Posts Tagged ‘pain in the shoulders’

  Hi everyone!

Sorry it’s been 12 days but I’ve been a tad busy… I’ve been making final arrangements to go back to Ohio for my 40th class reunion! When I first met my doctor, Dr. William Smith, I told him he had a year to get me well enough to attend my reunion and I wanted to wear 3 inch heels. Well here it is almost time to go and he kept his word! I tried on my heels the other day and I’m good to go!!! A while back I took in my 2 1/2 inch heels to my physical therapy doctor who taught me how to walk in them again… I’m pretty excited to be able to fulfill another thing on my bucket list. And on Thursday I start my first dance class. I bought myself some lessons as incentive but couldn’t use them til now… I’ll let you know on Thursday how it goes!

Well, additional questions have come up as I’ve gone through my website. Important questions I feel qualified to continue to answer. The more questions asked, the more informed you will be in making your final decision to have your life changed. As with all surgery, there are complications beyond the control of the doctor or that could not be seen at the time of your surgery. Just remember one thing, your doctor is acutely aware of the risks involved, therefore, it’s in his best interest to make sure everything he does is in your best interest. I say this because some of the questions asked seem to want to lay blame on someone. Surgery has it’s risks. That’s why you should be as informed as possible going into it.

HOWEVER, the surgery is only one small part of the healing process. YOU are the one in control of the final outcome. If you are a smoker and the doctor asks you to quit, THEN QUIT. The only person you are hurting is yourself AND the doctor can only do so much. Smoking is one of the biggest roadblocks to recovery. It limits your blood flow and slows down the healing way more than you can imagine. If your doctor tells you to go to physical therapy, THEN GO. During your operation, no matter which one you’ve had, your body goes through a severe trauma. The muscles he had to cut through to get to the area to be fixed need help so they can function at full capacity once again. It isn’t going to be forever, but after your surgery, you need to know you must make every effort to help yourself. THE DOCTOR CAN’T DO IT FOR YOU! One more thing, in most cases, your condition deteriorated over a long period of time. YOU ARE NOT GOING TO HEAL OVERNIGHT.

I spoke with one woman who told me she was planning on going across country as soon as she had her surgery. When I informed her she would have at least 6 months in a back brace she told me she didn’t have that kind of time. Her husband had retired the week before and they had always planned that as soon as he no longer had to work they were going to tour the country. It truly is a great plan for those who want to do that type of thing. But the reason she was going to have the surgery done was because she couldn’t step up into their RV due to her pain. I tried to reassure her that she’d be able to do all she wanted after the surgery but just not RIGHT after the surgery. Your body needs time to heal, and sometimes the healing is slower than we expected or wanted.

I temper what I tell perspective surgical candidates about my experiences not because I don’t want to scare them or not tell them the whole truth. My circumstances were very unique, and I was far more willing than most to comply with ALL of the recovery process. Some people are not so diligent and I’m OK with that if they are. Again, the only person they’re hurting is themselves. As for me, I’d been in pain for so long, I wanted to do everything possible to insure I had a complete and successful recovery. I lost an entire decade of my life to several disabilities and I needed to get on with things as quickly as possible and by doing the recovery necessary I was able to do that.

For most people, recovery can be totally and completely successful if they are willing to put forth the effort, unless of course, there are mitigating circumstances or complications. When a person does, they feel better about themselves. I had to give up my job because of the severity of my pain and succumb to a sedentary life for an entire decade. Because I wasn’t able to move as well as I once did, I put on weight. That in turn put more stress on my conditions. Which made it more painful, which made it necessary for more over-the-counter pain relievers. Those in turn, have an effect on your kidneys and liver because you’re taking so many a day just to get through. That makes you depressed which then makes you want to eat more and be less active. It’s a vicious circle with no real way out. That is, until you come to surgical relief. So it really does become a no-brainer that surgery is the best option, unless you are so terrified of surgery it’s impossible to overcome that fear. I don’t make light of that but let me address it head on. Would you rather be on drugs that change your personality, don’t really take away the pain for good and often times leave you “hooked” on them and still be limited with your mobility? Or would you rather know that after a time spent with surgery and recovery you can be drug free, and free to be as mobile as you once were.

