Progress update

We've just received a 6 week progress update from Nick's physio and it's looking good!
Nick has now started doing 20 minute sessions on court and this is going well. The target is for him to be able to manage an hour on court by the end of the month.
The physio is reporting...
- improve symmetry and control
- no pain or sciatica on straight leg raise/hamstring flexibility testing
- little or no symptoms on slump testing
- improved abs and oblique muscle activation, control and strength
Nick is also sounding more positive about it all too, so overall good progress!

Progress!

So, I forgot to publish my last post in February so dates of these posts now slightly askew!

Since February we have managed to find a great physio and s&c combo and Nick started working with them about 4 weeks ago. His pain is reducing but not fully resolved yet. He is also doing Pilates at least once a week.

To me, he seems to be standing straight again and not swerving when bending over (which he was doing quite badly before). So progress! He is, however, feeling a little disheartened as to how long it is taking.

We went to see a pain management doctor today and have now managed to get on the list for an epidural as the spinal consultant recommended. Unfortunately Nick's medical insurance won’t cover this so we are having to go through the NHS route, hence why it is taking so long. They reckoned it would be about 2 months before the appointment comes through, but at least he is now in the system and on the waiting list.

Back problems again

Forgot to publish this...

Update February 2018

So, about 6 months ago Nick began to feel pain in his lower back and a little sciatic pain in his right leg. He took some time off his tennis but it didn’t improve so he went back to see his consultant. He also had a new MRI.

Initially it was felt that it was just a flair up. He started seeing his physio again and also started Pilates. His back started to improve.

Last month he saw his consultant who agreed that he could start playing tennis again. Unfortunately, that aggravated his back and by about a fortnight ago he couldn’t sit for longer than a few minutes. We felt that something needed to be done however we didn’t know what.

Back to his physio who referred him to a physio who specialises in backs and tennis. After emailing the new physio he called and suggested that Nick should see a spinal surgeon.

We were extremely lucky that Nick could see the spinal surgeon today. He thoroughly reviewed Nick's MRIs. Key conclusions were...

• Nick has very weak core and glutes 
• One vertebrae has slipped relative to the one below (I believe the correct term is retrolisthesis) at L5/S1
• The L5/S1 disc is pressing on the nerve

There are two ways forward, however the first is a back fusion which would mean that he couldn’t continue tennis. The second option is that Nick strengthens his core muscles with a really good strength and conditioning programme.

So, I am feeling relieved that we understand more about the issues going on in Nick's back. I also feel that we have a potential way forward. Now we just need to sort out a good physio to help with new strength and conditioning programme....

Back to normal

Just a very brief update to say that Nick now seems to be back to normal. He has no lingering issues with his back and is playing about 16 hours of tennis a week. He does a fair amount of strength and conditioning work, but he really enjoys it so is happy to continue with it.

His tennis standard is roughly where he was pre-injury, though that does mean he still needs to catch up a little as everyone else has had an extra year and a half to improve. He's currently ranked about 40 in the country, so that needs quite a lot of work but it's improving all the time.

His school work didn't really suffer overall - in addition to the GCSEs that he did whilst recovering from his surgery, this year he has just completed his AS levels, getting straight As in all of them. He's currently trying to decide whether to go straight to playing on the ATP circuit or whether to try to go to university first once he has completed his A levels.

There was a nice article about him on his club's website recently - http://www.dukesmeadows.com/archive/catching-up-with-the-fctennis-academy-nick-nugent/

And here are a few photos of him to finish off....

 

At the All England Lawn Tennis Club, Wimbledon

After winning the Woking Tournament (Under 18s, men's, singles and doubles)

With the incredible trophy from winning the Men's at his local tennis club, Southfields LTC

 

With his brother collecting their exam results

 

 

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Back to winning

Lovely to see Nick winning again - 18 & Under Doubles Winners at the Sutton Grade 2 National Tour. Also made it to the third round of the singles, both results of which he was very pleased with.

Nick actually rolled his ankle five weeks ago and pulled four ligaments so we weren't even sure that he would be able to play in this tournament. But he followed medical advice and worked his rehab well so made it back on court just in time!

