Friday, 26 October 2012
In early 2006, after years of progressively worsening chronic pain due to a damaged lower back, I had surgery to remove the lumbar disc at the L5/S1 level of my lower spine. The failed disc was replaced with a new device – a three-piece metal joint called the Kineflex Lumbar Disc – which was under FDA study as an alternative to fusing the two bones together.
The artificial joint, which is made of a strong, durable cobalt chromium alloy (and should last longer than I do, I am told) maintains the natural movement of the back and that joint, where a fusion locks that joint up and grows the two bones together into one. In theory, the result is better overall since a fusion results in transferring the load and movement (and resulting wear and tear) to the adjacent joints.
The stuff that didn’t work…
This all came to pass after repeated attempts at less-invasive therapy and surgical procedures. From medication to physical therapy, then on to anti-inflammatory steroid injections (hot topic these days) and surgical procedure called a microdiscectomy, the pros tried many different approaches (and I suffered through even more pain and troubles) before we eventually settled on serious surgery. And even then it was still a tough decision.
Looking back on it now, I really waited too long before pulling the trigger each step of the way. Too long to go to the doctor in the first place, too long to get the first steps of treatment, and too long to get to a spine orthopedic specialist. I was beyond miserable, barely able to get on my feet (and sometimes unable to get up off the floor). I was quite literally in constant pain, and my mind and body had compensated – as the brain tends to do – by tuning out all but the worst of it from conscious awareness. But pain is still pain, and the lack of sleep and physical consequences of always compensating for it were just too great and went on for too long. By the time I had the ADR surgery, it was well past time to do something.
My doctor – Dr. Reginald Knight, who I hear now practices medicine somewhere on the east coast – Was awesome. I went up to Seattle and met with him. He evaluated me and determined surgery was the best remaining option in my case. He offered up the medical trial device as an option to fusion of the joint. In fact, it was a lottery-style program: I would either get the Kineflex device or another artificial disc, and I would not know which until after the surgery (since they were randomly and blindly assigned).
It was a pretty heavy duty procedure, known as an anterior approach (good description here), which involved cutting me open below my belly button and moving all my guts and stuff out of the way in order to get access to my spine from the front. Then they cut the ligaments along the joint, removed the badly damaged disc (a shock-absorbing-like structure between the vertebrae) and replaced it with the artificial disc. That process consisted of cutting some slots in the bone, spreading the joint out, and sliding the new artificial joint in place. Then they sewed me back up.
As I wrote about at the time, the first few days were pretty rough. But quickly I started to heal and within a few weeks I was getting better and better. Within an month and a half, I was travelling internationally and was well on the way to being “normal” again.
Life after the surgery…
I wrote about my status a year later, and commented on how much better things had become. Since that time, my back has only improved. I regularly ski and do anything I want. In fact, 99% of the time I forget I have the artificial disc at all. For a year or so after the surgery I would get some odd joint clunks and pops, but over time my body has adjusted and anymore it’s just part of me. Everything else seems to have aligned and adjusted.
When doing heavy-impact sports, such as skiing on icy or very hard surfaces, the jarring motion on my back can cause some inflammation. I have to watch out for that. But it’s more of an aggravation than a problem. I just have to remember that there’s no more shock absorber there – It’s all hard metal now. Once a joint is damaged as badly as mine was, you’ll never be 100% better I think, but I am consistently 90-95% like new, and that’s something I’m grateful for.
There are a few things people ask me about regularly, so I’ll list those here with some answers.
Q: How do you deal with airports? Do you set off metal detectors or get into trouble on those new millimeter-wave scanners?
A: No problems at all. The metal is non-ferrous, so it doesn’t set off magnetic sensors, and the millimeter-wave scanners look at surface items, not into your body. So I’ve had no issues at all, not even once. And I fly commercially a lot.
Q: What restrictions did your doctor place on you, and for how long?
A: Now every patient will get specific instructions from his/her doc, but mine were clear: My doc told me that I had missed out on enough life, and that I needed to follow some common sense rules post-surgery about not bending over or lifting anything for a couple weeks (mostly aimed I think at making sure my incision healed without tearing), but within a few weeks he told me it was time to get out and do whatever I wanted. If it was uncomfortable, I’d know not to go there. But, he said, no restrictions (literally) and that was it. I took him at his word and went to Germany for work, where I climbed the 400+ stone steps to the Heidelberg castle and walked mikes and miles.
Q: Have you placed any restrictions on yourself?
A: Since the trip to Germany in 2006, I’ve done nothing but stay active with skiing, boating, jet skiing and a variety of other crazy, stupid activities. I did give up my motorcycle, however (the street bike, not the dirt bike hah – I still have that one!). I found that when I rode it I was focused on what could happen to my back if I was in a motorcycle accident. If that joint was damaged, fixing it would not be much of an option. I’d rather not take that chance and I found that the mental distraction was not exactly safe, either. So that’s the one thing I gave up. For now, anyhow. :)
Q: Are there dangers and side effect of the surgery?
