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 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 + 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

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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1 week post-op

Well, Nick is now one week post op. Where is he at?

- no sciatic pain (or numbness, tingling etc)

- can stand up straight again

- no surgery pain, or surgery complications, wound healing nicely

- very tight hamstrings and glutes

- can't bend forwards much, but can extend his back

- can walk about 1 km at a time, twice a day

- doing stretches three times a day

- applying ice after any of walk or stretches

- practicing sitting, but can only manage about 15 minutes at a time

- has seen his physio once, and will see again in 2 weeks (would have been one week but next week is Christmas)

- no longer taking any painkillers

- fairly happy with his progress, but needless to say there is still a lingering fear that problems aren't resolved yet

 

His daily routine is now stretch - walk - stretch - walk - stretch with sitting up for mealtimes. I've added a page showing the stretches he now doing, 1 week post op.

We also visited an Alexander Technique practitioner today. Not a huge success. He found it quite hard work, especially when sitting down and he's not convinced that he feels any better for it.

Just for the record, his walks today were 2 x 0.7 and 1 x 0.5, no painkillers

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2 days post-op

9.30 am

Nick seems to have had a good nights sleep and got up about 9 am saying that he felt good. Certainy had a smile on his face, which he didn't have the night before. Went straight in to a full set of physio stretches - we had read that straight after waking up is a good time to do them as your muscles are warm and relaxed.

Managed to sit up for a light breakfast - he's really focusing on sitting up straight now but, likes us all, finds he keeps forgetting and reverts to a slight slouch. Slight dull back ache around the wound area, so 2x 200g Nurofen and an ice-pack for 20 minutes. Back to lying on the floor, although he prefers lying on his side to avoid irritating the wound. Switches sides about every 20 mins.

Note about ice-packs. Buy several, as they need time to re-freeze and you are likely to need ice before they have re-frozen. Also, try to find really slim ones (we found the Boots hot/cold sports compress the best) so that you can lie on them without it forcing your back up.

10.30 am. Just discovered that a thin cushion under Nick's bum takes the pressure off his lower back and helps him to lie on his back in less pain :-)

11 am. Out for a short walk, managed 893 steps (about 0.4 km). We've devised a clever route plan. Starting from home, he walks 20 yards up the road then turns round and walks back. If he feels OK, he sets off again in the opposite direction, again for 20 yards before returning home. If he feels OK, he sets off again. Etc. This way he can walk a fair distance overall but is never more than 20 yards from home should it start to hurt. This works better than one's instinct of walking until it hurts, and then realising that you have to walk the same distance again to get home and hence overdoing it.

Some wound pain after the walk so more ice spray. Nick's saying that the nurofen isn't helping at all so trying paracetamol this time - 2 x 500 mg. He's trying to have a snooze now.

12.30 pm. Didn't manage to snooze much and by 12.30 decided to do another round of physio stretches, followed by ice spray for 20 mins. Pain only when moves, so perhaps paracetamol is working better than nurofen. Slight frustration that the best position to alleviate pain is lying on his front, but then he can't do anything at all and gets fed up!

4 pm. Further ice spray at 2.15 pm and then another walk at 3.15 pm. Managed a little more this time (about 0.6 km) and Nick said it felt better. Only has a low level of back pain. More ice-spray on return and now has settled down to watch a James Bond film!

5.45 pm. Another set of physio exercises followed by ice spray. Reporting 'very low' levels of pain. Keeping fingers crossed it stays that way. Have now added a page on this blog showing these physio exercises that he's been doing.

10.45 pm. Not much changed since my last post. Nick managed to sit up for supper without issue but did head back to the futon pretty quickly. More ice spray around 9 pm. Slight back pain before going to bed, and he was worried that he wouldn't be able to sleep well so 2 x 500 g paracetamol before bedtime.

Overall not a bad day, and both of us relieved no sudden increase in pain like last night. Ice spray definitely his preferred method of cooling his back because you can cover a greater area and he doesn't have to worry about keeping a pack in place. We seem to have developed a routine of stretching, walking, stretching, walking and a final stretching session coupled with applying ice every 1.5 hours. Hoping that the progress keeps up.

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1 day post-op

8.20 am. Arrive at the hospital. Nick awake and fairly chirpy. Didn't have a great night, 'not bad' says Nick. Difficult getting to sleep and had a few painkillers to cope with wound pain. Wound hurts when knocked or pressed against, which is tricky when you are lying all the time! Healthy appetite and has enjoyed breakfast. Taken a couple of ibuprofen. Expecting physio to visit after breakfast.

