Recovery from Foraminotomy: Week 1

One week ago, I had cervical foraminotomy to hopefully cure my left arm and shoulder radiculopathy.

Right now, I feel like retrospectively reflecting on surgery and the first week post-op, so here we go! 

The procedure: 

Unilateral cervical foraminotomy at c5/c6 was performerd. 4 bone chips and the protruded disk material were removed. I was put in a halo, so besides the 2inch long incision I have staples in the sides of my head that will be removed 10 days post-op. The surgery took about 2 hours. 

The day of surgery:

I quit eating by 8pm the night before and had my last glass of water around 11pm. We left the house at 5.30am and arrived shortly after 6am at the hospital. I only waited a few minutes in the pre-surgery waiting room and was taken to vitals and checks promptly around 6.30. 

My weight was around 150# and I had a hard time giving my urine sample. Information you surely needed.

I changed into a rope and the nurse tried to place an IV in my right hand/arm. She blew two veins and I started to get a bit anxious. This was probably the most painful of it all. She tried twice on my right hand and wrist and completely messed up. Then, she tried my left hand and left me with a pretty big bruise...

My anaesthesiologist came in, locally numbed my hand/wrist and finally got the IV to work! Phew! 

The neuromonitoring guy came I hook me up to his thing and he my doc came to answer final questions and make sure everything was ready to go. 

I was ready to be taken down to the operation room and I think all I talked about were my big dogs and my cat. Then I was in some white room with bright lights. I think there were other patients on their beds around me but I may have been imagining all this! I think I was out shortly after. 

Crazy! 

I woke up in a different room with two nurses circling around me. I tried to move but couldn't and I tried to open my eyes or keep them open but couldn't! Crazy again! 

One nurse then fed me pudding and I know I really liked the pudding! Had it for every meal after that! Tried chocolate, too, but vanilla was way better!

Anyway, my throat hurt from the breathing tube. Since I was on my tummy during the procedure they had to put in a tube. My head hurt a bit - staples. Other than that I was just really tired. 

I was brought back into my room and my husband and his mom showed up quickly after. I needed to use the bathroom and got up around 11am. I felt fine, just a bit shaky. 

I saw a PT and OT to learn how to move and do things but I was up and walking "rounds" by the afternoon. Climbed the cute set up stairs as well. I didn't see any problems come up. 

Yet, we decided to stay a night to make sure. The hospital food wasn't all that bad either. And I liked the pudding! 

At night, my alarm went off several times because my pulse fell below 45 and 40 so, again to be safe they put me on the oxygen. 

I was able to be discharged around 11am the next day. 

Complication and problems post surgery: 

Low blood pressure and pulse. While it's relatively normal for me to have a sub 40 pulse at rest, in the hospital they found it necessary to put me on the oxygen tank and monitor me at night. 

Dizziness and blackouts. Most likely a side effect of meds and my low blood pressure. I passed out in the shower on day 4 post-op. Already the second shower was a bit shaky but I managed to sit down in time. Learned the hard way that a chair in the shower is very helpful; when I passed out and found myself lying on the shower floor crying, I did get scared a bit. I don't think I reinsured though. 

Constipation. All the meds caused some irregularities, that is, no movement. Miralax helped the most. I improved within 48hours of taking it. 

Nausea. Also, a side effect from meds. I quit taking my meds every 6 hours/day on day 6 post-op because I started feeling sick. Only when I actually feel increased pain or muscle spasms, am I taking oxycodone or a muscle relaxer. I have used Ibuprofen and Bromelain for pain/inflammation now and it's working so-so. 

Headaches. Positioning, the hard brace and meds also caused some bad headaches on day 5 and 6. The doctor suggested to try the soft brace and I am wearing it for sleeping or when I am lying down. This, in combination with going down on meds, headaches have improved 100%!

Arm pain. I am a bit concerned that my pain is returning. I haven't had that kind of nerve pain anymore prior to surgery so I am not sure what to think. Did I overdo it? For the most part, I have muscle spasms in my wrist, elbow and upper arm.

