Back Surgery - portal hypertension

So my hep doctors office has a cool feature where instead of having to go in for visits you can email them through the system to get questions answered. I needed to confirm some things before I schedule my yearly check up in December. I was hoping to not need an EGD and wanted to get the CT done before my visit so he could tell me how it looked. I guess I only need an ultrasound this year and no EGD since I have had so many ERCPs over the course of the year.

The other question I had was regarding surgery for my herniated disc. I am hesitant to have it as it sounded like a major surgery. He responded saying that with my labs being so good and consistent that getting my back fixed should not be an issue. He also said that this type of surgery is very well tolerated by cirrhosis patients because of the lack of bleeding.

So I was told to go ahead and start planning evaluation however to not have anything scheduled until after my yearly in December. That would work out seeing as it is September and I would want to wait until after the holidays to be laid up for a few weeks. I was curious if anyone else has had orthopedic surgery on their back with portal hypertension.

I also need to make sure I get a second opinion before I go and just let them operate, but maybe by January I can have surgery to get relief.

Syxx, I can't answer that specific question re: herniated disk repair with cirrhosis, but DO be sure you have a neurosurgeon do it and NOT an orthopedic surgeon. Have your hep doc recommend one to you.

Hugs,
Connie

I have decided to see the surgeon at the specialist I have been going to. After that though I am going to see the specialist at Abbott Northwestern to get a second opinion. Also that is where my hep does his hospital time.

I did a lot of research and the general view was that it was the individual surgeon that matters rather than his/her specialism. I saw both an orthopaedic surgeon who only does spinal work and also a neurosurgeon who does mainly spinal work. Both were highly recommended by local physiotherapists and did many many such operations a year. Of the two I decided the neurosurgeon was the one for me and went with him. I liked his calm, careful approach and the fact that a microdiscectomy is the simplest procedure he does.

He checked with my hep but as my blood was clotting OK he wasn't worried from a liver point of view.

Everything went fine - small scar - probably about 5cms or so. Full recovery was about 6 weeks but for normal day to day activities I was fine straight away. I drove after a week. I didn't need any looking after as such - I was completely self sufficient straight away and could cook and so on, just needed some help with carrying shopping for a bit. I used walking as my main therapy as advised by the surgeon.

For me, relief from the sciatica was instant. When I woke up in recovery that pain down my leg had gone. I only needed minimal pain relief after the op. I took two tramadol a day for about 3 days, then that was it.

Ann

Post Edited By Moderator (hep93) : 9/7/2013 11:13:11 AM (GMT-6)

Both places I am going are highly regarded and for the location of my herniation would be performed by a neurosurgeon who only does back repairs.

I do not know details yet, but my herniation protrudes into my chest cavity and is touching my spinal cord. I was told it is a big surgery, at least 2 ribs removed to make room to access. I am going to see the first surgeon since I have started there. My plan is to then go to Abbott Northwesterns Spine Institute. My hep and all my procedures to date have been done there, so they have easier access to my history. Since my hep does a weekly rotation there he can communicate with surgeons easily.

Post Edited By Moderator (hep93) : 9/7/2013 3:35:27 PM (GMT-6)

Syxx, that does indeed sound serious. I've never even heard of a herniation invading the chest cavity. This must be in the thoracic area. Either surgeon sounds fine, so it's up to you. Are you in a lot of pain?

I pray for the very best of outcomes for you. I intend to hold off on surgery as long as possible. I have too much else going on.

Hugs,
Connie

Well, here's hoping that you can have the surgery soon and finally get some relief. It's a shame you can't get with a Pain Clinic before that--one that is willing to prescribe something for you.

Is this in any way connected to your MS?

Hugs,
Connie

Sorry, thought you had that.

The patch may well work for you. As a drug user in the "distant past" as they call it, I do feel funny asking for pain meds, since the docs all know the history and it puts them in "alert" mode. My PCP has been seeing me for over 20 yrs., so she finally trusts me.

