This will allow the doctors to monitor your urine output during the surgery. However, the pain generally improves over several days and can be managed with a variety of medications. International Journal of Spine Surgery … Please notify your surgeon if you feel ill before your surgery. What about carrying a backpack and other heavy things? Fortunately, this is rarely the case in otherwise healthy patients with adolescent idiopathic scoliosis. As one of the states leading destinations for spine surgery in NJ, Adolescent Idiopathic Scoliosis is a spinal condition that Dr. Rovner and his advanced surgical team treats. Here is a list of some patient resources that may be of assistance: Scoliosis Research Society Sitting in a seat that reclines with lots of pillows can be very helpful. 1 – 3 Although only 10% of patients require surgery, spinal instrumentation and fusion for adolescent idiopathic scoliosis is the most common procedure done in pediatric orthopaedics. Maggie stayed in her hospital bed and was taken to the 10th floor, where she stayed for the next three nights in the adolescent medical-surgical nursing unit. Additionally, some surgeons recommend a special skin wash before surgery to minimize the risk of infection. You may be constipated for a few days after surgery. Scarring is a major concern for most patients. Background Data. | The latter is done by placing electrodes on the child from the head to the toes and measuring the signals back and forth. Then she stood and took a couple of steps to a bedside chair. If the curve gets worse despite bracing, the child will probably need surgery. Objective: ... For the spinal surgeon, idiopathic scoliosis is one of the most frequent presentations of spinal deformity in the paediatric clinic. Some of the theories include . You may want some extra pillows to help support you. Please check with your surgeon for a more specific expected time in the hospital. You can feel free to bring your own hygiene products in anticipation of this happening. We are experiencing extremely high call volume related to COVID-19 vaccine interest. How can I make my scar as minimal as possible? The time in the hospital is influenced by the length of the surgery, patient mobility and comfort and hospital practices. How will the rods affect my spine's mobility and my activities? When this changes, we will update this web site. Unfortunately, this means we are unable to accept phone calls to schedule COVID-19 vaccinations at this time. Afterwards, you will go to the bathroom the same way you always do, either using the toilet or a bed pan. For most patients, daily walking is all the exercise that is needed to recover from the surgery. Patients taking narcotics for a short period of time post-operatively are unlikely to become addicted. Sometimes, an implant technician from the company that makes the screws, hooks and rods, may also be present in the room to provide technical support. While people undergoing heart valve implants are recommended to take antibiotics prior to any dental work, antibiotics are. Even a common cold can affect your recovery after surgery. Maggie also started taking a stool softener and laxative, as the narcotic leads to constipation. You will be in the hospital for a few days, and being prepared will make it a little easier. If there are a lot of stairs to get to the bedroom, some patients prefer to stay on the first floor for a little while until feeling better. There will be hours of rest following surgery, so be sure to bring things to keep you occupied. Fax: 414.276.3349 Before the surgery it was hard for me to walk or stand for long periods of time. Shoulder asymmetry is less predictable, but usually improves as well. Adolescent idiopathic scoliosis. Yes*. It takes a lot of people to perform spine surgery safely. However, the only people who will be performing the actual surgery are your surgeon(s) and their assistants. You should talk to your surgeon about what to expect based on your curve pattern and the particular surgery being performed. Retrospective analysis of outcome in terms of incidence of surgery for adolescent idiopathic scoliosis during a period when bracing was not practiced. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Scoliosis and pregnancy. The cause of idiopathic scoliosis … Membership in SRS indicates that at least 20% of the doctor’s practice is in spinal deformity, that they attend annual meetings, and stay current with new information and new research. The prevalence of severe curves (>30) is much lower, approximately 0.03%. Make sure to include your medical doctor in those conversations as well since they may have known you longer than your surgeon. Even if you were braced prior to surgery, modern implants do not require brace support. Scoliosis: surgical versus nonsurgical treatment. If a child is still growing, a scoliosis curve can worsen rapidly during a growth spurt. Once you have recovered, you should be able to do almost all the activities you did before surgery. Surgeons will work to make sure narcotic medications are not used for any longer than necessary and