Balancing – 7 weeks post op

It’s been 7 full weeks since surgery to fuse my spine from L4 to S1.  My incision is well healed – not that people see it, heck I don’t even see it unless I turn just right and look in a mirror over my shoulder.  I run my fingers along it as I wash in the shower, and it’s smooth and doesn’t hurt to touch it.  I can rub lotion over it after my shower with no complaints either.  Gentle pressure around the surgical site is fine, the muscles seem to be fine underneath and I don’t feel anything “weird”.  When I had my toe fused a few years ago, the hardware is just under the skin – so I can visually see the plate and a couple of the screws in my foot – and obviously I can feel them under the skin.  Not the same with my back.  I’ve got a layer of skin, (fat), and muscle that covers my spine and therefore the screws and rods that are holding my spine into place.  Plus, there is bone kind of packed all around it like modeling clay that will ultimately add even more strength and stability.  If you read on the internet, you will hear that the first 3 months after fusion are critical for allowing the fusion to “set”, but you are not completely fused for more like a year, year and a half.  So, while 7 weeks sounds impressive…I’ve got a LONG road of healing ahead of me.

But really, I’ve come a LONG way already!  The first week, I could barely walk.  I used a walker most of the time and relied on a back brace any time I had to get up.  I couldn’t get out of the recliner without help, and it was a monumental effort to get onto the toilet, and back off of it.  One week post op I needed the walker to get up and back down from sitting – in the recliner or on the toilet – but I could walk without it (it was pretty handy for carrying stuff from the kitchen to the chair though!) I still used the back brace constantly when I was up.  I started walking up and down my driveway, with a cane, and I managed to actually cook a few meals.  Two weeks post op I was starting to feel more normal and steady on my feet – but my surgeon wanted me to wean off the use of the cane, and the back brace.  So I worked on that, and I started to drive a little bit too.  I also started to actually sleep in bed for a few hours each night.  It was hard to re-position during the night, but it was nice to be completely horizontal for a few hours.  Three weeks was acclimating to walking more and preparing to go back to work, finding clothes that I could wear, and getting as much rest as possible.  Four weeks post op I was back to work where the biggest challenge was making the drive in and home each day.  I worked short days, but they still felt long!  I also was allowed to begin doing stretches for my back and start to strengthen some of the muscles.    Five weeks post op, was still short work days, but I was feeling more and more comfortable and while I knew it would be a long and challenging day to teach my seminar that Friday – I felt like I was ready.  It zapped my energy, but I was glad to be teaching and feeling good enough to BE teaching.  I was also learning to recognize the necessity of resting – not just sitting at my desk with an ice pack, but truly resting.  Six weeks post op, I pushed through a long drive and teaching again, but had some girl time and rest with one of my favorite friends and her daughter, took time out for a massage, and an afternoon for more girl time with another favorite friend.  I also got the clearance from my surgeon to “do more” – return to things I’d been doing “pre surgery” like yoga and riding my exercise bike.

So it’s nearing the end of 7 weeks post op, and I’m sitting here feeling a little sorry for myself.  In my well established pattern of being a chronic over-achiever, I pushed my limits this week.  I had lots to get done, and not a lot of time to accomplish it.  So while I did sit in my chair in my office with ice on my back, and I did go for walks at lunch time, and I did do my stretches and a few gentle yoga poses, I didn’t actually do much resting.  And my brain was running a million miles an hour, so I didn’t sleep great either.  Add in laundry, housecleaning, dishes, and staying late to teach – and my body rebelled.  Remember last week when I said I am listening to my back and I can tell when I need to move, or get ice, or rest….well, I haven’t been great about that this week.  I’ve been hearing my back protesting – but I’ve not taken steps to calm it down.  Well, not until it screams at me…like it did yesterday.

So this week I’m working on finding the balance.  Using my voice to say no.  Giving myself grace for what I just can’t realistically do right now.  Leaving a little early from work, and using that extra time at home to actually rest – not do the dishes or the laundry – but rest.  I need to finish my book.  I need to write a few overdue thank you notes.  I need to rest – so that I can heal. If you saw me in the grocery store, or walking on campus you probably wouldn’t know that I had back surgery almost 8 weeks ago.  But I did.  I’ve got bones that are needing to heal.  I’ve got ticked off nerves that need to heal.  I’ve got muscles that need to relax so that the nerves will heal.  I’ve got muscles that need to rest before they will get stronger.  I can’t rush this process for my own convenience – and I really do need to listen to the subtle cues my back gives me.  What do I need most?  Rest.

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Finally Friday – 6 weeks post op

As I expected, the end of last week (flight to Seattle) and this week (drive to Richland) exhausted me.  Sleep, ice, rest, and my back feels alright – but the fatigue is a very real thing.  I just don’t bounce back as quick as I did before the surgery.  As Chel and others keep reminding me – I’m putting a ton of energy into healing my back, growing bone, and so my extra energy reserves are bound to be low.  Sleep, eat well, take good care of my back as it heals – REST – is all part of recovery.

