Eleven Weeks Since ACDF Surgery

It’s now exactly 11 weeks and 3 days post-surgery. Time has flown by, especially the last 3 weeks.

During the week 7 post-op visit with my surgeon, he said my x-rays look absolutely perfect. Here they are, in all their glory:

Side View – September 27, 2022
Front View

I must admit that, during the week or two prior to the consult, I was in a bit of a panic, worried that my not wearing the hard collar in the house or that I got frustrated and mowed the lawn once (the grass had grown to be hideously tall). But that concern was all for naught.

So that was great news. I asked about fusion, to which he said it would be “at least 6 months” before any fusion would be visible.” I look forward to my next visit with him on December 20th. I am hoping, but not expecting, that fusion will be visible. More importantly, I am hoping that nothing goes wrong between now and then, and the new x-rays taken for that visit show no changes in the hardware.

The titanium plate and screws are there to lock everything into place and keep it there. So I shouldn’t be too concerned and, truthfully, am very confident. BUT…during that visit I had a list of questions, most of which pertained to returning to activity. Golf, jogging, pickleball, yoga, lifting weights, etc. etc. etc. To my utter shock, he reviewed the list and gave me the go-ahead to do just about all of those activities immediately. The only two caveats:

I was in shock. He left the room and a nurse came in shortly after and then started dispensing a very different set of instructions:

I explained that the doctor just told me I could ditch the collar and return to activity immediately. She said something along the lines of, “He doesn’t know! I’m the one you’ll be emailing if something goes wrong as I deal with the patients daily.” I got it – she’s uber-conservative because she doesn’t want the risk or hassle. He’s pretty non-chalant, knowing the hardware shouldn’t move. With that, I decided right then that I was going to bet on the hardware and the surgeon’s directions. Of course, I didn’t tell the nurse, I just nodded, all the while thinking about getting out of there and getting on with seeing how my neck would feel without a collar on.

With that, we were done and she reminded me to put the collar back on as we were leaving. I waited until I left the building and then quickly removed it for good. That was almost 4 weeks ago. I don’t recall, but I might have put it back on for the car ride home, but that was it.

Since then, I have resumed most activity that I want to do without issue. My neck was *very* stiff the first week post-collar. I was starting to worry but it loosened up slightly each day after the first week. I continued walking daily, but also added in cardio (elliptical machine) and then started lifting weights again (machines, not free weights). For the first 2 weeks I struggled with chest presses, as my right tricep was still noticeably weaker than my left. But it’s getting there and not nearly as weak as it was.

As for mobility….that is concerning. The worry was that I would lose ~30% of neck mobility due to the plate/fusion. I’d say that’s probably about right as of today, it may be even slightly worse. But I am confident that will improve over time because I don’t feel a physical restriction due to the hardware. It seems to be caused by very tight muscles in the back of my neck. I start physical therapy in a few days and am hoping that accelerates increased mobility.

A few days after getting that clearance I made the mistake of going to the golf course. The first few holes I knew it was a mistake. While I probably would be okay now, at that point it was just too soon. Not just strength wise but cardio. I played a 12 hole course that is relatively short but is named “Rolling Turf” for a reason – it’s a workout just walking that thing. I’m now using a push cart – my days of slinging my bag over my shoulder are over – but it didn’t help as I was just out of cardio shape at that point, so pushing that cart up and down hills was tough. I made it through but it wasn’t as enjoyable as I’d hoped, so I’ll lay off golf until next year.

This past week I took a chance and jumped on the pickleball court. It’s been good. Again, cardio was an issue the first few times, but it is getting there. I’m playing with/against the “beginner” level, which ranges from a handful of decent players to many who don’t even understand the rules and are wholly non-competitive. So it’s fun, but frustrating at times as I want to push myself.

That’s it for this post. Again – check out my YouTube channel as I did record a video after the visit with the surgeon. I’ll post here and record another video in a couple of weeks from now. I start back to work next week. Looking forward to it.

