operation

Unfinished Business, Part 1

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I am such a procrastinator.

I posted twice in March, both open-ended stories, and at the end of April I find myself with a couple of loose ends to tie up. I’ve really got to do a better job of this. Not for the sake of the few readers who may accidentally stumble upon this modest collection of ramblings, but for the sake of my own self-discipline, which has been sadly lacking as of late.

In early March, in a post entitled “Here We Go Again!“, I told the beginning of my gallstone adventure, and left off, as I remember, having the complaint but no firm plans for its care.

After another week had gone by, I called the Medical Center and left a message on their machine for Dr. Daday (are there any medical facilities left that have actual people manning the phones?), reminding him that I was not having the greatest of times, and was counting on him to help me out. He returned my call the following day, telling me to call Dr. Vasily Sawyena a call. I called and made the appointment, which wasn’t for another week. Seven more days of agonized eating!

I showed up at his office a few minutes early, knowing there would be a mountain of paperwork to fill out. When my name was called, I went into the exam room and met the doctor.

“Let’s see,” he said, looking through a folder that contained the paperwork sent over by the medical center, “you’re here for a hernia, correct?”  He said it so seriously that even today I’m not sure if he meant it, or was merely starting the interview off with a joke. In any case, the session was short and sweet. He just confirmed some information and told me he could do the procedure the following Tuesday.

Afterward, I was going over a few things with Linda the the desk. Dr. Daday had told me that the procedure was no big deal, no hospital stay, and I should be back to normal in a couple of days. I wanted some verification.

“Well, yes, you can probably go back to work on a couple of days. But you still have to be careful. No lifting anything over ten pounds for a month or so.”

What? That wasn’t back to normal for me!

I asked about exercise, specifically my MMA workouts at Tiger’s.

“Oh, I don’t think so,” she said with some doubt.

Dr. Sawyena happened to walk past at that moment.

“Doctor, he does karate.”

“Not for the next six to eight weeks, he doesn’t,” the doc replied without slowing down.

“It’s still major surgery,”  Linda explained to me firmly.

Turns out that what Dr. Daday meant  by “no big deal” was a comparison to the way gall bladders used to be removed, with six-inch incisions, week-long hospital stays, and up to six-months of recovery. My procedure would be much simpler: a few barely noticeable cuts, gall bladder removed through the navel, dissolving stitches, no muss, no fuss, no months of lying around getting better afterward.

I was curious about what changes I’d have to make in my diet. I asked my best friend, Google, what they knew about it.

“AVOID THESE FOODS

Eggs (Research showed that eggs caused symptoms in up to 95% of patients. Try substituting flax seed gel in recipes that require eggs for the “glue”. That’s 1 TBSP ground flax seed to 3 TBSP hot water. Let cool and add.)
Pork
Onions
Fowl (turkey, chicken)
Dairy (milk, cheese, cream)
Gluten (wheat, barley, rye, spelt, kamut, etc.)
Corn
Coffee
Oranges, grapefruit
Nuts
Trans fats, Hydrogenated, partially-hydrogenated oils
Margarine
Fried Foods
Saturated fats
(even coconut oil until feeling better)
Red meats
Coffee, regular or decaf
Spicy foods
Chocolate
Ice cream
Black tea
Alcohol, beer, wine, liqueur
Fruit juice
Carbonated water
Tap water
Turnips
Cabbage, cauliflower
Colas and all sodas
Oats (for some people)

Avoid all artificial sweeteners, sugar, preservatives, refined and bleached foods (like white flour)

Avoid all possible food allergens.”

What the hell? What am I supposed to eat? Bread and bottled water?

Happily, the more sensible (as well as credible) medical websites, such as WebMD and Oprah.com, suggest that I would have to make no dietary adjustments. I decided to follow their advice.

The Big Day arrived. I got a call Monday night telling me that the surgery would take place the following morning at 9:30, and I should show up an hour earlier to take care of the paperwork and other preparatory matters.

I arrived at the scheduled time, filled out the paperwork, and put on the cap and gown. One of the prep nurses remembered me from last summer’s back surgery. Great. Not only does Foursquare tell me I’m mayor of the Medical Center, the Surgery Center and the Hospital, but now I’m becoming a familiar face in the operating room. Where everybody knows my name.

I was wheeled down to pre-op, where I re-identified myself to several personnel, including Dr. Sawyena, who stopped by to say Howdy. The anesthesiologist started an IV drip in my arm. I happened to glance at the clock over the door: it was 9:20 a.m.

The next thing I remember was almost waking up, and a nurse asking how I felt. I remember saying, “It hurts.” Because it did. She said she’d get something to help me feel better. Or something. I don’t remember for sure. I was only almost awake.

I regained my full faculties lying in the spot I started out from, in the prep area upstairs. As soon as I had shaken off the effects of the anesthesia, I was given a Lorna Doone and a small apple juice to  make sure I could keep food down. When that was happily established, the nurse told me I could get dressed while she called Jill; as soon as she got here, I could go home.

Shortly afterwards, she told me she had dialed Jill’s number, but it had gone right to voicemail. I asked the time; it was 11:15.

What??? 11:15? So in less than two hours, I had been prepped, the surgery had been performed, and now I was dressed and ready to go? Gotta love modern medicine. This is why I believe my 17-year-old will be around to see the start of the 22nd Century.

Anyway, to bring this runaway narrative to its conclusion, I’ve survived five weeks sans gall bladder with few ill effects. I’m planning on going back to Tiger’s in a couple of weeks, providing the lymphedema flare-up in my right foot clears up.

Yes, it’s always something. Getting old’s a bitch!

Here We Go Again!

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The past few weeks have certainly been interesting. I almost thought I’d traveled through time to revisit January of last year (see several posts I made then about my kidney stones, lymphedema, herniated disc, arthritis, et al), but no, this is a new set of travails.

