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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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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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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Brief history

15 months ago, aged 14, Nick started to have leg and back pain. As a keen tennis player, it was diagnosed as a muscular problem due to not stretching enough. So for the following few months he religiously performed a series of physio stretches several times a day (glutes, hamstrings, quads, piriformis etc).

The pain didn’t improve, and 3 months later his GP referred him to first an osteo and then a neurosurgeon. It took the neurosurgeon about 60 seconds to diagnose a herniated disc, and it was confirmed in an MRI the next day.

By this stage Nick was losing sensation in his foot, had reduced reflexes in his leg, had severe sciatica and couldn’t sit or stand for more than about 15 minutes without pain. He had difficulty bending forward, and could only reach his knees. These problems made life at school a nightmare for him.

10 months ago he had nerve decompression surgery to relieve the pressure on his sciatic nerve. Initially the situation improved, but very quickly (a matter of weeks) his original problems came back. He regularly saw his physio and tried to keep fit by swimming and cycling. However, his nerve was severely tethered and no amount of work seemed to release it.

3 months ago he tried a steroid injection in his spine to reduce the inflammation. He had relief for about a day, but beyond that it had limited effect.

1 month ago it was decided that the only option left for him was a micro-discectomy. By this stage he could not stand, sit, walk or even lie without pain.

This is where he is at today. He takes painkillers three times a day just to carry out his day to day activities. Remember he is only 15 years old! I hope this blog will help anyone else in a similar situation.