Playing sponge ball tennis!

Couldn't resist a few photos of Nick playing Sponge Ball tennis today, just to show that he is now flexible again .....

1 year post op

Nick is now 1 year post MD. Have to admit, the MD seems like a long long time ago! Here's an update….

- no back issues at all. Full range of movements, good flexibility, no postural issues and definitely no sciatica
- overall fitness and strength pretty much recovered now
- tennis training back at full capacity, being roughly 20 hours a week training plus competing about twice a month
- has started his A levels now. GCSE results went well (6 x A* and 4 x A)
- Nick feeling very happy with decision to have the MD

Nick has continued to see his movement coach each week, and in fact he is really enjoying the work. When he misses his movement work for a few days he says that he can really feel himself stiffening up. He also see his personal trainer twice a week for fitness and strength work. He feels that overall he needs to do a lot of fitness/strength and conditioning work.

He hasn't managed to fully regain his tennis rating or ranking yet - still a lot of catching up to do, but this is normal after such a long period of time off. He is well on his way though, and still very committed to getting there.

8 months post-op

Nick is now comfortably past 8 months post-op. He is doing extremely well....

• Saw his physio last week who is very pleased with him. She was delighted to see him touch the floor with legs straight. He is also no longer lopsided when bending forwards.
• His core muscles are now kicking in, which in turn supports him properly. He stands straight and tall - something we hadn't seen in a long time.
• Straight leg raise is about 85 deg on left side and about 80 deg on his right, so still some residual tightness in his right side, but levels are above what most people would achieve ordinarily so he is happy with that.
• No sciatic or back pain at all.
• He managed to do his tennis academy squads last week each day, which involves about 4 hours of fitness and tennis each day (plus an hour of cycling to/from the centre) with no bad effects on his back.
• Although his physio feels it is not necessary for him to see her again he is going to continue his movement work which has been working so well for him.

He now regards his injury as something in the past rather than a current issue, although he is very aware that he needs to keep up his fitness and core strength work. His tennis isn't quite back to where he was before, but he is making rapid progress in getting there and he is certainly now confidant that he will get there.

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7 months post op

Nick continues to make good progress. He is working hard on his core strength and movement work, at least once if not twice a day. No longer lopsided when he bends forwards....

He is also working on general fitness levels, cycling and playing tennis being the main means. He is losing weight too as a consequence.

Playing tennis regularly. In fact he's just yesterday won his club's Men's Championships, picking up a rather grand trophy...

So all in all good news. He is going to continue with his movement and core work for a few months then have a final review with his physio, at which point we are hoping that she will sign him off.

 

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6 months post op

Nick is now 6months post op. He continues to progress well and is noticeably better than one month ago....

• Sitting is no longer a problem for him
• He now stands straight pretty much all the time and it is becoming more natural and less of an effort for him. When tired he does still need to concentrate on standing straight though as his back muscles are not yet fully strengthened
• Still has tight hamstring on his right side, resulting in him being noticeably still a little lopsided....

• He does physio stretches, movement work and core strengthening work every day at least once, usually twice
• His core is improving and beginning to engage properly, resulting in a better connection between his upper and lower back and his hips. As a consequence he has started to use his hips again when playing tennis.
• Tennis. Can now manage a couple of hours at a time and has played some competitive matches. He's discovered that, not surprisingly, his consistency is poor and he gets tired easily. He played in a National tournament in May and was a little demoralised to see how his peer group have progressed in his absence. However, being Nick, this has simply motivated him more to improve
• School. So far he has managed to sit through all his exams without issue and only has two left so we are hopeful that he will be alright
• Emotionally. Happier as he can now play tennis again, although being in the middle of his GCSEs means that he's not exactly ecstatic! Does get frustrated with his standard of tennis and lack of fitness and has come to realise that returning to his former standard will take a while.
• Outlook - we are anticipating him needing only a few more physio sessions, but more strength and conditioning and movement work as they will take a while to fully recover.

