Spinal Fusion: 1 Month Update

spine titanium hardware lumbar fusion

It’s been 5 weeks since I had spinal fusion. Going into it, my surgeon stressed how major of a surgery this is and got his point across by saying that I would “hate [him] for the first 3 weeks” and at a date closer to surgery said I would “want to find [him] and kill [him] for the first 3 weeks.” Let’s just say that the statements were not NOT correct…!

Depending on why you’re here (you enjoy reading “novels”, you’re recovering from surgery and want to know how a particular part went, or you’re just skimming), I’ve split this into headings to help you get to where you’re going faster.

Diagnosis and Background

I was diagnosed with spondylolisthesis in mid-April after my left leg numbness while riding a bike finally got bad enough that I couldn’t ignore it. I followed my hunch that it was a nerve / spine issue and not a circulatory issue and went straight to see a spine doc. Turns out my hunch was correct — the L5 vertebrae had fractured at some point long ago and slipped forward, crushing nerves in the process. The vertebrae was not in a stable position and would continue to slip forward over time and I could risk permanent loss of function in my left leg if left unattended long enough.  (Yes, I got a 2nd opinion. Yes, I went through PT and traction. Yes, I tried nerve-blocking medications. Yes, I gave up biking and went on 20 hours a day of bedrest for at least a month to try and halt the symptoms’ progress. Nothing worked and things just kept getting worse.)

 

File_001
Now I have titanium in my spine AND my right foot!!

 

I had L5 / S1 fusion at the very end of June, which is a fusion at the lowest lumbar vertebrae. The two surgeons  (vascular, and a spinal specialist) first went through my abdomen, moved everything aside to reach my spine (including working around the blood superhighways, the abdominal aorta and inferior vena cava, gulp), and then removed the disc between the vertebrae and basically added little metal spacers with sharp teeth to hold the two vertebrae apart from “inside”. They put my circulatory system and guts back, stitched me up, and then flipped me over onto my stomach. Next, the spine surgeon bid adieu to the vascular surgeon and completed the surgery by making an incision in my back, removing fractured vertebral bone bits, opening up the nerve portals (my word, not his). Then he added screws to L5 and S1, attached them with rods to add further support and keep them apart, and packed the whole area with a combination of my ground up bone, cadaver bone, and a magical material made by Medtronic called BMP (synthesized from hamster ovaries! The FDA says so).

pain_rating
Image credit goes to the amazing Randall Munroe of XKCD.com, who encourages folks like me to use his images as long as I link back to the source and give him full credit.

Hospital Stay

I was in the hospital for 3 nights and 4 days. What they say is true – they WILL likely make you walk on the same day of your surgery. My “walk” was getting out on one side of the bed, walking around the foot of my bed, and getting back in. I was dizzy; uncoordinated; still attached to a catheter, drain, IV, multiple monitors; and I hurt like hell. Pain ranged from a 4 to a 9. (I reserve a pain rating of “10” for what I imagine actively getting a major appendage sawed off without anesthesia would feel like. Never been there.) I have a vivid memory of clinging to the bed rail, crying and shaking because I hurt so badly. This was while on a combination of VERY strong narcotics, IV pain medications, and muscle relaxants. I don’t remember much else from the hospital stay and I consider that a gift.

During the hospital stay I had to do 4 things before they would let me go home: have my pain “under control” with just oral medications, show I could dress myself (putting your underwear on with a grabber while a helpful OT watches is … special), walk up stairs unaided, and poop. I am so thankful for the wonderful nurses and therapists who clearly cared about me as a human and tried to make my hospital stay as pleasant as possible.

 

… spinal fusion has been great and I wouldn’t change a thing — I can walk 6x further than I could beforehand and without nerve pain and leg numbness, and I can sit on a bike seat for 60 minutes instead of 10 minutes before the numbness begins to gradually bother me, starting with a tingly left big toe. … It’s a journey, and my general trajectory is up. I just have to keep climbing.

First Week at Home

Things at this point are still a blur. My appetite was fickle but I was eating regular foods and had alarms set for every 4 hours to make sure I took all the prescribed pain meds, at their maximum prescribed dose, as often as I was able. I hurt, I slept a lot, and my brain was generally mush. I weighed 25 lbs more than normal (24.5, to be exact) when I got home from the hospital so my normal clothes didn’t fit. My abdomen was distended and I looked like I was at least 4-5 months pregnant. I was SO GLAD I had stocked up on comfy nightgowns and loose-fitting dresses for taking my required walks outside. Slip on shoes were great, even around the house — having arch support made me feel less clumsy. My doctor was right in that I could put on my own shoes due to my flexibility going into surgery, but that’s not the norm.  Tying shoes is HARD but possible most days. On the days it’s not possible, I ask the kid if he’ll tie them! Ha!

 

File_001 (1).jpeg
Me, bloated and showing off my use of grabbers! The can koozie says “OT REX – UNSTOPPABLE”!!

