4 months - still good

It has been about 4 months since my disc replacement and everything is still going fine.  My slight hip pain has lessened to the point I don't really notice it unless I bend over forward with me knees locked, but I pretty much never do that, instead bending my knees and hips whenever I bend over.

I finished up with my PT a few weeks ago as I had met all their goals.  They said they might consider having me back at 6 months post op to progress to the last phase if I want, although I don't know if I'll need it.  I still do my circuit of PT exercises maybe 2-3 times per week.  I have not been stretching or nerve flossing as much, but it hasn't seemed to cause any problems.  I have been doing cardio work on my elliptical and some medium resistance work using resistance bands and pushups.

I have more and more days where I sometimes forget I had surgery not that long ago since I feel so normal.  I'm feeling great, much better than I expected.  I hope it stays this way for a long time!

13.5 weeks

Mr. Boeree reviewed my xrays, but I just didn't get around to posting the info until now.  Here is what he had to say:

Dear Tim,

I have now had a chance to have a look at your X-rays and I am very pleased with them.   The implant remains in an excellent position.   As you will see on the flexion and extension views, particularly if you toggle between them, you can really see how the implant moves at that level.   You can also see on the lateral views that the implant is very well bonded to the bone now.  You therefore get a gold star for being an exemplary patient in all respects!

Kind regards,

Nick

So I got that going for me.  At this point, I'm feeling more normal.  The small amount of right hip pain I had when doing a straight leg raise has lessened in the last two weeks and is more like a stiffness instead.  The leg sweating seems to be getting a bit more intermittent as well.  I am still doing physical therapy twice a week, but at this point they are short 15 minute sessions just using the MedEx extension machine.  In addition, I'm doing the circuit of 12 back related exercises given to me by the PTs twice a week and workouts consisting of pushups and seated rows, high rows, pull downs, curls, chest press, chest flies, and straight arm shoulder raises using resistance bands.  I also just bought an elliptical machine which I plan to use to build my cardio back up instead of doing the high impact aerobic routines I used to.  I also do my lower body stretched, retlouping, and nerve gliding most mornings.

They have progressed at PT to lifting 40lbs off the floor with no problems (and using proper form of course).  I have gone for a few short outside bike rides and was able to do my fall yard work with no problems (leaf blowing/vac and carrying the heavy bags of leaves to the curb).  Although, my back muscles do get a little tired after a bit, but I think that would happen even with a healthy disc.  I would also say that my sitting time is pretty much unlimited at this point and I get no soreness from it.

At weeks 11 and 12 I did jog some stairs and noticed some back soreness from that.  It was more of a muscular soreness that extended along the long muscles on either side of my spine.  The soreness actually went up to just below my shoulder blades and extended down my back and flared slightly into my hips.  I wasn't sure if it was from the stair jogging or the PT, so this last week I did not do the jogging, and did not have the soreness.  So I think I may lay off that for awhile yet.  I have also not tried any normal jogging yet either, and even though the surgeons have said I can, I think I'll hold off until spring.

My confidence has gotten better and I am comfortable doing pretty much everything except the intense workouts I used to do before the injury.  I don't think I would try to lift something super heavy or to exert myself 100% yet.  After almost 2 years of issues, I'm just enjoying not hurting anymore too much to risk it.

My posts from this point will probably be more sparse as things are not changing as much and everything is still going well.  I'll of course update if anything starts giving me problems or I do something surprising that I didn't think I would be able to do.

12 weeks - made it

Well, I made it to the magical 12 week mark and am still feeling fine.  This is the milestone date at which Mr. Boeree said I should be cleared to return to normal activities, although after spending almost 7 months this year recovering from my 2 surgeries, I'm still a little hesitant to just jump back in, especially after my experience with my first surgery.  I have not tried any jogging or running yet and probably will wait for a bit yet.  I may try to get in a couple of outside bike rides before the snow comes.

I had xrays today:

The one I was most interested in seeing the the left standing 20 degree one that shows the gap between the disc and the vertebrate. My surgeon here in the US said that everything looked fine and when I asked if the gap between the disc and the vertebrate should be filled in with bone, he said that the gap doesn't completely fill in and you normally just see the bone growth in the left and right "wing" areas that are in contact with the disc.  He also said that you wouldn't really be able to see that bone growth in an xray which I was kind of surprised to hear.  He also said it looks like the disc is functioning properly and he could tell that it was moving the way it was designed to.  He said that I should be cleared to return to whatever activities I want as long as it feels fine.  I then asked him about doing the MedEx physical therapy machine that involves twisting, and he said that I should wait until about 6 months to try that.  So kind of a mixed signal there.

I sent the xrays to Mr. Boeree and he responded right away and said "As for physical restrictions at this stage, I don’t think there need to be any specific limits on what you should do, with reason!  I think it is always sensible to respect your back but you can bend, lift, twist etc, and can get back into most sports at this stage.  Before giving you a full pass I would like to check your x-rays so I’ll get back to you then if I may?"  He just needed to get the xrays loaded into his imaging system.

One small side effect that has surfaced in the last 4-6 weeks is some noticeably increased sweating on my upper hamstrings.  Both my surgeon and Mr. Boeree seemed to think this was an unusual side effect, but both thought that it probably was due the surgery as the parasympathetic nerve system does run down the side of the spine.  Usually, people who have effects experience the opposite, where they get patches of extremely dry skin.  In any case, they said that those types of effects almost always revert back to normal over time as the nerves get back to normal.  It is not a big deal to me, just something I noticed.  Some people even continue to experience nerve pain for up to 9-12 months after surgery (luckily I don't have any of that).

I also asked my surgeon about having to use antibiotics for dental work and he was very adamant that I needed to talk preventative antibiotics whenever I get any kind of dental work including cleanings for the rest of my life.  Apparently, there is some risk of bacteria getting into the bloodstream and traveling to the disc and causing problems.  This is common to all joint replacements such as knees and hips as well.  So he said to make sure to tell my dentist I had an artificial joint beforehand so that they can prescribe them.

10 weeks

I'll keep this one short and sweet.  Still doing well and feeling pretty good.  Getting a bit stronger thanks to my physical therapy, but still feel like I have a ways to go before I get back into good shape.  I went for a short bike ride today for 30mins and was reminded that my cardio fitness level is still pretty low, but that will come back with time.  Still 2 weeks before the magic 12 week mark and my next set of xrays.  Even after that, I think I'll still be pretty hesitant to do anything high impact for awhile, even though I feel good enough to even now.

9 weeks

Recovery is still progressing well.  I'm feeling more normal each day, but still trying to be cautious.  I've been progressing through physical therapy and they have moved me up to some more challenging exercises that definitely make me sweat.  It feels good to be able to do some type of exercise that tires me out.  They have also started me using a MedEx lumbar strengthening machine during my visits.  It is basically a giant workout machine which they can precisely control how far I can move and how resistance is there.  It is basically a restricted back extension machine that focuses on the lumbar spine muscles.  I still have to keep stretching at least twice a day to keep the right sided, straight leg raise pain away (although I did have some soreness today for the first time even though I had done my stretches).

Still good

Not much new to report.  Still doing well with gradual improvement.  I've been building up my sitting time while working.  I am sitting on an exercise ball for part of the day while working.  By about 2:00 I start to feel some back fatigue, but I think this is more muscular fatigue as a result of getting used to sitting for longer periods of time and sitting on the ball which takes more energy.  By the end of the day, I am pretty tired.  It's been almost 2 years since I sat upright through an entire day of work.

I have noticed a decrease in my hip pain after I added in a few new stretches into my PT routine.  Currently, I am doing the following:

Rocking my pelvis back and forth sitting on the ball
Rocking pelvis side to side on the ball
Pelvic circles on the ball
Retlouping (google it) to mobilize nerves.
Straight leg hamstring stretches while lying on my back, and pumping my ankle to also mobilize the nerve.
Glute stretches on my back, one leg straight on the floor, pulling the other knee to the same shoulder for a while and then towards the opposite shoulder.
Laying on my stomach propped up on my elbows for a couple minutes.
Flexing core muscles and holding for 10-30 seconds 10 times per day.
Stretching hamstrings by putting my leg up on the 4th stair with my knee locked.
This one sounds a little strange but it works really well:  I take a tennis ball and put it under one of my glutes and roll around on it along the sciatic nerve channel.  It hurts a little but it really helps to break up any adhesions that can form which kind of glue the sciatic nerve to the surrounding tissues.

