3 months post op L5/S1 PLIF - questions

[kangaroo]

Hey everyone,

My father underwent a L5/S1 PLIF (posterior fusion). It has been approximately 12-13 weeks since surgery and I have a few questions and observations that I would like to share.

1) Pain killers are being weaned off at the moment. Dad has gone from 20mg Oxycontin to now using normal 5mg Oxycodone tabs twice a day. Withdrawal symptoms have included depression, lack of energy and fits of being cold. Next weaning stage will be done next week I think. I doesn't seem like Dad is in too much pain after cutting down. Real test is when oxy is cut off completely.

2) The main complaint at the moment is lack of flexibility and energy. He is doing physio and hydrotherapy. Mind you, he does quite a bit of non demanding house work and helps Mum with the food and such. Normally after dinner (6-7pm) he barely has any energy left. Does that seem normal at this stage? Another complaint is that he feels very cold at night. We have heaters and everything else on (near the end of Winter in Sydney, AU) but sometimes cannot bear it. Mostly the cold is near his legs. He sits and stands mainly after 6pm after doing all his walking and exercise in the morning. Is this normal? Can anyone share how energy levels might return?

3) We had a post op meeting at Week 7. The instrumentation looked good but fusion had still not started. There is another appointment at middle of September (3.5 months post op) to see if the fusion is occurring yet or not. Fingers crossed for that. Although, he does not see himself working maybe until the 6 month mark :-(

4) Any other tips for someone on the 3 month mark that I may have missed? I am trying to keep his mind active at this stage and his mental health. Any thing we can look out for and observe to predict and determine how successful the procedure has been.

edit: His exercise program consists of walking about 4-5 km a day, all during daytime. Sometimes during night time on the treadmill at slower speeds. Fewer kms during days of physio and hydro.

Thanks for reading everyone. I really just needed to share all this with someone.

[Maria]

I don't know how old your father is however I think that's he's doing quite well in his recovery to date based on the recentness of his surgery. 3 months out is not that that long ago with regard to the nature of the surgery.

The activity level sounds good and I am sure that withdrawal from pain med plays some part in his symptoms though people differ in terms of withdrawal and also depending which meds. I would think even if he didn't come off of pain meds completely that wouldn't be so unusual either.

Re working .. after an open discectomy at L5S1 which isn't as big a surgery as a fusion at that level it took me 3 months to get back to work part time and I was in my late 30's at the time. My job was as a clinical coordinator/Nurse Practitioner however I mostly did paperwork the first few months upon returning to work again at only part time and at the 6 month mark I returned full time to work.

There are the expectations for recovery that the medical world has for a person and then there's reality and what I think you're seeing is the latter although I think your father sounds like he's very much on schedule with a decent recovery. Expectations should not dictate that he overdo or push himself into a recovery mode that he might reinjure himself with or feel uncomfortable with (creating more pain).

His legs.. is there a color change by any chance? Is the color of both extremities normal such as before surgery (that is if all was normal before surgery in both legs/feet re color/circulation/etc). Can he tolerate his trousers against his legs and sheets upon his legs and such? Have you mentioned to the doctor what he is experiencing? Does wearing a warm thick pair of socks help alleviate that sensation? Just wondering if it's there's some circulatory type of thing going on or something else perhaps. All in all that he can stand on his feet and help your Mom out, take walks daily and such and tolerate it all well without creating more pain and in fact having his meds decreased and seeming to tolerate it all bodes well for him. The sensation he's feeling could be just part and parcel of the fusion recovery process (speak to his surgeon on this).

For years post my 2nd back surgery I had what I considered ice cold feet feeling so much of the time .. always needed my feet warmed up except in the heat of summer. Then again I had what was known as neuropathies in both legs so had some odd sensations related to nerve type of response but no circulatory problems.

Recovery from a surgery such as this and withdrawal from pain meds and such can have a lot to do with the energy level factor. If your father was cleared medically before surgery with no major health concerns then I would imagine he's still healthy and just recovering at his pace re energy and such.

It never hurts to bring these questions up to the surgeon or his general practitioner and see if there is any further diagnostic testing that might be performed.

Wishing your father the best with his continued recovery and please ask as many questions as you'd like and return and let us know how your father continues to progress!

[kangaroo]

Thanks for the detailed and informative reply Maria. I appreciate it.

Originally Posted by Maria

I don't know how old your father is however I think that's he's doing quite well in his recovery to date based on the recentness of his surgery.

Dad is 49 years old. I keep telling him he's doing so well. We're quite proud of him.

Originally Posted by Maria

Re working.
Expectations should not dictate that he overdo or push himself into a recovery mode that he might reinjure himself with or feel uncomfortable with (creating more pain).

We are hopeful that his employer will offer a sort of flexibility with his work. I too think that after 6 months he should be better able to gauge what he can and cannot do. His job is as a process line machine operator sadly (bending and lifiting). We are definitely being careful and reminding him to take a good pace. The last thing we want is further issues :-(

Re: Legs.

It could very well be a combination of circulatory problems and maybe the fusion process as well (especially since l5/s1 is near nerves of the legs). We will definitely speak to the surgeon about this. I'm thinking of getting him to wear the compression stockings from the hospital from the evening to see if it improves the cold sensation.

Overall, I will definitely keep updating dad's condition. Thanks again for the reply. Very helpful indeed.

Right now, I think getting rid of the night dosage of oxycodone 5mg is a bit too much for dad. He might need to stay on that for a little longer. He is still continuing 75mg Lyrica/Pregbalin twice a day.

[Maria]

Your Dad is a youngster! Lol! Wishing him a continued good recovery and I too am sorry to read his job involves bending and lifting. I definitely would not recommend that he go back to work any sooner than he absolutely has to and preferably to something not involving lifting and bending. That being said, again my best to your Dad!

[fischotter]

I have the same Promlems taking off oxycodon. I raised the amount from 120mg to 60mg and then after three weeks i tried to go down another 10mg. When i was at 30mg, i had exactly the same Problems as your Dad. The only difference i am 60 years old and have at the time 6 operations behind me. At the moment I am taking 3 x 20mg because the Pain has raised again. In about 2-3 years i will be fixed from th3 to s1.
have a nice sunday.

ciao
peter

[Jim M2]

Your dad may have some depression. I think it comes from loss of hope that things will get better. I think your Dad has made excellent progress. I hope he feels better soon.