On the day of the surgery, I was supposed to arrive at 2:30 with a surgery time of 4:00. My doctor, however, is notoriously late so I figured it would be running an hour behind. I was in for a surprise - I didn't actually go back to the OR until after 6 and the actual surgery didn't start until about 6:30. I was pretty stressed by that point because I was hungry and had way too much time by myself in pre-op to worry about the surgery.
I was given fentanyl (a powerful pain killer) in my IV before they wheeled me back to help begin the sedation process. I was put on a bed face-down that had a large hump in the middle, so that my stomach rested on it elevating my low back where the battery pack was being placed. My head rested in a face-cradle that was pretty uncomfortable, but I knew I would soon be in la-la-land, so I didn't mind much. They had to tape the nasal cannula to my face because it kept slipping out at that angle and they did a double prep (meaning they covered me in that iodine soap twice - it was so damn cold). They shaved some hair at the center and left side, but left enough on top so that it would cover the bald spots. But to be honest, at that point they could have shaved my whole head if they thought it would help my headaches. I had lost all sense of vanity.
After I was prepped, I was given Versed to augment the sedation, IV antibiotics, and lidocaine injections into my scalp to numb the area for the lead placement. Hollow needles were driven under the scalp to place the leads much like the trial surgery. The battery pack can handle up to 4 leads and 16 contact points (each lead has either 4 or 8 contact points). The doc planned on using 3 leads - one 4 contact point (quatrode) near the left AT nerve, one 8 contact point (octrode) to cover the left occipital nerve (greater and lesser), and one 4 wide-placed contact point lead to cover the right occipital nerve (see diagram of nerves here). The St. Jude rep with us in the OR didn't have the 4 wide-placed lead, so he opted to use two octrodes instead. One octrode covers the left AT nerve and left lesser occipital nerve. The other octrode covers the left greater occipital nerve and right greater occipital nerve. I'm still not sure that this placement will cover all of my pain, a frustration I will discuss later.
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| Close-up picture of percutaneous octrode |
After the leads were placed, the St. Jude rep turned on the stimulator to make sure I felt the stimulation in my head. After that, I was put under using propofol to implant the wires and battery pack. The good news is that the lead placement didn't hurt nearly as bad as it did during the trial, proving that I was not given enough sedation during the trial surgery. In fact, I barely remember the lead placement during the permanent surgery. The original plan was to make one incision on my head for lead placement, one small incision on my neck to help tunnel the wires down (no wire extender was needed because they make super long leads now that go down to your neck), and one incision on my low back/hip for battery placement. However, I'm a thin person and the doctor warned me that getting the wires down my back would be difficult because the skin doesn't have a lot of give, so additional "nicks" might be needed to give my skin more stretch. They use a hollow plastic tube to tunnel the wires from your neck to the low back. I ended up with two incisions on my head to place the leads, one incision at the base of my head and one on my neck to help get the wires down, a "nick" on my mid back, and the incision on my low back for the battery pack.
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| Comparison of battery pack to silver dollar |
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| Battery pack features |
I woke up as they wheeled me back to recovery. It was almost 8:00 by then. The nurse told me they had washed my hair because it was full of blood - something for which I was very grateful! The St. Jude rep walked me through using the remote for my stimulator, showed me briefly how to recharge my battery, and told me there was a magnet I could use to turn the unit on and off if I didn't have my remote. He also programmed the stimulator with 3 programs, but told me that they would be insufficient because I was still numb from surgery and they program based on your feedback. For example, he would turn on one lead and slowly increase the power until I felt the stimulation. He would continue to increase it until I told him what level was comfortable and then when it became uncomfortable. The rep also gave me my post-op instructions and told me they had used dermabond - a surgical glue - instead of bandages and stitches to close up my wounds. This meant I could take a shower and wash my hair as soon as 48 hours post-op and sponge baths on the front only until then! Also no bandages with surgical tape, which was fantastic because I'm allergic to the adhesive on surgical tape. I was warned not to bend, twist, lift anything over 5 pounds, reach, or move my neck around too much for 4-6 weeks. I made sure my boyfriend was present during all of this because I knew I wouldn't remember much due to the anesthesia-induced wooziness. I strongly suggest to anyone having this surgery that you have someone with you for this part as well. I was sent home with an antibiotic prescription and a prescription for additional pain medication for 2 weeks.
If you click here, you can see pictures of my incisions at 2 days post-op. Warning - if you have a weak stomach for incisions, you might not want to look. They are pretty benign considering there are no staples, but there is dried blood under the dermabond. Next up, I will discuss my recovery experience. It might take me a few days to get it all documented. I want to be very thorough. I also plan to create a list of supplies I found important to have on hand during my recovery for those planning to undergo ONS implantation. Until then, wishing everyone relief from their pain.
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