Once I started doing the stair stretch, and the tennis ball thing, I noticed a decrease in my hip pain in just a couple days.  I think I maybe had some adhesions on the nerves that I was able to break up a bit.  My right hamstring is still tighter than my left one, but it is getting better.

I feel better each week, but am still not doing any strenuous or high impact exercises yet.  I am pretty out of shape and still have a ways to go to get back to a place where I feel fit again.  I just don't want to take any chances.

7 weeks out

I'm now 7 weeks out and still doing pretty well.  I started land based physical therapy this week and the first session was just some gentle stretching, mobilization, and nerve flossing exercises.  Introducing some new movements that I have been avoiding while the bone bonds to the disc, and some of them felt a little strange after not doing them for awhile.  I still have some right hip pain when doing a leg raise that has maybe improved a little bit, but it varies day to day so it is hard to tell. 

I started back to work this week.  I have started to transition to sitting more as I was laying down most of the time I wasn't up doing things or walking.  I have noticed an increase in fatigue this week.  Just being upright for more time and concentrating for work really seems to take it out of me.  Hoping I can start doing some more cardio at PT to help get myself back in shape.  I've also been thinking of buying an elliptical machine so I can do lower impact cardio workouts in my house.

Mr. Boeree got back to me and said that what I was seeing was just due to the X ray not being centered on L5-S1 which caused the far side of the vertebrate to appear in the spot I was concerned about.  He said there was nothing at all to worry about.

Adios compression socks

I am now 6 weeks out from my surgery and doing great so far.  I am happy to be done with the compression socks, although I did get used to them somewhat as the weeks went by.  At the magical 6 week mark, I am now allowed to resume "light aerobic exercises" such as the elliptical machine or stationary bicycling.  I have completed my pool physical therapy and will be starting some land based PT shortly. 

I had a set of xrays this morning and a follow up with my surgeon here in the US, who was very interested to hear about my experience.  He gave me an order for the land based physical therapy at a different location as he liked their program for post disc replacement a bit better.  This will make 4 total different physical therapists I've been to since the start of my "journey."  He was happy with the placement of the disc.  I also asked him for a copy of his CV and a letter stating the average costs of a discectomy and fusion to include in my insurance claim.  Hopefully, they will see that my disc replacement costs were much less than a fusion would have been and cover the costs.  I go back for another follow up and xrays in 6 weeks.

He also asked about what I had been told about possible future facet joint complications and I told him that one of the reasons I went with the M6 was because of the graded resistance that should help prevent facet overloading.  He said that was a good point, as he had only worked with the Charite, Maverick, and ProDisc devices, none of which had graded resistance.  He then showed me a device he had used with some success on patients that had facet issues.  The small device called the Coflex helps unload the facet joints and is a very simple and easy surgery.  This is good to know in the event I develop any facet problems in the future (although I hope the M6 prevents this).

Here is a link with some more info on the Coflex:
http://www.paradigmspine.com/products/interspinous_technology/coflex/indication_specific/en/

Here are my 6 week xrays:

The placement still looks good, although when I looked closely at the side view, it looked to me that I might have a small area of bone growth on the posterior (back) surface of the top endplate.  My surgeon here did not mention it and I didn't see it until I took a closer look at the images once I got home.  I'm not 100% sure of what I'm seeing, but I sent the images to Mr. Boeree and asked him about it, so we will see what he says.

Other than that, things are still going great.  I've been keeping my activities limited to walking and the pool therapy to this point just to be safe.  My hip pain is still present when I do a straight leg raise, although it's very minor and has improved a small amount.  It is really barely worth mentioning, and would not be much of a problem if it never went away.  I go back to work on Monday and since I work from home, this should not be much of a problem.

5 weeks

Not much new to report.  Still doing multiple walks per day and pool therapy twice a week which feels pretty easy for the most part.  Many of the exercises don't seem to feel like they are doing much, but I do feel better than normal the day after.  Doing bicycle kicks in the corner of the pool is nice since it is the one thing I feel safe to try to get my heart rate up a little.  The pain I had in my abs after the first session did not come back after subsequent pool sessions.  The pain in my hip is a little better and seems to depend on activity level.  A couple ibuprofen seem to knock it down pretty well when needed.  I have xrays and a follow up appt. with my surgeon here in the USA next week.  Still being careful with my movements, but slowly incorporating small increases to my range of motion, maybe a quarter twist or bend would be the very max I would do at this point.  No new significant adverse events which means so far so good.

4 weeks

Not much new to report.  I think I'm still doing pretty well at this activity level.  I still have some pain in my right hip but only when I do a straight leg raise, which is pretty easy to avoid in everyday life so it is not much more than an annoyance.  I am still doing the nerve flossing stretches in case it is scar tissue causing the hip pain.  These stretches aim to keep the sciatic nerve moving along in its channel to avoid/break up scar tissue from adhering to the nerve and causing pain.  It could also just be residual swelling/irritation from the surgery.  I had something similar after my first discectomy surgery earlier this year and it eventually went away (before the reherniation).  I've also been keeping up with my walking regiment, but a day or two a week I'll skip the longer walk to give myself a rest day.  I still get pretty tired easily, especially after a longer walk or in the afternoons and I have some pain in my abs when I do anything to utilize them.  I'm also still wearing the DVT socks, but I think I've gotten used to them and they don't itch as much anymore, but I'm still looking forward to them going away in 2 more weeks.

Tonight I went out with some friends for one of their birthdays and sat for a few hours total with a couple of short breaks just to stand up for a few seconds and then we went to a concert and stood for a couple hours as well.  I did not feel any additional pain from this, but I still plan to be careful and treat nights like this as special occasions and not push it.  It was the most sitting and standing I've done continuously without a break to lay down since well before my surgery.

Another odd fun fact is that I hadn't sneezed since the week after my surgery until tonight.  Right after the surgery, when I sneezed, I could definitely feel something hard/strange in my back which I can only assume was the vertebrate rattling a bit against the disc.  It didn't really hurt that much, but it was an unsettling/foreign feeling.  I have a little trick to short circuit my sneezes so I had been using it for the past couple weeks.  Well, tonight one finally snuck out and I did not have any strange feeling at all.  It felt completely normal.  I'm not sure this is any kind of clinical benchmark, but I'm treating it as one for myself.

Pool therapy

I started pool therapy at my local physical therapist.  It felt good to do something other than walking.  The activities seemed pretty simple in the pool (walking, marching, moving arms back and forth, bicycle kicks etc.) but I can feel it in my abs afterwards.  They had to split my ab muscles and then they sutured them back together during the surgery, so some soreness is normal while things heal back up.  It's a good reminder that I still have a ways to go.

3 weeks

I am now officially 3 weeks out from my disc replacement surgery, half way to the magical 6 week mark which will allow me to resume some light aerobic activities until 12 weeks, at which point, the bone should be firmly attached to the artificial disc.

I'm falling into a routine of a 1.5 mile walk in the morning, a longer 50 - 60 minute walk after lunch and another 1.5 mile walk in the evening.  Sometimes I break the midday walk in half and lay out by the lake near my house and read for an hour or two just for something to do before I walk home.  I'm following each walk with some gentle hamstring stretches using a rope to raise my leg in front of me with my knee locked while laying on my back.  I then pump my foot while doing the stretch to help move the sciatic nerve through the channel to help keep it mobile and to keep adhesions from forming on the nerve.  I think I may have some scar tissue starting to form along the right nerve root (Mr. Boeree mentioned that it looked like there was a small amount as a result from my first surgery) and I'm hoping that I can keep it at bay with the stretching.  It is not too bad at this point, I only notice it when I do a straight leg raise and my leg extends past the point it would during a normal walking stride.  It is a bit painful when I do the stretch, I really feel it in my hip area.  I'm trying to find a balance of productive stretching, without taking things too far.  I think it is helping, as in just a couple days I can notice a small change in how far I can stretch my leg before the hip pain starts.

I have an evaluation with a physical therapist on Friday before I start pool therapy which I'm looking forward to for something other than just walking to do.

I've resumed taking ibuprofen and I've found that taking it with a larger amount of food (think meal or small meal instead of snack) seems to be helping a bit with the stomach upset.  I'm still planning on taking breaks if the stomach upset comes back.

Other than that, so far so good.  I don't get any pain when laying on my side in bed, no spasms, and not much other pain at this activity level.  I'm still of course being very careful with my movements at this point.  I can sit for about an hour before I get any discomfort, and even then it is very small and I stop more out of concern for interrupting the bone growth than for the discomfort.  I've gone out for dinner a couple of times with friends and it works really well to get a high table which is much easier to stand up and take a break from sitting.

