Screwed

My spine sur­gery was sev­en weeks ago, today. Re­cov­ery is com­ing along well, from what I can tell and what I’m told. I’ve been in­cred­ibly for­tu­nate.

I’ve got a few notes on how things are go­ing so far and what to ex­pect, but I have to start with a couple of pic­tures that put things in­to con­text:

Here’s the view of my new ti­tani­um col­lec­tion, as seen from the back.

And there’s the view from the side.

Those ba­bies are 7 cen­ti­meters long.

(Augh­h­h­h­hh!!!)

I sort of like to look at these be­cause they re­mind me that some­thing re­mark­able and crazy and life-sav­ing and really rough on my body has been done in­side my back. It’s not just the things that I can feel, like that I have a nice new scar and lower back pain…. it’s that there’s some ser­i­ous stuff go­ing on in­side my body… it’s SUP­POSED to hurt right now, and “re­cov­ery” is about com­plic­ated bio­logy, not just ly­ing around groan­ing.

On the surgery

Sur­gery, it turns out, got com­plic­ated.

For some reas­on, I was a little more wor­ried about this sur­gery than the last four or five I’ve been through. Not sure why. Maybe it was that I had a choice about when to do it? Maybe it was that it in­volved put­ting met­al in my spine? Not sure.

Be­fore sur­gery I keep think­ing back to the last one. I dis­tinctly re­call the mo­ment of black-out. They wheeled me in­to the op­er­at­ing room. I looked around, try­ing to count the people and identi­fy the ma­chines. I looked up at the big lights and thought “wow, those are cool”, and then … im­me­di­ate black-out. It was so heavy, it al­most landed in my brain with a thunk. That mo­ment of go­ing un­der kept stay­ing with me as we ap­proached this next sur­gery.

So, for whatever reas­on, I was a little leery of this sur­gery, and some­times caught my­self think­ing about what would hap­pen if I didn’t wake up. I did a token job of ar­ran­ging my af­fairs. I made sure my wife had my im­port­ant pass­words. I al­most sor­ted my sock draw­er.

I went ahead with the sur­gery any­way. What choice did I have, really? And I wasn’t ac­tu­ally more nervous or any­thing at the hos­pit­al… al­though I do re­call, as they put in the IV with the an­es­thesia, briefly won­der­ing if that would be it.

We had a dif­fer­ent sort of ex­cite­ment.

As I floated to­ward con­scious­ness after sur­gery, I re­mem­ber my sur­geon be­ing there at the side of the bed, ask­ing the usu­al ques­tions. “Can you lift your left leg a bit? Now your right? Push up your toes? And down? Oth­er foot? And down?”

I didn’t real­ize just how ser­i­ous these ques­tions were, this time.

When the op­er­a­tion was over and I was still un­con­scious in Re­cov­ery, the doc­tor came out to find Michele. The sur­gery had gone a few hours longer than ex­pec­ted. She said he looked wor­ried, nervous. Not good. He ex­plained that there had been com­plic­a­tions… that on one side of my back, they dis­covered I had what are “con­joined nerve roots”, mean­ing that the nerves leav­ing my spine to go down my leg are doubled. These com­plic­ate sur­gery. Two nerves are try­ing to fit through a space built for one. This con­di­tion is rare. So they looked on the oth­er side of my back (be­cause they had to op­er­ate on both sides) and found the same thing. He’s nev­er seen or heard of a pa­tient with two sets of doubled nerves. Ap­par­ently this res­ul­ted in some pretty amaz­ing swear­ing in the op­er­at­ing room.

So, he had to re­think how he was go­ing to put the ti­tani­um cages in­to my spine, and work around the dual nerves on both sides. He thought the re­vised met­al place­ment would still work, but we’d see. Also, there was a chance there would be nerve dam­age, with some risk of loss of mo­bil­ity or sen­sa­tion in my legs.

I had no idea of any of this as he asked me to wiggle my toes. I just wiggled my toes, as dir­ec­ted. Then I lif­ted my leg. Then I pushed my toes down. Everything seemed nor­mal, of course! I didn’t no­tice, but Michele said that after I was able to move both legs, the sur­geon looked dis­tinctly re­lieved.

It was only a few days later, as Michele ex­plained this all to me after the an­es­thesia cleared, that I real­ized just what an amaz­ingly big and scary deal this was.

