Entry fusion surgery).  The purpose of the Rear Entry procedure is to enable him to wind surgical wire around the rounded-"points" (Bob's blog lingo) aka "wings" of the posterior, adjacent C-6 and C-7 vertebral "bodies" (medical lingo).  If that doesn't look like it'll do the trick, once he enters that flesh and blood homo sapiens named Susie, Dr. Schwartz told us he'd have to "punch" a hole horizontally through the vertebral wings and insert a tiny rod to hold the vertebrae in place.  

Whew, that was a long explanation.  'Course it  was nowhere near as long as the four hours, that's right, four hours, which Dr. Schwartz told us he expects the neck fusion to take this Tuesday.

Okay, enough already.  But please, please-please-please......pray for Susie, especially this coming Super Tuesday.  "Super" only because hopefully, once the surgeon stabilizes those snarky fractured back bones, Susie will begin to get some pain relief, although she's always going to have a loss of some part of her former neck flexion, and her child-like Joy in all God's creation.

More anon...............










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