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View Full Version : What is the point of post-surgical restrictions really?



amelot
12-16-2012, 08:11 AM
If I feel like bending to pick something off the floor, what can it hurt? I may be a little sore after, so. . .? Am I messing up my fusion to do things like that? Will it make me less straight? I don't think it will pull anything loose. Just wondered. Need a little fear to keep me in line I guess. I'm 4 months post surgery now.

leahdragonfly
12-16-2012, 11:01 AM
Hi there,

as someone who suffered broken rods and a huge revision surgery to fix them, I am absolutely open-mouthed reading your post.

After going through this huge surgery and difficult recovery, how can you have such a careless, defiant attitude about your doctor's restrictions? You apparently fail to realize that your doctor gave you the restrictions for a good reason (so you don't harm your still-healing back and mess it all up), not just to be mean or annoy you. Yes, you can potentially pull things loose, or disrupt the fusion process. That's why your doctor gave you restrictions in the first place.

So yes, to be very clear, you must follow your doctor's orders unless you want to mess up your back and risk jeopardizing your healing from the surgery. If you do not respect the activity restrictions, you definitely should. It's that simple. You need to find some fear and respect your doctor's instructions.

titaniumed
12-16-2012, 12:46 PM
Amelot

It sounds like you are doing great.....and at the 4 month stage many of us feel like we make huge leaps in improvement.

Healing time can be a confusing thing....especially when you get hit by a truck,(surgery) then heal, it feels like you are doing pretty darn good and you are ready to push the limits. These limits we all hit at some point and create pain.

Text books will say 12 months for “bone” to fuse. This is plus and minus many months, and they REALLY DON’T KNOW at what rates bone heals at. In a child, I could imagine extremely rapid rates, and in an adult these rates must be at a slower rate.

Fusion material, or the bone that’s healing can be like stone or cheesecake....this is how this can vary, and it only makes sense to give it the time it needs to heal. If the integrity is compromised for some reason, your rods will eventually break at some point. If they break, you will need more surgery.....revision surgery.

If it takes a year, and you are at 4 months, and me being lousy at math, that leaves a long way to go.....(smiley face)

Bending produces and incredible amount of force in the spine. Its extremely high, and you don’t want to take that chance right now. Do the one leg squat, with one hand on your knee and go down with your spine vertical with no bending.

Build your leg muscles by practicing squats. Do this at the kitchen counter with one hand on one knee and one hand on the counter.

Left hand on counter, right hand on right knee, left leg bends back. Go down and reach without bending.

Walk like a model on the catwalk. Head up, spine straight and erect. Keep this thought in your mind. Your in catwalk training......and stay on the catwalk.

We are all models in our recoveries.....remember Right Said Fred? “I’m so sexy, it hurts” That’s our theme song you know. LOL

Keep up the good work!
Ed

LindaRacine
12-16-2012, 01:01 PM
Until fusion really gets started, you can definitely pull screws out. And, often, if you end up with a screw or screws pulling out, you may need to have your fusion extended up or down. That's a risk most of us aren't willing to take.

--Linda

tae_tap
12-16-2012, 01:52 PM
If I feel like bending to pick something off the floor, what can it hurt? I may be a little sore after, so. . .? Am I messing up my fusion to do things like that? Will it make me less straight? I don't think it will pull anything loose. Just wondered. Need a little fear to keep me in line I guess. I'm 4 months post surgery now.

Oh my goodness! Very important to follow directions! I have a short fusion and am cautious to follow all my doctors instructions to a tee! I work daily with feet and when we do surgical proceedures such as a bunionectomy and we say no weight bearing, we mean no weight bearing! I have had patients not follow directions and messed the pin up which caused their foot to go back to looking deformed and then massive infection follows. Be careful and do what your told!

Tamena

amelot
12-17-2012, 08:28 AM
Thank you so much for your responses! I don't mean to be a wise (insert your own word here) but I really needed to hear that from patients. I have new twin grandbabies and a special needs grandbaby and it's very hard to overcome the maternal (grandternal?) instincts to help out, but your responses have strengthened my resolve to behave myself. I really appreciate you taking the time to respond!

amelot
12-17-2012, 12:09 PM
[QUOTE=leahdragonfly;145363]Hi there,

as someone who suffered broken rods and a huge revision surgery to fix them, I am absolutely open-mouthed reading your post.

susancook
12-17-2012, 06:11 PM
Thank you so much for your responses! I don't mean to be a wise (insert your own word here) but I really needed to hear that from patients. I have new twin grandbabies and a special needs grandbaby and it's very hard to overcome the maternal (grandternal?) instincts to help out, but your responses have strengthened my resolve to behave myself. I really appreciate you taking the time to respond!

