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    Old 08-15-2011, 08:59 AM   #1
    sandycreech
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    ACDF in 2 weeks - pain meds/hospital bed?

    Hi, I am very nervous - 3 level ACDF on August 29th. I just got a call from hospital asking for my co-pay of $1,450.. So it is much more real now. I have 2 questions.

    1 - pain - I know it will be bad. Historically any pain meds make me sick and I throw them up within 24 hours. Compazine (anti-nausea meds) give me lock jaw (grinding teeth) so I am very nervous about how to deal with pain! Ideas anyone? I go see the doc this Friday to ask him.

    2 - hospital bed - I've heard it is very hard to move after this for the first 2 weeks. Someone suggested a hospital bed brought home. Can anyone give any thoughts on this. I'm currently sleeping on our pull out futon (with a good mattress on it) as our waterbed is too painful to lay in now.

    I have a TENS and I swear by it - it really helps block pain. Can I use this right after the surgery - will the metal plate in my head cause it not to work for some reason?

    Thanks for your thoughts and ideas. 2 weeks from right now, at noon, I'll be in surgery.

    Sandy

     
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    Old 08-15-2011, 03:35 PM   #2
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    What levels are being fused?

    I had C5-C7 which is a 2 level fusion (C5-C6 and C6-C7) ACDF. The hospital stay is short, usually 1-2 nights. And I was glad my doctor prescribed a cervical collar which I was fitted with before my surgery. This was a relatively easy surgery.

    At home I did use a bed wedge. They discourage you from laying down all the time and a hospital bed would be an expensive option. With a 15" bed wedge I was able to sleep somewhat with a combination of pillows. Prepare for pain meds with something you can eat easily when you take the medication. I often took it with rice krispie treats and this averted any nausea. Zofran is newer than compazine so you can always ask to have that prescribed for at home. What I needed most at home was a muscle relaxant. I doubt you will be able to use a TENS near your neck in the early recovery.

    Moving around after ACDF was quite easy. The biggest mistake I made was not moving around enough so as soon as allowed (about 1 week after) I started with 5 minutes on the treadmill at 1 mph. I increased the time by 1 minute a day. When I reached 10 minutes I increased the speed by a small increment. I always stopped whenever I had pain instead of pushing myself.

    I had a grabber at home (can be purchased at any large pharmacy) which helped me pick up stuff that was out of reach. I've used it over and over since as I also have lumbar and knee issues.
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    Old 08-15-2011, 03:44 PM   #3
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    Hi spineAZ - I'm having C4 to C7 fused. The rice krispy treats is a wonderful idea!!! I'll get a bunch of them. Did you have any swallowing problems? I don't have a treadmill. I do have a gym membership so it would work as I start to feel better, but don't think I'll want to head to the gym for awhile after this! I did read it is good to get out and walk.

    I did look at bed wedges today. I see a 12" I'm thinking of getting. Hospital beds are very expensive to rent. Too bad about the TENS - it is amazing how it works to get rid of the pain! I have it on my list to ask my doctor when I see him this Friday.

    Do you remember how long after the surgery you started to feel "good" again? I'm real worried about just how much movement I'll have after being fused 3 levels..

    Thanks for your thoughts and info.

    Sandy

     
    Old 08-15-2011, 04:21 PM   #4
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    I just typed up a big response to you when the WiFi died. So let me know if I leave anything out I should have mentioned.

    The bedwedge is awesome. If you are married/living with a partner you'll likely want to sleep alone. I was up at unpredictable hours wanting the TV on, etc.

    I bought the pre-packaged rice krispie treats. There was something about the density of them and they also could be kept in the night stand for easy access.

    I woke up with a scratchy throat. The nurses gave me cepacol lozenges, I had hubby buy a box as well so I could stop asking the nurses for one every time I wanted one. They served me a normal dinner and the nurse urged me to cut up stuff small and eat. She felt that making the swallowing mechanism work soon after surgery helps get it back into normal functioning. She said people who spend days on soft foods like popsicles, jello, etc aren't "challenging" the swallowing and the mechanism can become less responsive. I managed to down a steak in tiny bites and she was right. I felt better after making my system start swallowing again.