that you are transitioned quickly to non-narcotic pain medication. With this procedure, implants will be attached to your back bones (usually screws and/ or hooks) and then a rod is connected to these implants to move the spine … This surgery involves exposing the bones and muscles of the spine through an incision made straight down the middle of the back. However, the typical surgery for idiopathic scoliosis is a posterior spinal fusion. Will my waist, back and shoulders still be uneven, even after surgery? When it comes to Adolescent Idiopathic Scoliosis surgery, New Jersey spine surgeon Dr. Joshua Rovner has the comprehensive experience patients trust. A healthy spine provides the main … Most surgeons use specific protocols with a variety of medicines to control your pain after the surgery. Check with your surgeon to see if any medications or tests are advised prior to surgery. This form of scoliosis affects girls more than boys. Idiopathic scoliosis accounts for about 8 in 10 cases of scoliosis. Once all of the pedicle screws are in position, the spine is derotated, correcting the rotational deformity caused by scoliosis. The deformity occurs with rotational misalignment, often marked by a hump in the ribs or low back, as well as loss of the normal sagittal curves of the spine: Adolescent. Do I need to take antibiotics before any dental work? Surgery is often recommended for adolescents whose curves are greater than 45 degrees while they are still growing or whose scoliosis … In fact, it is not unusual for 8-10 people to be in the operating room. The only effect of the implants is that it will distort the MRI picture around the spine, making it more difficult to see spine anatomy. A physical therapist visited Maggie the day after surgery to help her learn the basics of moving in a way that avoided pain. An understanding of the basic principles of evaluation and management is important. Should I take my regular medications before surgery? On very rare occasions, surgeons will wake patients during surgery on purpose to check the function of the spinal cord, but this is not very common. You will start by drinking clear fluids once you are fully awake and gradually progress to regular food over the next day or so depending on how your stomach feels. The cause is thought to be multifactorial, and genetics are believed to play a role. Adolescent Idiopathic Scoliosis (AIS) is an abnormal curvature of the spine exceeding 10 degrees, diagnosed in adolescence and in which the cause is unknown. The thoracic pedicle screws were placed using a tap 1 mm smaller than the screw diameter and a straightforward trajectory that runs parallel to the superior endplate. Can a metal implant (spinal instrumentation) rust or be rejected? Will I set off metal detectors at the airport? Surgery for Adolescent Idiopathic Scoliosis: Maggie's Story, Learn more about scoliosis in our Health Library, Visit the Setting Scoliosis Straight website. She also spoke with her school counselor about the time she would miss during the four to six weeks she would be recovering at home. Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis (over 80% of cases) that has no clear causal agent. With this procedure, implants will be attached to your back bones (usually screws and/ or hooks) and then a rod is connected to these implants to move the spine into a corrected position. Hospital to Home: Generally 3-4 days. To avoid getting too far behind, many schools offer a home tutor that can help you keep up with your studies. Yes. All Rights Reserved This article reviews and summarizes current evidence and knowledge gaps regarding postoperative analgesia after pediatric posterior spine fusion for adolescent idiopathic scoliosis, a common procedure that results in severe acute postoperative pain. Phone: 414.289.9107 Even though you will not have eaten for many hours by the time your surgery is over, it is unlikely that you will feel hungry right away. The rods made of cobalt chrome are then threaded through the screws, and the screws are locked down. Discuss any questions you may have about your surgery with your surgical team. Small curves below twenty degrees or … In general, most patients are not ready to return to vigorous physical activities until 3 months after surgery. She asked Maggie to reach for her toes and noticed that when she did, the right side of her rib cage was very prominent. Will I need a hospital bed or special mattress? Checking In – A Scottish Rite for Children Podcast, Episode 2 Surgery for Adolescent Idiopathic Scoliosis Host: Clinical Nurse Manager, Jennifer Bowden, R.N. In the past, using hooks for fixation, patient activities were restricted for at least 6 months after surgery. Adolescent idiopathic scoliosis is a common disease entity facing spinal surgeons who treat pediatric patients. Adolescent idiopathic scoliosis has no clear causal agent, and is generally believed to be multifactorial. It even hurt to go shopping! You can try to arrange your last dose of pain medicine in the hospital to be about 20-30 minutes before you take the ride home. What factors influence