OK, I want to use my case merely as an example to get some clarity on a bigger issue -- where does appropriate recovery from ACDF stop and overdoing it start?
I am Day 9 after 2 level ACDF (C4-5,C5-6) with donor bone and plate. No hard or soft collar prescribed. Discharged 34 hours post surgery with rx for 1 Vicodin every 6 hours and 1 Ribaxin every 6 hours. Told no extreme flexion, extension, twisting, bending or lifting, no driving or sex until follow up appointiment in 5 weeks. Period, end of instructions, other than incision care.
Since getting home, I have spent most of the days sitting, standing or walking. Lying down is not easy for me yet, as I have bad spasms when I wake up in the morning, whether I use recliner or various pillow configurations in bed. Wife bought me cervical pillow today, so we will see how that feels. When seated, I either am reading, watching TV, working on computer or on the phone. I have setup computer (laptop) so that screen is at eye level on desk in front of recliner, and I have extra keyboard and mouse in my lap, so I do not have to raise my arms or move my head a lot. Similarly, I have headset for phone so I do not bend neck. This enables me to work and maintain some mental sanity, without physically taxing myself.
Nonetheless, I have ongoing muscle pain and spasm issues in my shoulders and upper back, as well as a little ongoing tenderness in the throat and some swallowing issues, which I understand are normal. So, am I overdoing? By some standards people have received, I am, by others, not so much. I can't envision laying flat on my back or in a recliner 24/7, nor can I believe that is healthy. I also can't envision driving or doiong neck exercises at the moment -- if I inadvertently flex or extend much, my neck lets me know, and I took one short ride with my son yesterday, and paid for it. So, where is that "golden mean"?
It still boggles my mind that there can be such huge differences in post-surgery instructions for what are functionally identical procedures. Without a brace, it is virtually impossible to not move your neck in ways that are probably not indicated -- though pain is usually a good indicator when that occurs.
This may be more a rant than a topic, but worth a shot . . . Thanks!
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I don't think there is any magical line of demarcation.
I tried my first drive (I just had to have a DVD) at a few days out.
Yes, it hurt.
I hit the golf range about 10 days out (collar on).
No, it didn't hurt.
As time went by, I discovered what did cause inflammation and pain and what did not. I took a very long car trip at about 6 weeks out. Driving long distances doesn't work well for me even now. Sitting/standing 16-18 hours a day at a conference for 4 days straight almost 3 months out made me very sore. Sore as could be, but more like sore after a weekend of athletics. Lifting, carrying things was never a problem. I was doing the grocery shopping early on. Sitting for long periods is difficult, especially in public chairs.
I always thought there was much more to be gained by light activity - walking and such - than laying around. I've never been much for the "but you're gonna pay for it" stuff. So what? I expected to pay for physical activities with inflammation and soreness before my surgery. It's hardly a shock to get whacked by it after a surgery. Of course things get inflammed. Duh. As long as the fusion is stable, what's the big deal?
I think it's different for each person, and expectations play an important role.
At 10 days, my surgeon thought it had been 1 month based on my attitude. At 30 days, he thought it had been 3 months based on my attitude. Most people will self-limit their activities with no problem. You can lay in bed for 3 months straight and still have a bad fusion.
So, I have no idea, is what I'm basically sayin'.
As always, your surgeon or physician is your best guide.
"Use your health, even to the point of wearing it out. That is what it is for." George Bernard Shaw
Last edited by ThoreauFan; 02-16-2007 at 04:29 PM.
I've had two ACDFs - each time I was overnight in the hospital and home the next day, and the Dr recommended that I never again lift 75 pounds or more, no overhead work (like painting a ceiling), and no activities like roller coasters, or forcing my head too far (like a look over the shoulder for a lane change), etc. My situation sounds like yours - donor bone and plate (so no hip incision to deal with), and no collar (my Dr said that would just weaken my neck muscles, and make the recovery time longer). I had some shower restrictions to not get the incision wet for 3 days.
The first 2 or 3 days home was kind of grim - hard to sleep, change position, etc. On the second day home, I started walking on the treadmill (winter and snow outside). Every hour I would walk a few minutes, and added time bit by bit. Sitting or laying around too much is, for me, bad for the body and bad for the spirit. Within 2 to 3 weeks I was driving and getting out pretty much as I felt like, although I did take 6 weeks off from work to get my new neck off to a good start.