    Will you have a cervical collar? Mine was fitted for me 2-3 wk before surgery. Some surgeons don't use them feeling the hardware gives enough support but I always felt that it helped me not move in the wrong way, support my muscles, not have my head fall to the side while sleeping, not turning my neck (as in forgetting I just had surgery and hearing hubby drop something behind me, I couldn't just whip the head around to see what had fallen). So ask if he'll prescribe on. If not some people buy one at a medical supply store or pharmacy. I used mine 24 hr a day (besides showering) for about 4 weeks. After that he let me take it off for short periods. Some docs say that using one causes neck muscles to get weak but I could still tell my muscles had to work enough to stay active in the collar.

    Ask if you will have a bone growth stimulator. Most common cervical version hangs around the neck with a battery pack. It produces a small electrical field to aid in fusion. Some ins companies wont approve it and my current spine doc says he feels it can't hurt but it's not a "must have".

    Consider telling the doctor to fix whatever he may find when he gets in there. When my prior orth spine surgeon said my C4 was "iffy" we never discussed possibly adding it in, and now it should have been. I was headed for an ACDF revision this Fall when my bad knee got worse and at 45 am having a knee replacement. (Don't let my surgical history worry you, I have very lax ligaments and tendons so joints from spine to knees to feet to hands get too loose and some have to be fixed surgically).

    If you can walk outside that's as good as a treadmill. I live in Phoenix and had my ACDF in late May. By then it's already 100 degrees every day and walking outside wasn't an option. Make sure somebody walks with you especially early on. You never realize how much you look down when walking or typing until you have a collar on. I thought I was the worlds fastest typist but I guess I glance down more than I thought so typing was hard.

    If you have the searing nerve pain in arms/hands that is common for people heading for an ACDF you may find you have significant relief upon waking. However some pain takes a long time to go away as nerves heal VERY slowly and thus pain improvement can be a slow process.

    I returned to work 6 weeks post op and it was hard, more due to exhaustion than neck pain, though 4 hr into the day I needed to go home so I did a gradual return to work (now due to other problems I no longer work). I'd say after the ACDF I finally felt decent at 2-3 months. I even changed jobs in August after the May ACDF and the only reason I felt okay doing so was how my neck was feeling better every day.
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    Old 08-16-2011, 03:01 PM   #5
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    Hi spineAZ - my gosh, you have given me so much good information. I've added much of your last message to my doctor aptm this Friday for pre-op. I'm not sure if he is going to give me a collar (I do have a soft one I can wear, I wear it now when I have to look down for more than a minute or two to prevent neck pain). I don't think he is planning the bone growth stimulator. My original doctor was (who was only going to fuse 2 and not worry about #3- I dumped him and found another who is planning on fusing all 3).

    My husband is scouring craigslist to find me a hospital bed to use for a few weeks. I'll be at home alone from day 5 or so and it will probably help a bunch to get me in and out of bed. Then when we are done with it we can sell it again.

    I am so glad you told me about the scratchy throat and still being able to eat. I've read that some people can barely swallow and that is really scaring me. I am buying soft foods just in case, and I did get some sore throat meds to bring to the hospital.

    I will definitely ask the doctor about fixing anything else he finds while he is in there. I'm definitely hoping to never have to repeat this!

    I live near Orlando so it is hot, but I enjoy the heat. Still I likely won't go far for a walk, and will have my husband come with me. I don't know how long it will be until I can go to the gym and get on treadmill in the AC. That is another one for the question list!

    I did have the burning pain, pins and needles and completely numb arm. I had 3 epidurals - last one about 45 days ago. It must be wearing off already as pain is starting to come back in left arm already. I am hoping I'll have the surgery before it comes back in full strength. And I had a feeling of having a knife behind my left shoulder blade, it was HORRIBLE! That is the main reason I'm having this, I don't want to ever feel that again. Doc said it was the nerve root completely compressed causing the pain.