Your investment today and for the next 8 months or so....and forever in doing some things will pay off in the future when you are healed and finally totally fused. It will be a shame to undue some of the hardware and suffer an injury that gives lifelong limitations and pain being cavalier and reckless about limiting yourself now. Sounds like you are feeling pretty good physically, and while that is GREAT, it makes you want to do more and take more risks. Sometimes damage from too much activity and not restricting yourself will give longterm changes that cannot be undone. I have not had surgery, but am a medical professional who has seen some damage from people who don't listen to restrictions advice postop. Sometimes, it's really ugly.

So, bite the bullet and restrict yourself. Your grandkids will always be around to love and you to help them. Help out how you can...remembering that it is an investment in your FUTURE.

Susan

susancook
12-17-2012, 06:22 PM
[QUOTE=leahdragonfly;145363]Hi there,

as someone who suffered broken rods and a huge revision surgery to fix them, I am absolutely open-mouthed reading your post.

I am sure that Gayle will reply soon, but she has details about the rod breaking on:
12-15-2011, 11:12 AM#1
"The pop that was hear around the world". Go to Surgical Revisions and type in "leahdragonfly" in the box on the upper R corner. The blog is about 1/2 way down the page.
Susan

leahdragonfly
12-17-2012, 07:05 PM
Hi amelot,

here is a link to my posts about my broken rods and revision surgery:

http://www.scoliosis.org/forum/showthread.php?12856-The-pop-that-was-hear-around-the-world&highlight=the+pop+that+was+hear+around+the+world

Basically, the first rod broke when I was just standing still, barely leaning forward a minimal amount. The break was undetectable on imaging. A month later I was changing into my work scrubs and dropped my shirt on the floor. I bent over to pick it up and felt/heard a tremendous and painful pop. I had x-rays again, and this time both rods were clearly and visibly broken.

Confusedmom
12-17-2012, 11:12 PM
Okay, I agree with everything everyone has said about following doctors' orders. But, just an FYI, Dr. Lenke told me at 5 WEEKS post-op that I could begin to lift restrictions. I have since often wondered if he forgot how far along I was (or wasn't) when he said that. But that's what he said. Also, the booklet they give all the patients at Barnes says the BLT restrictions are for four months--not one year.

However, having said all that, I am constantly worried that I screwed up something in the S1 area early on. I was on the phone one day and, not thinking, started to sit down on my bed by hiking my leg up like I would have before surgery. Ouch!!! Not long after that I started experiencing the hip/butt/leg pain that I still have at 9-months postop. Moral of the story: I wish I had been more careful!!

Evelyn

amelot
12-18-2012, 10:29 AM
Hi amelot,

here is a link to my posts about my broken rods and revision surgery:

http://www.scoliosis.org/forum/showthread.php?12856-The-pop-that-was-hear-around-the-world&highlight=the+pop+that+was+hear+around+the+world

Basically, the first rod broke when I was just standing still, barely leaning forward a minimal amount. The break was undetectable on imaging. A month later I was changing into my work scrubs and dropped my shirt on the floor. I bent over to pick it up and felt/heard a tremendous and painful pop. I had x-rays again, and this time both rods were clearly and visibly broken.
Is there no way they could have told you that you weren't totally fused?

amelot
12-18-2012, 10:31 AM
Okay, I agree with everything everyone has said about following doctors' orders. But, just an FYI, Dr. Lenke told me at 5 WEEKS post-op that I could begin to lift restrictions.
Evelyn

At 2 months, I thought he told me to try things and don't do them if they hurt. (My husband didn't hear it that way.) That's why I posed the question. Thank you! Someone else told me that I could bend "at the hip," but not bend my back.

leahdragonfly
12-18-2012, 04:33 PM
Is there no way they could have told you that you weren't totally fused?

No, I had a completely positive one-year check-up and x-rays just about 6 weeks before the first rod broke. You really can not tell if fusion is complete from x-rays apparently.

Every surgeon gives differing advice/restrictions, based on the individual and the surgery. I would recommend you contact your surgeon's office and ask for a clarification about your particular restrictions.

