Mrs_JWM Posted May 8, 2017 Share Posted May 8, 2017 My 74-y-o FIL is having a spinal laminectomy and fusion of C4 - C7. I wondered if anyone would be willing to share their experiences with this, specifically​ about the recovery time. He lives by himself almost 3 hours away and I can't get a sense of what he had done to prepare for this surgery. We've said we would come each weekend to help with food prep., groceries, laundry, and housework - he said he doesn't think he'll need this, even though he won't be able to drive or lift over 10 lbs. for 6 weeks. He also lives in an upstairs apartment and has some dietary restrictions that may make finding prepared food a little difficult. He is usually very dramatic about his medical needs, but this time, I think the doctor rubbed him the wrong way a bit because the dr. wanted my husband and me involved in the pre-surgery consultation. Currently, we have the weekends we would need to go out there blocked off so that we're available to go if he needs us to, and my husband plans to be there on the surgery date and again for his discharge, but he hasn't even told us what time the surgery is. He tends to do things like this, "Oh...I didn't know you didn't know." Umm...how would we? Usually, I would be more proactive about finding out all the details and making the plans, but I kind of want to see how this plays out. We have it roughly planned as far as the days, so it won't inconvenience us if he calls the night before... Anyway - any thoughts or advice would be appreciated! Sent from my Moto G (4) using Tapatalk Quote Link to comment Share on other sites More sharing options...
Starr Posted May 8, 2017 Share Posted May 8, 2017 I think it's rare that anyone can manage well alone immediately post op at home. There's food, pain meds, probably constant use of a support collar, no driving but follow up appts needed...I'm sorry he's not being more forthcoming so you can help him with post op planning. He must be scared and just decided not to think about it. :grouphug: :grouphug: :grouphug: Google his surgery and you will find lots of info. 2 Quote Link to comment Share on other sites More sharing options...
zoobie Posted May 8, 2017 Share Posted May 8, 2017 I don't think his expectations are realistic. That's a really intense surgery. It's not often done on people of any age, and it would be a difficult recovery in a young person. If he has your DH on a HIPAA release, your DH can call and talk to the doctor's office. I would really go in person if at all possible. I would have someone stay with him in the hospital if at all possible. Everyone should have an advocate, but elderly people are prone to a type of hospital delirium. Will he be going to a rehab facility rather than straight home? I'd be pretty surprised if they weren't recommending rehab facility. Has he had a second opinion? Does he have plans for someone driving him after? He won't be able to (and shouldn't!!!) drive for a while... (I don't have personal experience with a family member, only clients.) 3 Quote Link to comment Share on other sites More sharing options...
almondbutterandjelly Posted May 8, 2017 Share Posted May 8, 2017 Well, it's only marginally similar, but my dd16 had spinal fusion surgery in March, and I have to tell you that I think your dfil probably should have someone with him day and night for at least a week. There are meds, not just pain, but the anti-constipation stuff, and those all need to be done on a schedule. If he's loopy or not feeling well, he's not going to be giving himself meds in a timely manner. Plus, you know, there's the anti-constipation battle after surgery. That may take a few days to work itself out. We had to ply my dd with prunes and yogurt, in addition to her prescription miralax and stool softener. Again, not the exact same surgery, but not super-duper different. Best of luck. 3 Quote Link to comment Share on other sites More sharing options...
Mrs_JWM Posted May 8, 2017 Author Share Posted May 8, 2017 Thank you all for your replies. You're confirming my concerns. We'll see how things play out. Maybe he's completely all set and just not telling us the specifics, but I doubt it. I was surprised that the doctor didn't recommend a short-term rehab stay, too. Sent from my Moto G (4) using Tapatalk Quote Link to comment Share on other sites More sharing options...
zoobie Posted May 8, 2017 Share Posted May 8, 2017 Thank you all for your replies. You're confirming my concerns. We'll see how things play out. Maybe he's completely all set and just not telling us the specifics, but I doubt it. I was surprised that the doctor didn't recommend a short-term rehab stay, too. Sent from my Moto G (4) using Tapatalk I'd try to get DH to be more proactive than wait and see. That's a really serious surgery that could have serious complications. What would your role be in providing or ensuring provision of permanent, full-time care should that be necessary? 2 Quote Link to comment Share on other sites More sharing options...
