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    Old 08-21-2012, 05:21 PM   #1
    fastcarbon
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    Lumbar fusion progress

    I had a PLIF and ALF or 360 degree fusion S1-L4 and a stabilizing device between L4 and L3 which is supposed to prolong the time for the spine to degrade a level higher and again require fusion. I am a 70 year old competitive cyclist and trail runner and the Doc thought the device would allow more flexability in the spine for athletics.
    I am now 22 days post surgery. After 4 days in the hospital I was sent to a rehab hospital for 6 days where I received PT 3 - 4 times per day plus walking with a walker accompanied by a nurse. I now get PT at the house 3 times per week.
    After two trips to the ER where I received 2 Dilaudid? shots plus Valium. Both legs from ankle to buttocks were at a 9 - 10 pain level (screaming level). ER called my surgeon at 3 AM and I was given 10/325 Oxycodone (Percocet) at 1 tablet every 4 hours and Neurontin (Gabapentin) 300mg 3 times per day. After my second ER visit my Percocet was increased to 20 mg per 4 hours. I am finding that I can control the pain with a schedule that gives me the meds before there is pain. Generally the leg pain only occurred at night. Days are spent in a recliner and nights sleeping on the side with a pillow between the knees. I have PT exercises to do twice daily in the recliner. I walk 2 times per day up to 1/2 mile.

    I was hoping to return to work in 6 weeks but I suspect I may still be drugged up based on the experiences of others. Isn't it interesting that prior to the surgery leg pain isn't really discussed by the Docs. They gave me a list of possible negative outcomes with nerve pain listed. I will admit that both sciatic pain and back pain except for the surgical pain were gone after surgery and that leg pain is my only complaint. But that leg pain is worse than any back pain I ever had.
    A young lady in her early 30's was in my rehab hospital. She had the identical surgery to mine by the same Doc 3 days later than mine. She has been to ER also with leg pain at night. Her's was so bad they hospitalized her for two days. She gets Dilaudid pills for pain and something called Nucynta for her nerves. Our surgeon has a sterling reputation and teaches back surgery. As opposed to many posts his office has paid outstanding attention to our differing pain management issues. I wish all well with your pain. I think you have to have the surgery to appreciate what nerve pain is. I will report my progress.

     
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    Old 08-21-2012, 07:13 PM   #2
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    Re: Lumbar fusion progress

    You are one amazing person! I hope everything will work the way you want it to work and your recovery will continue smooth and pain free.
    Unfortunately this is a nature of the beast. Recovery after big spinal surgeries are long and painful; too many bumps on a road. For 3 days you feel you on a way to recovery, than you take couple steps back and so on...
    My both surgeons have very pristine reputation, written a lot of books about spinal fusions, nerve damages, etc. They both work on research and pefromed surgeries on serious spinal damages for famous athlets in a world.
    Yet, I am permanently disabled with a lot of nerve damages living life under PM. No, this is not my doctors fault at all. Just when we read information they give us to sign before surgery, you see where it's written what may happen during surgery especially about nerve damages. This happened to me; I also got Arachnoiditis as a complication. It happens. Nothing can be done to help. Need another surgery but was told that with each spinal surgery, our spines become weaker and weaker so we try to buy some time by having epidurals and other treatments to help pain.
    Same as you, during first 2 years after my first surgery, I was many times admitted to the hospital for 4-7 days. Nothing could help my pain; I was on strong IV doses of opiates, but nothing helped. They thought I developed infection and when I was told that this may be a case, first time in my life I learned what depression means.

    I have a question for you; I don't understand why your PM Dr doesn't Rx you pain medication despite your pain and visits to ER. I was told by my Doctors to never let pain go high, to take my Rx drugs when pain just starts elevating, b/c if it gets too high, very hard to bring it down.
    And as a rule: we dont heal when we in pain. My Doctors insist me taking my drugs and not to play hero. They are 100% right; if I try to wait, I know it will need couple hours to bring my pain down.
    I know that ER must report to your DR if you go and get opiates there. you been there twice, why is he doesn't keep you on some kind pain killers? Obviously, you need help on regular basis, so why wait until pain escalates this high that you need to go to ER?
    Usually, when pain persistent, they keep you on Long acting (LA) opiates every 6 or 8 hours and on Break Through (BT) drug like Percocet. This way your blood plasma levels don't jump, drugs keep it on same levels helping your pain.

    I wish you fast recovery and less pain. I always feel for people who had surgeries, hoped to live life pain free and instead you get new pains. But we all shell hope for that light at the end of the tunnel...

    Moldova

     
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    Old 08-21-2012, 09:05 PM   #3
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    Re: Lumbar fusion progress

    It may be that you are walking too far too soon, given the amount of leg pain you are experiencing. The point of walking in the first 10-12 weeks post surgery is to stretch out the spinal nerves. This helps to prevent scar tissue from attaching to the nerves as it grows and fills in. The best way to accomplish this is to take a number of short walks rather than one or two longer ones. This also keeps the patient from becoming overly tired and from irritating the SI joints and sciatic nerves.