10.30 am. Spoken to surgeon who is happy with Nick's progress. Also seen physio which has proven really helpful. Have a list of very basic and gentle stretches for him to do 3 times a day and had a good discussion about when to see his normal physio again. Nick's recommended to start gentle, short walks as soon as possible. Nick reporting that he can sit straight without pain :-) and they checked that he can walk upstairs. Having a shower here at the hospital after which they will replace his dressing and then he can go home!

Dressing and steri-strips came off in the shower so we've had our first glance of the wound.

11.30 am and Nick's back home! We have some extra painkillers in case his wound starts to hurt, but he is pain free at the moment :-) He's set up on the futon on the living room floor with his laptop and bag of food to his side. When he stands up he can now stand straight and suddenly seems taller than before.

 

1.30 pm. Managed to sit up at dining table for a quick lunch, although he said it was tiring on his back muscles. Full set of physio stretches followed by ice on back for 20 mins (using an exercise band to hold in place as he is is lying on his side to avoid pressure on the wound).

2.30 pm. Short 10 minute walk (approx 0.5 km) followed by ice-pack and 2 x nurofen. Slight back ache. Measured height - 1.5 cms taller than pre-surgery!

5 pm. Full set of physio stretches followed by Deep Freeze ice-spray. Spray easier to use, but only lasted about 10 minutes so reapplied after 10 mins. Some mild dull back ache around the wound. Nick finds most comfortable position is lying on his side.

We are both learning that you need to use a timer/stopwatch etc to remind us when next activity is, otherwise you just lose track of time.

6.30 pm. More ice spray. A little bit of back pain around the wound but not enough to require any painkillers.

9.30 pm. Had a bit of a set back this evening. All was going well - little pain, managed to sit up for supper and was pretty happy about life until about 8.30 pm. Wound started to hurt so we put an ice pack on and waited 20 mins. But the pain worsened and Nick described the sensation as if the wound was ripping apart. Indeed, it had started to bleed again.

So, took a Diydrocodeine and Nick has been lying face down (lying on back hurts too much) since then. He's feeling very miserable indeed. Shame, cos today had been going so well.

10.20 pm. Diydrocodeine has had desired effect and Nick's pain has greatly reduced. Gone to bed now, hopeful that he will manage a good nights sleep.

I think that today we have been amazed at the impact the surgery has had. We expected a reduction in sciatic pain, but there has been a huge impact on his 'structural' or biomechanics as well. He can now stand properly, he looks as flexible as you would expect a teenager to be and he walks normally. I hadn't realised the impact that the hernia had had on these. He says that he feels 'freed'. The pain this evening is surgery pain and I am sure it will disapate over the next few days.

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Operation Day!

7.20. At the hospital waiting to see the nurse. Operation booked for 8 am. Nick feeling thirsty and tired.

8.15. Seen nurse, anaethetist and surgeon. Looks like going into theatre 9 ish.

9.45. Nick went in at 9.30 am. Am told op takes about 30 mins, so I should be called down to recovery soon!

10.50. Still not back and working hard not to start worrying.

11 am. Surgeon came up to say all has gone well. Took longer than expected as Nick's disc is still very soft and 'like rubber' and so hard to remove. Nerve is now definitely not compressed at all. Not much disc left so he says he would be surprised if there is a re-hernia. Nick can expect relief from the sciatica very quickly, but to expect some residual back pain initially.

11.30 am. Went down to recovery. Nick very very groggy but otherwise fine. Reports some mild back pain, but basically he's still asleep. Taken back to his room.

12 pm. Another visit from the surgeon to check on Nick, who is now a little more alert but is still dozing on and off. Drinking a lot.

1.30 pm. Bit more pain so taken some painkillers. Wound has bled a fair bit but I gather that is normal. He's beginning to get a bit hungry.

2.45 pm. Both Nick and I slept for an hour. Nick has managed to get out of bed but says that standing tall and straight feels strange! No pain and sounding much more chirpy. Eating well.

5 pm. After a few chirpy hours and plenty to drink Nick is tired again and has fallen asleep. He reports no pain at all, and no sciatica but that may be due to the drugs still flowing through him.

6 pm. Supper arrives. Have you ever tried eating canelloni whilst lying completely horizontal? But, great discovery - can sit at almost 45 degrees with leg straight! That's the first time in almost 12 months. Still no pain reports and to his delight there is football on TV.

8 pm. Have left Nick looking comfortable and pretty chirpy, watching football with my husband, so I can get home for some rest.

Overall today seems to have gone well so I should be able to sleep better tonight.

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