Transcription:
Caring for a Family Member After Spine Surgery

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment, neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.

Caitlin Whyte: Welcome to Say Yes to Good Health with Memorial Hospital. I'm Caitlin Whyte. Caring for a family member after spine surgery can be a challenging process. It really changes the day-to-day life of not only the patient, but for you as the caretaker as well, and can feel like an intimidating responsibility to take on. So, joining us to talk more about the best ways to support someone post spine surgery is Dr. Rahul Basho, an orthopedic spine surgery specialist, seeing patients in Carthage, Illinois at Memorial Medical Clinic.

So, doctor, I understand you recently took on this role yourself and cared for your mother after her spine surgery, so you have a unique view from all sides of this situation. Tell us a bit about caring for your mother and just how that impacted your day-to-day when you first took on this role.

Rahul Basho, MD: Well, you know, the unique part of this whole situation is the fact that I actually did her surgery. And then, not only was I playing the role of her surgeon, but I was also playing the role of her caretaker after surgery. And so, it gave me a really interesting perspective in terms of caring for the postoperative spine patient, what the difficulties are, what the challenges are. And there are a lot of things that I say in clinic when we talk about surgery, but one thing that I haven't focused as much on was how complicated the postoperative course can be. So, it gave me a lot of insight.

Caitlin Whyte: Well, that is such an incredible perspective to have. So, let's start with, you know, before the surgery even happens. What are some things that you should be planning for before the day?

Rahul Basho, MD: You should be looking throughout your home and making sure, number one, that you fall-proofed your home. One thing we don't want to happen after surgery is for a patient to come home and to fall. If they end up falling, you could be back in the hospital, you could need more surgery. And so, rugs, big no-no; pets, make sure that either your pets are cared for by someone else or secured in a way where leashes aren't there for you to trip over. You want to look at accessibility. What room are you going to be staying in? Maybe your bedroom does have a bathroom in it, maybe it doesn't. How hard is it to get to the bathroom? All of those little things that nobody thinks about, they become a big deal when you come home after surgery.

Caitlin Whyte: Absolutely. So, I'd love to kind of go through this chronologically. You know, you have this kind of prepped now, now it's the day of the surgery, it's happened. What are the logistics of bringing someone home after a spinal surgery? And then, what are some things to consider just in that day one of moving them in and getting them set up?

Rahul Basho, MD: Well, you got to take a step back and look at how do I get home? How am I going to qualify to even go home? So once you have your spine surgery, the day of surgery, I'd say in 95% of cases, we get patients up and we get them moving.

Studies have shown that the earlier you move, the more you use your muscles, the more likely you are to have a positive outcome, the less likely you are to have complications such as blood clots or fevers or infections. So, we try to get the patients, you know, even if it's just sitting at the side of the bed on day one, we get patients up. And then, on the following day, typically, what we do is we have therapy see you. Therapy will do an assessment. They'll figure out, you know, do you have steps in your house? Do we need to work on steps? They'll show you how to safely roll out of bed, what we call log rolling after spine surgery. We want to minimize twisting. So, you're moving your hips and your shoulders the same way. You're learning how to safely go from sitting to standing, how to get to the bathroom. If you're able to meet that criteria of independence that the therapist have set out, then you qualify to go home. You know, I tell all my patients, everybody wants to go home as quickly as possible. But to go home, you got to show therapy that you're safe to go home and you're strong enough to be at home. You got to be able to get to the bathroom, use the bathroom. You got to have your pain controlled. If those criteria are met in one day, you go home in one day. If it's met in five days, you go home in five days. Most patients for a, you know, bread and butter back surgery are going home on day one or day two now, with all the newer minimally invasive techniques.

So now, you know, you've qualified to go home. Logistically, how do you get home? Well, typically what happens is the nurses will put you in a wheelchair because they don't want you falling at some point or tripping over something. The hospital's a busy place. They take you out. They, you know, help you get into the vehicle and then, you drive home. And again, we had mentioned earlier about steps and getting into the house. Typically, you're on a walker after a lower back surgery, and you'll use that walker. The therapist at this point have already shown you how to use that walker to get up the stairs and then you're back in your home. And then, it becomes just like being in the hospital.

You know, patients, they have some trepidation when it's time to go home, and that's totally understandable. And that's the beauty of the inpatient setting, is I tell my patients, it's easy. You know, the rules are everything that they have you do here, the way that you do it, that's exactly how you're going to do it at home. So, that process of being in the hospital, there's a lot of teaching that's going on in addition to the healing.

