Tag Archives: sciatica

My experience in hospital last June

It has taken me a while to get around to writing this. To start with, I liked many of the nurses and Health Care Assistants (HCAs) on the ward, they were understaffed and trying to manage 16 barely mobile post-op orthopaedic patients. I liked my surgeon and his team. They did a good job on my back and the sciatica has all gone (though I was warned that it could come back if the L4/L5 disc gets worse again). But the ward team fucked up badly at the start and I was put through avoidable extra pain because of it.  So, to begin the story:

In early-mid June 2012 I was admitted to hospital for spinal surgery (microdiscectomy at L4/L5 & bone fusion at L5/S1) to try to solve my long-term severe bilateral sciatica from two ruptured discs. I also suffer from Fibromyalgia (along with other health problems) and am on a regular medication regimen that I & my GP have worked out over the years. It works for me and stops me lying in bed, sobbing in pain, for most of each day.

The first indication of a problem was when I arrived and they had the wrong name for me on the whiteboard – I have two “middle” names, they had picked the second of my middle names and my surname. Then they discovered that the various folders for me also all had different names. Each of three folders (all necessary, apparently) had a different “first” name selected from my full name. It is a good thing that though my surname is not unusual, none of my given names have been common for the last few generations.

The next issue did not become apparent until later but started at this point… My husband had created and printed out 4 (four) copies of a timetable for my medication needs (I take something every two hours from 7am until 11pm – missing a single dose will cause my pain levels to increase, missing more feels like an exponential increase in pain & fatigue levels). I also had a carrier bag with a week’s worth of medication in it (a two-week supply fills about 1/3 of a large airline cabin bag). I handed these to the HCA who was checking me in and was pretty much ignored while I was trying to explain about the timetables and my medication.

I went into theatre at around 9am & had a 5-6 hour operation during which I was positioned on my front, with thighs raised on pillows so that they and my shoulders took my entire weight (to keep my abdomen from putting upward pressure on my spine). In recovery, I spoke to someone and said I needed my regular medication (and told them what I was due to have then) so that I could manage the pain properly. I was given a single capsule of one of the three medications that I was due at that time of the day and told I could have the rest when I went back to the ward where my medications were.

But I got no further medication when I got to the ward. Despite repeatedly asking for it and telling them they had my timetable the response was continually parroted “you were only written up for one X and you’ve had that. You can’t have any more until the doctor says you can! ” Added to “we only dispense every 4 hours” and “a doctor will see you tomorrow to determine your needs”. Oh, and they had no knowledge of my timetables. I cried and moaned constantly with pain and was told to “calm down”. I begged for painkillers. I was refused. At this point I was not only in pain from the surgery site, but the Fibromyalgia had gone into full-on flare-up mode with the added bonus of a migraine AND my thighs, which had been “dead” & numb from the pressure of my weight on them for so long, started to get seriously painful pins and needles (sounds trivial, but it felt like my skin was both being flayed and burned off from the inside, that particular pain continued for over a month). By this time it was around 2am, I think, and I could no longer handle the pain in any way, shape or form so started screaming uncontrollably. I was pretty incoherent by this point. The nursing assistant’s “calm down”s started to be appended with “the anaesthetist is coming”.

Shortly afterwards a doctor (the anaesthetist) was brought to me to have a “chat” – she gave me morphine. As the morphine knocked the pain down a notch or two I was able to point out that my GP had already “written me up” for the essential medications to manage my conditions, that being what a prescription was for, but that I could not possibly manage them if the hospital was so idiotic as to ignore that. I also pointed out that MY regimen was 2 hourly, not 4, and the hospital insisting on 4 would mean that I would be in severe pain for the latter two hours of each period. At this point they “found” the timetables we had provided (one was even in the locked cupboard by my bed with my medication). I showed her the app on my phone that tracks my medication, sets off an alarm and reminds me what to take at the appropriate times. I explained again that I have been managing my condition this way for a few years now.  She thought about it and asked if I would be able to cope better if I had “control” of my medications.  Oh, hells, YES!  Finally a note was written for the nurses that “the patient will manage her own medications & notify a nurse what she is to take & when. ” I was also put on a self-administering morphine pump (badly inserted catheter meant a moderate level of pain started to build in that arm if I didn’t keep my  forearm raised vertically & eventually the fluid was leaking into flesh & causing swelling so it was removed after 2-3 days) & regularly offered oramorph during the night when I could not sleep (night-time being a period when I do not schedule medications for myself as I expect to be lying down and doing nothing to increase pain levels) – I had to stop using oramorph after a couple of days as it was clear they were triggering migraines. My husband bought in my refillable icepack & Imigran as the hospital had nothing suitable.

