Friday, June 16, 2017

Today I Had My Back Surgery

Today, I had my back surgery.  I arrived at 8:00 to check in and get prepped.  The surgery was scheduled to start at 9:40, but the surgeon was running ahead of schedule, so they were able to wheel me into the OR a few minutes early.  They gave me a sedative before we left the pre-op room.  I remember them wheeling my bed through the hallway, but I don’t remember arriving at the OR.  By then, I was already asleep.

The surgeon called this procedure a posterior microdiscectomy.  The release form had a much longer description, which I can’t remember.  This is a stock image (from a different hospital) that shows roughly what they did.

The surgery took less than an hour.  Then they moved me to a recovery room, while they waited for the anesthetic to wear off.  Then they moved me to an observation room, where family can visit.  It’s possible I regained consciousness in the recovery room, but the first thing I remember is being in the observation room.

It was immediately apparent that the surgery was successful.  I no longer had the chest discomfort that I’ve had for the last 19 days.  I also had no discomfort in my legs.  That can be a side-effect.  I wiggled my toes in both feet.  No loss of feeling or motor control.  So far, so good.

I eventually learned that they only had to make a small incision, they didn’t have to remove much of the bone, and they were able to remove the disk material that was impacting my spinal cord.  There were no complications.  The surgeon characterized the procedure as “boring.”  You don’t want surgery to be exciting, so that was good news.

This was my first major surgery, so I didn’t know how my body would react to the anesthetic.  I seem to have had a best-case scenario.  By the time I got to the observation room, it was wearing off quickly.  I didn’t have any nausea, and I felt like eating.  I started with some water and crackers.  Then the nurse asked me if I wanted any other food.  I asked if they had pizza.  They did.  Hospital food isn’t as bad as I was led to believe.  Either that, or it has improved.  Now it’s like ordering room service.  My first post-op meal was pizza and cranberry juice.

I have some post-surgical pain at the site of the incision, but so far it’s minor.  They gave me a prescription for a narcotic pain reliever, but so far I haven’t needed it.  I’m hoping to manage the pain with Tylenol.  I’m also taking a muscle relaxant.

For the next two weeks, I have to follow a few rules to minimize the risks of infection or bleeding.  I can’t shower for two days.  After that, I can shower with a water-proof bandage, but I can’t bathe.  I can’t take aspirin or other NSAIDs.

I also have rules to prevent reinjuring by back or tearing open the incision.  For at least two weeks, I have to avoid bending or twisting my back.  I have a brace to help with that.  For six weeks, I have a 10 pound lifting restriction.  That probably rules out any air travel, since even a carry-on bag ways well over 10 pounds.  I’m not to do any yard work or housework.  YAY!  (I don’t mind helping with the housework, but I hate yardwork.)

I have to avoid high-impact activities for 12 weeks.  That includes running.  I’ve already cancelled travel plans for my next five races.  I expect to cancel my plans for several others. 

I'm allowed to walk.  In fact, they strong encourage walking.  There are a few races on my schedule that may be walkable, but I don’t know if the doctors will want me walking that far.  I’ll ask about that at one of my follow-up appointments.  For now, it looks like it’s going to be a boring summer.

I know I said boring is better than exciting, but these restrictions will test my patience.  I hate cancelling races, but I want to put this behind me.  I don’t want to make it worse, like I did with the injuries I had two years ago.

Wednesday, June 14, 2017

I Need to Have Surgery to Relieve the Pressure on my Spinal Cord.

When it comes to healthcare, it’s important to be your own advocate.  Doctors can give you answers, but sometimes you have to know which questions to ask.

When I went to the clinic two weeks ago, their focus was my heart.  I had chest pain on the left side, which is a red flag.  It took nine days before they could completely rule out heart problems.  Then they gave me a clean bill of health and said, “Good luck on your trail run.”  At that point, they were assuming I had a muscle strain that would heal with rest.  So was I, but I wanted to know for sure.  I scheduled a consultation with an orthopedist.  Had I not done that, I wouldn’t have known I had a spinal injury.

After an exam, the orthopedist knew it was a nerve, rather than a muscle injury.  She was on the fence about ordering an MRI.  MRIs are expensive.  I have insurance, but I would still have a significant out-of-pocket cost.  I wanted to know for sure, so I encouraged doing the MRI.  Had I not done that, I wouldn’t have learned how serious my condition was.

Had I not aggressively pursued more information, I probably would have started the Bighorn Trail 100, not knowing that I had nerve damage that would make me more apt to trip and fall, and also not knowing that a fall could easily result in permanent disability.