Caitlin Whyte: Let's take it from the perspective of the caretaker. I'm thinking of just myself. You know, I bring my loved one, my mom, my dad home. What does a day-to-day look like? Should I be, you know, working from home? Should I be sitting next to them? Just what kind of has to happen from morning to night until they're back on their own.

Rahul Basho, MD: To go home, most people have to have attained a certain amount of independence. I always think for the first, you know, I'd say two to three days, it's good to have someone at home at all times in case there's a fall, in case something unexpected happens. And, you know, beyond that, I think that patients and families feel safer with higher, you know, amounts of independence and time alone.

But those first few days are critical. And so, number one, I always think it's good to have family around. What can you expect? I mean, I think you're going to be helping prepare meals. You're going to be helping with mobility. You're going to be watching over them, making sure they're getting to the bathroom safely. But again, a lot of this stuff, they've already done in the hospital. And so, it shouldn't be that you're having to be hands on constantly. You're more of in a supervisory role.

Caitlin Whyte: That makes sense. Now, let's talk about pain management. I'm sure that is key to this discussion, and especially as a caretaker helping to manage medications and just comfort. Tell us about that process when it comes to, you know, postoperative care at home.

Rahul Basho, MD: Sure. You know, for patients to be able to go home, their pain has to be controlled. And whether you know that's on Tylenol or an oral narcotic, it all depends on the type of surgery, the patient's history with medications, how they respond to them. But typically, we're sending patients home with a combination of a muscle relaxant and oral pain medication that they can take as they need every, you know, four to six hours for pain. We want patients off of those as quickly as possible because they cause constipation. And of course, with months and months of use, they can become habit-forming.

But most patients, for the first two weeks, they're taking the medications, I'd say every four to six hours. At the end of two weeks, patients are starting to transition off of them and onto oral Tylenol in most cases.

Caitlin Whyte: Gotcha. So, how do caretakers navigate medical appointments? When does the first followup or additional followups happen? And you know, how active should the support person be in kind of, you know, being in the room, taking notes, just being a part of that additional care process?

Rahul Basho, MD: You know, I always tell my patients that an extra set of eyes and ears is a good thing to have in the clinic. When patients come and see me, sometimes they're in pain. You know, sometimes they get news that they need surgery and it's sobering news. And so, you're not always processing everything the doctor says in the best way. And it's a stressful environment for some patients. And so, having someone there to listen, to, take notes, to provide their input is always a good thing.

Typically for, you know, a back surgery, I'm seeing my patients at two weeks, six weeks, three months. A fusion, which is a bigger back surgery I'm following these patients out for a year, two weeks, six weeks, three months, six months, one year. So, we have multiple visits. And throughout those visits, we're going through their progress, we're checking x-rays. And so, a lot of information is conveyed. I always encourage family members to come to appointments.

I can't tell you how many times I have a visit with a patient. We see each other for, let's say, three months, and we go through all of the conservative things, the injections, the therapy, and we talk about surgery and comes to surgery, I can't tell you how many patients show up to their preoperative appointments with me alone. And I know that they're not going to be home alone. So, you know, there's a lot of education that's being missed out on by the families. So, I think it's a great point that you bring up. Showing up to your loved ones' appointments is a good thing. Showing up to their preoperative appointment, I would say, is almost necessary because you're going to be setting yourself back if you're learning all of this on the fly.

Caitlin Whyte: And I'm sure just emotionally, it's great to have someone, you know, you love with you in that room when you're hearing all this news and, you know, like you said, intaking all this information.

Rahul Basho, MD: Absolutely. I think that there's comfort in knowing that somebody agrees with what you've heard and agrees with the plan and understands and gives you their input. I mean, there's solace in that. So, I think that's a good thing.

Caitlin Whyte: Of course. Now with such a big procedure like spinal surgery, what should be changed or rearranged when it comes to that living space? I know we touched on stairs and rugs and things like that, but let's dig into it a bit more, maybe the things that people wouldn't really notice or think about. You know, rugs are definitely something we talk about a lot when it comes to falling and tripping. But, you know, especially if someone's moving into your house and you might not realize that you have these obstacles in the way, what are some things people should consider about their home and their space?

Rahul Basho, MD: A lot of this I learned after I did my mother's surgery. So, number one, I never realized how wide a walker is and how narrow some of our doorways are. And so, you have to make sure that your doorways-- you know, some older homes have very narrow doorways. Can your walker really get through that doorway easily or are you going to be scraping up your knuckles as you go through it? So, that's one thing to think about.

