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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Back to work – More or less

Week 4 post op as of Monday, September 10.

Friday I went to a training at work – spent a few hours visiting and training and eating catered lunch.  After about 6 hours, my brain and body were tired and I headed home.

Monday I went to work knowing I had a whole lot that needed to be done in a short period of time.  I dread this particular week every semester for its work load and stress level – so coming back this week was bound to be a challenge.  I managed to get through most of the day – and getting most of what HAD to be done, done.

I can now clearly and easily tell when it’s time to get up and move.  Stairs are using different muscles – but in a good way – than what I’ve done for the last 4 weeks.  I’m still using ice packs to help control pain.  I’ve had to be a bit more casual in my work attire as well.  Usually I wear some version of khakis or casual slacks and a nice blouse, and then jeans and a nice blouse on Fridays.  Well – the waistline of jeans and khakis rubs right across my incision.  I can tolerate it for 2-3 hours – but then it’s pretty annoying.  So I asked and was given permission to wear leggings to work (better than pajama pants!), and I’ve had to be creative in finding shirts and sweaters that allow me some modesty and cover my butt.  I’m generally opposed to leggings except for working out – and today’s college students wear them all.the.time!  With no thought to modesty and covering their butt – no matter the size/shape!  But I digress – I do have modesty, and so I’ve been carefully considering how I can be work appropriate as I continue the recovery process.

Ok…so ice packs, moving when I feel like it, and soft elastic waist-lines to keep my incision happy.  And knowing my limits.  Monday I did about 7 hours, Tuesday was 6, and Wednesday about 6 1/2.  We’ll see how the rest of the week pans out – but I’m making an educated guess (tee hee…I work in education….get it???) that 6 hours is going to be my norm for a while.  If I didn’t have an hour each way, and a scheduled hour lunch break (making for an 11 hour round trip out of the house working gig) it might be different.  But for now – that’s what feels comfortable.  And thankfully, my work is very accommodating.

I’ve also begun doing more light stretches under doc’s orders.  Hamstrings, calves, quadriceps (wall sits), pelvic tilts, knee to chest, half crunches, etc.  Things to just start using those lower lumbar back muscles a tiny bit, and stretch my legs and hips out.  I’ve been doing some hip and hamstring stretches all along (the PT in the hospital said I could) plus some just ankle and knee rotations. Really just focusing on being comfortable and not getting locked up as stiff as a two-by-four!  Hence, I can still put my own socks on, tie my shoes,  and all that.  I’m still being very very careful not to bend or twist in the area of the fusion – only the pelvic tilt I’ve started this week per the doc.  I’m making slow but steady progress I think.  Getting stronger  – for example, I can more easily kneel down to pick up the dog food bowls and put them down full.  The stairs at work will help that too.  Stretching and using all the thigh and hip muscles more.

I’m off pain meds during the day – so just muscle relaxers and regular tylenol – and ice – and walking – and stretching.  I can tell when hour 5 rolls around, as I start to tighten up and little twinges pop up.  So I know that’s the best time to do a gentle walk  – to the freezer – and get a fresh ice pack and sit for a while.  6 hours is the interval for both tylenol and the muscle relaxer.  It would be nice if I could take something a bit longer lasting – but not for a while.  Regular NSAIDS like ibuprofen and aleve affect bone growth and recovery in a fusion, so I’m not supposed to take them.  I’ve still been taking half a pain pill at bedtime, and another half at the magic 6 hours later – but I need to start taking a “read” on my body and see if I really need it or not.  I think more than anything I’m just “afraid” of the pain.  We’ll see how it goes this week I guess.

You know how I said I can clearly tell and feel when it’s time to move?  Yeah, that makes sleeping and the whole “overnight” thing interesting.  Meds last 5-6 hours, ice packs 2-3 hours, and my position needs to change somewhere in there too.  Pre-surgery I slept mostly on my right side.  Post-op has been mostly on my back with a pillow under my knees – but I get so stiff – and my hamstrings…yowsers.  So I’ve been trying to do a bit of side sleeping the last couple of nights too – left and right side.  Not sure either side is more comfortable – it’s just nice to have some options.  I tend to start on my back with ice, and then roll (log roll, log roll, log roll – hips and shoulders together!) to one side for a while…and then eventually get up, go get new ice, and start all over.  Only to be awakened a few hours later with warm ice packs, stiff legs, and need for 3am meds.  But the variety is nice

Oh…another interesting discovery this week – for the next YEAR…before I go to the dentist (even for just a cleaning) I have to take antibiotics.  And no major dental work without clearance from my back surgeon.  The bone growing business is SERIOUS apparently.  I also have to wait until after 6 weeks before I do anything.  I was due for a cleaning this week, but have rescheduled for mid October now.

Anyway, that’s how the week is going.  It’s nice to be back to a sort of normal routine, and I know the fatigue is to be expected.  I actually sort of scared myself a bit when I looked at my calendar and realized that the end of next week begins my seminar series that I teach…good mental challenge for me, but I have a sneaking suspicion it will be more physically tiring for me this time too.  I have a strategy session planned for tomorrow morning to get my head back in the game and make some solid plans.

I’ve been thinking about appropriate scriptures for this post for a couple of days – there are great verses in so many books of the bible – the New Testament for certain – any of the gospels, Philippians, Ephesians.  The Psalms of course – so beautiful and poetic.  But as always, when I start thinking about scripture to share, God leads me to the perfect one. I hope this verse from the prophet Jeremiah, from the book of Lamentations moves you as well.

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