Starr Posted May 8, 2017 Share Posted May 8, 2017 The doctors don't suggest rehab if the patient makes it seem they have plenty of help at home. The doctor may not be able to give you information but you can call the doctor or nurse and let them know what things look like from your fil s side. 2 Quote Link to comment Share on other sites More sharing options...
Bambam Posted May 8, 2017 Share Posted May 8, 2017 One thing to remember is it seems to take older folks quite a time to recover from anesthesia. Sometimes they aren't themselves at first, and it can take several days or possibly a week to recover. It can be scary if you aren't at least warned. 2 Quote Link to comment Share on other sites More sharing options...
Mrs_JWM Posted May 8, 2017 Author Share Posted May 8, 2017 It's interesting - we did talk to the doctor during the pre-surgery consult, and we stressed that my FIL lives alone. When I asked my FIL about what specifically he has done to prepare, he has been very vague. He's said he's talked to some people and he's got some frozen pizza. I do think he'll need help with managing his medication, plus he has lower-back issues for which he receives cortisone shots. I'm concerned that being in bed during recovery is going to aggravate this, making him even less able to get around. His dietary restrictions are part of his gastrointestinal issues, so any digestive upset will also be difficult for him to deal with. The last thing I heard from him was almost two weeks ago when I suggested he might want to talk to some homecare agencies to see if he could arrange some care and he didn't respond anymore. He isn't an "old" 74, but this is major surgery. Thank you all for your suggestions and information. Quote Link to comment Share on other sites More sharing options...
Jann in TX Posted May 8, 2017 Share Posted May 8, 2017 He will be in no shape to get out of bed to warm up pizza! Please have him fill out the HIPPA form so your DH (and or you) can visit with the Dr. I had a spinal fusion in 2009. I was FLOORED for a week-- I was encouraged to walk around daily-- but it was PAINFUL (and necessary). I was not able to prepare my own meals or even able to get my own meds... I NEEDED DH and my dds to help. After 2 weeks I was back to a mostly functional mom-- but it was 6 weeks before I was allowed to feed the horse or do most other chores like dishes and laundry. 2 Quote Link to comment Share on other sites More sharing options...
RKWAcademy Posted May 8, 2017 Share Posted May 8, 2017 I only had C5 & 6 fused but I needed my mom to come and stay with us for a week. Between the pain meds and the discomfort (you have to sleep in a really awful collar for awhile and then a softer collar that is equally difficult to sleep in), I needed help for several days just getting up and around. I don't remember being in pain for long because I stopped the pain meds very soon. I just know the pills knocked me out when I did take them. I remember lying down was so uncomfortable because of the collar. I was in my 30s, I can imagine a 70 year old would heal much slower. He needs someone there for several days at a minimum. And he'll need someone to drive him to appointments because I think it was 6 weeks before I was allowed to drive. 2 Quote Link to comment Share on other sites More sharing options...
Mrs_JWM Posted May 8, 2017 Author Share Posted May 8, 2017 Jann and RKW - did you need to have your dressings changed? I'm wondering how he'll manage that. I just talked to a home care agency, and it sounds like they'll be able to do an evaluation fairly quickly if he needs help once he's discharged. Someone could come for two hours a day. I think a nurse would have to do the dressing changes. Or the aide could drive him to the doctor's office and he could have it changed there. My MIL (they're divorced and she lives 1.5 hrs. from him) and I had discussed setting up one of those scheduling websites where people can sign up to help out, but he seemed so resistant that we didn't pursue it. His friends tend to be flaky anyway, so I don't know if it would work out. I also looked into short-term respite care at independent living facilities and now I want to go live in one...is that bad? :lol: Chef-prepared meals? New people to talk to? Someone to do my housekeeping? WHO WOULDN"T WANT THAT?!! Mostly, I'll be honest - I'm annoyed! We talked to him about this WEEKS ago and asked him what we could to help get him settled and got nowhere. :cursing: As always, appreciate you guys! Quote Link to comment Share on other sites More sharing options...
RKWAcademy Posted May 9, 2017 Share Posted May 9, 2017 No, I had no dressing. It's a small cut, 1.5" to the side of my throat. It was glued together. It had to stay dry for 10-14 days but I did sneak a hair washing a time or two. Then when it can get wet, it dissolves or washes off within a few showers - I'm foggy on those details but there were no stitches and no oozing of any sort, very clean and tidy! But he may have a much bigger incision. 1 Quote Link to comment Share on other sites More sharing options...