After seeing the MRI and doing a more thorough exam, the orthopedist referred me to a neurosurgeon for a consultation.  I had that appointment on Tuesday.  It was only then that I understood.  The doctor told me I needed surgery.  Not, “I recommend surgery” or “Surgery is your best option.”  It was more like, “You need surgery as soon as possible.  We can get you in on Friday.”  Surgical procedures aren’t normally scheduled that quickly.

I was a little shell-shocked.  I thought there was a good chance that the disk extrusion would heal eventually with non-intrusive treatments.  It probably would, but there's a more immediate concern.  The disk is exerting so much pressure on my spinal cord that it's already causing nerve damage.  It's imperative that they relieve the pressure as soon as possible.

So far, I had been lucky.  I was having intermittent discomfort in my chest.  I wasn’t having pain anywhere else.  I wasn’t having weakness or numbness in my legs.  I wasn’t losing motor control.  I wasn’t losing control of my bowel or bladder.  All of those things were possible.  If I move in a way that causes further compression of the disk between my T8 and T9 vertebrae, it could put more pressure on my spinal cord, resulting in nerve damage that would likely be permanent.

To impress upon me how certain he was that I needed this surgery, the doctor used the phrase “slam dunk.”  Then he started talking about Superman.  Actually, he asked me if I knew who Christopher Reeve was.  If you don’t know, he was the star of four Superman movies.  Then he injured his spinal cord in a horse riding accident.  After that, he was paralyzed from the neck down.  He eventually died at the age of 52.  That’s four years younger than I am.

His point was that unlike most tissue, nerves don’t heal.  If you injure your spinal cord, the damage is permanent.  I was already showing symptoms of nerve damage in my right leg.

I’ve never had surgery before, and I never thought I would have spinal surgery without getting a second opinion first.  As he showed me my MRI images for the second time, he explained why my T8/T9 extrusion was so serious.  I quickly came to understand that the risk of not having surgery was significantly greater than the risks of the surgery itself.  I was nervous about the surgery, but I was much more nervous about what could happen at any time before the surgery.  Suddenly three days seemed like a long time to wait.

The procedure is basically to make an incision in my back, cut a hole through the bone, and then remove enough disk material to relieve the pressure on my spinal cord.

This morning, I went back to the hospital with Deb, so she could see the MRI images herself and ask questions.  Then I had a preparatory procedure that involved having a CT scan so they could insert a marker into my back.  That will show the surgeon precisely where my vertebrae are.  The surgery requires pinpoint precision.  In the afternoon, I had another doctor appointment to go over pre-op procedures.

Tomorrow, I don’t have any doctor appointments, so I’ll have a full day to freak out.  I’ll read through all my instructions for the surgery, and I’ll do one last workout on the stationary bike.  I’m not allowed to run, because the impact could cause further damage to my spine.  After the surgery, I’ll still have strict restrictions on my activity while I recover.  For the first two weeks, I won’t even be able to ride the bike.  I probably won’t be able to run for the next three months.  I’ve already cancelled the Bighorn 100, but I need to start cancelling reservations for my other summer races.

My surgery is scheduled for Friday.  Believe it or not, neuro-surgery is now an outpatient procedure.  The procedure itself should only take one to two hours, but it will be done under a general anesthetic, so I’ll have to stay in the hospital until that wears off.  I should be able to go home the same day.

Wish me luck.

Monday, June 12, 2017

I Finally Know What's Causing My Chest Pain.

I finally found out for sure what’s causing my chest pain, and it wasn’t good news.

When I saw an orthopedist at Tria last Thursday, it was hard to localize the pain.  That led her to believe it was a pinched nerve, rather than a strained muscle.  No one muscle could explain all the places where I was feeling pain, but a nerve could.  On my chest X-ray, she noticed some smaller than normal gaps between some of the vertebrae in my upper back.  That could mean a bulging disk, but the only way to be sure was to do an MRI.  I went in on Friday to get MRIs on my neck and my upper back.  I had to wait until today, to see the doctor for the results.

She knew I still needed to decide whether I was going to run the Bighorn Trail 100, so she suggested that I do another short run to see how I feel.  If I was in pain after a four mile run, I probably shouldn’t try to run 100 with this injury.

On Friday, I did an easy 3.5 mile run, while doing my best to minimize the movement of my left arm.  On level ground, that wasn’t too difficult, and it enabled me run without any discomfort.  When I got to a small hill, it was harder to keep my left arm from moving.  I had a small amount of discomfort, but it wasn’t too bad.

Previously, the pain seemed to come from all over the left side of my chest.  Now it was more consistent.  Certain movements of my left arm caused pain in one of the pectoral muscles.  Over the weekend, I learned to avoid most of the movements that caused pain.  If I kept my left elbow pinned to my side, I could move my left hand and forearm without any discomfort.

