The following information is provided to help you become more familiar with the procedure for which you are scheduled. This information is not a substitute for a full discussion with your physician, but it may help answer some preliminary questions
A hernia is caused by a weakness in the abdominal muscles that hold your intestines in place. When a hernia occurs, part of the intestine can enter through the weakened area, causing pain and swelling. This weak area in the muscle can be repaired surgically. The information listed below should answer some of your questions about post-operative care. If you have any of the following, notify your physician or clinic immediately: extreme pain and sudden swelling around the incision, increased redness and tenderness around the incision, increased drainage from the incision, fever and chills
When can I remove the gauze dressings ?
After the operation, you will have a gauze dressing over your incision. Keep the gauze dry for 24 hours. Some blood-staining of your dressing is normal. If you note any excess bleeding, hold pressure on the dressing for 20 minutes. Then remove the dressing and put clean, dry gauze on the incision. If this recurs, apply pressure and notify your physician
When can I take a shower
or bath ?
After three days, you may get your incision wet. Take off the dressing. Leave
the tiny white tapes in place. The incision may get wet but try not to soak it.
Be sure to dry the area thoroughly
What about
my stitches ?
If you have
outside skin stitches, they will need to be removed in approximately seven to 10
days. You will be given an appointment to return to see your private surgeon or
be asked to make an appointment in the Surgery Clinic
What about
the steri-strips ?
These are
small white tapes that help to close the skin over the internal stitches. If
they begin to come off after bathing, press them back down on the skin with a
dry towel. Within seven to 10 days, they will begin to peel off. This means they
are ready to come off and you can safely and gently remove them
Will I have
much pain ?
It is normal
to have pain at the incision after surgery. This may increase the second day and
then gradually decrease over the next week. You should take your pain medicine
as directed. There may be some swelling and bruising around the incision and
into the scrotum or groin. This is normal and will resolve on its own. If the
swelling increases after the first two days after surgery, you should notify
your physician
When can I
eat ?
You may eat
your normal diet and take any other medications as per your usual routine. Since
the pain medicine can also have a constipating effect, your bowel habits may be
altered for several days. You may want to increase your intake of fiber foods
(fresh fruits, vegetables, cereals, and whole grain breads) and also your fluid
intake to at least two quarts per day. If there are no results in two days, you
may take a mild laxative such as Milk of Magnesia. For further problems, consult
your physician
What about
activity ?
Take it easy
for 24 to 48 hours. Resume your activities gradually. Walk short distances. Some
stretching exercises are okay; however, you should avoid straining, bearing
down, and abdominal stretching. Short and more frequent periods of activity are
more helpful than longer, more strenuous activity. Use pain as your limit. If it
hurts a lot, do not do it. You should not do any heavy lifting (more than 15
pounds) for four to six weeks
When can I drive ?
You should not drive for about two weeks. Remember, you may not be comfortable making quick movements. Also, you should wait to drive until you no longer need pain medication
Spinal surgery may involve implanting metal devices (rods, screws and/or metal plates) on the sides of your spine to help strengthen it. The type of device used and the extent of surgery required depend upon your specific problem. Your physician will discuss with you what treatment will best suit your needs
The following information may help you better understand the treatment of pituitary adenomas by surgical removal
What is a
pituitary adenoma ?
The
pituitary gland lies behind the sphenoid bone, a bone at the base of the skull.
A pituitary adenoma is a tumor of the pituitary gland. It causes symptoms either
from compression of nearby brain structures or from abnormal hormone production.
Most pituitary adenomas measure less than 10 mm. almost all adenomas are benign,
which means that they are relatively slow-growing and are slow to invade
surrounding tissues. They rarely spread to other areas of the body
What happens
during surgery ?
The surgical
removal of a pituitary adenoma can usually be performed by a method called a
trans-sphenoid operation. The surgeon approaches the pituitary gland by making
an incision beneath the upper lip to expose the nasal passage. Using a
microscope and specialized micro instruments, the surgeon enters the sphenoid
bone, and eventually an opening is made in the wall of the bone to expose the
pituitary gland. When the tumor is removed, the cavity is sealed, sometimes with
a piece of fat that the surgeon removes from the patient's abdomen. The surgeon
then applies"glue" made from the patient's own blood that was donated before
surgery. Vaseline gauze is then packed into the nasal cavities and the procedure
is completed
Are there any special preparations for this type of
surgery
?
You will
probably be given antibiotic nose drops to use for 2 or 3 days before the
operation to discourage the growth of bacteria
Will I have
pain when I wake up ?
Your
throat may be sore from the tube that was placed there during surgery. You may
be given pain medication if the incision in your upper lip or abdomen is
painful. Some patients have a headache or feel a sensation of pressure from the
nasal packing. Pain medicine is available if you have any discomfort
When can I
resume activity ?
Most
patients feel well enough to get up on the evening of the day they have their
operation. The day after surgery you may get out of bed with assistance. You may
progress to walking as much as you are able. It is important for you to slowly
increase your activity
When can I
eat and drink ?
You will not be given anything to drink until you are fully awake. You will have
an intravenous catheter in your arm to provide fluids until you are drinking
adequately, usually about 24 to 48 hours. Solid foods will be started when you
are able to tolerate them. Some people may experience tenderness of the upper
lip and gums. Semi-solid foods such as jello or custard may be easier for you to
eat.
Will I be able to breathe through my nose
?