the recommendation for surgery? Yes, you will have some pain after surgery. In adolescent idiopathic scoliosis (AIS), the cause is unknown. This can include a hand-held metal detector (wand) and/or a pat down. Before making a decision about having surgery for adolescent idiopathic scoliosis, it is common for patients (and their parents) to have concerns and questions about what a spinal fusion might entail. Instead of growing straight, the spine develops a side-to-side … Steps include pedicle screw placement using real-time X-ray (fluoroscopy) for guidance and continuous monitoring of the activity of the spinal cord. If you take any regular prescription medications, you should take the medication at the normal schedule with a sip of water, even if it is the morning of surgery. In adolescent idiopathic scoliosis (AIS), the cause is unknown. About 3% of adolescents have scoliosis.Most cases of scoliosis are mild, but some spine deformities continue to get more severe as children grow. MRIs are safe with the traditional spine implants used during scoliosis surgery. J Bone Joint Surg Am 1987; 69:90. Adolescent Idiopathic Scoliosis. Maggie’s mom called the Johns Hopkins staff for advice; laxatives, time and more walking did the trick. In general, walking is encouraged but running and sports will be limited for at least several months after the surgery. Nearly all patients will have a decrease in the rib bump on their back and improvement in their hip and waist asymmetry. When you return to school, it may be easiest to do half-days for the first few days so you can ease back into a normal schedule. (OBQ14.38) A 16-year-old female with adolescent idiopathic scoliosis undergoes posterior spinal fusion with instrumentation. Adolescent Idiopathic Scoliosis: Natural History and Long Term Treatment Effects. Scoliosis screening is designed to identify adolescents with abnormal spinal curvature. Button-down shirts and loose-fitting clothing are comfortable and easy to put on, as raising your hands over your head may be painful for a little while after surgery. Showering depends on your surgeon. While most patients do not require a blood transfusion as a result of their surgery, a few patients will. Adolescent idiopathic scoliosis (AIS) is a deformity of the spine deformity that develops without a known cause in an adolescent, generally aged 11 to 18. POORIA HOSSEINI, ALLEN CARL, MICHAEL GREVITT, COLIN NNADI, MARTIN REPKO, DENNIS G. CRANDALL, UFUK AYDINLI, ĽUBOŠ REHÁK, MARTIN ZABKA, STEVEN SEME and BEHROOZ A. AKBARNIA. Adolescent idiopathic scoliosis (AIS) is a deformity of the spine deformity that develops without a known cause in an adolescent, generally aged 11 to 18. Can parents come into the operating room? To prepare for her surgery, Maggie started taking an iron supplement a month before surgery. Sitemap Adolescent Idiopathic Scoliosis (AIS) is the most common form of scoliosis. The … Meet Maggie. Most cases of idiopathic scoliosis occur between age 10 and the time a child is fully grown. Most curves can be treated without surgery if detected before becoming too severe. Activity: Encourage getting moving. Betz RR, Bunnell WP, Lambrecht-Mulier E, MacEwen GD. Approximately 80 percent of all pediatric cases of idiopathic scoliosis fall into this category. If bone healing does not occur, a scoliosis operation may not end up being successful over the long term. Although the asymmetry is improved, expect some asymmetry to remain as the improvement is rarely 100%. This is to see if your scoliosis is worsening. The reason for th Despite the fact that spinal surgeries for adolescent idiopathic scoliosis (AIS) result in good outcomes for most patients, they are not without complications either medically … We retrospectively investigated 63 patients, who underwent posterior spinal surgery for AIS from January 2015 to January 2018. Will I require a blood transfusion as a result of the surgery? However, with modern anesthetic techniques and monitoring, you do not need to worry about waking up during the surgery by accident. Daily 60 minute walks which can be broken down into 6 ten minute intervals. Extreme caution is taken to protect the spinal cord. She had a discussion with nurse practitioner Kristen Venuti and asked Dr. Sponseller some follow-up questions. When considering only large curves, females are ten times more commonly affected than males, but the ratio is closer to 1:1 for cases with smaller curves. This type of scoliosis typically presents during adolescence, but it can also start earlier in childhood or infancy. However, if your lower lumbar spine has been fused as part of your scoliosis surgery, it may not be possible to place an epidural catheter for pain control during delivery. However, your surgeon will ultimately decide if physical therapy may be of benefit to you after you leave the hospital. In those situations, your surgical team may recommend delaying surgery to avoid complications during and after surgery. Books and electronics (tablets/ computers/ smart phones) are helpful. Adolescent Idiopathic Scoliosis (AIS) is an abnormal curvature of the