4 Weeks After 2-Level Cervical Fusion and I feel great!

Its hard to believe it has been four weeks already. It would be a lie to say I've never looked back since the surgery, wondering what I've done this for. But at this point, I can say I feel fantastic and am so glad I've gone through it. Although I haven't tested how my ROM is now, the mere fact that my pain is gone has itself increased my function.

I'm not exercising my arms or upper body at all on doctor's orders, but from normal use my left hand strength is almost back to normal and I have no limitations on what I can do with it. I can sleep on my side again with no pain. Today I raked the yard for several hours, wearing the neck brace, and I have had no symptoms as a result.

My neck itself feels almost back to normal. I am having no trouble swallowing and can not feel any internal swelling in my esophagus. The scar tissue is still obvious visually and to the touch but continues to improve. The scar itself also looks far better than I was hoping. (pictures here: http://acdf-neckiswack.blogspot.com/p/my-scar-photographic-retrospective.html)

Facing down the last two weeks in the brace, I know I can do it. I have to admit it, I have taken it off several times to drive short distances to the grocery store. It has not been difficult at all to get used to not having it on. I've still been careful not to rotate too much but it has been a relief, to say the least. If the Xrays in 2 weeks don't show good signs of healing, I am going to be seriously bummed!

Stairway Butt Luge: Not Recommended

The title of this post is dirtier than intended - never fear, this post is G-rated. So I was feeling great yesterday. I worked four days this week, about 4-5 hours a day and really had no major problems. I took a lot of breaks and spread the work out so I wasn't staring fixedly at the screen for too long. No pain in the neck, shoulders or back, yippee!

So its Friday night and I'm getting ready to get my margarita on at our favorite Mexican cantina. I had gone upstairs to get my sewing machine which I was loaning to a friend. I'm carrying it by the handle (its not heavy), have one hand on the rail and I'm wearing my brace like a good girl. On the second step from the top, my sneaker slips, both feet are in the air and I land, hard, on my rump and bump all the way down. (Sounds like a kesser-known Dr. Seuss). Aside from the noise I made dropping the sewing machine, it was quite a clatter.

My kids came running with horrified looks in their faces. Somehow I realize as I'm sitting there assessing, I managed not to bang my head or torque my neck at all. Aside from my throbbing butt, I'm okay. As I stand up, it feels like that character's toe in "I'm Gonna Git You Sucka":

http://www.youtube.com/watch?v=vHLD4LvnPTI&feature=youtube_gdata_player

I ring up the neurosurgeon on call and he says as long as I don't have any new pain or tingling, not to worry. Unfortunately, the Tylenol I took didn't quite help enough for me to be able to sit in the wooden chair at the restaurant for long. Back to my old friend Ultram and bed. Fortunately, this morning, I feel much better. Its still seriously sore but I can tell its just a bad bruise of the tushy, I'll spare you the pics. I got up early and walked 5.5 miles, rough at first but better afterwards. As if I needed another reminder to be careful on the stairs!

Ladies Only: Late visit from your favorite Aunt!

Just when I thought I'd experienced the last of the medication side effects, it dawned on me that I hadn't had a visit from Aunt Flow since the surgery. My how time flies when you're self-absorbed to the point of mania! One of Hydrocodone's side effects is alteration of menstrual cycle, yippee. So, here she arrives in all her fury and I can't resort to my usual high dose Ibuprofen because the Doctor has said it interferes with healing. Since the only thing I can take, Tylenol, is of no use, I'm heading back for the Ultram. Now I'm glad they prescribe 50x more pills than I could ever take.

Since I am still walking outside every day and now that the incision is healed, I have started using Mederma SPF 30. Rubbing the scar does not hurt, exactly, but the skin is sensitive and the tissue beneath is definitely still swollen. Although it's not painful, when I swallow my neck muscles feel a little sluggish. My esophagus is also still a little smaller than before because I still occasionally have trouble getting food down if I have not properly chewed it. The only other lingering symptom is the numbness in my left thumb. It waxes and wanes, worsening after I walk. The doctor said it would persist because the nerve remains irritable.

