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9 Days post op posterior Cervical Fusion

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Chronic Pain
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Taller Now
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Joined : Jun 2014
Posts : 356
Posted 4/15/2019 4:20 AM (GMT -7)

Update:
I had my surgery on Wednesday (4/10/19). It didn’t go quite as planned. I was supposed to have C5-7 posterior fusion with rods and screws to fix a nonfusion (psuedoarthrosis at C6/7) of a C4-7 ACDF done in 2014, and also a left laminectomy at C6.

The neurosurgeon did a C5-7 fusion on right side. My bones were so soft on the left side that he could only do a C6-T1 fusion and the bone at T1 was so small that he had to use a different smaller screw. It was a difficult situation but he got the screw secured but it went through the bone and sticks out beyond my bone (vertebrae). He also said my arthritis was so bad he cleaned out the right and left sides at C6 (laminectomy).

Immediately after surgery the awful part I have been dealing with for years is GONE! Yes I have surgical pain but it’s not that bad. In fact I am going to stop the diladid they put me on and go to just Norco (I was but my insurance denied it). A X-ray and CT scan post op does show the screw touching my C7? nerve, which explains my numb fingers and achy arm. They thought about going back in the next morning to try to reposition the screw but it comes with the risk of failure because of my soft, small bones. I chose to wait and see; if I have a numb finger then no big deal. If I fuse and continue to have problems they will remove the hardware. If I don’t fuse and have issues then I may be up a creek without a paddle, an exterior neck brace was discussed......

What surprises me is how little my post op pain is compared to what I was dealing with and much less than my anterior surgery. Yes, moving my arms sets off my muscles but it is manageable.
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straydog
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Posted 4/15/2019 9:19 AM (GMT -7)
TN, I have thinking about you & wondering how you are doing. What a great report from you to say the least. So glad to read the horrible pain is abating & you are finding the post op pain tolerable. Just a little food for thought, you mentioned stopping the dilaudid. If you have been on it consistently, perhaps you should consider cutting your dose in half. Give it a week at least so that you don't have the potential of any side effects.

As far as the issue with the screw I am guessing this will be a wait & see as your healing progresses. Please take good care of yourself. Being this pain free so fast is all new to you, so please do not over do things.

Keep us posted.
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(Seashell)
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Posted 4/15/2019 10:51 AM (GMT -7)
TallerNow:
What an absolutely fortunate outcome from your recent cervical surgery. What a liberating feeling you have been granted in such a significant pain reduction. A vision of rainbows.

I agree with Susie to taper the dilaudid. I am on oral dilaudid and a fentanyl patch and find the dilaudid more impacting of the two on me. You may experience withdrawal symptoms if you abruptly discontinue the dilaudid, despite continued dosing with Norco/hydrocodone.

Savor the pain reduction and your reclaimed body space. Your body as a friend instead of a foe. Sending you wishes in your recovery,
Karen
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straydog
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Posted 4/25/2019 7:19 AM (GMT -7)
TN, I am going to try to revive your post-op thread here, hopefully we can keep this one going, lol.

You are approximately 15 days post-op? Too soon to think about traveling at this point. In all honesty at the 3 month mark very short 1/2 day outings. Six month mark see how you feel & where you are at. I know it sounds like a long time away. Listen to your body & what your gut feeling tells you about getting out & about.

I have made trips to please my husband & those ended up a major disaster. I am talking about 2 days after getting to the destination we had to leave & come home. I would get taken to ER & get admitted for a few days. I knew going in it was a big risk. I stopped doing this because it was not worth it. I finally told my husband that I was done with taking trips when I did not feel well. He would always tell me, you are just tired & you need to get away to relax, lol.

We just had a conversation 3 days ago about him wanting to go on a trip, S.D. or where ever. I cannot ride in a vehicle long distance. I could maybe do a short a short plane trip. I have zero interest in a cruise, too many people & smells in places too small for me. I would go nuts on a cruise. Keep in mind we are lake people & get out on our boat, lol.

