7 weeks post op

This last week has been spent focusing on two things...firstly getting Nick back into schooling, and secondly improving his strength and flexibility.

Schooling

Last week Nick sat most of his exams at home. As his lessons were being used to go over the exams we decided that it was better for him to stay at home and sit his before going back into school. So far he has managed all but one exam. We started with the shortest first and ended with the longest since he still finds it difficult to sit for long.

On Thursday he went into school for two lessons and on Friday he managed three. Then on Monday he managed a whole morning, although he had to come home earlier than planned as he had quite a lot of pain. The pain was effecting his posture so we decided it was time to rest rather than to push through the pain. A couple of ibuprofen and a three hour lie down and he was OK. He also saw his physio and she was happy that the pain was just temporary.

Today he managed a morning of school but he rested for two lessons (which were free lessons). He did however manage a double period without adverse effect.

So overall, managing some return to school. It's slow progress, but there is progress.

Strength and flexibility

Nick is still a little bit frustrated by his lack of flexibility. Some days are better than others. Generally he can reach half way down his calves. He says his calves are feeling a bit looser but hamstrings are still very tight. Glutes a bit looser.

He's also working on strength - see 7 weeks exercise tab - but we haven't really tested to see if there is any change.

Generally not much change from 6 weeks post op. Straight leg raise slightly better (50/55 degrees), possibly some buttock pain (he's not sure) and he can sit for longer. Can now sit on the floor with his legs out straight which he says he couldn't do before.

 

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6 weeks post-op review

Nick is now 6 weeks post-op, and today he saw his surgeon for his follow up appointment. He also saw his physio yesterday.

This is where Nick is at....

• Occasionally a little sciatic pain in his calf and thigh
• No lower back pain
• A little upper back ache when he sits for a long time (maybe stiffness?)
• Able to sit for about an hour at a time
• Bending forwards. Sometimes reaches about half way down his calf, sometimes he can only reach his knees. Update as writing this - Nick has just been able to reach three quarters down his calf!
• Sitting straight leg raise - to virtually horizontal
• Lying straight leg raise - about 50 degrees
• Very tight hamstrings, glutes and calf muscles
• Not taking any pain medication or muscle relaxants. Finishing off his course of anti-inflammatories
• Doing the 6 weeks post-op exercises which now includes some strengthening work, along with lots of stretching
• Not been able to go back to school yet as today was the first time he could sit for as long as an hour
• Managing to sit some of his mock exams at home
• Emotionally, prior to our visit to the surgeon he was a little worried about progress, however the surgeon has put his mind at rest

The surgeon was completely comfortable with Nick's progress. Specifically...

 

• he felt that Nick was likely to experience a little sciatic pain because the nerve is healing and was compressed for such a long time prior to his operation (about 15 months)
• Nick should not worry about experiencing occasional pain. If necessary he should take some painkillers, but unless the pain continues for as long as a week some pain is not a concern
• Nick will need to push through some pain in order to continue progressing
• Nick should try to keep as mobile as possible - to continue walking and doing his physio exercises
• Nick should try to return to school, probably on a gradual basis initially, to avoid getting left behind
• Nick needs to keep a long term view, and not just focus on each day at a time, as he will have good days and bad days - it’s the long term progress that is important

Overall, the surgeon was completely relaxed about Nick's progress, which I think was the main factor in re-assuring Nick. Nick was noticeably happier and more relaxed afterwards, which in itself was lovely to see.

And I have coined a new phrase - 'surgeons think in months, physios in weeks and patients in days'. I think this reflects the differing perspectives that each have and helps both Nick and me to remember to look beyond each day.

 

And I have added in his 6 weeks post-op exercises in a new tab.

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5 weeks + 2 days - school?

Over the last two days Nick has tried going into school for a short time. Yesterday he went in for a 45 minute meeting, and today he sat a 1 hour exam.

Yesterday wasn't a great success. Although he managed to sit through the meeting, he was very stiff afterwards and had a little sciatic pain in his leg. He was also exhausted, and it took him several hours of lying down to return to 'normal'.

He faired slightly better today, possibly because he was able to stand up and stretch after 30 minutes, but he was again stiff with a little sciatic pain. I also noticed that then when he met his friends in the corridor he unintentionally leant forwards and started to stand incorrectly. This was probably because he is so tall (6 ft 3") but possibly also out of habit. I mentioned it to him on the way home, and he agreed and also decided that he needed to focus on standing properly.

After talking to school we have decided that Nick is not ready to return to normal school life. In fact, most of next week will be spent going through the exams, and as Nick hasn't sat them yet we decided it would better for him to stay at home and gradually work his way through the exams. He may need to go in for a few lessons towards the end of the week, but we'll decide on that nearer the time.