On Tuesday I had my 6 week check up with my surgeon.  X-rays first, that look very much like the ones they took 3 weeks earlier – except that I did flexion and extension instead of just standing up straight.  Doc says I’m pretty much where he expects me to be.  I talked through some of what I have been feeling nerve wise – and he takes credit for ticking off the nerves.  During surgery he had to move them out of the way to clean up the joints and do the fusion.  Nerves are slow to heal, but what I had pre-surgery was physical pinching of the nerves – now they are just irritated and need to adjust.  Continuing with ice through out the day and rest will keep the inflammation down and hopefully keep the nerves happier.  I have another appointment in about 8 weeks.  I have an appointment with the physical therapist in about 2 weeks and then appointments twice a week to see her for about 6 weeks.  I can start riding my exercise bike, and doing gentle yoga.  Gentle walking and stretching will also continue, and helps with the mad nerves stuff.  Still no NSAIDS – they affect fusion healing.  Still no heat – not good for the fusion either.  Careful and smart return to doing more and more – and working up to lifting up to about 35 pounds by the next time I see the doc.  As the nerves heal, and the muscles get stronger, the sense of soreness will dissipate as well.  Honestly, it’s not my back/surgical site that bothers me.  It’s my butt and down my legs to my feet – all nerve related.  When I’m not good about walking, resting, stretching, icing – that’s when the nerves start firing all crazy.  The muscle relaxers keep me from having major cramping and charlie horses – so that’s a good thing…but the muscles in my legs are sore.

Ok, but how do I really feel????  Well, pretty good most of the time.  The good outweighs the bad for sure.  I am moving better each day, feeling stronger.  I still am not wearing much besides leggings – as the waist band of my jeans and work pants rubs funny across my incision site and irritates it.  I can wear them for a couple hours, but then I am just annoyed – so leggings and a couple super soft elastic waisted skirts and such are my work wardrobe for now.  I’m able to do laundry without much trouble, and load and empty the dishwasher, even change the sheets on my bed.  I can bring in 2-3 smaller pieces of fire wood at a time so I don’t freeze.  I can take the trash out to the big can – as long as I don’t let it get too full – or put the used kitty litter in there – that makes it too heavy.

I’m thankful that I’m doing as well as I am, and that I can start to do even more, and get back to most of my routine. I know my back will tell me when to slow down, take a break, and sit on some ice for 30 minutes and take a break.

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3 weeks post op

I’m starting to recognize that this recovery is a whole lot of ups and downs – 2 steps forward one step back.  Although, I also recognize that I am constantly  making small adjustments to what I’m doing.  While I do mostly have good days, it is the overnights that prove the biggest challenge.

First off…overnight I’m in one of two positions in bed – flat on my back with pillows under my knees  – or on my right side with knees bent, pillows between my knees and feet, and a pillow behind by back.  When I’m on my back, it’s pretty easy to keep the ice pack right where it needs to be, but after a couple hours the ice pack is no longer ice – it’s body temp.  When I’m on my side, the pillow behind my back is both for a bit of support – but also to hold the ice pack in place.  It’s the best I can do, but not the most effective for keeping the ice in place.  And of course, again it’s the melting factor.  So I’m also up several times a night.  I get stiff and uncomfortable no matter the position after a bit – and inevitably the cat wants to sleep on my feet or something which doesn’t help matters at all.  So I get up and pace the hallway to loosen up the muscles – stop at the bathroom since I’m up – pace some more – get a fresh ice pack, and back to bed.  I’m blaming it mostly on back surgery – but a 15 year old cheap mattress doesn’t help the situation I’m sure.

Inflammation is still an ongoing management issue as well.  During the day I walk quite a bit – which helps to keep the blood flowing and reduce the inflammation – or encourage it to dissipate anyway.  I do a lot of walking to the mail box and back – a couple walks in the morning, a couple in the afternoon, and one in the evening as it’s getting dark out.  If I’m in town at the winery, I take a longer walk around town every 2-3 hours.  My fitness app says I’m getting between 4500-8500 steps a day depending on what I do.  My surgeon wants at least 5000 right now.  I’m also supposed to ice my back frequently and for at least 20 minutes each time.  I try and be good about sitting down every hour or two to ice.  It’s actually a good pain management strategy too, as it decreases inflammation and increases blood flow.

My surgeon wanted me to wean off the back brace so that my muscles will gain strength.  I’m mostly off of it now – although I have been wearing it when I drive “just in case”.  It gives me just a bit of extra support as I gain confidence and get more comfortable with how to get in and out of vehicles without straining muscles or twisting my spine the wrong way.

My surgeon also has me weaning off the pain pills.  I’ve managed to reduce them to half doses every 6 hours (down from full doses every 4 hours) – which conveniently coincides with the 6 hours between muscle relaxers and the 6 hours between doses of OTC Tylenol.  I’m feeling pretty good at this level, and may start dropping the daytime doses and see how that goes.   I’m still only 3 weeks post op from major surgery – and the phrase my surgeon used was “First, you need to rest, Second you need to Ice, Third you need to walk, Fourth you need to do-but not overdo. Listen to your back.”  Seems like solid advice to me, and as I’ve said before, he has a great success rate with his surgeries.

Healing takes time and work….and rest.  But I do feel like I’m doing so much better, able to do most things around the house, and concentrate enough to do some telecommuting and help out with other projects for the winery and a few church deacon things too.  I’m trying to stay positive and be a good patient who follows directions!