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.

Image result for lamentations 3 24

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.

Image result for Isaiah 40:31