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Any nurses post ACDF?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:31 AM in Back Surgery and Neck Surgery
Just wondering how long before you returned to work & how it went when you did. I am 8 wks post op today & have been doing really well. I still have some muscle pain in neck/upper back as well as numbness & tingling in my extremities BUT all of this is better than it was pre-op. I've been walking a lot & doing my PT exercises. I live alone so I've been doing all necessary household stuff as well. I occasionally take a skelaxin & a couple advil but try to just use moist heat for pain.

I THOUGHT I was ready to go back to work & so I did today with a 15 lb lifting limit. I work in acute dialysis so it's not always as physical as other areas. I think I was really careful & my coworkers were very helpful (unfortunately I had a c-diff pt but I was the "cleaner" not the roller). We were busy but not CRAZY busy. As soon as I started setting up in the morning I knew it wasn't gonna be as easy as I thought. After a couple hours I was hurting so I took a skelaxin & 800mg of advil. By the end of the day I was REALLY hurting & my numbness/tingling was much worse in my fingers. I'm not sure what to do. I want to be back to work & start getting back to "normal" but I don't want to make my neck worse. My unit REALLY needs me right now because we are a specialty unit & there isn't anyone to help out for the upcoming vacations. The girl that has been working my schedule also works full time somewhere else & isn't able to take on call.

I'd like to know how other nurses did on their return to work. I think I can handle the increased pain but will I do more damage to my neck? I'm a little discouraged because I was so sure that it would go well today.


  • I didn't have surgery yet, but I will have to back to work at about 8 weeks. You know they need you, yet you're still healing. Ask for help and make sure they understand that you need to take it slow. It's so hard when you work and have pain or you're recovering. I'm a teacher and I'm on my feet a lot. I spend most nights with heat on my back and neck. It stinks!!! Just make sure you take care of yourself.

    Good Luck!

  • I work in an OR and was 8 weeks before I returned to work after the second ACDF (am now fused C3-6.) The first week I worked only M-W-F as can't do half a shift in OR because of staffing. Second week I worked full time 40 hours. But it was at least 3 more months before I felt 'recovered.' Luckily we have great CNAs that were great with helping to move/flip patients as needed.

    Body mechanics become even more important, especially how you use your arms, shoulders, and neck. I found I was slower doing everything for months. You will find that stiff muscles, muscles that have been protecting your neck/posture during your post-op period, now are being made to work - it becomes a circle.....but it will get better! It will take time (each person is different) for the nerves to get back functioning without letting you know they are there. I had bilateral tingling in both hands and doc thought it was ulner nerve entrapment. But it was my smart girlfriend that asked what I had been doing with my arms. Dah - I'd been using my garden lopper to cut some branches off a tree :) It soon subsided. But those of use that live alone (and recover alone) are so used to doing everything for ourselves that we just keep on doing them without thinking. Even carrying a laundry basket 2 flights to the basement is a strain!

    So try to pace yourself with home activities! My moist heating pad, then gentle ROM slow stretches, then ice became my routing for months, walking, and reading lots of books! So the house got a little dusty...so what!
  • I guess I underestimated what a 10-12 hr shift would feel like after 8 weeks. I had PT today & my therapist is pretty concerned about some of my symptoms as they seen to indicate levels other than those I had surgery for. He does not think I should be back to work yet. At his insistence I called my surgeons office but only talked to his medical assistant who told me to try to either "ease" back into work or they could put me off again. All I care about is not injuring myself further. I can tolerate quite a bit of pain & I would really like keep working if possible. I had a long talk with my manager today & I'm going to try to continue on full time. We will try to find some solutions for the tasks that break my restrictions. She understands now that there is a possibility I may need more time off. Hopefully it won't come to that. I'm just hoping for some quiet days!

    Thank you for responding. Nursing is such a unique field & it was very helpful to read about what you went through. I guess I was doing so well I thought that I would just slide back into my life. Knowing that it took you 3 months to really feel well helps put things in perspective for me.