Bottom line, explain to your husband you would like to travel in the future, however, it's a trip that you want to enjoy with him. Nothing worse than feeling bad & being away from home. Take care.
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Taller Now
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Posted 4/25/2019 8:12 AM (GMT -7)
Thanks Susie. Great advice as always. Like you, I like open spaces and few people. We live on acreage surrounded by wildlife refuge lands, a destination place itself. I feel no need to leave. And like you my last time was a disaster. I appreciate your timeline. I see my neurosurgeon next Friday and was wondering if I could slip him a note to address the topic without me bringing it up to avoid hurting my husband’s feelings? My bones are so soft that fusion is a huge issue for me. I can’t be risking that at all.

Yesterday I sat outside, then coached my husband through changing the sheets, helping him with pillow cases. He went out with a friend for a couple of hours (which made me very happy) so I made my own dinner. It doesn’t sound like much but my pain escalated in a real bad way. It reminded me of how fragile everything still is as it tries to heal. My pain is up today and I want to cry but will hold back the tears. I feel so guilty not being able to do enjoy things with my husband as he would like and deserves.
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straydog
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Posted 4/25/2019 10:20 AM (GMT -7)
TN, try to save yourself some extra grief & let go of the guilt feelings. It's time to take inventory of all the medical conditions you have dealt with. Meaning look at the surgeries that you have undergone. Each time you had surgery the decision was made to improve your overall being, this includes being able to do things with your husband that you both have missed doing. It has been all about getting some sort of semblance of your life back. None of this was self inflicted! It took me awhile to realize everything I had done or tried was to improve myself and be a better functioning family member.

Does your drs office have a patient portal online? If so, perhaps a brief note to your dr can be done now, before the appt next week. This could be done without causing any issues. If you do not have this, then I suggest a call to your drs nurse, let her discuss it with your dr ahead of time.

I would avoid being in a car as much possible for awhile. You have a lot of healing to do on the inside regardless of how you have healed on the outside. I took my grandson to school this morning, saw a pickup t-bone a lady in a 20 mph school zone!! He was coming out of the school parking lot & hit her. Low impact crash but he tore up the entire passenger side of her SUV.

Maybe it's time to share your feelings with your husband. Let him know you are aware it has impacted both of your lives & you are very much aware of the impact it has made on him. I would remind him your goal is to heal from this surgery with the very best outcome you can have. You are at the stage now, that further surgery down the road is something that needs to be avoided.

I completely understand where your thoughts are on this subject. Ha, ha, I just bought a topical ointment on Amazon for pain. My grandson's golf instructor told me about it. Her aunt uses it & says it's fantastic, so I will give it a try. If it works any I will post about it here, lol. Hey, at this stage I am still looking.
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Taller Now
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Posted 4/25/2019 11:32 AM (GMT -7)
Thanks Susie for the honesty. Brought tears to my eyes. Every time I think I have accepted my reality and dealt with the emotional issues of my health, I find myself in a new one. Without my faith I would be a real basket case. I think I will wait until the topic comes up from my husband again and the be honest with him. My daughter told me that lovingly setting boundaries with people is loving yourself enough to do so. And that I can’t be responsible for what someone else does with it. I think this might be one of those situations.

My last neurosurgeon wanted me in a car as little as possible for the first six months. Said the vibration of a car ride slows fusion, not to mention the risk of an accident. But the reality is unless I want to go, really want, then faking a vacation is not going to go well. My husband and I have been together for well over forty years and he knows me well enough to know when I am just being polite. He wants me to have a good time, see me smile.

I need to heal as in fusing my bones together and you are right, nothing is more important than that, no trip, no chore, nothing. This is my last chance to get this right and I would not want any regrets to reflect on thinking, “if only....”.

I hope your magical cream works. 😂 sometimes getting our muscles to feel better can make the more internal things feel better. I had a conversation with a developer of topical creams one day, and he acknowledged that they have their limitations, namely the depth to which they can affect pain. The more superficial the pain generator the more likely a topical will help. He didn’t think the arthritis in my spine was superficial enough to benefit from topicals.

Have a wonderful day!
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(Seashell)
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Posted 4/25/2019 11:55 AM (GMT -7)
TallerNow:
You can only do what you can do. You live in your body and know it best. Trust your intuitions and listen to your inner voice.

