Monday, April 25, 2011

Day 35...Progress?

This has been a much smoother week. I got some good advice at the beginning of the week and it has paid off with a smoother, though not trouble free week.
The good advice was delivered by a slightly exasperated friend who's "in the business" - that is he's closely involved in these sorts of operations. His advice was simple: "you need to treat yourself like you've been in a major car accident with multiple injuries and you are now in the recovery phase". I think he and those around me felt like I was behaving as if I was recovering from a stubbed toe, and having the same expectations of myself. That really was the big issue - my expectations of myself.
So, taking that advice on board I've had a better week, particularly emotionally. Not perfect by any means, but certainly vastly improved. I've also continued to demonstrate to myself the things that I can't do yet. The main thing is sitting. The more I sit, the more pain I get and the longer it lasts. I also get pain if I walk too far and so I've limited that as well. Having said that I did 22.5 km for the week and a rather epic 5.5 km in one shot yesterday. That was a mistake!
I've also ditched the anti-spasmodic drug this week, with no apparent negative effect. So now it's just two tablets a day. That feels like an achievement in itself!
As for the sitting problem, I'm trialling a Bambach Saddle Seat, at the suggestion of my ever supportive physio. The verdict is very much open on this still. I like the position, but it causes soreness in my inner thighs and if I sit long enough an ache in my lower back. However it has doubled my capacity to sit, from around 5-10 minutes pain free to around 20-25 minutes pain free.
I am seriously keen to hear from others who might have had a lumbar fusion and have direct experience of this chair. Please leave your experiences in the comments.
So the summary is: a much better week/ However the team at work will just have to wait. I'm not ready to start working today guys and it's going to be some weeks yet in my view!

Sunday, April 17, 2011

Day 28...time ticks slowly

This has been a remarkably tough week. I think the biggest issue has been a huge gap between what I think I should be able to do and what I can do. I've walked 25.7 km, not including incidental walking - across the road, round the house, etc. That includes one day where I didn't walk at all, except around the house. My biggest walking day was yesterday where I did two walks totalling 7.1 km. I ended the day feeling OK, except for a persistent dull ache in the base of my spine and general aching and stiffness.
For me the tough thing is to remember that 4 weeks ago I couldn't walk 300 metres without sitting down 3 times (and still arriving a pale, shaking mess) and that it's been over 3 years since I've been able to walk 7 km in a day. So that's got to be progress of a massive scale.
Nevertheless I've absolutely been through the emotional wringer. Half way through my long walk yesterday I stopped for lunch and found myself sitting eating my lunch with tears streaming down my face, wondering how the hell I was ever going to walk home from there and whether the pain and slowness were ever going to improve. God knows what the other patrons thought! Anyway walk home I did.
The problem is that I then feel an overwhelming need for sleep. So I slept for a couple of hours before my next walk. This was supposed to be a short walk before dinner. I bumped into a couple of friends and spent some time chatting with them about their plans for a new house. It was a great end to the day and improved my mood no end. So from the deepest downs to a reasonable up. No doubt it won't be the last time that happens, but I am surprised at how emotionally labile I am.
The key stopper for me at the moment is sitting down. Basically I can't, except for very short periods. I do sit sometimes for longer periods (like writing this post) but the suffering that results is directly proportional to the length of time spent sitting. The optimal maximum seems to be about 5 minutes. Not much hope of a return to work any time soon at that rate.
My mental target for return to work has always been 6 weeks post-op. At the moment I can't see myself being able to front up to work in 2 weeks' time. We'll see.
I also desperately want to get into the pool, however there is one little area of the suture line that is healing by secondary intention and I'm not game to get into some foetid pool until that is completely settled.
For those who've had to put up with my intensely unhappy behaviour this week, in person, on the phone or on Twitter, my apologies. I hope I stop behaving like that soon. I'm trying. thanks for all your support.

Sunday, April 10, 2011

Day 21...where am I up to?

