Today I Had My Six Week Follow-Up

It’s been six weeks since my back surgery.  Today, I had my second follow-up appointment.  The nurse practitioner at the neurosurgery center was pleased that I’m not experiencing any pain, and I’m no longer taking any medication for pain.

She examined my incision and confirmed it’s completely healed.  I was pretty sure it was, but it’s hard for me to see it, since it’s in the middle of my back.  I can now shower, bathe or swim without any need to bandage it.

Then we talked about which activities I can do and which activities I still need to avoid.  I can’t do anything high impact (including running) for six more weeks, but it’s OK to do low-impact activities like bicycling or swimming.  I can also continue to walk, which was my only form of exercise for the last six weeks.

The nurse practitioner  I saw today was different than the one I saw four weeks ago, so I had to bring her up to date on my race-walking.  We talked about how much I’ve been walking, my upcoming marathons, and how fast I’ll need to walk them.  She said it’s OK to go ahead and walk those marathons.  She would have been more concerned if my surgery had been in the lumbar region, but because it was a thoracic surgery, there’s far less risk.

That said, she couldn’t guarantee there wouldn’t be any risk at all.  It takes 12 weeks for a herniated disk to fully heal.  Until then, there’s still an increased risk of re-herniation.  Prior to 12 weeks, somewhere between eight and fourteen percent of patients experience re-herniation.  That’s why I can’t do any running.  They worry most about activities that can be jarring to my spine.

Until today, I wasn’t supposed to do any housework or yardwork.  Now I can begin doing those activities again, so long as they don’t hurt, don’t cause excessive bending or twisting, and don’t violate my lifting restriction.  I asked specifically about mowing the lawn.  I shouldn’t do that for six more weeks.

My lifting restriction will be my biggest headache for my upcoming trip to Europe.  Until today, I couldn’t lift anything over 10 pounds.  Now I can lift up to 15 pounds, and I can increase that by about two pounds per week.  When I go on my trip, I’ll still need to pay attention to how much my bags weigh.  I may have to get a suitcase with wheels.

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.

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.