Mr. Nick Boeree - Killed in Motorcycle Crash

I just learned that the surgeon who did my artificial disc surgery in England was tragically killed in a motorcycle accident this week.  Link to article  Another Link I can hardly express my profound shock and sadness at this terrible loss.  Mr. Boeree was an excellent surgeon and one of the most kind and friendly doctors I ever had the pleasure of meeting.  Everyone that I have ever met that had an encounter with him also said the same.  He literally gave me my life back after nearly two years of pain and other failed treatments/surgeries.  I can't help but think of his friends, family, co-workers, and his other patients and how they must feel about this sad loss of such a great man who helped so many.  My heart goes out to all of them.  Thank you, Nick, for all you did for me.

Email from Mr. Boeree

Here is the email response I got from my surgeon in the UK, Mr Boeree after he viewed my 6 month xrays:

Your X-rays look really good.   You can see that you have good movement through the disc replacement (flick between the flexion and extension views).  The implant is clearly completely bonded to the bone now and is essentially part of you.   It is working well and remains in an excellent position.

 

There aren't really any additional restrictions over and above those that I suggested at the outset.   I am pleased to say as well that I have not seen any problems with the M6-L and I simply get more enthusiastic about the implant the more I use it and the more we see really good outcomes such as yours.

From this point, my surgeon in the US wanted a follow up in 6 months and then probably only once a year after that.  

 

At this point, I feel really good, although I think I will always be extra cautious with my back.  I avoid extreme movements with my back like bending forward and exerting pressure to try and see how far I could bend, or extreme twisting.  Normal bending and twisting are fine, but I don't try to force my range of motion past what comes naturally.  I used to twist to crack my lower back and I do not do that at all anymore.  I used to do yoga that involved lots of bending and twisting, which I no longer do just to be safe.  I'm also cautious about lifting very heavy objects (think 50lbs or more) and will probably try to avoid moving furniture up stairs from now on.  Perhaps my new disc could handle all of this, but the risk of finding out that it couldn't is not worth it to me knowing what would be on the other side if something went wrong.  I'm waiting for spring to try some jogging, although I feel like I could try it now if the weather was nicer.

 

I'm still probably a little gun shy after all I've gone through, but at this point I'm very glad I had the surgery and very happy with the results.  I don't think my back will ever be as good as it was before the injury, but it is light years ahead of where it was before the surgery.

6 months = all good

I have reached the 6 month post-op milestone and am still doing great.  No major problems to report.  I still have some minor leg sweating from time to time, but it is less than it was.  I can sit for as long as I want without pain, but after a long day of sitting all day, I sometimes notice some slight decrease sensitivity/numbness in the outside part of the soles of my feet, but it is very very minor and goes away after laying down for a little while.  Not an issue at all, just something I noticed.  I have not tried any jogging as it is winter here and I figure it best to wait until all the ice is gone, but I feel like I could if needed.  Although, I have switched to using an elliptical for my cardio as I figure it would save on the repeated impacts the disc would have to endure.  I don't need to go back for xrays again for another 6 months and then just once per year after that.  Here are the 6 month xrays:

5+ months

Just a quick note to say all is still good.  No problems.  I've been able to make it through long days of work consisting of sitting all day with little to no discomfort.  After a long day of sitting for work, I sometimes notice some very slight numbness/decrease in sensitivity along the outside edge of the bottoms of my feet, although this goes away after laying down for a short time and does not cause my any problems or discomfort.  I have not taken any painkillers for my back since my post surgery healing phase.  I've been exercising using my elliptical machine, resistance bands, and my physical therapy circuit which seem to be fine.  Let's hope it stays this way for a long time.

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.