I have a fusion surgery (L5-S1), with support insertion in L4-L5 scheduled for January 12, 2012. I had a laminectomy at L5-S1 in 1984 and another in the same place in 1994. Dodged the fusion bullet then, but I didn't make it this time. I am having the surgery at CIMA Hospital in San Jose, Costa Rica.
We have a four month old yellow labrador puppy, Ruby. We have had a personally trainer come out and work with us since we got her at two months old. We have concentrated on her training, knowing that this surgery was in the not too distant future. Well, it came a little earlier than expected. Any tips on dealing with pets during recovery.
I read and printed out the post-surgery tips. Fantastic, practical ideas!
Welcome to the board. Sorry you are starting out the new year facing spinal fusion surgery...but it sounds like you are preparing yourself and your house ahead of time, which will aid your recovery.
How responsible are you for the care of the pup? I was just thinking this morning as I put one of our dog's bowls on the floor, how difficult that used to be. After fusion you will want to avoid any bending or twisting at the waist, so if you feed the dog, you'll need to figure out how to put the dish in place...harder with a bowl of water than food!
Does the dog sleep with you? Hopefully not. You will not want the dog anywhere near your incision until you are healed. You will not want the dog stepping on you, leaning on you, etc.
If you walk the dog, this will be difficult as you cannot be pulled. Hopefully you will have someone to walk the pup for the next months. I know it is important to reenforce the training your pup has received, but again, I hope there is someone else in the family who can do it. It is very important that you do nothing to put stress on any part of your back while you are healing.
Unfortunately, working with a dog, you would be working your left side more than your right. While you are healing you will want to keep every activity centered on your body as much as possible. This includes simple activities like sitting. You will want to sit with your feet flat on the floor, with your weight evenly divided between your "sit bones" (in other words, do not cross one leg over the other).
The other danger with a pup is the danger of tripping over her, or getting your feet tangled up if she makes a sudden lunge or movement you aren't anticipating. You will find that your balance may be somewhat compromised for awhile post surgery. If you have any nerve damage, it can also effect your balance and ability to catch yourself if you start to fall or stumble.
That's about all I can think of at the moment. Hopefully others will chime in with more suggestions.
Good luck to you and please post with any questions or concerns that may come up as you move forward with the fusion process.
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Thank you so much for all the "Heads Up's" I had thought of some of them but not all. Fortunately my husband does the lion's share of the bending and twisting as I have too much pain even now to be able to handle Ruby other than to caress her. He runs 30 minutes with her every morning to try and burn off the excess puppy energy and he may be doing it twice a day once I have surgery. I can reenforce some of the training, but bending or manhandling her is already out of my league.
She does sleep in our room but not with us. She sleeps in a closed grate during the night and is happy to do so. It is sort of her refuge.
The most interesting comment was being "centered." I didn't realize that. I already have a tendency to lose my balance and fall so I will start concentrating on this aspect more fully.
I am currently swimming about half a kilometer and walking (in water) half a kilometer six days a week, along with about 45 minutes of leg, arm, and back exercises. I love to swim, dearly love it, and my one question to the surgeon was, "Will I still be able to swim after this surgery." He said "Not only will you be ABLE to swim, but you will HAVE TO swim!" He said I could be in the pool as early as two weeks, post surgery. In that context, I am actually looking forward to rehabilitation. I mention this because I am hoping that this aspect will permit to recover in the quickest, most stable and dramatic way possible. Then I can tussle with Ruby sooner than expected.
Thanks again for taking the time to give me "Ruby Tips."
One interesting thing about participating in a forum such as this is seeing the varying opinions coming from different spine surgeons. If you had posted a question regarding swimming, I would have given you completely different advice from what your surgeon has told you.
I am going to still make some comments, even though they differ from what your surgeon told you, just so you are aware of a few things to watch out for.
First, let me warn you that surgeons tend to be overly "optimistic" in their comments regarding recovery, often telling patients they will be doing things sooner than in reality, it turns out to be. The surgeon I had first gave almost no instructions, just telling his patients, "if it hurts, don't do it."
The problem with this advice is that you usually don't realize it is going to hurt until it is too late and you've already caused a problem for yourself.
And, after having had three spine surgeries, I am a big believer in erring on the side of being conservative. There is no point in pushing yourself, only to cause a flare of nerve pain that ultimately ends up taking longer to recover from, or in more serious cases, keeps the bone from fusing, etc.
I don't fully understand what is being done at L4-L5, but in any case, the last lumbar segment will be fused and will be immobilized. Any time a patient is fused, it puts additional stress on the first segment on either side of the area that is immobilized.
In the case of L5-S1, there isn't much movement to begin with, and the sacral area is naturally fused, so the first area post surgery that will take the brunt of all spinal movement with be the SI joints.