Not initially. You will have nasal packing for 48
to 72 hours after surgery. A small "sling" type dressing will be placed under
your nose. The sling will be changed by your nurses as needed. After several
days, drainage usually stops and the sling can be removed. It is important to
remember not to sniff or blow your nose while the packing is in place. After the
packing is removed, you will be taking decongestant pills to relieve any sinus
headaches and congestion
The word "stenosis" refers to narrowing. In the case of lumbar spinal stenosis, it refers to marrowing of the passages for the nerves within and between bones. The nerves to the legs come out of the bottom of the spinal cord and travel through the spinal canal. At each level in the lumbar spine, a pair of nerves come out of the canal, one on each side, in the foramen (gap) between two of the bones.
With increasing age, spurs form on the edges of the vertebra. The term spondylosis is often used to refer to this process. Spondylosis occurs to some extent in all people, but much earlier in some than others. The process may be accelerated by use (i.e. heavy labor) or injury, but that hypothesis has not been validated in humans.
As the spurs increase in size, they may encroach on the spinal canal (through which the nerves travel as a bundle) or on the foramena (through which the nerves exit). This obviously occurs earlier in people who were born with narrower spinal canals and foramena.
The ligaments (this is the flexible stuff near the joint of a turkey leg that you cut to get the leg off) that connect on vertebra to the next also get larger (hypertrophy) with maturity, they may contribute to this narrowing if they get large enough.
The encroachment of the spurs and ligaments on the spinal canal and foramena results in narrowing, thus "stenosis."
NEUROGENIC CLAUDICATION
Lumbar spinal stenosis does not generally cause back pain, and many people with lumbar spinal stenosis have no symptoms whatsoever. When lumbar spinal stenosis does cause symptoms, these follow a very stereotyped pattern. Patients generally describe and aching, tightness, numbness, or cramp-like pain that start in the buttocks or hips. This is brought on by standing or walking, and relieved by sitting. With increasing standing time or walking distance, the sensation spreads down the thighs to the legs. In severe cases the legs may become numb and weak. The amount of time that the person can stand or the distance he can walk before symptoms start is generally constant. Any flexion of the spine relieves the symptoms....many people find that when shopping, for example, they can go farther if they lean on a shopping cart. If the condition progresses (see below), the time and distance the person can go gets shorter. In severe cases people get symptoms immediately upon standing, or even at rest.
PROGRESSION
Studies suggest that about one third of patient with lumbar spinal stenosis get better spontaneously after a flare-up, another third stay the same, and about one third get worse.
TREATMENT
Although physical therapy, chiropractic manipulation, and injections have not been shown to be better than placebo in well-controlled outcome studies, all are commonly used and are thought to be safe. For patients with worsening symptoms, surgery offers an excellent chance for marked or complete relief.
SURGERY
Surgery for lumbar spinal stenosis consists of removal of the compressing elements, the bone spurs and hypertrophied ligaments. There is no evidence that one procedure works better than any other. In the Graduate Hospital series, we recently followed up all patients who underwent surgery for lumbar spinal stenosis over a six year period. Fifty percent (50%) of these were asymptomatic, and another 40% had minor symptoms that did not limit their activities in any way. This is better than the outcome with lumbar disc in younger patients, where at best only a 70% good outcome is achieved.
EFFECT OF AGE
Since the process underlying lumbar spinal stenosis is age-related, many
patients develop symptoms in their seventh, eighth, or ninth decades of life.
As surgical and anesthetic techniques have improved, surgery on patients of this
age has become safer. There have been no deaths in the Graduate Hospital
series, although patients are carefully screened prior to recommending surgery.
WHERE TO GO FROM HERE
If you think you may have symptoms of lumbar spinal stenosis, the first thing to do is to consult with your physician. Many cases can be managed at that level. An imaging study (CT or MRI) is not necessary in every case. Also there are other diseases whose symptoms can mimic lumbar spinal stenosis
Brain tumors can be grouped according to whether they are benign or malignant, or according to whether they originated in the brain or came to it (usually throught the blood stream) from some other portion of the body. Tumors that originate in the brain seldom metastasize (go to) other areas of the body, but they can be serious or fatal nevertheless.
Aside from exposure to ionizing radiation or vinyl chloride, there are no known causes of brain tumors. Some families are prone to brain tumors, and the genetic basis of this is an area of active research.
Except in special circumstances, an MRI is generally obtained during the evaluation of a patient with a brain tumor.
Most brain tumors require at least a biopsy - a small operation to get a sample and prove the abnormal object or area is a tumor. Usually the surgeon can tell before surgery whether or not the tumor can be easily removed. When the tumor can be completely removed, often no additional treatment is needed, and the patient may be cured. Some tumors are so prone to recurrence that radiation treatment or chemotherapy, or both, are given even after complete removal.
Trigeminal neuralgia ("Tic doloreux") is causes by a small blood vessel pressing on the nerve that supplies feeling to the face. To understand this, we need to review a little bit of anatomy.
Most people know that the brain floats in fluid inside the skull, but many people have never thought about all the nerves, arteries, and veins that cross this gap from the body into (and out of) the brain. These connections usually have curves or coils in them to allow slack for the brain to shift slightly - for the same reason that a telephone cord is coiled.
Trigeminal neuralgia occurs when an artery or vein moves and presses on the nerve to the face between where it comes out of the brain and where is goes into the base of the skull. The pressure stimulates the fibers in the nerve, causing them to fire and the brain to perceive pain.
Trigeminal neuralgia sometimes seems to be brought on by a tooth extraction or other injury, but often there is no apparent cause.
Trigeminal neuralgia may go into spontaneous remission, sometimes for many years.
The vast majority of people with trigeminal neuralgia respond to medication. Four drugs are commonly used:
carbamazepine
baclofen
gabapentin
phenytoin
People who do not respond to any of these drugs may actually not have trigeminal neuralgia but a related condition, "atypical facial pain."
People who respond to these drugs but cannot take them because of side effects can be helped with surgery.
There are two main groups of surgical treatments for trigeminal neuralgia -
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