My name is Tam and I live in Northern Virginia. I'm a 40yo married, working mom of 4 (one child is an adult now, *whew*) - for my paid job (LOL!), I work administratively at a desk all day, 2 monitors, like a tennis match. When I'm not sitting, staring at my monitors and manipulating databases, I might be found lugging files, some from drawers above shoulder level since I'm 5'2". In advance, I will apologize that I'm long-winded, but I do want to share my story.
In 2005, I was stopped in construction traffic when I was slammed from behind by a guy going full-speed ~60mph. I'm lucky I survived - he must've hit the sweet spot of my cheap Neon or something. I had to settle - I needed a car! Injuries were "minor," I was primarily treated for whiplash-type injuries and trigger points with 6 months of PT & chiro. Then the insurance coverage ran out, just after I had my first MRI that showed the beginnings of disc degeneration. But it seemed like it was minor - maybe just "typical aging" at 35. So the back specialist wasn't overly concerned as he was discharging me because insurance was done and I couldn't keep up PT at that pace out of pocket. Other than muscle spasms, I didn't deal with much after that.
In February 2011, while working at my pressure-cooker job, I started to have searing pain running down my shoulder blade, across my collarbone, and down into my arm. I had trouble turning my head to the left. So... I saw my PCP, who decided to dose me for a week with some Naproxen and Flexeril and see if it went away. It didn't. So in her wisdom, she decided not to image first and sent me to PT. PT fought with my spine and it wouldn't move. Trigger points were flaring all through my neck, shoulders, and shoulder blades. Two months in, I was getting worse, not better. My thumb and index finger started going numb on me. I started losing dexterity. Sometimes it felt like the signals my brain was sending my fingers wasn't connecting, as I tried to type. Holding a pen became difficult - I had to write larger for it to be legible.
Back to the PCP I went, who initially thought, "Maybe carpal tunnel, and let's do bloodwork to R/O something systemic. Buy a brace and wear it for a week." My PT shook her head and said, "No, no way is it carpal tunnel - call her and ask for an MRI." Well, to try to keep it short, the MRI was a mess - bone spurs everywhere, various forms of arthritis all throughout the mid-to-lower c-spine, herniation at one level with a huge osteophyte complex, partial signal loss and dessication at the level above, low-grade left neural compression at C4/C5. And at C5/C6, I was looking at high-grade right foraminal compression, mid-grade ventral nerve root compression, and low-grade right paracentral compression. Oh, and some minor flattening effacement of the spinal cord. My PCP? She called me herself to tell me that the MRI said I had a sinus infection but she didn't have the primary results yet. A week later, after I already picked up a disc and report on my own, my PCP's receptionist called to tell me that I had arthritis - go see a pain specialist - and your bloodwork is clear. Ha.
I took my PCP's advice under advisement and talked to my PT, who was astounded that she was ignoring the herniation and stenosis. So under her advice, I contacted one of the local Spine Institutes. They asked me to submit my reports and MRI discs, they notified me that I was accepted and asked if I wanted to go conservative first or jump straight into seeing a surgeon. I figured it's always best to try conservative... so I started off with physiatry.
Nice physiatrist, fairly new - only a couple of years into practice. He took one look at my MRI, declared it "not pretty at all" and told me that if a surgeon looked at it, he'd most likely say "Surgery, definitely" - but that's what surgeons do. I was there because I wanted to see if it could be avoided, obviously. And, here came the drugs. Switch from Naproxen to Celebrex. But anti-inflammatories weren't strong enough - my PCP had already tossed in some Vicodin, but he increased the frequency - BIG bottle. Add Neurontin for nerve pain. I'd already tried Flexeril & Skelaxin - we didn't want to go to Soma yet - so we went with Valium for my trigger points, since I have anxiety disorder anyway. I was given LidoDerm patches for topical treatment. This was all, on top of my Wellbutrin and piggy-back Celexa for my anxiety. And my occasional migraine meds. And my inhaler for my asthma. Yeah, I don't know how I stayed awake during the day, but I did. Oh, and I had a TENS unit prescribed so I could e-stim myself whenever needed.
A couple months in, meds weren't working. We did a trigger point injection and I could barely tolerate it - not to mention, my nerves didn't like it, I had new radiculopathy paths. He wasn't so sure that nerve blocks or steroid injections were going to be the answer, given that response. We did an EMG - arm and hand were "as expected" for someone with my diagnosis. My entire shoulder girdle and neck showed remarkable nerve damage. My primary arm was significantly weaker than my secondary - I was given ~5 pound lifting restriction. And... he asked what I wanted to do next. Did I want to increase and add drugs? Maybe try an injection once? More drugs? I don't know how I wouldn't be a zombie if I took more. No, let's talk to the surgeon to see all the sides of the picture. My husband asked the physiatrist, "Are the treatments that you suggest actually going to improve the condition or just mask the symptoms.?" And the doctor confessed, "We might slow it down, but it won't be reversed. And, yes, there is a slight risk that she could eventually lose use of her right arm." Ok. That decided it. Losing use of my arm doesn't work for me. Let's see the surgeon and get the full picture.
