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.

Eight Weeks, has it really been Eight Weeks?

The first week of this whole saga was spent in hospital and it was a bit of a blur, the days and nights seemed to fly by, and in retrospect I suspect a fairly heavy drug load helped that. Since then you've been able to read about the ups and downs here on a weekly basis. This is the last weekly update unless there's something pretty interesting.

This week has been all about reducing pain relief quite dramatically. By next week I'll be down to zero as far as the heavy duty pain medication is concerned. I've had some withdrawal symptoms which haven't been nice - mainly gut cramps. In reality they've been pretty mild so far.

I've continued my walking, but in line with last week it's been more moderate than earlier weeks and that's been good. Total for the week is 23.5 km. I also did another session in the pool - some walking and gentle exercise. I came out feeling like I'd done a work out but very relaxed and flexible. It was great and I think I could get addicted!

As in previous weeks I've had ups and downs with pain and discomfort. It's become clear that this whole saga has been a big success. I've gone from being unable to walk 150 metres 2 months ago to being able to reel off 7 km at a reasonable speed if I need to. That's success if ever I heard it. It's also clear that after having had various back pains and problems for most of my life - starting as a teenager in the early '70s - a single operation isn't going to solve all of that. One or two other levels in my spine that had previously been problematic but which were fairly settled before the surgery are now complaining again. I think that will settle down over time. The lumbo-sacral area of my back is best described as "fragile" at the moment. It's not hard to trigger off unsettling localised pain and discomfort - low key but annoying. I think a lot of that is about a few bits of titanium being buried there and the muscles needing to get used to sitting over and around that. It's too easy to focus on that sort of thing when you've just had major surgery. It's too easy to become a bit obsessive about things, so I've been trying to ride with that stuff and it generally passes after a few days. In addition I've got a 16cm scar from the base of my spine. That's become more of an issue over time, feeling slightly tight and "catching" at odd moments when I move. Again I'm trying not to focus on that and just working instead to maintain flexibility.

The things I still can't/haven't done are interesting: I can't put on my shoes and socks, mainly as I don't want to bend and twist enough to do that; I haven't driven for 8 weeks - I refuse to do that whilst on painkillers even though I think I'm quite OK to do it; I can't sit for long periods, though that's improving - up to about 20 minutes in the right chair; I can't lift and pull or push; I don't think I can sail yet and want to talk to the surgeon about that; I haven't flown - I can't get into the aircraft and the drugs prohibit it anyway.

So that's it. I've got a review with the surgeon on Wednesday and I'm planning to start work the week after. It is a good moment for thanks though: to my daughter who has faithfully put on socks for her ageing dad for most of the last 8 weeks; to Sandy in a local shop who smiled and got down on her knees to undo my laces one day when I got trapped in my shoes with nobody to help me get them off; to Maddy and Dan for the lifesaving Red Cross parcel of books - thanks guys you don't know how much I needed that; to the surgical team - you guys rock; to the nursing staff at 3LP - I couldn't have asked for more care and support and all with a smile; to my mates for enduring lunch with me when I needed company; to my neighbour for his words of wisdom; to my physio for holding my hand when it all got too much; to Chris for his wisdom and support; to Graham who'd been there before and was a calming force and full of great advice; and to my wife for all her support and for putting up with me at all!

It's been a real team effort and I can't imagine how much more goes into something like winning an Olympic Medal!

Week 7 - Up, Down, Up, Down...

After a pretty good week in Week 6 this week has been a bit of a mixture. Wednesday, Thursday and Friday were particularly bad days with a return to pain levels of a couple of weeks ago. The heat packs came back into use and my mood plummeted. I took things pretty quietly and just tried not to aggravate anything and it seems to be settling down.

I started the week pretty well with a long walk on Monday and a walk and a session in the hydrotherapy pool - my first - on Tuesday. The hydrotherapy pool was great, the water was warm and the gentle exercise with lots of my weight supported was great. Interestingly I clearly used muscles I hadn't used for some time as I could feel them the next day!

I'm not sure what caused things to go down hill later in the week but I found it particularly frustrating as I'd been going so well! Because of the progress in week 6 I'd also chosen Friday of week 7 as the day to start reducing my reliance on heavy duty painkillers. After a conference with my doctor we settled on a gradual reduction approach and the use of paracetamol as needed to take up any slack. Being stubborn I chose to continue with the plan and cut my daily intake by 25%. I've had to use paracetamol a couple of times to take up the slack but not in any continuous way. I also haven't yet suffered any untoward withdrawal effects from reducing the heavy duty painkillers. So that's all positive. Tomorrow I'm due to reduce intake by a further 33% so let's hope that goes as well!

Distance walked this week was 25.2 km which is a slight reduction on the previous week and reflects my "take it easy" approach over the latter part of the week.

Six Weeks - It's Magical!

The physio has been saying to me "the magic date is 6 weeks." She doesn't really know why but she maintains that 6 weeks post-surgery seems to be a big milestone for people like me with a spinal fusion. Well guess what? I think she's right. I walked into her rooms this week and she said just two words: "New man". She felt that I looked different, was walking much better and overall looked like I was making big progress. I felt the same.

Today is 42 days post-op. I've walked 28.8 kilometres for the week, not including local jaunts and coincidental stuff around the house and up and down stairs. I still feel like my back aches a lot, I still have right buttock pain but it all feels much more controllable.

Immediately after surgery my weight started a slow but steady decline as I had reduced appetite and was increasing exercise. That decline had stopped, and indeed somehow in week 5 I put on 500 grams, much to my disgust. However the weight loss has resumed this week and I'm feeling good for it.

The remaining issue is sitting, I can't do that for very long at all and somehow I need to do that in order to return to work. Six weeks was always the target date for return to work. That's not going to happen but there's nothing I can do about that!

I also had an unexpected experience on Friday. I attended the funeral of a fellow pilot, killed in an air crash recently. I couldn't sit down for that long, so I stood for a bit over an hour. Standing still for an hour, however, reproduced an old back problem that I hadn't experienced for at least 10 years and which is not associated with the levels that I've had surgery on! Go figure that one!!

So in summary a really good week. Next target is to start to get off the last 2 painkillers that I'm on.

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.

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!

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, anxiety...as 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.