As the weeks stretch on, my inability to drive while wearing the neck brace is taking a toll. Now that I'm out of the acute phase, its gotten tougher to get rides from folks. Something as simple as needing new batteries in my mouse (because I can't use the stupid trackpad ;p) throws off the whole day. Never again will I take mobility for granted. As a person who likes to get things accomplished, this aspect of recovery is proving harder tham the boredom. If you're thinking I should just take the brace off and drive myself, I tried but after 3 weeks of not rotating your neck, I don't have the ROM to pull it off. So, I'll wear out the sidewalks for 3 more weeks.

3 weeks post cervical fusion: Easing back into work

I got the okay to start work today, half days in the afternoons.  So far so good but I am definitely going slowly.  My job is largely sedentary so the challenge is varying position as much as possible.  I'm sitting on the Variable Balans chair (see below) and finding it is encouraging me to relax my shoulders away from the neck brace which has been a big problem for me. 

Today's schedule was:  Work 1 hour, walk around for 5 minutes.  Work another hour, take a 15 minute break to relax, etc.  I definitely am not ready to sit at a desk for 10 hours so I am glad my company permits me to start back half days. 

Physically, I am continuing to feel some mild to moderate aching and stiffness in my neck and upper back.  I noticed my spine seemed to have a different shape at the cervico-thoracic juncture (where the neck connects to the upper back) - a sort of bump.  When I spoke to the nurse, she reassured me it was normal having just had this procedure and that it was partly swelling which would diminish.  There's no pain its just a different feeling spine than it was before, I guess I shouldn't be shocked? It also looks a little different.  If I get a mirror and look at my neck from the side, there's a bit of a bulge there. 

My neck itself however seems to be much less swollen.  I can tell because I am having to cinch up the velcro straps of the neck brace more and more.  (See!  I knew there was another good reason to wear the brace ;)  There is obvious scar tissue under the incision but the discoloration is very diminished.   The skin around the incision feels more normal, less numb.  Unfortunately, the heat has picked way up and I am still sporting a heat rash under the brace.  I've taken to wearing it over my shirt rather than under which was my vain attempt to hide it a little, ha.

Back on the sauce and wig shopping

Right after the doctor told me I had to wear the neck brace 24-7 for 3 more weeks, I started taking it off for short periods of time, starting with the shower.  I'm careful about not moving around too much but it feels so stiff I don't really want to move it.  We had some people over for dinner last night and sitting at the bar trying to talk to someone next to me was impossible so I took the stupid thing off again.  What a relief!  One glass of sangria later and I almost forgot to put it back on. 

Then today I notice my diligence in wearing the brace has resulted in a delightful rash under the collar where the base presses on my sternum.  I am washing the pads a lot and still this thing is irritating me.  Grrrr!  On top of this new development, the last few days I have been absolutely lethargic.  No increase in activity (the opposite) but I am unable to get off the couch. 

Ironically, despite all this lounging about reading celebrity biographies (I know, right?) I can't sleep at all.  I got up and took some Tylenol PM last night but it seemed to have the opposite effect.  I may go back to the good stuff if I'm still sleepless tonight.  I'm aching in my neck, shoulders and back and my first post-surgical attempt at drying and styling my hair left me completely exhausted.  That will be the end of that, next up, ponytails and wigs. 

On the upside, the kids and I walked to the grocery store today and bought groceries to cook dinner for Father's Day.  100% Kid-inspired menu: Yellow Snow Risotto, World's Most Dangerous Vegetable (corn on the cob because of the pointy holders), You're a Dork Pork Tenderloin and Yellow Snow Dog Dirt Cake. 

First post-op visit after fusion

Somehow, it was a bit of a letdown. I think I was naively hoping he'd be so impressed with my progress he'd lift my restrictions and release my neck from prison. Alas, it was not to be. He was pleased to hear I was off the meds but it was a pretty perfunctory visit. No exam, no Xray, just a lovely chat. I did see the intra-operative Xray showing the plate in position and normal cervical curvature, something not previously in evidence.

