Category Archives: back problems

Spine Surgery

After the second opinion, I was scheduled for lumbar surgery a couple of weeks later.  As the day approached, I was left in a sort of surreal mix of expectation and dread.  While I knew surgery would be painful, I focused on the less-invasive surgery that I would have instead of the spinal fusion recommended by the first doctor I was referred to.

I was able to pre-admit to the hospital after the second opinion, so I was able to show up at the appointed time and place for surgery without having any other requirements.  Since the show time was 6:30 AM, we decided to get a room at a hotel adjacent to the hospital.  Also, since we still have a nursing three-month-old, we needed make some arrangements for his care.  I was able to get one of my sisters to come down and watch the little one while my wife spent time with me as needed.  This arrangement worked well except for the dirty old men who made comments about my son sleeping in the baby borjn carrier worn by my sister, including something about “I’d like to sleep there, too”.  Creepy.

The morning of surgery I got up and we walked across the pedestrian bridge to the hospital.  I was totally at ease;  I expected to be a little nervous, but I found that I was really calm and composed.  I guess when the status quo is difficult enough, a chance at improvement is nothing to be worried about.  After checking in with the admin folks, I was taken back to prep for surgery.  Off came my clothes, and on went some sort of paper gown with built-in heating capacity.  It was even decorated with a dog paw or something.  When hospitals take your dignity, there are no half measures.  Shortly after my transformation to surgery chic, the IV lady came in.  She managed to use an apparently dull needle to penetrate the “tough skin”, as she put it, on the top of my hand.  I’m not sure how that is tough skin; I guess I need to stop backhanding everyone.  After some muddling around with needles, I had an IV successfully installed.  Soon, the anesthesiologist came and introduced himself. He introduced himself as the head of anesthesiology.  I wondered if this was due to a lack of volunteers to work with my surgeon?  I imagine he is a demanding person to work for, like he should be.  Soon, the neurosurgery PA came in and marked on my back.  I asked him how they would identify where to operate when the time came, and he explained how they have a one level x-ray that can pinpoint exactly where on my spine the problem is.  In a few minutes, several more doctors came in and introduced themselves.  Apparently there were going to be several interns for both anesthesiology and neurosurgery, as well as for the nurses.  It this point I’m wondering where the head doctor is, and if I should charge admission to this thing.  I don’t know how large the operating rooms are, but I suspect it will be pretty crowded. While we were waiting for the doctor, my wife was brought back to wait with me.  I think she was more nervous than I was about the whole thing.  While she was there, the doctors and nurses formed a sort of circle outside of the cubicle where I was lying resplendent in my paper gown.  Then we heard a hushed whisper- “Dr. So and So is coming,” and the kibitzing circle melted away.

The doctor was reassuring and briefly said hello, went over the details of the surgery, and then vanished.  I was given something to relax me (not really needed), said goodby to my wife, and was wheeled down to surgery. I remember asking how many operating rooms were in this hospital, and being astounded by the response, but I don’t remember what the number was.

The next thing I recall was lying sideways in a modified fetal position, with some people I’d never seen before asking how I was feeling.  Since they asked, I checked that I could still wiggle my toes, and then noted that there was considerable pain from my back, and I was experiencing a little nausea.  I told the nurse that I was feeling a little sick, so she gave me some medicine and put a alcohol swab across my nose.  This actually helped, although I did ask her to get me a bucket.  It dawned on me that it was probably going to be very painful to retch with a massive cut in your back.

Another doctor came to talk to me, and I discovered that he and I graduated from the same college.  Since all of these doctors had introduced themselves to me, I wanted to make conversation.  I began asking them what college and medical school they had attended, hoping to get one who had gone to the same college as my wife and I did.  It was a small triumph in a fog of nausea and pain, but I found one.  We even remembered some of the same professors.

Eventually I was wheeled to my room, where I was placed in one of the most uncomfortable beds I’d ever lain in.  It had some feature where it inflated a bladder with air to keep circulation and prevent bed sores, the nurses advised me.  What I noted was that just about every time I got comfortable or almost to sleep, a surprisingly loud pump would start to inflate the bed and make my comfortable position uncomfortable.  The good news is that I didn’t get bed sores; I also didn’t get any sleep to speak of.

My wife was able to spend time with me in my room.  I was in considerable pain, but was able to make do.  She told me that a doctor called her from the the operating room and told her that there was tissue that was impinging on the nerve which was removed, in addition to some of the bone in the area that was narrowed.  The surgeon didn’t have to do anything to the disc.  This was actually better news than we were expecting.