    I'm hurting pretty bad tonight (I didn't work today) & just took a skelaxin & percocet. After hardly taking any meds for so long it feels like such a step back. I still have percocets left from the 50 he gave me when I left the hospital & the skelaxin I've had for about 7 months. I do not like to take pills at all! I love my moist heat but sometimes it just isn't enough. Hopefully, this is just a little reality (and ego) check & work will get easier as the days go by.
  • Oh my!!! Tell me you didn't go straight back to a 10-12 hour shift! But am glad to hear your PT person is monitoring your symptoms and that you could share your concerns with your work manager. I hope you have a follow-up appt. with your surgeon real soon. My best advocate was the PA that works with my surgeon. I hope you start to feel better soon but only you know how much physical stress you can take.

    You did say that your pre-op symptoms have improved since surgery so that is a positive. I'm curious as to what PT is doing for you. I did not have PT after either ACDF. But after the 2nd surgery (about 4 weeks post-op) I had such bad upper back pain that I had a choice of doing local PT or driving the 60 miles to use my surgeon's in office chiro. Decided on the chiro and am so glad I did. Four sessions with him totally relieved the upper back pain. His motto was that if he couldn't relieve my pain in 4 sessions then something else was going on. I figured that if indeed the C7 was now symptomatic (bulging pre-op) then he would tell surgeon and further evaluation would happen without delay.

    While you don't say how long you have been a nurse, many of us feel the need to get back to work ASAP and just suck up the feeling lousey - our patients need us. As a surgeon remarked after coming right back to work after a knee scope, sports docs are used to atheletes pushing to get back to their sport ASAP, while the average person wants to delay returning to work for months :)

    It is harder for us to be our own advocate and admit when we need help until we are in a serious position. You indeed may need more time to recover and you should give yourself permission to take it. Is there any way you could shorten your shift hours or work only 2 days a week for a couple of weeks??
  • classical2mu...Yes, I work 10 hrs shifts that easily turn into much longer & I worked about 11 hrs my 1st day back. Yesterday I was there about 9 hrs with the last 2 hrs just catching up on some required education & testing. I was miserable again last night. My symptoms WERE much better & now I feel that in 2 days working I have set myself back to how I felt about 3-4 wks ago except my pain is worse & I do have a few new symptoms.

    You are exactly right as to how nurses are with regard to taking care of themselves. I have been an RN for 17 yrs. I have been so stressed the past few days worrying about how they will manage if I go off again. At least they had some notice before my surgery. I knew that I had done some damage & it would just get worse if I kept working but I couldn't help thinking about my coworkers & hoping I could just push through it.

    Today the decision was taken out of my hands. My therapist said I CANNOT WORK or even do my PT exercises. He said my nerves were completely "jacked up". He did a bunch of testing & wrote a little note about what was going on with me & I brought it to my doc's office. I didn't actually get to speak to anyone other than the receptionist who said she would give it to the medical assistant.

    I felt soooo good on Sunday! Everyday I was walking, doing my PT, doing some pilates & all my household stuff without pain. Now even simple things hurt. Hopefully, in a couple of days things will calm down & I can start working towards building up my strength again. I want to be back to work. Except for the pain, it was so nice to be back this week.

    Kat, are you feeling ok working those 4 hrs? I hope things are getting better. You have that trip soon right?

    Oh yeah, classical2mu....I started PT at about 3 wks post op because my muscles are so tight & knotted. At first they did extensive massage along with heat & e-stim. Then, after my collar came off we started doing strengthening exercises as well. Things were going really well til Mon.

  • Joann,

    Glad the PT documented the status of your nerves! Now admit it, aren't you feeling a sense of relief that a 3rd party validated your concerns!?
    Think of it this way--if you were in a bad auto accident, work would not have had notice and they would be without your wonderful skills for a lot longer than your current recovery. Somehow they manage to survive.....

