Spinal Tap Next Week - A few questions!

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Spinal Tap Next Week - A few questions!

Postby pookpook » Thu Oct 04, 2007 7:35 am

Hi! I have been undergoing testing for MS due to left sided numbness and pins/needles and left sided weekness. My first brain MRI showed lesions consistant with demylinating disease. I have been checked for ON, which was negative. I am waiting on 2 MRI's for my C Spine and T Spine.

I have a spinal tap scheduled for 10/11 at my neurologist's office. He is going to do the tap in the office and I am supposed to be able to get right up afterward and leave. I asked if I could drive myself (2 hours - one way) and he said that was fine.

I thought that these are usually done with rest afterward - like that you were unable to get off your back for an hour or so in order to avoid the headache. Is this right?
:?:

I was scheduled for this last month and had my husband (and myself!) get off of work only to drive there and have the wrong date!

I appreciate any feedback and experiences with this. I was ready to do it last month and now I am nervous!

Thanks!

Becky
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Postby sh8un » Thu Oct 04, 2007 7:45 am

Hi pookpook
I like your name...I am an RN and I work in neurosurgery. We perform spinal taps on our unit and everytime, the patient has to stay flat for at least one hour but mostly two. This is to avoid leaks from the site which would lead to headaches amoung other things. If there is a leak, it means that there is an open hole and you could end up with infections. I am also not sure why you are having a spinal tap when you already have lesions in your brain???
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Postby Arcee » Thu Oct 04, 2007 7:52 am

Becky, my original doctor said I could move around after the spinal tap. Whether it was because I moved or he just screwed up, I had one of those incredibly excruciating, debilitating headaches after it. So I would recommend taking any precautions that you can. And, if you have the misfortune of having the headache, then I would seriously consider taking the follow up injection to patch it. I regret not having done that.
You most likely will be fine though. Just wanted to share the info since you asked.
I also had to have the tap even though the lesions were obvious. I think it was an insurance or diagnostic requirement.
- Arcee
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Postby jimmylegs » Thu Oct 04, 2007 11:28 am

i can't remember the order of mri and tap, but i definitely got the results of my tap last, after the brain and spine mri findings had confirmed lesions all over the place.

i got the nasty post-tap headache. they had me lay down for half an hour after, but it wasn't enough. i got up when they said it was okay, and off i went into the land of errands and regular life, but the headache said nice try. i had two choices: lie down, or suffer. stupidly i kept trying to get things done. can't remember exactly how long, but maybe a week later, the docs said something like if it's not gone by monday, you'll have to come in for a blood patch. i did not like the sound of that, yay more needles in the spine, so i self-prescribed a weekend of bed rest to give the hole a break from the pressure of being upright. fortunately it worked and i did not have to go for a blood patch.

so that's my story, i agree with the other recommendations about precautions. i posted something else interesting on here some time back too.... will have a quick look for it...
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Postby jimmylegs » Thu Oct 04, 2007 11:43 am

here's part of a post for lucy101 back in july of this year:

if you do get the lumbar puncture, show whoever's going to do it this site:

http://www.geocities.com/HotSprings/Villa/5422/index.html

i think hopefully this stuff is pretty much common knowledge http://www.pulmonaryreviews.com/dec00/pr_dec00_puncturehead.html, but maybe i happened to be one of the ppl that are not helped by even the most careful angle of insertion. i only found all this out after the fact and never asked my neuro how he'd done my LP. but if it comes up for you, why not be sure it's all known, when someone's about to stick the needle into your own spinal cord!!
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Postby AllyB » Thu Oct 04, 2007 2:11 pm

Hi there

We are even more conservative here in South Africa: I was admitted to the neuro ward and had to lie flat for 8 hours afterward (even had to use the bedpan!), and I had no headaches...I also had lesions on mri, then had the spinal tap to confirm the diagnosis (even though I had both old and new lesions), and it was positive for oc bands. The tap was fine, the local anaesthetic was ok, and I did not even realise when he had finished the procedure - I was just a bit panicky at the idea of it. I also had iV steroids immediately after the procedure (they also take blood at the same time because there is some sort of comparison that they do).