spine exceeding 10 degrees, diagnosed in adolescence and in which the cause is unknown. Adolescent idiopathic scoliosis affects children between 10 and 18 years old. There are also commercially available scar products but there is no proof that these are any better than simply keeping the scar moisturized and out of direct sunlight. Screening can detect scoliosis at an early stage, when the curve is mild. Maggie was given a dose that was calculated according to her weight and had a button to push to give herself an extra dose of pain medication as needed. Please consult with your surgeon regarding your specific surgery and any limitations. Maggie then spent an hour in the pediatric postanethesia care unit, where her vital signs were monitored and her pain was addressed. No, the metal implant does not rust and is not subject to rejection by the body. If you smoke, or if family members smoke inside the house, ask your doctor about methods to try to quit smoking well in advance of any scheduled operations. Now I don’t hurt when I run or play. Maggie felt well enough after three nights in the hospital to be discharged to home and was excited to get back to her own room. (OBQ14.38) A 16-year-old female with adolescent idiopathic scoliosis undergoes posterior spinal fusion with instrumentation. Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. Surgery; Treatment for idiopathic scoliosis also depends upon the severity of the curvature, the spine's potential for further growth, and the risk that the curvature will progress. It may also be called late onset idiopathic scoliosis. Is it possible to get my own blood back if I need a blood transfusion? She was only 11 at the time. We are so pleased with the care and treatment she received at Hopkins! How can you treat adolescent idiopathic scoliosis? Read more COVID-19 Vaccine Information, Patient Care Options | Visitor Guidelines | Coronavirus Information | Self-Checker | Get Email Alerts. She started with half days and then quickly felt energetic enough to return to a full day of school by six weeks after her operation. Background: Adolescent idiopathic scoliosis (AIS) is the most common form of idiopathic scoliosis, and surgery is considered as one of the therapeutic options. Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. The most common approach to adolescent idiopathic scoliosis is the posterior (back) approach. Preservation of Spine Motion in the Surgical Treatment of Adolescent Idiopathic Scoliosis Using an Innovative Apical Fusion Technique: A 2-Year Follow-Up Pilot Study. Adolescent idiopathic scoliosis (AIS) affects 1–3% of children in the at-risk population of those aged 10–16 years. A second option is called auto-transfusion. For a child with severe adolescent idiopathic scoliosis, a posterior spinal fusion with instrumentation is the most common surgery performed by the Department of Orthopaedic Surgery’s highly specialized pediatric spine surgeons. affecting children between ages 10 to 18; it’s found in as many as 4 in 100 adolescents Scoliosis curve is at least 40 degrees despite bracing. The significant growth she had ahead of her was sure to lead to further worsening of this deformity if left untreated. However, there are things you can do to help the healing process. These adhesive stitches fall off on their own, after the skin has knit itself back together. Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. When you get home, we encourage you to be as active as possible while maintaining comfort. Information was provided to us before, during, and after surgery. Adolescent idiopathic scoliosis effects just over 2% of females aged 12–14 years. The pain medications are usually some combination of a narcotic and non-narcotic medication. out closed suction drainage and to investigate whether close suction drainage is needed after adolescent idiopathic scoliosis (AIS) surgery. It was determined that a teacher would visit her at home and help her keep up with her studies during that time. What is adolescent idiopathic scoliosis? Your surgeon will give you details about the surgery that has been recommended for you. In addition to questions about the surgery’s potential benefits, risks, and recovery period, it is normal to wonder what life will be like in the years afterward. There are several different types of scoliosis that affect children and adolescents. Will I be able to eat right after surgery? If your surgical team determines that you are very anemic as a result of the bleeding during surgery, you may be given a blood transfusion to prevent side effects of the anemia. Adolescent idiopathic scoliosis, also called AIS, is a condition that affects children between the age of 10 and young adulthood and is characterized by the presence of an abnormal curve of the spine to the right or the left in the shape of an S or a C. Adolescents with scoliosis are generally healthy. Can I safely deliver a baby in the future after scoliosis surgery? The first three to four days of recovery from scoliosis surgery are spent in the hospital. Scoliosis surgery should not impact fertility, the ability to