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.