MOVIN' AHEAD

Incisions three months post surgery.

Here we are three months post second fusion. As you've noticed I haven't posted for quite awhile...I apologize to those of you following this blog. At the beginning of this there were so many big things that were happening on a daily basis I felt I had a lot to write about. Wanting to keep you posted on everything that you might experience if you chose to do this operation, I felt it necessary for a daily update of meds, pain, sleep pattern, exercise, etc. At this point during my recovery there sincerely are no HUGE leaps forward. Yes there are daily mini-advancements that all add up to final healing sometime down the road. But there is nothing noteworthy to post on a daily basis. That, though, is a good thing for me and maybe a indication of where you should also be during your recovery three months after surgery.

My three-month follow-up visit was February 17th, 2012. The first fusion which was done on my L4-L5 on October 14, 2010, clearly shows on the x-ray that complete fusion along the edges of the implant cage has occurred. It was exciting to see and such a difference from an x-ray over a year ago. Most orthopaedic spine surgeons will tell you it can take up to three years for full fusion to take place. Of course a lot depends on your health and your exercise regime. My surgeon was very happy with the healing and growth of the first fusion. Coming in May, I will be having a 64-slice CT Scan that will, in three-dimensions, show just how 'filled in' the entire disc space it. I'm looking forward to it.

This last fusion which took place November 17, 2011 and was at the L5-S1 level, shows no movement since the surgery. The first three months after surgery are critical to the fusion 'setting'...usually at this point it is in the position it will permanently fuse in. You are very limited in what you can do during these three months. NO LIFTING, NO BENDING at all. Of course you don't feel like doing those things anyway, so it's not real difficult to follow the doc's instructions. He actually said I'm at the point where I have "NO RESTRICTIONS" (his words). I can do what I feel like doing but to be sure to not do things that will cause pain...pain is the message your body gives you when you are overdoing it or doing something that is stressing the fusion area. So, I have gone back to the weight machines at the gym...but with a very low resistance. I only want to re-tone my arms and legs and not try to do MAJOR weights like I did after the first fusion...which led to the second fusion. I can walk over two miles with no leg weakness and am biking with a very good cardio rate for up to 45 minutes. Exercise is SO critical to the whole healing process. A handful of folks I met who told me they had family members or friends who DID NOT heal fully after this type of surgery also revealed that those patients DID NOT exercise before OR after the surgery. If you KNOW you won't be committed to the post surgery exercise routine...then I BEG you to not do this surgery. I fear your outcome will not be good.

Overall, I'm back to my normal life with minimal pain at times. Every once in a while I do have a pain level that will reach a 5 or 6. Usually after a LONG day at work with a lot of up and down from my chair and a lot of driving. Of course, stress can add to a pain level...and that, too, happens from time to time. A couple of extra strength Tylenol, though, takes care of any discomfort. I've only had to resort to 1/2 a Vicodin (hydrocodone) on two occasions. Sleep is very good even though when I roll from my back to either side I still wake up because I've got to put a pillow between my legs /knees for comfort. I DO NOT bend at the waist and, frankly, haven't done so for nearly two years. I am working at getting my quads in better shape in order to use those muscles to squat/rise when I need to pick something up. I still and probably will always use my extended grippers around the house. Why bend and put stress on the rest of my back if I don't have to. Right?

Here is a link about this surgery that I found to be very interesting. I'm a curious gal and always want to know the mechanics behind everything...this surgery being no different. Please check out the links attached to this webpage. This might help you as you make your decision to move forward with a fusion. I will keep this blog up even though I may not post very often. I want it to be here for anyone who may have questions and may need to contact someone who has been through this procedure...twice.