I misunderstood the restrictions about bending---I knew it was not ok to bend my back, but I thought it was ok to bend forward from my hips (such as to lean over the sink while brushing my teeth, for example). I thought as long as I held my back itself straight I was within the restrictions. This was simply a failure on my part to fully understand the restrictions. I also did not know I shouldn't bend forward more than 90 degrees in a sitting position. I learned these things later from reading posts by our moderator, Linda Racine. These restrictions were not really made perfectly clear to me. So I will always wonder in my mind if I harmed my fusion, or if I would have had broken rods anyway. I had surgery as a teen to fuse L4-S1 for spondylolisthesis. It was in 1984 and at that time they did a fusion without hardware, and I had to wear a body cast for 3 months. I felt well afterward, but came to learn at age 40 that the L4/5 level had a pseudoarthrosis and never fused. So my surgeon said that for some reason maybe I am not a great fuser!

Sorry if I sounded harsh in my first post to you, but as you can see, I have been through a lot with my back, and I would hate for anyone else to have to go through a major revision like I did if it can be avoided in any way.

Best of luck, and before you know it, you will be able to legally bend and lift those grandbabies of yours.

SpineTime
12-19-2012, 03:48 AM
I misunderstood the restrictions about bending---I knew it was not ok to bend my back, but I thought it was ok to bend forward from my hips (such as to lean over the sink while brushing my teeth, for example). I thought as long as I held my back itself straight I was within the restrictions.

I haven't had surgery, and I've wondered about this. Maybe this is a dumb question, but while you're under the restrictions, how do you manage things like brushing your teeth, washing your hands, or washing your face at a sink without bending forward at all? I can't wash my hands without bending at our bathroom sinks. I just tried it at the kitchen sink and I think I could do it, just barely.

amelot
12-19-2012, 09:54 AM
Sorry if I sounded harsh in my first post to you.

I'm not a very compliant person, and I REALLY needed some tough words! I really appreciate you giving them to me. Really!

Confusedmom
12-19-2012, 08:18 PM
I haven't had surgery, and I've wondered about this. Maybe this is a dumb question, but while you're under the restrictions, how do you manage things like brushing your teeth, washing your hands, or washing your face at a sink without bending forward at all? I can't wash my hands without bending at our bathroom sinks. I just tried it at the kitchen sink and I think I could do it, just barely.

Brushing teeth: use two cups. One to rinse your mouth and the other to spit the toothpaste in.

Washing hands: Try to find a sink in your house that's tall enough. If not possible, try squatting at your hips/knees just a little to get to the right height.

Washing face: Use a washcloth and bring it up to you. Actually, I usually just do it in the shower in the morning and use a face wipe at night so I don't have to lean over the sink.

If you are being fused to the sacrum these things might be an issue even after restrictions are lifted. It's just difficult to bend over sinks. Also while eating I often have to bring my plate or bowl up to my chest or I spill all over myself.

SpineTime
12-20-2012, 01:49 AM
Brushing teeth: use two cups. One to rinse your mouth and the other to spit the toothpaste in.

Washing hands: Try to find a sink in your house that's tall enough. If not possible, try squatting at your hips/knees just a little to get to the right height.

Washing face: Use a washcloth and bring it up to you. Actually, I usually just do it in the shower in the morning and use a face wipe at night so I don't have to lean over the sink.

If you are being fused to the sacrum these things might be an issue even after restrictions are lifted. It's just difficult to bend over sinks. Also while eating I often have to bring my plate or bowl up to my chest or I spill all over myself.

Thank you for the tips! I don't remember this being talked about here, but I really wondered because I lean way over the sink when I brush my teeth, and when I wash my face too. If I don't, I manage to get water everywhere. Actually, my back hurts so much I've gotten in the habit of leaning/slumping onto the counter because it hurts less than standing. I would be fused to the sacrum, so I'm glad you mentioned it might continue to be an issue. Good to know. As far as eating, I can easily spill things on myself as it is now, so that will be nothing new. LOL.

Does anyone else have ways of doing these things they'd like to share?

Irina
12-20-2012, 11:42 AM
Re: brushing teeth - somebody (I think Ed) said that he brushes his teeth in the shower and it sounds like another good idea to me.

