My ACDF Surgery Experience

(Fair warning...long post)

Today is the one week anniversary of having ACDF (Anterior Cervical Diskectomy and Fusion) surgery. I had a herniated disc in my neck in the C5-6 area, thanks to an automobile accident. It was causing some pain in my neck and numbness in my left hand. I now have a small plate thingie screwed into two of my vertebrae, some adult stem-cell material living where my herniated disc used to be, and what I hope will turn out to be a cool scar on the front of my neck.

The surgery itself lasted approximately 1 hour, or so I’m told. I had it done as an outpatient procedure, beginning around 7:30am. I ended up staying in the hospital until approximately 4:00pm, if memory serves. (Please understand that morphine and other pain meds make my recollections of specific details a bit fuzzy.)

Two days before surgery, I had a consultation with my doctor and made all arrangements with the hospital. This included blood tests, urine tests, x-ray, EKG, etc. The following day, I found out that my white blood count was quite elevated. Unfortunately, this could delay my surgery. The medical professionals decided to wait until the following day and allow the anesthesiologist determine whether or not I would be allowed to have the surgery. Thankfully, I was determined to be healthy, even though the elevated white blood count indicated a possible infection somewhere that could potentially compromise my post-op health. To this day, the source of the infection remains unknown.

I woke up from surgery in recovery wearing a relatively small bandage (approx. 6” x 3” of gauze covered by a much larger piece of what felt and looked like very sticky plastic wrap) and a soft collar. I must be sensitive to anesthesia because I remember vomiting once. I was later wheeled into a room where my family was waiting for me. This is where things are really fuzzy. I think I was given morphine in the recovery area, so I was in and out for the next couple of hours. I was also given antibiotics later in the day to help with the potential infection. The next things I remember were trying to talk to my family, eating some ice chips, having a few visitors, and later being given a meal to eat. (FYI, this meal included Salisbury steak, cornbread, red potatoes, turnip greens, milk and applesauce, I think. I tell you the menu now because this will be humorous after the next couple of paragraphs.)

Eating has been the most interesting challenge. For the first couple of days particularly, I was unable to eat “normally”. Swallowing was just downright painful, even with pain meds. Also, I felt like I was going to choke or inhale bits of food after swallowing…like fluids or food was resting on a little shelf above my airway and would be sucked in on the next breath. It was a very panicky time for me. Even swallowing water was difficult – my throat was swollen, and more often than not, all of the water, even when I took smaller amounts, wouldn’t go down with one swallow. I definitely have had to take smaller mouthfuls of food and drink. I also found myself taking large breaths before swallowing, just in case I needed to cough something out that fell into my airway. I have also been using a dessert spoon instead of a regular spoon so that my bite portions are smaller. (I can’t open my mouth as far as I normally do, either.) When I get especially panicky, I stand up, really straight, to eat. I don’t know why exactly, but for some reason I feel more in control should there be a choking problem…like everything is now in a straight line down to my stomach with a lessened chance of choking. (I have no idea why my mind has chosen to fixate on this choking thing.)

My diet this week has been modified to soft, small-particle type foods. For example, my breakfasts usually include a combination of a couple of soft foods like a half of a banana, jell-o, a frozen fruit popsicle, fruit cocktail (preferably peaches), pudding, etc. I also keep a cup of water nearby, just in case. I have also been able to add spaghetti-o’s with meatballs, tomato soup, oatmeal, cheese and macaroni, and mashed potatoes to my menu choices over the past few days. Everything with any substance must be chewed thoroughly, else larger food particles get stuck in my throat. (Unfortunately, I discovered yesterday that I could eat Peanut Butter M&M’s, too!)

I sensed I needed to be careful about what I ate because some foods create more mucus in my throat than others. To me, mucus = additional swallowing, possibly choking. I find myself drinking water more than anything else. Though some of my foods are liquid, or liquid based, like soup and popsicles, water tends to cut the mucus created by other foods best. Things that are milk-based, like ice cream, isn’t so friendly to my throat. While the cold feels good, the mucus that’s left behind isn’t worth it to me. Not everyone has mucus problems after milk products, but for me, it’s just something I get to look forward to. Carbonated beverages don’t feel so great to me. The bubbling is something of a burning sensation, and any resulting burp has been a little painful…it’s a relief, but it hurts. I’m not a real fan of carbonated beverages on a normal day, so maybe that has something to do with it, too.

Now, you need to understand that I’m no svelte model. I’m VERY…‘healthy’. Let’s just say that I weigh more than my 6’ tall husband, and I shop from women’s sizes. So, not being able to eat was a disappointment and a shock. In my mind, considering nothing was cut inside my esophagus, I figured eating would be a whole lot simpler than it has been. Though I don’t know for sure, my guess is that the swelling from the surrounding tissues is hampering normal swallowing. I hoped that this would calm down after a few days, but my guess is that it won’t return to normal until after around 4 weeks, when the swollen tissues are far less inflamed.