That made me wonder if I could run without discomfort if my left arm was in a sling.  I gave that a try on Sunday.  I ran on the treadmill, which made it easy to experiment with different grades.  Running slowly on level ground, I felt OK.  It was similar to the run I did on Friday, but I didn’t need to make a conscious effort to control my arm motion.

After about a mile, I started to run uphill.  As I put more effort into the run, I would occasionally notice momentary discomfort in my left pec, but it wasn’t a big deal.  Eventually, I set the grade steep enough that I had to walk.  I was still working hard, but I was much more comfortable.  Walking is far less jarring than running, which makes it easier for me to keep my arm relaxed.  That part of my workout was promising.

As I turned the grade back down and resumed running, I once again noticed some temporary discomfort.  Overall, doing a mostly uphill workout wearing a sling felt about the same as doing an easy level ground workout without the sling.  I still had big concerns about running with a sling.  I didn’t know if it would cause muscles in my upper back to get sore.  I also didn’t know how much the strap would make me chafe after running with it for several hours.  I wasn’t convinced that I could do the race this way, but I also wasn’t convinced that I couldn’t.

I still had to make a decision about Bighorn.  I booked my flight with miles, so I had until this morning to cancel the flight without penalty.  As recently as Saturday, I desperately wanted to do the race, but it seemed like a bad idea.  I felt surprisingly good yesterday and better this morning.  I felt like I was turning the corner.  It may help that I’ve been getting better at avoiding motions that cause discomfort.

This morning, I had my follow-up with the orthopedist.  Going in, I was optimistic.  I felt much better this morning than I did last Thursday.  With four more days to recover, I was leaning toward doing the race.

I told the doctor how I felt over the weekend and how my runs went.  She was encouraged by my progress, but didn’t want me to do any more running with a sling.  She shared my concerns, but was also worried that it would alter my stride in ways that could cause other problems.

Then she gave me the results of my MRIs.  I have a couple issues in my cervical spine, but the big issue was in the thoracic spine.  I have a large disk extrusion between my T8 and T9 vertebrae.  The disk is filling most of the space where my spinal cord should be.  That’s pushing my spinal cord way to the left.

She was expecting to see a disk impinging on one of the thoracic nerves.  That would explain my chest pain.  This disk was impinging on the spinal cord itself, which could potentially cause a multitude of problems in my lower body as well.  She was a little surprised that I wasn’t having more symptoms.

She couldn’t tell me it was OK to run Bighorn, but she also wasn’t willing to tell me I couldn’t do it.  Then she decided to do some tests of nerve function in my legs and feet.  One of the tests revealed a neurological symptom in my right foot.  After doing that test, she told me she didn’t want me to do the race.

Her concern was that all the jarring of a long trail race could cause me to develop worse symptoms in my legs.  That in turn, could cause me to fall.  She was worried I would not only be setting myself up for failure, but I could develop symptoms that are much worse than what I have now.

She referred me to a neurosurgeon at another clinic for a consultation.  That doesn’t mean I need surgery.  It just means I need the opinion of a specialist.  I’m still cautiously optimistic that this injury can resolve itself over time.

I see the neurosurgeon tomorrow morning.  In the meantime, I’m not supposed to run or do any activity that’s jarring to my spine.  I’m also supposed to avoid activities that twist my back or create pressure in my chest.  I can resume some strength training exercises, but something like a bench press is still out of the question.  To maintain some of my aerobic fitness, I can ride a stationary bike.

After today’s appointment, I cancelled my flight.  I won’t be running Bighorn this year.  That was disappointing.  I’ve worked so hard to get in shape for it.  Until two weeks ago, I like my chances of finishing it this year.

My other summer races are also in question, but I’m taking it one race at a time.  For now, I’m waiting to see what the neurosurgeon says.

Thursday, June 8, 2017

I Still Don't Know What's Causing That Chest Pain

This is a long overdue follow-up to my race report for the Coeur d’Alene Marathon.  During that race, I started experiencing some discomfort on the left side of my chest.  Chest pain, particularly on the left side, can be a symptom of heart problems.  I didn’t have any other symptoms, so I continued running.  I went on to have a pretty good race.  Immediately after the race, I felt fine, but the pain came back later in the day.  It only hurt when I moved my left arm or the left side of my torso, so I assumed it was most likely a muscular problem.

It didn’t seem life threatening, so I waited until I got home to see a doctor.  I used to see a doctor who specialized in sports medicine, but he recently moved.  Since I don’t currently have a regular clinician, I made an appointment with whoever could see me soonest.  That turned out to be a doctor at a different clinic who could see me the next morning.  Her specialty is internal medicine.