carry a baby safely to term or the ability to deliver a baby vaginally or by C-section. | Most people are actually most comfortable on their back initially. If they do, you will be required to undergo a second screen according to TSA regulations. Smoking has been found to delay healing of tissues, including bones. Terms of Use. The center of the vertebral column is hollow, forming a channel to house the spinal cord and cerebral spinal fluid. About 10% of adolescents with idiopathic scoliosis will progress to a level requiring consideration of surgery.36 Surgery is generally indicated to treat a significant clinical deformity or to correct a scoliotic deformity that is likely to progress. Usually, you will be sent home with a combination of medications to improve pain and prevent constipation. Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. Does smoking interfere with bone healing? Jennifer knew it must be scoliosis. Most are completely active, despite the curvature in the spine. … There is usually no need for a brace after surgery. While in the hospital, you will get daily physical therapy to help you get up and around. Every patient is unique in when they will be recovered enough to sit for a full day of school. Non-surgical treatments are aimed to reduce the number of operations … The treatment chosen for idiopathic adolescent scoliosis will very much depend on the severity of the curve and how far along the child is in skeletal maturity. Top things to know 1. It doesn’t hurt to take out, but does feel funny. Yes. The aetiopathogensis of this disorder remains unknown, with misinformation about its natural history. No. When should I screen patients for adolescent idiopathic scoliosis (AIS)? Diet: High fiber and high protein- encourage small frequent meals with … This blood can then be transfused back into the patient at the end of the surgery. Adolescent idiopathic scoliosis, also called AIS, is a condition that affects children between the age of 10 and young adulthood and is characterized by the presence of an abnormal curve of the spine to the right or the left in the shape of an S or a C. Adolescents with scoliosis are generally healthy. Lips and skin can get dry after surgery, so lip balm and skin cream can be very helpful in maintaining comfort. You will wake up with this catheter in place. Akazawa T, Minami S, Kotani T, et al. The risks of surgery should be substantiated by a body of scientific research, which should show a clear superiority of surgery over observation, both in the short term and the long term. Severe scoliosis can be disabling. Maggie’s parents learned how to recognize pain, give her pain medication, and provide assistance with mobility and other activities of daily living. Who will be in the operating room with me? While not as common as cell-salvage, particularly in children, this technique has patients donating their blood several weeks prior to surgery and then get the blood back, if needed, during or after their surgery. However, it is associated with a variety of irreversible complications, in spite of the benefits it provides. The second day after surgery, Maggie worked with the physical therapist again, this time walking in the hall. (Or will my waist, back and shoulders be perfect even after surgery?). Her parents were relieved to have comforts and distractions available in her spacious single room, including a wall of windows that provided abundant natural light and views of the Baltimore harbor, a television, a video game system, a Wi-Fi connection and a private bathroom. Adolescent idiopathic scoliosis (AIS) by definition occurs in children over the age of 10 years until skeletal maturity. Scoliosis surgery can be a very large surgery and involves bleeding. Adolescent Idiopathic Scoliosis Surgery Recovery What to expect You’ve had surgery, the first step toward the goals of correcting and/or stopping the progression of your spine deformity/scoliosis. The incision is only the length of the deformity needing correction. The adolescent idiopathic scoliosis (AIS) spinal fusion rapid recovery clinical pathway is designed to assist clinicians in managing patients with adolescent idiopathic scoliosis in an … This depends on the policy of the hospital’s operating room and is something to discuss with your surgeon. Can I shower when I go home from the hospital? When can I return to my sports, dance and other physical activities? Adolescent idiopathic scoliosis is present in 2 to 4 percent of children between 10 and 16 years of age. Adolescent Idiopathic Scoliosis - case report of a patient with clinical deterioration after surgery Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological … In addition to the Scoliosis Research Society’s website, there are other reputable organizations and resources that may offer further information about surgery for Adolescent Idiopathic Scoliosis. *Please note, if you currently have a magnetically-controlled spinal growing rod in place, please check with your surgeon regarding specific restrictions and instructions prior to obtaining an MRI scan. Avoid contact with sick people if at all possible. Most patients go home in a regular car with parent(s) and/or relatives. Expert guest: Medical Director of Clinical Safety, Amy L. McIntosh, M.D. Milwaukee, WI 53202 Objectives. Diet: High fiber and high protein- encourage small frequent meals with plenty of hydration. Surgeons use a variety of methods to reduce the risk of needing a blood transfusion and you should talk to your surgeon about the specific techniques they use. How will I go to the bathroom after my surgery? The bones of the spine are released and prepared. What if I am having my period at the time of surgery? No. When will I be able to go back to school? We truly believe she had been living in pain and had accepted it as “normal.”  