    Had I listened to my surgeon the first ACDF, I would have been back to work in 4 weeks. But a coworker had an ACDF several months before, came back in 4 weeks and told me in retrospect she should have stayed out 6 weeks. Doc's PA was in full agreement ('he doesn't really understand how physical is your job!') and authorized the 6 weeks. I was really glad I did and even the M-W-F the first week was exhausting mentally and physically. Then 2 years later when I needed urgent ACDF for 2 more levels (and only 2 months before was out for 3 weeks for a clavicle resection) I thought for sure I would be fired and broke out in tears when spine surgeon told me I could not delay like the first time. While boss didn't like it, I wasn't fired. Being a long time good employee, and knowing how much I love my work, does have its perks even during the darkest hours. It had to be done period! Spine doc, man of few words, said 'oh it will be just like your first surgery.' Wrong!!! At 8 weeks I went M-W-F again but it was even more months before I felt 'healed' although while home those last few weeks I felt good and eager to return to work.

    I relate this to you only to stress that many surgeons really don't understand the dynamics of our jobs and the stress of ADL, especially for those of us that live alone and do everything for ourselves.
    He never should have allowed you to return to such a long shift nevermind full time! I don't care how young you are! The body needs time to heal. Ironically, I made a list of nurses and surgeons and anesthesia people who had ACDFs in just the past 3 years and the number is over 15!! I think we are at a high risk and some of it has to be work related, subtle as it may be.

    Now 2 years after the ACDF#2, I have learned my new neck pain (never had it before, just arm pain) is due to significant arthritis (RA vs OA) at C1-2. Have gotten accupuncture which helpd a lot with the muscle spasms for 2 months. Just had another Rx today but with a stimulator. The concern now is I am increasingly losing my balance and stumbling a little - cord compression? Trust me, I don't want a fusion at that level! I doubt I could function in my job with that kind of fusion, and that really scares me.

    So please don't push yourself!! Transitional syndrome does happen. The reality is you may need more cervical work done in the future so do everything now to heal well. A 2 level fusion is more to heal than a one level - you know that!

    So please be good to yourself and stay home! I'm really sorry you have had such a setback. But it is only temporary....in terms of a lifetime, this is a very small percentage! :)

    Keep us posted at to what your doc says! And as my girlfriend told me on several occasions, 'you are entitled to one pity party with each surgery :)'
  • Everything you said is so true & yes, I am relieved.

    I heard from the doc's office & they called me in a rx for Mobic. I've never taken it before...I hope it helps. They offered to call in some narcotics but I told them I just wanted an anti-inflammatory for now. Hopefully, a couple days rest will get me back to where I was Sunday. I'd like to try accupuncture but it's not covered under my insurance.

    You never had neck pain before...I never had arm pain before today only neck pain. Have you had a recent MRI? That stumbling is concerning. I had cord compression at 2 levels & was getting clumsy before my surgery. I am curious about treatment for issues at C-1 & C-2...I have "moderate degeneration of the atlanto-axial joint" per my MRI. My surgeon didn't really comment on it. It's kinda scary having issues at that level, I am only 37.

    Thank you so much for your support. I hope there are no more fusions in your future!
  • Mobic takes at least a week before you might notice improvement. I still added Advil in additon - a big no-no as both are NSAIDS and the risk of a GI bleed is more, obviously. I stopped the Mobic after 2 months and just went back to the Advil. But everyone is different :) Sometimes adding arthritis strength Tylenol helps.

    Perhaps you just need more time with gradual increase in activity. You may have just overdone it and need to step back a little. Many of us have done that, so you aren't the first.

    My doc wants an MRI now. I now have balance issues, just very briefly though, several times a day, whereas 6 weeks ago it was only 1-2x a week. So will just have to wait for the results. No sense getting in a twit about it. I had told the doc who did the accupuncture and he said that was indicative of cord compression....don't want to go there! It is just annoying, not dangerous.

    I hope you are not working this coming week and giving your nerves time to settle down. Did the PT person discharge you? You are only 8 weeks post-op!! Please don't get discouraged (easy to say, I know.) Remembber you get only one pity party this round :)
  • No pity party needed :))) I'm sure this is just a minor setback. I should have listened to my therapist on Tuesday but I'm too stubborn! I knew Monday night that I had seriously overdone it but ignored it & went back for more on Wed.