    It is not customary to have to go to the emergency room after lumbar fusion. You might try easing up on all activities and just taking short walks in between your rests until the nerves begin to calm down. Once you start having nerve pain, it can be very difficult to get back under control. Once irritated, it can set off a vicious cycle -- it is so easy for the nerve itself to become inflamed.

    Many people have problems with the SI joints after a multi-level lower lumbar fusion. Suddenly the most active segments of the spine are immobilized, and the next area with any movement is the SI joint. The piriformis muscle runs across the buttock, attaching by the SI joint and near the hip on the other side. The sciatic nerve runs directly underneath the piriformis (and through it in some people). Of course all these separate parts work together when we begin to walk. When anything is slightly irritated, swollen or out of alignment, the result is frequently either "hip" pain or leg pain, made worse by walking....Usually the more one walks, the worse the pain.

    Try to learn to listen to your body. Recovery is a slow process requiring a great deal of patience. You will find that you have some progress followed by a bit of a set-back. This is very normal and what most people experience. You will find that you cannot rush recovery or do it on your own timetable...when you try, you may just find yourself creating more problems. This is a race that is usually won by the tortoise.

     
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    Old 08-21-2012, 10:53 PM   #4
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    Re: Lumbar fusion progress

    Quote:
    Originally Posted by teteri66 View Post
    It may be that you are walking too far too soon, given the amount of leg pain you are experiencing. The point of walking in the first 10-12 weeks post surgery is to stretch out the spinal nerves. This helps to prevent scar tissue from attaching to the nerves as it grows and fills in. The best way to accomplish this is to take a number of short walks rather than one or two longer ones. This also keeps the patient from becoming overly tired and from irritating the SI joints and sciatic nerves.

    It is not customary to have to go to the emergency room after lumbar fusion. You might try easing up on all activities and just taking short walks in between your rests until the nerves begin to calm down. Once you start having nerve pain, it can be very difficult to get back under control. Once irritated, it can set off a vicious cycle -- it is so easy for the nerve itself to become inflamed.

    Many people have problems with the SI joints after a multi-level lower lumbar fusion. Suddenly the most active segments of the spine are immobilized, and the next area with any movement is the SI joint. The piriformis muscle runs across the buttock, attaching by the SI joint and near the hip on the other side. The sciatic nerve runs directly underneath the piriformis (and through it in some people). Of course all these separate parts work together when we begin to walk. When anything is slightly irritated, swollen or out of alignment, the result is frequently either "hip" pain or leg pain, made worse by walking....Usually the more one walks, the worse the pain.

    Try to learn to listen to your body. Recovery is a slow process requiring a great deal of patience. You will find that you have some progress followed by a bit of a set-back. This is very normal and what most people experience. You will find that you cannot rush recovery or do it on your own timetable...when you try, you may just find yourself creating more problems. This is a race that is usually won by the tortoise.
    . Wow!!! How informative and well written!! I just learned a lot from you. Thanks for contributing so much on here. It truely helps so many!

     
    Old 10-14-2012, 01:25 PM   #5
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    Smile Re: Lumbar fusion progress

    Thanks all for your advice and messages of hope. I found the Neurontin at 1800mg along with Percocet did control my pain. I am now pretty much off Percocet and was able to drop Neurontin to 1200mg. I unfortunately found myself with short term memory loss and balance problems so had to use a cane. Two weeks ago my Doc allowed me to ride my trainer ( racing bike mounted on a trainer) so I try to do 30 minutes fairly light spinning AM and take my dog on a half hour walk PM.
    Due to my "loopiness" and need for a cane the Doc gave me 75mg Lyrica 2x per day the first week and change to 3x next week. The loopiness and instability are gone but I am developing something like cramping pain in my upper legs. Lyrica, at least at this dose and this time, doesn't control the pain like Neurontin did.
    So that is my progress. I am still very hopeful that I can return to a semblance of my former life.
    I know some of you were concerned with my level of activity. To be sure I have had days off of exercise when too tired. I do find after 5 minutes of spinning the pain in my legs goes away and stays away for a few hours.
    I do have to say that both back pain and sciatica have not returned.Even knowing what I have now I would still have had the surgery as I couldn't stand for more than 5 minutes without my legs going numb plus the sciatic pain that never left. I just had an MRI which shows lots of space for the nerves so I gather they are repairing themselves, ableit very slowly.

    I think with the right combo of meds I could do sedentary work. Hopefully I can find that combo. the Lyrica side effects will have to really decrease.

    The surgeon told me he was happy with my progress and thought I was ahead of what he expected so I will slog along asking advice from you guys

     
    Old 10-14-2012, 01:32 PM   #6
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    Re: Lumbar fusion progress

    Glad you are feeling better. Remember that sitting too long is not good either. I myself can't figure out how I will work ever with no option to lay down or recline with my feet up at any job.
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    Old 10-14-2012, 03:03 PM   #7
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    Re: Lumbar fusion progress

    It probably seems like a long time to you, but you are only almost two months out from your surgery. Sounds like you are doing very well.

