Question
QUESTION: Hello Leslie, I had a discectomy and fusion on C5-7, 5 weeks ago. My question is reguarding some throat difficulties I'm experiencing.  My throat feels tight and uncomfortable, but the main problem I'm having is occasionaly my pain pills are getting stuck in my throat.  I haven't had any problems swallowing any food or anything else for that matter, but a couple times a week my piils are getting stuck in my throat and it makes me gag as I try to spit it up.  Is there a chance something is wrong or is this normal?  I'm assuming the tightness is normal since they had to cut through my neck muscles, but the pills gettting stuck is worrying me. If there is something wrong I'm scared they will have to open me again.  Any feedback would be greatly appreciated.  Thank you in advance.      Anthony

ANSWER: Hi Anthony-
Sounds like you've been through alot lately!  I will do my best to give you some information, and please ask follow up questions if I leave something out, ok?

This difficulty in swallowing (called "dysphagia") is not uncommon after surgery where they go in through the front of the neck.  Some people seem to have it very badly, while others experience it rarely.  The good news is that it is probably not something they will need to slice you up for again.  I will add a link to an article at the end of this that you can read for a bit more depth, but for now I can tell you that -depending on whose article you read- as many as 50% of patients experience some problem with tightness or swallowing after surgery.  According to one article, 50% reported difficulty 1 month after surgery, but at 6 months that number dropped to 17%.  So it will likely improve over time.

What you are feeling is likely attributed to scar tissue in the area- it doesn't move like regular tissue, it is not as flexible.  I had a very deep scar after surgery down the back of my neck, and it hurt like crazy to move- I was told to use deep pressure massage on the scar.  This is, of course, AFTER the wound itself has healed.  Try just putting your fingers on the area and pressing gently but firm and move them just a little at first.  This will help to loosen the scar tissue.  If it hurts, though, don't continue!  I don't think you can hurt yourself this way or I would never recommend it, but if you feel pain you should check with a doctor to be sure there is no other complication.

So, without knowing more about your specific case, I would say to cautiously try massage and stretching of the area, see if some of the tightness can be alleviated by loosening the tissue.  Plus, according to those studies, it may just take some time for such invasive surgery to heal.  I would recommend giving it a bit more time -- if you feel you are getting worse, however, please do consult a doctor.  In the meantime, check if your medicine comes in a smaller sized pill, or even in a liquid form.  I have also read that some people experience less problems with carbonated drinks like soda pop, might be worth a try?

I hope some of this will help- if nothing else at least you will know it is not uncommon and it is rarely something that is permanent.  Feel free to ask again if you like, and in the meantime, Good Luck-

-leslie

http://www.csrs.org/web/outcomes/clinsafetyoutcomespaper.pdf


---------- FOLLOW-UP ----------

QUESTION: hello again Leslie. Well it has now been 9 weeks since my surgery and I have a couple questions for you.  I saw my surgeon 2 weeks ago about my throat/swallowing issues, and he sent me to have soft tissue exrays done. After examining my throat and the exrays he told me that everything was looking good, but Im still feeling and uncomfortable knot in my throat and a feeling of tightness when I swallow. Is this going to get better or do you think my surgeon is hiding something? Also I'm getting alot of muscle spasms and wonder if it's related to surgery because I've been tested for everything serious that causes muscle spasms(ms, als...) before they found my cervical spine problem, and all tests were O.K.  

Only one more question, I promise.  I had alot of muscle atrophy (mostly upper body, arms, hands, wrists) due to the compression of my spinal cord and Im confused as to how this exactly happened, and will I ever regain the muscle and strength? Because my hands are really weak.     Thank You in advance for your help!!    Anthony
ANSWER: Hello again Anthony- always nice to have people back!