You may know already but there is a divide among surgeons as to whether a neck brace is requuired. My Doc explained that the studies didn't show much benefit for single-level fusions. But for 2+ levels, there was a slightly better fusion rate. So I will deal with the inconvenience and put my vanity on the shelf for a bit longer! Its the only spine I got, right?

So a new scrip for a reality check: 4 more weeks in the neck brace, 4 more weeks of no driving. The good news is that he said I could go back to work when I felt ready. He did suggest starting off part-time, working afternoons since he said it was less likely to spill over to 6+ hours instead of half days. Lucky me, my husband works in the same building so my ride is a snap.

Next up, workplace modifications! A fellow spine patient, Ken, just this week told me about Ergotron products. Here is the link to their site: http://www.ergotron.com/

I'm considering the Workfit S sit-stand workstation:

Would love to hear from anyone who has a similar product. Looking to start back part-time next Tuesday, 3 weeks post-op. Feeling pretty pleased about it so far, let's hope that continues!

2 Weeks! The good news and the meh news

Having made it to the two week mark, the time seems to have gone faster than I'd have thought.  Probably that's at least partially due to medication-induced haze, but when you're filling your days with TV and twitter, that's about as good as I could have hoped for.  I'm due for a follow-up appointment tomorrow to check on the progress of my fusion (hazy Xray here I come!) and I'm still holding out a wee hope that he'll say I'm doing so well, I can take off the neck brace.

Unfortunately, my progress in terms of mobility and pain seems to have plateaued.  While I don't have any real pain per se, I'm quite stiff and achy in the upper back, near my shoulder blades.  I'm sure its because of how I'm holding myself to avoid flexing my neck.  Unfortunately, it woke me up last night and I had to take some meds to calm down the spasms.   

Today after the shower, I walked around a bit getting dressed without the neck brace.  I thought I was doing pretty well until I accidentally only slightly flexed my neck backwards.  Owie!  Immediately put that thing right back on.  Even if it is just to remind me not to move too much, I guess I'm glad its there.  Starting to be concerned about "spaghetti neck" after wearing it for 6 weeks but maybe that's what PT is for? 

So here is a shot of my scar on day 14:


Scar day 14

The little scab at the end is from where the drain was stitched in (yuk!).  The steri-strips came off yesterday altogether.  The rashy looking areas are from where I broke out due to my allergy to surgical tape (oy).  The skin around the scar is still an odd combination of sensitive and numb.  There's definitely some scar tissue lurking in there.  Overall, its better than I had hoped it would be.  Thanks Doc!

I can still feel some constriction in my throat when I swallow - it feels like my esophagus is still swollen somewhat although its not affecting my ability to eat, unfortunately.  The only other issue now is my jaw and teeth are sore from having to fight the neck brace under my jaw.  Overall pain and discomfort rating:  1 out of 10. 

No pain but boredom gaining on me: Day 12

Even without resuming household chores (other than clearing the occasional dirty dish), I still feel like I may be doing too much. In the absence of actual pain, I think I was so used to functioning while in real pain for so long, I don't think anything of marching along feeling stiff and achy in my neck and upper back. By the afternoon, say 2-o'clock, even if all I've done is walk, watch TV or fool around on the computer, I'm wiped out.  Now my 2-week checkup is looming and I'm fretting what the X-ray will show and my level of readiness to go back to work.

Truly, being totally dependent for my needs is a drag. I had to call for help today getting out of a sports bra because it was caught up in the collar. I probably could have managed it if I took the collar off but I'm convinced I'll torque my neck somehow so I'm not risking it. When my sister came to take me to Staples to get printer ink, I was so excited it was sad. Alas, after I get out somewhere, pretty quickly I'm looking to go home.

For those still keeping track, I have stopped all painkillers but have 1/2 a Vicodin at bedtime. I never really felt like the muscle relaxers did anything but add to my overall feeling wonky so I have discontinued those completely as well. What I can see of the incision looks pretty good. The steri-strips are loose so I've been peeling them off little by little. I am also happily fully back to a normal diet, including my appreciation for coffee, albeit in a much more limited fashion.