I am sure you will be fine, but I would not drive back (sitting position with pressure on the back), and would insist on lying down for a while afterward - i think it is worth it to save yourself terrible pain!
All the best.
Al
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Postby jimmylegs » Thu Oct 04, 2007 3:34 pm

sounds like the african lengthy precautions might be the right idea, ally!

PP, i had nerves too... the more they freeze it, the less you'll know about it. i got an extra round of freezing before i couldn't tell anything about what was going on back there, then it wasn't so bad.

below, some stuff from the 80s. the way i read it, remaining prone after LP is not necessary if they do it right. and if they do it wrong, an hour isn't going to help.

i've been looking for studies on post LP headache prevention and/or management that carry the prone time out past 6 hours, and have not found one yet. all i know is, three days did it for me. ally do you know where your docs came up with the magic number 8?

PP, best case scenario i think, is that your doc is a total pro at LP, and you'll get away pain-free!

if it starts in on you after a while, you can call in the support crew to spoil you for a couple days on the couch.

if it starts to bug you on the way home, maybe it will be mild and you'll make it home okay, and rest on the couch as much as you can.

at worst, if they send you home with a bad case, can you hole up near the doc's with a friend, or at a motel and call for pizza?

ps. if you do find yourself confined to the couch... if you crawl to the door to sign for pizza or use the bathroom, it's easier on the headache than walking the whole way - just pop upright at the last minute lol!

Anesthesiology. 1989 May;70(5):729-31.

Needle bevel direction and headache after inadvertent dural puncture.Norris MC, Leighton BL, DeSimone CA.
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania.

To study the effect of needle bevel direction on the incidence and severity of headache following inadvertent dural puncture occurring during the identification of the epidural space, the authors randomly assigned obstetric anesthesia residents to identify epidural space with the bevel of the epidural needle oriented either parallel or perpendicular to the longitudinal dural fibers. If dural puncture occurred, an observer unaware of the needle bevel direction, daily assessed the presence and severity of any subsequent headache. Of the 1,558 women who received epidural analgesia during this study, 41 women suffered dural puncture, 20 with the needle bevel oriented perpendicular to the longitudinal dural fibers and 21 with the needle bevel inserted parallel to the dural fibers (NS). Fourteen of 20 women in the group in which the needle bevel was perpendicular to dural fibers developed a moderate to severe headache, whereas only five of 21 in the group in which the needle bevel was parallel to dural fibers did so (P less than 0.005). Similarly, we administered a therapeutic blood patch to ten of 20 women in the perpendicular group but to only four of 21 in the parallel group (P less than 0.05). Thus, identifying the epidural space with the needle bevel oriented parallel to the longitudinal dural fibers limits the size of the subsequent dural tear and, therefore, lowers the incidence of headache should dural perforation occur.


in the following study, the sample size looks like you'd get meaningful results, but without looking at the full text, it is unclear whether all these patients were treated using exactly the same methodology, so differences in needle size, experience, and needle bevel orientation are suspect with regard to cause of post-LP PH:

Cephalalgia
Volume 8 Issue 2 Page 75-78, June 1988
Post-lumbar-puncture headache: The significance of body posture. A controlled study of 300 patients
Steinar T Vilming, Harald Schrader, Inge Monstad (1988)

Abstract
Post-lumbar-puncture headache: The significance of body posture
A controlled study of 300 patients
Steinar T Vilming, Harald Schrader, Inge MonstadDepartment of Neurology, Ullevål Hospital, University of Oslo, Oslo, Norway
Correspondence to Steinar T Vilming, Department of Neurology, Akershus County Hospital, 1474 Nordbyhagen, Norway;
Abstract
In this single-blind, randomized study of post-lumbar-puncture headache (PPH) in 300 neurologic inpatients the significance of body posture after lumbar puncture (LP) was evaluated. Immediate mobilization was compared with bed rest for 6 h (3 h prone followed by 3 h supine posture). Contrary to the widely held belief, this investigation did not show significant differences between recumbent and ambulant patients as to frequency of PPH in the total material (39% versus 35%) or when men (31% versus 29%) and women (48% versus 41%) were evaluated separately. Headache associated with nausea was significantly more frequent in the recumbent than in the ambulant patients both in the total material (23% versus 13%) and in women (35% versus 16%). Thus, immediate mobilization seems to be preferable after LP.


in the study below, i don't believe 30 minutes is a meaningful length of time after which to assess the effectiveness of remaining prone.

