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    Old 08-14-2006, 02:13 PM   #1
    Lilacs&Lillies
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    What to expect when the collar comes off?

    I have my first x-rays to check for fusion (ACDF C-5-6) tomorrow and then the doctor visit right after. Can those of you who've been there let me know what to expect when the collar comes off?

    Like, did you do physical therapy?
    Were you sore?
    What were your restrictions, etc.

    I've "cheated" a few times recently by (very carefully) showering without the collar on. Seems like the back of my neck hurt when washing my hair. I can't imagine what it will be like without it for real.

    Any info, hints, tips, etc. appreciated.
    Thank you

     
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    Old 08-14-2006, 10:59 PM   #2
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    Re: What to expect when the collar comes off?

    I had an aspen collar for 6 weeks. I showered every other day and kept my head aligned straight while washing/rinsing. My doctor was fine with this as long as I put the collar on right after I showered.

    I had the collar for 6 weeks and when it was removed I finally got a good night sleep, but I did feel a little vulnerable as if I was too 'delicate' (you get so used to not moving your head you are almost afraid to move it when the collar comes off).

    I did not do any PT. I got the collar off on a Monday and returned to work part time on that Friday. I was sore in the first few weeks after the collar came off and was concerned - but when I spoke to my doctor he explained that (1) my neck had been immobilized and I had not really had to support my own head or make any significant neck movements; and (2) now that an area of my spine was fused, that area would no longer bend. So the neck muscles have to re-learn how to function and adjust to the new 'rigid' area of the fusion.

    I would say I was more sore than in true pain, but I did find the need to take some muscle relaxants and/or pain meds at the end of each day. I am just at week 12 and there are days that go by in which I don't need any prescription pain meds. And, when I do, it's usually 1/2 to 1/4 of a tablet.

    Karin
    C5-C7 ACDF 5/18/06
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    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 08-15-2006, 04:16 AM   #3
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    Re: What to expect when the collar comes off?

    Karin,

    Thank you for your reply. And for mentioning the meds. I didn't know if I should ask to have some more on hand or not - just have a few left.

    Yesterday I did some mending - had my head bent down quite a while with the collar on, and was so sore last night I had to go back to Rx meds.

    Do you have any restrictions now or is it more of just a 'common sense' thing working your way back to normal?

    Thanks again for your help

     
    Old 08-15-2006, 07:13 AM   #4
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    Re: What to expect when the collar comes off?

    Hi,

    My collar was on 24/7 for 12 weeks! I went to PT after six months.

    I think that PT is a critical part of this recovery (irregardless of what some docs think). I was given an excercise routine to strengthen the neck which I still do every other day (2+ years later).

    The strengthening of the neck is very important. It will help to eleviate the potential for a level above or below failing sometime down the road.

    Ask for a physical therapist that understands neck injury recovery.

    Too many doctors think that just because their patients want "instant" results, that they should provide them. This is a long recovery. Complete fusion doesn't occur until one year after the surgery.

    There are more and more people with failed fusions who didn't wear the collar, or wore it for a short period, did no physical therapy, and went right back to work. If you take that course, good luck.

    BTW, I was off the pain meds at 3 weeks, and never took any after that.

    Dennis

    Last edited by dennisgb; 08-15-2006 at 07:16 AM.

     
    Old 08-15-2006, 02:49 PM   #5
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    Re: What to expect when the collar comes off?

    Thanks for your reply Dennis.

    Doc said things were "coming along" , plate & screws, etc, look good and I could stop the collar now. When I asked if there was fusion, he said "Oh no - that takes about a year." You could clearly still see the "chunk" of donor bone there and he said next year that chunk should not be obvious.

    My restrictions are just "common sense' things like - no strenuous exercises, no jogging, no boating, no horseback riding, no amusement parks, racquet ball - etc. that type thing.

    I sort of chickened out asking for more pain meds to have on hand. Before surgery I took large doses of NSAIDs (for other arthritic/neuro problems) and he said no more than a couple a day on bad days - so not sure what I'll do about that. He said my soreness and the "horse pill stuck in the throat" feeling would continue to slowly improve.

    I had hoped for PT or an exercise program, but he shook it off as unnecessary. The doc who did the ESI's said strong muscles in the neck and back can make a world of difference and I do NOT want to go through this ever again.

    So when you got your collar off at 3 months, then you took it easy for 3 months and THEN started PT? Is that right? Maybe I'll ask my GP for a recommendation - he's an osteopath, so I'm sure he would agree.
    - What type of exercises did you do?

    N.S. made the comment that if he saw me again, it wouldn't be for the area he fused, it would be one of the adjacent areas that are already borderline. - - gee! I hope I never see him again, then!