I was a busy and engaged little gal until the looming shadow of chronic illness caught up with me. I worked for Accenture/Arthrur Anderson as a consultant, a high pressure position. My endocrine conditions, invisible to the outside world, had been taking a toll. My body compensated for years beyond what was reasonable . . . until it could no longer.

It was like I was on the freeway of life, traveling down the thoroughfare at 65 mph with the greater populace. And then fragile health dictated that I take an off-ramp exit.

That was then. This is now.

The best that any of us can do is to do the best that we can. Listening to the body that is our own.

I get up each morning and out both feet on the ground. Some days, this is a major accomplishment in itself.

As a physical therapist, I worked with individuals who had sustained severe head and spinal cord injuries. The worst of the worst. Lives shattered in an instant. My own brother is a brain cancer survivor. These experiences temper my own relationship with myself as I wade through my own compelling health issues. Compassion for self is a must.

I would encourage you to begin open and honest dialogue with your husband. It sounds as though you have a marriage and relationship that is genuine in care for one another.

One thing I regret is not asking more directly for what I have needed from my nuclear family. I hide the depths of my struggles, keeping an outward appearance and tempo that I was A-OK - when I obviously was not. My family kept hoping upon hope that I would “get better.” I had made it through ICU stays where the prognosis was grim. It created a certain expectation that I would always be able to marshall through.

We each reach our personal limit, at some point. It is less any single health issue that has deflated me. It is more the cumulative weight of multiple health issues and the sustained slog through the years. We all experience this, to one degree or another. It becomes more difficult to reclaim our baseline with each health hiccup.

Life may now be different for you and your husband then you would want or intend it to be.

Do not shy away from conversation and dialogue with your husband. In sharing, there comes the humanness that sustains us. In sharing, common ground is to be found. Be open to each other’s experience.

I have recently been told that my intestinal fragility is not something that I will recover from. There is an expiration date. It is not expected to be immediate, but it is defined.

I do not feel sad. I was not surprised by the discussion with my Palliative Care team.

It does make me want to express to members here the fragility of life. Say what you need to say to those that you love. Live your with no regrets. Live your authentic life. You get but this one life. No second acts. Enjoy it as best as you can.
Karen
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Darla
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Posted 4/26/2019 4:02 AM (GMT -7)
Taller Now I keep thinking about this thread. Issues we all deal with...how much should we push ourselves to do. I have said many of the same things you say...I live with wildlife around in a beautiful, peaceful home. I have pushed myself all my life and I want to sit hear and lick my wounds. I have been urged to do things for my husband I would not want to do. Doing something for the partner should never be at the expense of your health, of course. And I don't think he would want that. But if it is uncomfortable I would still try and do it. If it is unwise or unsafe hopefully he would not hear of it and the discussion can be open. Best with this difficult issue!
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Taller Now
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Posts : 356
Posted 4/26/2019 7:52 AM (GMT -7)
Thanks everyone for weighing in.

Karen, you are so right, life is precious and fragile, which ties into what Darla mentioned; to do as much as we can for those we love. The sacrifices of our caretakers can’t go unnoticed. And I believe the most important thing in life is love.

Things will sort themselves out. I am just three weeks post op and the trauma and anesthesia effects on my body and mind are still fresh, not allowing me to think clearly. I also need to work out my own issues as to why I always feel so guilty for being a limitation to my husband.

I hope we can all embrace this day and the blessings around us. And even if we are in a not so good situation knowing too (as Karen mentioned) that there is always someone who has it worse. Enjoy the day, friends.
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Taller Now
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Joined : Jun 2014
Posts : 356
Posted 4/26/2019 7:55 AM (GMT -7)
Karen,
As a retired PT do you have any suggestions for my trapezius muscle pain right now? Ice or heat? Ice feels better but my husband says heat will bring more healing. I try to keep my elbows in and not engage the muscles too much as it certainly wakes things up.
Thanks, TN
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straydog
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Posted 7/12/2019 8:04 AM (GMT -7)
TN, it's been awhile since we have heard from you. When you get a minute we would love to hear from you & get an update.
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Taller Now
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Joined : Jun 2014
Posts : 356
Posted 7/12/2019 9:36 AM (GMT -7)
Update: my neck is doing great!
Or at least the part they fixed. The pain that I had (broken neck pain) is still gone. At the end of May I showed a little bit of fusion in my facet joints. I go back at the end of this month. Since my old pain is gone I do feel my low grade arthritis pain in my upper C spine, but it’s more a dull nagging pain, nothing severe. I will be asking my neurosurgeon about my difficulty swallowing still and when I talk a lot (like at social gatherings). I will update you at the end of the month to let you know how fusion is going etc. I feel like it must be going well because I have done things that would have normally sent me to the ER with neck pain.