When you saw your surgeon last time did he comment on what to expect regarding the tightness?  Or did he just say Looks Good?  My experience with doctors is that generally they aren't hiding things-- the malpractice suits would be too phenomenal.  If you want a second opinion, I see nothing at all wrong with that.  Maybe go to an ear nose and throat doctor, or someone else who is a surgeon and has a good reputation, and just tell them the surgery you had and the problem you are now having.  (Sometimes telling the other doctor's name makes it seem like you're asking them to comment on the guy, not on your issue)  Ask if this is normal and what sort of prognosis they'd expect.  If I were you I'd also ask why I wasn't informed of this possible side-effect before the surgery...

They'll probably agree with your first doc if everything is healing well, etc, but you might get some additional info.

Muscle spasms- are they in the area around the surgery? or in the muscles of your upper back/shoulder blades?

And the atrophy- now that you're 9 weeks post-op are you still losing muscle, staying the same, or able to regain strength in the areas (even if it's just a little)?

Let me know those and I can be more specific, cool?
thanks
leslie

---------- FOLLOW-UP ----------

QUESTION: Thanks leslie. This is how the found my problem....I went to the doctors because I was feeling weak all over(especially arms, and hands) and my muscles were atrophying and I was having muscle spasms all over (this was in Nov of 06).  
The doctors ran all kinds of bloodwork which came back O.K. and then refered me to a neurologist.  They tested me for MS, AlS, MRI and CAT scan of the brain, the whole nine yards and everything was fine until they did MRI of the spine and found Degenerating disks and the spinal compression.

It's just that a lot of my previous problems I still seem to be having. Still have some pain in the neck area, fingers are weak and sometimes tingling, and still muscle spasms.  My muscles aren't atrophing further, but i'm just confused as to why they atrophied from the compression (you know how these doctors rush you).
I just thought I'd be feeling alot better than I do, but my surgeon says everything looks Good. As far as what he said when I saw him, I told him my throat feels(and looked) like when I swallow it moves down and to the left(away from incision). He told me that it isnt, and showed me on my soft tissue exrays that my wind pipe is clear and open.
He's a good surgeon, I checked him out before, but you know how these guys are. I've never before had a surgery and I just feel weird. Thank you again

Answer
hmmm- I think we're about to get into things that I can't say from a distance... The best I can do is give you some basics, since I am not a doctor and have not seen you, etc.

Atrophy-- if the pressure in your spine was causing nerve problems (which it surely was), that can cause weakness and limited movement.  It is not the compression itself that causes atrophy, right?, it is that compression causes weakness or pain- which causes less movement or exercise -- which THEN leads to atrophy.  Does that make sense?  

The pain in your neck COULD be from the healing after surgery.  The tingling/numbness COULD be due to small amounts of swelling in the area, also from surgery. But if these things are not improving, ie LESS pain and numbness, I think you should find out more about WHY.  You can talk again to your surgeon- do you have any more follow up appts?  If he says Looks Good try saying "But it doesn't feel good, and I thought I would see more improvement by now but instead I have the same problems as I did before the surgery. Can you tell me why that is the case?  Should I expect improvement?"  The other option would be to see someone else and ask them the questions

Doctors are always in a hurry, but if you slow them down (and they are good people) they'll give you more than the basic 'Looks good' answers.   You have to stand up for yourself, though.  I don't mean accuse them- just ask for explanations when you don't understand things.  It is something i believe to be very important.

In the meantime, try doing a little physical therapy with your hands and arms.  Not too hard, just very basic stuff to see if it helps reverse the atrophy.  Try stretching your neck several times a day.  Tell the dr you've done this and what the results are...  The swallowing problem may just require more time- if I remember right, ony around 15% of people have this feeling once it's been 6 months after surgery- it may still fix itself.

So, talk to your doc or a different doc- take in a list of questions, you can even write down the answers they give you.  Just get between him and the door!  It is your body and your health and your LIFE.  Make the guy earn that money you're paying him!

Good luck- you know where to find me if you have more to ask, but I've been about as specific as I can with the issues so far (since i am not medically trained, etc)  Hope you feel better-

Leslie