Improvement post-op (so far):

As I said, I currently have occasional pain in my shoulder and upper arm but my surgeon said it should go away. He called it residual pain that was caused by inflammation and regeneration of the nerves. After all, I had surgery and it wasn't just a magic trick! Yet, no numbness or tingling have reoccurred. 

I feel like my range of motion has already improved, but I cannot really tell since I am not doing any crazy overhead moves. 

With the incision healing up and me trying to keep up good nutritional and recovery habits, I am sure I will be back to normal before I know it. Then, I will have to focus on rebuilding strength and muscle.

I am now wearing a soft brace about half the time and the incision looks good. The hair they had to shave is starting to grow back and I feel stronger every day.

First week post-op tips:

Eat. Have people cook for you or prepare a lot and freeze it. You will just not feel up to much of anything but you will need to eat.

Take miralax. Kick start bowl movement right away.

Set up your bed. Get a wedge for your bed and plenty of pillows (soft-hard) to adjust your lying position for any occasion.

Chair in shower. Get a shower chair and if at all possible have somebody at you side when you shower.

No overhead. Try not to reach overhead and get clothes ready that are easy to change.

Move slowly but move. Go for short walks, and get up often. Make slow and controlled movements. This helps circulation, healing and your mind. 

Call your doctor. With any questions or problems. I have asked every little thing and was happy to get response within 24hrs very time. 

Avoid heat. Interaction with meds or simply the impact of changes in temperature can impact you more than you would think shortly after surgery, even if you feel great! 

Know your meds! What they do to help you, but also what thy can do I harm you. If you understand your meds you can much better adjust and work around it all. Also, don't become addicted! 

Call friends! Let people know what you are going through and let them help you, even if it's just a phone call! It's helpful to know people are thinking about you. 

Stay positive!  Listen to your body and be careful!

Outlook

I'm looking forward to  start doing slow airsquats and increase my daily walks. Hopefully in a week from today I can drive and start PT! 

Giving up is not an option

We all have been to points in our lives at which we began to question:

Which route should I take?

Will I make the right choice?

Or, is it even worth it?

Many give up right at this point. They listen to all the nay-sayers, the non-believers, and those who simply do not know what we humans are actually capable of. Trapped in a system that is sick in its own way, I can't blame anyone who is unable to break free. I have been there myself probably more than I would like to admit. Yet, I have learned fromy past experiences that truly anything is possible. I just have to keep reminding myself of that lower that lives within.

When I started crossfit almost 2 years ago, I had no idea of what it would actually do to me and how important it would become in my life. At the same time, and as much as (or because of the fact that) I live crossfit so much, I need to look inside myself to anchor my feelings and to not get carried away in the storm I am I finding myself in right now.

Crossfit has changed me.

Yes, I have become physically strong. In fact, stronger than I ever thought I could be, but while the weight on my bar increased, I began to shed the burdens I was carrying inside. I had always tried to fit in. I wanted to be accepted, appreciated, acknowledged and recognized. In crossfit, this seemed to be happening. Even without looking good on the outside. I mean, have you ever seen the faces we make when we lift heavy weights? And for me, I turn tomato red with any physical activity already. A sweaty mess. So, I rid myself of the burden of becoming yet another "perfect woman," and felt I was returning to who I was supposed to be. A strong woman - inside and out.

But it's not just the sport hat did this to me. It's the community. Never have I felt more welcomed, accepted, and supported than in the crossfit community.

In fact, without it - I guarantee - I would have already given up and surrendered. I would be miserable. And worst of all, I would not have acted in my beat interest. My "fear of failure" would have won over my "thirst for success." Yes, I would be so miserable.

Although I must admit that i am getting increasingly frustrated about being injured and especially about being unable to do what I love (insert CrossFit), I am starting to appreciate the side of me that is usually pushed to the side: vulnerability.

It is difficult to step outside and see my neighbors who are all about 20-40 years older than me do yard work, walk their dogs or even go for a jog. It is even more difficult to get in the car and pass runners, cyclists and those, on the contrary, who sit at the bus stop smoking a cigarette throwing away heir health... Most difficult, however, is to go to the gym to do simple stretching exercises and easy, modifed movements while everyone around me is rigging the PR bell - loud and proud - as they should be.