Two years after the last ACDF, I still have some chronic pain and cramps in my neck and shoulders - but I'm much better than if I had not had the operation. Driving is different since I don't have the same range of motion, and its hard to look down the long aisles at the grocery store or Target, for the same reason.
My advice - stay within your comfort zone, but get back to normal as soon possible, by walking and getting out and around as you feel able. Take it slow, but do a little more each day as you feel able - you may find that you have to learn a 'new normal'. If I had no surgery at all, and did nothing but sit or lie down for 6 weeks, I would feel terrible from the inactivity.
jeff.........i think u nailed it on the head. each person has similar symptoms; however, what varies is the different diagnoses/procedures coming from the neurosurgeon. if it feels good , do it. your body will tell you when you've over done it; likewise, you are probably more tolerant to pain than others. my fusion, level 1-c3/4/5, partial initial paralysis of left side of the body. 3 months post op, a little problem with some shoulder movement over my head. reading your post, i can tell that you are a strong willed person. open your mind to full recovery, and the gratification of improvement will be a joyous occasion............by god's grace bryan stinchcomb
As you've obviously already figured out, the recovery process is different for each person. You know best what you can and cannot do; it's just a matter of learning to 'listen' to your body. Whenever you are hurting the most, try to think about what you've been doing. Look for commonalities. I know I always tell folks, "If it hurts, don't it it", but there IS a difference between 'good hurt' and 'bad hurt'. If you think it will help at all, keep an activity/pain log and see if you find any correlations. At least you're trying to understand instead of being like some dimwit who goes out and, say, jumps on a trampoline and then says, "Dang, why am I in so much pain?"
Does that make any sense at all?
I will note that sometimes healing nerves are 'slow'; i.e., they do not always respond with pain right away. I know sometimes I'd do a questionable activity, feel OK afterwards and think everything was fine, then be in agony two days later. The whole process is a little freaky.
You mentioned being on the computer several hours a day. I don't know if your mouse hand is on the side where you were having pain, but the forefinger and thumb are associated with the C6 level, so even something as simple as that could potentially cause you some pain. Same with turning pages in a book. And I don't know about anyone else, but talking made my throat sore for several weeks after surgery. Swallowing and eating weren't a problem. Go figure.
You sound as though you're doing pretty well and trying to keep yourself occupied, which is good, while at the same time being conscious of the fact that your body is healing. You are, however, only nine days out from surgery, which really is not a very long time. Maybe consider shorter stretches of work with rest in between. Work for an hour, then watch TV or listen to music or an audiobook for 10 minutes. Even that gives the muscles a little time to relax and recuperate.
In the end, though, you're the boss of yourself. You can be a good boss or a bad boss.
Good luck, and hope you're feeling better soon.
p.s. I couldn't get up, even from a recliner, without cradling the base of my skull in my hands for about the first two weeks.
p.p.s TF - what IS it about the public chairs? I can't believe how many of them make my neck hurt!
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I think that you mistake resting for inactivity.. they are different... resting is taking a break between activities.. I believe in doing as much as you reasonably can as soon as possible after surgery... I was the one getting up only a few hours after surgery to go to the bathroom!! But it really does help my spasms if I just lay down for 5-10 minutes, just to take the weight of my head off my poor neck muscles..and I dont take muscle relaxers hardly at all I haven't really needed them (maybe 5-6x in four weeks) I used to have to lay down more frequently and for longer time periods, I am only having to do this about once a day now and spend the rest of the day mostly standing, walking or doing light housekeeping and cooking I try to sit less than about 3-4 hours total a day. Today I : took a shower, did two loads of laundry, talked on phone while walking around house,went out to eat, went with my dh for doing errands (mostly in car) then went to the grocery store, put groceries away, cooked and did some dishes (it is still hard to put heavy plates up on high shelves and for the last two nights have gone with dh and dd to our workout place,, walked laps and went on stationary bike for 10 minutes (moved my head too much) now this is not anywhere near what how busy I was before surgery!! But my dh was still disappointed that I became tired at the grocery store.... He wanted to go to the mall afterwards!! He said boy you are really out of shape!! LOL!! In his defense he is becoming tired of babying me so much!! My doc like everyone else's didn't give me a clue as to what I should be doing..so I'm also playing it by ear and my FIRST appointment is this tuesday...hope everyone will feel better soon!! Jean (bdancer)
I had C5/6 & 6/7 done on an outpatient basis, sent home with vicodin as needed and a soft collar for two weeks. Biggest restriction I had was not to lower my chin. I think that while you are sitting using your laptop, even though you have a setup that doesn't require much movement, that may be the culprit for your muscle spasms in neck and shoulders. I only say that because unless your head/neck is resting on the back of the recliner, you are supporting your head/neck with those muscles, and they get tired! I for one find it hard to sit at the computer for very long without movement. That's why I'm still out of work at 6 weeks post op, and looking at going back part time in a couple more weeks. I believe walking is a good thing. Stairs still wear me out, though. I find that low level activity is good, and I get through the morning pretty good, but by lunchtime or so, my heavy head and neck need resting for a while...then I'm up and about again, cooking dinner, etc.