NOT YET READY FOR PRIME TIME

Yep, still here. You may notice that the updates are not 'day to day' as noted in my blog description. More like week to week now. Why is that? I AM improving each day. Little by little. But I didn't and don't figure you want just little improvements to be mentioned. Let's wait for big ones. Of course the big ones are all the little day to day ones added up. So, here goes. I'm finally sleeping with only an occasional Tylenol PM. I'm pretty much able to roll over from side to side while in bed without TOTALLY waking up. I am conscious enough, though, to make sure there is a pillow in between my lower legs. Without that pillow, which has happened once, I am awakened by extremely bad low back pain. Not a fun thing to be awakened by. Almost as bad as being awoken by the cat throwing up on the pillow next to you. That's a whole other story.

There has been a marked change in my stride and pace when I walk. My stride actually changed after my first surgery...it became shorter, but my pace actually became a bit faster after about six months. I've noticed that if I try to have what was a 'normal' length stride before the second surgery...well, my right hip will protest quite loudly, the pain forcing me to shorten the stride. I still don't have my pre-surgery pace yet. Forget running too...not happening. Thankfully, the weakness in my legs after walking about a mile is all gone. I've been doing close to three miles on weekends with no problems. I still cannot comfortably walk on the treadmill at the gym. Even though they are brand new and have a ''cushion" soft walking surface...I think it's because I am not yet in rhythm with my new 'legs', so to speak. That's the only way I can describe it. It seems the treadmill actually drags my feet back causing my hips to hurt. Oh well...it took about six months after the first surgery to be able to walk on the treadmill. I'm guessing that will be the same timeframe this time.

The stationary bike is going great...always do at LEAST thirty minutes a night on it. I vary the routine to keep it interesting. I am able to mix in a few 'hills' with higher resistance. I try for 10 miles in fifty minutes once a week. I've backed off on the stair climbing therapy...once every ten days or so.

Last evening I tried couch surfing again...I actually got comfortable for about an hour while watching the Mecum Auto Auctions (we're into vintage cars). The cats were thrilled I was back on the couch and they all clamored for a spot ON ME. I had quite a time getting OFF the couch...a bit painful, even with the assistance of my husband. Of course the pain didn't reallly hit until I was trying to fall asleep...which I did, only to wake up in the middle of the night in a lot of pain...the most I've felt in about two weeks. I resisted taking a Percocet or Vicodin, instead opting for two extra strength Tylenol...that did the trick...thankfully. Note to self: leave couch surfing to the professionals or those folks who haven't been subjected to two back surgeries in thirteen months.

If you've had spinal fusion and are tracking your progress with mine please don't think you are behind if you aren't yet able to do the things I am doing. And if you are ahead of me on some areas...GOOD FOR YOU!!! Keep going, you're on the right track. Everyone will progress at a different pace. I feel that as long as you are making some positive steps forward, as small as they may be, you are headed down the right pathway. Keep moving.

I MADE IT THIS FAR

Yep...nine weeks today since I became worth more money because of the addition of titanium to my body. I thought this transcript from a 2007 radio show, which features my surgeon, Dr. Faissal Zahrawi, might be of interest if you are considering fusion surgery. It's straight from the doctor's mouth...maybe will answer a question or two you may have.

Now for the update...the car driving is still not the best. I'm getting more comfortable with driving my own vehicle (a 2001 Ford Explorer Sport), but the company truck (a 2010 Dodge Ram 1500, with a hemi-had to add that because it's a guy thing) is NOT comfortable at all. Can't believe a $33,000.00 vehicle can be THAT uncomfortable. However, riding in our personal vehicle is actually MUCH more comfortable. Still a little bit of soreness and pinching towards the bottom of the incisions when I sit fully against the seat.

I've laid off the Tylenol PM at night for falling asleep and I feel I am back in my normal sleep zone. I've actually been able to comfortably sleep for a couple of hours on my right side with minimal right hip pain. I still wake up to turn over, but feel with a little more time my body will make the move without waking me up. It seems like a little thing, but, oh, it makes a world of difference for a good night's sleep.