Mrs_JWM Posted May 9, 2017 Author Share Posted May 9, 2017 No, I had no dressing. It's a small cut, 1.5" to the side of my throat. It was glued together. It had to stay dry for 10-14 days but I did sneak a hair washing a time or two. Then when it can get wet, it dissolves or washes off within a few showers - I'm foggy on those details but there were no stitches and no oozing of any sort, very clean and tidy! But he may have a much bigger incision.Thank you for that info, RKW! I've heard of that sort of dressing, so I'm hoping that's what he'll have! Sent from my Moto G (4) using Tapatalk Quote Link to comment Share on other sites More sharing options...
Plink Posted May 9, 2017 Share Posted May 9, 2017 It really depends on the person. Some of us bunce back quickly, and others take a while. At his age, I'd expect the latter. Showering was surprisingly exhausting for me, as was simply walking to the bathroom. It took a good several weeks before I was capable of basic self-care. If there is any possability of admitting him to rehab after discharge from the hospital, accept it. They will keep up with his meds, start him on PT, and take care of all of his ADLs. Quote Link to comment Share on other sites More sharing options...
TechWife Posted May 9, 2017 Share Posted May 9, 2017 I have a lot of alarm bells going off about this situation. My elderly parents recently passed away and we had a lot of varied experiences with them. Your husband needs to explain to his father that he wants to make sure his wishes are followed as closely as possible and that he wants him to regain his independence as quickly as possible. In order to do this, he wants to be involved so that he knows what and when to advocate on his behalf. Explain that he will be unconscious and that for a time after that he may not feel like himself due to exhaustion and pain issues. He can explain to him that he wants to be able to get him what he needs when he needs it, not to have to hope someone else is taking care of things or that someone else is addressing any issues. Elderly patients are not at all like other patients. I think it's imperative for your husband to be there as much as possible and for as long as possible. He should try to go to the pre-op appointment with his father, even if it means being there a couple of days before the surgery itself. Have him ask your father to sign a HIPPA release with each provider - all doctors (including anesthesiology), hospitals, rehabs, nursing agencies and pharmacies. He needs to stay at the hospital with his father as much as possible - 24/7 if he can. It is not extreme to do that at all! He needs an advocate. Please find out if the hospital has an ACE unit and if it does, insist that he be admitted there. If they don't have unit, ask if they have a team. If not, ask if they have an Elder Life Care Program. These teams specialize in the care of elderly people. The goal with elderly patients should be to get them out of the hospital as quickly as possible. Rehab sounds like it might be a viable solution for him if he requires assistance and intensive physical therapy. Elderly people deteriorate very quickly in the hospital and often are discharged more disabled than they were when they were admitted. Be on the lookout for hospital induced delirium - if you notice a change in behavior, be sure someone pays attention immediately. If you can't get anyone to pay attention (do not let them put you off "until the doctor makes rounds"), call the hospital switchboard and ask for a patient advocate. If you don't get anywhere there, call the CEO's office. Call the pharmacy, pick up the phone and call the doctors office yourself (the surgeon, the anesthesiologist, his GP, the MD on call for psychiatry, whoever you can get to listen to you). Make someone pay attention! The consequences of this delirium can be life long and life altering for elderly patients (this happened to my father). The article I linked above has a lot of tips on reducing/avoiding hospital induced delirium - I so wish we had known all of this information before my father was hospitalized (his hospital based delirium developed into dementia and he gradually lost touch with the world around him). Anesthesia and pain medications act differently in the elderly than they do in younger patients. Ask the doctor what the pain management plan is. Ask how they will be monitoring side effects particularly as they relate to elderly people. If necessary, when in the hospital, he should talk to the anesthesiologist and the pharmacy team and make sure they are taking his age into account with his medication selection, dosage, frequency and duration. Think about bringing diversionary activities for your FIL to keep him mentally sharp - games, puzzles, conversations about hobbies, visitors, reading the newspaper out load - whatever floats his boat and keeps him mentally alert. Don't just watch tv with him - talk about the shows, the news - encourage mental activity. Make sure he has comfortable things from home - a blanket or afghan, favorite slippers, etc.. As far as home care agencies go - it sounds like you talked to a private duty agency. Please be aware that Medicare will not pay for this type of care. They only pay for intermittent home nursing (someone to check vitals, administer meds, wound care, etc.) and