Another interesting disc similar to the M6

I found a link to another disc which also provides 6 degrees of motion similar to the M6. It seems to operate in a similar manner to the M6 with a compressible core that provides graded resistance, but it has spikes instead of keels to keep the disc in place, and contains a core of silicone surrounding compressible beads with a polycarbonate urethane ring around that. Couldn't find a lot more info on it other than I think Dr. Bertagnoli in Germany uses these along with the M6 and ProDisc.

It will be interesting to see which of these discs proves most successful over time.

Lp-ESP disc:
http://www.supramedical.co.uk/Lumbar-Artificial-Disc/

More pictures

I added a link to the right of more of the pictures the surgical team took during my operation.  They show actual pictures of the procedure including the incision and the disc once it was implanted so if you are squeamish, you may not want to look.  There are brief descriptions for each of the photos also.

2 weeks

I'm now 2 weeks post surgery and still doing well. I'm taking 3-4 walks per day varying in length from 30-50 mins. Yesterday, I decided to walk around the lake near my house which is just over 3 miles and I think that was just a bit too far. Nothing major, but I did have a little sciatica on my right side for the rest of the night, but it seems to have quieted down overnight. So I think my walking limit at this stage is somewhere between 2 and 3 miles in one shot.

I contacted my surgeon here in the states and he is going to get me a prescription to start some pool therapy and then wants a follow up appt. At 6 weeks post surgery with xrays.

I've taken a break from the NSAIDs since they started to upset my stomach a bit. I usually have about a 2 weeks limit before this happens and I've been taking them since right after the surgery. I think I'm going to stagger the days on which I take them.

Other than that, I have not had any major pain at this stage yet, but I have noticed some sciatica here and there, some tightness in my back intermittently, and some times have the feeling like my low back could use a good crack (of course this would involve twisting which is still a big no-no). This is all probably due to my back getting used to the new disc height and how the implant is moving, along with the healing going on in there. I do still get tired pretty easily. The incision is feeling better. No more bleeding and I've not worn jeans so I think that has helped give things a chance to heal. I do sometimes notice some slight soreness in my abs, particularly after last nights longer walk. But all in all, so far so good.

Home

I had my last physio pool session on Friday. We did a few more exercises than the first session and it lasted a bit longer. Since I was doing so well, the physio said I would only need a few weeks of pool sessions before I could move onto land based physical therapy. Mr. Boeree had mentioned this as well in our last consult.

After the pool session, I had my staples removed. She put some steri-strips across the wound to hold things together for the flight home. It is nice to have the staples out as it does not pull as much. However, since the incision is directly across my waistband line, it has been a bit uncomfortable to wear jeans. I wore them on the flight home, and had some bleeding through the dressing which is probably also partially due to the blood thinners they have me on to prevent blood clots. I may try to round up some more steri-strips for some extra support. If I had it to do over again, I would have bought a pair of track suit pants and wore those instead of jeans.

The trip home was a long day. I was not in much pain, however. I took some ibuprofen and some tramadol preemptively which I think helped. Luckily, the traffic was not bad and it took about an hour to get from eastleigh to heathrow. I found a bench in the airport and was able to lay down for the hour and 45 mins before our flight boarded. I had a business class flight with a lay flat seat which I think is required after a surgery like this. Even so, you need to be upright for take offs, landing, and if you want to eat without getting food all over yourself. Then it was a short drive to my house and I was home. I didn't end up using the wheelchair in the airport, but I would have if I hadn't been able to tolerate standing around for security/customs etc.

I got back home and was a little sore and very tired, so I took another ibuprofen and went to bed. I still get tired pretty quickly, and as you might imagine, the day wore me out pretty good. Today my parents helped me with some grocery shopping before they took off. It is nice to be home and to have all the planning and worrying over for now. I'm off work until sept. 19th so I can concentrate on getting better.

There is a therapy pool at the hospital not far from where I live and they have a low back program that I am going to try to have my surgeon here sign the papers for to get me in.

Once again, I want to say thanks for all my well wishers. I appreciate the support and hope the best for those who are recovering from a similar back surgery, or are planning on one.

Staples out tomorrow

I had my last face to face consultation with Mr. Boeree on Tuesday in which he just stressed to be cautious, outlined the things I should avoid doing until 6 and 12 weeks (no twisting bending, heavy lifting, tennis, golfing, etc), and reminded me that there will most likely be ups and downs during my recovery. The swelling in my abdomen is going down a bit, but I do have some attractive bruising around the incision still.

I had my first physio session the pool yesterday. The pool was very warm and we just did some water walking, legs raises, leg swings and some bicycle kicking in the corner of the pool. It only lasted about 10-15minutes at the most, but I guess it is best to be cautious at this stage.

Tomorrow I go back for my last physio appointment, after which I'll get the staples taken out which will be nice since the incision is right at the level of my waistband so is a bit uncomfortable when I walk and my pants rub on the staples a bit. I also got a call letting me know that they will have my medical records for me to pick up tomorrow as well.

Other than that, I've just been taking 3-4 walks per day as suggested by Mr. Boeree. I still get tired pretty easily. Looking forward to coming back home as I'm getting a little bit bored at this stage.

Out

I was released from the hospital on Sunday morning. I probably could have gone home on Saturday, but I had a bit of dizziness in the morning, which went away, but I decided to stay the night just to be safe and since there was no added cost. I am still doing good,walking 3-4 times per day for 10-30 minutes. I'm going to see Mr. Boeree today for a follow up and then have a physio pool session tomorrow and 1 on friday after which I'll get my clips taken out.

Today I am hoping to get a copy of my medical records and a payment receipt as I am going to try to submit this to my insurance company, even though the chance I will be reimbursed is probably pretty small.

Recovery day 3

Not much to report today. Was a bit dizzy in the morning, but that went away after some breakfast. The physio came in and we walked a couple flights of stairs without any problems. Mr. Boeree and Dr. Herbertson both popped in separately again to do a quick check and they thought it would be fine if I left for the hotel tomorrow morning.

I have had less pain than I anticipated, althought I have been keeping my activities limited to 4-5 short walks up and down the hallways and a few sets of stairs today. I have not had any back spasms, or pain although i do get some small little blips here and there. The incision site is still swollen and some times I get a small amount of pain when I do something that pulls at the incision. I have had no pain while sitting, although I am limiting my sitting to no more than 15 mins at a time for now. The old nerve pain I used to feel in my hip, low back and calf is gone most likely as a result of the removal of the disc that was pressing on the nerve. I'm a bit nervous to see how my back will handle the bumps of the taxi ride to the hotel tomorrow, so fingers crossed.

They have had me on paracetamol (Tylenol) for pain, an inti-inflammatory, and have been giving me blood thinner injections to reduce the risks of forming a blood clot during the flight home. Once I am released from the hospital, I will take blood tinnier pills instead of the injections.

I'll come back to see Mr. Boeree on Tuesday, on wednesday and Friday I have pool sessions with the physio and I get the staples removed from my incision after my pool session next Friday.

Recovery day 2

Things have been progressing well today. I woke up this morning and they removed the catheter, which I was glad to be rid of. The physio came and I went for a short walk and then managed a shower while sitting in the shower chair. I managed to put my contacts in, brush my teeth, and hair, before I started to get light headed and felt a little faint. So I quickly put my gown back on, and laid down in the bed and felt better in just a short while. The nurse had been waiting outside just in case. She checked my bp which was fine and gave me a little oxygen as a precaution.

I was then taken down to xray to confirm that the disc was still in place, and everything looked ok to my untrained eye. Mr boeree had popped in earlier just to see that I was doing ok. The anesthetist, mike Herbertson also came in to check on me and also popped in later in the evening. I have been very impressed with just the number of times the doctors have stopped in to check on me.

They removed the ports in my hands and also took several large chunks of arm hair as they use some sort of freakishly strong tape to hold them in place. My wrists are sporting a couple nice bald spots. Brett had warned of this on his blog, and he was right.

I was allowed to return to eating normally today and the food here is fantastic. I had a light breakfast of cereal and fruit, a lunch of beef consumme, lamb, potatoes, and vegetables and a dinner of prawn cocktail (which was kind of like shrimp salad), roast duck, potatoes and veggies, and a vanilla creme brûlée for dessert.