Tomorrow I'll be finishing up my second full week of work. I'm actually making better progress after this second surgery than I did after my first. I am glad I kept all my daily notes from the first surgery. They are good guideposts on my recovery road this time around. I feel I am ahead of the game. Maybe it's because I knew what to expect this time. Maybe it's because I am in a much better mental and physical condition than I was in October 2010 for the first surgery. Whatever the reason, I am truly grateful at how well I am progressing. Please, though, don't think this surgery and recovery is a cup of tea. It is NOT. You must take the rehab very seriously and stick to it...hopefully for the rest of your life. You MUST listen to your doctor's pre and post op instructions. No bending, no lifting...PERIOD. You and your body will adjust to the new parameters. Trust me, you will. I still get impatient when I drop something and have to either ask someone to pick it up or, if I'm alone, go to the next room to get my Grip 'n Grab tool. I have found, though, when out in public folks are genuinely sympathetic when I explain why I need help...and I've been surprised at how many of them have friends or family members who also have back issues, so they totally understand where I am coming from. People are good.

REVELATION

So I get home from the 'Y' tonight after 45 minutes of hard riding on the stationary bike. A full 8.24 miles with an average heartrate of 129. Yeah for me. After my shower...some acute pain in the lower left of my back, right at the fusion site. Very sore! Dammit, I have overdone it AGAIN! What is wrong with me?! The fusion is in NO WAY anywhere near to 'settling', as that usually happens around three months. I know this, yet can't seem to slow down. There's really no need to push myself so hard on the bike, just as long as I am doing SOMETHING each night to help my healing progress. I am SO angry with myself and have NO one to blame but MYSELF!! The voice in my head screamed at me to 'take it easy' and I ignored it. Every time I have ignored that voice I have gotten into trouble. Period! If you don't learn as you age I feel you are wasting your life. I cannot let this be my path. I cannot have another one of these surgeries. Listen to your voice...

I've made it to work for 4 full days this week. My main pain issue in the afternoon has been migraines. Still have a very difficult time driving. Much more painful than after my first surgery. I am guessing that will eventually work itself out. But for now I am trying to drive VERY short distances. On the bright side, my travel as a passenger is slowly decreasing in pain. Here is a photo of the incisions with the two blue arrows indicating the 'bumps' where the ends of the long stitch have not yet absorbed. It's a little red because I just got out of the shower after massaging the area as recommended by my doctor's assistant at my last visit. I am happy to report that the incision on the left that was causing a lot of nerve pain at the skin level it getting better VERY quickly since following the massage advice. Am still doing the one Tylenol PM before bed and am, thankfully, sleeping 'normally' for me. I guess we all get into a daily/nightly routine and when that is so horribly interrupted by something as traumatic as a surgery it's hard to reprogram our body/brain to a whole new routine...along with the pain and pills to relieve that pain. Time is what I needed and continue to need to heal on all levels. That and listening to the voice telling me to 'take it easy'.

KEEP SCRATCHIN' THAT ITCH

This morning was my seven-week post-op check up. But let me first tell you what I did this weekend. Nothing spectacular, I'm sure you'll think...but for me it's a tiny step forward. I was able to use my garden edger and edge around one of the bigger azalea beds in our front yard. For those non-gardeners, an edger is one of those things that look somewhat like a shovel, but the bottom is rounded and very sharp and used to push into the soil to form an 'edge' between the bed and the grass. It requires some strength in the legs to push it into the ground. Most of the pressure then translates to your hips...hence, then to your pelvis/low back. But, I was VERY careful and completed the task without pain or problems. Gardening is my zen time and I have REALLY missed it over the past 18 months. I have done some things, but am now unable to do it all by myself anymore. It's the new now and my husband and I have figured out ways to do the tasks without strain on me (or him). It's a passion for me and something I will NEVER give up...I'll just have to find ways to do things to cause no FUTURE back problems.