Another positive development is the new neck brace is so much better I sometimes (wait for it) FORGET I HAVE IT ON. Shocking, I know. From what I have read of others' reoveries, it seems I've been pretty lucky from the pain standpoint though, so no complaints here. Wishing the same for all you fellow future cyborgs as well!

Karma's a b*@&! and so am I

One of my earliest cases as a young defense lawyer involved a 50-ish year old woman who was a passenger in a car my client rear-ended when traffic slowed suddenly due to an accident. My client testified at trial that there had been a car between his and the Plaintiff's which darted into the next lane to avoid the accident and he couldn't stop in time. We were in a notoriously liberal jurisdiction and were braced for the worst. She was claiming an injury to her back from the impact and we spent a ton of time wading through her prior medical records to show she had problems long before this accident.

During the Plaintiff's testimony, she was describing the activities she couldn't do anymore. She became tearful at one point, saying "I miss riding my bike". My 30 year old self noticed one of the jurors laughing a little bit as I was thinking how disingenuous her statement sounded.

Here I sit years later, having recently gone through surgery which has left me unable to resume activities I used to enjoy like cycling. Just like that Plaintiff, my condition is probably just something that developed over time as I aged, nobody's "fault". But dammit, I miss my bike now too! Feel free to laugh, it is silly. But the realization that some activities are probably forever off limits for me is something I mourn quietly now but every day. Giving myself an F in compassion.

Don't Anger All the Dogs in the Neighborhood (with a nod to DirecTV)

So even though I understood the neck brace was supposed to limit neck flexion and extension which meant I can't look down, the full ramifications of this didn't hit me until after I spent some time strolling the neighborhood walking paths.  The non-neck brace wearing population are likely blissfully unaware of the benefits of being able to see where you put your feet.  Below are some charts I prepared based on my research (margin of error +/- 15%):

You can clearly see that most of the world are able safely to place their feet willy nilly without taking extra precautions.  When your neck can be flexed so you can fully take in your surroundings, your eyes send a signal to your feet alerting them of the dangers ahead.  Wearers of the cervical collar are deprived of this  previously taken-for-granted skill. 

My exhaustive research efforts over the past 10 days are represented below:

That's right, five out of ten walks result in dog mess on your shoes.  After my last session of shoe cleaning, I decided to take matters into my own hands.  I contacted my neighborhood homeowners association and lodged a formal complaint.  Clearly, the ordinances requiring pet-owners to bag their pet's offerings were not being enforced strictly enough.  On top of that, the owners who wouldn't pick up after themselves couldn't be bothered to lead their dogs to the grassy area to go where walkers would be far less likely to encounter it.  My suggestion was for stiffer penalties for violations:  Owners caught violationg the ordinance would be made to clean up the pathway.  Pet violators would be required to wear sandwich boards proclaiming their status:

After lodging my complaint, apparently word spread among the canine population.  The next day, when I stepped out of my house I encountered a mountain of dog poo on my front steps.  So the lesson I've learned here is, take care of your spine. Because if you don't, you wind up wearing a neck brace and fouling your shoes while out on a walk and when you complain to the community association about it, all the dogs conspire to do their business in your front yard. 

Mumford and Sons and Donna Summer

I hope too much walking doesn't adversely affect my fusion because I am clinging to the lifeline of my only activity.  Yes, I am getting an awful reverse-dickey tan line on my neck but I don't care.  In my former pre-cyborg life, I would run to the beat of the songs on my ipod.  Now that I am relegated to walking, there's a lot of embarrassing finger dancing going on.  I've found that Mumford and Sons' Little Lion Man and Donna Summer's Bad Girls have a bpm that pretty well matches my walking pace which somewhat obviates the need for finger shimmying but not completely.  Thank goodness my kids don't walk with me because the combination of neck brace, speed walking and jazzy fingers would surely drive them over the edge with mombarrassment.

At 10 days out I am finding myself actually more at ease with the slowed down pace of things.  Pre-surgery I joked about how maternity leave was my favorite vacation ever.  This period has been the longest time I've ever spent away from work but so far I am making the most of it.  Being able to spend every day doing nothing but taking care of your body is a luxury that I've never had. 