 

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5 months post-op

Gosh, Nick is now 5 months post-op. It sounds like a long time but it doesn't feel like a long time. This is where Nick is at....

• Most day to day activities do not cause him a problem. He can walk, run, sit, lie etc without difficulty. However there are a few tweaks to this...

1. Sitting for longer than about an hour causes him discomfort and sometimes pain
2. When tired, or after sitting for a while, he tends to push his upper back forward because his back still doesn't have full strength to hold him upright
3. He still can't reach much below his knees (with legs kept straight)
4. He still has a lower straight leg raise on his right side

• He is focusing hard on improving his core and back strength and does exercises at least once if not twice a day. He also stretches a lot.
• He's lost a lot of fitness and put on a little weight so he needs to work on those too.
• Tennis. He is playing tennis again but needs to do a full warm up routine and stretches afterwards. He needs a good rest (lying down) afterwards and at the moment can only manage playing every other day - two days in a row would be too much for him. He has played a few competitive matches and each time he copes better.
• School. He started his GCSEs yesterday and has coped so far. He decided to drop one exam because it was a 2 hour paper and he had 3 hours of other exams scheduled for the same day - five hours of sitting would be too much for him. We have also arranged for him to be allowed 'supervised rest breaks' during exams if he needs to stand up and stretch out - required a letter from his doctor and organising with his school.
• Emotionally. Much happier and more like his former self. This is probably partly because he is not often in pain but probably mainly because he is back playing tennis, which is the love of his life. He is a lot more chirpy and cheerful than of recent months which is really love to see.
• Physio. His physio is anticipating about 6 more sessions will be needed, and expects him to be able to return fully to his pre-herniated disc days. He can't wait!

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4 months post-op update - feeling good!

Nick is now making good progress :-) He is....

• Doing a lot of strength work on his core and legs, under the weekly guidance of his physio
• Continuing a lot of stretching
• Playing tennis again, although so far only a maximum of one hour at a time
• Able to sit for reasonable lengths of time for his GCSE revision
• Standing straight most of the time
• Much more optimistic and positive
• Starting to plan his return to competitive tennis

Progress seems to be improving pretty quickly over the last few weeks. Each day he pushes himself just a little further and so far there have been no bad effects. He is slightly cautious still, which is not surprising really, but he is so happy to be able to play tennis again! So pretty good news overall.

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3 1/2 mths update - feeling positive

 

Since my last update Nick has been back to see his consultant. Nick found the visit incredibly encouraging because...

• His consultant told him how much better Nick is now compared to pre-op (always good to hear)
• There was no suggestion of anything else going on/wrong
• The main issue now seems to be Nick's loss of muscle strength, particularly in his core, and
• He needs to continue to mobilise his lower back

The strength point was particularly encouraging for Nick as he knows that with good guidance from his physio and some hard work he can build his strength back up. It is just a question of putting in the hard work, which Nick is very happy to do.

 

After seeing the consultant Nick saw his physio again (the consultant was insistent that his program was managed by his physio) who has given him some core strength exercises. Nick is attacking them with gusto and even after only a few days is seeing improvements. Yeah!

 

In terms of school, Nick is still managing full days but finding it tough. On days when he can't get to lie down at break/lunch pain can start to kick in again which in turn tires him further. But he is just about managing it and term ends in a weeks time so not long to go.

 

So overall pretty positive and looking forward to improvements continuing.

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3 months post-op

Well, Nick is now 3 months post-op and somehow 3 months feels like a landmark. I should have written this update a few days ago, but it was his 16th birthday yesterday and I wanted him to enjoy his birthday rather than thinking about his back.

Bit of a sideline, but he wanted a tennis theme for his birthday cake to celebrate getting back on court. So not my best ever cake, but it does undeniably have a tennis theme...

And another shot from his birthday - sitting by the sofa enjoying some time with his brother. It is easy to forget that a few months ago he wouldn't have been able to sit like this...

Anyway, where is Nick at?

Generally, he is continuing as he was, making slow but steady progress. He is still a long long way from being back to normal though. We are due to see his consultant tomorrow. This was following Nick's physio's concerns that something may not be quite right as she feels he is not progressing as quickly as she would have hoped. I will update next week as to what his consultant says.

