Observations & Musings

Today marks 4-weeks from my TLIF L2-L5 surgery. After trial and error, we (the neurosurgeon and myself) figured out what dose of gabapentin (a medication used for nerve pain) worked best for the nerve pain I was having in my left leg—pain that was keeping me awake. After a second change to dosing, on Monday night I had the best night’s sleep I’ve had since surgery. It’s surprising just how much sleep affects a person’s whole outlook and demeaner. I found a decent night’s sleep will also affect pain levels. However, while I still have insomnia from time to time, it’s not due to leg pain.

Where I’m at today: Staples are out, and the steri-strips are off. My incision, though long, looks fantastic and the seroma is decreasing in size. It’s getting easier each day to log-roll out of bed and get dressed. I’m still using my walker but can take a few steps away from it. It’s been over a week since I needed to take the narcotic pain medication on a regular basis. However, I did have a day where, BAM, out of the blue without rhyme nor reason, I had a day of increased pain. The only thing that would bring it to a manageable level was taking one. While I could drive if I’m not taking the narcotic, I’m not able to get to the car or truck without a walker, so Shawn does all the driving for appointments. He also has decided that using a wheelchair to get me from the car into my appointments is prudent for time’s sake. I’m now up sitting at my computer every day for 1 ½ to 2-hours with breaks. I am also doing some light cooking. My appetite is still poor, but eating small frequent meals/snacks, seems to have halted the weight loss. Of course, it’s hard to actually weigh oneself when you’re in a hard-side cast and can’t bend over to SEE the dial.

It's time, at this 4-week mark (and to answer questions I’ve had), to share the back story. That is, how did I get to the point of surgery? First and foremost, back surgery is rarely about pain. As my neurosurgeon explained at my consult, “If all you were having was pain, I would not do this surgery.” Additionally, since pain isn’t something that shows on imaging studies, any type of back surgery is only done if additional symptoms match what imaging shows. Typically, back surgery is done when imaging shows structural changes that are severely affecting nerves.

My ‘back’ story:

I have had chronic back pain for more that 25-years after a lifting injury at work. I did not need surgery then as I only had a slightly bulging disk. After going through a chronic pain program, I learned how to manage and live with the chronic pain, which helped as osteoarthritis set in about 15-years ago. I never let the pain stop me from doing what needed to be done, nor stop me from the fun outdoor activities that are an important part of my life. Gardening, farm projects, kayaking, hiking, biking, tent camping, and snowshoeing. Tylenol and a prescription anti-inflammatory did wonders to help with pain as well. Fast forward a few years: 2 ½ years ago, I noticed I was getting pain in my left buttock and back of my thigh when I would drive more than 45-minutes or when I was kayaking. I also noticed the pain level in my back was increasing. At my physical a few months later, I mentioned it to my primary. She said because of the radiating pain, she was skipping x-rays and heading right to an MRI. She warned me that she anticipated the results wouldn’t be good and she was right. What showed was severe central spinal stenosis, moderate foraminal stenosis, and some large bulging discs. Because I was so active, we skipped PT and went right to a pain management (PM) referral. After meeting with the PM physician, we opted to start spinal injections. The first three injections (spaced 4-5 months apart) worked like a charm! The 4th one lasted 1-week and symptoms had worsened. Back to the PM physician for the next steps. 

Another MRI (about 1-year after the 1^st one) revealed a rapid progression of the spinal stenosis as well as two discs that had herniated into the nerve canals. At this point, because leg pain was waking me at night, we added a nerve medication and a referral to a neurosurgeon was written. Because our area only has one neurosurgeon, it took 2-months to get in. I went in prepared to have two levels worked on. One minimally, while the other one fused. I remember leaving the appointment and driving home in shock. I needed a full fusion on 3-levels done in my lower back. He warned me that the surgery was intensive, and the recovery period of 12-18 months would be one of the hardest things I would ever do. He also warned me it might be one of the most painful things I would ever do. He was not wrong. It would be a minimum of 3-months in a brace. I wouldn’t be able to hike until mid-summer (biking short distances was possible), work my bow and hunt until fall, snowshoe until winter, while kayaking would be nearly 18-months out. He suggested that the way to get though it was to pick one thing that I wanted to work for and make those my goal. I picked ALL my favorite outdoor activities.

