I felt I had to take some painkillers to get some rest / sleep this afternoon, so I took two Cosalgesic and got 2 good hours' sleep. When I woke up, I felt by no means 100%, but better than when I fell asleep. I got worried then about addiction to these things since yesterday I had a new "nauseous" pain in my knees. I Googled "painkiller addiction withdrawal cosalgesic" and read two articles. Now I'm really worried that I should stop taking them. See http://trusted.md/feed/items/system/2007/06/17/the_old_ladys_friend and http://www.essentialdrugs.org/indices/archive/200502/msg00000.php. This particular tablet has been banned in a few countries. It's also known as Distalgesic or Dolorgesic.

http://www.spine-health.com/topics/conserv/painkiller/painkiller01.html mentions some symptoms of painkiller withdrawal. Of the ones mentioned, I have muscle and bone ache, sweats and insomnia, and had these coming out of the first op too. :( I guess I'll just have go back to DVDs and games to keep my mind off the nasty feelings.

BTW, my right hip / ITB (/ SIJ?) are still popping all over the place, which is quite alarming. It means that I can either move the way healthy people move and cause a pop, or alter my bending movements and not pop. Two theories which I'm worried about:

(1) Once my lower back is fine - assuming that day comes - I'll be able to put more weight on it and take the load off my hip and get my hip joint stronger through correct movement and exercise.

(2) My hip is hopelessly buggered since my knees and lower back have not borne loads correctly for the last 2 years.

My knees are the weakest link right now, so I have ordered some knee braces from badbacks.com.au. I hope they arrive next week.

It's Wednesday, three weeks and one day after the op. I have to write this down because mentally it's quite tough to make it through this time.

I took myself of the painkillers on Monday this week (ie. 2 days ago) and it's been quite a struggle since then. I have had the following physical feelings, which have come and gone for hours at a time:

- inflammation of lower back at SIJs
- sharp, central pain in lumbar spine
- raw / sore feeling on surface of skin (on the wound - this is here all the time)
- tight and painful lumbar muscles after playing in playground
- sharp knee pains when crouching / climbing steps (as always)
- "nauseous" knee pains when trying to sleep
- a non-uncomfortable moving sensation as I walk as the lower end of the titanium rods (?) protrude a little
- "burning" feeling around bone graft area, although this is receding
- inability to sleep for more than 2-3 hours at a time
- numb + bruised feeling in my left buttock

The big bruise on my right hip (which was green and yellow and purple) has almost gone.

On Friday 13th Oct I woke up with a stiff neck. I must have taken a meltonin tablet and fallen asleep in an awkward position. I was worried for the next 36 hours that it would be permanent like the morning of 7th Jan. I Google "wake up with a stiff neck" and came across a few remedies which I tried. As I type this 4 days later, I think I have recovered 90%. I was going to go to see a physio with my wife, but then thought better of it until I felt I could be prdded and lie down on a massage table comfortably.

Yesterday I had a strong headache, brought on by staying in bed watching a DVD and a stiff neck. I took two Panadol Extras and it went away by then end of the day.

My aim now is to go out and walk on flat ground regularly and try to sort out my sleep routine. My back muscles have been cut up and haven't worked properly for 5 years. They are therefore probably completely atrophied and it may take 6 careful months for me to get my strength back. Until then, I will probably continue to have some of the pains reported above.

Mentally, the stress of not knowing whether I will eventually recover / feel the same / feel worse after this is all making relaxing my muscles and getting to sleep very difficult. My current approach is to immerse myself in tasks (be their recreational or errands) and try and make the time fly by.

The weather is good but pollution is very high, which makes going outside less than perfect. Other personal stress factors contribute.

It's been a while since my last message so I think for my future benefit, I want to record my changing sensations and emotions over the last week.

I can walk - but having said that I could walk before the op too. The thing is - can I bend over / crouch down / use my back muscles for anything? Will my knees go back to normal? The answer is, "It's too early to tell".

On the positive side...

(a) I am taking painkillers less frequently.
(b) I can't feel the sharp right SI pain I used to (I think!)
(c) Since last weekend, my skin around the wound is less sensitive than a week ago.
(d) On Monday I felt really quite a lot better and went to the playground twice to play ball and frisbee with my son.
(e) My pains move around a bit (left buttock, right L5, right ankle, knees, etc.) which doesn't sound good but is what happened last time I had an op so it doesn't scare me.
(f) I stumbled twice in the last two days when walking in public. Despite the jarring sensation, it was nowhere near as painful as after the previous op, and didn't leave me inflammed for days afterwards (only worried that I may have slowed the fusion).
(g) I feel I am in better hands this time than last.