    I get short term disability, so I'm not in a rush to come back. Doc said 6-8 weeks. I know they will hold my job for up to 12 weeks, so that is good. I don't want to come back for a few hours and fall asleep at my desk!

    Thanks again for your kind words and good advice!!

    Sandy

     
    Old 08-16-2011, 04:13 PM   #6
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    Too bad we don't live closer. I'd use the hospital bed after you as I have knee replacement 9/28.

    You probably won't need the hospital bed though, please ask your doc for his opinion. My guess is he'll expect you to be up and around soon and say you shouldn't need the bed. The times it has been needed by people here is they can't get in/out of bed such as a waterbed with no guest bed option. As long as you have the bed wedge and a comfortable enough bed you should be fine. This isn't a lay in bed and recover surgery, it's more of be up as much as you can. And getting in/out of bed wasn't even a concern for me as it was just as easy as normal. Keep in mind if you get a hospital bed it has to be the fully electric one or it's not worth it. Many home modesl aren't as sophisticated in movement such as bed height .

    A better bet is a reclining chair that hits your neck at the right point. Many people here have done that and sleep in recliner at night and sit in it during the day. The expectation is you'll get up every morning and find a comfy place to sit/recline during the day. I spent my days in the family room ina reclining chair. Maybe start a thread here of "Recliner or Hosp Bed at home after ACDF" to get thoughts of other members.

    If your STD is a policy via your employer and you'll be filing a claim thru an insurance company (or a third party administrator) they will approve you for 6 weeks from the date of surgery. Then anything beyond that will require objective medical proof to extend STD (I was in that business for over 15 yr and help out many people with disability claims questions, process questions, and even SS questions for those out of work an extended period of time on the Disabilities board here)

    So after the surgery if anything comes up that slows your recovery discuss it with your doctor and with STD. For example, I had a claim once where we approved 3 mo after a lumbar fusion and the person couldn't return to work due to a fact that was never in the records or in a discussion, she had achrondoplasic dwarfism. That had resulted in many joint problems and pain. She eventually returned to work at about 6 mo. If you have other medical symptoms or diagnoses that affect recovery let them know. When I had a second neck surgery they initially approved me for 6 wk but it was extended to 8 wk as my 3 person office had become a 2 person office and my coworker was on vacation right as I was set to return. The manager in another state asked for 2 additional weeks as he didn't want me working alone, handling huge files without assistance, etc. Since my work had temporarily been moved to Texas (where my new manager was) he didn't see the logic in hiring a Temp (as STD suggested to get me back to work) to asssist me for 2 wk when his staff was already handling my work.

    So up front let STD and surgeon know of any other conditions you have that may impede recovery speed such as other joint arthritis, diabetes, MS, etc. And if anything happens after surgery such as infection, additional surgery (related or not), etc elt your surgeon know ASAP and STD as well. Often it's the surgeon's medical assistant or nurse completing paperwork (with doc reviewing and signing) so find out who does disability paperwok next week and make friends with that person. My spine surgeon's MA is a lifesaver for me.

    IF by some chance your employer does the STD inside the company, then often less medcical proof is needed for extending STD.

    In either case tell the doc you expect 8 wk out and if doing well sooner you can always have him release you sooner.
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    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

    Last edited by SpineAZ; 08-16-2011 at 04:22 PM.

     
    Old 08-16-2011, 05:56 PM   #7
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    Sandy....good luck with your ACDF...I didn't have that surgery(mine was from the back) so I couldn't give you any advice on what to have on hand. But Spine has great ideas.

    And SpineAZ....good luck with the TKR. I know you'll do great and love the new knee.

    hugs to both of you..............Jenny

     
    Old 08-17-2011, 02:00 PM   #8
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    Sandy....you shouldn't need or even use a hospital bed at home. It is very important to get up and be moving around so you heal faster. Even I was up and walking around 2 days after surgery and I was a 6 level. Never used or needed a hospital bed at home.

