Thursday, May 26, 2011

Spinal Fusion - The end of stage one

The last week has been a bit of a milestone week in terms of my recovery from the surgery. It's also caused me to pause and reflect about the whole process. So this post is really a brief review of the achievements and a little bit of reflection and recounting of my learning.
First the milestones. I had my 8 week review with the surgeon. That was great. Many surgeons only want to hear the good, mine however listened to and explored both the good and the not so good. We charted a path forward - with two more milestones - and we worked through a list of dos and don'ts. The next milestone is at 4 months. Until then I'm allowed to flex (bend forward) but I can't lift, pull or twist and I can only extend (stretch backwards) in a very minor way. I got to do my own shoes and socks for the first time in his rooms as he examined me - that was so tough! I'm also only allowed to sail on calm days for the next two months. The aim being not to fall on my arse until the bone has had a little more time to heal. The great thing was I got to chuck away the orthotic brace I've worn since the surgery.
I left the surgeon's rooms feeling buoyed up and positive.
On Friday of last week I finally finished all the opioid painkillers. I'd been going through a process of tapering those off and that finished on Friday. That also felt like a huge achievement and the pain - such as it is - is easily managed with some paracetamol. This is a hurdle that I'm told many people find hard. Indeed a fair proportion find it too difficult to get over the painkiller hurdle. So that felt like an achievement and I feel more energetic now that they have gone.
On the Sunday I drove for the first time in exactly 9 weeks. I refused to drive whilst on the opioids, even though there was apparently nothing to stop me doing so. I didn't feel it was right. I also liked being forced to walk everywhere I needed to go. Not driving kept me walking.
The actual driving part was easy - like riding a bike - once learned never forgotten. What quickly became clear was that it was going to be very hard to find a comfortable driving position. The actual process of driving and sitting in the car triggered off all sorts of pain and I'm still working on the best driving position.
Monday brought a return to work. That was easier than I expected. The drive to and fro was hard but the actual process of going back was easy, made easier because the work environment demands a lot of walking.
So what are the lessons?
Firstly, would I do it again? The answer is a resounding yes! I had substantial pain and very limited capacity to stand and walk prior to the surgery. I could only stand comfortably for less than 5 minutes, sometimes less than 2. Longer became intensely painful. I could not walk 150 metres. After the surgery I have virtually unlimited standing and walking tolerance and I have walked up to 7 kilometres at one go. That is a great change and it's kind of returned my life to normal. I caught myself looking for the next seat and the next tram the other day and laughed when I realised that it was an old habit and I didn't have to do that anymore.
Is it a miracle? No! I still have, and probably always will have, some pain and some lack of flexibility and function. Having had substantial back problems for nearly 30 years it's simply silly to expect one operation to wash that away like some magic wand. What I have got is hugely improved quality of life and physical function. What more could you ask for?
What would I do differently? My surgeon prefers simple walking as rehabilitation for the first 8 weeks. That however left me on my own and without a lot of guidance for those 8 weeks. My GP had little experience of rehab from this surgery so he couldn't provide much guidance. When I had a new pain, or spasm or pain was slow to go, I had nobody to turn to, nobody to help me understand what was happening and whether it was "normal" or worrying. To counter that I took myself back to my physio in the first week out of hospital and started very gentle strengthening exercises and some massage to relieve muscle spasm. She also provided very good guidance about how fast/slow I was recovering, based on the many patients like me that she sees. That guidance included letting me vent and deal with my anxiety when things didn't go well. In retrospect I should have asked my surgeon to write to her when he discharged me from hospital so that she was "part of the team" and knew what the surgeon expected.
The other thing I'd do differently is to get into the pool earlier. From 6 weeks I've been going to hydrotherapy sessions with a physio at a local hospital. These sessions are fantastic, they really aid strengthening and leave you feeling relaxed and flexible and tired. In retrospect I should have covered the one small part of the surgical incision that was slow to heal and got into the pool at 4 weeks - or earlier.
It's also important to understand that this is not just a physical challenge. It's an emotional challenge. At times I couldn't see how I would ever return to normal; I couldn't see how the pain would ever go away; I couldn't see how I would ever function "normally" (drive, tie my shoes, bend...); I couldn't see how I would ever return to work. I would get very depressed and emotional. I was also lonely. I spent most of my days walking alone or resting. I was alone with my thoughts most of the time, and when my thoughts turned dismal it was very hard to stay happy. A real blessing was ringing up my mates and arranging to have lunch with them. some weeks I had lunch with somebody every day! I don't know what they made of it, but it was a really important part of keeping me whole and happy and I thank them for putting up with me.
I think it was also much tougher than I realised on my family. Even though I had all these dark concerns about the future and about my recovery, I never felt overwhelmed by it, not after I left hospital. So for me ultimately it was a series of challenges that, in retrospect, were all pretty manageable. I've since found out how hard it was on my family and they didn't see it as very manageable for me. My wife has back problems. The other night I jokingly said to her that I could thoroughly recommend a fusion. She burst into tears, as a reaction to what she perceived I'd been through. Somehow I should have looked after them better. I'm never one to be stoic, I'd rather be truthful and accurate when someone asks how I'm going. Perhaps some more stoicism would have been better.
My final piece of reflection is that setting and knocking over goals is important and you need support for your goals and support to achieve them. For me, the biggest single challenge was to get the right strategy to taper the opioids without getting withdrawal. I didn't want pain and withdrawal together because I wanted to get it right and over with first time. I had a lot of support to get the right strategy and to implement it. The sense of achievement and of personal capability is really dramatic and in my view is the single most important step in my recovery - moving beyond artificial means to manage my pain and getting rid of the unwanted effects of the drugs.

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