Hugs,
Connie

I've not familiar with Bupren, but it sounds like a good option. Go for it! It hurts me to know you are in so much unrelenting pain. I woke up with screaming back pain. I think it's from sitting in a friend's recliner for 2 hours last night while I watched a movie.

Hugs,
Connie

I will definitely keep everyone updated. It would be December at the earliest, which actually works good for me. I want to get a second opinion with the doctors at Abbott Northwestern where my hep works, just makes sense.

On a good note I finally called my doctor and vented about my pain management. I told her I understand she does not want to prescribe meds, but no one does. All the specialists just give you recommendations to give to your PCP. Even the pain management clinic manages oversight but works with prescribing through your PCP.

I said this is my quality of life and I cannot continue on this course. I need someone who is willing to work with me to find a way to manage my meds. It would only be for a few months, hopefully, with surgery coming up.

After that she asked me how much of the vicodin I was taking. I told her it is always less than 2grams a day because of my liver. I also said the vicodin barely does anything because it is the low dose. I brought up extended release meds and patches.

I am going in tomorrow to review this all again and come up with a course. So hopefully it goes well.

Post Edited By Moderator (hep93) : 9/9/2013 9:22:37 PM (GMT-6)

Syxx Hi, I was on Butrans for several years, and was more than happy not to have to take a bunch of pills, my liver would just throb and my enzymes went thru the roof. But there are things about Butrans patch, they worked really good .....but it first has to get into your system which takes a good 24 hours or more, they stick fine, but they are supposed to last 7 days they last about 4 days. Unless you have good insurance or have this medicine authorized, which all the doc has to do is call your insurance and let them know there is nothing else, as pills affect our livers and it's too much of a risk. I mean they won't tell them your medical business, but they will tell them its something we can ONLY take for our own protection. And it is. All worth it, to protect our liver from more harm, YES. But you can ONLY start from a 5mcg to 20mcg. That's it--can't go any higher if you needed to. My enzymes went down and now I'm on Fentanyl 25mcg which is cheaper and stronger. If you need to increase Fent don't stop at 20mcg. It can go pretty high, and wouldn't want to go to only exactly what I need to control my pain.....Oh gooosssh didn't mean to write so much. Hope this helped.

Blessings,
gavemegrace

Post Edited By Moderator (hep93) : 9/9/2013 9:26:42 PM (GMT-6)

Syxx Hi, I was on Butrans for several years, and was more than happy not to have to take a bunch of pills, my liver would just throb and my enzymes went thru the roof. But there are things about Butrans patch, they worked really good .....but it first has to get into your system which takes a good 24 hours or more, they stick fine, but they are supposed to last 7 days they last about 4 days. Unless you have good insurance or have this medicine authorized, which all the doc has to do is call your insurance and let them know there is nothing else as pills effect our livers and its to much of a risk. I mean they won't tell them your medical business, but they will tell them its something we can ONLY take for our own protection. So is it. All worth it, to protect our liver from more harm YES. But you can ONLY start from a 5mcg to 20mcg. That's it can't go any higher if you needed to. My enzymes went down and now I'm on Fentenyl 25mcg which is cheaper and stronger. If you need to increase Fent don't stop at 20mcg. It can go pretty high, and wouldn't want to go to only exactly what I need to control my pain.....Oh gooosssh didn't mean to write so much. Hope this helped.

Blessings,
gavemegrace

Surgeon 1 visit will be on the 25th. He is not a neurosurgeon but I did some research and he has advanced training in dealing with spinal cord injuries.

My PCP is referring me to see a neurosurgeon who she said is the best she knows of. No bedside manner but great surgeon, which is fine by me. My goal is to shoot for Dec. if possible.

Pain wise I am doing good, the Oxy ER works good, but wears off at 8 to 10 hours.

No liver news from this guy for another week when I get my labs done again.