A: All major surgery has risk. Anesthesia, bleeding problems – these are real any time someone goes under the knife. In particular this procedure has some risk related to blood vessel damage, since there are some key vessels to watch out for. In addition, there’s a risk of possible nerve damage that men especially should be aware of, since it can affect fertility and – well – let’s just call it “plumbing operations.” You can look it up if you like. Sometimes the damage is self-correcting over time, other times it’s permanent. Don’t avoid talking about the possible issues there. While it’s rare and occurs in a very small percentage of cases, once a guy is affected he is 100% affected - and probability just isn’t relevant at that point.
Past writings for people who are interested…
For people who are looking for information, or for anyone who cares to read back in time stalker-style (hah), I documented my surgery experience and early recovery, plus my one year results, here on this site:
I also documented the mess of different things the docs tried, but which failed – much of the stuff that led up to the major surgery:
Thursday, 15 February 2007
On February 15th, 2006 I was wheeled into a surgical suite to have the intervertebral disc between the L5 and S1 vertebrae removed and replaced with a three-piece mechanical replacement joint. The Kineflex artificial disc was in FDA trials at the time, so I was a test subject for an all-metal design that was working its way to market. As of the time of this writing, it's still working though the approval process. If my own personal experience is any indication of what ought to happen, then the Kineflex disc should be approved and shipped to the market as soon as possible. Granted, it's important that the device be used only where appropriate, but for people who today stand in the same shoes I wore up until a year ago, the artificial disc replacement (ADR) is a miracle, and can be a true life gift.
I have 15 degrees range of motion in the L5/S1 joint, which is excellent. My doctor told me at my one-year visit the other day that people with seven degrees or more range of motion are doing very well. So, that's good news. He's also very happy with the level of activity I have been able to take on since the surgery.
It's taken some time for me to get to where I feel pretty much "normal" (whatever that is). Shortly after my surgery I started to feel much much better. As time went on, I realized just how much pain I'd been in. And over the intervening months I have just gotten better and better. A couple weeks ago I went skiing with my friend up at Timberline on Mt. Hood, and was taking some of the smaller jumps without pain and without really even thinking (or at least without being concerned) about the fact that I have this metal contraption in my spine (and that, my friends, is the telling attribute of my experience).
The fact that there are days where I don't even think about my back is amazing. Who would have thought that I could go from being unable to sleep more than an hour or so at a time, and living with constant debilitating pain, to an active and almost pain-free person who can once again do almost anything I want. People who work with me and my friends can tell you how pathetic and practically crippled I was before surgery. Today they say I am a new person. When my doctor told me to go out and live my life, with no real restrictions (but to be sure to take good care of my back), I took him at his word. Nowadays I lift things the "right" way and I'm careful to respect what remains of my natural spine. But mostly I simply don't have to think about it too much.
The surgical procedure for ADR is a serious one, and not one to be taken lightly. Really, everything else should be tried before resorting to surgery of any kind. In my case they did injections, physical therapy, exercises, shrinking the disc in size... you name it. Even just medication. None of the other options helped. So, my choices were fusion of the two vertebrae or a prosthetic artificial disc replacement that was fairly new-fangled (at least in the United States, where many medical technologies actually get to market very late in the game).
I recently received an email from one of the creators of the Kineflex artificial lumbar disc, Malan de Villiers. That was cool, hearing from someone who actually designed the device that has changed my life so dramatically for the good.
I have my life back. That's something to be grateful for.
Monday, 22 May 2006
If you're not into x-rays or thinking about surgery and stuff like that, you can just skip this one. Many people have had me promise to show them pictures of the artificial disc that was implanted in me three months ago once I got them, so - well - here you go. This is a pretty amazing and relatively new (in the USA anyhow) area of medicine.
The Kineflex artificial lumbar disc is a three-piece metal-on-metal mechanical replacement, which is used to treat chronic and severe lumbar pain due to degenerative disc disease. It's in FDA trials right now, which makes me a bit of a guinea pig. It's not the kind of surgery you decide to do without a lot of serious thought and only after trying every other option. It replaced my natural disc, and now my severe back and leg pain that I lived with 24 hours a day for years is practically gone - and as a bonus I am a little bit taller than I was before the surgery. As I've said here before, I have my life back thanks to the doctors and the people that built this little device.
How'd they get it in there? The made an 8-inch horizontal incision just below my belly button (yep, they approach the spine from the front), spread the bones apart, removed the disc that was damaged, and put this new one in place.
You can click each image to view them larger-sized. I've removed any sensitive personal information.
Tuesday, 04 April 2006
It's been seven weeks since I underwent surgery on my lower back up near Seattle, Washington. I was the recipient of a Kineflex lumbar artificial disc, a three-part, all-metal mechanical replacement for the torn, herniated and collapsed (degenerated) disc between my L5 and S1 vertebrae. That's the lowest one in your spine.
This surgery has truly given me my life back.