Looking back, these past eleven weeks since the surgery, and the months prior in pain and all of the fear and uncertainty, it’s been quite a year. I have been saying to myself since day 3 post-surgery that I could have gone back to work then. But I’m glad I was able to take this time off to truly recover. I was in a bad mental state. The lead-up to the surgery took its toll. I was burned out both with my work and with my personal life. My relationships with others suffered and I have some work to do in that regard for sure. One of the great things about the past few weeks, post-collar, is I was able to rekindle some relationships. I have more to go. I am so much more positive since the surgery. I didn’t realize it but I was in fact in physical decline for at least the past five years or so due to the cord compression and pain due to the pinched nerve. It wasn’t so bad that I couldn’t go about my life, but I was pretty negative and not very nice to be around a lot. I realize now that I was so focused on fitness because working out was my way of getting through the pain. The adrenaline that working out provided was my self-medication.

Onward.


Six Weeks Since ACDF Surgery

So it’s been about six weeks since my four level anterior discectomy with fusion (ACDF) surgery. Recovery has gone really well. Honestly, it’s gone unbelievably well. In my last post, I said I woke up from surgery in no pain aside from some very achy shoulders and upper back. I just assumed that, within hours, the anesthesia and/or any pain meds they gave me during the surgery would wear off and I would be in a lot of pain. I was fully expecting to be on narcotics for the first few days, if not weeks. But the pain never came. Over the next few days the aching shoulders and upper back subsided, and even in the incision remained painless to me.

It took about 8 days for the swelling in my neck to go down. By the morning of day 10 the swallowing issues were pretty much gone. I am still, even now, six weeks later, in shock that the recovery was so smooth and painless.

I did notice that I would get tired, not sleepy tired but more of a slight fatigue, enough to want to just sit down, pretty quickly. But the next day after getting home from the hospital I was up and walking around the house a lot and doing chores.

Walking Daily

My goal as soon as I got home was to MOVE. Move, move, move. Nothing crazy, but sitting around all day was to be avoided. Don’t get me wrong – the majority of the last six weeks has consisted of me on my computer, or watching television. It’s been a slog. But just about every day I have gone on at least one long walk. The first week after surgery I walked around the neighborhood, which wasn’t easy as I live in a suburban township that has a lot of traffic and a lot of streets that do not have sidewalks. Eventually, I paid for a monthly membership at our local Community Center, because it has an indoor track. It’s about 1.3 miles from my house, so my daily routine consists of one long walk:

So about 5 miles total. Some days I will do up to 7 miles. I am convinced that walking has helped my recovery greatly, particularly by loosening up the shoulders and limbs.

I’ve tried to keep myself busy at home too, but it’s been difficult. I just haven’t been all that motivated to do anything productive. While at the hospital, prior to discharge, I was instructed to wear a hard collar whenever standing or moving. When sitting and sleeping, I could wear a soft collar. I was provided a “Philadelphia” collar for showering.

In reality, after the first week or two, I just wear the soft collar when in the house regardless of whether I’m up or just sitting. When I leave the house I absolutely always wore the hard collar. It’ll be great to not have to wear it when walking, which I hope the surgeon will allow when I meet with him next week. The Philadelphia collar was horrible – I found it was very uncomfortable and pressed too hard on my neck. It wasn’t painful, it was just awkward and I honestly don’t think was sized correctly for me. After the 2nd week, when I noticed my neck felt pretty strong, I stopped using it. I haven’t worn a collar when showering since.

My neck feels pretty strong now and has for the last few weeks. It never felt “weak” really, but I notice a difference each week since surgery. But I can tell for sure that, once I am told I can ditch the collar, that I will have some aches and there will be a transition period before I am fully comfortable without the collar. Physical therapy, which I assume will be prescribed, should help with that but just exercising and moving without the support of a collar should be enough on its own to whip my neck back into shape (no pun intended!).

Facebook and Social Media

In the weeks leading up to surgery I joined the Anterior Cervical Discectomy and Fusion Facebook group, which I highly recommend anyone going through this surgery join. But, and this is important to understand, the vast majority of discussions in that group are negative. I spotted this right away and basically turned off notifications for it until the week before my surgery, and I made sure to not even read anything negative. My main goal was to find out what I could do to make things go smoother and less painful. The vast majority of ACDF surgeries go well, people recover nicely, and they move on with their lives. If you base your perspective on what is posted to that Facebook group, you’ll expect the worst…no, you’ll expect, as I did, that at the very least you will be writhing in pain, require narcotics and muscle relaxant medications just to get through the first month if not months. Sadly, some of the advice given in that group is really bad too. The “take it easy!!!” mantra is one. Along with the insistence on telling people to drink milkshakes and eat ice cream all day, when asked what to do to ease the swelling and/or sore throat post surgery. I know it’s a bit judgmental and maybe creepy but before I consider anyone’s advice on that group I look at their profile pic. Sadly, many look like they’ve been dealing with “issues” outside of ACDF related. I won’t go any further other than to say, overall, it’s a great group to get some support and, more importantly, some useful tips for recovery. But there is a lot of sad stories going on in there for sure, and a lot of the advice given is to be avoided.