    You'll have a neck brace on and it is quite easy to get up out of bed with the brace on. The brace will keep your neck safe. No need to have a bed that you put up in order to get out of bed.

    You are having surgery from the front and the people I've talked to have told me that it is relatively painless surgery in comparison to others. Yes, you have an incision in your neck but there isn't any pulling on the incision as you have a brace holding your neck in the position the doc wants.

    Having had over 30 surgeries, it is so important to get up and move around so you don't get clots in your legs or post-op pneumonia. And it speeds healing so much to have you up and moving around. Even when I was having major complications, I was up and being walked around the ward to keep anything else away. And SpineAZ....you'll find that you can't use the knee lift part of the bed after TKR...you REALLY have to watch for clots.

    I used my recliner when up so I could sleep in a chair if I was too tired to go back to bed but was cautioned about using the leg rest in case of pressure causing clots. SpineAZ suggested a wedge pillow but I found that not to work as it pushed on my neck brace. I never, with either surgery, needed anything other than my own bed...and sometimes, that is the best place to rest....like getting back into your own nest. Sleep does not come easy with pain meds in you.

    Please don't waste time, money or energy looking for a bed you won't need. Instead, put it into making food ahead so you can eat well and recover fast. And get a bottle of Vit. B Complex in...B is needed for optimum nerve performance and it helps them to heal faster. And some Vit. A cream for the scar...I used fresh aloe as well and both help.

    Knowing I may be headed for surgery I am already doing what I now know I needed to do before my others...cleaning the floors and getting all junk up and off the floors. It's hard to see the floor with the brace on and I kept tripping on stuff left on the floor by hubby(or cats). Slipped on newspapers he left in a pile that fell over and almost killed me! Get rid of throw rugs for that period of time too. Try walking around with your head held high and see what you can't see on the floor so you know what has to be cleared. No one warned me about that.

    And since bending over is a problem, having food made ahead is wonderful. Portable food stuff you can eat and drink in bed or wherever you happen to be sitting is good. I moved the microwave up to eye level rather than lower so I could see what was cooking and if it was done.....it's hard to bend down and see.

    And if you really want to get something...get a stool for the shower so you can sit and relax in the water once the stitches are out. It feels so good but you may be tired.

    If you have a soft collar at home, put it on and then imagine it being higher up and then see what you can do and what you can't. That will tell you what you need to do ahead of time...but buying a hospital bed is not one of them. Save the money for the bills. You'll have them.

    hugs............Jenny

     
    Old 08-17-2011, 02:47 PM   #9
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    Hi both Jennybyc and spineaz - again, a big thanks to your words of wisdom...

    I see the doctor on Friday and have lots of questions. I am going to look at a used home version hospital bed tonight (electric up and down but not for height). My normal bed is a waterbed that I haven't been able to lay in for 4 months - it puts pressure on my neck and is terribly painful! (just like riding in a car, very painful). I've been sleeping in a futon which is acceptable, but it is very very low to the ground and I have to almost push myself and bend to get out of it. We don't have a recliner I can use. The lady wants $100 for it, and hopefully we can resell it for $50 when I'm done. I'll be alone for most nights and mornings since my husband will go to work again on day 5 so I figured I'd better get something better than what I have. I'll let you know how it goes. But thanks for all your advice. I sure wish we lived closer!!

    I did check with STD and it is with Mutual of Omaha. She said she is still awaiting my paperwork back from my doctor (I'll ask about that on Friday for sure). Said it shouldn't be a problem if I am out up to 11 weeks, but ultimately it is what the doctor writes and my recovery that dictates how long I am out.

    Last time I talked to the doctor he was not going to give me a neck brace, said the hardware would work by itself. He is a neurosurgeon and has been in practice 30 plus years. I guess I just have to believe him? I do have a soft collar and have had plenty of days I've worn it as it really helps with the pain of needing to look down (I had to deliver a litter of puppies a few weeks ago during all this - definitely a neck collar kind of day and night!)..