Some notes on recovery

To fill in a few spe­cif­ics:

  • If all goes well, which at this point the sur­geon ex­pects it to, I will back to “100%” about three to four months after sur­gery, i.e. Au­gust / Septem­ber.
  • I spent the first sev­er­al days after sur­gery in the hos­pit­al, days dom­in­ated by pain, fa­tigue, and the con­stant in­ter­rup­tions of the hos­pit­al routine. I re­mem­ber count­ing the tubes at­tached to my body, con­spir­ing to keep me trapped in un­com­fort­able po­s­i­tions on the bed… there were at least five. The worst, by far, was the cath­et­er, but they were all bad. My goal was to get them all out of me, be­cause once they were out and I could walk a little bit, then they’d let me go home. I was out in two days, thanks in large part to the amaz­ing nurse I had on day one, who said “you aren’t on va­ca­tion, your job is to leave here… let’s min­im­ize your meds and max­im­ize your move­ment and sleep”. She was fant­ast­ic.
  • I spent the next week in bed at home, drift­ing in and out of sleep, un­re­lated to time of day. While awake, I could use light­weight elec­tron­ics. The new Zelda game on the Nin­tendo Switch was awe­some and kept me sane.
  • Around two weeks in, I had my first med­ic­al fol­low-up. The nurse prac­ti­tion­er, who is awe­some, told me that my scar was look­ing good, and that I could ex­pect to go back to work in oth­er two to four weeks. WHAT?! I had thought, be­fore sur­gery, that I would be out of work for about two weeks. But no, I’d mis­un­der­stood… the ba­sic re­com­mend­a­tion was ex­pect to be un­able to to work for about six. Between pain, fa­tigue, in­ab­il­ity to fo­cus… Ar­gh! So we tried to factor that in, tried to ad­just work sched­ule a little bit more, and de­cided to play it by ear from there.
  • Over the fol­low­ing three weeks, I took a stab at nor­mal life. I could drive a little bit, walk a little bit and sit a little bit. That first trip to the cof­fee shop was so ex­cit­ing. In week three, I made it back in­to work for a few hours, and then slowly worked my way up to sev­er­al days a week and 4-6 hours per day at work, go­ing slowly.
  • Around week 4, I had a fol­lowup with my sur­geon. Everything was look­ing good… the scar was heal­ing fine, the X-rays looked good, my move­ment was good, so he cleared me for light ex­er­cise, told me to start phys­ic­al ther­apy, and said, yeah, I could ride my bike out­side again, but to keep it with­in lim­its of pain and fa­tigue.
  • So, four weeks (to the day) from sur­gery, I made it back out on my bike and slowly cruised through the woods on a quiet road, just en­joy­ing the free­dom of move­ment and the simple ex­er­cise of ped­al­ing. Such a re­lief.
  • It be­came ob­vi­ous in here that I was try­ing to work full time to keep up with the load and needs at work, and that was start­ing to really hurt.. I just didn’t have the en­ergy to keep up or to make sound de­cisions. I pri­or­it­ized hard, de­ferred a lot, and scaled back. It helps to have sup­port at work for this, but real­ity is that the things go­ing on need me in­volved… this re­mains dif­fi­cult.
  • In week 5, I went for a town line sprint on my bike. It was an easy one, and it seemed like a good idea at the time. Turns out that pump­ing 1200 watts through my back res­ul­ted in two days of man­dat­ory down­time. Won’t try that again for a while.
  • Week 6 was when they ex­pec­ted me to be back to work for the first time. I was ap­par­ently lucky, in that I was able to put in at least par­tial work on key things as of week three. It’s hard to ima­gine wait­ing un­til this point to start pick­ing up work again…
  • Here we are at week 7. Every week has got­ten a little bet­ter, and yet every day is so in­cred­ibly lim­it­ing and frus­trat­ing. I can stay ver­tic­al now for prob­ably four hours, then I cave in. I can ride for about two hours, but can’t go too hard. I still don’t have the en­ergy to make it through a full or in­tense work day. Pain is a con­stant, it’s just a mat­ter of de­gree. Sleep is rough. Get­ting up from the bed or couch is chal­len­ging, get­ting up from the floor is a booby-trapped lo­gist­ics puzzle.

Now, it’s sev­en weeks in, many more to go. On one hand, it all hurts and it’s lim­it­ing. On the oth­er hand, it’s com­pletely amaz­ing that I’ve got this hard­ware in me, it seems to be work­ing, and I’m out and about and hav­ing a more-or-less nor­mal life of work­ing, walk­ing, and rid­ing, just with lim­its.

A few more thoughts

Perspectives

The per­spect­ive that I have, deep in my head, about this whole thing, seems per­haps a bit off.

I hear about people with chron­ic back pain, and people with bad backs, and so on, and it just doesn’t oc­cur to me that I’m one of those folks. I’m just me. I hap­pen to have had this su­per bad thing go­ing on in my back. It’s just a thing.

Which means that I oc­ca­sion­ally find my­self mov­ing in a way that causes pain in my back, and I catch my­self think­ing “ow! What’s up with that?”. Then the rest of my brain catches up with that and says “you freek­ing mor­on, you totally know what’s up with that, you’ve just had back sur­gery!” and the first part of me goes, “oh yeah, that’s right, for­got. Sorry”.

