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Input please--delaying surgery

I will try to make this brief. I recently found out I will need a four level acdf. Here is my dilemma. I have been trying to stop smoking for several months. Obviously, I must before the surgery. I have been taking hydrocodone 10 mg, 3 times a day for almost a year. After taking most muscle relaxers and having no results, I am now taking Soma 350 and Neurontin for nerve pain. I want to delay the surgery (and with careful monitoring, my doctor said that would be safe) until I can have some confidence that I have completely quit smoking, and I would like to lose a little weight and just overall be in better shape before tackling major surgery. The problem is, my pain is not controlled. That makes it very difficult to do even simple things like walking, taking care of my home and family, and of course the pain adds stress which makes staying away from smoking more difficult. One of the reasons I want the surgery is to eventually get away from the pain medicine altogether, or at least as little as possible. I guess my question is...if my doctor suggest increasing pain meds, should I? Or just tough it out until surgery on the dose I am on? I do understand I will not be pain free, but I need to be better able to function. Then I go around in a circle and think...just have the surgery now, so that you can start the road to recovery. There is compression of the spinal chord and nerve damage already, so I wont be delaying surgery very long. Just a few months at most, Any input would be appreciated. Thanks everyone!


  • Only you can say what's best for you. You sound scared. That's normal!! My surgery took 15 months to get to.
    Think positive and set little goals for yourself. Write down what you need and what you want.. Look at it the next day and in a relaxed state. I started writing the littlest things down realizing that the medication does affect your thinking, emotions and sometimes judgement calls. I tried to stick to a routine.
    Do you have a trusted friend or someone who you can confide in? Maybe even a spiritual advisor.
    I wish you all the best support in your journey.
    46 F Avg Hgt/Weight non-smkr/drkr, ex-runner
    Chronic back/neck pain/urticaria (pic)
    ADCF C6-7, 11/13
    C3-4-5 , L3-4-5-S1 DDD bulge annular tear

  • Doug HellDoug Hell Posts: 335
    edited 02/27/2015 - 4:21 AM
    I am glad that you are aware that this is indeed something that you need to take care of sooner as opposed to later. Do not delay too long as I have read many horror stories surrounding those that waited too long with a spinal compression....

    As we all know, smoking is the biggest complication for fusions not fusing, so I commend you for trying so hard. This is going to have to be a mind over matter situation as your situation is dire! Please just do it!

    Have you thought about taking an extended release/long acting opiod med such as MS Contin? Extended release and long-acting opioids often contain higher doses of medication than immediate release opioids and opioid/non-opioid combination drugs and can help regulate your pain. MS Contin has worked wonders for me. Just a suggestion! Maybe ask your Doctor about it?

    Wishing you all the best.

    Realize that FEAR is our worst enemy. Get up & get out in that stormy weather of the real world & kick fear in the teeth. Stare at it dead in the eyes & walk right through it into the storm; because once you're wet, you won’t fear the rain anymore
  • DC 90,

    If I had could back in time and do it all over again, I wouldn't have wasted time with anything but a long acting opiate and I certainly wouldn't worry what others may think of the matter.

  • Talked to pAin management doc today. New emg shows that the nerve damage is now bilateral, so going for second surgical opinion next week, but it looks like sooner rather than later. That said, he suggested a slight increase in current meds instead of trying something completely different this close to surgery. If I delay (or insurance does), then we will try something different next month.
  • Not sure if you are working with orthopedic doctor or neurologist, but it's a definite to get a second opinion. Looking back I wish I had. I've taken Hydrocodone 10/325 for years now beginning (at various dosages and with various medications) after my C4-5-6 fusions in 1996. If it had been available, I would have and will definitely, if given the opportunity, have the Artificial Disk Replacement in the future. As you know the disks above and below the fused levels experience increased wear. The wear is decreased with the ADR. Increase the medication if your doctor approves and maybe that will help you quit smoking. I hope to hear from you after recovery!
    1996 - C4-5, C5-6 Fusions
    2010 - Medtronic Cervical SCS (leads implanted at C-2)
    2010 - SCS went AWRY :( .
    2011 - SCS REMOVED :)
    2011 - SEID
    Please......Do not agree to CERVICAL SCS w/o researching outcomes.
    God Bless you :)

  • Thanks everyone for the info. I want the artificial disc but they aren't available for four level use, so it looks like fusion is my only choice
  • DC 90, a four level fusion is significant. That can take a long time to heal post surgery. The fact that you have a PM doctor is good, he or she will be understanding of the situation. If you do the opiates correctly you will find a dose that allows you to continue your career and also do things with the family albeit with less intensity. I personally use the new drug Zohydro and kept Norco on hand for break through pain management. I have a wife, two kids and a complex job so it can be done.

    I am finally at the stage in healing where I no longer use the short acting opiates and am on a 90 day wind down of the long acting ones. If you ever want to some tips on managing the opiates Ill be glad to share them. You can use them and be productive.

