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!

Follow Up Appointment Day 18 Post Op

It’s  been a busy few days – I’ve been to town a couple of times. My parents, Uncle, and 2 Nephews all stopped for an overnight camping visit – and I had my post op follow up with my doc.

So let’s back track – Day 16 I ventured into town (25ish miles) for x-rays and groceries.  My mother-in-law came and picked me up with all my “stuff”.  Pillows, cooler bag with ice packs, bag of medications, water bottle, cane, back brace, wallet, and the discharge note from the doc saying get x-rays please before your followup.  Well, turns out I was early and the docs office hadn’t sent the “order” down to the hospital yet, so the nice lady called up to the docs office and took my phone number and said hopefully they’ll get that to us soon.

So, back to the car, and we decided to go do our grocery shopping trip while we waited for the call back.  I hadn’t been shopping in probably 3 weeks, so the fridge was pretty empty.  I managed to get through the shopping experience without too much difficulty.  But remember, I’m not supposed to lift anything over 5 pounds.  I did pretty good I think – but by the end of it…I was tired…ready for a pain pill…and some lunch.  Mom in law had a bunch of stuff too, so we got it all out to the car and loaded in the back.  As we were finishing up the hospital called and said I could come get my x-rays.

Back to the hospital, checked in, and got called back for my x-rays.  It was the same tech as before my surgery, and so I sweet talked him into letting me take pictures of the x-rays too – he laughed at my nerdy-ness but let me.  I wasn’t really surprised by them, I mean I’d googled plenty of pictures of spinal fusion x-rays – so I knew pretty much what to expect, but it was kinda cool to see it with my own eyes.  But…I wasn’t quite sure what I was seeing, and wanted to confirm with my doctor before I shared them.

We finished out our trip to town with A&W root beer and burgers, and headed home.  Unloaded groceries and I then blissfully sat down with some ice and just relaxed – probably dosed off for a bit – for the next couple of hours.  Fixed some french dip sandwiches for dinner and went to bed – exhausted.

Going to town is more tiring than I expected.  Not sure why exactly, but it is.

When I got up Wednesday morning, while making coffee, I got a text from my mom.  They were leaving Anaconda, MT and headed our way.  Whoops…I thought they were coming on Thursday….oh well – they would be here in 8ish hours.  I did some light housework that didn’t require me lifting anything over 5 pounds…and tried to rest and ice throughout the day.  We had a great visit, mom and dad made us a simple but yummy dinner, they were impressed with my mobility 17 or so days after spinal fusion, and the boys…whew….well behaved…but go, go, go….always doing something.  Bella enjoyed the distraction and people to play ball with her!!  Silly dog!  We all headed to bed about 10…and yep….I was TIRED.  This healing thing apparently takes a LOT of energy.

Got up and made coffee, walked the driveway to get the blood flowing, and visited with everyone for a bit on a crisp Idaho morning.  Uncle Steve got started on breakfast (BACON!!!) and visited with an eye on the clock.  Had a quick breakfast with them, and then it was off to the shower for me so I would be ready with mom-in-law showed up to chauffeur me to town for my doc appointment.  Got me packed up with ice, pills, pillows, back brace, cane, wallet, etc.  Gave hugs and kisses all the way around – and off we went to town.

Doc was pleased with my progress.  He pulled the mesh off my incision, and proclaimed it looked perfect.  I can’t see it without a mirror, so I’ll take his word for it until I can examine it nekkid in the bathroom mirror – or convince someone to take a picture.  Ever tried to take a selfie of your lumbar spine???  Yeah…I wouldn’t recommend it…LOL

I am supposed to continue to rest – healing takes energy.  I’m supposed to walk lots – I’m doing about 5000 steps a day, but am supposed to listen to my back and DON’T OVER DO IT.  It’s time to wean off the back brace – so that my muscles can get stronger.  Continue to ice every hour if possible, again, listen to my back – don’t over do it.  Continue to wean off the pain meds too – but be smart about it – no points for being a hero in pain.  I’m not at risk for worrying about liver damage or becoming addicted – healing takes time, and pain slows down progress.  I asked about transitioning to tylenol and he strongly encouraged it, but to pay attention to the 4000mg per day dose – as I taper back on the pain meds, I can take more of Tylenol – but he again assured me – I’m young and healthy – stay ahead of the pain, be smart, and listen to your back.  Rest.  Also, stay on top of the muscle relaxers – they will be the biggest help through this transition.  What I’m feeling nerve wise is totally normal, and should continue to diminish each day.

We talked about my returning to work….he would really like me to rest as much as possible, but understands that most folks need to get back to work.  He has asked me to take an additional week off.  He also issued me a handicap permit so that I can park closer to my office on campus for the next few months.  Bottom line, I need to be on light duty, very limited lifting, bending, twisting in the work place for at at least another month.  Thankfully I know I can continue to tele-commute some, my boss is being great about that.