Somewhere along the way, someone, perhaps a doctor, had told my wife that I needed to urinate or they would use a catheter.  I didn’t like the sound of that at all, so I drank quite a bit of water, and the next time the nurses showed up, I told them that I needed to go to the bathroom.  Suddenly a walker appeared and placed in front of me.  I started to get up, but the nurses told me to take it easy and go slow;  grab the bed, then with one hand, grab the walker, then the walker with the other hand, etc.  I didn’t think I was that bad off, but I did what they wanted me to anyway.  Eventually I was permitted to shuffle off in the direction of the bathroom.  Much to my chagrin, the nurses followed me in to the bathroom, and provided me with a custom jug to urinate into.  Now I don’t know of anyone had had this same experience before, but it is pretty difficult to urinate into a jug with two burly female nurses watching and with your back feeling like a knife was stuck into it.  It soon became apparent that nothing was going to happen, so I told them that I didn’t think I was going to fall, and didn’t think I was going to be able to produce anything with them standing there.  They turned the faucet on for a little helpful ambiance, but even that wasn’t enough to open the floodgates.  I shuffled back to the bed and climbed in after drinking some more water.

After they left I got the walker and shuffled off to try again.  My wife told the that there was a large sign on my door proclaiming me as a “Fall Risk,” explaining why the nurses were so careful.  I eventually was able to produce a small amount of urine, which I hoped was enough to keep from having a catheter.  Just to be sure I could go, I had even more water, something that I would later regret.

The nurses kept a tally of how much went in, and how much came out.  They were concerned that there was an imbalance.  The surgeon and his lackeys breezed in to check on me.  He said that I didn’t need a catheter since I was relatively young, and told me the surgery went well.  He asked me of the nerve symptoms had abated, and I told him that most of them had, but I still had a pain in my right buttock.  He explained that this was normal, as they inflamed the nerves while doing surgery, and told me I might have other symptoms as well.  I asked him if I needed to have my dressing changed, and he said “I’m really busy, I’ve got to go” and beat a hasty retreat.  Since he indicated that I wouldn’t likely need a catheter, when the nurses came back and expressed concern over the liquid imbalance, I asked them to call the surgeon before they used a catheter.  That delayed them enough for me to get things moving, and I averted that fate.

Food was brought, but I wasn’t very hungry.  I think I had a little yogurt, and little else.  I had some pain, so they brought some morphine, but I didn’t notice any effect from it at all.  I got a couple of loritab pills and that was it.  Honestly, though, I didn’t really need anything else. While I wasn’t comfortable, I wasn’t about to die from pain either.

As the hours ticked by, I sent my wife to the hotel so she could get some sleep and to care for the little one.  After she left, I had a very eventful evening.  All of the water that I had drunk, plus the IV fluids that I had been given, and the coffee that I drank had left me over hydrated.  From about 1 to 4 in the morning I did little else besides urinate, call the nurse or tech to measure the urine and empty it, and seemingly as soon as they left, I refilled it again.  I developed hiccups, and when combined with my over-hydrated state resulted in heartburn and eventually nausea.  I paced around the room, breathing in through my nose and out my mouth in an attempt to calm my stomach.  It narrowly worked.  I actually had the bile in my throat, but managed not to wretch and eventually was able to get my liquid balance back, and my stomach settled.

In the morning, I was discharged.  All in all it was quite an experience.  The best advice I can give is not to drink a lot of water after surgery, forget your dignity, and don’t expect to get any sleep.  I’ll have to heal to see if the surgery will ultimately be successful, but I’m optimistic.

Second Opinion, Second Thoughts on My Spine

As I explained in a previous post, I have a serious back injury that keeps me from sitting without pain. Sitting is something that I had certainly taken for granted, never having had any problem or pain from sitting. In fact, when I’ve sprained my ankle or been sore from exercising or running, sitting had been a way to have some relief from my pain. I’ve never hurt while sitting. Since my injury, I have spent most of the time either lying down, standing or kneeling. Eventually, even standing will cause discomfort. I was told by a orthopedic spinal surgeon that I needed to have fusion surgery, where my injured disc would be removed and my vertebrae surgically fused together.

After I shared this diagnosis with family members and friends, I received lots of advice about how to proceed. An uncle who had back surgery recommended that I go to a neurosurgeon who specialized in spinal surgery; this was echoed by others who had a history of back ailments. I began to look for a suitable surgeon. The most qualified one I could find had a glowing biography; service in the Air Force, numerous published articles, professional associations, and the chairman of the spinal surgery department at the closest teaching hospital to us. I called his office, discovered that he did take my brand of insurance, and got an appointment. The only problem was my appointment wasn’t for 8 weeks, a seeming eternity for someone with a back problem. I called his office and asked to be on the list of people willing to move my appointment if one became available. I was exited about finding such a qualified doctor willing to have a look at my case, but frustrated by the delay in getting the second opinion, since I was almost certain the answer would be the same as my first diagnosis.