...back to the doctor....he wasn't in today...well, he was, but had to leave for a meeting before he could see me. They were running very behind this morning. X-rays were taken and I got to see his assistant, who is also training with him to do surgery. Man, did I feel old....she couldn't have been more than thirty!! Anyway, one advantage today was that she wasn't as rushed as the doc sometimes is. She addressed my concern about the left scar really hurting and the two 'bumps' at the top and bottom of the scar. Those areas are where a l-o-n-g stitch was put under the skin and the thread ends were pulled through. My body has not completely absorbed the thread yet. Also, that scar is hurting because the nerve endings are coming 'back to life' where the edges meet and are very tender. She recommended massaging and gently scratching the area several times a day in order to send the message to the brain that this is 'new' skin and needs to be recognized as such. So, you can guess what I've been doing all day.

The three dots on my x-ray that are in the new 'disc' implant are there to help the surgeon measure the height of the disc space during surgery...as you are constantly being x-rayed during the procedure. The blue arrows in the photo show those dots. It seems they used a different disc implant this second time around. I'm hoping it's as successful as the first implant seems to be. A lot of these surgeons actually are investors in the companies that supply the hardware for these procedures. I am fully aware that my surgeon is an investor in NuVasive, hence, he uses their products. There's no doubt they don't want hardware failures to occur (can you say malpractice?), so they do use tried and true medical devices, not just items 'sold' by the prettiest representative. Anyway...my doctor's assistant said that I cannot do any machine weightlifting for another six weeks, which will be when my next appointment is. My leg weakness is normal and should eventually pass...so she said. I can continue to walk all I want, ride the stationary bike and lap swim, which I haven't done yet as it's still a bit cold here in Florida. And, yes, I was given a pass to start driving again. Yeah!!

I'm having good (little to no pain) days and bad days (pain level at 4+). I know that eventually the good will outnumber the bad. It's the waiting that is really killing me. The fusion of the L4-L5 from October 2010 showed a LOT of bone growth between the two vertebrae on the x-ray today. The growth of bone can (and does) continue well past the two year post surgery mark. And, truthfully, I feel absolutely NO PAIN at all from the first fusion. I am having some muscle soreness at mid-back from time to time, mostly at the end of the day when I am tired and have done to much. I have found out that I still need to rest from time to time during the day (mostly just lie down on my bed for about 30 minutes) in order to make it all day and not have to deal with so much muscle soreness. I had two really good night's sleep this weekend and that really has helped. Yes, I am still taking one Tylenol PM 1/2 hour before bedtime...I wasn't going to do that this weekend, but I really needed the sleep. Otherwise, an occasional extra strength Tylenol is all I need when the pain level gets too high to function....which, thankfully, isn't too often. The assistant at the office today said I was doing remarkably well seven weeks post surgery....I wonder if she says that to everyone. Nonetheless, I wholeheartedly agree with her...

A GOOD THING

Almost a full day yesterday at work...a whole eight hours. I normally work nine. Remarkably very little pain or discomfort. Until today. You know I get my hopes up that the pain is over one day and the next day I'm popping extra strength Tylenol and Excedrin (add a migraine to the back pain.) That's my day today. Not complain', just sayin'. You have to know this is normal and will continue to be the norm for quite some time. I have to know that too and have to accept that, as hard as it is. When you add this to the depression/anxiety...well it can be very tiring.

I tried the new treadmill at the YMCA last night. Not quite ready to hit it hard. I did a slow walk with short steps (2 mph) for only one mile. Not a banner distance for me. But it is dark when we get home so it is difficult to walk outside. I will make up for it this weekend though. Am also up to 35 minutes on the stationary bike. It's about 7 1/2 miles...not too bad. I am also increasing the resistance level on the bike, so that is helping my cardio and my leg strength.

My sleep is okay, though I am waking up about 1/2 hour before the alarm goes off. That is SO frustrating! The weekend is here. I promise to take it easy and continue to heal. It's all I can do right now.