With a little food in my system, the light headedness started to go away and I've been for a couple short walks just down the hall and back. They may release me to the hotel tomorrow or Sunday depending on what I'm comfortable with. The anesthetist said I'm doing about as good as one can do after getting a disc replacement. This is good news, but it will still be a long road back to recovery over the next 3-4 months.

I got a surprise visit from Si, who has posted a number of comments on brett's blog as well as my own. He lives nearby and was at the hospital for his physio appt. He is around 3 months out from his M6-L disc replacement with Mr. Boeree and seems to be doing pretty well so far. We chatted for a while about our experiences and it was nice to meet someone face to face that has had the same surgery. Hope I'm doing as well as him in 3 months.

Thanks again for all the support and encouragement!

Xrays

Here is an image of the pre-op xray of my spine.  The disc height was still pretty good, although Mr. Boeree indicated that when he operated on it that it was drying out and the posterior portion of the disc was badly fissured so it was good that I had it removed.

Here is an xray I had today showing the placement of the artificial disc from the side:

And from a frontal view, angled up into my body to try to get the disc head on since the L5-S1 disc angles downward.

The placement looks excellent to me (although I am no medical professional). 

I had asked Mr. Boeree during our pre-operative consultation if there was any concern with the fact that the M6 keels are very low profile and the possibility that the surface of the vertebral body could be a bit curved, thus preventing the keels from implanting into the bone.  He said that there may be some unevenness in the bone, but it rarely prevented the keel from going into the bone along the entire length of the keels.  Also any space between the implant and the bone gradually fills in with bony growth as the vertebrate bonds to the implant so this was not a worry in the long term. 

Mine looks pretty good to me and I can see the keels in the bone.

Recovery day 1

I slept pretty well last night. I think the morphine really knocked me out. The nurse would come In every 15-30mins to check bp and fluids, but I still slept pretty deeply and had some pretty vivid dreams (and I'm not one who normally remembers dreams). Today has been pretty good also. I used the morphine pump a few times this morning and the physio came around and I stood up for the first time with my new disc. I was a tiny bit light headed, but felt fine. Once the nurses could hear bowel sounds, I was allowed to start drinking water instead of just having ice cubes.

This afternoon, the physio came back and this time I walked a small circle out into the hallway and back into my room, with everything feeling ok. They then disconnected my morphine pump and switched over to just oral paracetamol (what we call acetaminophen). I'm glad I used the morphine pump gradually, not waiting for the pain to build up as I think I bypassed the toughness that can come the first night or so. It didn't seem to slow down the recovery of my intestines too much as I was allowed to have a bowl of soup for dinner tonight which was really good. My stomach handled it just fine and things are coming back online. They unhooked the iv fluids and said they would take the catheter out tomorrow which will be the last of the plumbing to be unhooked.


The food menu looks awesome here with things like, steak, lamb, and prawn cocktail for dinner, I just hope I don't get the boot before I get a chance to have one of their dinners.

They can rebuild me, they have the technology...

Here a few of the tame pics from my surgery.  Not sure everyone wants to see the really cool ones that might make the squeamish cringe.

The surgeon before the disc goes in.  The thumbs up is crucial to proper placement ;)

 A couple close ups of the disc.

My disc in its new home, my spine.  They got some great photos.  If you ask me, I think they would look great in the brochure.

 Mr. Boeree taking the time to walk through the pictures and explain to me what was happening in each one.  This was the morning after the surgery.  Seriously, what kind of surgeon would take the time to do this?  Answer: a good one who cares about his patients.

Surgery day

I'm doing pretty well so far. I've been sleeping on and off most of the day, as the morphine seems to do a great job of sending me of to la la land. I came in at 7:00am this morning and was being put under at about 8:40 as I was the first surgery. I asked if they would be willing to take some pictures during the surgery and they said that would be fine. And boy did they ever, they took 41 pictures all together with some great shots of each stage in the process, including a picture of my new disc right after they put it in my spine! I'll post some of them later, as I'm just using an iPad my friend Austin loaned me which has been really really nice, but I can't transfer the photos from my moms camera to it.

Before I was taken off to surgery, I had a consultation with the anesthetist who explained what would happen and reviewed all my information. Not long after mr. Boeree came in and we reviewed the risks once again and I signed the consent form. (In the uk, surgeons go by mr. Instead of dr. A tradition dating back to the days when surgeons were not medical professions, but rather tradesmen.)

I woke up in recovery and was wheeled back to my room where I fell asleep for a while. the nurses come in and check on me about every 15 minutes and take blood pressure, temperature, and look things over. I have been using the morphine pump maybe once every 45 minutes or so,not because I'm in much pain, but rather to stay ahead of it. So far I've had a little soreness around the incision, which is not too bad, but other than that, I've felt great so far. I'm expecting the pain to kick In tomorrow once they have me off the morphine pump and up and walking around. They put a catheter in so I haven't had to get up, but they said that should come out tomorrow. I've not been allowed to eat since they need to wait until the intestines wake back up as they can take a while to come back online after being jostled a bit during the surgery. So only ice cubes today. I have heard a few gurglings from my stomach already which is a good sign.

Mr. Boeree came to see how I was doing after the surgery and again this afternoon when I was a little more awake. My mom had transferred the photos onto her computer and mr. Boeree actually walked through them all with me, explaining exactly what was occurring in each! That was pretty cool. He said he put in a large, 10mm height disc with a 10 degree lordosis and had excellent placement of the disc. I don't think I've ever had a doctor take so much time with me, which has been outstanding.

Out of surgery

Just a quick update to say that I am out of surgery and everything went very well. I was first in line this morning. I had some back pain immediately after waking up so I took a couple shots from the morphine pump and fell asleep. After waking up, I'm in very little pain right now, although I haven't really tried moving at all. Everyone at the hospital so far has been extremely kind, far beyond my expectations. Still a little sleepy from the meds, so I'll give more details later, but wanted to say thanks for all the well wishes from everyone.

Pre-op assessment

I had my preoperative assessment appointment yesterday afternoon. They drew several vials of blood, took xrays and explained what would be happening the day of my admission. I have to be at the hospital at 7:00am on Wednesday morning, although I won't know the actual time of my surgery until Wednesday. They showed me around a bit. They hospital looked clean and in good order and the room looked comfortable.

I had a consultation with Mr. Boeree in which he explained the surgery steps, which I basically already knew. They make a horizontal incision a few inches below the belly button. Since the l5-s1 disc is not situated horizontally, but instead is sort of tipped downwards, they make the incision a bit lower than a higher disc so that they can approach back upwards to have strait on access to the disc. The rectus (aka ab muscles) is separated, the peritoneum and organs moved to the side, and the vessels are moved to the sides before removing the disc and replacing it. He had my mris on the screen and explained in detail what would need to be removed. I had him double check my facet joints as if these are fused, a disc replacement is not advisable, but mine looked fine.

He explained the risks or blood clots, dural tears, and nerve damage once again. He seemed very kind and intelligent and answered all of my questions. I feel very comfortable having him perform the operation after meeting him. I mentioned I had been in contact with some of his other patients via our blogs and said hi from Brett and Joey sue, which brought a big smile to his face and he said he thought it was great that we were all sharing our information to keep ourselves educated. I was given a special body wash soap I am to use on Tuesday and Wednesday morning while I shower. I am not supposed to eat anything after 2 am Wednesday morning, but can drink water until 6am.

I also got to see the m6 disc I will be getting as well as a pro- disc and a charite to compare. I was struck at how small the discs are and how little they actually move, but in the context of the models of the spine, they seemed to make sense. The height of the core of the m6 is probably no thicker than 2 quarters stacked on top of each other. It seemed pretty stiff to me, but mr. Boeree said the demonstration model was actually looser than the actual one. It is amazing that movements of only a few millimeters make such a big difference when dealing with such things. He also said I should take NSAIDs for a few weeks after the operation to prevent bone overgrowth and auto fusion, which he didn't expect in my case since my disc height is still pretty good. He also said I should wear compression socks for 6 weeks after the surgery to help prevent blood clots. He also said they would be giving me blood thinner injections while in the hospital and then pills once out to prevent blood clots on my flight home.

Today is a free day so we just took our time getting up and are wandering around eastleigh a bit. I have not gotten used to the time difference or sleeping in the same room as my mother so I haven't gotten very much sleep the past couple days. I plan to hit the fitness center in the hotel later and do some elliptical as my last bit of exercise before my surgery.