    I wish I had known that about Mobic...I would have asked for Toradol. I just wanted something to take for a few days til things calm down. Normally, I only take Advil or Tylenol but they weren't helping the last few days.

    I'm not sure when I will go back to work. I have to drop off some forms to my doc's office & see what they say. I don't have an appt with him til June 23rd. I will be sure to go back part time for a little while when I do return. I learned my lesson :O I'll spend the time working on building up strength & flexibility. I'm not sure about PT. He told me not to come for my last appt next Tues. He was hoping I would see the doc yesterday. I know my exercises so I can do them when the pain subsides.

    Good luck with the MRI & let me know how it goes.
  • Joann,

    Glad to hear about your decision to back off for awhile and let your nerves settle down. Did your surgeon tell you how long before you can take any NSAID? Range can be from 4-8 weeks as there is concern about them impacting on the fusion rate. You did say that you were starting to fuse, which is good. I wasn't fully fused till 12 months and that was with using a bone stimulator for 4 months as I was a multi-level fusion. I must admit I am a little surprised your surgeon put you on Mobic.....Do you have a PCP that you can contact for some pain medication? I was given valium for muscle relaxant which really helped. Does the Skelaxin help you?

    I hope you are financially okay....enough sick time to cover the extra weeks you are needing now. I got sandbagged when I had a SLAP repair of my shoulder. Instead of 3 weeks, I was out of work for 2 months and used all my vacation time, sick time, and still needed to dip into my savings. Stress!! Since then I made sure I socked away every spare dollar into my savings. So when I needed 2 surgeries back to back (no pun intended - clavicle resection, then 2nd cervical fusion) at least I didn't have the stress of income to pay basic bills. Even now I only have built up 15 sick days for any future need but my savings account is now flush and that is a comfort.

    It is hard when you are not feeling well to do much of anything at home. Reading became my escape. Read so many books in that 6 months that my distance vision actually went back to normal after 40 years of being near-sighted! Even the opthomologist was surprised but had heard of it. So there was a silver lining :)

    I will keep you in my prayers that this set-back is short lived!
  • I did not get to speak to my surgeon, just his medical assistant. He does not have a PA...the girl I thought was his PA is actually a CST/CFA. He told me I could use NSAIDS after 6 wks. His medical assistant offered to call me in some Darvocet but I was hoping an NSAID would work. Skelaxin helps a little, not much. I've used it in the past & it worked great but no so much now. My surgeon did not prescribe it...I had a refill left from last year when I asked one of the docs in my dept to call me in some. That was back when I thought all my issues were muscular & had no idea my spine was messed up. You know...self treating & all that :P I'm sure if I call the office on Monday they will call in something else...but hopefully, I'll feel better by then :)))

    Our vacation/sick/holiday time is all lumped in together as PTO. I had about 100 hours before I went off. I do have short term disability which kicked in after 30 days...that will be continued now once I turn in the paperwork from doc's office. It's enough to keep me going if I'm careful. I have some savings as well (my down payment for the house I wanted to buy this year). So, financially I'm ok for now.

    I have been watching a ton of movies. I am an avid reader but have not been able to read since surgery. When I keep my arms up I get the tinglies. Even laying on my side I can't get in a comfortable reading position. I've been trying to do it the last two weeks & manage about 15 mins so maybe it will start to get easier.

    You are in my prayers as well.
  • I found this site and I am glad did (Although wish I did not have a reason to) I have been experiencing neck,bilateral shoulder pain, severe lack of range of motion with intermittant numbness in left and right arm. It has been over 6 months The pt,medications and time have not changed anything and I find it has worsened and at times I can not believe the pain. I have put off surgery for my own reason I have seen successful outcomes and I have seen the other side with the patients I have taken care of. I am wondering what brought you to have the surgery.
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