Being supportive of them is important to me. I can be happy with them,bbut I admit that their successes can taste bitter sweet. This is where I am being tested, and this is where I grow stronger. I feed from this. I may not use the fuel just now, but I will when I return.

As much as I hate being injured, as much as I hate not being in control of my body, I am convinced that setbacks like these are put in our ways to challenge us to new levels, to overcome the impossible, and to advance in a way that we simply did not expect.

Most importantly: GIVING UP IS NOT AN OPTION!

Here are two stories (one in German and one in English) that basically talk about willpower, not giving up, and the possibilty of the impossible:

The German article is about Sami Khedira, a German soccer player (Nationalmannschaft) who suffered a typical soccer injury: Kreuzbandriss (= rupture of cruciate ligament). His quick recovery is said to be a combination of both, excellent medical help and his hard work. Two important factors in anyone's recovery. I'm clearly shooting for my part, and so far I am consulting any source I can to get the best medical help available to me.

http://www.dfb.de/news/de/training-und-wissen/das-kreuz-mit-dem-kreuzband/61049.html

In this one, we learn about Miranda Oldroyd, a female crossfit athlete who had a car accident that almost cost her her life. Her story is inspirational and reminds me of my situation. I am not going to give up. I'd rather become the beast of airsquats and pistols but I will not make my injury define me.

http://espn.go.com/espnw/athletes-life/article/11250303/espnw-how-crossfit-saved-miranda-oldroyd-life

Pain, surgery, and athletics

For the last 5 months I have been living with pain and only for the last 3 months have I been stepping back at the gym- at least with overhead movements. Ironically, pain increased drastically with me doing this. Also, unfortunately those are the movements I need to work on most. I've been blessed with some strong legs and a decent booty, but my chest and arms are the weakest parts of my body. Consequently, I am strong at lifts that are are hip-explosive and utilize leg strength. Think cleans, deadlifts (I have a strong grip), thrusters, squats. 

While the pain in my shoulder and arm at first didn't quite stop me from hitting WODs, I soon started noticing loss of strength on my left side. At first, I explained it with being right-handed, and simply considered my left side less strong. Kind of BS, if I consider how I did extra heavy left-hand curls and focused on using my left more in training. It did not help.

Muscle weakness also caused me to not hit any more maxes and I began to stagnate and even regress. Then with my EMG and MRI results, and conversations with my doctors and PTs, I ended the cycle of denial and stopped through the pain.

Light-weight back squats, front squats, pistols, step ups, one armed curls, one armed pullups and push-ups, leg raises, one armed planks, lunges... Yep, basically lower body movements are ok, but nothing over head. Even TGUs on the left shall be avoided. The last PR in my records book was a 210# FS PR about a month ago. Since, I had to take more loads off the bar.

Focus on form. Focus on core. Focus on legs. But I it is very frustrating to feel like I am losing all my strength and fall bac behind everyone else at the gym.


So, I was seeking out data and stories about athletes returning to sports with and without back surgery.

Here are some if my finds


http://www.back-surgery.com/athletes-spine-surgery/

http://www.medicaldaily.com/pros-and-complications-microdiscectomy-and-why-tiger-woods-missing-masters-back-surgery-273900 (this one mentions Tiger Woods, who had back surgery)


http://www.michaelgleibermd.com/blog/74-professional-athletes-undergoing-cervical-spine-surgery.html (this one has short videos explaining different procedures and mentions Peyton Manning who had cervical spine procedures)


http://www.readingneckandspine.com/return-to-play-after-anterior-cervical-discectomy.html (nice read, written by a fellowship-trained orthopedic spinal surgeon named Setphen Banco (MD), citing studies and using Manning as an example as well)

http://www.orthogate.org/patient-education/cervical-spine/cervical-discectomy.html (summary)



---------------------

Today I did the following at the gym, just to keep working a bit - all very slow and controlled - watching my pain level.