    I am not the type of person to sit still so I know I'll want to be up and about. But I've heard with not being able to look down, going out for walks will be very difficult. I'll likely ask my husband to walk with me when he is home in the evening, but the for day hours I'll be on my own from when I wake up till 7 pm at night.

    Thanks for the tip on vitamin E complex and vitamin A cream - they are on my list of things to get the night before..

    As to showering one person wrote she brought in a beach chair and her husband washed her hair for her in the tub. I guess I'll try that. Our shower does have a bench in it (but it is cold to sit on since it is tile!), so once I do progress to showers I have somewhere to sit if necessary. Thanks for the wonderful tip.

    Having food made is a wonderful idea! I think I'll cook up a pot of stew this weekend and freeze several bowls! I've heard the first week food that is softer is easier, but it is also good to challenge yourself and try to swallow as soon as you can. So I have some soft foods on the list and some others that I like but will need a bit of cutting. I imagine cutting food is difficult if you can't look down! Oh, I have so many things to learn.

    How soon did either of you go into a shower or pool? I love to swim , or at least move around in our pool. You'll both laugh, but we have 6 dogs and they all love to swim with us! We have bins of toys for them that we throw in and they jump to get them and then get them out of the pool. I know I won't be able to bend to pick up their toys, but at least if I can get in the pool I'll get some exercise moving around. It is just scarry to think of getting in there and not looking down!!

    I am sending both of you a hug - you are both very brave women who have had many surgeries. the time you spend her to calm the nerves of us newbies is very grateful!! I wish you both the best and hope that the surgery goes well for you as well.

    Sandy

     
    Old 08-17-2011, 04:35 PM   #10
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    I typed up a long response and lost it….ugh, my fault.

    Most people don’t realize how STD is done; thinking the date the physician denotes as the expected return to work date is what drives the claim. In fact, the dates means very little. Mutual of Omaha, as like many other insurance companies, uses well documented and standard disability claim duration guidelines in “Managed Disability”. Managed Disability means that every claim is carefully managed to minimize time away from work.

    The ins co takes into consideration the diagnosis, type of surgery, and the type of job/occupation. Job categories are: sedentary, light, medium, heavy, and very heavy. Unless your job is in the heavy/very heavy category, and ACDF results in approval to 6 weeks post op. The initial approval letter will likely say “you are approved through (date) and are expected to return to work on (date). If you find you are unable to return to work, please have your physicians send us proof of medical reasons that you are not yet able to return to work. Proof would be medical records, office notes, test results, etc which show that your recovery has been delayed.

    STD for ACDF is most commonly approved through 6 weeks post-op. The STD plan most often requires that STD begin after a few days out of work, those days you use PTO/vacation/sick pay.

    Three basic ways to submit STD claims, your employer will tell you which you’ll use:
    *Paper: You are sent forms for you and the doctor, the employer fills out their portion and provides that to the ins co.
    *Telephonic: Your HR/Benefits give you a phone number to call to start your claim. Have all the contact information for your doctor and the surgical facility at hand before making that call.
    *On-Line: Your HR/Benefits gives you instructions of how to submit your claim online.

    One key form is an authorization to allow the doctor to talk to Mutual of Omaha. At the doctor’s appointment ask if they have an authorization form you can complete so they can talk to Mutual of Omaha to expedite the claim. In case they don’t, bring a homemade one that has your full name/address/contact info at the top and your DOB. Then type “I (name) give the office of Dr. (name) permission to provide any requested information to Mutual of Omaha for the purpose of my Short Term Disability claim”. Then sign and date.