I used to say if I did not work (outside of the home) I'd be the fittest, craftiest, dinner-on-the-table-at-5 mom ever.  I don't know about dinner but I'd definitely be fit.  The lemons into lemonade part of recovery is definitely being well-rested, eating right (mostly because of the nausea-induced vegetarianism) and walking 4-5 miles every day.  When I used to jog, if I could fit in 3 times a week it was a miracle and I would run about 3.5 miles.  Now that I'm walking slightly more than that 7 days a week, it actually seems to be almost as good a workout.  Who knew? 

First field trip, mood swings and bad breath :)

After not going anywhere for 9 days other than my neighborhood walking trails, stir crazy has taken on a newer and fuller meaning. So when my husband called asking me to get some items together to register my son for soccer, I "sprang" into action. Birth certificate, health forms, code of conduct, triple check. Small passport size photo? What on earth, no. So I snap one with the digital camera thinking I'll just print it but of course there's no ink. So I transferred it to a zip drive so we could print it at the drugstore. After convincing him to take me, battle of the unduly sensitive touch screen ensued. After nearly bursting into tears and then getting stabby, I forgot why I wanted to leave the house in the first place.

I have tapered off the Vicodin pretty aggressively (if you checked out the new charts and graphs page you already know!). I am wondering if I am having some side effects from the meds and/or withdrawal from them. The mood swings have only happened for the last two days, after I am down to a pill and a half per day. The other neat little thing I've noticed is a nearly fatal case of Halitosis. I'm brushing my teeth 3 times a day but its hardly helping. Sorry Hubs!

Not to be deterred by a little hormone spike, I went ahead with plans to have dinner out for the first time. Unfortunately, I didn't pay enough attention to the part of the hospital discharge instructions that said to avoid long trips by car. Even though the restaurant was only 15 minutes away, with my not so gentle-driving Dad at the helm, every bump of those back roads hurt. Why I had to make reservations at to some backwoods eatery, I don't know. Sitting in the wooden chair for 90 minutes wasn't too bad but by the time we were done, I was ready for the recliner. All in all, a good reminder that I am still in recovery. Day 9: physical status=9, mental status=8.

One week post-op: Almost back to normal?

7 days of almost the same exact daily routine, punctuated by fluxuating medication levels and I feel lucky to be doing so well. Now that I'm down to 1 & 1/2 Vicodin a day, the longevity of the recovery process is sinking in. The one thing about the initial, acute phase is that there are so many things to deal with the time passes pretty quickly. Now that I'm almost pain-free and the only thing left to deal with is the nuisance of the neck brace, I think this is where the real challenge begins. Since I'm no Dr. House, I don't have a ready supply of intriguing medical mysteries to solve. The only puzzle I want to solve is what I can do for the next 2 to 5 (oh my gosh don't let it be 5) weeks before I'm released to go back to work.

I don't want to compare my current condition condition to that of those who have permanent, disabling impairments, but this process has put the plight of the truly disabled in mind. I'm so pleased with myself for having nailed the showering with the neck brace routine but I think I'm handling that well only because I know its temporary. I never understood the mental impact of having to struggle every day of your life to do small things like put on a shirt, brush your hair or pick something up off the floor. Managing to keep your wits about you when you have to devote so much mental energy to simply getting through the day takes some serious inner strength. My hat is off to those who do and do it with grace.

6 days is too soon to try to work!

I've been progressing so well, I logged on to my work computer just to respond to some emails, or so I thought. 2 hours later, I'm still typing and I have a headache. I propped the laptop up so I wouldnt have to look down but it still was a strain. So I got up and walked for an hour but it was so hot I sweated all over the stupid neck brace pads. My husband went back to work today so I'm on my own, hence the rash of poor decisions, I guess.

After showering, I had to change the neck brace pads myself. After washing them out, I had to stand up to put it back on and it was harder than I thought. I was holding myself so stiffly my neck and shoulders were pretty painful. Now that I'm down to 1/2 doses of Vicodin, I'm much more aware of my pain levels. My front incisor is tender and sensitive to temperature. i'm guessing it got banged during intubation or extubation. Good thing I'm still not eating hard foods though, I'm still eating a soft, bland diet. Unwittingly, I guess this has been a surgery-induced cleanse - no caffeine, alcohol or fatty foods. I've lost 10 pounds so far, but I think that will level off.