Arrived in england

So my mom and I made it over to England. The flight was long and the eggs they served us for breakfast on the plane upset both of our stomachs so we are still a bit queasy from that. Unfortunately, the Internet at the holiday inn is very expensive, so we won't have constant access. Also the breakfast at the hotel seems to be about $21per person so we are scouting other food options nearby.

Hopefully, they have free wifi at the hospital we can use while we are there. Right now we are at a coffee shop about a mile from our hotel with free wifi. We have all day tomorrow to explore and I have my first pre-op appt. On Monday afternoon.

I got word on Friday morning that the wire payment went through, but I was hit by a hefty currency conversion fee of around 3% by the bank in england since my bank could only wire outgoing funds in us dollars. Had I known I could have payed by debit card and saved around $800 since my debit card only has a 1% conversion fee. Oh well, nothing I can do now.

Other than that I am pretty nervous to finally be here after so much planning. It's hard to believe this is really happening.

Flying on Friday

Only a couple more days before I leave for England.  I wired the payment over on Monday.  My bank needed me to get the address of the bank and the name on the account which was not included in the initial information I was sent.  That took a couple days since the financial person, Sam, was out of the office last Friday and the first part of Monday.  The wire can take a few days to process, apparently, and Sam said she would let me know when it was received.  No word yet, and I'm a bit nervous that if anything goes wrong, I'll be cutting it very, very close since they need the payment in advance of the surgery.  But it is out of my control, so I try to make peace with that.  I was approved for Short Term Disability for work (for the second time this year) and will be off work until Sept. 19th.  I'm now just tying up loose ends and finishing laundry so I'll have enough clothes to pack.

Tests done and sent

I had my MRSA screening and urine tests done yesterday, and everything looked fine.  These were required by the pre-assessment nurse, Julie, in the UK before leaving.  Luckily, my provider has an online portal where I can get my test results immediately once they were in.  I was able to export them and email them back over to the UK today, so it was a pretty fast turnaround.  Otherwise, I would have had to gone back up to pick up the test results and then find someone with a scanner or a fax machine to get them sent.  Nice to have something be simpler than I expected.  I haven't heard from the financial person they said would be contacting me so I sent an email asking about that and Jo, said she would go give that person a nudge.  I'm leaving a week from Friday and just don't want any surprises at this point that could jeopardize the trip.  This is something I find myself worrying about and it will be nice when it is all put in motion.

Hotel booked

So I booked my hotel, the Holiday Inn in Eastleigh.  I called the hotel and asked about the special rates that were mentioned on Dr. Boeree's website, but the lady on the phone said they didn't have any special rates so I went ahead and booked the room online.  I joined a points club called the Priority Club http://www.ichotelsgroup.com/h/d/pc/1/en/reg and booked through their website (thanks Joey Sue for the suggestion!) I think my stay should earn me enough points for some free nights someplace when I'm recovered.

Got my order for the MRSA tests from my surgeon and the appt. scheduled early next week to get that taken care of.  The nurse said it takes a day or two to get the test results back so I should be in good shape time-wise to get them send over before the surgery.

Date is set, flight is booked, leaving July 29, returning August 14

I got confirmation from Jo Haley, the PA to the surgeon in England, that I am on the schedule for August 3rd.  I got an email from one of the nurses with a form that I filled out and sent back and a request to get some MRSA tests that need to be done and the results faxed over 2 weeks before my surgery.  Given that I don't have much time before I leave, I need to get these done ASAP.  I emailed my surgeon here to get an order written for the tests and hopefully he responds quickly so I can get them done in time for the results to be ready.

I booked my flights today, 1 for my Mom and 1 for myself.  Just my luck, overnight the fares for the weekend days jumped by about $2000 for my business class ticket alone.  This means that my trip will be a few days longer than I was originally planning to get the better price (leaving July 29th and returning August 14th), but hopefully should provide an extra time cushion should anything go wrong like a delayed flight.  I'll need the business class seat for the trip back because they lay flat.  Sitting after the surgery can be quite painful for awhile so this was a must for the return trip.  They were sold out of upgrades so I couldn't use my miles to upgrade a coach fare to business class, and it wasn't any cheaper to get business class on the return trip only so I had to buy a roundtrip business class ticket.  A bit more expensive than I hoped, but nothing I could do about it.  At least I will be able to lay flat on the way over there also.

Next on the list is to book some lodging.  The cottages I was looking at are booked so it looks like it will be a hotel.  I think I'm going to go with the Holiday Inn.  It is about 2.2 miles away according to google maps and on the contact page of http://www.nickboeree.com/contact/ it says they offer special rates to patients of the Spine Clinic.  I've also heard from others that have stayed there that it is pretty good and they are used to getting patients from the Spine Clinic.  My mom isn't comfortable driving in the UK as it will be the first time out of the USA for her so hopefully the close proximity will cut down on cab fares back and forth.

My checklist keeps growing as I think of more and more things I need to get done before I go.  I have to admit I had a few, "oh my god" moments today as this just got really real for me.  I have been thinking about this for so long, hoping to get the ball rolling, and now the reality of it is starting to sink in that this is going to finally happen.

Tentative surgery date: Aug. 3rd

I finally heard back today from Jo, Mr. Boeree's PA, about potential dates for the surgery.  She gave me a couple to pick from and I picked the soonest one, August 3rd.  She is going to be out tomorrow and will finalize everything on Thursday so I can start booking flights/lodging etc.  This will mean I will need to fly out from the US on either July 30th or 31st depending on what time I need to be there on Monday for pre-op consultations/tests etc.

There is a lot I will need to take care of in the 2 and a half short weeks before I leave including booking flights, finding a place to stay, finding transport to Eastleigh from the Heathrow airport, getting any pre-op tests/procedures done, arranging for short term disability from work, getting the funds together to cover the surgery and having them wired over, and preparing and packing for travel.

I am looking at a couple of rental houses in the area:
http://www.kingsmerecottage.com/cottage/Welcome.html
http://www.winchesterholidayhomes.co.uk/Properties/Properties.html

I have emailed them both to see if they are available during the time frame I'll be over there (July 31-Aug1 to Aug. 12).  Since both my parents want to come over with me, I figured these would be more comfortable than cramming into a hotel room together for 2 weeks which I think would have a good chance of driving us all crazy.  I need something that is relatively close to the hospital (no more than 12 miles) since I'll have to go back there a couple of times after I'm released and I've read that car rides can be tough right after the surgery.  If these aren't available, I'll have to find a hotel in the area although, most appear to be at least as expensive if not more so than the rentals.

I also found a couple of websites for taxis that can take me to Eastleigh from the Heathrow airport.  The hospital can arrange transport for both way for £300, but I think I can find something quite a bit less expensive if I look a bit (hopefully more in the range of £200 total for both trips).


http://www.eastleighcabco.com/
http://www.londontobirmingham.com/TaxiFromHeathrowToEastleigh.aspx
http://www.southamptonairporttransfer.co.uk/taxi-fares.html

Feels kinda scary to have this becoming more a reality, but I'm also excited that it will hopefully get me back to doing the things I've missed for so long.

More info from England

I had requested the cost information for the surgery and I got it today along with some additional information.  The inclusive costs for a single level L5-S1 disc replacement with an M6-L would be £18,300 (you can do the currency conversion if you're really interested).  That covers everything connected with the hospital stay, including the pre-assessment visit and investigations, all the hospital charges, the surgeons and anaesthetists fees and physical therarpy while at the hospital (and afterwards at the hospital while you stay in the locality).

They also offer arranging a car to pick you up from the airport and driving you the 1 hour to Eastleigh and also the return trip for a fee of  £300 total.  I might look into finding a taxi service that might be a little less expensive.

After the surgery, I'll be in the hospital for 3-4 days and he recommended staying in hotel for an additional week or so after that before I fly back.

I also got a list of hotels in the area, although I am also looking into perhaps renting a vacation house for a couple weeks since both my parents are planning to come with and all of us in the same hotel room for a couple weeks might drive us all crazy.  It will be a matter of finding something available that is close enough as car rides right after the surgery can be tough, and I'll need to go back to the hospital a few times for PT.  They do allow you to stay at the hospital for free for a few days before the surgery.  They will allow you stay in the hospital after the normal discharge time (usually 3-4 days after the surgery) for £75 per night for the room and meals.

I don't have the exact date of my surgery scheduled yet.  That will be the next thing to get nailed down and then I can start booking flights, lodging, etc.