My final conversation with him was the nerdy part – what did he actually do, what am I seeing on the x-rays?  He started out sarcastically (making me laugh), telling me about positioning and draping in the OR – but finally got down to the actual surgery part.  He cleaned out the damaged disc tissues and cleaned up the arthritic bone changes between L4-5 and L5-S1, and used “cages” as spacers and then filled in with bone material.  You can kind of see the  cages a bit on the x-ray but I wasn’t for sure.  He also placed 6 screws, 3 on each side, plus 3 rods – 2 vertical and one horizontal as a cross brace.  Bone material was placed all around the area too – kind of like packing it around all the hardware like putty – and it will ultimately fuse to the bone in the vertebrae to create a solid mass of bone in that area.

In 2 more weeks I am to start the exercises he gave me in the “Back owner’s Manual” – some simple stretches in preparation for actual physical therapy.  For now…just walk, control pain and muscle spasms, REST and heal.  I’ll follow up with him again on September 25th.

So here are the post-op x-rays of my back….

   

It is expected with this new stability in my spine that I will continue to have diminished nerve pain, diminished arthritic pain, and be able to physically do more.  Walk more, stand more, exercise more, and just generally just be back to my normal self.  It will happen, I just have to be patient and let the healing take place.

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Day 11 Post Op

So there is this thing in life called balance.  It can refer to standing on one foot and not toppling over.  It can refer to yoga poses that defy gravity and require crazy core strength and concentration.  It can refer to tires and wheels and avoiding that shake and shimmy at 58 miles per hour.  It can refer to the acid balance in soap or wine to give you the perfect bar or bottle.  It can refer to sugars and fats and calories and carbohydrates.  It can refer to time in scripture versus time on social media.  And…of course it can refer to healing and recovery from spinal fusion.

Today is day 11 after my spinal fusion. Lisa indulged my inner nerd yesterday and actually measured my incision for me.  You know I can’t actually see it without a mirror – or a cell phone camera picture – so I was just guestimating its size.  6 inches.  Based on the pain I was pretty sure it was the length of my forearm – but apparently not.  It will actually end up being a pretty boring and subtle scar – it’s just glued together with a mesh over the top of it – no stitches or staples.  All the impressive rods and screws are under the skin waiting to be revealed next week on x-ray.  Based on other fusion x-rays I’ve seen, I’m guessing there are 6 screws and 2 rods, and possibly a few spacers in the disc spaces.  I’ll know more next week.

So, back to the balance thing.  Each day I get physically a little stronger – a little more fluid in my movement – a little more confident and sure in my steps.  You see, a huge part of balance is the ability of the muscles in your core and along your back to respond and react to subtle changes in terrain to keep you from toppling over like an toddler.  Arms out to steady, no quick movements, and keeping track of where your feet are.  Using a walker or cane…or a wall, cabinet, table, etc.  All in an effort to remain upright, or to transition from sitting to standing to sitting again.  It gets easier each day, but it is still a challenge while those muscles continue to heal.

The other thing I’m having to keep in balance is the inflammation (aka swelling) of the surgical site.  Remember last week when I was having muscle spasms so bad they started me on steroids?  Well, I’m done with the steroids, and they really did help, but I still have inflammation to manage.  My meds have anti-inflammatories in them (acetaminophen aka Tylenol), and I need to ice my back, and I need to move – all these things together promote healing which helps with the inflammation.  During the day I stay fairly comfortable and I get up and move more.  I walk around outside.  I walk to the bathroom and back, kitchen and back, go sit outside, go sit inside, etc.  I use ice regularly, and take my meds on time.  By the time night time rolls around – I’m tired, and need to rest.  But I get stiff overnight…I can’t just roll over and re-position, take the pressure off one side or the other.  I’m pretty well stuck in one position in the recliner.  I need to get up and move every couple of hours to get the blood flowing, replace the ice packs, and stay up on my meds. This doesn’t make for the most restful and restorative sleep.  Being in the recliner is still the most comfortable place for me, but I’m thinking I might need to try some creative pillow bracing to see if I can adjust my position slightly to allow a bit longer stretches of sleep overnight.  While getting up and walking for 5 or 10 minutes does help my discomfort – I’m not generally an insomniac – so messing with my sleep makes me cranky!  All I can do is try something new/different each night and see how it goes.  Improvise, adapt, and overcome – that’s what they taught me in the military.

Pre-surgery I  had quite a bit of leg pain on my right side, across my hip and buttock, and down my leg.  Classic sciatic nerve pain.  I would occasionally get it on my left side to, but my right side was worse.  If I slept funny, the nerve would really flare and I would get severe muscle spasms across my hip preventing me from standing upright, and a dose of muscle relaxers and a 30 minute sit on a heating pad and it would relax enough for me to function.

Post-surgery the nerves are still mad and the inflammation around the surgical site has me feeling the same sciatic nerve pain…but on the left side more than the right.  A bit of numbness in both feet, and just generally feeling  like my hips are really tight.  I am able to do some hip stretches, and I do roll my ankles around while I’m sitting down – but I do just get restless after a while.  Walking, icing, and taking my meds – they all work together to help me attempt to stay in balance, keep the inflammation down, and ultimately heal.  Now if I can just find an overnight routine that will allow me some good sleep too – that would be primo!

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