Right out of the gate I want to answer a question posed to me online. “What kind of doctor performs the ACDF and XLIF? My doctor is a NEUROSURGEON. More importantly he is a doctor affiliated with NuVasive, the company instrumental in the development of the minimally invasive spinal fusions. NuVasive trains orthopedic surgeons as well as neurosurgeons to perform the ACDF and XLIF along with other minimally invasive techniques. Depending on the type of condition you have will dictate what type of technique your doctor will use. If this procedure is something you’re wanting to explore further, go to the NuVasive website where they can connect you with a NuVasive surgeon in your region.

Let me address the surgery itself. Minimally invasive ACDF, XLIF or even the hip replacement I had done puts less stress on your body. I’ll explain in simple terms. Because of HOW your doctor gets to the area needed fixed, he is able to do this by no longer cutting into as many layers of muscles and tendons. In years past, a surgeon had only one method to reach the affected area, through all the layers of muscle and tendons. In doing so, they caused as much or more damage to your body just to reach that area. That’s why so often you’ve heard of someone’s brother’s, uncle’s, cousin who had back surgery and swears it was the worst thing they ever did. IT DOESN’T HAVE TO BE LIKE THAT ANYMORE. More and more doctors are being trained in the minimally invasive procedures giving rise to a very high number of success stories. Another very HUGE plus of the minimally invasive procedures is that a patient isn’t on the operating table near as long as the old method. The XLIF procedure I had done was three hours and twenty minutes. Normally, with any other doctor, it would’ve taken about an hour per level. Since I had six levels done, it should have taken at least six and that’s not including opening and closing. Dr. William Smith is exceptional and world renown. I am very blessed to have Dr. Smith as my doctor.

An added benefit of the minimally invasive procedures is, there is less blood loss. I had a patient speak with me about his pending operation. I told him that I was in the hospital three days and was amazed. But he was opting for the conventional procedure because he liked his doctor and the surgery would be closer to home. As it turned out, he spent five weeks in the hospital. During the first eight hour operation he started to “bleed out” and the doctor had to stop the operation. This was NOT an minimally invasive XLIF procedure. He closed him to let him recover from the blood loss. Three weeks later they went back in to finish the job they started. It was a long, painful, grueling process. One he said, he never wished anyone would have to go through. I feel really bad for him, but in the end, it came down to him choosing the wrong procedure for the wrong reason. He is getting better and more mobile every day. He did say that he was very frightened by the whole ordeal and wished he’d made a different decision. Hindsight is always 20/20.

Someone asked, “how strong is a lumbar fusion?” Well I’ve been told that if I was in a car accident, the other unfused portions of my back would break before my fusion would; taking into consideration you are more than six months out from the operation and all things went well. My doctor takes x-rays at different intervals of my healing post-op to see how well the fusion is “taking.” The x-rays will clearly give him a measure of what’s happening in my body. The more successful the fusion is the more solid the spine looks in the x-rays. Dr. Smith has always been pleased with my progress.

Another question was asked about the swelling of my legs post XLIF. I suppose it all depends on many circumstances. One, how active are you post-op? Activity and movement are important during the first phase of your recovery. I’m not talking about walking around the block, I’m talking about just doing the passive exercises prescribed to you while in bed, like moving your feet up and down and bringing your legs to a bent position while laying down and moving your legs from side to side. And then there’s always the trek to the bathroom. I’m glad I live on one floor so I could walk to the bathroom.

A family member was recovering from a hip replacement and had a portable potty brought to her bedside. She got no real exercise at all and she never did really recover from the surgery. I have to add she also refused to do any of the physical therapy exercises at home on her own. Keep remembering… your recovery success is up to you! No one else. Swelling can also happen when edema occurs, which is often treated with medication. As you become more active post-op, your swelling should subside, unless of course there are some other medical issues you need to deal with.