Overall, he seems to be doing OK. We just need to be careful not to overdo anything, especially sitting.

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5 weeks post-op summary

Nick is now 5 weeks post-op. Generally he feels he is doing quite well, fairly positive about it all. Not taking any painkillers or muscle relaxants, just continuing his course of anti-inflammatories. This is where he is at....

 

• Stands tall and straight
• Sitting - haven't really tested recently. Can do about 30 minutes - will be trying a 45 minute session at school tomorrow
• Bending forwards. Can reach past his knees, about 2 inches.
• Describes a hamstring tightness as the reason for being unable to bend further (rather than sciatica)
• Sciatica - occasionally has a little sciatic pain in his calf
• Buttock pain/ache seems to have gone
• Doing the 4 weeks post-op exercise routine
• Finds swimming a bit tricky, can trigger mild sciatica
• Schoolwork. Doing some at home but finds he gets very tired. Doing most of it lying down. Hoping to do a GCSE at school on Friday
• Currently trying to plan how he can return to school, whilst still doing physio stretches and not over-doing it and causing a flare-up.

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4 weeks + 5 days post op. 1 step back, 2 steps forwards

One step back, two steps forward

Nick visited the physio again this evening. To his delight he seems to be better now than he was pre his flare-up. His straight leg raise is now about 50 degrees and he can reach about two inches below his knees. He has no sciatica, even when she raises his leg. He does have incredibly tight hamstrings and it is this tightness, rather than sciatic pain, that prevents him raising his leg further. We regard this as good news, because we know that we can loosen his hamstrings.

He has some additional exercises - see page '4 weeks (post flare-up) exercises' and is back to a little cycling and some swimming. He is beginning to think about how he will cope when he goes back to school which we are hoping he will do next week. So tomorrow I need to start talking to the school again about his return.

So, it looks like he took one step back but two steps forwards.

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4 weeks + 3 days

Over the last two days Nick has sort of oscillated between no pain (yesterday) and a little buttock pain (today). He's not taking any painkillers or muscle relaxants, just the anti-inflammatories which were a 10 day course. Yesterday he said that, with the exception of bending forwards, he had no pain at all which he was absolutely delighted about. It's the first time in the last 15 months that he has been pain-free.

He's being very cautious about not over-doing it. He's doing the 1 week post-op exercises and a little walking, but that is all. This slight buttock pain (more a sort of ache) is annoying - we just can't work out what triggers it. Although it doesn't worry him hugely, I can see that it niggles at him. Oh well, just have to be patient I guess.

He does seem to be sleeping again OK now which is a relief as I am sure being exhausted can't help with coping with it all.

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4 weeks + 1 day - over the flare-up!

Phew, Nick seems to have got over the flare-up. He can stand and sit properly again, has virtually no pain (just a little sensation in his calf), needed no painkillers today and is generally back to his normal pre flare-up self. He has been incredibly cautious today re exercise, basically just a couple of short walks and the basic physio stretches but he says that he wants to start re-introducing the 1 week post-op exercises tomorrow.

 

He tried a little gentle swimming in a hydro pool yesterday but found that it triggered a little pain in his calf so will wait until next week before going again. Mind you, his idea of 'gentle' was 100 lengths - admittedly it's a very small pool - which was a bit more than I was envisaging!

 

I'll give him one last diazepam tonight to help him sleep but I am hopeful that he is back on the road to recovery.

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4 weeks post-op summary

This is Nick at 4 weeks post-op.
In the last few days has had what seems to be a flare-up. Still monitoring it closely and because of the flare-up he is now really cautious of over-doing it. Just prior to this flare-up he was doing really well...

Pre his flare-up....

• Could sit about 20 minutes then again if he had a brief walk in between
• Could reach just below his knees
• Could stand up straight and walk correctly
• No problems with surgery wound
• Was off painkillers and no need for ice/heat
• Some residual pain in his calf and buttock
• Doing the three weeks post op exercise routine, including some cycling

Post his flare-up....

• Taking anti-inflammatories and muscle relaxants
• Back to the 'basic physio stretches' only
• Walking about 1 km gently
• Sleeping a lot - probably because of the muscle relaxants
• Can still reach below his knees
• Can stand properly, although could manage this only once he started taking the muscle relaxants/anti-inflammatories. Before the meds and in peak flare-up he could no longer stand or sit
• We've ditched taking his exams for the moment until we are over this flare-up.

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4 weeks post op

So, Nick's now at 4 weeks post op. A few days ago I was anticipating a very different 'this is where he is at' type post than what you are getting! For the moment I am going to update during the day to see how this flare up is developing. Hopefully by the end of the day I will manage a proper 4 week summary.