I started taking off makeup in the shower and like it much better than doing it over the sink even now, before the surgery. I also put a magnifying mirror with built-in light on the high dresser and use it to put make up on instead of leaning towards the mirror in my bathroom.

jackieg412
12-20-2012, 02:58 PM
Yes all doctors write different restrictions,but do your best to follow them. I reached for a tissue 6 days after the 1st surgery and fractured through the vertabrae above the fusion, so things do happen!
I also can suggest a water bottle as it is next to impossible to drink from a fountain when you are out some where. I also have to stand to eat and raise the plate to me as I am not able to bend forward.I am one who is left with a difficult time sitting and really wiggle in the car and have learned how to almost stand there also. My other suggestion is to always have 2 of everything in the shower as you will drop things that you need.
Jackie

Irina
12-20-2012, 03:31 PM
Jackie,

If it's Ok to ask - why can't you bend forward? I was under an impression that people should be able to bend from the hips after all is well and healed. No???

Susie*Bee
12-20-2012, 03:39 PM
I use a cup to spit into when I brush my teeth also. (smile) Also, when I put on my make up, I use a hand mirror (one of those that's about 8"?) and just alternate hands when I apply my eyeliner and mascara. There's no way I could lean forward to the bathroom mirror. Sometimes when I'm visiting other's bathrooms I need to remember to scope out where their TP is located because some are in hard to get to places without twisting... so sometimes I grab my TP before sitting down. I'll try to think of any other tidbits and add if I think of some.

naptown78
12-20-2012, 07:57 PM
I must be different. I use my sink for washing my face, brushing my teeth, putting on makeup etc. I bend slightly forward, just bending one of my knees into the vanity for support. I don't find it difficult at all. As far as bending, I can pick up things on the floor...I just tend to squat down to protect my back. I tie my shoes by bringing my foot up to my opposite knee. As for the original question on this thread, it is very important to follow restrictions for the first few months. I wore a brace after all my surgeries which helps. But even after that, I practice common sense back protection. I have too much time and money invested in my back and don't intend to go back in that operating room again!

susancook
12-21-2012, 02:19 AM
Thank you so much for all of your suggestions. Keep them coming as I am writing them down!
Susan...becoming less afraid

JenniferG
12-21-2012, 12:10 PM
I'm another who has no trouble bending forward over the basin to clean teeth, apply makeup etc. I just bend from the hips.

loves to skate
12-21-2012, 07:28 PM
I'm another who has no trouble bending forward over the basin to clean teeth, apply makeup etc. I just bend from the hips.

I do the same. I also lean on one had to support myself.
Sally

golfnut
12-21-2012, 09:06 PM
There was definitely an improvement after my first year with almost everything. I truly forget that I am fused the majority of the time, which means, life is good!

LindaRacine
12-22-2012, 11:25 AM
Okay, I agree with everything everyone has said about following doctors' orders. But, just an FYI, Dr. Lenke told me at 5 WEEKS post-op that I could begin to lift restrictions. I have since often wondered if he forgot how far along I was (or wasn't) when he said that. But that's what he said. Also, the booklet they give all the patients at Barnes says the BLT restrictions are for four months--not one year.

However, having said all that, I am constantly worried that I screwed up something in the S1 area early on. I was on the phone one day and, not thinking, started to sit down on my bed by hiking my leg up like I would have before surgery. Ouch!!! Not long after that I started experiencing the hip/butt/leg pain that I still have at 9-months postop. Moral of the story: I wish I had been more careful!!

Evelyn

Some doctors are a lot less strict about restrictions, especially with current implants, which are fairly secure. For the most part, most centers seem to lift all restrictions somewhere between 3 and 6 months, though they may extend that restriction in some patients that are at higher risk.

LindaRacine
12-22-2012, 11:32 AM
I believe that people think they bend from the waist, they don't actually do that. I've never seen a picture or xrays of anyone who claims they bend at the waist, so I can't be certain. If they do, they would have to have some unusual anatomy.

Here's an xray of what the skeleton looks like in flexion:

http://static.spineuniverse.com/sites/default/files/images/2010/11/29/ozuna125postopflex.jpg

titaniumed
12-22-2012, 09:01 PM
There was definitely an improvement after my first year with almost everything. I truly forget that I am fused the majority of the time, which means, life is good!

This is it! The main goal.....forgetting your fused.....

that and the golf swing, of course. (smiley face)

Congratulations Karen

Ed