Mountain Equine - Courtney S. Diehl, DVM / Steamboat Springs, Colorado

Recovering from Back Surgery

I had major back surgery on Feb 22nd.  They fused my spine and now I have rods and screws and bone grafts and all sorts of things in my lower back.  Obviously I cannot perform my duties as a horse vet, so have been forced to step back from my profession for a few months until the doctors tell me I can go back to work.  The rehab rules are simple.  No bending, lifting or twisting for 4+ months.  As that pretty much describes my life as a vet, it looks like I’ll have to be finding new employment for a while.

Why the surgery?  Well, in a nutshell, I broke my back.  My surgeon thinks it probably happened quite a few years ago and I suspect a severe crash on skis may have caused it.  I was on telemark skis on Beaver Creek mountain, and came off a fun bump run called Ripsaw.  Those of you who have skied it know the run and it is guaranteed to fry your legs.  There’s a groomed runout at the base of the trail which goes straight down to the chairlift, and thinking I was down, pretty much pointed my skis and took off.  The light was flat and rather than the smooth groomed cruise I thought I’d have to the lift, I entered another mogul field at a high rate of speed.  Apparently the snowcats hadn’t make it to the base of Ripsaw that day.

Your heels aren’t attached on tele-skis and I was immediately flung forward, landing chest first on a huge bump and my spine did what skiers call “the scorpion”.  When you’re on your stomach and your skies are in front of your face, it’s probably not good.  I won’t go into details about what happened to my left boob during that same wreck, but that wasn’t good either.

Did I go to the doctor?  Of course not.  I rested (briefly), took anti-inflammatory meds and kept skiing and doing vet work.  Over the years, the low grade pain in my back gradually increased, and I just assumed that I worked hard, I was tired, and of course my back ached.  Many people get out of bed on a daily basis with various aches and pains, and horse vet work is grueling and very physical.  Of course I ached.  I guess I didn’t want to stop and think about what an injury would do to my career.

So I did nothing about it, doctor-wise, but I did start cross country running and going to the gym regularly, thinking I was just out of shape and if I strengthened my core, the aches would go away.  I hurt my hip running about two years ago, so had to quit that activity.  Those of us who are built like me (and have an aching lower back) probably shouldn’t consider running as a regular activity.  Duh.

I finally decided to go to the doctor this past November, as the hip just wouldn’t quit aching.  The doctor took x-rays of my hip and lower back, and after viewing the destruction on my lower back said incredulously, “Don’t you have low back pain?”  I said, “Well I guess.  But I’m here for my hip!”

Isn’t denial a wonderful thing?

So off to The Steadman Clinic in Vail and Dr Corenman, and two MRI’s later, it was clear that I needed immediate back surgery to decompress a crushed nerve and fuse two vertebrae.  I still need hip surgery too, but somehow I’m just not that worried about getting that scheduled right now.  Dr Corenman is probably the greatest back surgeon in the country and I would never go see anyone else.  He fixed me, and even through the surgical pain, I can tell that I’m going to be a new woman!

I wanted to talk about the pain management protocol that patients are typically placed on after major surgeries like that one I just had.  My husband had the same surgery almost exactly one year ago, and was given the same drugs as I while in the hospital.  While we had two very different experiences on the medications, I would summarize both as disastrous.

When you come out of surgery, obviously you’ve got the anesthesia in your system, and I had had a morphine spinal block as well.  I was grateful for the block and wasn’t in very much pain, but unfortunately I had a severe itching reaction to the morphine which required several doses of benadryl every few hours.  The nurses were wonderful and their care in the hospital was excellent, but I was gouging my skin off itching.

When I moved to ICU, they started  Cefazolin, an IV antibiotic,  Percocet and OxyCodone, Colace, GI medications, IV Dilaudid- another opioid, Valium, nalbuphine- another opioid, and Ambien.  I received an IV injection of Narcan as needed to reverse the effects of all of the opioids and anti-nausea meds to help me from getting sick from all of the meds. They get you up and walking the day after surgery, and I had a nurse and a therapist helping me learn to get out of bed properly and walk, and even negotiate stairs.

After two days, I was transferred out of ICU and into the general care ward.  My drug regimen remained aggressive.  Although I’d been up walking and eating regular meals, I started to get sick, and by day 3 post surgery, they day I was supposed to go home, I was unable to walk, talk or eat.  The room spun and every time I stood, I’d black out.  My speech sounded like I’d been on a three day drinking bender.  I was severely sick to my stomach and had a sick, poisoned headache and couldn’t watch TV or read.  They said I was not thriving and ordered abdominal x-rays which showed a constipated GI tract, a well documented side effect from opioid use.

My husband and daughter had come to the hospital to pick me up, and I cannot remember what I said to them .  I couldn’t even lift my head.  I do remember my husband saying to the nurse, “What did you give her?  She can’t even take cold medicine!”  They left the hospital without me and I was too sick to care.

I was taken off the Percocet and OxyCodone, Dilaudid and Ambien and switched to Tylenol,   They kept the anti-nausea meds on board but I was still to ill to eat for another 24 hours.  It took more drugs to get my gut working again, and when it finally came to life, I was even sicker for several hours.  I’ll spare you the details.  Again, the nurses were awesome, and I remember one saying to me, “Courtney, you’re just going to have to go through this without the pain medicine.”  I looked at her and said, “I’ll take the pain any day of the week over what I just went through!” She said, “I don’t blame you.”

I got to go home the next day, but the prescriptions waiting for me at the hospital pharmacy were Dilaudid, Valium, and anti-nausea meds and stool softeners.  They insisted I’d need these pain meds, as I could not recover from a spinal fusion without them.

I left the Dilaudid at the pharmacy.  There was no way I was going to take that drug again after what I’d just been through.  But I left with the rest, and I remember my nurse cautioning me to try to take just a quarter of the Valium tablets rather than the 1-2 tabs in the dosing instructions on the label.  She was astonished that the Dilaudid had been included in the regimen, and I know she’d gone to bat for me against taking that drug any more, but she was overruled.

I followed the instructions, including the extremely low dose of the Valium but by the second day at home, I was as deathly ill as that horrible day in the hospital.  Obviously I couldn’t take any of these medicines, so I tossed them all except the Tylenol, went to the pot shop and picked up a bottle of CBD cannabis oil.  Because it contains no THC, the psychoactive component of marijuana which also severely disagrees with me, I felt ok with giving it a try.  A whiff of THC in my system, and I’m on the ground with heart palpitations, convinced that I can’t breathe and everyone hates me.

CBD oil  is reputed to help with pain and nausea, as well as other ill effects, and so far it is helping me, not making me sick.  It has also allowed me to further decrease the amount of Tylenol I’m taking to give my liver a break.   I have some meditations that I’m doing daily to manage pain, and am going to get some acupuncture in a few days.  I’ve doubled up on my Juice Plus fruit and veggie powders and they are soothing my system and making me feel amazingly better.  Whole foods are powerful medicine.

I understand that opiates and narcotics have a place in medicine and I do not question that there are people out there who benefit from some of these medications.  Clearly I’m not among them.   I’m grateful for the good nurses I had in the hospital and grateful for the care that I received.  They did their best- they just got stuck with a lightweight for a patient.  Man, I’d make a terrible junkie.  I’m so grateful that there are other avenues for pain management.

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COURTNEY S. DIEHL, DVM

MOBILE EQUINE VETERINARIAN

Steamboat Springs, Colorado
Since 2000, Dr. Diehl has provided mobile equine veterinary services in the Rocky Mountains.

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