ACDF Portal

Tricks and Techniques

According to Donald Knuth, a trick is something that has proven useful once, whereas a technique is a trick that has proven useful twice. One of the difficulties in coping with the aftermath of ACDF surgery is that there are so many things that one needs to learn in such a short period of time, that it is hard for the tricks to become techniques. Your mileage may vary, but here are some things I have learned presented in the order in which I discovered them.

Table of contents

  1. Chooosing a cup to drink from
  2. Educating yourself
  3. How to make yogurt
  4. Getting the right chair
  5. My advice on pillows
  6. Avoiding choking
  7. Clean tasting drinking straws
  8. Ah... those well meaning friends
  9. Before you have the surgery
  10. Bitesize foods
  11. Room temperature
  12. Managing pain with pain meds
  13. Swallowing, burping, hiccups, and sneezing

[* Cups you can drink from *] If you happen to be in the United States, your kitchen is probably filled a fine selection of roughly cylindrical mugs for tea and coffee. You will discover that you will be unable to drink from them without a straw.

This might be a good time to break out the traditional china cups if you would prefer to avoid being confused with your children or grandchildren through the use of the sippy-cup. The conical shape of the traditional china will not bang into the jaw jacker, and the flare along the rim will allow you to take a relatively small amount of hot liquid into your mouth at a time.

Similarly, tumblers that are wider at the top (like pint beer glasses) are easier to navigate than straight wall glassware. My optimum water glass turned out to be this one although un-monogrammed. Plastic is not a bad idea --- you will be weak and clumsy.

[* Educate yourself *] Hey, this is your neck, right? It is the one you will be living with for the foreseeable future, yes? So, do some simple things to make you a better recipient of the medical system's care.

If you haven't been interested in medicine, today would be a good day to suddenly develop a passionate interest. Get familiar with the terminology. Learn the vertebrae; you should be able to recognize the cervical vertebrae by number when you look at an X-ray. Know your drugs; Wikipedia is an excellent source of information, and they are not trying to sell you a political anti-narcotic message.

Make sure that your family and friends have the details of your procedure well understood so that they do not misrepresent it to other people. Be sure to have a written, accurate description of your condition handy in case you should need to show it to other medical personnel --- in an emergency this may up your chances of survival.

[* Yogurt *] Starving as you will be, and needing calcium to keep those bones fusing, yogurt may be the answer. It is easy to eat and even if you are lactose intolerant, the bacteria have taken care of that problem for you ... that's what makes it yogurt.

After several failures, the best way of making yogurt is also the easiest. There is no need to buy a yogurt maker!

  1. Set aside a (60ml)(1/4 cup) of yogurt, and let it come to room temperature.
  2. Pour (2L)(half gallon) of whole milk into a clean 3L to 4L saucepan. You need the calories, and yogurt tastes much better made with whole milk. At least in the United States, the product sold in supermarkets is a pale immitation of the full bodied thing. The saucepan will need a snugly fitting lid, although it need not be airtight.
  3. Draw some cold water in the sink to a depth equal to the depth of the milk in the saucepan.
  4. Warm the milk on the cooktop at medium heat until it reaches frothing temperature, which is somewhere around (85C)(180F). Use a thermometer whose readings you trust to be accurate to monitor the speed at which you warm it. Use a whisk to stir the milk as it warms to prevent a [harmless but unaesthetic] crust from forming on the bottom of the pan.
  5. Take the saucepan off the stove, and set it in the sink of cold water. It should sit almost weightlessly on the bottom of the sink, or just slightly float. Be sure not to let water drip from the faucet into the pan of milk. Whisk the milk to speed cooling.
  6. When the milk reaches (45C)(115F) remove the saucepan from the sink and add the yogurt to the milk. Whisk it into the mix for ten or fifteen seconds to ensure it is well mixed.
  7. Cover the pan.
  8. Put the pan in the warmest room in the house.
  9. Do nothing for at least 10 hours.

If you need the saucepan for other purposes, transfer the fresh yogurt to some other vessel for storage in the fridge. Otherwise, just put the whole thing in the fridge. If you are hell-bent on ruining a good thing, you can add flavorings just prior to chilling it down.

Rather that wasting your hard earned cash buying milk and failing with several batches, let me stress the important points of the above story: [a] Heating the milk will kill all the competitive bacteria that will try to displace your yogurt culture and turn the milk into a rancid mess. [b] If you err on the temp at which you add the yogurt to the milk, err on the high side. [c] The interior of the saucepan should be non-reactive. Do not use scratched teflon, aluminum, etc. Something with a ceramic or stainless steel lining will be best. [d] As with all cooking, don't rush it. Warm the milk slowly. Let the yogurt sit undisturbed from 6pm to the next morning.

Finally, keep in mind that yogurt comes from the hot parts of the world where it was developed to keep milk from spoiling, and to make milk edible to the majority of the world's people, who unlike those of us with Northern European ancestry, develop lactose intolerance after the age of two.

