T MINUS 24 HOURS.

It all starts at 5:30 am tomorrow. It was a busy week of getting prepared for the spine fusion surgery. I had to get another set of labs done as well as a new EKG. I got my post-operative prescriptions filled - one for Percocet and another for Soma. I also was measured and fitted for my new back brace which I will spend the next two months wearing. It's a sexy little thing.

I was measured for the back brace at a prosthetics clinic. After measuring my waist, ribcage, hips, and the distance from my breastplate to my belly button, the prosthetics specialist sends the measurements to a company in Florida that custom-makes the brace in about a day and ships it back to the clinic. I went back to the office Thursday to try on the brace and make sure that it fits well. To be honest, it is very comfortable, much more so than I would have imagined. It feels really supportive, and I feel like it gives my muscles a much needed break from supporting my weak frame. I will take it with me to the hospital, and the surgical team will put it on me right after the surgery. It is much thinner and lighter than I thought it would be and fits nicely under a hoodie or a larger t-shirt. Plus ladies, it lifts and separates if you catch my drift . . .

I had my pre-operative appointment Tuesday and my surgeon went through what to expect Monday and the days following the surgery. He explained the risks, including but not limited to stroke and heart attack during the surgery that could cause paralysis and blood clots (he did say that he does NOT believe this will happen as my EKG and labs were normal). He also wanted to make sure I understood that I may or may not get the results I want from the surgery, and that once he made the incision and starting working on my spine, he reserved the right to change the care plan based on what he finds.

The surgery will take 7-8 hours, and the nurses will get me up and walking once I awake from anesthesia. After that, he recommends I spend about an hour a day walking to keep mobile and reduce the chances for blood clots. As soon as I am able to perform basic functions (pass gas, urinate, walk) I can be discharged from the hospital and go home. (The gas issue may seem a bit strange, but apparently the removal and replacement of my lower organs to fuse the anterior vertebrae causes an influx of air and bloating.)

[A post-publication note: the surgery was not 7-8 hours, it was closer to ten. The nurses did not get me up and walking afterwards. I was in so much pain that could not be managed that the focus was more on pumping enough morphine into my body to make me stop moaning in despair. I could not walk for more than a couple minutes because of pain and exhaustion, certainly not the previously recommended hour, and to prevent clots the nurses put these little booties on my feet that sent electrical impulses through my legs. They would constantly wake me up. Although I was able to meet the three pieces of criteria for discharge within a couple of days, I developed respiratory issues that kept me in the hospital. I also was in terrible pain - did I already mention that?]

So the agenda today consists of stopping any solid foods at 1:30 and start drinking a magnesium citrate cocktail at 4pm and another four ounce cocktail at 8pm. I recommend buying the lemon flavored magnesium citrate and chilling it for a couple of days in the fridge. Then, add it to some Crystal Light lemonade and drink that over ice. The Crystal Light is clear enough that it can be consumed until the few hours before surgery when you cannot have any liquids.

In case you have never had the opportunity to participate in this pre-operative ritual, magnesium citrate is a powerhouse laxative that clears out the digestive tract so that moving my intestines around will be easier. So I will be spending my evening in the bathroom. It is well stocked with bottled water, the latest issues of Oprah and Shape, and my laptop. At least this is a chance to catch-up on my reading.

In rereading previous posts, I have noticed that the majority are technical explanations of what has happened over the past four years and what is about to happen in the next four months, and that I have not spent much time writing about the emotional aspects of what is to come.

I'll be perfectly honest: I am very nervous and scared. Some of my fears include waking up paralyzed and spending the rest of my life in a wheelchair, a fear dispelled by my surgeon. Another fear is waking up from anesthesia during the surgery, feeling everything the surgeon is doing, and not being able to communicate to anyone about it. I also have no idea how much pain to expect after this and that scares me. And I do not want to leave the hospital with a prescription for OxyContin - that drug scares me to death. I hope that whatever pain surfaces post-surgery can be controlled with Percocet, or my drug of choice, Tramadol.

