Yo, Mr White, ever heard of PDPH?

Thursday 6th April, the hours after the second surgery. The spinal anesthetic gradually dissolved. The more I regained my mobility, the more I started to feel the pain. Before going to sleep, I asked for a painkiller. By midnight, even that felt like I never took it. My ankle felt like as if it was in a massive meat grinder. Even worse, I had the worst headache I ever felt. Is this migraine? I looked at my phone: it was 0:09 AM. “No chance of calling the nurse with this device above my bed not functioning… Anyway, I have to withhold this pain somehow.” I felt very determined to make it through the night. In agony, I started scratching the bed and biting my teeth. But the pain I felt was indescribable. It felt like an hour or so passed. I looked back at my phone. It was 0:21 AM. I could not believe my eyes. I felt like I cannot take this anymore. Fresh out of surgery, my leg elevated, I was unable to move. Luckily I saw the Biker make a motion.

“Are you awake?” – I asked. “I am.” – he said, adding: “Do you need help?” I told him I regret to say so, and ask him a favor – but this time around I admit, I need help. He climbed out of his bed, with one leg and one arm functioning only properly and slowly made his way out to the corridor. I could hear him talking to the night nurse, before he returned to his bed. Soon after, the nurse arrived with a syringe. To this day, I have no idea what it was that she shot in my upper arm. All I know is that I was knocked out until the morning. Upon waking up, I did my regular morning wash routine which proved a mistake. The headache kicked in within minutes. I was unaware I should have remained laid totally horizontal all day to avoid the consequences. Which were on the way…

Upon the early morning doctor’s visit on Friday, I explained what I felt overnight and the doctor confirmed my face looked “weary of pain.” He remarked to the day nurses to give me more painkillers and recommended drinking coffee or cola. When my parents arrived visiting in the morning hours, I was fairly OK, misled by the effect of the fresh dose of intravenous painkillers. I was also happy to have the second surgery behind me. After they left and I had my lunch, this fresh dose of painkiller also seems to have dissolved. The migraine was back and getting stronger and stronger. I was in agony. When my parents arrived back in the afternoon with my brother, I was in the phase that I could hardly talk. With my eyes closed, I could do nothing more than scratch the bed in pain. The migraine felt like a hood, that was being pulled over my brain from the back to the front, and once there, the pressure became unbearable. I had no idea what was happening. My father went out to ask for a painkiller from the nurse, who arrived with a pill that would have no chance against this. I apologized to my parents and brother, and I felt sorry for them that they see me in this state. Realizing they would not be able to do much, I could see them departing behind a curtain of tears. Soon after, the other day nurse arrived and introduced another dose of an intravenous painkiller cocktail.

orhThanks to the medication and her advice of remaining fully laid horizontal, I could start researching what was happening over the internet. Researching the symptoms I soon found, that what I experience is called Post-dural-puncture headache (PDPH), a side-effect of the double spinal anesthetics I received within the same week. Speaking to my wife, I also learned that this is a common side effect to the epidural anesthetics as well, which she observed when she was in hospital after our daughter’s birth. She managed to connect me with the father of my son’s kindergarten mate, who was an anesthesiologist. He was very supportive and confirmed that a so-called “blood patch” procedure exists, which might be a cure to this. He also explained that the reason I feel this pain is that the cerebrospinal fluid surrounding my brain probably trickled away due to the leak that the syringe caused on the dura mater. This literally causes my brain to get in direct contact with the skull from within – thus the pressure and extreme pain. This is PDPH. He then expressed his surprise as well, claiming it is not recommended to perform a spinal anesthetic twice on the same place within the same week – which is what happened in my case. To my greatest surprise however, at this hospital, none of the nurses and not even the doctors seemed to have heard of this, nor the “blood patch” procedure. The head of the department gave me an estimation of a week for this pain to go away…

A day later, a new patient was rolled in our room, while I was taking a nap early Saturday afternoon. My room-mates woke me up saying that there was an anesthesiologist in the room, and we asked him to come over. “Mr White”, the anesthesiologist was a young man, and to the most pleasant surprise, he was open to talk. From my story, he quickly understood that I “did my homework” in research and following the recommendations to remain laid and avoid moving my “nodding muscle” in particular, he promised to come back on Monday when I would undergo a “minor load test.” After he left, I felt half healed simply because I was listened and answered to. My room-mates shared my impression that finally, we met one doctor who took the time to talk meaningfully, answer all questions, doubts and fears which made The Difference.

On Monday April 10th, I received an unexpected visitor. A young nurse whom I never met before came over to my bed, and asked me to go along with her. I reminded her, that I should not move, yet she reassured me she was aware of my condition and insisted that I should give it a try. Slowly I moved myself in a seated position, and could feel the blood rush in the leg. Once I rested for a minute I slowly stood up with the crutches, and following a few seconds of finding my balance, for the first time since my arrival 10 days earlier, I made my way towards the exit door of the room…

On the corridor we turned left, and the nurse was escorting me along, until we reached the main area of the nurses and the fridge – I was unaware there was a fridge until now. I then asked to turn back as it was getting very painful due to the swelling in my leg. When I made it back to my bed, to my greatest surprise, Mr White appeared. He was there, observing all along: apparently, this was my test, which I successfully accomplished. After some test questions, he reassured me I was on the way of recovery… Finally!

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