What's the pathway from your bedroom to your bathroom? Is that a straightforward path? Is that something that you could do at night? How well lit is the pathway at night? A lot of falls occur when patients are going to the bathroom. And you know, as we age, all of our night vision deteriorates to some degree. And so, do you have night lights set up in the right way? Is that pathway clearly lit? And if you've got little kids at home, you know, kids have toys. Toys have wheels. Do we have toys scattered about the place where somebody could step on something and slip?

So, you know, those are the things that popped up when my mother was here. She stayed with me for about eight weeks after her surgery. And it really made me revamp what I tell my patients before surgery in terms of what to do to prep after surgery. So, it was a good learning experience for me.

Caitlin Whyte: Yeah, I'm sure that must be so interesting, especially doing the surgery on your mother. Oh, my gosh.

Rahul Basho, MD: Yeah. You know, I struggled with that for a long time. I thought about sending her to one of my colleagues and I got mixed opinions in terms of whether you should operate on a family member or not. But, you know, her condition and what she had is exactly what I treat. And I had ordered her MRI, ordered her conservative treatment. I just felt like nobody was going to know her better than, obviously, her own son. And so, it was just the right thing to do. It felt right. And, fortunately, it's gone very well.

Caitlin Whyte: If you don't mind me asking, I mean, was she on board with that or was she excited to have you do it?

Rahul Basho, MD: She trusts me and, you know, obviously, she made some jokes about, "Are you sure you want to do your mother's surgery? Are you sure you're well trained?" So, she had fun with it. But I think that she has been my someone who's helped guide me through college medical school residency, so she knows I'm well qualified.

Caitlin Whyte: Gotta love those moms sometimes though. She's got to make it a little hard. Getting back to some of the logistics though, you mentioned walkers as being key equipment to have. Is there anything else that we should consider having around in terms of just other equipment?

Rahul Basho, MD: You know, if it's hard for you to go from sitting on the toilet to standing up because the toilet is too low, sometimes we order raised toilet seats for patients. You're not allowed to bend down and pick things up off the ground. And, you know, some patients, they don't want to ask for help or there's nobody around, so there's a grabber. We sometimes prescribe grabbers where you can just kind of get stuff up, pick up your socks from the ground and things like that. Usually with therapy, there's an assessment that occurs in terms of what you have and what you need. These items are either given or prescribed to you before you leave the hospital.

Caitlin Whyte: Okay. That's good to know. That we don't necessarily have to worry about it afterwards or getting on Amazon or anything like that.

Rahul Basho, MD: Right.

Caitlin Whyte: So, you mentioned your mother was with you for about eight weeks when she was post-op. Are there any moments that maybe stuck out to you or just that you tell your patients, things where you should reach out to a doctor? Maybe a milestone that's missed or a concern that maybe requires a little more urgency?

Rahul Basho, MD: Typically, if you're having pain that's not controlled with the medications or pain that's preventing you from participating in day-to-day activities like walking, I mean, everybody hurts after surgery. But if it's the kind of hurt that's keeping you in bed and preventing you from, you know, moving or mobilizing, that's something your doctor needs to hear about.

And, you know, everybody's response to pain is different. Everybody's response to the medications is different. So, your doctor who's been seeing you now, likely for a number of weeks or months, will have an understanding of where you're at, and is that normal pain or is that not. The other thing is, when we go home from the hospital, the doctor will check your dressings and your incisions and you'll not be discharged unless it's dry. So if you start to have drainage, that's another thing that the doctor needs to know about.

Caitlin Whyte: You know, I'm thinking now a little more down the line of this process and how we can ease people back into their daily tasks and being even more independent than the independence necessary to leave the hospital, right? So, getting back to a point where maybe you're starting to cook for yourself, shower more independently, things like that. And I'm thinking, you know, there's of course people who are probably super ready to get going and you have to slow them down. But maybe there's people that are a little more hesitant, they're kind of afraid to get back into it at the risk of hurting something again. How do you balance just that timeline and when people are ready to start getting back into their old routine?

Rahul Basho, MD: Yeah. So, you know, for a fusion, which is a bigger back surgery where we're asking bone to grow, typically, it's about six to eight weeks, let's say, for bone to form in a way where the surgery and the surgical site is stable enough to progress. And so, we typically have patients walking, but not doing anything aggressive for the first six weeks. At the end of six weeks, if x-rays look good, that's when we get you off your restrictions and start pushing you in therapy.

Now, another part of your question, which I think is very interesting, is that there are some people that you have to slow down and some people that you have to push, and that's part of the art of medicine. I'll get farmers that are insistent that they have to, you know, be healed by this date because these are all the responsibilities that they have to take care of. Those are the people that I have to kind of, you know, typically say, "Hey, listen, you don't want to do this again. You want to give yourself the best possible chance at success with one procedure. So, you got to be good about your restrictions."