“There’s pain in my shoulder after my lumbar XLIF surgery.” Yes, there will be some pain in your shoulder on the side you were operated on. Remember, instead of the doctor cutting through all your muscles, his assistant “pulled” them aside so he could work on your affected area. By pulling all those muscles aside, they’re stretched from their attaching points, often farther away than you may think that they are attached. I’m grateful to my doctor for explaining that I would have that pain afterwards so it came as no real surprise when it did. It should subside within a couple of weeks post-op, at least mine did.

Yes, there will be pain the length of your leg for a short while. This too will subside as the nerves reconnect that your doctor had to work on. Actually he probably released the nerves from being pinched and you may have a feeling like someone is poking a needle into your skin in a hundred different places. That’s your nerve endings reconnecting. Each person will experience this a little differently and the length of time it takes for your nerves to regenerate will be different as well.

One of the coolest things about minimally invasive surgery is the fact that you have very small scars in comparison to conventional surgeries. I have three, two-inch scars on my right side. Dr. Smith also needed to go into the back, so I have a one-inch scar on my spine at waist level; which has almost disappeared. Prepare yourself to wear very loose, comfortable clothing for a few months until you can put a pair of pants or skirt on with a tighter waistband. The incisions are usually made right at the waistline. I have a propensity to keloid so I had to work on my side scars with some Vitamin E oil. I got the 40,000 IU’s, but for most people the 10,000IU’s should do the trick. (you can find this in most drug stores or health food places such as Whole Foods) When you rub it on your scar, push with some degree of pressure. You’re not looking to reopen your wound, but you are wanting to break up the scar tissue forming underneath where the doctor actually cut. Mine was flat and comfortable within a few months.

One parent was concerned about picking their child up after surgery. Whether it’s the XLIF or the ACDF or for that matter even the total hip, you should probably avoid doing any lifting until you’re cleared from your doctor to do so. Make arrangements for someone to do those kinds of activities until you are more able. One trick would be to sit in a chair or on the sofa and either have the child brought to you or to have the toddler climb up to you. Lifting in the first couple of months of any surgery should be avoided unless otherwise specified by your physician.

OK, so I’m four months post-op from my ACDF and I have a few bits of wisdom for those who have just had it or are thinking about it. Let me preface this by saying…I WOULD DO IT AGAIN IN A HEARTBEAT!!! The relief I got from the pain was immediate.

The surgical pain is a little bit different. One has to understand that within a little less than 8 weeks after I had my ACDF, I had to have a total hip replacement. This meant I had to have another airway put down my throat, allthewhile healing from the neck surgery. This posed some interesting problems for me healing from the ACDF. It was four days after my ACDF hard brace came off that I found out I’d have to have a total hip replacement.

The hard brace, I’m not gonna sugar-coat, was the most unpleasant thing I’d experienced so far. We have a natural tendency to twist our head in a certain direction of sound, or to look down when we drop something. With the hard brace I tried to do all that but my chin was caught making it immobile. Each time I did this my jaw had extra pressure on it from trying to look a certain way. My teeth hurt a lot from that pressure. I was uncomfortable most of the time. The only relief I got was if I went to lay down or at night because I was able to wear a soft brace if I was laying down. But I knew it was only for six weeks. My back brace was on for four months, originally being told I’d have to wear it for six months. 

I don’t know if it was a combination of being in the brace for six weeks and having to have another airway put down my throat, but the healing of my neck has been slow for me even though it’s only been four months. I just feel I should be further along than I am. It’s felt like someone is choking me, not enough not to breathe, but still choking me. What it really is, is the muscles they stretched to get to the area of the spine to fuse, relaxing. The right side of my face is still slightly puffy, but I’ve never had my jaw go completely out of place afterwards. I did have some clicking, but my doctor of PT gave me some mouth exercises to help with that. A few weeks of doing those and my jaw felt much better.