I have been vlogging my recovery on YouTube, and if you’re interested in much more detail and more timely updates on my progress, I suggest checking me out there.

Next up:

X-rays of my cervical spine are scheduled for Monday. Then, my much-anticipated follow-up appointment with my surgeon is the next morning on Tuesday. I can’t wait : ) My expectations are that I will be told that my x-rays look great, the hardware is set and that I am well on my way to fusing, and I no longer need to wear a collar. While I will be asking all kinds of questions, including when can I expect to get back to practicing yoga and lifting weights, I am expecting a “Take it easy until after PT answer.” Fingers crossed.


Surgery Success!

My Hospital Bed At Jefferson University Hospital

Wow. I just read through my last couple of posts here and almost cried. It’s been about six weeks since surgery. Honestly, I have felt pretty darn good ever since waking up from surgery. I literally was awoken by the surgical team, on the gurney on the way out of the operating room, and first things that ran through my mind were:

  1. I’m alive. I made it through.
  2. My shoulders and upper back ache, and my throat is definitely swollen, but overall I don’t have any real pain. Must be the meds or anesthesia?
  3. No radiculopathy pain in my shoulder or arm anymore!

They wheeled me to the PACU. I forget what PACU stands for, but basically it is the post surgery area where you get closely monitored until your room is available. I remember just laying there oddly elated. Elated that I got through it. Probably more so that I felt pretty good considering I had just had my neck sliced open, bones drilled, etc. etc. Really, aside from very achy shoulders I felt fine. And even the hard collar, which turned out to be a new one provided post surgery (they told me after that the collar I was issued at the surgeon’s office was WAY undersized), was not uncomfortable. I didn’t even feel any pain from the incision. It felt miraculous.

After about 2 hours in the PACU I started to get really annoyed. I recall that I kept telling myself to chill out, that you need to just be thankful. But I was annoyed that it was taking so long to get to my room. I just wanted to get to my room, see my wife, and exhale. It took almost 5 hours to get a room. The hospital was super busy. They did allow my wife to come up to see me in the PACU for a few minutes, which apparently is very unusual. Although they assured me this was an exception due to the delay in room availability, when she appeared I thought to myself, “Something must have gone wrong. They don’t let visitors in here. This might be it.” But no, I was fine. They just didn’t have rooms available.

Eventually they wheeled me to my room. I insisted on getting out of the gurney and getting into bed on my own, and they obliged. I felt like I would have no problem walking, but when I got up I was very wobbly. I was worried. My room was very small, but nice. I noticed later, during my long walks around the corridor, that my room was one of the smaller ones, and also was closest to the nurses station. That sounds like a benefit, but no, it was always noisy. But I had trouble sleeping so I liked the distraction.

Three hours later, after much begging*, an equipment tech who seemed to also double as a nursing assistant, volunteered to walk the corridors with me. I think around fifteen minutes in she started to regret it. We walked for about 25 or 30 minutes. She said it was just about one mile total. I was able to walk fine. My legs felt light. Only concern was my heart rate was up. It didn’t go down until the next day – we still don’t know why.

It wasn’t all roses. My throat was definitely swollen, big time. I did have the expected difficulty in swallowing. I forced myself to drink, through a straw of course, and eat ice chips constantly. I felt as though it was like exercise for my throat – to stretch it back out as quickly as possible. Probably not really effective approach but I figured it couldn’t hurt. The surgeon’s assistants came to check on me and when I told them about the swollen throat they immediately ordered a steroid to be injected. Within an hour or two I started to feel it working, to the point where I was able to eat dinner that evening no problem. It was actually *really* good. But when I took the cover off of the plate I got a chuckle, as it looked like steak. It turned out to be a very soft meatloaf. My complements to the culinary staff at Jefferson University Hospital – the food was excellent.