On the negative side...

(a) On Tuesday I felt pretty crap. My knees were painful and I almost thought I could feel the right SI pain again.
(b) My right hip / ITB (??) still pops on demand. Surely this should go away if everything else is secure and I am walking correctly? My ITBs are tight.
(c) I still can't bend / crouch etc. because of my left SI bone graft site soreness. It feels like a burning sensation, which the painkillers alleviate, but it still feels a lot better than the previous op.
(d) I worry that once I start to put the pressure back on my lower back, I'll have some (new) pain somewhere in the L5 / S1 region brought about by additional stresses on other joints or a failure to fuse. This worry keeps we awake at night.
(e) I still don't sleep through the night. I am starting to have vivid dreams (which presumably indicate a deeper level of sleep) but toss and turn a lot to relieve cold sweat from stress and to pop my hip.
(f) My knees are crap after walking up / downhill. I worry that unless I get patella braces or strengthen them, I will be back where I started again. Maybe this whole thing started with my knees not working and the steep neighbourhood I live in?
(g) Other personal stresses which are unrelated to my back keep me awake too, and it's a vicious cycle once you sleep badly.
(h) Perhaps some of the tablets are affecting my mood, since I've been quite up and down, but maybe that's just my mind reacting to my physical condition.

Let's see how the next week goes. I am using the notebook most of the day. I received an nice folding aluminium "desk" today from an anonymous source. It came to the door wrapped in newspaper, and helps keep the notebook at a good height above my lap in bed. Whoever sent it, thank you!

OK, so all is not well. After a gushing review of my hospital stay, I found out today that the dressing on my wounds was not as waterproff as it was supposed to be and the cotton in in got soaked after my first shower at home. I had to pay HK$ 50 to get a taxi all the way back, get a nurse to change my dressing, then spend 15 minutes doing paperwork so the hospital could charge me for the pleasure. I was asked to take the paperwork to the receptionist on the ground floor. She said she couldn't tell me how much it was but that she'd swipe my credit card and the accounts people would call me, today being a public holiday. I said, "I was a patient here until yesterday. Can't I just pay you HK$ 100 and we can be done with?" Apparently not >:.

Never mind, I sleep beautifully from 2 to 6pm and I don't think turning over in bed is a major struggle anymore. Hooray for that!

It is six days since my operation, and the first time I've got on the internet since. May I just say this. How great a difference it makes to have a surgeon who shows concern, who is up with the latest techniques, and in a hospital that looks after its patients well!

I was dreading going into hospital, to the point of showing visible signs of ageing as well as sleeplessness. The operation was postponed by about an hour due to someone (the anaesthetist?) being stuck in traffic, which did nothing to calm my nerves. But after the 2 hour, 15 minute operation, I was happy to see that I was relatively pain free and the sun was shining outside. In fact the most discomfort I felt was in my old bone graft site (left iliac crest)! The thought of going under the knife must have rekindled the burnbing sensation in those nerve endings.

Thankfully the catheter to enable me to empty my bladder was inserted before and removed after the operation before I came to. I was anaesthetised lying on my back ("because we need to give you oxygen"), and then they flipped me over for the procedure. Three incisions were made: 2 vertical ones either side of my large back muscles to get the crews and rods in, and one smaller one somewhere near the top of my left buttock to harvest some bone from my illiac crest. There was no pain at at from the bone harvest site! In fact as I lay there with the anaesthetic wearing off, the only spasm I almost felt was in my old harvest site from Dec 2004! I did also jolt awake as I was falling into a deep sleep but this didn't cause any extra pain.

I am really amazed at the difference between this operation and the last one. Here are the main points:

(1) No harvest site pain. The first time it was excruciating and I cried for 30 minutes when I came to. This time I almost felt as though they'd done nothing to me.

(2) Much easier time getting on my feet. Last time I wasn't allowed to eat for 3 days because I couldn't make it to the toilet. This time they asked me to eat of drink whatever I wanted. I was walking on the day after the op. There were three tubes draining my three wounds linked to vaccuum bottles. To move around, they disconnected two of them and I'd attach the largest one to my walking frame to shuffle down the corridor. That was removed two days later too. I was walking up and down stairs atfer three days.

(3) Last time I lost 10 kilos in one week. This time I may actually have put on weight so good was the hospital food.

(4) Last time the nurses were pretty rough and frequently bumped the bed which set off wound spams. Only one nurse bumped her trolley into the bed this time.

(5) Not until my last day did a nurse not respond promptly to a call for assistance. Last time it used to be pretty predicatable.