    Most employers run STD and FMLA concurrently (at the same time) so if your STD claim ends at 6 wk post op you can take additional time under FMLA if your doctor agrees to complete needed paperwork. STD is based on the policy/plan definition of disabled which most often means the inability to do the essential duties of your job. FMLA is not based on disability, just on medical request for time off for your care or the care of direct relatives.
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    Old 08-17-2011, 07:15 PM   #11
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    Hi spineAZ, you certainly do have the STD downpat!! I am very grateful for your expertise. At my job there is a 2 week waiting period before I can get STD. I have some vacation time left and a holiday falls in that time and my employer said I will get paid for it. So in the 2 weeks I'll only have one day not paid. Then the STD will kick in. I already filled out all the FMLA and STD paperwork and dropped the necessary copies at my doctors office almost 2 weeks ago. Nothing is done yet so I'm gonna raise hell on Friday when I go. My office said they must have them by early next week..

    I will definitely ask the doctor about an authorization to speak directly to the insurance company. But I am pretty sure I remember that in the stack of paperwork.

    This sure is very confusing.

    We had no luck with the hospital bed tonight. We drove an hour after the lady emailed my husband 3 times today. And she was a no show! So upsetting. There is one more we are going to look at close by and if that doesn't work I'll go with the wedge - I found one on ****** for $30.. But I would need to do it soon, I'm running out of time.

    How are you feeling? Can you do much walking with your knee the way it is? I don't know much about knee problems so I can't help much! Now if you want to talk about computer viruses or backups I'm your gal! I work at a college in Winter Park in the IT dept.

    Take care and again a big thanks for your thoughts, time and wisdom!

    Sandy

     
    Old 08-17-2011, 07:35 PM   #12
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    In the interest of time perhaps order the bed wedge since it's not much in terms of cost. Some hospital beds come with the frame only and mattress is a separate purchase. Unless you get a hospital bed cheap you may end up regretting spending big money on one. If the futon hasn't been working for you perhaps a replacement bed at standard height. We have a store here with a full/queen set at $200 or less. Not the most luxurious but great for guest room.

    Your surgeon's office may be holding the forms until the appointment. Often they want to discuss with the patient before completion. They don't know if you are out of work now. The form requires the doc put the date you were first unable to work and he won't know your specific situation, other diagnosis you may have, medications, what your job requires, etc.
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    Last edited by SpineAZ; 08-17-2011 at 07:40 PM.

     
    Old 08-18-2011, 09:04 AM   #13
    sandycreech
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    Hi spineaz and jennybyc. I hope you are both feeling as well as you can be. My heart really goes out to both of you to be having continued pain after all you have been thru.

    Quick question, I saw on the list of items to have prior to ACDF - get button down tops as you cannot put a top on over your head. I have a few, not sure if I need more. So far I do not think I'll have a hard colar to wear. Do you have any idea of how long a time it is before I can pull a shirt over my head?

    My husband really thinks I need this hospital bed. We drove an hour last night only for a no-show! I told him if we don't have a bed by tonight I'm ordering the wedge!

    Thanks again for all your comments and suggestions. Even though I am very worried, talking to both of you is really helping!!

    Sandy

     
    Old 08-18-2011, 09:17 AM   #14
    SpineAZ
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    Re: ACDF in 2 weeks - pain meds/hospital bed?

    I ordered button down shirts from a catalog. CHEAP shirts. You can go to stores like KMart or WalMart and check out their selection of button down shirts, especially clearance. Check the mens department also, they often have some baseball jersey type button downs and if you find those in cotton they are quite comfortable. Get a few that are comfortable to wear, maybe one size bigger than you wear. I then donated most of those shirts to Goodwill and kept a few for "just in case". It's not only for the brace but more comfortable to put on and take off a button down shirt.

    The interesting thing is your husband probably doesn't get that you won't be bed bound after this surgery. You will be expected to be up and out of bed during the day finding a comfortable place to sit/recline, take small walks, etc. The cost of a hospital bed are likely higher than the benefit. If you have a standard bed with a bed wedge you'll be able to get comfortable. Make sure you have pillows that can easily be adjusted, in case you need to buy 1-2 pillows that are very easy to mush and fold. Many people here have found recliners to be more comfortable than bed. You can rent recliners or find a clearance one at a furniture store.
    __________________
    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
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    sandycreech (08-18-2011)
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