[* Invest in a high-quality adjustable chair *] Somewhere between horizontal and vertical there is an optimal angle of recline. For math-minded readers, the intermediate value theorem says it is so. For non-engineers, it makes sense that if horizontal and vertical are each uncomfortable, there must be a best angle of lean between the two. The angle probably depends on how long it has been since the surgery and what you want to do (read, watch TV, listen to music), hence the need for adjustment as you recover. You will be weakened, so you will want a chair that is as physically light as possible.

[* Pillows are cheap -- get a selection *] I now have a substantial pillow collection. Among the most useful have been a somewhat overstuffed down pillow that was fairly expensive, and a small pillow no larger than a salami that was free, so cost is no predictor of success. The U-shaped airplane travel pillows have been good, but so have some odds and ends that were intended for decoration.

[* Keep water nearby *] Always keep some water handy, preferably in a spill-proof mug. You are likely to continuously make the mistake of taking bites that are too large, or trying to swallow too rapidly. I cannot give an accurate count of the number of times I have "almost choked."

[* Drinking straws *] Straws have their uses. But plastic drinking staws appear to be covered with some microfine plastic powder that tastes terrible. You may wish to get a glass straw, but if not, I have found it useful to buy a few cans of club soda, and sip a little water through the straws to clean them before using them in a beverage whose taste you care about. I launder a few straws at a time, and set them aside for the day's uses.

[* Dealing with well meaning people who suggests chiropractors, accupunturists, and the like *] Unfortunately, I can offer no advice here. It has amazed me in the past few months how many people who have not seen an X-ray nor an MRI, and who could not even begin to make sense of one, have suggested an adjustment or a few well placed sticks. The way I look at it, a brutal rearrangement of the neck might kill you, and accupuncture might delay your seeking appropriate treatment.

I care about my friends; on the other hand I see nothing to be gained by allowing people to wallow in their fantasies about the perceived ineffectiveness of Western medicine. After all, recommending that people do something potentially dangerous and destructive is not really what friendship is all about.

[* Preparing your house by leaving home *] There are quite a few suggestions on the net that one take a home inspection tour to determine if things are where you will be able to reach them. If you are like me, and you have lived in the same house for seven or eight years, you will have a hard time finding anything wrong with the current setup.

A better use of your time is to strap on the head vise, and head for either a friend's house for your trial run, or a public place such as the grocery store. The first lesson is learning to ignore the many peripheral stimuli along the way. There will be no notice given to whose house is up for sale, strange people standing on the curb, or sales marked in store windows. The periphery is gone.

Once in the grocery store, it is like seeing the world through a hand-held unsteady-cam such as was used to nauseating excess in the otherwise excellent HBO miniseries John Adams. Parallels of the following kind of event have repeated themselves hourly since my experimental, pre-surgery trip to the grocery:

You pick something from the shelf; a bag of lentils, let's say. It was probably conveniently at eye level, else you might not have noticed it. You drop it in the shopping cart, and continue on. There is now no easy way to glance at the shopping cart to see if you got the things on your list.

This happens at home constantly. Do I have my glasses in my shirt pocket? Are the pain pills upstairs or downstairs? If I don't happen to be facing the clock, what time is it?

[* Finding bitesize foods *] Forget everything you have learned about the presentation of food, and focus your attentions on convenience. As an example, a goldfish cracker is an easy thing to eat because the tiny cracker can be entirely inserted in the mouth, whereas a piece of bread with butter and jelly is a logistical mess, likely to be found half on your face.

[* Room temperature food *] Most food is easier to handle around room temperature. Overly hot liquids may not be easily spat out. Molten cheese is a particular peril. Overly cold items cause your throat to constrict undoing any transient benefit there might be from icing an internal wound. Learn to enjoy tea and coffee at room temp.

[* Pain medication *] There is some danger of overdosing on pain medication, but it is miniscule compared with the unnecessary pain of not taking enough. From the very beginning of this event, I have been considerably underestimating my consumption of the pain pills. I can't be sure, but I think the thought process is like this:

1: Two pills every four hours is the max allowed. 2: I don't really want to take two at once because it might make me vomit. That would really hurt. 3: I'll take one. 4: Thirty minutes have passed, the edge is off the pain a bit, and I still have that nagging thought in my mind about no more than two pills every four hours. At least I remember to look at the clock. 5: Another half hour drags by, and I finally write down a time four hours from now as the next time to take pain pills.

So, not only have I unconsciously cut my dose in half, I have stretched four hours to five. In other words, I have become my own nanny.

[* Swallowing, burps, hiccups, and sneezing *] It matters not which direction the food or beverage is moving through your throat --- it is an equal amount of unpleasant work. So, I strongly recommend uncarbonated drinks, or simply letting them go flat before consumption.

The first post-op sneeze nearly killed me. I thought my head had detached, and I hurt for ten minutes afterward. Consequently, I started taking a clone of Zyrtec each morning to try to minimize the sneezing. Perfume and cologne .. in fact, any "chemical" smell ... seems to be objectionable, so encourage your spouse and friends to lay off the odors.