What the Doctor Said After Thirteen Months

Today was my final visit with my spine surgeon, thirteen months after my lumbar laminectomy last summer. I did my research and had my questions ready on the phone so I wouldn’t forget to ask anything important.

Biggest question – Is what I have now what I’m going to get post-op? Answer: Probably yes. He does not discount the power of prayer and continued hard physical work to see additional progress, but most of the improvement comes in the first year. I have good leg strength but my ankle has almost no improvement and there continues to be numbness, tingling, spasms, and pressure. That probably will not go away. He is very pleased with how much I progressed, which tells me that he may not have thought I could come this far, so I’m not complaining.

Will the stenosis come back? Answer: Not before 15-20 years if at all. My spine was very well cleaned out of compression and he doesn’t think it will be a problem. I do have some compression issues at other points (specifically S3) but have NO plans for any additional surgery, though I’ll monitor things to see if they change.

Should I plan to continue PT for the long term? Answer: No. It does the most good in the first 6-8 months, though help for specific functions (such as using the rollator) would warrant additional sessions. I must continue leg and arm exercises on my own, which I already figured out.

What about using a power chair? Answer: As long as I don’t overuse it, it should be helpful. But I cannot stop walking or I will lose the ability to do it. I should aim to use a rollator and manual wheelchair in my apartment, walk in the hallway for some longer distance practice, and reserve the power chair for longer distances to keep from straining and inflamming my arm and shoulder.

What kind of doctor should I be seeing for continued care? Answer: A physical medicine and rehabilitation specialist, usually found associated with pain management practices. But for the most part, I probably will not need to be managed. If my primary care or pain management doctors can’t figure out what I need, I could go to a specialist in my current pain management practice. Mostly I’m going now to manage SI joint pain with medication since I can’t have an injection due to blood thinners for the blood clot.

I like my surgeon and would recommend him, though I hope no one I know needs a spine surgeon anytime soon. I’m also glad to have graduated from his care. For now, I’m using my rented wheelchair until my Phoebe chair gets evaluated and fixed, hoping that will happen on site on Wednesday when the service guys come. There are things I don’t like about Phoebe but there are more things I don’t like about the rental chair and I want to get back to normal as soon as I can.

Today’s updates

Just got back from my first longish walk in two weeks (before the sprained ankle). I spent two days this week walking around the apartment with the walker, but today I went out into the hall, down to the elevators, and back again. It wasn’t as easy as it was two weeks ago but I only needed a few very short standing rest stops on the way back. I probably should have stopped at the fire doors instead of going all the way to the end of the hall but I’m not sorry I did what I did. But I’m also not going back out to walk the other half of the hall today, either.

Second, I’m seeing yet another doctor on Friday, a vascular specialist. They’ll probably do another ultrasound (of course) or two so they can check out the other leg as well. I’m actually glad for the referral since the right leg has been swollen and heavy for so long. I’m hoping the specialist will figure out what’s going on and come up with a plan to treat it.

I asked the office to email the registration forms so I could work on them at home. Being me, I converted them to fillable PDF forms so I could just type the answers instead of trying to write really tiny letters to fit in the too-short spaces. Bet they’ll be surprised when they get them.

Image credit: Photo 18832936 / Vascular © Qiming Yao | Dreamstime.com

Apparently I’m Not Eating Enough Apples

I’m eating strawberries and peaches, not apples, these days, which may explain the medical appointments that appeared on my calendar.

Today was my Medicare Wellness Visit where you get asked all the questions you already answered on their e-checkin system. My BP was 136/62, which is great. I got the “Remember these 5 words” test that Trump nailed so successfully (my words were banana, tie, pen, house, car). This is a long way from an annual physical; I guess they think that we old people on Medicare don’t need to actually be touched but just answer a bunch of questions. My doctor is leaving her current practice tomorrow and I’m grateful that I was able to see her before she moves on, though I plan to follow her. She renewed all of the medications that she manages for me, then Cliff the Phlebotomist did the easiest stick for blood that I’ve had lo these many years. Tomorrow I’ll know what those red drops of blood reveal. At least this didn’t happen at 4am the way it almost always does when you’re in a medical facility. Oh, and I also got a referral to physical therapy for some ultrasound on the sore ankle. I really can’t feel a lot down there so I don’t know whether it’s better or not.

But one unexpected twist was being sent for a STAT ultrasound of my lower right leg to rule out possible deep vein thrombosis. My leg from toe to groin has been extra puffy with edema which we’re treating with diuretics, but a “squeeze test” of the calf almost had me jumping out of the chair, so DVT had to be ruled out. It’s a good thing that I went, because I just got a call telling me that they found a clot in my foot. What??? He called in a blood thinner for me to take once a day for three months which will dissolve the clot. But wow. Good thing I’m seeing my own cardiologist in 2 weeks. Good thing my doctor sent me for the ultrasound.

Tomorrow is a trip to see the pain doctor to review SI joint pains that have been giving me a hard time sleeping at night. I know I’m not sleeping in the best position to relieve those, but I don’t have much of a choice – I’m flat on my back with the bed raised up at the feet and a little at the head. I would give anything to sleep in my side but that’s just not in the cards. I don’t know if this doctor will think an SI joint injection would help (they have before) or if he’ll want to do something else.

Maybe I should just try eating more apples.