5th Day: Settled into a routine but not yet bored

So truthfully, it still feels like I'm on a somewhat lame vacation.  I'm waking up at almost a normal time, having a leisurely continental breakfast and taking a walk around the lake.  Without the kids here the pace has slowed way down which has been good for a while but I can see the novelty wearing off and soon. 

After stretching the painkillers overnight to 8 hours, I decided to halve the dose this morning.  Turned out well as it gave me just a little pain relief to deal with the neck and shoulder aching but didn't make me loopy.  After last night's spectacularly trippy waking dream (mile-long waterslides manned by aliens ending in a vat of mac n' cheese), I wanted to try to keep my conscious hours as lucid as possible.  I've not had any more dizziness today except for a few short episodes while on the second walk.  Up to 5 miles, day 5.  Surely I can't keep this up...or can I???

Second shower last night was more successful than the first mostly because I figured out how to deal with keeping my long hair out of the velcro of the neck brace.  While drying the plastic pieces of the brace, I reclined on the bed to let my neck air out a bit.  The steri-strips aren't showing many signs of letting go and the whole area under the dressing is still pretty rashy.  Photo below:

Incision Day 5 Post-Surgery

Day 5 Summary:  Mental status = almost returned to normal.  Phsically, lump in throat remains, albeit smaller.  Skin around incision still numb and tender, rash maybe slightly less red.  Strength a little shy of normal, ~90%.  Pain minimal, shoulders and neck a little achy.

Day 4 - 4 miles, 4 meals

Day 4 graced me with cooler weather and less itching. Started the day off with a little food (banana) and 2 mile walk. Now that I'm out and about more, I'm getting used to the looks from passersby. I'm still not used to not being able to look down so I'm navigating curbs like a granny.

I've spaced the meds out to almost six hours with no noticeable increase in neck pain. My arm is still pain free with only occasional numbness in the thumb. Unfortunately, the neck brace is driving me nuts. Even after adjusting the pads it still feels too big. I'm wearing a regular Aspen collar but found the Aspen Vista on-line which looks like it might solve my issues because it is more adjustable for a shorter neck. I'm also hoping the wider opening at the front will help with the itching. If I'm really going to wear it for 5 more weeks, I figure it's worth it. Sporty green color a nice bonus!

Although my stomach is mostly settled, I'm still reacting strongly to smells like coffee and mulch. Having trouble eating protein or milk-based foods but did branch out to mashed potatoes. For those still interested, five days without a productive trip to the loo were a few too many. Oy!

Day 3 post-op: Clean and mostly sober

Without the nausea, my outlook has dramatically improved. Being able to keep some more normal food down made a huge difference. I have worked my way up to plain rice and broth. I took a couple of short walks but still feeling slightly unsteady. I only need one painkiller instead of two and that has helped me not feel as groggy.

I pretty much dozed through the whole day yesterday which, coupled with not eating much left me feeling weak and woozy. I decided to try to sleep in my bed and was pleasantly surprised to find it was ok. The 10-inch foam wedge pillow with a soft regular pillow at the top was just enough height for me to sleep comfortably. I actually got about 11 hours of sleep, getting up only for painkillers. This morning, after a mile and a half walk, it was shower time.

The actual shower itself wasn't too bad but because I have long hair that made it tricky. Changing the neck brace pads was harder than I thought. I tried to do it lying down but couldn't figure out whether the pads were on correctly. So I ended up standing in front of the mirror. I dont know if it was the shower or sweating from the walk but the incision was itching like mad. I took off the dressing and the skin underneath was pretty red and rashy looking. Overall the neck itself looks okay, only a little swelling I could see. It was throbbing visibly with my pulse which was kind of creepy. The skin around the incision actually feels a little numb when I touch it.

Overall, 3 days post-op and the sore throat is still present but much improved. Nausea under control, neck and shoulder muscles slightly sore, overall discomfort 2.5 out of 10.