I will leave out the rest of the details as this post is getting long, but the next morning my heart rate slowed down and, since I otherwise felt good, once the surgeons saw that I could swallow they authorized discharge. Around 11am or so that morning, after one night in the hospital, I was discharged. Shockingly (to me), they let me walk out on my own. I expected a mandatory wheel chair ride, but no, the nurse told me I could go and pointed me towards the elevator. I later found out from my wife that my room was in the Ear, Nose, and Throat ward and not the neurosurgery ward, so I didn’t have nurses experienced in neurosurgery. That made some things make more sense. I won’t go into it, but the one nurse I had for the evening shift was not particularly helpful. Biggest gripe was that she wouldn’t allow me to walk. Walking, I believe, was critical to my recovery. So I was relieved when I woke up very early the next morning and met with the doctors and they told me I could be disconnected from all of the monitoring equipment and am free to walk as much as I wanted, in anticipation of discharge later that morning.

This post wasn’t meant to be a detailed trip down memory lane of my hospital stay : ) It was meant to be focused on how my recovery has gone since. But I guess it’s better to make that a separate post, so I’ll do that.

The ride home from the hospital was a little nerve-wracking but mostly uneventful. My brother and sister-in law were waiting in the drive up lane in front of the hospital. I walked out and got in and they took me home. I made it.


Surgery Tomorrow

Got the call this afternoon confirming the time to report for surgery – 4:45AM. I’m thrilled that it is early. The sooner the better.

I just recorded a couple of short videos of me standing in front of my phone and demonstrating my current neck mobility, so that I can eventually compare it. After viewing them, I was surprised to see that I currently can’t get my neck around as far as I thought I could. So glad I recorded them. The downside to it is that, man, I look like I’ve gained 25 pounds and 15 years of age all of a sudden. I knew my overall health was declining due to the stress of this ordeal but geez…

So glad this is finally coming to the next phase – recovery.


I’m Getting a Four Level ACDF this Week

I’ll keep this post short(er).

After meeting with the surgeon at Jefferson, he recommended a 4 level ACDF. I have no idea what went into his thinking but it was clear to me that he had spent time trying to figure out why the NYC surgeon, who is someone he clearly respects and speaks with often, recommended the more extensive surgery. In the end, he thinks I have a “80 to 90 percent chance” of the ACDF working. That’s good enough for me. Worst case, which will be horrible if it happens, is I will have to get a posterior surgery.

Today is Sunday. Last Tuesday I met one last time with my surgeon to sign the consent forms, got fitted for a hard collar (which isn’t that hard really). Thursday I went downtown and did an EKG, got a physical, blood tests, and met with an Internist who had a bunch of questions. In the end, she said I’m one of the healthiest people they’ve had in there. I guess it was a compliment but for a minute or so after she said it I started to question this whole thing yet again. But, pretty much from then on I am at peace with this and, surprisingly, I am not anxious. If anything, I’m more in “Let’s Fucking Go!” mode. I am tired of this and want to get this surgery behind me and start healing. Let the chips fall. This has gone on for far too long, consumed too much of my life. Time to move forward and either get used to a “new normal” that is either really bad, or hopefully, good. I yearn for the days of exercising, being active, feeling alive.

Tomorrow morning I head back into the city for a COVID test. I believe it is the “swab all the way up your nasal canal, touching your brain” type test but I don’t care. I’m more concerned with passing it. The last thing I need is to have to push this surgery back. If I pass the COVID test, it’s a go for Wednesday.

Forgot to mention – so about 3 weeks ago (a few days after my last post), the right side radiculopathy came back with a vengeance. For about 2 weeks it was horrible, but this past week it is has subsided to almost nothing. I’ve been sleeping in the recliner every night and probably will keep doing so, as I know I’ll need to do it for a while post surgery. But the pain is 95% gone to the point that, if surgery wasn’t in a few days I’d probably start working out again. In fact, just as I type this I’m wondering if it wouldn’t be cool to do, perhaps, one last yoga class tomorrow night. It’ll certainly be the last one for at least 4 months I believe. Nah, I won’t do it. I need to just chill, enjoy the last couple of days before the rest of my life begins. The new normal.

I’m about as ready as I can be, I think. I initiated the short-term disability claim. Surgeon says request 12 weeks. I’ll confirm with my claim manager and HR tomorrow. I’ve been burned out from this health thing to the point where I am burned out from my job, so this time away might be a good thing (not really, but you get my point). Onward.