That’s prob­ably healthy, but it gets me think­ing about this in sev­er­al ways:

  • I am ac­tu­ally in a situ­ation now where we think that, des­pite all this stuff, I will be head­ing back to­wards nearly nor­mal and healthy. That’s AMAZ­ING, and I am su­per lucky.
  • On the oth­er hand, I have four ma­jor screws, a cage, and two ti­tani­um rods in my spine. That is NOT NOR­MAL, and I can’t pre­tend that everything is just fine and I can ig­nore it. I have to be more care­ful, put time in­to stretch­ing and core, and keep it mind.

The right call on timing

Back in April, I had a choice about hav­ing this sur­gery done early this year (i.e. in June or Ju­ly), or delay­ing un­til late in the year. The the­ory, then, was that my pain be­fore sur­gery might be minor enough that I could have a good sum­mer, and then do the sur­gery in the fall when I’d nor­mally be less act­ive. Or, I could do it early to get it over with. At that point, I was des­per­ately hop­ing that I’d be in good enough shape to ride in the Alps this Ju­ly on two dif­fer­ent trips, and then could have the sur­gery in Novem­ber or Decem­ber. How­ever, by late April, it began to be clear that my con­di­tion was de­teri­or­at­ing pretty rap­idly, and even if I de­ferred the sur­gery, I’d be in no shape to ride a bike in the sum­mer… even walk­ing was get­ting hard. So, while things were un­cer­tain, when the chance came up to have this sur­gery in May came up, I took it im­me­di­ately. Among oth­er things, that elim­in­ated any chance of rid­ing with my friends in the Alps. Ah well. Today, as I head to­ward full re­cov­ery by Septem­ber, that was so ob­vi­ously the right call.

Riding alternatives

One set of my friends just spent last week in the French Alps above Nice, on a trip I had hoped to be on. They had a fant­ast­ic time. I was here, be­gin­ning to ride on my bike again, work­ing my way up to two-hour long rides and strug­gling with the rolling hills we have around Con­cord. In­tel­lec­tu­ally, I wish I could have been there with them, but emo­tion­ally, it hasn’t been a big deal. Ah well, a missed op­por­tun­ity. I’m glad they went, and I’m glad I’m re­cov­er­ing. No re­grets. (I had the op­tion to go with them any­way and ride in the van to help with food and mor­al sup­port, but that would have been Hell. The flights would have been a pain night­mare, the ride in the van would have sucked, and I would’ve wanted to be on the bike with every cell in my body.) I sup­pose that I wish life had worked out dif­fer­ently, but play­ing with the cards I’ve been dealt, not go­ing was the right thing, and no re­grets.

The source

It seems that this “con­joined nerve root” prob­lem that came up in sur­gery is the likely cause of all this back pain, in­clud­ing everything from over a year ago. In es­sence, my L4/L5 nerves, thanks to a ge­net­ic vari­ation, are doubled on both sides. They were go­ing though a space in the back­bone - around the fa­cet joint - bio­lo­gic­ally de­signed for one nerve, not two. This in­creased scar­ring, which ag­grav­ated the her­ni­ated disc that was the first thing de­tec­ted in the course of this treat­ment. That nerve dens­ity caused the pain on both sides of my back, with bone rub­bing on nerve that was go­ing to lead to per­man­ent pain and loss of move­ment. The only fix that we cur­rently have for this is what we just did - re­mov­al of the fa­cet joint and then fus­ing the spine for sta­bil­ity.

It wigs me out just a little bit that I now have ti­tani­um rods hold­ing me to­geth­er where I used to have bone.

It wigs me out a whole lot that, if it wer­en’t for this kind of sur­gery, I’d be in per­man­ent de­bil­it­at­ing pain and un­able to walk for the rest of my life.

Looking Ahead

Now it’s a mat­ter of giv­ing my body time to heal. I’m do­ing phys­ic­al ther­apy, rid­ing easy reg­u­larly, bump­ing up fo­cus on nu­tri­tious eat­ing, and try­ing to mod­er­ate work. If all goes well, I’ll be back up to full speed at work in the next month, in ad­ven­ture mode by Fall of this year, and have many years of pain-free use of my back ahead of me.

Gotta say.. while I wish none of this had happened, I find my­self land­ing on the grat­it­ude side of the equa­tion.

I am so lucky that this kind of med­ic­al op­tion ex­ists now, and so for­tu­nate that I’m in a situ­ation with work and fam­ily that I’m able to have the op­er­a­tion and ab­sorb in­to life with min­im­al im­pact on my fam­ily and me.

So, while, yes, I am now quite lit­er­ally “screwed” with four of those massive things in my spine, I’m feel­ing dis­tinctly the op­pos­ite.