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John’s Story Labor Day, 1999 Why I bother. It is not my style to think deeply about who I am. My life is more typically characterized by reaction to events, issues, stresses and responsibilities of marriage, children and work. So I now find myself, after surgery, spending many hours on my back contemplating where I have been in recent months, and what caused me to arrive at this point where waking days blend into nights, and then days again. The questions surface incessantly. What’s next? Will I have a life again? Will I play golf with my son? Will I romance my wife? Will I dance with my daughter? Will I work again? Will regularity return? These questions haunted me only a week ago, causing me to wake and briefly cry over the uncertainty of it all. It only seemed appropriate to emote at such a traumatic time in a life. Well there seems to be a rainbow left for me, and so I will write so that others who are feeling deep blue can look ahead, beyond a mere operation. Who I am. I’m 49, an attorney in the Los Angeles area. I’ve been blessed with a wonderful wife, Marci, and two great kids, Michael, eleven and Brooke, nine. We live in a suburban hideaway with safe streets and good public schools. Seasons pass with baseball, basketball, and a myriad of other activities pointed squarely in the direction of the kids. This is fairly easy, since my law office is only a mile from home. The office overlooks a beautiful lake. While many attorneys hate their work, I have, for 22 years actually enjoyed helping people in this profession. My trial work in business and personal injury requires a lot of driving, standing and walking. Files, which are often large, must be schlepped to court or home. A strong back is a prerequisite of the job. My Back. I learned at about age 30 that my back would get "sore" after golf or gardening. Nothing an Advil couldn’t handle. A couple minor auto accidents in the early 90s gave me some increased discomfort, but really nothing serious. I knew about spondylolisthesis (usually a congenital condition where one vertebrae slips forward over another), and I knew I had it. My 96 year old grandmother also had it, but never needed surgery. Fortunately, I was largely symptom free for years. In the past 20 years I would jog regularly up to 7 miles, worked out at the gym, skiied, golfed, gardened, and stayed in pretty fit. Then in the fall of 98, while catching fly balls with Michael, I stumbled back and did a rather ungraceful butt plant. Shake it off. My back was sore, and I noticed a little "sciatica" when I walked. Take Advil. "John, why are you walking like that?", my wife would sometimes mutter. I continued to play golf. Saw a chiropractor who did some manipulations, but I started to get worse. The outside of the right leg and calf would ache if I stood too long, or walked too far. It was getting worse and I needed an MD. The chiro ordered an MRI at my request and saw what could best be described as ugly. I had degenerating disks at L4-S1, Grade 2 Spondylolisthesis, and after "flexion-extension" films confirmed that the spine was "unstable", I was in trouble. A neurosurgeon studied the films, squeezed his eyebrows repeatedly then said, "er, well, John I would suggest you try and exercise program for awhile…it might help" His tone lacked a spirited optimism I was seeking, so I said okay. I tried various forms of exercise, including hours at the gym, Medex back strengthening physical therapy, crunches till I thought I’d die. My body looked great I was told, and I felt great. The doctor said I couldn’t really hurt myself, so I went skiing in January ’99. The falls on ice aggravated the leg pain, which never really went away. Advil no longer worked, so I tried stronger medications which had no effect on the plyers grip-like pain I endured when I stood more than 5 minutes. Now going to McDonalds had to be planned for off-peak hours, to avoid lines, lest I wished to dine a la Toyota. I quit physical therapy which did be no good, and spent those dollars on books, massage, and golf, which surprisingly did not make my back worse. Now I had to rent a golf cart, and I was feeling old. Scouting now did not mean looking for prospective kids for my son’s team. The search for a bench became priority one. I began to take up conversations with others like me, who would sit outside on a bench while their families shopped at the mall, or waited in line at a theme park. Waiting in line at the DMV for a handicapped parking placard was not a pleasant time. My neurosurgeon told me that I might need surgery if the therapy did not work. He said it would probably require a fusion because of the spinal instability, but he did not do those surgeries. I asked who he would use. He mentioned Dawson at UCLA and Watkins, at USC which I did not even write down. I bought a recumbent road bike and started riding up to 40 miles at a time, figuring if I did not fix myself, then I’ll be in the best damn shape when they sharpen the knives. I asked around about doctors, and kept hearing these two doctors spoken of repeatedly. So I saw Dr. Dawson who looked at my MRI, took some more flexion and extension x-rays and calmly announced that the only way to fix me was to fuse the spine including putting in screws and rods in the back. Just one level at L5-S1, with a bone graft from my pelvis. He would do a posterior (from the back) approach, and I would have an 85% probability of "fusing". I asked what would happen if I did not fuse. He said the hardware can break (like bending a paper clip over and over) if the bone grafts don’t fuse, and a second, more involved surgery would be required. But I was a good candidate, since I was in shape, and a non smoker. "What alternative is there to surgery?" I asked. He said there wasn’t anything he felt would work, so why waste my money. I thanked him and left, feeling a bit like a victim. So I decided to get a second (really third) opinion from Dr. Watkins, who is spine surgeon to the PGA tour. He looked at the films and said, "Yup, we can fix that…anterior-posterior 360 degree fusion with screws rods, bone graft, etc." Twice the surgery recommended by Dawson. "Better chance of successful fusion, with a 360, he said, and I would also do a two-level fusion" "Alternatives?", I calmly sought. He said I could try a special back strengthening program he designed and an epidural nerve block. I tried both with no success. Now with two somewhat diverse opinions, I called saw a third spine surgeon only to learn that both opinions were medically supported, and both doctors were top surgeons. Less is more, or so I thought. It would be Dawson. I looked to Marci who bit her lip softly and agreed. August 9 would be the date, and blood would be donated beforehand. As the date approached, I played my last rounds of golf, hobbled through museums and amusement parks, and bicycled like a mad