Early-on after surgery, I did have some real muscle tightness but as I did my physical therapy exercises, that subsided. I had a lot of breathing and swallowing issues right after my ACDF but it was my own darn fault. You see, I refused to take the steroids the doctor prescribed while in the hospital. It wasn’t until he was out of town five days later that I realized I was in trouble and had to call his PA, Joe to have a script called in. Joe said they’d take a couple of days to kick in but I should be OK. They did and I was, but not before it gave me a real scare! A really stupid move on my part! Hindsight is always 20/20!

I didn’t have any face pain after my ACDF, except right afterwards, but that subsided quickly. It was from them pulling those muscles aside to get to the vertebra. It was really weird for a while because when I tapped on my neck it sounded so hollow. All the muscles and inner-workings; voice box, esophagus, etc were so far over and they needed time to work their way back. It took almost a month for the tapping to not sound so hollow! Before my ACDF my arms were constantly going numb and my right fingers were numb as well. As soon as the ACDF was done, the numbness went away.

Right before surgery I asked Dr. Smith if I’d be able to sing again. He answered, “Most people recover nicely getting their voice back and have no problems. A small percent end up with a rasp in their voice for a good while and an even smaller percent will have the rasp permanently.” Well, that didn’t really answer my question, but then again, it did. What he was telling me was what I could hope to expect, but that each person’s recovery is different and he wasn’t going to predict anything.

He did advise me that I shouldn’t put a strain on my voice until I was like at least four months out to allow everything to work back into place and then I could start to do singing warm ups and vocalizing a little. I’ve started the warm ups and the vocalizing and I’m here to tell you it still feels like there’s a lump in my throat. I’m wondering if I should get my throat stretched. The more I use my throat and neck muscles for talking and singing the less I feel like someone’s choking me, it’s still there, but less and less as the days go by. I imagine that by the six month mark I should have my voice back completely with no discomfort in my neck at all. Just in time for rehearsals for Christmas Choir. Now my singing voice will be a different story. I don’t know how far up the scale I’ll be able to go, but from the preliminary exercises….well, let’s just say, I’m very hopeful! The more I get control of the muscles the better the sound is. I’m starting to do some things I didn’t do before so I’m treading on mighty uncharted territory. More along the lines of contemporary singing rather than the opera type that I was trained to sing. That’s OK, I like a good adventure!

I’ve had some unique experiences because of me having an XLIF and a total hip. I am glad however that I didn’t have the total hip any sooner. If I had, I don’t think it would’ve rendered the same positive results. By that I mean, my back had to pretty much completely heal before Dr. Michael Crovetti, the hip surgeon, would know how to set my hip so I didn’t have to wear orthotics any longer. He did the final “tweaking” so to speak to my structure. Even though Dr. Smith had stabilized and straightened my back to a degree, my shoulders were still visible crooked. One was higher than the other. It wasn’t until Dr. Crovetti replaced my hip that I now stand with both shoulders even.

I had a picture taken at the NuVasive Cheetah Ball in San Diego with Bill Walton and Nate “Rock” Quarry. Standing between the two of them made it really obvious how crooked I still was, but that was before the hip surgery. I’d love to have another picture taken between the two of them again just so I can hang them side by side to show the comparison. With each surgery I’ve become a better person! Physically and mentally. If anyone is facing the same dilemma, to them I say, have the back done first, wait and heal completely from that and then have the hip done. You won’t regret it. I’D DO IT AGAIN IN A HEARTBEAT!!!

So as I close for now, I hope this has opened your eyes to some of my experiences. Do your research and make sure you fully understand what it will take to heal. And whatever you do, remember that your doctor can only do so much, it’s up to you to do the rest! Choosing a minimally invasive procedure is a step in the right direction… enjoy your journey.

 As always remember to take care of you and yours,

hugs,

Kathleen