Phone consultation with Dr. Nick Boeree

I had my telephone consultation with Dr. Nick Boeree from England today.  My phone rang at exactly the time that his PA had arranged with me via email yesterday.  He assured me that he was ok, and had just had a bump on the head and apologized for having to reschedule.  I didn't ask specifically what happened as we moved right into other matters.  We first reviewed my history and it was quite obvious that he had reviewed the information I had sent and looked carefully at my MRIs.  He said that it looked like the L5-S1 disc was degenerating and had lost some height towards the back and was bulging out after the re-herniation.  He also mentioned that my L4-L5 disc looked like it had a very very slight darkening that was nothing to worry about now and would be more of a concern if I were going to get a fusion or a non shock absorbing disc (like those available in the US).  He didn't think it warranted any action now, but was more just something to keep in mind.  We also talked about my symptoms, where I had pain etc.  He advised that he didn't think getting another L5-S1 discectomy would be a good option since I didn't heal well from the first one and it would cause the loss of more disc height.  This was right inline with what I was thinking, but it was good to get confirmation from a pro.

He then explained the disc replacement procedure which was pretty similar to the information he has on his website, which is very detailed and clear.  We also talked about some of the risks of the surgery, but he said that they would be very minimal for someone of my age who doesn't have any other major medical issues.  He said that he really would have no reservations at all about doing the surgery and while there were always risks and he could not absolutely guarantee no problems, he felt that I was an excellent candidate for a disc replacement.

We then talked about his experience with disc replacement surgery.  He has been doing them for about 10 years, using the Charite and ProDisc before switching to the Spinal Kinetics M6 which he felt was a far superior disc.  He has done multiple 100s of disc replacement operations and usually does 1-2 per week on average, with the rest of his time spent doing other spine related surgeries.  He went over some of the testing they do for the M6 which simulated a lifetime's worth (or even more) of usage with no problems.  I said my only concern was how the polymer based materials would stand up over 20 or more years of usage in the body with regards to the polymers oxidizing and becoming brittle over a long period of time and he said that the materials used in the disc had been used in other medical applications such as knee and hip replacements and had shown no/very little signs of that type of degradation.  He was also careful to say that as the disc is still relatively new, it has not had time to amass years of a proven track record so there could be unknown factors that could arise in the distant future.

He stressed that he had no monetary interest in the M6, owned no shares of the company and used it solely because he thought it would give the best outcomes to his patients compared to any other discs on the market.  He also stressed that he was very committed to providing 1 on 1 treatment for a specific patients needs and was not running a "surgical factory" where he was just trying to get as many patients through as possible.  He said his highest goal was not to make loads and loads of money, but to make sure his patients got the best care he could provide.

I asked him about activities that I would absolutely want to avoid after having recovered from a disc replacement (it takes around 3 months for the bone to grow into the disc to secure it in place) and he said that I would have very few restrictions but did warn that things like bungee jumping, trampolining, and sky diving would probably not be advisable (but pullups would be ok, since I like to do these as part of my workouts).  He said that even though the disc itself is much stronger than a natural disc, the place that a failure would most likely occur would be that the artificial disc could possibly become separated from the bone in the event of an extreme hard landing while the spine was in extension (ie bending backwards).  He said it was hard to give absolutes and guarantees about what would be unsafe, but he said to use common sense and err on the side of caution.  In general, it would take a pretty traumatic event to cause a problem, but that doesn't mean one could do the extreme activities without some risk.

He talked for the entire 30 minutes before having to move onto another patient consultation.  He said I should think it over and if I wanted to proceed, that I should email him or his PA.  The lead time for getting the surgery is usually 3-4 weeks at a minimum but he did mention that he was vacationing for a week in July so it would probably be in the August time frame at the earliest. 

My general impressions were that Dr. Boeree was a very kind, thoughtful, honest, articulate, humble, and intelligent person.  I got no sense at all of any sort of arrogance from him. I felt very comfortable talking to him and at no time did I get the impression that he was trying to pressure or persuade me to get the surgery.  He simply laid out the facts and the risks and his opinions.  This is in line with all of the other numerous reviews that I have read from other patients of his.

I emailed back to get a price quote just to make sure, even though I had a good idea of what it will run as well as information about lodging, transportation, etc. and barring any unforeseen surprises, I'm pretty much set on getting the surgery from him.  Now will just be a matter of nailing down the date, and working out the logistics which will be no small task.

England surgical consult delayed

So I received an email from Dr. Nick Boeree's PA to set up a telephone consult a few days ago.  I send my credit card information to cover the $400 fee and was scheduled to have the consult this morning at 10:30AM.  So I gathered all my information, did some last minute additional research to have the info fresh in my mind, and wrote down a list of questions I wanted to be sure to cover.  Unfortunately, by 10:50AM, I had still not gotten the call.  As I was about to send off an email to ask what was happening, when I got a call from the PA saying that the surgeon had taken a little fall and bumped his head.  They said they didn't think it was serious as he was walking and talking just fine, but wanted to get him checked to make sure.  She said he might contact me yet today, and if not, they would reschedule for next week.  Jo (the PA) was very apologetic and very nice on the phone.  She had also sent an email in addition to calling.  I guess it is just one of those random things that you can't foresee.  I just hope the surgeon is OK, for his own sake and for the sake of his other patients (a lot of whom are much worse off than myself).  So keep your fingers crossed for him.

Contacted surgeon in England

So I send an email to Dr. Nick Boeree via the inquiry form on his website a few days ago, and Dr. Boeree responded himself within 24 hours and gave instructions on how to upload my MRIs and Xrays.  I was surprised that he responded himself to an initial inquiry instead of an assistant.  His email was very cordial.  Once I uploaded the info, he emailed me back and said his PA would contact to set up a phone consultation with me once they got my images into their system and he had a chance to review them.  You have to pay about $400 for the 30 min. consultation, but I think they deduct this from the price of the surgery if you end up having one there.  In any case, it will be well worth it either way.  So now I'm waiting for his PA to get back to me.

Appt. with Surgeon

So I met with my surgeon today.  We reviewed my status and he said he usually recommends doing another discectomy surgery before going overseas to try a disc replacement, but he also said that a disc replacement was an option if that is what I wanted to do.  I voiced my concerns about the large tear in my disc, and the failure of my disc to heal on its own when I had the internal disc tear, again failing to improve on its own during a year of conservative therapy after the initial herniation, and a failure to heal after surgery even though I did everything everyone recommended to me and more.  Also, I never regained the ability to sit for very long even after the surgery, and there would be at least another 4 month recovery before we could even see if the bet paid off.  He said he understood those concerns and that they were valid.  He had researched the Spinal Kinetics M6-L and said it looked like the best disc out there based on the data available.  He also mentioned the Rainer CA disc which they were looking at potentially being a trial site for.  I had reservations about the Rainer's ability to form a lasting bond with the bone.  I had read in another blog, where Dr. Boeree had the same concerns, and had also heard of the plastic walls of the disc splitting.  Also, there is almost zero track record for the Rainer disc so it would be a complete shot in the dark.  The M6 doesn't have a large number of years of experience, but it does have at least some years of usage with excellent results.

So we decided to pursue the disc replacement path.  He said he would have someone send me my medical records in an electronic format so I could send them overseas.  He also gave me a printed copy that I can scan in manually if I need to.  So the next step is to gather my records and contact Dr. Nick Boeree in England for a consultation.  From the hours of research, and numerous personal experiences with Dr. Boeree I had read closely, I have hope that he will be able to help.  I have yet to find a negative report from a patient of his.  My parents have their passport applications sent in, and I sent mine to be renewed this week and I paid the extra fee to have it expedited.  My surgeon said he would do whatever I needed to help facilitate the process, which I appreciated and is the reason I chose him to be my surgeon in the first place.  I hoped I wouldn't have had to rely on his experience with disc replacement when I had my first surgery, but I'm glad I planned for it just in case.

Waiting... and research

So after the cortisone shot has had time to kick in a bit, I'm feeling a little better.  I still get woken up in the middle of the night when I accidentally roll onto my side which seems to cause something to press into the nerves and I'm usually sore in the mornings unless I happen to sleep perfectly on my back without shifting in my sleep, which almost never happens.  But with ice and medication, I'm usually at a tolerable level by mid afternoon if I just lay down all morning while I work.  Sitting is still a mixed bag.  Sometimes it seems I can sit for maybe up to an hour, and other times, less.  I think it depends on where the disc fragment happens to be at as I think it moves around a bit.  The waiting and waiting seems endless at times.  It has been nearly a month since I re-herniated my disc and I'm anxious to get back on the road to recovery, which will probably require more surgery and a long recovery.