On the other hand my low back has been real bad. In fact I told my PM that it feels like my pump stopped working, so he ran a test on it and the catheter, and everything is working fine, but my pain in my low back and legs remains high. It started when my back went out. I don’t go back for a discussion on that either until the end of the month. He mentioned both upping my meds, possibly changing them and or adding extra meds in my pump. My neurosurgeon said in May that if my low back wasn’t better he would take a new look at it. I would be happy if my neurosurgeon said he could fix my low back like my neck but doctors have said in the past that it is inoperable.

A bit discouraging to get one thing fixed and have something else get worse. But counting my blessings.
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straydog
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Posted 7/13/2019 9:03 AM (GMT -7)
TN, I happy to hear that you have seen improvement from the old pain! I can tell by your tone in the post you are in a better place with things.

Hopefully your PM doc will increase your pump or add whatever he feels is necessary. Don't give up on the pump, you are still early with it. I am happy that your PM doc is smart about pumps, not all docs are.

I look forward to your updates.
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White Beard
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Posted 7/13/2019 11:14 PM (GMT -7)
TN have you seen an ENT specialist about your swallowing difficulties? Definitely talk with your neurosurgeon about it. After my first fusion I literally had problems with swallowing and my gag reflex for years after my first ACDF at C6/7. So I can definitely emphasize with you on that! According to an ENT specialist I saw he said damage to the nerves going to the Larynx is not all that uncommon with this type of surgery. I know that doesn't help much when your the one experiencing the problem! But I do wish you all the best! And it is good hearing from you!

White Beard
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Taller Now
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Joined : Jun 2014
Posts : 356
Posted 7/14/2019 8:37 AM (GMT -7)
White Beard,
Thanks for the suggestion, I was definitely going to bring it up at my next appointment. I had a terrible time after first anterior four level fusion, eating only soft foods for four months but it gradually got better. But this swallowing and what feels like swelling in my throat when I talk is new and worsening since my recent multilevel posterior fusion. When you went to the ENT, were they able to do anything for you? I know most if the time when nerves are damaged they just throw up their hands and say live with it.

Don’t you also have a pain pump? If so, how long did it take before you got relief? And did you ever go backwards in your pain relief? My husband keeps saying it is a waste and I should just get it removed. I think we still have more to try both in dosage and types of medication. I have had it since last May.

Thanks all - always good to be back in my original pain support family. ❤️
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White Beard
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Posted 7/15/2019 12:10 AM (GMT -7)
TN Sorry to say the ENT specialist was not able to help me. The swallowing problems and gagging problems have significantly decreased over the years but even now if I put to much strain or stress on my neck or turn to quickly or what ever I will often have some problems especially with gagging and swallowing. I know when I was getting my second ACDF 25 years after my first one the ENT specialist then told me my vocal cords on my right side were still partially paralyzed and that was a major cause of my swallowing and gagging problems. Certain movements especially ones that put strain or stress on my cervical spine and associated muscles give me problems. Including talking allot or trying to sing. After all these years I guess I have just accepted it! As I never found any Doctors that could ever provide any help!


As for the pain pump it was an absolute Godsend for me! And continues to be so! I got mine implanted in June of 2014 and they are telling me next summer I will be needing to get it replaced because of it getting near the end of it's battery life. There was a period where the pump didn't seem to be helping me that much and I was using my PTM to give me bolus doses as much as I could up to 10 times in a 24 hour period. So when I went in for my next refill they reprogrammed it to increase the continuous infusion dosage and that helped allot! But sometimes I still use my PTM to give me bolus doses but usually not more than a couple times a day! And since I don't use it as much they reprogrammed my PTM to give a maximum of 8 bolus doses in a 24 hour period with at least a 60 minutes between each use.