Before the procedure, I was always - and I quite literally mean always - in pain. Real pain, the kind that wears you down every minute of every day. The kind of chronic pain that people can't fully understand until they've lived with it themselves. It wears you down, chews you up, and eventually spits you out. "Normal" for me was a lot like the "normal" road noise is for someone who lives right next to a freeway: Spend your whole life around it and your brain tunes it out just to cope, but it's always there. Sure, louder noises still annoy you, but the mind has a way of coping with whatever you throw at it, at least as best it can. But that background pain still has an effect, progressively more so over time. When the sound is gone, it's almost deafening. And when the pain is gone, you finally realize just how bad it's been.
I feel ten times better than I've felt in more than ten years. Seriously.
Yeah, I am a guinea pig of sorts - the artificial disc I was fortunate enough to receive was provided to me as part of an FDA trial - not very many people have this hardware in their bodies. I did more than a year of careful and critical research on artificial disc surgery before I decided to take the leap. I considered bone fusion (which is the classic and most common treatment for my condition) and I tried every other treatment that was available to me - physical therapy, exercise, medicine, cortisone injections, minimally invasive procedures, you name it. When it came down to it, it was a choice between bone fusion or ADR (artificial disc replacement) procedure. the ADR device allows the joint to remain mobile instead of locking it up permanently, and I am only 38 years old (well for a few days anyhow), so staying mobile is important to me. Because I had a 50/50 chance of receiving either a Charite or Kineflex artificial disc (they split the patients randomly, half and half), I also had to become confident in both technologies (the Charite is two metal plates with a plastic core, while the Kineflex is the same basic idea, but with a different design and a metal core). I can tell you that I was lucky and got the one I really wanted (the Kineflex), but either would have been okay with me.
Not everyone is the same, and surgery is rough stuff. The procedure is a serious one with potential side effects that one has to be ready to accept. Everyone's body is different and surgery is in large part an art, which means they all go slightly differently. Many people benefit from the new technology, while some are not so fortunate. That said, I am so grateful for my decision and to my doctors and the staff that have given me so much back. I did not fully realize how bad off I was until now, and still each day I keep feeling better. It will likely be many months before I can say I am healed and recovered, but I can see and believe that day's coming, which is something I had almost given up hope on before.
I write this from what used to be one of the most painful places in my life: An airliner seat at 37,000 feet. And guess what?
It doesn't hurt anymore.
Monday, 06 March 2006
Update: You can read all of my posts about my Kineflex ADR surgery at this link.
Many of you who read this know that I had back surgery recently. The surgery was an Artificial Disc Replacement at the L5/S1 level, with a Kineflex artificial lumbar disc. It's been almost three weeks, and my current assignment from the doc is plenty of rest (and so I am at home almost all the time), combined with walking as much as I reasonably can, but without overdoing it. I'll soon be able to go into work part of the time for very light duty. Right now I am able to do some work from home, which is one of the things that helps to keep me sane day after day.
Progress milestones while healing - big and small - really stand out in a recovery like this. I was able today - for the first time - to walk the half mile trek to my mailbox and back. It's the longest single outdoor walk I have done so far. I live at the end of a long gravel driveway, up and down two steep hills. As I was climbing the first hill and neared the top, it dawned on me that I was not slowing any, and that it didn't hurt!! Wow! By the time I got back to the house, I was quite worn out (exhausted, really), but no worse for the wear physically. Progress! Not to mention it's a great psychological milestone. Before the surgery I would have been staggering, clumsy and in pain before I got a hundred yards into it. Three weeks ago I was re-learning muscle movement just to walk at all for the first few days.
So, slowly but surly, getting better. I just have to make very, very sure I don't over-extend myself or bend the wrong ways (I am limited in certain motions for now), and I have to pace myself so I don't wear out. Unfortunately when I do wear out it happens quickly and I tend to crash from an energy standpoint. Other than that, I feel much better overall than I did before the surgery and, despite some surgical side effects that take time to work themselves out, I'm encouraged.
One of the things that has made this whole Artificial Disc Replacement surgery thing bearable is an online forum called the ADR Support Forum over at at ADRSupport.org. ADR is a newer technology in the United States, although it's been prevalent in Europe and other places for many years. There are lots of great people on the forum who have either gone though ADR surgery or who are looking into it and wanting to find out more, so it was a great resource for me pre-op and it still is after surgery. Highly recommended for reading and participation if anyone is considering an ADR procedure.
Friday, 17 February 2006
(This is not a techie post, but since there are many people out there asking how I am doing after surgery, I'll write about it here. It will also help me remember how things went and what happened when)
It's two days after my surgery, and I'm heading home this evening from the hospital, which I am looking forward to. This hospital is great (truly), but somehow the idea of having a fire in the fireplace and being in familiar surroundings is more appealing.
My body hurts, pretty bad. Like I got hit by a truck. but it's not the old pain, which is great. I can walk a short while (well, it's a lot like walking, but it's labored at best), and the physical therapist had me walk up and down a flight of training stairs. Who would have known it could be so much work? This is a lot like learning to walk all over again.
I was able to take a quick shower today (they do some fancy stuff with the incision when they close you up, and showering is actually a good thing to do once you're up to standing for that long). Thank goodness! The hot water helped relax some of my tense muscles.