BACK A STEP

Made it to work today for what I was hoping would be my first regular workday since surgery. We have some cold weather here right now. For those up north, please don't laugh at this...it was 42 degrees this morning and set to be colder tomorrow  morning. I'm certainly hoping the weather has nothing to do with my pain today. I was able to work for six hours (8-2). It was hard to keep reminding myself to get up every fifteen minutes and walk around to relieve  'pressure'  in my low back. And I paid for it! I was able to go to my in-laws house and nap for a couple of hours, then I got up and walked around their neighborhood for a little over a mile. The ride home was extremely painful. It's a mental challenge when you do so well for a couple of days and then....boom....you feel like you are back to square one...well, maybe square two. The incision on the left side is causing me a lot of pain, feeling like it is pulling constantly and very tender to the touch. Something new to deal with right now. These are not necessarily complaints just things that are going on nearly seven weeks post surgery that might also be happening to you (or will happen to you) and I want you to know about them. Maybe it's normal, but I certainly don't remember the incision pain after my first surgery. Yes, the incisions were very small, but all the same it's not fun.

The Tylenol PM seems to be working to help me sleep. I've had what I consider 'normal' sleep the past three nights. I'm going to try to do without taking one this weekend when sleep (or lack thereof) won't matter as much. I'm guessing that I am now getting back into a regular work routine I will naturally fall into my regular sleep pattern.

I'm still doing stairs, foot over foot (the regular way), all the marching exercises and we are on our way to the gym right now. The stationary bike is my workout friend right now. I'm able to do about 30-40 minutes at a fairly decent resistance and get a pretty darn good cardio workout. It does feel good!! Thankfully there is no pain when I am riding...and I'm doing something good for myself and helping the healing process along.

OUTLASTING THE DAY

I made it!! Yes, I did my entire two-plus walking miles tonight without having to make a pit stop for an energy recharge! All that on top of going to Winter Park (Florida) this morning to view an exhibit at Polasek Gardens, have lunch at Panera Bread with my dear husband of almost twenty-six years and to walk about ten blocks doing some after Christmas shopping. Yeah for me, I was able to sit for about 45 minutes in one of those high padded stools at a table while eating...and I had no pain!! I even had a somewhat comfortable thirty mile ride to our destination...and back. Seems like I'm ending the year on a good note. Not to say that the year has been bad. It hasn't. I'm still healing very well from my October 2010 back surgery fusion and I'm on the road to healing from this current surgery. There have been some serious downs during the past fourteen months, but they, thankfully, don't outweigh the ups.

I did buy a new pair of walking shoes today. Doesn't seem like a big deal to those who have not had back surgery, but it's a major thing to me. I've been wearing a particular type of walking shoe for nearly eight years...not the same pair of course. I love the brand, comfort and price. But, woe is me, they are no longer made...so I stopped at my favorite shoe store on the way home from Winter Park and was able to find a comparable pair. They are comfortable, but they are different. Different enough that they did cause a bit of muscle pain in my low back as I was walking this afternoon. I don't think, though, that they will cause an permanent problem while walking. Hopefully I've found my new 'favorite' walking shoes. If so I'll be going back and buying several pairs.

As with last year, I've noticed that there are times throughout the day when I literally feel no discomfort or pain in my back. It's a good feeling to not be constantly reminded of the surgical trauma and resulting titanium screws and rods that have invaded my body. Sometimes I almost feel 'normal'. The new normal though. I know that eventually I will have back to back days that there won't even be a twinge of anything in my back to remind me of the surgery. But until then I do pray for the strength to mentally and physically get through all the tough times.

At the advice of a friend, I tried Tylenol PM (a generic form) last night to help with sleep. I only took 1/2 of a pill along with 1 extra strength Tylenol (a generic form). I did sleep very well and was even able to sleep for a bit on my left side with a  pillow between my legs. That is a milestone for me!! Of course this evening, with all the early New Years revelers lighting off all sorts of illegal fireworks well into the new morning hours, sleep might be elusive regardless the sleep aid.