It was the idea of my favorite activities that was behind a long conversation with Justin, my son. He asked if I would be able to do all the things I loved, and if so, what modifications I would need to make. We talked about each and every one as well as what modifications I might need to make. The conversation was therapeutic, which is why, I’m certain, that he asked. Justin has a wisdom about him that surprises me from time to time. Especailly his insights about people. Talking about and planning to do all the outdoor activities that I love to do, was just enough to remind me there was a reason why I was suffering through this long healing process. Not only is my mother wise, but so is my son. I would say, based on that, I did alright as a mother.

Surgery was 2-weeks ago. In some ways, I think, “2-weeks already?” yet—the days have drug by. An endless succession of position changes, small meals (to counter the lack of appetite), medication for pain, broken sleep both day and night, and wishing the healing would occur faster. Watching movies that I’ve seen before because of the inability to concentrate. Even reading a book at this stage is pointless. Part of the scrambled brain issue is due to broken sleep. This is night seven of the ‘middle of the night, severe nerve pain (left leg), that is waking me up and keeping me awake. Earlier in the week, I reached out to my surgeon. We discussed that this can be a normal occurrence, due to nerves regenerating and inflammation from the surgery still compressing some of the nerves. My provider and I decided to try tripling the medication (Gabapentin) for nerve pain. It takes a few days to a week for it to kick in, which is why I’m sitting at my MAC again at 1:00 am. Position changes, walking, and a middle of the night shower seem to work the best. I’ve been assured this sudden appearance of increase nerve pain is completely normal. Some of the pain can be attributed to regeneration of the nerves affected by the spinal stenosis, while others are simply due to the swelling and inflammation from the surgery itself. After all, there was a lot of work done in that 9” incision along my spine. How long it lasts? Will is gradually disappear or BAM be gone in a flash? Nobody knows.

However, I am noting small improvements as the days go by. Though I am still using the “Cadillac” style walker (thanks Mom), I am now able to help with dishes, keep the counters clean, and fold light pieces of laundry. I have also figured out just what one can do with a good long handled grabber. For example, feeding Kitzi his wet cat food twice a day. I’ve also been able to assist with making dinner. When I’m having an emotional moment (I’ve cried more in the last 2-weeks than I have in 2-years), Shawn reminds me that I’m doing great and that I’m on the road to recovery. He tells me that he sees improvement every day. Getting out of bed and moving around is easier than it was 1-week ago. He also reminds me of the activities I have to look forward to this summer. Hiking, gardening, and perhaps even out on my bike.

Finally, after 2-weeks my appetite has returned. However, how I eat resembles more like a toddler than a grown woman. The combination of the brace (aka corset) and lack of eating means I get full very quickly-- ½ slice of pizza or ½ burger with ½ cup of salad fills me up. To counter this, I’ve adopted a small, frequent meals and snacks plan. Losing weight while healing from a major surgery, is NOT the way to go. I still start each day with a protein shake or Ensure. My typical breakfast has been 1-2 small pieces of sourdough toast with almond butter (need that protein for healing) and fruit. The other odd thing that happened after surgery, was that I lost my taste for coffee. I had one cup the day after surgery to stave off the dreaded caffeine headache. It worked but I didn’t enjoy it like I normally would, so I switched to tea. I attributed the off taste due to the thrush infection I had in my mouth arising from several factors. This week, since the thrush is gone, I tried a cup of my own coffee, NOT hospital coffee, thinking perhaps a better quality would taste better. I couldn’t finish the cup. Perhaps what I was missing was frothed milk—mmm maybe tomorrow.

My trusy walker and grabbing handle.

My typical healthy breakfast

My excitement for this week? I get the 32 staples along my incision line removed on Wednesday!