TN It sounds to me like they need to do a reevaluation of your infusion rate and strength of your medication. I can't think of any good reason that your pump (assuming the pump and catheter is all working correctly) that you aren't getting adequate pain relief for the intended area that the pump was implanted for?? Unless the dosage and or medication strength is not adequate for relieving your pain. And that.... I would think ..... they should be able to adjust for?

I hope you can get some help with this! Good luck to you TN I wish you well!

White Beard
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Taller Now
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Posted 7/15/2019 9:37 AM (GMT -7)
Thanks for the input.
My pain pump has a lots of room to increase the meds. One of my problems has been when they try to increase me more than 2-3% I get sick (nausea, dizzy). So we have been doing a 2% increase every few weeks for over a year then stopped before my neck surgery. Then resumed recently (at 0.4mg/ day of morphine). My dose is super low. I have always been super sensitive to meds. So I think we will work on a more aggressive increase and possibly adding bupovocaine (sp?). One of my worsening issues in my thoracic and lumbar spine are two areas that feel unstable, where one wrong move and my back goes into complete lockdown. I have a hard time imaging how a pain pump would prevent my back going into spasm.

I imagine that they will need to run tests on my swallowing etc. I read up on it yesterday and it could be anything from residual nerve damage from my original 2014 neck surgery (although read that even posterior surgery of recent can cause it) to bone spurs, hardware issues etc. I just know it is getting worse to the point of being scary.

I appreciate you and all of my friends here. You continue to be a blessing.
TN
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straydog
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Posted 7/22/2019 11:40 AM (GMT -7)
TN, I had Bupvicaine in both of my pumps. It was explained to me it helps work on the pain receptors. The only problem I had with it was my right leg had quite a bit of numbness. My pm dr ignored my complaints of this. The first year with my pump was not a good one, in fact I told him I wanted it taken out. I was not getting the relief he told me I would. I was really disappointed. I have COPD & of course respiratory depression can occur with pain medication. Like you, my increases were very, very small ones. He then tried the normal increases a little at a time. My saving grace was he decided to get out of pain mgt & go back to anesthesiology.

He referred me to a new pm dr & this lady was great. We discussed the numbness in my right leg, my dose was too high. She said the dose should never be over 7.3mg in a pump. Bupviacaine is used for epidurals, C-sections & those sort of things. It's a numbing agent! She said the dose of pain meds in my pump is what they start out, not something a year later. After being under her care she made a big difference. Her only comment was he was a good dr & really wanted to help his patients, but he knew nothing about meds used in pumps & how to dose one.

With you being so sensitive to medications I understand where you are at. You are right, the dose you are at now is nothing. Just stay the course of small increases perhaps every 2-3 weeks. My neighbor is an RN, I discussed with him my dose that first year. He said you are not getting hardly anything over a 24 hour time frame.

Just remind your husband that your pump is not a failure, the problem is your sensitivity to the medications. Hang in there.
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Taller Now
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Posted 7/22/2019 2:27 PM (GMT -7)
Thanks for the encouragement Susie. It is very discouraging right now. My neck is having new issues including the swallowing and talking issue, and my low back and leg pain is awful. I see the neurosurgeon tomorrow and my PM next week. It can’t come soon enough since I am limited in activity right now from unmanaged pain. My PM has said there is lots of room for medication and that I need to get my dose up to be effective. I already have numbness in my left foot and leg so perhaps I wouldn’t notice a little bit more. I’ll keep you posted. Thanks again for the input.
❤️TN
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straydog
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Posted 7/23/2019 7:53 AM (GMT -7)
TN, I do understand being discouraged. Just remind yourself it's the sensitivity to the medication & being on very, very low dose. That is the problem, not the pump itself. I think your pain be different if you had been dosed with the normal schedule. Every patient has to get to the sweet spot that works well for them. I'm wondering if the dr will try to change you to something different in the pump, unless you react so much to medications.

Are you using your PTM yet so you can give yourself a bolus? Or is the dr worried about you having a reaction with the medication?

Please let us know how your appt goes.
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straydog
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Posted 9/13/2019 10:26 AM (GMT -7)
TN, it's been a while since we have heard from you. Please give us an update when you can!
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