Yesterday was hell. Starting with X-rays (which came out just fine), standing up was very painful - I had terrible muscle spasms in my lower back and legs, along with pain and nausea. Nothing like feeling nauseas and (forgive the graphical discussion) having to puke, which of course hurts like hell since your abdominal muscles contract hard each time. I'm glad that phase seems to be over with.
More than a few people have asked me what exactly they did to my back during this surgery. I've decided its not a big secret or anything, and that in fact it's really very interesting. First they removed the inter-vertebral disc in the lowest part of my lower back, at the L5/S1 space. Discs in your back are the softer tissues between the bony vertebrae that act as shock absorbers and allow your back to move in all directions. think of them as like a little pillow filled with squishy stuff (well, sort of). Mine was herniated (torn and pooching out into the space where the nerves run) and degenerated (loss of water and height, thinner than it used to be). In other words, pretty much all ragged and shot. The medical term for the thinning and drying out of the disc is "Degenerative Disc Disease." You body won't correct it on it's own - the physical damage is done and it usually just gets worse over time.
Once they removed the bad disc, they put in an artificial disc replacement implant - a spinal prosthesis, you could say. It's called a Kineflex lumbar artificial disc, and you can see a quick video of what it looks like and how it works here. The Kineflex device is a newer design, and I received it through a study program that is comparing the Kineflex disc to the Charite disc as part of a FDA clinical trial in the United States (email or call me if you want some details - contact info is in the right-side menu bar). I did a lot of research - on fusion options, artificial disc options, do-nothing options, individual surgeons, etc - before I decided to go this route. Artificial discs are - in the right patients - an alternative to fusion of the two bones. The ADR devices don't act like a shock absorber (neither does fusion, for that matter), but they do retain close to natural motion in the joint. As you might imagine, it's a fairly expensive procedure, and at least for now insurance companies in the United States are rarely paying for the procedure because it's too new for them (the first model to get FDA approval was the Charite and that was in the fall of 2004), and they instead prefer the fusion route. That's the way health care works.
And for those people looking here for technical posts - well, sorry. They'll be back soon enough.
Sunday, 12 February 2006
If the knife doesn't kill me, the stress just might... On Wednesday at around 7am I'll be up in the Seattle area on a table in a surgical suite, and with any luck about an hour and a half (or so) later I'll be hallucinating and stuff in the recovery room as the proud and successful recipient of a artificial disc replacement at the L5/S1 joint in my lower back. I get to lay around in a hospital bed for a couple/few days, then can head home to lie around a whole lot more.
It's not quite Steve Austin style stuff, but the plan is to replace a collapsed, herniated and generally failed lumbar disc with a mechanical replacement. I'll be like a scaled-down version the bionic man. Not quite six million dollars worth of work (more like in the tens of thousands), but I am told they can rebuild me, they have the technology.
Truth be told, I'm just a bit scared. I've never been through surgery anywhere near this extensive before, and the decision to do this has been a long and tedious process involving a lot of risk and personal decisions. In the past I've had epidural injections of cortisone, lots of physical therapy, a minimally-invasive microdiscectomy surgical procedure, more physical therapy, medication, rest, exercise, you name it. But when a body part's shot, it's just shot.
Since then I decided - after meeting with a few highly regarded and experienced surgeons who told me I'm just delaying the inevitable fusion or artificial disc surgery - to stick it out for a while and see if I could just deal with the pain. The problem is, in order to do that I've had to keep myself from doing a lot of the things one needs to do in a normal life from day to day, as well as a lot of the things that help make life enjoyable, and that's no good.
So, here I am. Surgery could mean a great improvement in my quality of life. Of course it's not without risks (you really want someone operating on your spine?), and the past year has been mostly about deciding whether the risks of the procedure are worth the potential benefits and avoiding surgery. The pain has not improved much if at all, it always limits me, and at many times it's quite unbearable. Life's no good like this. So, it's time. My doctor is very experienced and I have lots of confidence in him. The facility is great. No more excuses.
As always seems to happen (Ask Murphy why, I sure there's a law about it), workplace and life situations, stresses and pressures are coming to a head right about the time I have to do this surgery, but I've decided that I really only get one life, and one body for that life. Jobs are something that can flex and be molded and true friends will wait, so while I'm wanting to get back to work and life as soon as it's realistic, I have to take care of this other stuff first, slow and steady as they say.
But I'm not just worried and scared. I'm also excited. The prospect of healing and being able to do many of the things I used to take for granted is truly something to look forward to - things like loading the trash cans into the truck to take to the dump, or walking the dog more than a quarter mile, or riding a bike or my motorcycle, or sitting in a chair for more than 15 minutes at a time, or even just being able to pick things up off the floor.
That and not falling flat on my face in the hallway because I twist or step the wrong way, or because I drag my leg and pain shoots out my foot - That's just one of many things I am looking forward to no longer experiencing.
