Wednesday, January 30, 2013

Week 2 post-L5-S1 slice and dice: good news, not so good news

I had a bilateral discectomy on January 18, and yesterday I had my first follow-up visit with my surgeon. I received immediate relief from the searing electrical shock-type pain down my left leg right after surgery, thankfully, but the recovery so far has been difficult and with a few setbacks due to the severity of the disc herniation and what the doc found once in there.

Instead of slicing away all of the herniated disc tissue, he had to chisel more than half of it out because I apparently had the initial herniation was over a year ago (I had no idea). The acute attack I had in August 2012 was what led to the surgery, so the older portion had turned into calcified bone spur. A herniation that old means a higher risk that full recovery -- the numbness, and even the pain, will not be successful. Time will tell.

Aware of the risks and limitations of surgery

So patients facing this surgery are made well aware by their surgeons that the operation may not resolve all of the problems; the goal is to first take care of acute pain that kills your quality of life, and the hope is once the trauma of the surgery itself passes, the nerves affecting feeling and strength in the affected legs will, over the next 6-9 months, resolve fully, partiallly, or not at all.

The riskiest part of it is the first two weeks post-surgery, when the chance of re-herniation is at its peak (10%-15%), in my case it's riskier because of how much had to be removed and how it was removed (the "chiseling). No twisting, bending or lifting more than 5 lbs for at least 6 weeks is the rule. Sitting at length and staying in bed are strongly discouraged.

I haven't had problems with avoiding the bending. It's really hard to catch yourself not mildly twisting because you don't think about it. My partner Kate has been good about reminding me, and I have a grabber device to pick things up that I drop.

The best PT is to be able to walk as soon as possible, working up to 15 minutes a couple of times a day. I was able to walk about 10 minutes the day after I got home. I was dead tired and sore, but it was walking free from the pain that was disabling pre-surgery. It was amazing.

Problems began that evening though-- I started running a fever that jacked up to 102.5. We called the 24-hour line and was told to just take Tylenol every few hours to bring it down, max total dose of 2 grams (8 pills) in 24 hours. It did in fact, bring it down, but I was wiped out, drained, and up all night trying to get fluids in as well.

This occurred for the next few days, always at evening. It was usually accompanied by incision pain that required me to go through a couple of ice packs as well before I could get to sleep.

Then I had several days/nights without a fever. Was able to sleep in 2-3 hour chunks, which wasn't too bad.

Why the fever? 

Well, the inflammation from the surgery itself can cause it, along with reaction from the anesthesia. They discharge you with a device to blow/inhale into every hour or so to ensure that you don't develop pneumonia. I really didn't have much congestion or discomfort from anesthesia this time around.

That explains a fever in the first couple of days. Once you get into the 5-7 day window post-surgery, it's likely to be infection of the incision or continued inflammation from the surgery around the nerves.

The incision

Other good news -- the incision was healing well -- my lower back was very bruised, and the slice was about 2.5 inches long. The surgeon used dissolving stitches inside, and the equivalent of Krazy Glue to seal me up externally. Since I couldn't shower for 2 days after surgery, Kate washed the incision manually with Dr. Bronner's tea tree soap, which is mild and clear and has antiseptic properties. After air drying we put on a bandage. The doc said I could go without a bandage after 4 days, but we did it for an additional 2 because there was discharge, mostly because clothing rubbing against it aggravated the wound.

Then the horrid itching began, mostly from the adhesive in the bandages plus the glue residue that started to break up and wear off of the wound. All normal stuff. Washing it and air drying it a couple of times a day accelerated the healing. But it was itching like crazy until the glue finally fell off over this past weekend.

When I feel the incision, it's a bit lumpy, and the surrounding tissue is tender and a bit inflamed, and the muscles are tight. This is normal.