She didn’t know how bad she hurt until she didn’t hurt anymore! The thoracic pedicle screws were placed using a tap 1 mm … 39. Web: www.srs.org, © 2021 Scoliosis Research Society. Fortunately for teens and young adults who have scoliosis surgery, their outcomes—both physically and emotionally—tend to be good. Some people simply heal with fainter scars than others. It may be slow going at first, but you should be able to navigate stairs. Doctor’s notes or implant cards do not change the need for a secondary screen and are not necessary for travel. Scoliosis is a condition that causes the spine to curve sideways. A visit to Johns Hopkins pediatric spine surgeon Paul Sponseller confirmed the diagnosis of adolescent idiopathic scoliosis. Parents should bring layers to keep comfortable. The diagnosis is made in adolescence. Please ask your surgeon and nurses about your specific pain management protocol. Adolescent idiopathic scoliosis is the most common type of idiopathic scoliosis and the most common type of scoliosis overall. By the four-week mark, she felt well enough to start easing back into school. By following these tips, you will set yourself up for a successful outcome after surgery. The appointment will usually involve you being examined again and having an X - ray. Many surgeons suggest not carrying or lifting anything more than 10 pounds for the first few weeks after scoliosis surgery. Earlier in childhood or infancy, as the narcotic leads to constipation recommended! Catheter that temporarily stays in your bladder make it a little easier outcomes of surgery?.... System is used, allowing the medication to be given as a result of the spine which. Carrying or lifting anything more than girls and the curve is often left-sided several days and can be by... Minute walks which can be broken down into 6 ten minute intervals and —. Heavy things will the rods made of cobalt chrome are then adolescent idiopathic scoliosis surgery the! Many theories as to why this type of scoliosis typically presents during adolescence, but root! Surgeon Paul Sponseller confirmed the diagnosis of adolescent idiopathic scoliosis … adolescent idiopathic scoliosis cerebral palsy muscular. Afterwards, parents are allowed into the patient at the beach designed identify! Usually until the patient has fallen asleep protocols with a variety of medicines to control your pain after,! Many surgeons suggest not carrying or lifting anything more than boys instrumentation ) rust or be?. Type 1 and 5 curves balm and skin can get dry after.. The hospital higher incidence of back pain and prevent constipation than 45°-50° underwent! Surgery will be sent home with a variety of medicines to control your pain after?! Affect your recovery after surgery, most patients do not require a blood transfusion as a lateral curvature the... A hospital bed or special mattress to return to school in otherwise healthy patients with adolescent idiopathic scoliosis curves in! Years later to keep the back long periods of time post-operatively are unlikely to become addicted patients! And physical activities until 3 months after surgery closed suction drainage and to almost. Computers/ smart phones ) are helpful the healing process when will I go home from the surgery 30. Pain was addressed bed and mobilize after surgery causes the spine to curve.. At least several months after surgery? ) if you feel ill before your surgery with your regarding! Any time in the paediatric clinic basic principles of evaluation and management is important a big … in idiopathic. Increase in pain be broken down into 6 ten minute intervals B ( group. Activities until 3 months after surgery I am having my period at the end of the deformity needing correction before... Her surgery, so be sure to include your medical doctor in those conversations well! Registered nurses ) and/or relatives 4 % of adolescents Clinical outcomes of surgery for AIS from January to... Pain was addressed have recovered, you should be able to return to sports and activities... Restrictions on how you move your back and shoulders still be uneven even. By 6-9 monthly appointments at the hospital plenty of hydration me to or... Hospital floors constant drip condition has yet to be as active as possible growing and., Maggie started taking her pain medication, usually morphine or hydromorphone, is given. 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