Anyhow, It'll be lighter than usual posting here probably for a little while 'til this is behind me. Maybe a little bit more to write over the next couple days, but come Wednesday I think I'll be rather out of it. Cross your fingers for me.
Monday, 23 January 2006
Life, work and everything else is pretty crazy these days. I'm tentatively scheduled for some major surgery on my lower back in February, and my day (and evening) job is hectic and quite challenging in many ways (but I'm not complaining). Add everything else that happens in life into the mix, well... Recently it's been just a bit overwhelming at times.
I've traveled more than usual lately. One of the things I found made it more bearable (besides wearing my rigid back brace on airplanes - thank goodness for that stupid thing) is the new iPod video model I recently picked up. I discovered Battlestar Galactica, the revived show that everyone and their brother has apparently seen and raves about. Now I can see why they rave. I used to watch the original series when I was a kid - it was the greatest show on TV for a period of time, at least in my book. So, I purchased the pilot mini-series of the new, modern version via iTunes a couple weeks ago and watched it on my flights to Philly and Pittsburgh. What a great show. Definitely made a couple long flights much more sane. I downloaded the first season of the show the other night and will start watching that soon.
Some of you know I've had back problems for some time. I now have back surgery set for February 15th in Seattle. There are some tests that I have to get done before then, too (bone scan, labs, etc.). From what the doc says, I guess I will be relatively out of it for a while - at least a few weeks. It's quite an intimidating prospect, actually: I have never had major surgery before, so I am more than just a little nervous, even though the doc is terrific and has tons of experience. More on that later, maybe when the day gets closer. Afterward it will certainly make for an interesting and geeky bionic-man kind of tale, assuming all works out and the surgery actually happens. First things first.
Have you ever had major surgery? Care to share your experience? Mine will be an anterior (read: from the front) approach to the lumbar spine (at L5-S1), where they'll remove the disc and then do their handiwork. Not too common, but maybe there's someone else out there who's been through that sort of thing. If so, let me know.
Friday, 29 April 2005
In December I had a minimally-invasive surgical procedure done on my lower back to try to help correct a herniated disc down there in my spine at the L5/S1 joint (that's just below hip level). The end result was a limited success, and I am pretty much back where I was before the procedure nowadays, as far as the back/leg pain, numbness and reduced motor skills in my legs go.
The original procedure was no guarantee, but we had high hopes. I decided a minimally-invasive procedure - one that would not require any permanent changes, cutting or physical limitations - was a good first shot to take. It just didn't work out as well as I would have liked.
So, I have seen three highly-recommended doctors recently to talk with them about what can be done to help. I am in some level of pain 24/7, I wake up several times every night from the pain, and I am basically restricting my own activity so much that I am becoming fairly miserable and generally unhappy in life. I can't stand for any period of time, I can't stay seated for very long, walking any real distance is painful, lying down requires me to shift around constantly (hence waking up from pain), and really the only position that I can get into that gives me some relief is whatever position I am not in at the time.
The doctor who did the procedure in December told me he thought there were a few remaining possibilities for me: Live with it (always an option), maybe do a microsdiscectomy (an iffy proposition), bone fusion of the joint, or artificial disc replacement.
And, as it turns out, each of these three doctors I consulted with came to pretty much the same conclusion: The only thing that will work for me at this point is removal of the bad disc, followed by either fusing the joint or replacing the disc with an artificial one. Both methods have been around for a while. Artificial discs received FDA approval in the U.S. last year.
It's been very interesting (and enlightening) to visit three neurological surgeons with no information other than my MRI films and a verbal history of my pain and medical care, to see what they would tell me. I did not tell any of them what the other docs said or thought or diagnosed, but all three came up with the same result. That's encouraging, at least in terms of knowing where I really stand. Of course, the idea that I need a fairly major surgery to be better is a little intimidating. But, one further point of encouragement is the fact that all three doctors were quite confident that surgery would make a huge difference in my quality of life. All three said that I am practically the perfect candidate to benefit in a huge way from the procedure.
Then I started thinking about whether it's the "right" thing to do - Is it right to cut into your body and remove parts or put in fake parts? These thoughts keep going through my mind and I'm actually a bit surprised. I guess I just never had the chance to think them before now.
So now comes the decision. Oh boy, this is definitely not the easiest part. Deciding which doctors (it takes two - a vascular surgeon as well as the neurological surgeon), when to have it done (if at all), and which procedure is the best option for me. Not to mention the health insurance company part - who knows what they'll have to say.
A fusion means six to nine months of take-it-easy time, and a longer period of relative inactivity (that includes work). An artificial disc does not have the healing time (there is no fusion process to worry about) and so return to work/normal life is much faster. Fusion has been around for a long, long time. Artificial discs are newer - especially in the U.S. - but have been around for about 15 or so years.
The actual surgical procedure followed to do either the disc replacement or the fusion is pretty much identical. The only real difference is what goes between the vertebrae once they get to where they're headed - some metal cages, some bone, or the artificial disc. Getting in there and closing up is virtually the same.