I have to say that once I was given control over my medications again, things improved rapidly. But taking note of a pre-existing illness, especially FMS that has such a huge effect on how your body handles additional trauma and pain, should be a vital part of post-op nursing care. Refusing to provide a patient with their prescribed medication because they didn’t bother to check it or to pass the timetable to someone with the authority to re-approve its use within the sovereign grounds of the hospital is simply inexcusable. If a patient has to start screaming with pain to get it taken seriously they have failed in their jobs.

I have been suffering severe & chronic depression that has worsened since the surgery & the physical recovery is still ongoing. I should probably have registered a formal complaint at the time but I was just glad to get out (and then spent several weeks with even more limited mobility than usual and lots of pain that sort of knock such ideas out of your head). My surgeon and his team were, for the most part, excellent – I can’t fault them for something that the nursing staff should have been dealing with.

When Every Day is a Pyjama Day…

…It’s not as much fun as you might think.

For most people a “Pyjama Day” is a day when they have nothing they have to do or get done, no reason to leave the house and so they enjoy the luxury of lazing around in their night-clothes.  For me a PJ Day is one where I have the choice of getting out of bed and getting dressed or getting out of bed and making it downstairs because trying to do all three will leave me incapable of doing anything else for that day and perhaps the next.  I have been having more PJ Days than usual recently.  The combination of the FMS – Fibromyalgia Syndrome – (with associated other symptoms) and the additional pain from the sciatica leaves me more fatigued than I have ever been.  An odd side effect of this is that I have actually bought and started wearing PJs!  I haven’t done that since I was about 14 years old.

My morning starts, if I have actually managed to get any sleep (that’s a whole post by itself), when my husband helps me to sit up at around seven am.  He puts a small handful of pills into my left hand (er… current count is six individual tablets/capsules) and a glass of water into my right.  I take the lot in one go.  Then he helps me lie down again so that the drugs can start to take effect and reduce my pain levels a bit before I have to try getting up.  Then he leaves and heads to work.  Sometimes I am able to get out of bed by around eight or eight-thirty, but there are days when I simply can’t do it.  Or I will manage to get out of bed but am in agony by the time I make it to the bathroom.  Some days I’ll fight that by taking extra Tramadol (I am already on the maximum daily dose, my GP is aware that I am taking more but won’t prescribe anything stronger) and try to keep going despite the pain and associated fatigue – especially if I have made a commitment to do something, I hate letting people down – the next day I remember why I’m not supposed to do that… it’s as if I “borrowed” the energy from the next day and so I’m hit more than twice as hard and can then be “flattened” and “spoonless”* for a couple of days, usually with the added joy of a migraine.  But on those really severe pain days, I pretty much fall back into bed, flip the heating pad on and try to sleep through it.  On the more average days, and PJ Days, I make it downstairs by nine am, flip the computer and the kettle on, say hello to my lovebirds (let the youngest, Sketch, out for a fly around and some time on my shoulder – she has no mate and is bonded with us instead), and spend the next few hours alternatingly between being at the computer writing or playing World of Warcraft, sitting in a different chair reading, lying down flat on my back and, on really good days, pottering about the kitchen cooking and baking.

Since I developed severe bilateral sciatica 18 months ago, my PJ days have increased markedly along with the increase in pain levels.  And, as the specialist is reluctant to operate (because of the added complication of the fibro “…the combination[…] does not predispose her to having a predictably excellent result”) and my GP won’t prescribe me anything stronger than I am already on (OMGWTFBBQ!11!!111!!!!!eleventyone! I might get dependent on them…. you mean more than I already am on my current handful of drugs that I take every two hours?) , I suspect it will remain that way until my two prolapsed and slowly leaking discs have been totally squeezed out from between the vertebrae – pressing on my spinal column the whole time – and the stuff is absorbed or whatever happens to it and I just have three vertebrae sitting one atop the other with no shock absorber between them and even more limited flexibility in my spine**.  I expect nothing helpful from the Pain Management appointment that I have been referred for (an “urgent appointment” took them 2-3 weeks to send me the letter asking me to call and book, then the first appointment available was another 6 weeks away).  I’ve read their booklet that they give to patients and the only thing in there that I haven’t tried in the past decade or more is “Making yourself feel better by lying to yourself about how you are actually feeling” or, as the professionals call it, “Cognitive Behavioural Therapy” (or “Neuro-Linguistic Programming” – they seem identical to me).  If it works for you… great, terrific, I couldn’t be more happy for you.  But all it does for me is trigger thoughts and feelings of violence and anger by making me want to smack the person telling me how to think and feel… that might make me feel better, briefly.

I need more spoons.  And a new body.

* The Spoon Theory was written several years ago by Christine Miserandino and is the simplest and best way I have ever found to explain how people with chronic pain deal with their lives.

** The specialist suggests that many people with sciatica “suffer for many years and then find the pain has gone” of course, that’s 10-20 years later in most cases