Hi all,
My decompression is in 2-3 weeks. 2 things. First: hair.
Has anyone had the surgery without having ANY of their hair shaved? I had a surgeon in mind and recently switched to another one I feel much more comfortable with. Crazy thing is, he does the procedure typically without shaving hair! I was skeptical about this at first for obvious reasons. That just sounded like a cleanliness issue to me. Besides, I’d already done the research and surveyed the various shave jobs to get an idea of what I’d end up with. However, he said the recent research actually shows a lower incidence of infection when you choose not to shave hair. He did say that If he has trouble feeling around and finding where he wants to make the incision that he may shave a tiny strip in the middle underneath my hair to get a better look, but only as a last report…and even then only a tiny amount being taken. Besides that, he just plans on generously applying the sterilizing/cleaning goop, parting my hair, and making the incision in the part! Has anyone heard of doing it this way?
- pain medication immediately after surgery;
I have read people’s experiences describing everything from feeling like Tylenol + hydrocodone pills would’ve done the trick, to the hourly IV meds weren’t enough to keep from waking up in excruciating pain that made some wish to die. Is anyone willing to offer what medications they specifically had you on as you woke up and recovered? My surgeon mentioned a morphine drip… Which made me feel very comforted of course for obvious reasons. I’m wondering if some of the pain-ridden stories I’ve read about might’ve been due to not having access to the strongest pain medication, or if we’re talking about pain so immense that morphine doesn’t even cut it. I know everyone’s pain threshold is different and the surgery affects everyone individually so I can’t hope for anyone to give me the exact “answer” of what it’s going to feel like, but it couldn’t hurt to ask!
Concerning point 2 - pain - this was a helpful and informative response given to another member a few months back. Hope you find it reassuring:
Reply by TJ1 on December 7, 2015 at 1:32pm
Okay, I don't want to seem as if I am dismissing the problem here, because I am not. But there are a few things you doctors DO know better than patients. One of them is the fact that the use of opiates following Craniotomy is generally a bad idea and most frequently leads to long term and severe pain that is very difficult to control. In some instances it takes a vaery long time to recover. That is why your doctor chose the maximum amount while waiting to reevaluate. Your well-meaning PCP should NEVER have given more.
The pain is not what you think it is. There simply is not that much to hurt with craniotomy. There will be pain along the incision line which are generally small. There are few pain receptors in dura, there is pain insensitivity of the brain, and in fact reduced pain fibre density along the incision lines. Your pain is a reaction to something else.
Following craniotomy (or head trauma) the body has a fascinating thing that happens which is the development of autoanalgesia. If left alone the body will develop its own analgesia. If interrupted with opiates, it does not. Opiates interrupt the natural healing process, and turn what should last days or a few week at most into something that can last for months. That is not to say the pain you are experiencing can not and should not be treated. Torodol has helped many as has Paracetamol, dextromethorphan, ketamine, gabapentin, and even dexmedetomidine infusions.
The most common reason for pain following decompression surgery is irritation of the Trigeminal Nerves (there are five) the greater and lesser auricular nerves (a branch of second- and third-cervical spinal nerves) and the greater and lesser occipital nerves. One should ask about scalp blocks that would whip these guys into shape. MOST NS will evaluate these things at the first Post op appointemet. as it take just about that long for things to settle down.
There are some other things to consider as well even a slight amount of Depressed respiration can give rise to hypercarbia which increases cerebral blood volume and consequently raise the intracranial pressures (ICP). If you think you hurt now, it pales to the headache a raised ICP causes. Moreover altered neurological status following neurosurgical procedures and the subjective nature of pain assessment hampers the appropriate quantification of pain. Keep in mind the the cause of your pain that lead to the decompression surgery in first place up to 40% of the time is NOT the result of the Chiari, and surgery only magnifies it. Analgesia as you know didn't work before the surgery (and rarely works on neuralgia anyway) It isn't gtoing to help much beyond zonking you after surgery.
I am disappointed you were not told all of this going in. You should have been.