For those of you still hanging in here, and more importantly perhaps for those of you considering an operation like this, here's a day 21 round up.
First some background. I caused injury to the L5-S1 level of my spine a long time ago when I ruptured the disc. I had a difficult period straight after the injury but since then things have travelled on OK. In 1991 I lost sensation in the front of my right thigh and at the same time I developed an intermittent deep nagging pain in the centre of the front of my right thigh. Those are all things that you learn to live with.
Over about the last 5 years I've developed intermittent bouts of lower back and buttock pain which have become progressively worse. They took up two forms. The first was a nagging pain of varying intensity which at its worst left me flat out on the floor unable to do anything. The other, more troubling, was pain in my buttocks legs and feet which got worse on standing. Towards the end 5 minutes was too long to stand and I couldn't walk either for more than a few metres. That meant that it was time for action.
The symptoms were caused by stenosis of the neural foramina at L5-S1. That means that where the spinal nerves exited the spinal column through a gap, called the neural foramen, they were being crushed. This was happening because the facet joints at L5-S1 were slowly collapsing leaving an ever smaller gap for the spinal nerves to exit. Those are the nerves that control parts of your legs and that's why I had troubles.
My surgery was minimalist. I had a laminectomy, where the laminae - bits of bone behind the spinal column - were removed. The facet joints were also removed and four pedicle screws were inserted - one on each side of each vertebra through an area of tough bone called the pedicle. Then the nerve root on the right hand side was gently moved aside and a piece of plastic (PEEK in fact) called a fusion cage was slipped in between the two vertebrae. The idea was to re-establish the gap which used to be held open by the disc. Saying that the fusion cage was "slipped in" makes it sound easier than it was. Quite a bit of force was needed to re-establish the original gap and to get the cage where it was supposed to be. The cage was packed full of munched up bone that had been removed from my spine and the space behind the cage was also packed full of the same bone. This bone will grow and fuse the two vertebrae together.
Then a rod was placed vertically between the pedicle screws on each side of my spine and finally a cross piece was placed between the rods and the job was finished, but for closing the muscle and skin layers.
When I woke up I was totally pain free at the incision line and on the left side of my back and in my left leg. All the pain I'd been suffering on that left side had gone and has never returned. On the right hand side I had localised pain, muscle spasm and some intermittent leg pain. That has remained, though it's improving.
So to day 21. Here's the situation:
  • Walk 5 km;
  • Shower and dress myself;
  • Sit for up to 10 minutes without too much discomfort and longer with significantly more discomfort;
  • I can get in and out of bed and roll over with no external assistance;
  • I've been able to manage flights of 20 stairs since day 3 - up and down - unaided;
  • I can stand for long periods of time, basically pain free;
  • I can lay for long periods so long as it's absolutely flat.
Not bad considering where I've come from. Now to the bad bits:
  • I'm still on 2 long-acting opioid pain killers per day plus 1 anti-spasmodic for the spasm in my right buttock. Can't see when I'll be off those, but on the other hand I've weened myself off a bucket load of other stuff already;
  • I don't drive because of the drugs I'm on - personal choice;
  • I don't know whether my right side will ever get better than it is now and that's not great;
  • I'm a bit depressed - people work and do their own thing and I'm left either walking (slowly) or lying down. Movies are all crap, I've read all the decent books I can find and I've listened to my whole music collection I think!
  • I'm frustrated out of my brain! I can't sit so I can't work and I can't travel. I feel like I'm in limbo.
The bottom line is I'd probably do it again in a flash, even though the outcome is far from clear. Next week, I'm hoping one last little area on the suture line will be healed and I'll be able to hit the pool. That'll be a new distraction for all of 2.5 minutes, but a new distraction nevertheless!

Thursday, April 7, 2011

Two steps forward, one back...

It's day 18 from surgery. Since last weekend I've done another couple of long walks but I've finally had to admit that it's probably not the best thing I could be doing. Finally yesterday, after "good" advice from a range of sources, I took a day off and didn't walk at all. I did the normal walk around the house, read, get food, but that's about it. I did two other things though: I stopped taking all of the short acting opiate painkillers, leaving only two sustained released drugs and something for muscle spasm; and I slept.
I couldn't believe how much I slept, 2 hours, some food, then another 2 hours, then dinner and some TV and then off to bed and slept for 7 hours straight. My body must have wanted to tell me something! I also didn't get bad withdrawals from the painkillers. I'd been expecting worse, all I really got was feeling slightly hypersensitive and grumpy. Some who know me well would say "what's new about that?"!
Today I hit the road again with a small 2km walk and after talking to the physio I'm going to try and stick to a smaller number of shorter walks - around the 2km length rather than a 5-6km out and back marathon.
My surgical scar has one little area that's not quite healed, so I'm hanging out for that to sort itself out. Once that's healed I can do some deep water walking. I'm so bored at the moment that even a small change like that is something to really look forward to.
What's particularly wearing is that I can either walk, stand or lie flat. I can only sit for very short periods and I really suffer if I try and sit for longer. No trips in the car to speak of, no going out to lunch with someone (I tried and suffered afterwards). So life's pretty boring.
Still I should stop bitching. The signs for the long term outcome are pretty good and I managed through some contortions to put my own socks on today. Big win! Don't ask me how!!
Things will no doubt improve as I'm able to do more. Till then I'm like a caged lion!
Hey and thanks for all the support and suggestions on Twitter - you're champs, thank you!