home health aids to complete specific tasks (help bathing, changing sheets, etc.). They do not pay home health aids to drive patients to appointments. A hospital social worker can be a wealth of information. They should be involved in his discharge planning, which should start immediately. They can connect him with a Medicare certified nursing agency (or private duty if that's what is preferred and it is affordable for him), medical equipment (he may temporarily need a walker, for example). Medicare pays for PT and OT both outpatient and at home for qualifying patients. They will make referrals for those services as well. If he does go to a rehab hospital, they can help you find one. If you have a choice between rehab units/hospitals - visit them! I can't stress how important that is! Ask about staffing, training, activities, frequency of therapies, etc.. This is the time to start researching what types of resources are available in his area for the elderly. Everything from rides to actives to help with long term planning. The more you know now the easier it will be to make decisions later. If you think assisted living or nursing homes might be in his future, get a list of what is available in his area and start researching them. I wish I could type everything I learned - through research and experience. Feel free to ask questions and if I know the answer I'll be happy to share with you from my experience. I'm not a dr or nurse, just a daughter. Don't let any medical professional minimize your concerns, families are the ones on the front lines of medical care! 4 Quote Link to comment Share on other sites More sharing options...
Slartibartfast Posted May 9, 2017 Share Posted May 9, 2017 This is a rough surgery and will take a great deal of time for him to recover. He is really going to need help, the Dr is probably right that someone needed to be there for the consultation. Is there any way you can call the Dr and discuss what his needs may be? Quote Link to comment Share on other sites More sharing options...
Starr Posted May 9, 2017 Share Posted May 9, 2017 Another difficulty is that someone needs to supervise the care he gets once home. Sometimes the patient fires the aide because they can't think straight and get irritated or the they love an aide that isn't really doing their job... I wonder if they know he's going home alone the doctor might approve some time in rehab. Quote Link to comment Share on other sites More sharing options...
Jann in TX Posted May 9, 2017 Share Posted May 9, 2017 Jann and RKW - did you need to have your dressings changed? No dressing to change. I had some stitches that dissolved on their own--- but mostly medical tape. No oozing. The brace was NOT comfortable! I forgot I was in that blasted thing for several months... 1 Quote Link to comment Share on other sites More sharing options...
Mrs_JWM Posted May 9, 2017 Author Share Posted May 9, 2017 TechWife, you've given us a lot of things to consider. I appreciate all the information and the advocacy language to use. We have stressed to the doctor that he lives alone and we asked about short-term rehab, but the doctor seemed to think it was unnecessary. We also asked the doctor about home health care and bright it up again with my FIL, but he says the doctor will decide if he needs this. I have encouraged my FIL to get things in place for that and he hasn't done it. If it's not ordered by the doctor, he can afford to hire private-pay nurses or aides for a few hours a day. We have compiled information about what is available on the area, but he is resistant to it. The surgery is scheduled for this Saturday, and I'm afraid he's left it rather late to get these things in place. My husband​ isn't great about dealing with his father. I hesitate to push too much, but I'm very concerned, too. There's a bit of my FIL not wanting to seem "old" in front of the doctor, too, add I think this is really clouding his judgement. Sent from my Moto G (4) using Tapatalk 1 Quote Link to comment Share on other sites More sharing options...
TechWife Posted May 9, 2017 Share Posted May 9, 2017 We have compiled information about what is available on the area, but he is resistant to it. The surgery is scheduled for this Saturday, and I'm afraid he's left it rather late to get these things in place. The hospital social worker (aka "discharge planner") shouldn't allow a discharge without adequate care plans in place. The trick will be determining what is adequate making sure everyone is on board with that. One phrase your husband can use with these planners is "bounce back." It is a phrase that is used in healthcare when a patient is discharged but must be readmitted for treatment of the same illness or post operative care. The hospitals work to minimize their bounce back rates. If he says "I want to try to make sure he doesn't bounce back" they will immediately know what he is talking about and should get on board with him in making plans. If your husband gets home with your FIL after surgery and they realize additional help is needed, it isn't too late. It will take advocacy with the surgeon and perhaps your father's GP, but they can still work on it. It may require an additional hospitalization if he was discharged too early. 3 Quote Link to comment Share on other sites More sharing options...