Report from today’s doctor visit

I saw my primary care doctor today for the first time since mid-December to discuss bilateral upper arm/shoulder pain. As expected, I couldn’t get on the scale since there was nothing to hold on to, but that wasn’t a problem. Blood pressure was excellent (112/60) with slightly elevated temp. She concurred with my self-diagnosis of biceps tendonitis from overuse. Pain started after I got my new AFO’s which I put on every day with lots more walking, which puts extra pressure on the arms using the walker. I’m already taking a strong anti-inflammatory for arthritis which she wants me to continue, adding Flexoril to help relax the muscles, and she put through orders for additional therapy for the shoulders.

My earache is because of fluid on the ear but it’s not infected. It’s bad allergy season for me right now, which isn’t helping since I’m allergic to all the flowering things. I’m to make sure I take Flonase every day which I’ve been doing but not very regularly. The cough will also benefit from Flonase and a return to the hated Netipot.

I’ve also been prescribed Cymbalta as an anti-depressant, which I think is needed. This has been a very long eight months and I’ve had a harder and harder time staying positive and motivated. The medicine will help me get to a better place after I give it time to get in the system. I’m starting with the “old person” dose but it can titrate up if needed.

We also discussed a conversation I need to have with therapy about walking on my own in the apartment with a walker. I wasn’t allowed to do this before, but at some point, I need to be able to do it, so what needs to happen to make that possible? Feeding the cats and cleaning up their litterbox (and cat vomit) are best done from a chair to minimize fall risk, but walking to the kitchen or out to the porch shouldn’t be hard to do. I haven’t been close to falling and have been more worried about just being tired and needing to sit down. This shouldn’t be a problem in the apartment, unlike the hallway that has no chairs. Something for me to bring up with PT tomorrow.

Medical Catch Up

I’ve been having increasing pain in my left thigh over the past weeks, first around the inside of the knee and up into the groin. Weight bearing didn’t hurt but lifting the leg up, say to walk or heaven forbid, get the leg into bed, caused stabbity burning pain. That was the worst and had me avoiding the pain of getting into bed enough to just sleep in an uncomfortable non-reclining chair. My therapist used the diathermy machine and ultrasound, but it just got worse, and now I know why.

The problem isn’t really with the thigh at all, though there may be a muscle strain. We can’t do anything about that; it will heal on its own and in its own time. The problem actually is a pinched nerve in my back. After last weekend’s pain levels, I contacted my doctor and actually saw her on Monday for the first time since June. They did x-rays (which was all kinds of weird to do, since I was shoeless and without my AFO or really anything to hold on to) which didn’t show any kind of additional structural problem, but x-rays don’t show soft tissue damage.

The doctor said that it’s not at all unusual for someone who has back surgery to have another type of problem pop up in a different place several months after the surgery. The burning pain is nerve pain in my lower back, running down my outer left thigh. It’s actually in the same place that I had similar awful burning pain six years ago. I got a steroid shot and a prescription for a tapered dose of prednisone, which I’m currently taking, to help calm down the inflammation. I also have more pain pills which I’m taking. My new PT told me that it’s actually a good sign that I’m only feeling pain in the low back and outer thigh; that means inflammation is calming down. It’s not good when the pain goes lower and wider.

In the midst of all of this, I had my first home health visits, both a weekly nurse visit and two visits from a physical therapist, who did an assessment on Tuesday. It’s so hard to explain that this back/leg pain is brand new – I’ve been essentially pain free through all these past months, at least free of this type of pain, and I’m still surprised to stand up and feel how stiff and painful the thigh actually is. Today we had our first visit with exercise and walking. I’ve done all the things before, but haven’t done them in a while and they certainly felt different with the leg pain. At least I knew to take a pain pill 30 minutes before he came, and iced the back down after we finished. The cold feels good.

I also bought a lift chair without ever sitting in it. Not what I wanted to be doing but I had to have an other option to climbing into the bed when it hurts so much to do that. All week my aide has come in the evenings and helped me get the leg up pain-free, which was wonderful – but she can’t be here all the time, and I needed somewhere to sleep since the recliner had pretty much stopped reclining (another story for another day). The folks at Southside Furniture took pics of their inventory and I selected a chair from that after also looking up specs about them on the manufacturer’s website. It’s not the most comfortable chair ever, but it lays completely flat if I need it to, and will help me keep the legs up without having to actually LIFT them up. All good things. I slept in it last night and it was better than my alternatives.

Tomorrow is Christmas Day and my brother and sister-in-law will be visiting. I’m really looking forward to seeing them for the first time since they moved me down from rehab 2.5 months ago. And I have some small projects for them, including rearranging furniture in the living room to make sense now that I have the lift chair. All the other chairs face each other and the TV but I can’t see anyone’s faces if they sit in them where they are now. So we’ll move them and I’ll ride around in the wheelchair to be sure I can still navigate the space properly. I also want to rearrange furniture in the second room to accommodate a NuStep, which I’m still thinking I’ll buy. They’ve repaired the one here in my complex so I’ll start with that one first, but we’ll just have to see how it goes. We can use towels to layout where the mat would go for the machine and see just how much space it takes up (most of it, I think).

The AFO continues to be a problem; the therapist wants me to walk in the apartment more than I have been, but I can’t do it without the AFO. So I’m thrilled that I finally have an appointment with a foot specialist at Azalea Orthopedic in early January. He should be able to make that happen, and it could make all the difference.

My goal for next Christmas is to be walking around using my nice red rollator instead of using the wheelchair.