Improvement in flexibility

Your back is pretty stiff post-surgery, so you have to do specific PT exercises to loosen it and strengthen your core -- as I said above, walking is the best medicine. Kate had to dress me below the waist for the first week. I couldn't do much. This week I am able to dress myself without too much effort -- it's just slow going -- I am able to bend my weakened legs to get my socks on without bending at the waist when sitting. And I only wear clog-type Easy Spirit shoes, so I can easily get in and out of them.

I avoid jeans since they press on the wound, and leggings are hard to get on, so it's usually loose, pull-on yoga-type pants.

Amusements

Of course since I cannot sit around for long periods of time, watching full movies are of less interest than brain-free programming like the half-hour shows on HGTV, then I can get up and walk around doing laps in the house and rest for a bit. Kate and I had a howler of a time watching one show where this couple is doing a DIY remake of their bathroom and it's HIDEOUS. The husband put in a urinal ("because every real man needs one").  I had to get a screen grab.

 
When you're bored, lacking energy (and on pain meds)...well, you had to be there, lol. The Facebook thread on my wall about about this urinal was hilarious.

Getting sick, fever returns

It was great to see my brother Tim (he's five years younger); he came in on Friday to stay with me for a week to help out -- and so Kate could return to work. He has been cooking and cleaning and watching L&O (all flavors) with me.

Then the fever and chills returned. It didn't pop as high as 102, but hovered between 100-101. Again, it was only during the night. Since the incision looked fine, we were puzzled about what was causing it. However, I was starting to feel bad, as in a sore throat, and I was also developing nasal and chest congestion.

I was getting a cold. Nice. I had a flu shot, so my hope is that I can fight this off. It's kind of hard to do the walking I need to do for my PT when I feel like crap. The walking was actually wearing me down, and thus the cold was taking hold and running me down some more. Vicious cycle.

I don't have the energy to blog on PHB. It took a lot of time to get this composed because my ability to concentrate is almost nil between the surgical pain and the cold/flu. Good thing I went to the surgeon for the follow up yesterday.

The surgeon's recommendations at this point

1. The incision looks great, no need to be concerned about progress there, other than to continue to ice it if it's uncomfortable.

2. Fever: his concern is that I do have a cold or flu, and to watch that; but post-surgery inflammation could also be the cause. Continue treating with Tylenol as I have. And to watch for chest congestion. Coughing hard is obviously bad for the back -- it could cause reherniation.

3. Return of numbness and pins-and-needles in my left leg and intermittent twitching: the big concern. Since my case is a bit more severe than the norm, he's quite concerned about re-herniation because of the return of pre-surgery symptoms. He said that I definitely needed to recover using the full six weeks that I've taken off from work. The nerves are still settling.

The key recommendation was to be very conservative over the next 2 weeks. If I don't see any improvement in the numbness in my left leg, or symptoms worsen (as in pain), he wants me to call in and he's going to schedule an MRI to see if there has been any re-herniation. If there is, he has to go back in there and operate.

We agreed that I need to watch and wait over these next 2 weeks, monitoring the fever, since he suspects the inflammation from the rough surgery is the more likely reason for this issue than re-herniation, but my recovery is defintely going to be longer than anticipated.

He scheduled another follow up appointment in 4 weeks, and at that time he may do the MRI to confirm where things are if I make it past the next two weeks without incident before releasing me to go back to work after the 6 week mark. The major issues  - 1) I have a desk job and sitting all day is clearly not an option; 2) Because of the cold/flu/whatever it is, it's slowing down my recovery since I am weakened not only from the operation but a slammed immune system.

Thankfully (or not), I'm not on my rheumatoid arthritis meds, which would really put me in the tank re: suppressed immune system. It means my joints affected by RA are still killing me, but I'm safer from illness by being off of Enbrel in the wake of the spine surgery.

So that's where things are at week 2. I'm a bit scared about the next couple of weeks, but mindful that things could also improve.

At this point I have no more paid time off, so a long recovery will be a big problem at some point not far down the road. 




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