 

10 am. We were up early to see Nick's GP. Not looking too bad, some pain but clearly very worried about it all. The doctor has helped us with a pain management plan for flare ups consisting of a 10 day course of anti-inflammatories (diclofenac), some muscle relaxants (diazepam) for the next few days and some painkillers (codydramol) to use when he needs. Also gave him some anti-bacterial cream and anti-fungal spray for his tummy button. We talked about longer term neuropathic medication but decided to manage this flare up first.

Nick currently curled up on the sofa with a hot water bottle on his back (says that feels really nice) waiting for meds to kick in. Says he is feeling a bit better than yesterday which is hopeful. We have decided to ditch doing his mock exams, although he will need to go into school tomorrow for a French GCSE listening paper which being a public exam has to be done at school. Hopefully meds will have started to take effect by then.

11 am. Nick fast asleep. Very pleased - probably the best thing for him at the moment.

1.15 pm. Nick's just had some lunch and is looking so much better. Before lunch he was a bit groggy but after a bite to eat he began to perk up. Joking, laughing and generally happier. Very little pain, and did some very basic and gentle exercises (from just post op days) without problem. Can stand straight again. However, he doesn't want to overdo it so is back on the futon resting.

School called to say that they have arranged for him to do his GCSE exams later so he doesn't have to go in tomorrow after all. The teacher in charge of exams has had a micro-discectomy himself so genuinely understands what Nick is going through. Very helpful! Fingers crossed that all will keep on improving.

6.30 pm. Nick is still feeling a whole lot better. Very little pain (not taken any more painkillers since this morning) and more cheerful. He's gone for a couple of short gentle walks and done more stretches as he is concerned that he doesn't get stiff lying down so much. Still likes to lie on the hot water bottle!

He's decided not to take any painkillers tonight, just the anti-inflammatories and muscle relaxants. The downside of taking a stack of meds in one go is that you can't tell which one is having the right effect, so the plan is to drop the painkillers first and see if he is still doing OK.

Fingers crossed - looking like this was just a flare up.

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3 weeks + 6 days - shitty day

We've had a pretty shitty day today....

1 am. Nick wakes me up. He's in a lot of pain (buttocks), very upset and can't sleep. Desperately worried about this new pain. Took 1 x 30 mg Dihydrocodeine which after a while kicked in and he managed to get to sleep. Before going to bed he couldn't stand up straight which had upset me - he looked like his pre-op days which was depressing.

10 am. Nick wakes up and not looking or feeling too bad. Walks into the kitchen standing properly and walking tall - huge relief. Perhaps last night was just a temporary glitch. Cancel the planned trip to hydro pool for swimming because his tummy button is looking very infected.

11 am. Starts his first mock GCSE. We've planned out the day with basically cycles of sit - walk - sit - walk - exercise - rest. Each sit is doing his exam paper with an expected finish time of 3 ish.

Buttock pain gets steadily worse and he gets stiffer and stiffer. By the third cycle when he gets back from the walk he collapses on the floor by the door. Virtually in tears, unable to lift himself up to sitting and certainly can't stand. Abandon exam paper, another Dihyrocodeine.

Crawls to living room and rests on futon. Can't find a pain-free position at all.

5 pm. Visit to physio. His lower back had shifted a bit and muscles gone into spasm. Strangely can bend forward but can't stand straight. Lots of massage on lower back and calf. Advised that this may just be a flare up, and to rest with a warm pad on back. Revert back to the 1 week post-op stretches only. If no improvement in next 24-48 hours to contact surgeon again.

So, at time of writing (7. 30 pm) feeling pretty miserable and uncertain what is going on.

10.15 pm update. Took a couple of paracetamol and now looking a bit happier. Just praying that he manages to sleep tonight.

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3 weeks + 5 days - something happening

Something's happening but we are not quite sure what....

Straight off this morning Nick found it painful to lie on the floor with his legs out straight, but at the same time he was saying that his back felt looser and more flexible when standing. So rather than persist with his stretches he went for a short walk. Came back feeling a lot better, and could then lie down and do his stretches. The pain had been in his buttocks, and he described it like pulling a muscle (and as a sports person he does know what that feels like). Not sciatic and nothing in his back and no more than the normal slight ache in his calf.

During the day he followed his three week post op routine. In the afternoon he ended up lying on his bedroom floor (only because he couldn't be bothered to carry his school books downstairs to the living room). When he got up to do some lunges he had the pain in his buttock back again. So again, went for a walk which helped but the pain was still there. Lay down flat on his back and after about 20 minutes realised that he could stretch his legs out again.