At the moment...

• Sitting. Able to sit reasonable lengths of time, but is invariably tired and a little sore if he sits for too long
• Exercise. Still continuing his physio exercises but also playing tennis for about 20 minutes twice a week. Feels quite achy afterwards, even though he does stretch before and after playing.
• Standing. When not tired and pain free, he can stand straight. Otherwise he tends to tilt his pelvis and looks quite awkward.
• Bending. Still struggling to bend forwards.
• Muscles. Generally he says they feel fine, at least for the obvious ones (hams, glutes, calves etc). Stretching them every day.
• School. Managing normal school days, though usually tired and achy at the end of the day. Generally manages to complete his homework in the evenings but sometimes too tired and achy to sit up to do it.
• Sciatic pain - none
• Emotionally. Feels 'alright', says he feels 'happy and sad'. Happy because he is playing some tennis, sad because he's not better and still has problems.

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12 weeks post-op - all change!

OK. Two stages to this post. The first was written by Nick and myself together whist waiting this evening for Nick to have his sports massage. The second was written after the sports massage....

Pre massage...

Nick's overall view - A bit unsure about it all, I thought doing OK but physio not so sure. Heading back to see consultant next week on physio's advice. Chose to lie in this morning rather than get up early for physio exercises and this helped - no pain at breakfast time.

• Sitting - 'not bad', by the end of the day becomes a little problematic, meaning back, leg and buttocks sore
• Standing - if moving, OK. Dislikes standing still. Very sore and tends hunch forwards into wrong posture. Says it can feel strange to stand straight.
• Sciatic pain - has some pain in his thigh and buttocks. He's not sure of it's sciatic pain or not.
• Straight leg raise. Yesterday, before warm up about 40-50 degrees, after warm up about 60 degrees. Muscle tightness and a little pain in thigh is restrictive aspect
• Exercise. Done a few sessions of tennis, about 20 minutes each although feels that he may have overdone it. Tried football - not a good idea.
• Physio exercises - no change.
• Bending forwards - in physio yesterday managed a few inches past knees.
• School - managing full days days at school, but finding it tough to keep up with homework.
• Emotionally - says he's feeling 'alright, OK'. Happy to be back on court.
• Worried about the possibility of potential other problems.

And after the sports massage...

• Feeling great.
• Achieved personal best on straight leg raise - 65 degrees
• Standing straight without pain
• Complete turnaround from before

Which I think shows you how his mood, state of mind and physical state can change so easily!

 

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12 weeks post-op, pre-script

Feeling absolutely crap. Four hours ago I was feeling great. Nick was managing full days at school, hardly reporting any pain and has even been on court a few times. We seemed to be finally getting there.

Then we went to the physio. Physio wants him to go back to see the surgeon. To cut a long conversation short, she feels something is wrong and that he should be making quicker progress. It feels like we are back to square one again, with that sinking feeling that the person treating Nick doesn't know what to do.

But it's late and I've had a pretty lousy day today, so perhaps it will all look better tomorrow. Will try to post a less emotional and more objective 12 week summary tomorrow.

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Back on court photos

Couldn't resist uploading these - made my day.....

11 weeks post-op - very positive vibes

Well, we are all feeling a lot more positive this week! Nick has managed full days at school and he has been back on court a few times. He also says that he feels like he is improving, which is fantastic.

11 weeks post op summary

• School. Managing full days at school, although he does feel sore by the end of the day and needs to lie down when he gets home.
• Tennis. Doing gentle hitting for about 20 minutes once every two/three days. Feels general muscle ache afterwards but nothing worse. Coach commented today that Nick is moving much better post microdiscectomy compared to post nerve decompression.
• Physio exercises. No change on the 9 weeks programme except we have added bridging back in. His pelvic tilts are definitely improving.
• Sports massage. Had another this week and although tougher this time it still seemed to help, though not as much as the previous occasion.
• Muscles. Muscles not feeling tight.
• Sciatic pain. Not getting any :-)
• Sitting. Not brilliant, but managing lessons at school.
• Posture. Improving, especially when he's not thinking about it. Interesting psychological point there.
• Straight leg raise. Same - 60 degrees one side, 90 degrees other.
• Emotions. Much, much better. Seems more like his former self - positive, motivated, cheerful and generally much better.