man. Something told me I was in trouble, I would not be able to do these things for a long time, if ever. I surfed the web looking for information about the surgery, and complications. I read just enough to scare myself. A little knowledge….you know. The alarm went off at 3:00 am, but I was already awake. My stomach growled as I reached the hospital at five. The hospital staff was kind, and the doctor was warm and professional when he arrived to greet me on the gurney and explain again what he would do. It would be like a Sunday project in the garage, with drills, screwdrivers, and saws. The only difference was the blood. Nonetheless, Dr. Dawson was reassuring, and a distraction as the student nurse nervously tried and once failed to insert an IV into a vein in my left hand. Beds were filling around me, and the time was near. I actually deposited a tear on the pillow when the anesthesiologist announced she was going to add something to the IV to relax me. I knew that there was no turning back. I kissed my wife, and that was my last memory until recovery. I woke up, mentally pinched myself and thought I must be alive, at least I thought so. Good, so far. Soon my wife and family were greeting me as I was wheeled into my room. Not and ICU. Things were looking up. My wife said the doctor said everything went as planned. Actually better, since he did not need the bone graft, since there was plenty of bone available from the laminectomy part of the surgery. Great. I don’t remember much pain at first, and could control spasms of electric pain with morphine button. I had a catheter, so I did not need to move, and didn’t that first night. The next morning, August 10, I was greeted by a physical therapy student, who announced he was ready to stand me up. I thought he was out of his mind. What did this guy know. I hurt so bad just scratching my ass, and he thought I should stand up. Where was his boss? What did he know? The lawyer in me wondered if a legal case was developing. My mother raised me to be fairly compliant, so I said okay. It’s important to stand and walk early to minimize scar tissue formation I had read. He showed me how to use my hands to push on the bed while lowering my legs to get seated. I succeeded, but the pain was fierce. Then he had me stand and I felt the most horrible pain in my right leg that I had ever endured. Something was wrong. My research indicated that the leg pain should be gone after a decompressive laminectomy and fusion. It wasn’t, and I was confused. Over the next few days, the doctors came and went, each restraining their concern over my severe leg pain. The young residents were arrogant as hell, and I held back from offering a piece of my mind. I could walk up to a few minutes but every step was an event. I was put on non-steroidal anti-inflammatory medication, in the hope that my nerve root was inflamed by the surgery. I went home after the 4th day. At home I tried to walk "through the pain", keeping a log of the time I spent dragging my leg around the house. Seven or eight minutes at first, but the fatigue got to me. The doctor called and said I should try taking some steroids to reduce the inflamed nerve. I did, it didn’t. By the time of my first post-op visit to the doctor on August 19, I couldn’t walk even 3 minutes. Vicodin was by my side. I couldn’t sit at all, and I was scared. Why didn’t I just live with it? I played golf the week before surgery. I walked around the Getty Museum the day before. Now I was really crippled, and the doctor immediately agreed. An MRI was ordered stat which was essentially normal. Nonetheless, the doctor phoned me with the news that he would have to do a second surgery as soon as possible. Apparently the space around my L5 nerve was adequate on film and on the operating room table, but changed significantly when I stood up. He would have to separate L5 and S1 more, holding those vertebrae apart with a longer rod. He would also shave more bone around the nerve (called a foraminotomy). Was this guy kidding, or what? Well, friends, you can imagine how my confidence was shaken. What next? I chose the wrong doc, I thought. I’m part of the 15%, damn….same crummy luck. By now I had discovered Leslie’s wonderful spinal fusion web site, and made many friends on line. You all know who you are and what you did for me. I had no choice but I would have to wait 6 days, until the 30th before the operation could be done. I felt as if I would have to completely start over, and now things might be much worse. The doctor’s confidence was not shaken, and he said the problem could be fixed. August 30 (one week ago, as I write) I had the surgery. I woke up. The pain didn’t matter anymore. I only wanted to see that PT student again. Would I walk tomorrow or ever? No student would arrive. The same interns and residents would come by but without any arrogance, this time. They knew I had made the wrong turn on the way to the get well picnic. Finally the moment of truth arrived. I stood, and to my amazement, the leg pain was GONE. A soft breeze could be felt from the hospital vents and as hope returned. My first real smile in 10 months. During the 47 hours in the hospital this time, I found myself continually pacing the halls, often times with my derriere hanging out below the cinched corset, since I could not reach back to tie my gown. Little did I care, since I was walking without that vice in my leg. The back pain was severe enough, but a refreshing change from what I had been living with earlier that week. And so I went home. The faces on my family had changed. They too had been covering their nervousness, often despair at the changes being faced by their loving companion. Like sweet victory for us all,. I have continued to walk for the past week, timing and logging every second so I can improve without overdoing it. The back pain still wakes me several times a night, but my glee over what looks like a bright future masks most discomfort, even better than a pill. I look forward to checking my email and chatting with many people I have met from Leslie’s site. I sometimes feel a little guilty that I am improving faster than these new friends. But it would be unfair to feign pain when so many visiting the site are looking for truth, not to mention hope. I am reminded by many that set backs are the norm, and that fusion is an uncertain science. But one week after surgery two, I can say there is good reason for hope. Hopefully I’ll have little to say in future chapters about my recovery. Slow and continuing will do just fine. All, be well. John John has been kind enough to offer anyone interested to e-mail him.. |
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The Surgery:The Week Before * The Day Before * The Day Of * In The Hospital * Going Home * Let's Talk Pain * Home Again! Other Areas:Created and Maintained by Leslie Davidson.
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