These have very minimal movement to begin with, and are not designed to move a lot. Now that the lower lumbar spine is fused, the SI joints end up being stressed way more than usual. Most patients with L5-S1 problems, usually end up with some sort of residual SI joint dysfunction...sometimes appearing as piriformis syndrome, "hip" pain or pain across the buttocks.
This usually goes away as the patient adjusts to the new positioning after fusion, when the fascia, muscles and soft tissue become rebalanced and learn to work more effeciently. But some people have a hard time getting to this point. The trick is finding the right amount of exercise and therapy that strengthens these areas without causing a flare.
Which brings me to swimming....Most people are allowed to walk in a pool as soon as their incision is healed, but actual swimming isn't allowed for several months. Swimming on the stomach is somewhat problematic unless you swim with a snorkel, which will keep the body in alignment. Otherwise, swimming on the stomach results in the back being in extension, which is not good for the bone cells that are trying to mend together. Just as you are not allowed to sleep on your stomach, swimming on the stomach is not allowed for the same reasons.
Second, kicking the legs sets up a "shearing" type of movement as the legs move in opposition, which is also very hard on the fusion. So for these, and other reasons, many doctors will not let their patients swim strokes, or swim laps until they are showing signs of fusion.
My last surgery was more complex than what you are having done...so my restrictions were much more arduous than anything a person undergoing a one level fusion would be told, but...I was not allowed to swim strokes on my stomach until 15 months post surgery! I could swim backstroke (back crawl) and I could do aqua therapy. I could walk in the pool, but still am not allowed to use a kickboard....But I am making good progress, and have healed well, and most importantly, am pain-free for the first time in about eight years.
For Christmas, I treated myself to a snorkle that is designed for lap swimming. I haven't tried it out yet, but am eager to learn how to use it.
Of course, you should follow your surgeon's instructions. I just wanted you to hear another point of view. If you get in the pool and find that you are having more pain, you will have some idea why that might be the case, and you might want to rethink your approach to rehab...but these are not things for you to worry about now!
I will tell you ahead of your surgery that walking is the best exercise for you post surgery...regardless of anything else you do.
Do you know if you will be wearing a back brace?
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I canīt begin to tell you how much I appreciate your taking the time and thought to send me your replies. To fill you in a tad more and give you the right perspective of my response in turn, let me tell you that I have had, in my lifetime, 12 surgeries, not including various and sundry procedures. This will be my 13th. Fortunately, I am not superstitious! I can tell you, with that experience, that I give much, much more credibility to the one who has the T-Shirt (as a a matter of fact, a whole load of T-Shirts in your case) than the surgeon. Donīt misunderstand, I respect his opinion and know for a fact that he is the best in Costa Rica. I have, however, always thought that a lawyer should have to spend a night in jail, an accountant should have to endure a tax audit, and a surgeon should have to go through the surgery he or she performs. It is one thing to know the mechanics and consequences theoretically and even practically, but it is quite another thing to live them. For that reason and for the shear logic of your comments, I am giving them a great deal of weight. The motto is SLOW, BUT SURE!!!!!!! I do not want to be here again.
I remember from my previous laminectomies that walking brought my greatest relief. I may do some on dry land, but my most recent surgery (in May) was arthroscopic surgery on my right knee, meniscus repair, so I prefer water. I will see how I do in water.
I must say that the surgeon may have been referring to walking in water and I took the mental, giant leap to swimming because I enjoy it so much. Just this morning I spent almost three hours in the pool, prepping for surgery. I use a gadget called a SwiMP3 by Finis. I listen to Bible classes and all sorts of music while I walk, swim and exercise. Probably I could avoid surgery if I could live in the water, i.e, no gravity, but I fear I would shrivel up like a prune. As for the snorkel, yes, I do use a Finis snorkel, but it is just the tubing without the goggles part. I like to be as free of gadgets as possible when I swim. I realize what you are saying, because with the snorkel you can actually swim without kicking. Actually, because of my pain, I donīt really kick that much even now.
Which brings me to yet another point. I hope this is not a bad sign, but I am already having the pain in the buttocks that you mentioned. One of the caveats that the surgeon gave me was that the success of the surgery would depend greatly on how much nerve damage I already have. He said that because I have little feeling in my foot all the way up almost to my knee, but the fact that it comes and goes makes me think there may still be life in "them thar hills." Hopefully.
I would appreciate your comments on the importance or advantages of a hospital bed in the initial days after returning home. I have used one for previous surgeries but this one is obviously posture dependent.
Also I would like to thank you for the "centered" explanation when we were talking about Ruby. As a result, we are going to have the trainer here one day before surgery and again, the day I return from the hospital.
Bunches of thanks again. I truly enjoy communicating with you. Sharon