    Thanks again for sharing your experiences.
    Lilacs

     
    Old 08-15-2006, 06:56 PM   #6
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    Re: What to expect when the collar comes off?

    Lilacs:

    Right now I still have the standard lifting restriction, no jogging or any other 'neck strenuous' activities. I see the doctor again 8/28 and at that time will need to address what my 'updated' restrictions are. He had said that if all is well I should be able to reuturn to Curves (working out) after he sees me 8/28 and he always says that pain has to be my guide in the first 9 months after surgery. I think that at my 8/28 visit (which is essentially my 3 month post op visit) I won't have to see him again for another 3-6 months after that. Which is good since I changed jobs and my new job has good insurance, but does not have my doc as a participating doctor so when I see him it will be via 'out of network' benefits (costing me a bit more). But, I've always been willing to pay a bit more to get the right doctor/treatment so now that the majority of my costs are all taken care of - only minor costs should come into play in the future. I will talk to him about maybe my primary care doing the x-rays (since then the new insurance company would cover them) and then bringing them to the Orthopedic Spine Surgeon's office.

    When I went to see the doctor in July (at about 6 weeks post op) he was able to give me a non-narcotic pain medication (tylenol based prescription since advil, aleve, aspirin aren't yet allowed) and that helps during the day. But even today, at 12 weeks, I had a stressful day and overdid it at work (even though I have a 'desk job'). So I did take 1/2 of a pain pill and 1/2 of a muscle relaxant when I got home. Check with your pharmacist but many meds can be scored in half or even quarter. I find that 1/2 gives me just enough relief but doesn't give me all the loopy effects of a full dose. So sometimes I do 1/2 of the pain med and 1 tylenol together.

    I did tell him I had some muscle spasms and he said that he can prescribe physical therapy but he said it really doesn't seem to help much. He said the muscles are learning how to move in relation to the fused area. So he did give me more muscle relaxants and I find this is often all I need.

    Pre-surgically the doctor and I had a discussion about the fact that after you fuse an area in the spine, the discs above and below can begin to have problems (more stress on those discs) and I do have slight disc herniation at C4-5. My doctor's hope is that for now I won't have symptoms of that (or if I do they will be minor) and in the future if it gets worse the technology behind artificial discs might be more advanced to the level where he can do that for the C4-5 level if needed.

    Karin
    ACDF C5-C7 5/18/06
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    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 08-15-2006, 09:41 PM   #7
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    Re: What to expect when the collar comes off?

    Karin,

    It's nice to know your doctor will be seeing you for continued follow-ups. I feel so much WORSE without the collar on. Cooler, yes, but the back of my neck really hurts - which is frustrating since all my pre-op pain was in the arm, hand & fingers - not my neck. Is the back of the neck where your pain is now too?

    I was never on muscle relaxants post-operatively, as he uses Valium instead. It helped a lot, but I stopped taking them when I had summer school finals. Even tho I felt no sedation, extra calmness or anything on it (that I could tell anyway) - I was such a BEAR the week I went off it, that in hindsight I wonder if it was a withdrawl thing going on?! It very well could have been the fact that I had 2 term papers, 2 unit tests followed by 2 finals, the philadelphia collar on in humid 100+ degree heat, etc., but I was really so uncharacteristically grouchy that it did worry me. (My family didn't deserve the way I snapped at them that week.) Muscle relaxants usually wipe me out, and the Valium did not, so I thought it was a good suite for me - but now I'm afraid of it. Wonder if it can do that to you in just a couple weeks of it?

    Dennis, I'm glad you didn't need anything after only 3 weeks. Don't know if you're lucky or just have a high pain tolerance, but that's wonderful.

    Karin, I'm sorry you are still needing something - but it makes me less worried that I am feeling this way right now. - That "comfort in numbers" thing, I guess.
    If I feel this way again tomorrow, I will call the doc for his suggestions.

    I know everyone is different, but I am so grateful to have someone to talk to about their experience with the fusion, plate, etc.

    Thanks

     
    Old 08-16-2006, 09:40 AM   #8
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    Re: What to expect when the collar comes off?

    Quote:
    Originally Posted by Lilacs&Lillies
    Thanks for your reply Dennis.

    Doc said things were "coming along" , plate & screws, etc, look good and I could stop the collar now. When I asked if there was fusion, he said "Oh no - that takes about a year." You could clearly still see the "chunk" of donor bone there and he said next year that chunk should not be obvious.

    My restrictions are just "common sense' things like - no strenuous exercises, no jogging, no boating, no horseback riding, no amusement parks, racquet ball - etc. that type thing.