I saw the surgeon. He took x-rays to see the picture that day, and he said, "No doubt, conservative treatment is wrong for you. The ball started rolling in 2005, you work at a mostly sedentary job that puts pressure on your spine and also seems to cause you to have "forward head" from looking at your screens. This has been going on too long, the nerve is too damaged Yes, there's a chance... if you continue to treat it conservatively, you wouldn't feel it - you'd just wake up one day without being able to use your arm." Ok... get me scheduled. Now.
I had a C5/C6 ACDF (Anterior Cervical Discectomy & Fusion for other new members who might not know all the acronyms yet). I stayed overnight - no hassle from insurance, on paper it was a 23 hour observation and required no pre-auth. *Immediately* I could feel the decompression in my spine - it didn't feel like my head was jammed into my shoulders anymore. I was actually able to eat soft solids 1 hour post-op because I was starving and swallowing well. I had the PCA Dilaudid. Things were beautiful - I felt great with that PCA, I took lovely walks with it. I went home on Percocet. Eh, that was less great, but I slept a lot. And ate a lot of french toast - my husband has become an expert at french toast.
(This is where I mention that I'm lucky - my husband is in IT and can work from home if needed, so he's been home with me nearly every day of my recovery so far.)
Things got interesting 3 days post-op. I had some sort of reaction - severe itching all over my neck and chest, welts/hives - and I ended up at the ER (at a hospital 5 minutes away instead of the 30 minutes away hospital that performed the surgery - they're all corporately owned, so they have shared info). I had a CT, they took lots of blood, started giving me IV fluid but no meds - had to wait for CT results. If there was sign of infection inside, I would be back in for emergency surgery and I couldn't have any meds. After about an hour of itchy agony, they came back and said the CT was good, the bloodwork came back positive for both infection and histamines, so they were calling it cellulitis. Probably adhesive reaction (though it had never happened before with other surgeries). Husband thought maybe Betadine allergy, given how widespread it was, but that hadn't happened before, either. They kindly gave me an IV push of Morphine and Benadryl, with a double-dose of Keflex for the road. I got a script for more Keflex, but was told to follow-up the next day with my surgeon before filling. He says allergy, I think it was both, because it didn't fully clear until I finished the antibiotics that he ok'd. I did get to see my hardware in my CT, so that as cool. But... he had to change his protocol for me. His usual standard is collar for at least 2 weeks. I couldn't even wear a bandage over my incision, so I certainly couldn't wear a collar.
I'm now 3 weeks post-op. Incision is nearly healed - faster than usual, probably due to the open air exposure. I've had more than average difficulty with finding comfortable positions because I didn't have the collar to help. And I had nothing to remind me not to turn my head. Ouch. X-rays taken at my 2-week post-op appointment looked great so far. I'm still having some nerve issues, but I was warned in advance that the nerve may never 100% heal, it was so damaged. I go back to work at 4 weeks post-op, part-time at 4 hours a day for 2 weeks, and I have severe limitations on lifting (2 pounds) and NO FILING.
My biggest issue is pain management at the graft site. I had Percocet when I went home. The first dose was 30 tablets, which lasted just slightly more than 3 days at the dosage amount/rate. When I saw the doctor 4 days post-op, he gave me another 30 tablets, but said no more Percocet after that. So after another 3ish days, I reverted back to my left-over pre-op Vicodin. When I saw the doctor at my 2 week post-op, he wrote me a new script for Vicodin. 30 tablets - 1 every 6 hours, as needed. He said he'd give me one more round, if I needed it. Trying to ration the pills to last is. killing. me. At night, when I'm trying to find a comfortable position, 1 Vicodin tablet does nothing. I'm considering sports wrap and a piece of gauze over the incision so I can sleep with the collar for a while. I've had some severe pain rounds during the day - it's been damp and chilly - 1 Vicodin doesn't cut it. Yesterday, I had a physical and emotional meltdown. By my calculations, once I go back to work, he's going to have me on Tylenol only and I honestly don't know if it's going to be successful.
I go back to work the Monday after Thanksgiving and I have no idea how I'm going to sit at a desk and type for a long time. I took breaks while typing this post. My surgeon told me to start practicing... but it seriously HURTS.
Other than that, I'm tired all the time - and activity wears me out quickly. I was going to try to start going for walks on my own, but I get tired just walking around my house.
The surgeon already referred me back to the physiatrist to deal with the nerve issues and whether to wean the Neurontin. Since the physiatrist's specialty is pain management and rehab, I've scheduled an appointment pronto so I can also discuss pain management with him.
But the bottom line... and it took forever to get to it, thanks for reading: I do feel the difference in my spine and I know my body just has to get used to the hardware and the bone graft. I also wonder about C4/C5, if it's going to worsen, and I'll be back for another ACDF soon. There's the arthritis everywhere, so of course I'm going to get more spurs. But moral of the story: DON'T wait until the pain is this bad to consider talking to a surgeon - my nerve may never fully heal and I may always have residual side effects.