I'm just convinced that my disc is shot.  The latest MRI shows that it is darkening more and more, which means that it is drying out and degenerating.  Over time, the disc will most likely loose height and cause the vertebrate to get too close to each other and will eventually pinch the nerves going down my leg.  This is what is known as degenerative disc disease (DDD).  Right now my disc height is still ok, but over time, will most likely cause me problems again.  This is in addition to the risks of continuing to re-herniate disc fragments due to the large tear in the back of my disc which has refused to heal properly, which has already happened.  My disc has proven 3 times now (internal tear, first herniation, and second herniation post surgery) that it does not want to heal properly on its own and I think it's time to accept that and move towards getting it out of my body so I don't have to keep facing these issues over and over like I'm starting to now.

I'm hoping to get the ball rolling towards artificial disc replacement (ADR) at my next appt. with my surgeon on Thursday.  I know it will probably take at least a month and maybe even more to get all the arrangements, consultations, etc. made and that is assuming that everyone agrees and there aren't any more curveballs like finding out for some reason I'm not a candidate.  From all the research I've done on my own, I think I should be a good candidate (single disc level, good health, no bone weakening issues, no other back problems besides the disc), but that is just my University of Google medical degree talking.  After the surgery, they usually say it takes at least 6 weeks for the bone to fuse to the disc to ensure it stays in place and another 6 weeks before the bone is solid, and can take 9 months for nerves to completely settle down since they may be slightly stretched due to the change in disc height that can occur when the artificial disc is implanted.

So in the meantime, I've been doing more and more research to make sure that this would be the best option for me.  A lot of people ask me, "Why can't you get something done here?"  Well, they do perform some disc replacement operations in the US, although it hasn't been done here that long.  Unfortunately, most of the discs they use here are ball and socket designs such as the Maverick, or a slight variation with a plastic core like the ProDisc.  These artificial discs do not provide any shock absorption at all, which is one of the main functions of your discs.  Without any shock absorption, the other discs are forced to take the extra force and can lead to faster degeneration of the other disc levels (this is also a risk of spinal fusion surgeries).  Also, the ball and socket type discs do not provide any resistance when twisting like a normal disc does.  This can lead to problems with the facet joints since they can get overextended and damaged by the unnatural range of motion and lack of resistance.  My surgeon said that he has had a number of patients with the Maverick ball and socket disc and most have done very well.  The simple design of the Maverick is attractive in its simplicity, but since I am so young and want to keep the rest of my back as healthy as possible for as long as possible, the obvious known design issues make this not a good option for me.  Also, the two parts of the disc are not mechanically joined together by any means other than the natural pressure of spinal bones which makes me a bit nervous.

The disc I'm looking at is called the Spinal Kinetics M6-L developed by the Spinal Kinetics company based in the US.  It has a polymer core and woven fiber annulus that provide shock absorption, graded resistance when twisting, and movement in all 6 planes of motion.  My surgeon agreed that it most closely mimics the natural spinal disc closer than any other artificial disc in existence.  More than 10,000 of them have been implanted as of March of this year, the vast majority of which have been in Europe.  There are no obvious design flaws that have been called out other than the unknown performance of the polymers in the lumbar spine over the life of the patient.  No significant flaws were found during testing where they simulated heavy loads far beyond what the disc would experience in the human body while being immersed in a solution which mimics the environment in the body.  I haven't been able to find a single report of a failure of the materials yet in all my hours and hours of research of the M6, however, they have not had many years to prove themselves, so there are no guarantees on what will happen over time.

I have been continuing to follow a blog of a 25 year old guy who had an M6-L implanted.  He has kept a very informative blog including all of his research and consultations with his various doctors about their opinions and experience on the different discs.  I have a link to it on the right and would suggest anyone considering an ADR, to read his blog and pay close attention to the links he has to the M6 testing data.  His results so far have been much much better than the results I had with a discectomy (even before I reherniated).  I do realize however, that this does not guarantee I would have the same results if I had an ADR.

I have also been doing lots of reading of a few online communities devoted specifically to ADR surgeries where I can read personal experiences of hundreds of people who have had different discs with different doctors.  My research has almost become like a second job and I usually spend several hours a night searching and reading as much as I can.  I think at some point though, you can do too much research, and you are left to realize that there are no sure things.  But I guess I get comfort out of knowing as much as I can ahead of time so that I at least feel like I'm making the best possible decision based on all the information available since this will most likely affect me for the rest of my life.

The roller coaster

I went in to see my surgeon the morning after I had the very strong, sharp pains and muscle spasms.  I was kind of walking like an 80 year old, being very deliberate in all of my movements.  He took one look at me and said, "You look like you're walking very carefully."  I explained what had happened and he said that it was most likely scar tissue ripping free and that while it could be very painful, it actually was not a bad thing as things just freed up.  He gave me some oral steroids and muscle relaxers and said to call back in a week if it was still giving me problems and I would need to get another MRI.  I felt pretty relieved, most likely no big deal.

Over the next week, I experienced more bouts of sharp pains and some hip and leg pain that would come and go.  I just took it easy, and didn't really do much.  At times, it actually felt better than it had in a long time to sit, but then would be bad at other times.  The muscle relaxers turned me into a space cadet and it was very hard to keep my thoughts straight enough to work.  After a week, I developed a pain in my heel, although I had done nothing to my foot.  I was getting worried, and I decided I had better call my doctor again.  He said we needed to get an MRI to see what was going on, since if it was scar tissue, I should have been feeling better by now.

So I got in for my 3rd MRI, this time at Abbott.  I got in for a quick 5min discussion in the hallway the day after the MRI as he was completely booked, but agreed to overbook me into his schedule.  He said it looked like I had re-herniated a small disc fragment. 

He guessed that it was from doing pullups (although he had not only cleared me to do them before when I asked him, but had said they would help to take the load off my disc).  He guessed that this might have torn the disc apart a bit and let the fragment out.  He said he didn't have a lot of patients that did pullups and would probably tell his other patients to wait to do them in the future.  In any case, he said the fragment should reabsorb into the body in a couple of weeks.  But the fact that I reherniated meant that I still had a hole in the back of my disc which was not healed.  This was what was really bad.  After 4 months of sticking to a plan and being careful and doing absolutely everything my doctors and physical therapists has told me, my disc had not healed like it should have.  I don't blame the surgeon for telling me that pullups were ok and then having him suspect that they tore the disc apart.  The tear in my disc was quite large (which they didn't know until they opened me up for surgery), and combined with the fact that my disc just didn't want to heal no matter what I did, I was pretty convinced it was just a matter of time before something like this happened.  There was really nothing I could have done, but it still was like a punch in the gut.

Over the next couple days, the pain in my heel intensified to the point where it was hard to walk.  I understood this to be due to the disc fragment pressing on the part of the nerve that ran to my foot.  A few days later, I woke up and my heel felt fine, but I started to experience intense back, hip, and calf pain.  This pain got steadily worse and worse until it was at a level worse than my pre-surgery pain.  I'm guessing that the disc fragment had moved to a different spot and was causing this new pain.  I would experience some variability in my pain as it would sometimes feel much better for an hour and then come back.  I attribute this to the fragment possibly moving around.  One day, the pain was so bad, I had to take my first day off of work due to the pain because I couldn't concentrate well enough.  I was feeling pretty crappy and despondent.  Just when I thought I would be able to start getting back to a normal life, I'm now worse than ever.  This seems to be a never ending ordeal.

I had another dr. appt. with my surgeon and by this time, I was in extreme pain and was unable to walk without limping.  He suspected that perhaps the herniation had gotten worse and ordered yet another MRI. 
I had been doing a lot more research on disc replacement since the pain had been intensifying and I was becoming more and more convinced that my disc just would never heal properly.  It never healed on its own when I had the small disc tear, it never healed on its own after I herniated it, and now after surgery, it had also refused to heal properly.  I printed our a binder full of information about the disc I was looking at and the doctors in Europe who use it and brought it with my to my appt. and gave it to my surgeon.  He was familiar with the particular disc and said it looked like the best one out there today.  Unfortunately, since it is not approved by the FDA yet (despite being used successfully in Europe for some time) it is not available in the US.  He said that it could be an option, and that he would work with me and treat me when I came back if that is what I chose to do.  He had concerns that there was a possibility that the disc fragment would need to be removed surgically first before doing the disc replacement due to the location of the fragment which would make it impossible to get to when disc replacement, but we would need to get the MRI and see.