Sunday, April 3, 2011

Walking, walking

I'm used to walking at a pace that competes with the best of them. I guess that's at least 5.5 - 6km/h. Right now I'm only able to keep up about 2km/h. So that gives me plenty of time to sight see and smell the roses. I expect that speed will climb quite quickly but it's fast enough for now.
The surgeon had asked that I start off slowly and then build up to a reasonable walking distance each day. I'm not sure what that means exactly. I got out of hospital on Monday and managed to do a 1.0km walk that day, which seemed quite puny to me. That was in addition to all of the coincidental walking around the house and a visit to the super market. The next day was a little more at about 1.2km.
Then I stretched my legs and walked 1.7km the next day followed by a 2.0km day on the Thursday and a 2.1km day on the Friday.
All of this taught me two things: firstly I can't do speed just at the moment - I've still got a little bit of a drug load on board so I'm particularly careful crossing roads and checking where I put my feet. The second is much more galling: the run-up to the surgery was pretty rough, to the point that I couldn't really walk at all - 150 metres saw me out. Add to that a week in hospital, even though I did wear out quite a bit of the carpet walking after the surgery, and you end up with somebody who's seriously out of shape. I'm trying to put that right, but it's galling to raise a sweat just ambling somewhere at 2km/h!
My 5km jaunt yesterday left me pretty sore and sorry for myself so today I may slacken off a bit. We'll see. I can't see a trans-continental jaunt in my near future though - sorry Forrest Gump!

Friday, April 1, 2011

How do you do that?

So out of the ward, down in the lift, across the road and we're at the car. I'm not allowed to bend at the waist, I'm not allowed to twist and I'm not supposed to sit with my knees higher than my hips. So how do I get into the car seat? Well gingerly for a start...I got the car door open as far as it would go and sat on the edge of the seat facing outwards. Of course all modern cars have seat bolsters designed to retain you as you circuit the Nurburgring at 200+ km/h. All very useful in that situation but for my purposes a pain in the arse. Once perched on said seat bolster I then pivoted my legs into the car, after having somehow got my head inside without bending, twisting or doing any of the other forbidden things. The result, if done well is a simple pain-free entry into the car. The alternative is, well let's call it a mess. It works well though, so well, that a friend still uses it 17 years after his operation.
The ride home wasn't as bad as I thought it would be. The surgical site and my back are remarkably impervious to bumps and jolts. I'm simply not troubled by most of what a modern road can throw up.
Of far more importance was the problem of getting on top of drug management. I arrived home in possession of 7 different drugs, each with their own raison d'etre, timetable and regime. Up to that point I'd been rattling back about 20-25 tablets a day, not to mention various potions designed to keep the trains running in the face of the constipatory forces of the other 7 drugs. A spreadsheet was the only answer. Each drug, it's maximum daily dose, suggested dose and timing was set out in the spreadsheet and off we went on the magical mystery tour.
Quite quickly it became apparent that firstly my requirement for pain relief was falling and that the spreadsheet was allowing me to target my drug use to periods of need. Monday the intake fell to 15 tablets, Tuesday it was down to 10 tablets and by Wednesday it was down to 6 tablets.
Two things became apparent at that point: firstly my pain wasn't quite under control and so I was wasting my time a bit. Secondly I was having bouts of what turned out to be withdrawal. Shakes, shivers, sweats, I weaned myself down from the high levels of drugs.
Thursday the total number of tablets is back up to about 9 and that seems, for the time being to be the right balance. I'm hoping that I can carve into that further over the weekend.
The other thing that has to be tackled is my rehab programme. This can best be described as the modified Forrest Gump programme. Instead of "run Forrest, run" it's a case of "walk CA, walk". Basically the idea is to start off slowly and to build up to several kilometres a day over a period of weeks. Of course me, being me, the idea became fixed in my head that if small walks were good, then big walks were better. I'm currently paying the price for that as well!!
Overall though, this surgery is a miracle so far. The only thing I can't do for myself is to put my socks on. I can't work that one out yet. I can do anything else I've tried so far with some ingenuity including picking things up off the floor. That involves squatting, down on one knee, down on both knees, pick up the object and then the reverse the process. Stairs are no problem, though they're treated with due respect and driving is out of the question. I'm carrying too much of a drug load to want to be out on the roads at the moment, though from a purely physical point of view I think I would be capable of it, without the drugs.
More to come as I explore the niceties of a recovery as opposed to mere functionality.