    I sort of chickened out asking for more pain meds to have on hand. Before surgery I took large doses of NSAIDs (for other arthritic/neuro problems) and he said no more than a couple a day on bad days - so not sure what I'll do about that. He said my soreness and the "horse pill stuck in the throat" feeling would continue to slowly improve.

    I had hoped for PT or an exercise program, but he shook it off as unnecessary. The doc who did the ESI's said strong muscles in the neck and back can make a world of difference and I do NOT want to go through this ever again.

    So when you got your collar off at 3 months, then you took it easy for 3 months and THEN started PT? Is that right? Maybe I'll ask my GP for a recommendation - he's an osteopath, so I'm sure he would agree.
    - What type of exercises did you do?

    N.S. made the comment that if he saw me again, it wouldn't be for the area he fused, it would be one of the adjacent areas that are already borderline. - - gee! I hope I never see him again, then!

    Thanks again for sharing your experiences.
    Lilacs
    I had a minimal isometric excercise program to help get my neck back working again after the collar came off. My doc didn't want me to start PT until six months. He was a bit conservative. I honestly believe that the PT and continuing excercise has been critical to my successful recovery.

     
    Old 08-16-2006, 09:49 AM   #9
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    Re: What to expect when the collar comes off?

    Quote:
    Originally Posted by kross426
    Pre-surgically the doctor and I had a discussion about the fact that after you fuse an area in the spine, the discs above and below can begin to have problems (more stress on those discs) and I do have slight disc herniation at C4-5. My doctor's hope is that for now I won't have symptoms of that (or if I do they will be minor) and in the future if it gets worse the technology behind artificial discs might be more advanced to the level where he can do that for the C4-5 level if needed.
    This is the most common problem after ACDF surgery. I urge you to get a referral to a Physical Therapist that is versed in neck surgery and recovery. Strengthening the neck is critical to avoiding this problem. If you have a pre-existing problem at C4-5, you shouldn't even hesitate. If you do this, learn the excercises and make them part of your normal routine after you complete PT. If you think your surgeon is right, then good luck...I'll bet you'll be back here in a couple of years after your second surgery tho...sorry, I do not agree with what your doctor is telling you. Take the initiative to ask the questions about how PT and neck strengthening might help you given your issues at C4-5...

     
    Old 08-20-2006, 02:50 PM   #10
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    Re: What to expect when the collar comes off?

    Even though you've been told you don't have to use the collar, you might find it helpful to wear when you feel vulnerable - remember, not having to wear it doesn't mean you don't need it if it makes you comfortable. Instead of getting rid of it try weaning yourself and continue to use it when it makes you feel better, you'll find you need it less and less.

    Also, couldn't agree more with Dennis, physical therapy really helps and also slows you down when you're doing more than you should!

    W

     
    Old 08-22-2006, 09:32 PM   #11
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    Re: What to expect when the collar comes off?

    I have to agree with Dennis - I had to really *push* my OS to get him to prescribe physical therapy, but since it was a choice between that and having me crying in his office, he gave in. I had a month of PT at 3 months post surgery, and I've just started a second month of it at 6 months.

    The first month was just for my upper back, because I was having so much pain and soreness in the muscles. It's true that they have to adjust, but it's also true that knowing what exercises to do to strengthen them helps *immensely*. Plus, my PT did some deep tissue massage that worked wonders. After the collar came off but before the PT started I was a wreck because of the muscle pain and spasming.

    This new month of PT is to strengthen my neck muscles - keep them strong and flexible - to avoid recurrence of herniation at lower or higher levels. I really think this is the single best thing you can do for yourself after the surgery we had, to improve your chances of non-recurrence and to improve your quality of life. A very little pain is waaaay better than a lot!

     
    Old 08-23-2006, 07:18 AM   #12
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    Re: What to expect when the collar comes off?

    merryish,

    I couldn't agree with you more. I hope you learn the excercises and make them part of your daily routine, if you do, you will find that those pains and spasms will not happen anymore.

    I sure hope that people are listening to this. I know it is the single most important thing that I have done. Excercise!

    Just hear too many people who think that this is an easy fix, and go back to life as normal. To many doctors support this way of thinking, because they want their patients to be happy.

    Many of those who are listening, but don't, or won't do the excercise routine, will be back here in pain, and wondering why.

    Sorry, I'm up on my soapbox. This is one that is so important, that I will keep pushing it. If just a few people follow through, they will bring the support back to others. Trust me it works!

    Last edited by dennisgb; 08-23-2006 at 07:19 AM.

     
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