So off I went the next day to get my 2nd MRI in the last 12 days (this was on June 14th), my 4th MRI since my whole back ordeal started.  The surgeon called the next day and said, that it didn't look like the herniation had gotten any bigger, but that it hadn't changed much either. 

He suggested I get an Epidural Steroid Injection to help with the pain and buy myself some relief until we decided what needed to happen.  This would make 5 injections since the start of my back ordeal.

So on Friday, I had a friend generously drive me out to the special procedures clinic in Plymouth.  I had been in a lot of pain and the car ride out, combined with the long wait in the waiting room had driven my pain level up to an excruciating level.  They took my BP and it was 160/87 and my hands were shaking.  I rated my pain as a 9/10 and the nurse looked at me and said, "I'm just going to put down 10/10."  I limped into the procedure room and they did the injection, in which they also injected an anesthetic in addition to the steroid.  Luckily, this had an immediate effect and I felt a lot of relief.  They took me back out and my BP had dropped back down to close to normal and I could walk without limping.  The anesthetic they inject provides a lot of instant relief, but usually wears off overnight.  The steroid they inject helps to reduce the irritation and inflammation of the nerves and can take a few days to a week to take full effect and can last anywhere from a week to several months.  My past experience has varied quite a bit.

So the night of my injection, they instructed me to try and do normal, non-strenuous activities to see if the anesthetic helped.  They use this as a way to confirm if the pain is coming from the place they think it is.  If the pain goes away, they know that the pain was coming from the place where they injected.  If not, it must be from somewhere else.  It is often hard to localize the exact source of pain in back patients due to the numerous structure that can have problems that all cause similar pain.

I felt much better that night and was able to go out for dinner with some friends and walk to a couple of places in their neighborhood.  I think I sat for 2.5 to 3 hours with only some minimal discomfort/tiredness which was nice.  But I knew it would not be as good in the morning once the anesthetic wore off.
Sure enough, the next morning, the pain was worse, although not as intense as before the injection.  It can take a few days for the full effect of the steroid to kick in.

This brings us up to the current day.  My pain is a bit duller and not as sharp as before the injection, but it is still there.  I know this is just temporary as the injection will eventually wear off and I'll be back to where I was.  I have an appt. with my surgeon on Thursday to discuss next steps and I'm going to push for a more aggressive approach.  It is now nearly a month after I re-herniated my disc and more and more time goes by as I'm in pain and this isn't getting better.  I know a disc replacement will most likely mean several more months of planning, a risky surgery, and recovery but I just want to get back to being better and start on the path to that goal as soon as possible.

"Recovery" from surgery

As many people who have had discectomies experience, I had an immediate reduction in pain after the surgery.  They sent me home with narcotic pain medication, which I did not need at all since the post operative pain and the pain from the incision was nothing compared to the pain I had been in before the surgery.  This is due to the nerve being decompressed during the procedure.  I was quite hopeful, but I knew I had to take it easy and be very diligent about giving my disc time to heal over since I was now at a greater risk of re-herniation due to the hole in the back of my disc they had to make to remove the protruding disc material.  One wrong move could cause more disc material to come out of the disc and re-compress the nerves again.  It is definitely a situation in which feeling better does not necessarily mean you are better.

After getting home, my mom stayed with me for about a week at my house to help out, which I greatly appreciated.  I would spend my time lying with a pillow under my legs and getting up every hour or so to pace around my house for about 10-15minutes.  One of the risks of the surgery is that scar tissue can form around the nerves and cause pain.  Scar tissue is also very hard to remove and walking helps keep the nerve mobile and prevents scar tissue from adhering to the nerve itself.  So I had a very set schedule of walking which I stuck to diligently.  I also was not allowed to lift anything over 8lbs for the first 3-4weeks.  To put this in perspective, a gallon of milk is about 8lbs.  Also, no bending, no twisting, and only limited sitting were allowed.  So I was pretty much just watching movies, walking, tv, walking, playing some wii, and more walking.  My friends and family were awesome and came over to visit and brought me movies and food and just hung out.

After two weeks, my mom went back home and I returned to working.  I work from home and could do my job while continuing my recovery routine and laying on my back when I wasn't walking.  The doctor had warned that sitting could take a while to be comfortable again.  It was a pretty long road, and I felt couped up and stir crazy.  Unfortunately, the winter was a particularly bad one, so it was even difficult to go outside and walk due to all the ice on all of the sidewalks.  Every day felt like a week, but I was on a mission to make sure my disc healed properly, so I stuck to my routine.  Spinal discs do not have a direct blood supply and therefore get their nutrients kind of like a sponge by taking them from the surrounding fluids.  Walking gently compresses and decompresses the disc and this pumping action facilitates the transport of nutrients into the disc.  All the doctors said, walking was probably the best thing I could do.  I took glucosamine with MSM along with a hyaluronic acid and collagen supplement and drank lots of water and stuck to a good diet.  While there is some research to support that those supplements help with joint problems, and it is known that those compounds are all present in the disc material themselves, there is no hard evidence that they  make a big difference.  I thought that if there was even a chance that they would help, it would be worth the cost.  I would take them a few hours before walking along with a large glass of water in hopes that they would be at their maximum concentration in my bloodstream when I would be walking and therefore get into my disc.  I didn't know any of this for sure and was more of a theory, but based on everything I had been told, it sounded plausible.

After a solid month of this routine, and nearly going out of my mind at times being so restricted in what I could do, after my 4 week follow up with my doctor, I started a month of physical therapy.  This was the 3rd physical therapy location I had tried since the start of my ordeal.  I went twice a week and we basically just worked on gentle core strengthening exercises that I could do without bending my spine too much, along with some time on the arm bike, the recumbent bike, and some leg work on the Pilates machine.  We gradually increased the exercises, but they were still pretty tame.  I did the exercises they gave me as homework everyday diligently anyway.  If it even had a chance of helping, I was going to do it.  It felt great to be able to do at least something half way physical.  I was still having difficulty sitting for very long, which was similar to before the surgery, but the surgeon had said this could take time to come back.  I still had to lay down all day while I worked and I could only really sit for about 45mins without starting to get some pain.  I would stop immediately when I felt something since I did not want to squish the disc back apart and impede its healing.

I completed about a month of physical therapy and was feeling better, and more confident in my movements.
I really wanted to get back into some regular routine of working out so I came up with a set of moves that was comprised of all exercises that my physical therapist had given me and the addition of pushups and pullups.  I had some concerns about doing pullups so I asked the physical therapist who said it would be fine as long as my surgeon said it was fine.  I asked my surgeon and he said they would be fine and would even probably be good to help take some of the load off of the disc.  This disc should be healed enough by now.

So at nearly 3 months post surgery, and being done with physical therapy, my surgeon said he didn't need to see me back for anymore follow ups unless I had problems, but to remember that I was still at higher risk for re-herniation for a bit longer so not to do anything too crazy, but I should have been through the riskiest part.

So I continued with my homemade routine of PT exercises and pushups and pullups about 2-3 times per week for 3.5 weeks.  I tried going for a few short jogs for the first time in over a year and they felt ok.  I would ease into anything new I tried.  I had no intention of doing anything that would remotely endanger my disc (like picking up a weight) until at least 6 months out.  I was still having some difficulty sitting, and would get soreness after about 1.5 hours.  I also noticed if I sat for too long, I would be sore for a day or two after.  I was still laying down all day for work and still had to basically build my life around not sitting.  The not sitting part was pretty tough.  Long car rides were still out of the question.  You don't really realize how much you sit during a day until you can't do it.  I had been hoping that this would have been better by now.

Then at the end of May, nearly 4 months after my surgery, after finishing one of my exercise sessions of PT exercises, pushup and pullups,  I laid down on the floor for a few minutes after doing the workout.  I got up and was walking across the living room to my kitchen and something happened in my back.  I had an extremely sharp pain and intense muscle spasms.  My initial thought, was "Oh my god, what just happened?"  Nothing felt wrong when I had been doing my exercises.  I walked into the kitchen and was hit with another round of muscle spasms.  I grabbed an ice pack and went back into the living room and laid on the floor.  My heart started racing, what was going on?  The only time I had ever had muscle spasms before was when I herniated my disc nearly 14 months earlier.  After about 30mins on the floor, I slowly tried to get back up and was hit with another round of spasms and pain.  I just laid on the floor the rest of the night and knew I had to call my surgeon the next day.  I had more spasms and pain when I got up to go to bed.  I called the next day and luckily there had been a cancellation so I could get in that morning.