Anyhow, if anyone who reads this also happens to have received an artificial disc (or knows someone who has), please let me know - I'd like to communicate with you. Also, anyone who's had a fusion, same deal - please contact me by commenting on this post, or click the mail icon over in the navigation sidebar.
Sunday, 06 March 2005
Update on my back surgery stuff for the four or five of you who are following and care...
Well, since my back surgery procedure things in December, I have had some relief from the pain I was experiencing. I even had a couple of days where I felt better than I can ever remember feeling.
But overall, while things are certainly better in many ways, overall it's not been better enough, if you will, to call it resolved. I have been doing physical therapy for two full months and the pain has increased and decreased somewhat a number of times. But overall, it's still a problem - weakness in both legs, pain reaching from my back into my legs and feet, and enough pain to keep me up at night and severely limit my ability to do the regular day-to-day things I need (and want) to do in life.
The procedure that was done in December was a minimally-invasive procedure, in which the doc went inside the L5/S1 disc and removed some of the material there, which was to allow some of the bulging material that is impinging on my spine to be reduced, relieving pressure on the spinal nerves, and therefore relieving pain. Unfortunately, while it's better at times than it was, it's still a pretty serious problem.
So, the doc ordered a new MRI a couple weeks ago. We saw the films the other day. And it looks like its time to see another surgeon. At least this surgeon says so.
Unfortunately, the images are not all that good. The disc appears to have extruded more material at some point, so the problem and pain are in the same general location (same joint), and it feels and acts very much like what I was experiencing before the procedure, except that the pain moves from one leg to another somewhat regularly. I guess after 12 or so years of wear and tear, this is just not going to be a simple process.
So, off to a few more docs I go. The minimally invasive route was, I think, worth it for a first step, but now it's time to see what - if anything - can be done to better solve the problem. My current doc has his recommendations (microsurgical discectomy to cut out and remove the herniation), and we'll see what other docs think is the best thing to do.
I just finished a 6-day pack or methylprednisolone, which is a super-anti-inflammatory thing. For a couple of days, when the daily dose was high, I felt fairly okay. Now that it's all gone and all I am taking is the regular anti-inflammatory stuff, it's back to being pretty darned uncomfortable and at times pretty painful.
I don't expect to be made completely better - not at all. But it would be nice to be able to lean over the sink when I wash my hands and brush my teeth, or to be able to bend over to put on my socks and whatnot. Not to mention the fact that things like pulling weeds in the garden can't last for more than 5 or 10 minutes on a good day, and if I actually decide to pull the weeds, I'll pay for it for days.
Again, I am glad I went with the minimally invasive route first. It has helped me overall, and generally speaking I am in somewhat less pain, which is a good thing. I'll just have to move on from here and see what's the next best thing to do.
Wednesday, 12 January 2005
Forgive the non-tech post, but it’s a pretty good day today and apparently there are a large number of people who are keeping an eye out to see how I am doing after my back surgery last month. I have not posted much about it here, preferring to suffer in private, but for the first time today I feel like I am turning a corner, and it’s a great relief.
I’ve spent the past three weeks fighting what at times has been extreme pain, quite debilitating and agonizing. I had surgery on my L5–S1 disc, which was herniated and pushing pretty hard on the sciatic nerve roots in that joint. The condition made for chronic pain and occasional agonizingly painful periods where I would be left effectively non-functioning. It needed to be fixed.
I had the procedure done three days before Christmas, which was an interesting decision in and of itself, one that had more to do with insurance and coverage before the end of the year than anything. At any rate, after a couple days of feeling pretty good post-op, things got terribly painful the day after Christmas.
Apparently that’s not too unusual. It tends to get worse before it gets better, they say. But that doesn’t help me feel any better. And it got a lot worse for a while.
I have spent the past few weeks with friends living at my house to take care of me and carry me around, followed by dragging myself out now and then to do something like buy food or go to work for a little while. Last week I decided to work from home the last half of the week. I found I could do most (not all) of my work in bed, and that as long as the pain was reasonable I could be fairly productive. But staying at home all the time makes me a little stir crazy.
I went to work the past two days, found a couch to lie on with my laptop instead of sitting in a chair, and confirmed that taking it easy was – in fact – a good thing to do. Today I decided to stay home again and work from here (conference calls, VPNs, remote desktops, instant messaging and email are all amazing tools), and to go to my physical therapy appointment this afternoon.
Today is the first day in three weeks that I can say my pain level is below a 5 on a 10 point scale, all morning. That’s progress. Not to mention relief. There’s nothing quite like living in fear the pain will never go away, especially when you’re not sleeping and can’t put on your own clothes.
But the fact is it’s more about progress than about perfection here. And God willing, if today is an indicator, things are starting to look up – slow improvement, but looking up.
Of course, I have physical therapy in an hour or two, and who knows how I’ll feel after that. Probably worse, but if it means things get better down the road, I will just continue to suffer. With a smile on my face, of course.
Tuesday, 21 December 2004
Mid-day Wednesday I’ll be getting drugged up and surgically repaired. The time’s come for a microdiscectomy for my back problems (which I have written about here at a high level in the past). After trying exercise (ouch), stretching, medications, therapy, hanging upside down, chiropractors, you name it… Well, it’s just time.
