Question
QUESTION: Hello Jerry,
    I am a nurse and my family is looking to me to help answer questions about my sister in law's situation.
    Although she has had recent spinal surgery it appears that the outcome is similar to a spinal cord injury. She was operated on 4/3/07 at an out of state medical center. We are all  in New York. There are two family members with her now. At this point she has no feeling below her waist. She is unable to stand. Today they called me to say she is having an MRI done because of digestive problems.I know that she is diapered and has a Foley in.
    I don't know if there is a chance that there will be some improvement with rehab. Prior to surgery all of her symptoms were sensory and her motor ability was not affected. Could this be post surgical fluid, swelling and disruption? Is the digestion problem typical or is this a complication? We are thinking that she come back to New York for the rehab. I would so appreciate any of your input.Thank you.   Sincerely, Barbara Pulis
ANSWER: Since your sister-in-law is less than one week post-op and I don't have any real information on the surgery itself or her pre-op state, I would think that some of these symptoms may be post-operative swelling.  Some digestive problems can happen following any surgery and some of your sister-in-law's symptoms might stem from post-op swelling against nerves for the digestive system.  Again, it is difficult to state anything with certainty because of lack of full details.

Having said that, I feel that you should have the family members that are with her ask the physicians for a prognosis.  The doctors there have all the data.  I also am a strong advocate for family involvement in rehab.  If the family is stronger in New York, then that's where her best help is, in my opinion.

Thank you, Barbara for the question.  I hope that my answer has given you some assistance.

---------- FOLLOW-UP ----------

QUESTION: Thank you, Jerry, for your fast response, especially on Easter Sunday. I appreciate your input very much. I am sorry that I was not more clear with the details.

What I know so far is that going into the surgery the suspicion was a slow growing non-cancerous tumor on the spinal cord which was quite large. She had several opinions and was told for the most part that the tumor was inoperable. She was told that it was important to have a biopsy in order to determine the course of treatment which would in most instances be radiation.

Carolyn met with a doctor at a medical center which is rated very high for neurological treatment. He told her it was possible to debulk the tumor. She knew going in that there was the liklyhood of deficits but she is very scared that what she has now is what she will be left with. She has been asking the right questions but not getting even ball park type of answers.

I spoke with her this evening and I asked her to have the social worker include me tomorrow in the discussion about rehab.Carolyn has the sense that they want to move her very soon to rehab and prior to surgery shedid not think that the rehab would be very long. Her focus was on the radiation that she would need to recieve for about six weeks. She was visualizing some deficit but not the loss of ability to stand or the loss of bodily functions.

She did say that she can move her legs but that she can't feel them. Today the Foley was removed but she needed to be straight cathed twice. She has loss of appetite and feels bloated.

Prior to the surgery she had progressive numbness starting in her legs and it progressed to above her waist. Her feet also felt stiff and brittle. She lives in a 5 flight walk up in New York and managed the stairs and walking alright before the operation.

It was my feeling that she should do her rehab closer to home so I was happy to hear that you think that is a good idea too.Is it  possible to have sensory loss but still be able to walk or regain bladder and bowel control? Can rehab retrain pathways for this?

I remember when I went with her to the first team consultation in NYC the neurosurgeon told her that he would do the biopsy of the tumor at T10.

I am sorry that I have jumped around so much with my information and that it is not in a logical format.

I would again appreciate your thoughts. Thank you.

         Sincerely , Barbara

Answer
Thank you for the additional details.  It sounds as though things are progressing well since Carolyn is now feeling her legs and the Foley has been removed.  Progress in spinal cord cases is something that can't really be foretold because every spinal cord case is unique.

It certainly sounds as if the physicians are doing things in an orderly fashion including the slow move to rehab as opposed to trying to do things too fast.  

For walking and the return of bowel/bladder function, I believe that it's too early to say.  That's probably the same answer that her doctors are giving and unfortunately, that's really the truth.  Time is the biggest indicator for what will return.

Thanks for the details, Barbara.  I hope that this answer gives you some helpful information.