And then, there are those people that have either had an injury before or have fallen before and are very scared to progress and hypervigilant about pain and symptoms, and those are the people that need a little extra reassurance and a little push in the right direction. And so, you know, again, that just comes back to the art of medicine.

Caitlin Whyte: Of course. I'd love to also talk about nutrition post-surgery and in this care phase. Is there anything people should be adding or avoiding in their diets?

Rahul Basho, MD: When we have patients in the hospital, one thing we measure is their albumin level, which gives us an idea of how much protein they have in terms of healing. So, you want to have a good amount of protein in your diet or consuming some protein. You don't want to just be on carbohydrates. If you're diabetic, you want to watch your blood sugars and make sure that you're keeping your blood sugars at a reasonable level because we know that elevated blood sugars put you at risk for infections postoperatively. So, you want to avoid sugary foods, you want to eat protein, good balance of protein. I encourage my patients to take vitamin D and calcium supplementation. That helps with bony healing and bone health. Beyond that, a good varied diet is what I recommend.

I do at times find myself disappointed when I walk into my patient's rooms in the hospital and I see a bunch of sodas and sweets. So if any of my patients are hearing this, please, you know, once we're in the hospital, let's put our best foot forward here.

Caitlin Whyte: And to the caretakers, don't bring it in, right?

Rahul Basho, MD: Yeah. Agreed.

Caitlin Whyte: You know, we've gone through a lot of logistics, the equipment, the care, but how can we prep ourselves as caretakers for that emotional support and how best we can be there for our loved ones during this recovery process? Because of course, pain and healing is obviously at the top, but I'm sure there's a lot of just like emotional challenges that come up for people during their healing journey.

Rahul Basho, MD: Absolutely. I mean, surgery and healing, it disrupts many lives. It disrupts the patient's life. It disrupts their caregiver's lives and the family around them. And so, you know, one thing that we have to do is we have to be prepared for that disruption in our day-to-day routines. And when we're prepared for that ahead of time, I think we're more patient.

The other thing that we have to realize is that surgery is something that takes a long time to heal from. You know, even though patients are getting out of the hospital quicker, that doesn't translate into patients being back to their old selves quicker. There's still a prolonged healing process that has to take place. And we have to be patient and we have to make sure that we're applying the right amount of encouragement and pressure to our loved ones to continue seeing their progress.

But the one thing that family members can do to mentally prepare themselves is to show up to the appointments before surgery. Because at those appointments, you'll gain an understanding of what to expect, what can go wrong, what to look for. And when you have that information ahead of time, it makes the process so much easier.

Caitlin Whyte: So wrapping up here, we obviously want to be the best support for our patient, for our loved one, in the best ways that we can. How can we prepare ourselves emotionally for going through this period? It's going to be, you know, probably a couple weeks, maybe a couple months. And we need to be patient. We need to be on top of our stuff. So, how can we kind of get our heads as caretakers in the right space.

Rahul Basho, MD: You know, still try to make time for reading, relaxation, exercise because you want to make sure that you're in the best mental position to help your loved one heal.

The other thing is, is that don't be afraid to ask questions. Don't be afraid to find out from the doctor's office is this normal, is this not normal. Don't just assume things are going to get better. So, I think that the good caretakers that I see, they're people that have asked a lot of questions. They're people that have showed up to the appointments. They write things down. They have an understanding of what's normal and what's not normal. But they also make time for themselves. If you're constantly concerned and worried and hands on, I think that that can be something that becomes mentally fatiguing and you have to be at your most positive state. You have to be an optimist and a motivator. And to be that, you have to have all of those tools in your tool belt.

Caitlin Whyte: Of course. It's the old putting your oxygen mask on first to help others, right?

Rahul Basho, MD: That's a great analogy. That's a great analogy. Right.

Caitlin Whyte: Well, there is a lot to consider taking on this role, doctor. Thank you so much for your care and for sharing your knowledge and your personal experience with us today.

That was Dr. Rahul Basho, an orthopedic spine surgery specialist, seeing patients in Carthage, Illinois at Memorial Medical Clinic.

If you have more questions about caring for someone after a spinal surgery, you can reach out at 573-248-1010 or visit us online at mhtlc.org.

And that concludes this episode of Say Yes to Good Health with Memorial Hospital. We'd like to thank you for listening and invite you to download, subscribe, rate, and review on Apple Podcast, Spotify, or wherever you're listening. Please feel free to share these shows with your friends and loved ones. I'm Caitlin Whyte. Stay well.

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment, neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.