So, you can see why I started with 'feeling a lot more positive'. I am now starting to look forward to improvements, rather than worrying about any lack of improvements.

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10 weeks post-op: ups & downs

10 weeks post op and I have to admit that I'm not entirely sure where Nick is at. This week has had it's ups and downs, some improvements and some setbacks....

• Last week he managed three half days at school and then the half term break started. On the positive side, it felt like he was managing greater chunks of time at school, and by the end of the week he managed a double lesson without having to get up in the middle. On the other hand, he still needs to lie down at break, lunch and free periods and he didn't manage a full day.
• He had a school trip to the theatre one evening for his GCSE controlled assessment - 2 hours and 20 minutes including the interval. When he got home he seemed OK - certainly a lot better than I was expecting and he didn't want a painkiller. But the next morning he was absolutely exhausted and didn't make it into school until lunchtime. But at least he made it.
• Sitting - still a problem, but he hasn't done much in the last few days as he is taking the half-term break as an opportunity to rest as much as possible
• Posture - generally good except when in pain
• Straight leg raise, about 60 degrees on one side, 90 degrees on the other
• Exercise - not doing much. Doing his physio exercises (same as last week) but focusing on his pelvic tilts. He thinks that they are getting easier, but he's not sure. I'm doing a lot of hamstring stretches with him.
• Tennis. His physio said that he could try some gentle hitting, max 15 mins every 2 to 3 days. He hit against the wall in our garden yesterday and said that it felt OK. He was a little stiff in unexpected places afterwards, but the stiffness seems to have gone today so I suspect just a case of waking up some muscles.
• Sciatic pain - not routinely mentioning any. A little reoccurrence when stretching his hamstrings out fully.
• Buttock pain - seems to gone completely, at last.
• Bending forwards. No change and he is getting increasingly frustrated by this. I noticed that when he bends over with his knees bent then he is quite lopsided. When I took the photo below he swore to me that he was even, and didn't believe otherwise until I showed him the photo.

 

• Sports massage. Is loving them. And coped much better with school the day afterwards. Next one tomorrow.

Emotionally. Tricky this one! He sort of lost the plot a little over the last few days and ended up doing pretty much not much at all other than lying on the floor. In the end I lost my temper with him and that seems to have jolted him out of it and today he has been back to doing his exercise with gusto. And he has resumed his school work too. I felt pretty crap, but I knew that he needed it.

Overall, if I am being honest both Nick and I are a bit concerned that he has not improved more. We both keep being told that it will take a long time but sometimes I wonder if we are clutching at straws when we see an improvement. And I spend a lot of my time trying to stop myself worrying about it. But it's not easy! I keep deciding to book an appointment with our GP, but then I don't as I wonder whether we are just being impatient. I am beginning to try and find out where he should be at at 3 months post op as we are nearly there and 3 months seems like a long time.

 

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9 weeks post op

Two main aspects to the last week...

1. Nick is gradually increasing how many lessons at school he can make in a day, and
2. Working on improving his pelvic mobility.

Our weekly summary.....

• Sitting. Can make it through a double lesson (1 hr 20 mins) but gets up in the middle to loosen his back. Doesn't enjoy the double periods and really they are still a struggle for him but he is managing them
• Standing. As before, stands well when not in pain but tilts his pelvis when in pain
• Finds lying down the only really effective way to alleviate pain. Still needs quite a lot of lying down time to recover. Is now lying on his front propped up on his elbows as part of his physio exercises which he seems to like
• Muscles - Nick says that they don't feel tight any more so it looks like all that stretching has finally paid off!
• Bending forwards. Still not great, about a quarter of the way down his shin but he is trying not to focus on this in favour of focusing on improvements elsewhere
• Physio exercises - see new 9 week post op tab. Now working on pelvic mobility
• Has asked for another sports massage as he found it really helped
• Emotionally - says 'Don't feel too bad', and he seems generally more cheerful

Schooling

Has managed three full days and one half day. He was ill with a 'mini-flu' type thing on the fifth day. So missing some classes and only just about keeping up but this is an improvement overall. The downside of the extra time at school is that he spends more time in pain, which results on poor posture, and it can be hard for him to do his physio exercises. He now gets up at 6 am to do a set before he leaves - not easy for a teenager!