Bathing was interesting for the first couple of days. I was told not to get the bandages wet under any circumstances, but I knew I needed to bathe and wash my hair. What ended up working best for me was to take a shower and bathe as much as possible by myself. Then, here’s where I enlisted help. I asked either my mother or my husband to wash my back and my hair (because lifting my arms was difficult). Thankfully, we have one of those shower heads that has a long hose and hangs from a little holder – similar to a sprayer on the side of the sink. I bent over approximately halfway, folded a thick towel up and held it over the front side of my neck, covering my bandages very well, and had my Mom or husband carefully wet my head, wash my hair, and rinse me as quickly as they could. (FYI, my post-op orders said to limit bending and lifting.) This worked very well, in my opinion. As long as we avoided allowing the water to flow over my neck excessively and moved the process along fairly quickly, the towel absorbed any water that did run towards my chin before it got to the bandages.

By the way, ladies, since lifting my arms has been difficult, getting a sports bra that hooks in the front and one of those mu-mu style house coats with the front snaps has been a wonderful decision. I look like heck run over, but I have been completely and utterly comfortable and well-covered for visitors.

Sleeping has probably been one of the toughest things to figure out. I don’t know if I am wanting a different position for comfort each night, or what. I have been sleeping on the couch since the surgery. It allows me to sleep upright much easier, and this is how I feel most comfortable. I have slept in my soft collar every night but one (and I try to keep it on about half the time during the day, just in case). My preferred sleeping position seems to be VERY elevated from the hip up, keeping my neck as straight as possible. This usually involves about 5+ pillows against the arm of the sofa. Normally, I am more of a side sleeper and have a difficult time sleeping on my back. So, sleeping in a recliner is out. I found that if I laid on my back in a recliner or against the elevated pillows, I would either frequently wake up because I was uncomfortable or because I am snoring. I am just following my instincts on sleeping for now, even though sometimes it takes me about an hour to get situated into a comfortable position.

Speaking has been different. The larynx is unable to move as freely because of the swelling, I assume, so higher pitched speaking has been impossible. It’s also been difficult to speak louder. I also seem to walk with my head down a bit if I’m not wearing my soft collar. It feels like my head weighs more than it did before surgery, and my shoulders could use a massage to relax a little. (Of course, the thought of someone pressing on my neck and shoulders at the moment makes me queasy, so I’ll just put that massage on hold for now.)

After removing the outer bandage, I noticed that my incision is covered by a few pieces of surgical tape – the kind with strings in it. I saw no stitches but some clear sticky stuff below the surgical tape, so I am assuming that my incision has been glued shut. This is my first experience with glue (and only my second surgical experience, my first being a tonsillectomy), so I am curious how this will go. I was told that I could remove my outer bandage on the 5th post-op day, but I am not allowed to remove the surgical tape over the glue. This should all be allowed to come off on its own.

I was given a prescription for Tylox 5-500mg capsules, a combination of Tylenol and oxycodone, to take 2 capsules every 6 hours as needed. I never took the maximum amount of pain medication, usually taking only 1 pill every 5-6 hours. Honestly, I never felt like I needed it. My last dose of tylox was the evening of the 3rd or 4th day. Just before bedtime, I sensed that the previous dose had worn off, so I took one to help me sleep that night.

Since stopping my pain meds, there has been discomfort, but it’s certainly nothing that has kept me awake or hampered my abilities in any way. There is still some discomfort swallowing, but it gets a tiny bit better every day. If I can settle into a comfortable sleeping position, I can sleep through the night and usually only wake up once…this has been the case for the past 3 nights. My neck and shoulders hurt, but I think it’s because I’m holding them in a tense position to try to keep my chin/face aligned with the center of my chest to avoid turning my head.

At one point, I wondered if I was “normal” in my recovery. So, I got online to read about the post-op experiences of other people. I found that most of them had procedures that were more involved than mine, for example, they included reparations/fusions including more than one disc/vertebrae and required more hardware. To be honest, these stories didn’t help me at all. In fact, they just scared me. I got the impression that I was reading the “worst case scenarios,” so I quit reading and decided to just pay attention to what my own body was experiencing. I’ve been much calmer since, and I find that I can notice my own healing a whole lot better when I’m only comparing MY current experiences to MY previous experiences. Don’t get me wrong – I think one should be fairly well educated, especially about surgical procedures and expectations. I just think that in this day and age of computer information availability, we can get too much of the wrong information just as easily as we can get the correct and helpful kind. I have decided that as long as I am better today than I was yesterday, I am happy and calm.

The time has passed quickly since the surgery, once I got through those first couple of days. I would definitely recommend that you have help for at least 2 days afterwards. Stock up on soft foods such as those listed above. Don’t try to yell or speak louder – keep the remote with the mute button nearby, along with the phone. And just know that as soon as you swallow something you’re trying your best to eat carefully, that phone is going to ring. J

If you have any questions or if something is unclear, please feel free to write me. I’m a no-surprises kind of person, and if I can help, I surely will.