(6) Last time the surgeon visited me and seemed oblivious to my pain, wiggling my big toe to see "how I felt". This time they asked me how I felt, made me wear stockings to prevent DVT (deep vein thrombosis), and gave me plenty of pain killers without asking.

(7) The antibiotics and painkillers were administered through a catheter in my left hand. Last time, they took that out after a few days and had to keep jabbing me with needles in my stomach every time I needed a shot.

(8) The ward I was in had two beds per room, compared to four last time. I had earplugs, a laptop and headphones this time, but it was great not having noisy neighbours.

(9) The whole thing cost twice as much this time, HK$ 220,000.

(10) I have two large bruises on my right side which are now turning purple and green. I didn't understand why they were there. The surgeon said there was some blood seeping to the suface, whatever that means. Not painful anyway.

Day by day, here's how I felt, to the best of my recollection:

Tue Day 1 - operation ~ 9am. I came to around 1pm and felt pretty fine. Happy to be alive and pain free. Had a lot of trouble making full sentences and was overly chatty with the nurses. Drowsy but too excited to sleep much. No food or drink - my own choice.

Wed Day 2 - still felling dizzy from the general anaesthetic, played some computer games and drank some home made soup. As last time, it is incredibly difficult to pee (into a bottle) lying down, especially when people keep coming to check on you every hour. Walked to the toilet and back with a walking frame. Could really feel the two metal rods on either side of my spine. Not painful just "yucky". Refused painkillers.

Thu Day 3 - felt very sore and tight on my middle back. Accepted painkillers and had a visit from the physio who gave me some bed exercises to do. She said I should take the painkillers otherwsie I wouldn't be able to do the exercises. Fair enough. Had some food since I could make it to the toilet and back by myself. Not that hungry. Changed into hospital issue pyjamas, which meant I wasn't wondering the corridors showing off my bum any more. I had a rough shave, but couldn't lean over to get close enough to the mirror to deal with all the stray hairs under my chin. I had knee pain.

Fri Day 4 - my appetite came back and I was ravenous. The big tube came out and I could walk with a walking stick. My sense of balance was off. Took off the stockings which were too warm and tight for my liking. My hip flexors and ITB were very tight. I still have knee pain. They took the catheter out of the back of my left hand. It used to be quit uncomfortable every time I'd tighten that hand or try and put it through a sleeve.

Sat Day 5 - the main pain comes from the sore wounds which I had to lie on every time I got back into bed. I feel I could go home today but the hospital bed is more adjustable, which should help me sleep and relieve my knee pain. I finally get 6 hours' sleep in a row - something I haven't been able to do since Day 1.

Sun Day 6 - a nurse changed the dressing so I can have a shower for the first time and wash my oily hair. I seem to have hurt / strained (?) my left SI joint climbing up the stairs this morning. Hmm >:

I'm now home for a few weeks while my wounds heal, my bruises fade, and my muscles regain enough strength. While I felt quite secure in the hospital in the last few days, the ride in the taxi back home reminded me how fragile I still am. The bumps on the road and the action of getting in and out of the vehicle were painful. I was worn out my the time we got home and slept deeply for six hours in the afternoon.

I am now on Tramadol (50mg, 3 times a day), Diazepam (5mg, 2 times a day), and Cosalgesic / Distalgesic / Paracetamol (4 times a day, if required). These don't need to be taken with food.

So my advice to you is find a great modern surgeon and a great hospital. Don't be sick going into the operation - the first time I had a cold. And have it in good weather. Don't end up too sticky or too cold because you won't be able to have a shower for 5 days.

Here's a checklist for "next time" you need to have spinal fusion:

(1) Take a good laptop with a couple of good games, and some DVDs to watch. Remember the power cable and ask about (wireless) broadband, if you're into that sort of thing. I intentionally stayed away from the horrors of world news and the stresses of e-mail and work. Headphones.

(2) You'll feel hungry at strange times, so take some low-fuss fruit (bananas, apples, plums) your favourite cookies, and maybe your favourite tea bags.

(3) Take a relaxing book. I'd not recommend anything related to medicine, but that's just me. I was reading "The Last Oil Shock", which turned out to be too serious for the occasion.

(4) Earplugs, shaver (recharged?), toothbrush and toothpaste. Face wash, because you won't be able to have a shower and you'll end up with an oily face after a few days in bed.

(5) Two sets of clothes, because you may be sharing a ward with airconditioning controlled by consensus. I was a little feverish around day 3 and benefitted from a choice of blankets and clothes.

(6) Mobile phone set to vibrate and caller ID, so you can ignore all calls. A recharger for the phone.

That's enough for now, and I've been sitting upright too long. Let me know if you have your stories to share.