While I wanted to assume it was a muscular problem, I needed to know for sure that it wasn’t a heart condition.  When the nurse took my pulse and blood pressure, they were both within the normal ranges.  My oxygen saturation was 99%.  The doctor listened to my heart and lungs, and they sounded good.  The pain on my left side was intermittent, and corresponded to movements of my left arm or the left side of my torso.  That seemed to indicate muscle injury, rather than a heart condition.  To be on the safe side, she ordered a blood test, an EKG and a chest X-ray.

The EKG looked normal, and the X-ray didn’t show any abnormalities.  The blood test was for an enzyme that would be elevated if there was heart damage.  Later in the day, I learned that test result was negative.

The doctor’s best guess was that my arm motion during the race caused an injury to some of the small muscles between my ribs.  She said that type of injury is more likely if you’re dehydrated.  I didn’t feel like I was dehydrated during the race, but I did feel dehydrated the previous night.  My hotel room was really dry.

The doctor prescribed Naproxen and rest.  When I asked if there was anything else I could do, she suggested I could ice it.  That was last Tuesday.

I have a family history of heart disease, so she also recommended having a stress echocardiogram.  I’ve never had one before.  The earliest I could get one scheduled was today.  In the meantime, I mostly rested, and I tried to avoid using my left arm.

Last Wednesday, I went for a short run.  It was my first run since the Coeur d’Alene Marathon.  It wasn’t really a serious training run.  I just wanted to know if I could run without pain if I minimized my arm motion.  I held onto my T-shirt with my left hand to ensure my left arm wouldn’t swing.  Running that way, I had no discomfort, but it’s an awkward way to run.  As I said, it wasn’t serious training.  It was more of an experiment.  I ran for a little over a mile, and didn’t have any discomfort.

On Thursday and Friday, I did workouts on the stationary bike instead of running.  I seemed to be able to get quality workouts on the bike without causing discomfort.  Then I spent the weekend at the FANS 24-hour race, volunteering, and crewing for some friends who were running and walking.  Just walking back and forth between our campsite and the start/finish area was enough to make my side hurt.  That wasn’t encouraging.

I felt much better on Monday, so I went for a short run.  This time I ran 3.5 miles.  I ran at a slow enough pace that I wouldn’t have much arm motion.  That felt OK, so I tentatively decided to try a similar run on Wednesday.

There was rain in the forecast for Wednesday, but Tuesday was a beautiful day for running.  Against my better judgement, I decided to run for a second straight day.  I only ran 3.5 miles, but I ran a little bit faster.  I think I got overconfident.  I felt OK at the time, but later in the day, my side started to hurt.

On Wednesday, I hurt more than at any time previously.  Sometimes, I hurt just sitting in a chair without moving.  That was a first.  I didn’t even ride the stationary bike that day.  I just rested.  I also made an appointment with an orthopedist.  I had to get a better understanding of the extent of my injury.

This morning, I had my echocardiogram.  That involved pedaling on a recumbent bike with gradually increasing resistance while they took images of my heart.  Within an hour of getting home, I got the results.  With respect to my heart, I had a clean bill of health.

In the afternoon, I had my initial consultation with an orthopedist at Tria.  The doctor found it odd that I couldn’t localize the pain.  Sometimes it hurts in my left side, just under my armpit.  Sometimes the pain seems to extend into my left pectoral muscle.  Sometimes it radiates into my back.  If this was a muscle injury, the location of the pain should be more specific.  It seemed more likely to her that this is a pinched nerve.  There were spots on my X-ray that looked suspicious, but she couldn’t see anything conclusive.  I’m having an MRI tomorrow to look at the disks in my neck and upper back to see if I have a bulging disk.  I probably won’t learn anything until Monday.

I’m scheduled to run the Bighorn Trail 100 in just over a week.  I’ve done a lot of good training, especially in May.  I haven’t done much since Coeur d’Alene, but I would have been tapering anyway.  If it was just a matter of fitness, I would be ready to race.  If I had to endure some discomfort, I’d still race, as long as I had a realistic chance of finishing.  My concern is that attempting to run 100 miles would make this injury much worse.  I don’t want to start another downward spiral like the one I had two years ago.

If it is a disk that’s impinging on a nerve, the motion of running shouldn’t make it worse, but the jarring might.  A trail run will involve more jarring than a road race would.  The doctor’s advice was to do another short run before making my decision.  If a four mile run causes problems, running 100 miles is probably a bad idea.

I’ll probably make a decision about Bighorn in the next few days.