In the mean time, I explained to many of my friends and coworkers about my situation. While I don’t always feel it is necessary to divulge my medical information to others, some of the methods I used to cope with the pain and discomfort begged for an explanation. When you bring a large pillow to work and kneel in front of it to work on your computer, most people are understandably curious. When you lie on ice packs, most people notice and ask what is going on.
One of my coworkers had been visiting a chiropractor and mentioned my case to her. She purported to have a relative who had been in a similar situation who followed a treatment plan devised by this chiropractor and who had avoided having surgery for several decades. He gave me her card, and I decided that I would give her a call to see what she had to offer. Now keep in mind that I have been seeing a chiropractor for months. I had seen some improvement, but my chiropractor said he wouldn’t be able to fix the extent of the damage to my spine. I knew that he was probably right, but the thought of not having to have surgery, especially as drastic a surgery as a spinal fusion, was appealing to me. I called up her office, and got some slick talking receptionist who was sure that Dr. So-and-so would be able to fix me up. It would only take the new patient amount of $170 including x-rays to get her opinion and treatment plan. I asked what she would do differently than the current chiropractor that I was receiving treatment from, and she basically said “I’m not saying Dr. Whatsisname isn’t good, but I think we can get better results.” I asked what types of treatments the doctor offered, and if she could do anything else besides align my spine. As the conversation continued, I kept getting the impression that I was going to be sold something that I didn’t need. While attempting not to overtly slam the chiropractor that I was seeing, I was basically told that he didn’t know what he was doing and it would be better to see this new one. But, I was assured, she would tell me if she couldn’t treat my case. In my experience, it would take about a $1000 worth of treatment before she decided that she couldn’t fix it.

The whole scenario was troubling; I realized that I was vulnerable because I badly wanted to avoid surgery, but logically, I decided that the second chiropractor couldn’t offer anything other than spine alignment services, and therefore wasn’t likely to be any more successful than the chiropractor that I was already seeing. I was really torn, though. The idea of one last crack at my back by a chiropractor before surgery was appealing, but I decided I’d have the second opinion before making up my mind.

After weeks and weeks of trying to be patient, and generally failing, my second opinion appointment finally came. I was expecting a cursory look at my films, a brief interview, and a confirmation of the first opinion and well wishes. Instead, I got a whole new diagnosis, a proposed surgery that is much less invasive and should allow for a much quicker recovery. And the most amazing thing of all is that I have a surgery date in only a couple of weeks, a surprising development after the long wait for the second opinion. At my appointment, the first thing that happened was the student doctor (there is probably a more correct term here, but I don’t remember it offhand) came in and performed a neurological exam. She asked me quite a few questions, and said she would be back in a few minutes. After some more waiting (it was at a hospital, after all), the surgeon arrived. My first impression was that he reminded me of someone with his mannerisms, but it took me a while to remember who it was: Anton the food critic in the movie Ratatoullie. In fact, he seemed to be the caricature of a surgeon, with a booming voice and commanding, confident air.  Having previously worked with pilots, he took an immediate interest in my case and promised to get me back if it was possible(puns are almost impossible to avoid with this subject, I know I’m stretching here, but sometime I crack myself up–back to the post).  In fact, he had experience in returning pilots to flying even after more invasive surgeries than he prescribed for me.  He explained that the area in my lumbar spine that was causing the problem was not quite right.  There is supposed to be a certain amount of space where the nerves come out of the vertebrae, but in my case there was very little space.  This hadn’t cased me a problem before as there was just enough space.  However, when I had my flying over-g incident, my disc shifted into the already-too-small area containing nerves that went to my lower body, resulting in pain and lower body neurological pain.  His operating plan was to make a little more space for the nerves, and possibly trim the disc if he thought it was needed after opening me up.  All of this is definitely less invasive than removing a disc and fusing vertebrae.  After he explained what I needed to have done, I asked him when he could do it, expecting to hear something like “in a couple of months”, but instead he checked his calendar, and came up with a date a scant couple of weeks away.  Wow.  I can’t wait to get this fixed and get back to normal.  While there are risks for any surgery, there is a certainty that not having something done will result in pain and discomfort.  Given the track record of the surgeon, I like my chances.

I spend the rest of the day getting pre-admitted to the hospital since my surgery was so soon.  While I had an aching back from all the time in the hospital, and a long, painful ride home with a screaming two-month old, I was glad to have a possible end to all of this in sight.

The moral of the story:  get a second opinion.  I recommend you get one from a different medical discipline, if there is more than one approach to your problem.