 

I had purchased gear prior to surgery and during my hospital stay. I had and still have multiple grabbers staged around the house, used a toilet riser and a sock aide for the first week, still use a “dressing stick” and grabbers to put on clothing, and also made good use of walking poles for that in between time when I didn’t need the full-on walker but wasn’t steady enough on my own. I can’t adequately spend any time near my feet or lower legs, so shaving or trimming my toenails is out unless I contort myself. It’s a risky venture.

It was helpful to have 24/7 support and to have my lovable but needy dog at the kennel for the first day or two at home. My 8 year old son was at his dad’s house for approximately the first week after I got home. I would have loved to see him sooner, but that’s not how custody schedules work sometimes. I was required to walk a few times a day for a minimum of 15-20 minutes at a time and I made it happen but it wasn’t pretty. I used a walker and made sure to have a chaperone with me at all times. I timed walks for after the pain meds had kicked in but they were still agonizing. I wasn’t allowed to sit for more than 20-30 minutes at a time without moving and not allowed to “BLT”, or bend, lift, or twist.

 

File_000 (2).jpeg
A picture of me, half dead and in my nightgown, on the trainer approximately 1 week after surgery. I kept resistance low, it sucked and I thought my guts were going to fall out, but I was compelled to do it to prove that I COULD. This was a SIGNIFICANT milestone for me.

 

The Rest of the Month

The rest of the month was all about gradually adding time and distance to my walks, and tentatively getting on the modified bike trainer at about the 1 week point. I cycled for all of 5 minutes and considered it a major victory! By week 3 I was ready to try out Zwift and had a blast. At 1 month out I’m abnormal in that I can walk a solid 5K without major issues (this is advanced for spinal fusion patients!) and can ride the trainer for about an hour before I want to die and/or puke. My surgeon was mostly correct in that I would hate him for the first three weeks; turns out, I hated him for weeks 1, 2, and 4. Week 3 was some sort of amazing renaissance period where everything was grand (it was probably the drugs). Week 4 I stalled out and felt exhausted, and that’s when I realized I needed a recovery week in my training.

Jul Workouts
Strava data! Hours of exercise per week, colored by activity type, starting about 5 days after surgery.

I gradually weaned (or am weaning) off of three most addictive, heavy-hitting medications at week 5. The muscle relaxers and pain medications made me feel drunk, and more often than not in a bad way. My moods were all over the place, unpredictable, and I had quite a few crying spells. I cut the Oxycontin and Valium together in stages over multiple weeks. I used a pill splitter to QUARTER medications so I could ease off slowly. It definitely wasn’t linear, with ups and downs and returns to higher doses at times. I still take both for breakthrough pain, probably once or twice a week.

Now I’m fighting to wean off of the Gabapentin, which has proved to be quite evil. I believe this is the medication that’s causing the vertigo and ataxia — at my full dose I run into things, have no spacial awareness, garble my words, and have gotten close to passing out multiple times. I’m down to 2/3 of the prescribed dose and some of the symptoms are already getting better. However, I’m having withdrawal symptoms now (insomnia, leg / nerve pains, eye twitching, headaches .. ugh) so my weaning process will be very slow. Some lucky people never experience this, but I tend to be the oddball who is medication sensitive and ends up with the rare side effects.

Surgery recovery takes a toll on your mental health. Not being able to do regular tasks for yourself is immensely frustrating especially when you’re stubborn and pride yourself on being self-sufficient. Having a shitty childhood where you often had to fend for yourself will do that to you. (No offense, dear father – you had your hands full “parenting” the addict and working 40+ hours a week to keep us afloat.) Just showering and getting ready for the day is hard, and at this point I’m usually pants-less in flowy dresses, no make-up, and with undone hair. I dread re-entering the “real world” where I’m expected to do these things before I show up at work. Putting on a real pair of pants can be a 10 minute ordeal! I can’t cook for myself unless it only involves the microwave or toaster oven, can’t bend to use the regular oven yet, I’m at home alone a lot, and I tend to get depressed about not being able to do things or the ongoing, but less severe, pain. I look fairly “normal” to outsiders, and I think that’s the hardest shift between this surgery and my foot surgeries. When you’re in a cast and on crutches, it’s obvious to the world that you’re ailing and need assistance. Unless I’m limping, I look like normal Melissa.

 

success
Image credit goes to Demetri Martin, from his book The Art of Doing.

Don’t get me wrong, spinal fusion has been great and I wouldn’t change a thing — I can walk 6x further than I could beforehand without nerve pain and leg numbness, and I can sit on a bike seat for 60 minutes instead of 10 minutes before the numbness begins to gradually bother me, starting with a tingly left big toe. The doc predicts that the numbness will continue to fade as time goes on. The nerves were crushed and angry for a very long time (I remember numbness as far back as 8 years, now that I really think about it), and it takes a while for the nerves to get less pissed off. It’s a journey, and my general trajectory is up. I just have to keep climbing.

File_003
BOAs are easier than laces! Now that I’m strong enough to reliably clip in and out, I’ve switched back to these shoes. I love my Kinetic trainer, we’re good friends.

 

4 thoughts on “Spinal Fusion: 1 Month Update

Leave a Reply