What many people don’t realize is how incredibly debilitating back pain can be. My condition is a herniated disc at the L5–S1 joint, which is in the lower part of the small of your back. The disc is that flexible shock-absorber that sits between your vertebrae. The herniated part is bulging out and pressing on the roots of two nerves that go all the way down my legs and into my feet. When I have back pain, it’s not just in my back – It’s shooting from my back, down my legs, and out the tips of my feet. At times it’s the kind of pain that keeps me from being able to get up off the floor, or even from being able to move without screaming. At other times the symptoms are clumsy legs and twinges of shooting pain. Other times my back just aches.
Anyhow – after nearly 10 years off-and-on of real pain and discomfort, I am looking forward to the decent possibility of lessening the pain and related problems.
People have been asking me if I am nervous. Truth be told, I’m really not. I trust my doctor and have confidence there. It’s not complicated surgery, and I will be home under my own power the same evening. I won’t be able to drive myself because of the medications they use for surgery, but hey, that’s why God made friends, to drive you back and forth when you’re in bad shape, right?
So, with any luck, by this time tomorrow night I’ll be feeling less pain than I am now.
If that should come to pass, it will be the best Christmas present I could possibly wish for. I’ve been good this year, so I hope I get my wish.
Wednesday, 08 December 2004
Well, for those who have followed (for some reason) my back ailments here, an update: Surgery will happen on December 22nd.
So, Percutaneous Discectomy it is – removal of some of the material inside the disc at the L5/S1 space to relieve pressure on the nerve root there. The doctor will remove some of the material from inside, the bulge moves back toward the void left by the removal, and the pressure is reduced. Hopefully.
Nice thing is, it’s outpatient day surgery – I’ll walk out and go straight home within a few hours of arriving there. I’ll also be wearing a back brace for a while and will have to do several weeks of physical therapy (whoopee), but in the end I am hopeful it will all be worth it.
I’ve done pretty much everything I can in order to try to make things work without surgery, so this is pretty much it. While I am not big on the idea of surgery, I am very much looking forward to the possibility of some relief and maybe even getting back to where I can physically do the things I used to do.
Wednesday, 13 October 2004
I'm sitting here now with a pain in my lower back, the result of a discogram procedure performed today on three lower bask discs. No pictures this time, but if you want to know what the procedure is there's info and a picture here.
I was prepped for this one by my doc to be ready for a very painful experience. A discogram is a procedure where he runs needles into the disc that is known/suspected to be the problem, as well as two others above it, one of which looks a little iffy but not as bad as the primary suspect disc, and another that looks normal and healthy. He then fills each up with fluid and a small amount of blocking agent "dye" that can be photographed on a CT scan after the procedure is completed.
Thing is, if you have a herniated disc and you pump fluid into it to blow it up/inflate it, that means the fluid will likely push the herniated portion harder into the problem area. That hurts, a lot much of the time. and that's what they want. That is how they verify the pain, and that if they choose to do surgery, they know exactly where the problem lies.
They can also look at the CT scan images and see where the dye flowed, which gives them an even better idea what they're up against and what kind of surgery - if any - is the best bet for the injury.
So anyhow, today was my day. I live about an hour or a little less northwest of Portland. The doctor who specializes in my back problem that I was referred to by my local doctor is in Salem, which is about an hour south of Portland. So, my friend Broc showed up at my place last night, made my guest bedroom useful, and got up early with me and drove me to Salem. He ate McDonald's and got coffee while I listened to him heckle me with tales of morning caffeine and food. I would not be able to eat or drink anything until after the procedure, and I was starving. And another thing - for me to not have coffee by 8am is unheard of.
The nurse was great this time - a little local anesthetic and the IV was right in (not like the last time at a different place...) and all I had to do was wait.
They got me into the room and on the table, and prepped my back. I heard the doctor come in.
And then the next thing I know, I was in the recovery area.
That's it. I have no freakin' clue what happened in the operating room, except that they did what they needed to do and I was not knocked out. But I swear to God, other than a vague recollection of a short painful stabbing experience with nothing solid to attach it to, I don't remember anything at all - it's like I jumped ahead an hour or so and that time never existed. I've never experienced that. Very strange.
Man - I hope I didn't say anything mean, stupid or embarrassing! :P
At any rate - we'll wait a couple weeks, let my back return to normal (I am a little more than just uncomfortable right now), I'm taking a trip, and when I get back it will be time to meet with the doc, once he has had time to review the results and consult with his partners, and see what if anything he can do to help.
Verdict: Expected severe pain, missed the whole damn thing in my memory, sore now but completely manageable - just a side effect of increasing the pressure and an expected consequence. The people were better than just good - they were thorough and terrific to me during the prep and after, and I have to assume they didn't tattoo me anywhere I can't see or something while I was "out of it." Doctor Olson and crew gets an A+ in my book.
