Wednesday, July 1, 2015

Fighting Back, Part Three: Recovery at Home

This is my third post in a series about my recent back surgery (specifically, a posterior lumbar fusion at L5/S1...a procedure intended to fix instability remaining after a 2011 anterior lumbar fusion).  If you missed them and are curious, here are links to Fighting Back, Part One: Overview of the Surgery and the Pre-Op Period and Fighting Back Part Two: In-Patient Recovery.

The First Days
  • When you leave the hospital, they give you a number of instructions.  Some are pretty standard post-op stuff and some are fusion-specific.  The key fusion-specific rules are referred to as "BLT" bending, lifting, or twisting.  I had built enough strength to be able to squat instead of bend and I'm pretty "handy" with my toes (e.g. I can pick up a dropped piece of a kid, I'd developed the skill of writing with my toes, big letters but legible).  It was definitely little twists that got me in the early days.  It's so natural to swivel a little to grab the shampoo bottle etc.  The rules are largely to prevent unnecessary pain, although it is possible a patient could knock something out of place before things heal and strengthen.
  • I left the hospital with the same meds I had when I went in.  This did mean there was quite a bit of pain at first, especially with getting up or shifting position. 
  • Most docs limit sitting to 15min increments following a lumbar fusion.  Mine doesn't.  He was clear he wanted me up and out of bed as much as possible.  Riding in a car is frowned upon and we had to stop several times during the drive home (it takes 90-120 min normally...the complexity of my issues demanded an out-of-town expert).
  • All docs encourage walking after a fusion surgery.   I did use a walker for the first couple of days at home.  As expected, I tended towards overdoing it.  I'm not going to provide details b/c I know if I read someone else's mileage I'd be tempted to keep up.  Don't be me with this stuff...I have some nasty demons in my head that push me to go further than I should.  
  • I was able to use the same brace I had last time.  For the first two weeks, it was on whenever I was out of bed.    
  • Two incision-related items:
    • One area in which a posterior surgery differs from an anterior approach is, obviously, the location of the incision.  When the incision was on my belly, I could handle my own dressing changes.  Not so much this time.  Honestly, I didn't see what it looked like the first day or two but after that it wasn't as bad as I imagined.  Still, grateful for my husband's helping hand with daily changes.  It was probably about a week to ten days before I stopped covering the wounds.
    • As my red hospital bracelet warned, I've reacted badly to both steri-strips (crazy itching) and medical tape (same plus hive-like skin allergy) in the past.  For the main incision, I had a Tegaderm-style bandage.  I also had a small, latex-free band-aid covering the wound from the drain (looked similar to an entry point for an IV).  Despite the attention to detail, I STILL managed to react getting red and itchy precisely where the bandages were adhered (and scratched since I'm apparently no better at resisting an itch than I was when I had chicken pox in preschool); there was even a "space" in the irritation where the gauze was located so it was definitely the bandages. Given that both are intended to be hypo-allergenic, it's pretty impressive how much my body hated them.  I need to talk to my GP about this one...
Initial Post-Op Appointment and the First Month Post-Op
  • I saw my surgeon again at the two week mark.  He took x-rays and checked the incision.  He said everything was looking good.  He reiterated his firm belief that "It will work" and again remarked on the fact that my skeleton looks like a child's (not a weight issue, as he said one can't eat one's way to bigger bones)
  • Since the 2w appointment, I only use my brace when I leave the house or am walking on the t-mill.  It is there to provide protection in case of a fall or a car accident (or even a sudden stop).  It is a bit embarrassing but I like that it warns people to avoid bumping into me and explains when I'm slow-moving.
  • I'm allowed to drive (per the doc, you can drive when you are confident you could react to a kid running out in front of your car), but prefer to stick close to home.  It is still hard to turn my body (and still best avoided) which makes it hard to change lanes and really hard to back out of a parking spot.
  • By around the two week mark, I was able to tell that the pain I was having was different from my "normal" pain.  This is REALLY good.  It suggests the pain is tied to recovering from the surgery itself and means they may have "gotten" the cause of my pain.  I've had small spells where I'm nearly pain-free.  It's amazing how much one notices (and appreciates!) a lack of pain after years of unrelenting severe pain.  Most days, I do have a decent level of pain and I need to remind myself that it's expected (more're gonna hurt for a few months when someone cuts you open and hammers screws into your spine).  Overall, I'm hopeful.
  • I'm still on the same meds.  Yesterday, I saw the clinical pharmacist who helps my GP manage my meds.  Although I was game to start decreasing (in large measure b/c I'm scared of how long it'll take and how rough it might be), she wants to wait till after my two month follow-up to make changes and (hopefully) begin the process of weaning me off them.
  • I've had setbacks.  I definitely hurt a lot more during bad weather.  I also have days when I simply feel depleted and that causes a pain spike.  I moved oddly one day and had a return of my old pain for a few days which was terrifying.  It has subsided.
It's about six or seven weeks now.  It's still hard.  Overall, I'd say dealing with these back issues is the hardest thing I've ever done (and I took the bar exam!!).  Recovery has been, and will continue to be, a matter of "two step forward, one step back."  There are good days and bad days and I can't always pinpoint a reason for the bad ones. I need to remind myself often that I can't expect much beyond that and that the bad days part of recovering from major surgery and are not a sign of doom.   Hopefully, it continues to add up to moving forward.  Slow and steady.

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