Pelvic tilting

His physio felt that Nick needed to correct his posture, and in particular his tendency to tilt his pelvis when in pain. However, Nick finds it really hard to do pelvic tilts, so he is having to learn how to do them. See tab on 9 weeks post op exercises. Hard work getting him to do them often enough (they're just not cool for a teenage boy).

Nick is the taller one on the left. For this photo he is trying to stand straight but is still tilting his pelvis. The other boy is my older son, one year older than Nick - he does a lot of strength and conditioning work as he is rower so perhaps not a very fair comparison for Nick!

Emotionally

Nick seems much more calm and settled now. It's possible that being back at school helps to distract him from his back, plus he gets to see all his friends again which cheers him up. But he is really looking forward to the half term break next week so that he can rest more plus have more time to do his physio exercises more often.

 

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8 weeks post-op - tough times

This last week seems to have felt like really hard work, for both Nick and myself.

Nick has found it very tough trying to get back to school, constantly trying but not managing. And every time he does make it to a lesson he ends up with more work to do whilst having to recover from making the lesson in the first place. He admitted to me that he had considered stopping school completely, which is extraordinary for him because he has always been completely determined to complete his schooling.

He was in school for a full day yesterday, which we now realise was a bit too soon. He was absolutely shattered afterwards and consequently needed a lie-in the next morning.

He is also still worried that something is not right, or at least that he is not progressing as much as he should be. His physio was re-iterating to him yesterday that it will take time because his nerve was compressed for so long. Also, Nick was using how far forwards he could bend as an indicator of progress. The physio discouraged this, pointing out that other aspects may be improving (eg how long he can sit) so he shouldn't focus on just one indicator.

He's had the start of a couple of flare-ups, but each time we have managed to divert it by rest or Diazepam. Each time it has been sitting that has caused the problem.

People are now starting to ask when he'll be starting to play tennis again - well meant questions but for someone who struggles to sit yet alone run it doesn't really help being asked when he can play tennis!

His year group at school are going through various activities designed to help them plan university/career paths which is creating another cause of anxiety for him. Hardly surprisingly he can't contemplate careers when all he has ever wanted to do was to play tennis and that's something he can't do at the moment.

Overall, this is where he is at...

• Can sit for about an hour at a time before his upper back starts to ache and he feels stiff
• Generally standing and walking properly unless pain has kicked in, when he then tends to lean forwards
• Only once taken any pain meds this week, and that was after sitting for too long
• Still needing to lie down a lot
• Finds gentle stationary cycling helps to mobilise his back
• Muscles - generally he says his muscles feel looser... hamstrings slightly, glutes fine, calves slightly. New last night at the physio was that his QL is tight
• Tried a sports massage last night, focusing on his QLs, glutes and hamstrings. Also being taught to breathe better to help relax. Comment re sports massage - yes, seems to have helped
• Emotionally, fragile. Ups and downs. Sometimes very worried about it all, sometimes pretty calm
• Schooling - tricky but slowly managing to sit through some lessons. Took an iPad into school yesterday so that he could type lying down. Double lessons still a bit of a nightmare for him
• Some of his physio exercises trigger pain on occasions so he tends to mix and match what he does, avoiding those that are painful. No new exercises added this week to his 7 week routine

Each evening we plan out the next day. I then email school and his teachers to let them know when Nick is hoping to be in and I keep my fingers crossed that he'll wake up the next morning feeling ready for it. It does make it hard for me to get much done as I never know in advance when I will be needed to take/collect him to/from school but we have found that planning more than one day in advance just doesn't work.

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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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