But despite this, I ready for surgery. I am ready to feel better. I am ready to be able to walk and ride my bike. I am ready to walk my dogs. I am ready to ski and hike and do all the things I haven't been able to do for some time now. I am ready to put this behind me and I am ready for my life (and my family's life) to revolve around something other than my back problems. I am ready.

I am lucky though. Despite anything that may happen, I can take comfort in the knowledge that I have a great family and a wonderful group of friends that would do anything for me. And that makes anything that comes along easier to bear.

I CAN'T WAIT FIVE YEARS.

Met with Dr. X from the University of Utah Orthopedic Center on Monday to get his perspective on my physical condition. Dr. X seems very conservative in his approach and does not perform many surgeries. I started the visit with new sets of X-rays, and since I sent him the CD of my most recent MRIs, I have to assume he reviewed those as well.

Dr. X was very much on the fence with his recommendations: he suggested I get a discogram, a procedure where the discs are injected with dye to better identify the ones that cause the pain. Unfortunately, discograms carry inherent risks, including the fact that the injection of the dye can cause an already weak disc to rupture, creating additional damage or a new herniation. Also, the dye can leak into damaged disks and make identifying damaged discs difficult if not impossible. And lastly, it is an extremely painful procedure for the patient that ultimately culminates in a somewhat unreliable outcome.

Dr. X spent a good deal of time talking about the risks of surgery and the fact that many surgeries do not relieve the pain as well as patients hope or are led to believe by their doctors. He talked about artificial disc replacement, and that this surgery is effective only in cases where one disc is creating pain (since I have four herniated discs, this type of surgery would be useless). In addition, there have been no long term studies into how much wear and tear artificial discs can take in a human body, and once an artificial disc is inserted, it can be life-threatening to replace it because of the arterial vein scarring that occurs in the original surgery. Hmmmm.

Upon discussing a spine fusion, Dr. X informed me that the outcomes are extremely unpredictable, with many patients getting 50 - 75% relief from pain. He also reviewed what I already know - that the surgery is very invasive and carries with it a long recovery.

By the time the consult was over, I wasn't sure if I had learned much more than I had already learned before the visit. However, something Dr. X said really resonated with me. He said that I could always wait five years to see what kinds of new technologies and therapies are available to help me. The more I thought about this, the clearer my options were: I am a 33-year-old woman who can barely dress herself, let along participate in other activities (skiing, hiking, walking my dogs, playing with my niece and nephew) I used to love doing. I do not have five years to spend like this.

And that's when I decided that I would go ahead with the surgery. I do not expect a perfect outcome, and I do not expect to be 100% pain-free. What I do hope for is to feel 50- 75% better than I do now, using 50 - 75% less medication than I take now. I want a piece of my old life back, and I am willing to face these odds to get it.

ABOUT SPINE FUSION SURGERY A.K.A ARE YOU @#%!*#@ KIDDING ME?

There is quite a bit of information out there about what a spinal fusion operation is, and there are many different ways to do it depending on your physician's opinion and preferences.

In a nutshell, here is what Bolted Bionic Surgeon told me: he will be in the operating room with a vascular surgeon and two other general surgeons that will assist. The vascular surgeon will create an incision in my lower belly area, move my lower abdominal organs onto a tray to clear the lumbar spine area, and seal off any arteries and veins that were opened and bleeding.

At that point, my spine surgeon will come in and begin the anterior entry portion of the surgery: he will remove what is left of the two discs, and insert synthetic bone where the discs were. After that, he provides a support system for the vertebrae using bolts and screws (I think he may have purchased them at Lowes the night before). Once that is complete, the general surgeon puts my organs back into their original locations and sews me up. Then they flip me over and the real fun begins.

At this point the posterior segment of the surgery begins. The spine surgeon makes an incision in my lumbar area and drills bolts and screws into the back of my vertebrae. these bolts and screws support a kind of "cage" that holds up L3-L4-L5. He then sews me up and the rehabilitation begins.

Why the two incisions front and back? Well, according to my surgeon, there is less blood loss and thus less blood tranfusion required by doing it this way. After this description of the surgery, which sounds abominable and extremely painful, I am sure interested to see what I learn from Dr. X in Utah next week during the second opinion.