Journal European Archives of Psychiatry and Clinical Neuroscience
Issue Volume 235, Number 2 / March, 1985
Pages 71-75

Is obligatory bed rest after lumbar puncture obsolete?
Marianne Dieterich1 and Th. Brandt1

Received: 14 March 1985

Summary After lumbar puncture (LP) an epidural CSF leakage caused by delayed closure of a dural defect leads to a decrease in CSF pressure. The resultant venous dilatation as well as downward shift of the brain with traction on pain-sensitive blood vessels and nerves frequently evokes post-lumbar puncture headache (PLPH), when the patient assumes the upright position. In previous studies differing opinions have been expressed about the prophylactic value of the posture taken by the patient after LP. The present study was designed to evaluate the benefit of the decrease of hydrostatic CSF pressure on the dural rent, when the patient lies down in a prone position with the head tilted down at an angle of 10° for 30 min immediately after LP: is it possible to accelerate the closure of the dural defect in this way and prevent PLPH? One group of patients (n = 78) lay in a prone position with the head tilted down at an angle of 10° for 30 min, the other group (n = 82) rose immediately after LP. PLPH was found to be independent of the posture in both groups and affected 44% and 41% of the patients, respectively, so that there is no longer any justification for requiring patients to remain in bed after LP.
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Re: Spinal Tap Next Week

Postby NHE » Thu Oct 04, 2007 4:37 pm

I was told to lay still for 30 minutes after my tap but didn't since I told the doctor that I felt fine. I think that it was about 20 minutes before I started feeling so nauseous from the headache that I had to go back to my hospital room and lay down. My headache lasted for a week and I had to go back for the blood patch. In retrospect, I wish that I had listened to the advice to lie still for a while after the tap. If I stood up for too long the headache felt like someone was trying to pull out my brains out through the back of my neck. I was told by the doctor who did the tap that they took a total of 15 mL. Later, I was told that this was a large amount. Perhaps if they take a smaller volume of fluid the headache may not be much of a problem. Still, it might be best to error on the side of caution and just give it some time lying still afterwards. I do not think that it would've been possible for me to drive with the headache and the nausea. Indeed, even after a week I had to have someone else drive me back to the hospital for the patch.

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Postby jimmylegs » Thu Oct 04, 2007 4:47 pm

i agree NHE, that there would definitely have to be some caution applied to the idea of driving, depending if a headache sets in, the timing, and severity.
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Postby REDHAIRANDTEMPER » Fri Oct 05, 2007 7:50 am

i was told to lay still as much as possible for three days and i wouldnt get a headache..i had to have someone drive me up there and back to my house and stay with me....i didnt have any problems what so ever when i did what they said...

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Postby jimmylegs » Fri Oct 05, 2007 9:10 am

that's great chris glad it was not a prob for you. definitely good to have someone helping you out.
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Postby REDHAIRANDTEMPER » Fri Oct 05, 2007 9:30 am

i truely think that is the reason i didnt have to many problems

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Postby jimmylegs » Fri Oct 05, 2007 11:34 am

sounds like a pretty good bet to me too :)
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Postby jimmylegs » Fri Oct 05, 2007 11:36 am

was it your docs that said that to you? the 3 day recommendation?
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Thanks!

Postby pookpook » Fri Oct 05, 2007 11:57 am

Thank you all for your responses! I really appreciate them. I am going to talk with the dtr before the LP and address my concerns.

I am not sure how to approach a doctor concerning his "technique". How do you go about that? Or approach him showing different methods?

Thanks again for your experiences and advice, I really appreciate it!

Becky
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