1k light row set to resistance 3 for warm-up followed by some easy stretching

40/40 GHD

10rds 5-10sec Ring holds alternating high and low 

5-5-5-5 ring rows 

Working up to heavy FS

5-4-4-3-3-3-2-2-1-1-1

35-65-85-105-115-125-135-145-155-165-175 (which is 35# below my 1RM)

4 rounds Untimed

250m row

20 alternating pistols 

20 alternating curls with 25#right/15#left DB

20 alternating step ups with 10#DB on each shoulder 

Spinal Surgeon #2

I went to another surgeon in South Denver today to get a second opinion. I liked this doctor much more than the first. He was more personable and professional, took his time to explain everything to me and my husband and did not rule out non-surgical options right away.

I still have another appointment set up but kind of feel it's not necessary anymore (nor do I have time to wait any longer). As I just implied the first surgeon I saw didn't take much time to explain or discuss my case, and didn't even consider non-surgical options.

So, surgeon #2 laid out the pros and cons of possible four options that my case would allow for - in his opinion.

(1) Epidural steroid injections

(2) Anterior cervical discectomy and fusion

(3) Anterior disc replacement

(4) Posterior cervical discectomy



We logically ruled out epidural steroid injections because of (a) failure of other conservative treatment including rest, meds (anti-inflammatories, steroids, narcotics for pain), physical therapy, dry needling, chiropractic manipulation, and (b) the location and size of the herniation.



Left with the remaining hree surgical options. But which one should I do? he compared my case to Peyton Manning and his fusion and showed me X-rays of successful fusions he did on athletes. Manning had (4) done but it didn't work out so (2) was his next step. While I was set on disc replacement over fusion after having done my own research - relying more on European studies than US-based research, I began to doubt this was really the right idea. Yet, I kind of excluded option (4)posterior cervical discectomy.



Nonetheless, this procedure actually shows high success rates, yet, it still may lead to one of the other options down the road (think Peyton Manning).

So should I go ahead and do (2) anterior cervical discectomy & fusion (Manning did this after (4) failed) or (3) anterior cervical instrumentation (aka replacement).



This surgeon worked with athletes, and said (2) was the standard procedure for elite athletes in high contact/impact sports. (3) However, lacks US-based research although it appears to be the preferred procedure in Europe and South America. and research has been promising.



Thinking it over and taking to my PT, reading yet a few more scholarly articles on the topic and some rational thinking made me second-guess going for a big surgery right away.



So, option (4) is what I decided and now the insurance approval battle has begun again.

Here are the titles and authors of some of he articles I've read and found helpful

In making my decision for the less invasive surgery:





(1) Early outcome of posterior cervical endoscopic discectomy: an alternative treatment choice for physically/socially active patients

by Kim, Chi Heon / Chung, Chun Kee / Kim, Hyun Jib / Jahng, Tae Ahn / Kim, Dong Gyu; 

Journal of Korean Medical Science



(2) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. by Ruetten S, et al.
Spine (Phila Pa 1976). 2008 Apr 20;33(9):940-8. doi: 10.1097/BRS.0b013e31816c8b67



(3) Minimally invasive cervical microendoscopic foraminotomy; Initial clinical experience. 

by Fessler RG, Khoo LT 

Neurosurgery 51(Suppl 5):S37-S54, 2002.



(4) Advances in Spinal Stabilization. 

by Haid RW Jr, Subach BR, Rodts GE Jr (eds):

Prog Neurol Surg. Basel, Karger, 2003, vol 16, pp 251-265




(5) This one is open access: http://www.karger.com/Article/FullText/351887?hl=1&q=Cervical%20posterior

Long-Term Results of Anterior versus Posterior Operations for Herniated Cervical Discs: Analysis of 6,000 Patients by Dohrmann G.J. · Hsieh J.C.

Section of Neurosurgery, University of Chicago Medical Center



(6) Outcomes Following Nonoperative and Operative Treatment for Cervical Disc Herniations in National Football League Athletes

by Hsu, Wellington K. MD

Spine Issue: Volume 36(10), 01 May 2011, p 800–805