    There may be times when the pain is too great and you have to take the short acting opiates and you end up in a stupor but that is just the deal.
  • Thanks and yes, I would be interested in any info you can share. Feel free to pm me. Did you have a four level as well?
  • It is indeed a very tough surgery to get through, especially if it is a posterior approach, as was mine (they cut through all the muscles to perform the surgery)..... Luckily, yours is an ACDF approach, so it will be less painful, but that too comes with its cons......What area are we talking about with respect to your surgery?

    It has been 14 months and I am still home dealing with the effects of it all.... That doesn't mean you will be, but we are all different in every aspect of the word "different" so bare that in mind. I will have to re-educate as returning to my old job is not an option for me.

    My situation may be a bit different as I was involved in a serious accident, so I was dealing with a burst fracture, 2 other fractures and a dislocated vertebrae as well...... Obviously, the fractures alone take a great deal of time to heal...... That being said though, U are up against a very big surgery, so don't expect to jump back in the game immediately with respect to your job. Also be advised that surgery is not always a pain fix. Less pain after the fact is merely a bonus, so don't go in EXPECTING to be pain free after the fact, you just might be disappointed.

    I wish you all the best with it. PM me or continue here if you would like something answered specifically, etc....

    Realize that FEAR is our worst enemy. Get up & get out in that stormy weather of the real world & kick fear in the teeth. Stare at it dead in the eyes & walk right through it into the storm; because once you're wet, you won’t fear the rain anymore
  • Dcs90DDcs90 Posts: 74
    edited 03/03/2015 - 7:00 AM
    I do realize it may not be a pain fix. The purpose of the surgery would be to avoid further loss of function. The surgery will be C3-C7. My issues, four ruptured disc, nerve impingement, congenitally narrow spinal canal, unconvertable joint arthritis, significant osteophytes and cord impingement, are not the result of an accident...I guess just bad luck. My biggest questions are how much range of motion will I loose? How quickly will I be able to get off pain meds? When you are in pain, it's so difficult to do something that may cause you even more pain in the hopes of getting better, eventually. Especially with no clear understanding as to how long that might be. My surgeon says I should be back to my life in six weeks. I pray he is right, but moving forward understanding he may be wrong. I am home with my kids, who are old enough to do things for themselves, so thankfully returning to work is not an issue right now. Finding this place has been invaluable. I have gained so much knowledge in a short amount of time. My surgeon has been great. He had probably answered 15 emails of random questions as I prepare for this. I still have one more surgeon to see, but the bar is pretty high to impress me.
  • Luckily for you (and myself), the majority of that function falls on C1-C4 (left to right). I've pretty much gained all of it back.... My problem is up and down as the majority of my injuries and fusion are lower cervical and upper thoracic..... I believe that up and down will be affected more for you as well. Remember that we are all different, but not expecting some sort of irreparable range of motion wouldn't be realistic as it is a fusion surgery remember. My advice to you is to do exactly what your Doctor says and when you start physiotherapy, do all the exercises set out by your PT.

    In my opinion, I think it's going to take a lot more than 6 weeks, but that indeed is the magical question.... How long will it take? Well, the sky is the limit and everyone is different. A few months seems more realistic to me, but that's me and despite going through it, I'm not you!

    As for pain meds? It has been 14 months and I am still on minimal amounts of narcotics. Unfortunately, my NS was right when he said there may be some residual pain... Today I am dealing with chronic pain. Though I am using many means of pain management, I still do need to take pills once a day. I may be on small doses for the rest of my life. It's something I hope to beat someday, but for now, I need to take small amounts every 24 hrs to help manage that pain....

    You are right when you say this site is a God send. There are some good people here going through exactly what you are going through and the good news is that we're only a message away!

    Sending healing vibes your way,

    Realize that FEAR is our worst enemy. Get up & get out in that stormy weather of the real world & kick fear in the teeth. Stare at it dead in the eyes & walk right through it into the storm; because once you're wet, you won’t fear the rain anymore
  • Dcs90DDcs90 Posts: 74
    edited 03/03/2015 - 9:39 AM
    Thank again for all the info. I think it is great that people who are post surgery take the time to come back here and reach out to those just starting the journey. I sure hope to do the same. Did you "fuse" correctly? And if so, how long did it take? My surgeon was honest that with this many levels that is the biggest concern, and that if one level didn't fuse it would require a "small" posterior operation to fuse from that side.
  • Yes, I was fully fused within 3 months, which is quick. It can take up to a full year...... Also note that it WILL still take a year to be 100% (whatever that number means), so be careful for the first year..... And please, NO SMOKING!

    For those that can't stop, I found a link here on spine-health, but please try to stop.....


    Here is another link for smokers!

    Realize that FEAR is our worst enemy. Get up & get out in that stormy weather of the real world & kick fear in the teeth. Stare at it dead in the eyes & walk right through it into the storm; because once you're wet, you won’t fear the rain anymore
  • Seeing my doctor tomorrow for Wellbutrin prescription. I had good results in the past with this. My surgeon has also ordered a bone growth stimulator to use after surgery. Maybe most importantly, I have fully explained dangerous of not quitting to my husband. He can be counted on to do anything short of tying me to the recliner. Lol. Of course, I realize the decision has to be mine. I won't lie, it is hard with the stress of preparing for surgery.
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