Mrs_JWM Posted May 9, 2017 Author Share Posted May 9, 2017 Thank you, again, TechWife, for really giving us the language to use. I spoke with him today, and all of my concerns were verified. He is completely unprepared. However, the surgery has been rescheduled for next week. Although he's supposed to enter through the ED and "they'll know what to do once I get there." Whaaat? Why no surgical admission at a specific time? Anyway, he seemed more on board with the idea of temporary care at a facility, but he also still thinks everything will go just fine. I had to keep saying, "That's great. I hope that, too. What should we plan to do in case you need more help so that you can get the care you need, recuperate, and continue to be independent?" 1 Quote Link to comment Share on other sites More sharing options...
TechWife Posted May 10, 2017 Share Posted May 10, 2017 Thank you, again, TechWife, for really giving us the language to use. I spoke with him today, and all of my concerns were verified. He is completely unprepared. However, the surgery has been rescheduled for next week. Although he's supposed to enter through the ED and "they'll know what to do once I get there." Whaaat? Why no surgical admission at a specific time? Anyway, he seemed more on board with the idea of temporary care at a facility, but he also still thinks everything will go just fine. I had to keep saying, "That's great. I hope that, too. What should we plan to do in case you need more help so that you can get the care you need, recuperate, and continue to be independent?" If he has an early surgery time, the ED doors may the the only ones unlocked. There will be directional signs from there. At least I hope that's what is going on. Your dh can call either the surgeon's office or patient registration the day before and ask how he checks in. 1 Quote Link to comment Share on other sites More sharing options...
abacus2 Posted May 10, 2017 Share Posted May 10, 2017 My FIL has had more than one similar surgery. We visited the day he came home. He needed help getting to and from the bathroom and was in no shaped to monitor his own meds. If I am remembering correctly, it was about a week before he could reliably make bathroom trips by himself. This is a major surgery to recover from. 1 Quote Link to comment Share on other sites More sharing options...
abacus2 Posted May 10, 2017 Share Posted May 10, 2017 (edited) double post Edited May 10, 2017 by abacus2 Quote Link to comment Share on other sites More sharing options...
Mrs_JWM Posted May 10, 2017 Author Share Posted May 10, 2017 Thank you, Abacus! That's more like what I'm anticipating. When I talked to him yesterday, he said, "You know, you can always call the doctor yourself and ask him all these questions." I have really tried to stress to him that we are trying to help him make the best decisions for himself, not make decisions for him. Making plans and caring them through is not one of his strengths. Again, thank you to all who offered advice and perspective. If any additional thoughts pop up, please send them my way! I'll update next week once the surgery is done and he's home. Sent from my Moto G (4) using Tapatalk Quote Link to comment Share on other sites More sharing options...
WestHoustonMom Posted May 10, 2017 Share Posted May 10, 2017 This is so true. My father had this surgery at 50, between C3 and C5, and he was in pretty good shape, never one to milk an illness or injury. He was in pretty bad shape for the first 3 weeks. I had to help him shower, and he had a plastic urinal by his bed so he didn't have to walk to the bathroom. I basically had to help him walk everywhere. I had to take time off of work and also recruited a few of his friends while I was back at work. I didn't have to deal with his wound at all because it was dissolvable stitches and waterproof tape. There will also be a decent amount of physical therapy to do afterwards as well. It really depends on the person. Some of us bunce back quickly, and others take a while. At his age, I'd expect the latter.Showering was surprisingly exhausting for me, as was simply walking to the bathroom. It took a good several weeks before I was capable of basic self-care. If there is any possability of admitting him to rehab after discharge from the hospital, accept it. They will keep up with his meds, start him on PT, and take care of all of his ADLs. 1 Quote Link to comment Share on other sites More sharing options...
Mrs_JWM Posted May 11, 2017 Author Share Posted May 11, 2017 Thank you, WestHoustonMom - I've asked about physical therapy a number of times, but the doctor says there won't be any. I was surprised. Sent from my Moto G (4) using Tapatalk Quote Link to comment Share on other sites More sharing options...
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