You are right though, about the wide and varied post-op treatment...it's perplexing! I do know one thing: I was not in any way, shape, or form prepared for what I am still going through. Thanks to this board, I have adjusted my expectations, and learned that I am not alone, and that's a big help!
You must remember you are ONLY 2 weeks out of major surgery and these things take time to heal. Why no collar (?) but I would a least get a soft collar for sleep. I am 3 months post op ACDF c5-7, still sleeping in a recliner and wearing a soft collar. Try to do what you can gently, your body will let you know when you are going overboard. I will start my first round of P/T next week to loosen up everything that I haven't been using for a long time. But again remember, the fusion can take from 6 months to a year before 100%. Walking has been my main source of exercise, so i'm looking foward to doing a little more. Everybody does heal differently and at their own pace so don't get discouraged if you don't think you are where you should be. Good luck and keep us posted on your progress!!
I second that computer thing. I have noticed the computer is the main cuplrit as to the contributor of my muscle spasms. (always has been and still is). The other day I spent 3 hours on the computer trying to find a good NYC hotel room and boy did I pay for it with spasms. Its frustrating because I love going on the thing. But I know its making things worse.
Thanks for all of the responses. I agree that I was totally unprepared for the magnitude of the recovery and the issues I would be facing. These spasms have been very debilitating over the past few days, and I called my NS office this morning to see about adjusting my muscle relaxant type or dosage. I am totally off the regular pain medication, but these spasms are kicking my *&*** all over the place.
I live in the Philippines (I'm an American) and my spine doctor has just informed me things in my cervical spine are bad, very bad and my only option is now fussion surgery. I have 3 levels of discs indenting my spinal cord and one vertebre pressing on the cord. He has me wearing a soft collar except for sleeping and eating, am not allowed to sit or stand for more than one hour at a time. Or do anything I absolutly do not have to do.
My husband and I arrive in San Francisco MArch 9 and I have an appt with a specialist on the 13th.
I am terrified of the surgery!!! But when I read one of you went home the same day others the day after...that gives me a better feeling. As for recover, I am not worried about that, I have a large supportive family.
It's the surgery that is scaring me to death!!! I have night mares of not waking up from the anethesia or having a terrible reaction to some medication they give me. My nerves are a mess and I work hard at being possitive and keeping up my spirits...but I'm still so scared.
I'm assuming I will need a two level fussion, maybe a three..how long does the surgery take? Is there a good chance of going home the same day? I'm really freaked out about staying in the hospitol.
Thank you for reading this and letting me vent my fears!
I understand your fears -- I felt anxious before the surgery as well. The length of the surgery depends upon what is being done (artificial disk, cage, fusion) and how many levels. In my case (2 levels, fusion with donor bone and plate) the surgery lasted about 2 hours, give or take 15 minutes. I was in Recovery Room for another hour or so. Bottom line is that they wheeled me into the ER at 7:30 AM and was in my room at 11:00 AM.
Going home the same day is doubtful, although I have seen some outpatient surgeries on the board. However, with multiple levels involved, you can pretty much count on one night in the hospital. They need to wean you off the morphine, make sure the incision site is OK, check bladder and bowel function, etc. I appreciated the night in the hospital, though the nurses did not really give me a chance to sleep much, given the frequent vital sign checks, medication administration, etc.
All in all, it is not bad, certainly not nearly as bad as I expected.