    I hope your progress continues and you will continue to SLOWLY increase your activity level. You want to gradually improve without causing sciatic pain to flare up. It may take months to get where you want to be, but it will be worth it if you can keep the sciatic nerve happy.

     
    Old 10-14-2012, 08:15 PM   #8
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    Smile Re: Lumbar fusion progress

    Quote:
    Originally Posted by workinmom572 View Post
    Glad you are feeling better. Remember that sitting too long is not good either. I myself can't figure out how I will work ever with no option to lay down or recline with my feet up at any job.
    I didn't think about the continuous sitting. I am probably further from returning to work than I thought, Most of my day is spent in a recliner.

     
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    Old 10-14-2012, 08:17 PM   #9
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    Re: Lumbar fusion progress

    Quote:
    Originally Posted by teteri66 View Post
    It probably seems like a long time to you, but you are only almost two months out from your surgery. Sounds like you are doing very well.

    I hope your progress continues and you will continue to SLOWLY increase your activity level. You want to gradually improve without causing sciatic pain to flare up. It may take months to get where you want to be, but it will be worth it if you can keep the sciatic nerve happy.
    Yes. I only do as much as the Doc allows without bending.

     
    Old 10-20-2012, 07:10 AM   #10
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    Re: Lumbar fusion progress

    I have severe back pain. I have had two back surgeries with the last being a fusion (L5-S1). I have gone through the long list of pain meds and I just want to point out the if you want to go back to work and not feel high/dizzy you might try Methadone.

    I am on 90mgs/day and it is like taking aspirin as far as "feeling" anything.

    Best of luck and God bless

     
    Old 10-20-2012, 09:22 AM   #11
    fastcarbon
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    Smile Re: Lumbar fusion progress

    Mikeh66: I appreciate the advice. I know almost nothing about this drug except I know it at least used to be used for Heroin addicts to get off it.
    I will talk to my surgeon. I do wonder if I would need to see a Pain Doc to get it. Did you find it addictive? What happens when you getr a drug screening? do you take it as a pain med or does it help with the nerve pain?
    I don't know if Neurontin or my new drug Lyrica actually accelerate nerve repair or just control nerve pain.
    Have you found the drug to allow clear thinking and stable walking. I am guessing too much of this drug would be intoxicating. Do you need to add increasing doses?
    I definitely will discuss this med with my surgeon. fastcarbon

     
    Old 10-20-2012, 04:03 PM   #12
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    Re: Lumbar fusion progress

    Yes this Methadone shows up on drug screens, Yes it is addicting, Yes you will think clear, No it does not make you dizzy.

    I guess the original reason for Methadone was for Heroin addicts, but it is a strong pain killer and for the same reason they give it to Heroin addicts is that it does not act like most drugs. There is no HIGH OR FUN with Methadone.

    Good luck and God bless

     
    Old 10-20-2012, 10:28 PM   #13
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    Re: Lumbar fusion progress

    As far as I know, nothing exists that helps nerves heal faster. Lyrica and neurontin (gabapentin) are in a class of drugs known as anti-epileptics. They affect chemicals and nerves in the body that are involved in the cause of seizures. Later it was determined that these drugs also affected some types of pain....hopefully Lyrica will work for you.

    You mentioned your sciatica was cleared up, but that you now have leg pain. Is it in the front or where is the pain located?

     
    Old 10-21-2012, 12:07 PM   #14
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    Re: Lumbar fusion progress

    teteri66: The pain appears as more of a generalized ache from the hips, hamstrings and calves into the ankles. It is not a shooting pain as I had with sciatica which was only on the left and which I could follow the path of the inflamed nerve from buttocks to the ankles. Both feet are continually numb from the ball of the foot forward. The back of the legs are sensitive to pressure and develop pain when contacting the leg support position on my recliner. If I sit in a straight back chair for a long period as in a restaurant for a couple hours my leg pain increases and I usually have to take a 10mg Percocet in order to sleep. With Neurontin at 1200mg I pretty much eliminated the pain except for after sitting in straight back chair. I ended up with a mind which was slow and forgetful. The Doc gave me Lyrica about 2 weeks ago which seems to kill the ache and sensitivity without impacting the mind as much as Neurontin. But I am in the process of going to 3 75mg doses a day from only two. I hope the mind problems don't come back. I had hoped to return to work but would need to sit in a chair for long periods so I guess I am not ready yet. fastcarbon

     
    Old 10-21-2012, 12:44 PM   #15
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    Re: Lumbar fusion progress

    I too suffered major mind issues when I began my Nuerontin. It has gotten better. The literature from tje pharmacy said amnesia *** a top side effect.
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