Stay safe this night...see you in the New Year.

MOVING ON UP

Well I made it six hours at work today even though my sleep is still not good. I did feel I had a bit more energy, which is a good thing right now. My walking routine is continuing gangbusters, as is the stationary bike at the YMCA. The improvements are small increments, but improvements nonetheless. I am grateful.

If you are getting ready to have spinal fusion I truly hope you are both mentally and physically prepared. You must committ yourself to the physical therapy, whether it is self-directed or doctor scheduled. Having gone through this twice I know that my attitude towards the therapy/exercise part has been what has helped me heal and remain somewhat flexible and able to eventually do just about everything I was able to do before both surgeries. Yes, you'll change the way you do those things, but you will still be able to do them. So please don't get discouraged if you begin to feel that you aren't making headway in your recovery. It happens to all of us. I will continue to take two steps forward and one step back...this I know from last year's experience. But it eventually did work out. I know it will again. It IS hard. I promised to tell you the truth, which I feel I have done to this point. You deserve to know what to expect, not just what a doctor/surgeon tells you to expect. Let's face it, your surgeon probably has not been through the surgery. He can only tell you what clinical information he has learned. There is no fault in that. It just is. My hope is this blog will continue to help you as you face this surgery...and as you recover....successfully.

MERRY CHRISTMAS

Incisions five weeks post surgery 12/25/11

If you're still with me I wish you and yours a very Merry Christmas. Didn't think I'd be spending my second Christmas in a row recovering from back surgery...but that's the way it goes.

Overall the past few days have been pretty good. I went to work for almost six hours on Friday (23rd), then grocery shopping, which was quite a harrowing experience. Everyone running around paying no attention to other human beings...and those of us with back surgery on our mind and body. I almost left the store because I was so afraid of being knocked into. Sounds very high-falootin', doesn't it? But you'd understand if you were in my position. Those little bumps magnify to your back and are quite painful sometimes.

Yesterday (24th) was my best day yet since surgery. Literally no pain or discomfort for most of my waking hours. I was able to 'work' in the yard for a couple of hours. That work consisted of picking up sticks/twigs with my handle Grip-n-Grab and putting them in the trash can. And I did some supervising of my dear husband as he weeded one of the flower beds. Yes, it is still in the 80's here in Florida and things are still growing gangbusters. Also used my lightweight (bought after last years surgery) leafblower to get the leaves off the front porch and driveway. It felt good, both mentally and physically, to 'get back in the yard'. Of course, I ruined a great day by trying to max and relax, as my husband says, on the living room couch. I honestly thought my back was ready for the cushy couch...it wasn't...and in a bad way. I barely lay down for ten seconds and knew it wasn't right and tried to get up. Had to leverage myself on my side and  push off a chair at the edge of the couch. My husband was right there in case I rolled off the couch. That set off a chain of events in my back that led to a lot of pain at the new fusion level and in my right hip. I hit my bed after two extra strength Tylenol...getting up two hours later to take a Vicodin. Ugh...one step forward, two back. On a bright note, I had a fairly good night's sleep. Maybe I was knew I had to sleep because Santa wouldn't visit if I was awake.

Five weeks post surgery I am slowly getting back into a normal daily routine, even making a full dinner the past two nights. I'm walking a minumum of two miles a day, doing at least sixty stairs daily and keeping up with all my leg lifts and stationary marches. I've added a hamstring stretch against the wall and that feels really good. I'm still having a hard time putting on my socks from either the standing or sitting position. My back muscles get quite tense and sore after I've been moving for a few hours. My legs get quite weak after walking for a period of time, although my cardio is just fine. I'm trying to figure that one out. It's something I'm going to ask my surgeon about during my January 9th follow up. Otherwise I feel I am progressing at a decent pace and am so thankful for this.