Past related writings:
Thursday, 22 July 2004
I've had two sets of epidural spinal injections to try to fix my back, and while I have had some relief, it's not solved the problem.
So, I went to the doctor the other day, and he decided its time to send me to the spinal surgeon. I guess there are a few procedure options - one of which involves heating up the intervertebral disc from the inside in order to cause it to shrink. The heated tissue scars and shrinks, so the protruding (herniated) part of the disc (which is pushing on the nerve roots where they attach to the spinal cord) recedes. The disc has a soft inner portion surrounded by a more fibrous shell, so to speak. A herniated disc is one where the fibrous shell gets torn and the center material bulges out. The bulging out part is what's pushing on the nerves. Oh, and it hurts (sometimes a lot).
Anyhow, the doctor that does this special heating/shrinking procedure (the more common procedure is a microdiscectomy, where they just go in with blades and cut out the bulging part) is in Salem, which is a good couple of hours from where I live. I guess there are a few docs in Portland that do something similar, but my doc wants me to go to this guy because its a newer procedure that heals faster and has shown good results (less scarring damage to the disc - it's more exact). So arranging visits and working with that doc will be a little complicated, and I don't even know for sure if I'll end up being a candidate for that particular method. But if it means pain relief, it's all good.
The craziest part of this problem is that most days I am uncomfortable - some pain but not unbearable. Other days (few and far between) I feel almost completely normal (I love those days). And on yet other days the pain is so unbearable it can't be described with words. Debilitating comes to mind, but that doesn't really paint the complete picture.
Anyone have any personal experience with any of these?
- Intradiscal Electrothermal Treatment
- Endoscopic laser foraminoplasty (ELF)
- Percutaneous discectomy (PAD)
Tuesday, 01 June 2004
I can't imagine there are many people who care about my pain and suffering, but for the few that do and who have asked me to show pictures, here is a followup to my first spinal injection post from a few weeks ago.
And this time there's pictures! (Click on the image for more detail and pictures from the scene of the crime with circles and arrows and a paragraph on the back of each one to be used as evidence against... Oops, never mind. The red arrows point to the inserted needles.)
I went back in this morning and had a second round of injections done, only this time I skipped the IV pain killers and anesthesia/relaxation stuff. Last time they gave me this stuff that made me all calm, and a bit groggy. It's not that I wanted to avoid that medication this time, it's just that the nurse couldn't get an IV stick in me successfully. After a few painful attempts at finding a vain (I had not had enough liquids the day before and could not drink anything this morning before the procedure), we gave up and I decided I'd endure the pain of the procedure over the pain of he failed IV sticks.
That turned out to be a good idea.
My doctor's a funny guy. When he heard I was not getting the IV drugs, he paused for a second or two, said, “Well ohhhhhkayyyy then,” and started in. Yeah, it was more painful, but all in all not too bad.
The picture above is from the procedure, where they stick a needle down in my spinal column, about 3 inches, into in the epidural space where he injected a “nerve block” and some cortisone steroid stuff, which will reduce the inflammation and hopefully solve my problem of not being able to carry the weight of my body on my own two feet from time to time. Either that or figure out something else, but this is the first step (after trying medication and physical therapy - the first invasive step, you could call it).
For anyone who's avoided procedures to help with back injuries or degeneration (I have a herniated and degenerated disk), let me tell you this: You can get some relief (in some cases complete relief I am told). While my pain returned (I was told it probably would), and I have to go through this second round, the freedom from pain when you get it is worthwhile. I did not realize how much pain I was in until it was gone. Kind of like beating your head against a wall, as they say: It feels so much better when you stop.
Anyhow, totally non-tech, and so now we return you to your regularly scheduled blogram...
Wednesday, 12 May 2004
For now let's call it a pound of “ouch” with an ounce of “anticipation-of-relief...”
This was a first time for me, seeing as how I've never had any kind of surgery or anything similar to what you might call a surgical procedure. This was minor, though: Today I had epidural injections of a corticosteroid and a nerve blocker put into my lower back. I've had pain for years now, constantly, that ranges from annoying at times to completely unbearable at others. Having done nothing up to this point to try to fix the problem other than taking anti-inflamatories, I decided at the doc's recommendation to try these shots and see what happens. If they don't work, he and I will see what's next. I just know I can't live comfortably with the pain any more, it's just become worse as time goes on.
So, anyhow, went to the hospital, they gave me some stuff that made me slightly loopy, and I was awake the whole time. Lots of needles in the back, stuff injected into the epidural space in my spine, kinda hurts, and now I am fluctuating between feeling pretty okay and having shooting pain, especially as the blocker wears off and the numbness subsides.
I am told by the doc that the pain may get somewhat worse before I start to feel better, and so far, he's right. But hey, this is I guy I am highly confident in as far as his medical abilities, and since this is what he said would likely happen, I guess I am not really surprised. I'll ride it out and see how it goes over the next day or two.
Anyhow, there are people out there who have been asking about this, and although it's completely non-tech, I thought I'd just post an update. I'm okay, the pain is there, expect it to get better.
© Copyright 2013 Greg Hughes
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