We concluded that it felt more muscular than a nerve issue so I massaged some Deep Heat in to see if that would help. His glutes were very tight and massaging them resulted in some pain in his buttocks and calf. But at the time of writing this he seems fine again.

He's seeing his physio tomorrow so with any luck she might be able to shed some light on this. The only other thing that has happened is that he has what looks like an infected tummy button, but I can't see how that could be connected to his micro-discectomy!

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3 weeks + 3 days

 

Yesterday was a bit of a washout for Nick's new routine. We started off well, but at 11 am there was a fatal accident outside our house and being the first on the scene it took me a few hours before I was free again. Both Nick and I found the whole incident very distressing and neither of us felt like doing exercises. Fortunately one of Nick's friends come over in the afternoon, which both cheered him up and distracted him from the police activity going on outside. Overall he only managed a few exercises and one short walk.

 

Today was much better. Nick carried out all of his new activities (see tab on 3 week post op exercises) except a swim. And to our delighted he was able to reach below his knees today for the first time! He did need to rest between activities and he says that he thinks the key is to be patient, but none the less this is, finally, a visible improvement. Yippee!!

 

I have added a page of his new exercises routine.

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3 weeks + 1 day post-op. Physio visit.

 

Nick went back to see the physio today. Generally happy with progress but did re-iterate that this will take some time. The main issues are twofold. Firstly his nerve is still tethered somewhere, which is why he still cannot get beyond about 40 degrees in the straight leg raise or bend forwards to touch his toes (with his knees straight). Secondly, a lot of his other muscles have tightened up, eg his hamstrings, glutes etc as a result of his limited movement for such a long time.

So, she is stepping up his activity levels. Nick felt ready for this too so is happy with the idea. The main extra activities are

• Cycling, but starting off with only a few minutes and gradually building up and avoiding hills or bumpy roads. Nick will start off indoors until he can manage a reasonable amount of time.
• Lunges, for 2-3 minutes
• Bridge with a stability ball, holding for 10 seconds, 10 times over
• Wobble board balance. Total of 20 minutes a day. Nick struggled just to stand still, but once he can manage that to try squats
• Standing hamstring stretches for 2-3 minutes at a time
• Sitting. To limit to 20 minutes, then walk, then resume sitting (rather than sitting until it hurts)
• Swimming. He can start swimming lengths if he wants to.

He is to continue his walking. For his existing '1 week post-op' stretches, to continue any which he feels are working for him. He's decided to continue the clam and the sit to stand.

Nick also tried out the cross trainer but found that it caused pain in his calf, plus we don't have access to one at home so we decided to leave it out.


Overall, the physio felt that Nick should be reducing the amount of time he spends lying down so we've decided that he should follow a rotation of the above to keep him moving. Not great news for his exam revision!


Will get a page up tomorrow summarising the three weeks post op routine with a few photos.


 

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3 weeks post-op

 

Nick is now 3 weeks post-op. Most of his day is still spent lying on the floor, interspersed with stretches (3 x day) and walks (3 x day) but overall this is where he is at....

• Slight pain in his calf. He's not sure whether this is sciatic or not and he is struggling to describe it. Not causing him a lot of concern though, and we are hoping it is just the nerve recovering.
• Tight muscle ache in his thigh - describes it as like a very tight muscle being slightly stretched
• Bending - may have been able to touch his knees today. Not checking regularly so not too sure. He feels there is some improvement.
• Walking - managing approx one mile (1.6 km) three times a day. Walks slightly stiffly but still hugely better than before the op. Getting rather board of the local area so occasionally we drive a few minutes to a different park.
• Sitting - can manage 35 minutes at a time but can feel himself tightening up and it might be inducing the calf pain. Has to concentrate on sitting straight. He is practicing sitting up at a table because he has exams to sit in a weeks time, and a return to school in three weeks time.
• Car journeys - has managed a couple of long journeys (about 2 hours) but each caused a fair amount of pain and/or stiffness so we wouldn't recommend car journeys at this stage.
• Sleeping - generally sleeping OK but sometimes feels too alert to sleep.
• Concentrating - difficulties concentrating for long, school work taking a lot longer than normal.
• No problems with the surgery wound but sometimes feels the need for some ice as it feels like it's bruised (no visible sign of bruising). Massaging vitamin E oil into it twice a day.
• Painkillers - not needing any at the moment.
• Hamstrings and glutes - still feel tight, not much change
• Physio/stretches - doing three sets a day. Feels ready for further physio and current stretches take less time to complete now.
• Emotionally - 'not worried but don't feel everything is fantastic yet'. Starting to talk about when and how he will be able to return to playing tennis.

 

 

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