Since my current medications cause me to occasionally lose focus, I won’t try to relate the whole story again, but instead refer to a recent email exchange between an old high school friend and myself. He felt compelled to write after seeing a few stutus updates on my Facebook page that made him wonder just exactly what was going on.

My friend wrote:

“How are you doing? I catch the occasional status of MRIs hospitials, issues… Have some broccoli and chicken sausage. Are having a world tour for your 60th birthday – Virgos on the road?”

My reply:

“Yes, the past few weeks have been particularly interesting. At the end of January, I was doing warm-up exercises in my karate class. During an innocent “Turn your head to the left”, I felt a sharp pain starting in my neck that traveled down into my left arm. I didn’t feel much different during the rest of the class, but by the end of the following day, I felt (or at least looked) much like Igor in the old Hammer Frankenstein movies: head cocked awkwardly to the left, left arm held in an unnatural position. Couldn’t sleep at night, of course. Any movement at all would make my shoulder protest loudly.

Had an MRI done on my neck and shoulder. The shoulder snapshots revealed an inflamed tendon running into my left bicep. The neck shots were useless. The pain in my shoulder refused to let me lie still, so there was too much movement to see anything.

The following week I was the recipient of a cervical epidural, which decreased my symptoms by about 75%. A second try MRI showed the culprit was arthritis pinching the tendon, or something. Those doctors have their own language meant to confuse you to the point that you just start nodding your head in agreement and digging your American Express Blue card out of your wallet. They figure another series of injections will get me back to normal. My next one is scheduled for next Monday.

The other current excitement started a couple of weeks ago on the Thursday night after my epidural. The steroid they’d injected had eased my shoulder pain to the point where I was finally able to look forward to a good night’s sleep. No luck. In the early hours of the morning, I awoke to a painful burning sensation in my gut that no amount of Tums or belching could sooth. During the day, when I ate, the food traveled to a certain point in my tummy, then it seemed as if it pressed against something that caused great distress. I was certain I was giving birth to a nice ulcer.

That Sunday evening, I was sitting in my recliner, contemplating the universe and watching Cameron save the world from zombies on his Xbox whilst sipping on a glass of Pinot Noir. When my glass was empty, I stood up with the intention of getting a refill. I suddenly felt extremely dizzy. Cam asked if I was OK, and I said I’d stood up ‘way too fast. I took a couple of steps into the kitchen, then went down hard. I came to sprawled out on the kitchen floor with Cam hovering over me, asking if I was all right.

I got to my knees and waited for my head to clear. When I felt OK, I told Cam that I was going to go lay down for a few minutes. Halfway to my room I blacked out again. Cam helped me to my bed. I told him that if it happened again, to call 9-1-1. His mom told him he should have called the first time I passed out, but I didn’t want to spend $600 to find out I was OK.

There were no further incidents. Every time I stand up, it’s very slowly, and I wait to make sure that I can take a step without falling over. I have a nice bruise on my chin courtesy of the kitchen table to remind me to be careful.

Finally making a long story short, I visited the doc the following day, and the diagnosis was gallstones. He had suffered with them some ten years ago, so he knew what I was talking about. (Of course, he should know what I was talking about anyway, being a doctor and all). He ordered an ultrasound and some blood work, which confirmed his suspicions. He told me that I should have the surgery as soon as possible, and he was going to call a few surgeons and see who was available to do it now.

That was a week ago. I’m certain he hasn’t forgotten about me. Maybe all of his surgeon friends went on a golf outing together.

Other that already telling everyone I’m a sexagenarian, I haven’t given the sixtieth much thought, as if ignoring it will keep it from coming. I’m hoping the Medical Center will name an exam room after me, since there have been weeks I’ve spent more time waiting to see one of the doctors than I’ve spent at home sipping a martini. If I don’t get at least a card from the staff, I’ll be disappointed; I’ve had to recite my D.O.B. to almost every doctor, nurse, PA, internist and receptionist so many times that there can be no way they don’t know when my birthday is.

Anyway, I have plenty of time to plan for celebrations. Of course, it seems like only yesterday that I was thinking I had plenty of time to deal with having a teenage son. “Time passes by and leaves you with nothin’, mister, but boring stories of glory days. ” – Bruce Springsteen. “Anybody can get old. All you have to do is live long enough.” – Groucho

*Sigh*”

And that’s the scoop. Still waiting for word of my pending cholecystectomy. Every meal is an adventure in discomfort.

 

More to follow, I’m sure.

Recovered

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So here we are, two months after my surgery, and I’m allegedly ready to return to normal activities, according to Dr. Shakil and Chris the Therapy Guy. The doc has cleared me for returning slowly to MMA training, and says I can make the six hour drive to see my mother in Ohio as long as I stop and walk around and give my back frequent breaks.

I have three more physical therapy sessions scheduled for next week, then Chris says I won’t need him anymore.

Thing is, I still get leg pains if I stand too long. Not like they use to be, granted, certainly not as intense, but I do have to sit down on occasion. It’s allegedly not unusual, and I’m told to be patient.

The Patient Patient, that’s me.

But what am I going to complain about when the pain goes away and I’m dancing with the stars again?

I’m sure I’ll think of something.

Recovery

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There isn’t much to say about my recovery, because I haven’t much. Recovered, that is.

After the doc OK’d me to resume certain activities at my two-week checkup, I went back to Jill’s, gathered my goodies, and drove back to my place. Cameron accompanied me to help out where he could (starting with transporting all of my stuff from the car up to my humble abode). I went back to work the next day (don’t even get me started on the mess I came back to; I know they tried hard, but…anyway…). I was supposed to limit my workday to 3 to 4 hours, so I sat at my desk for 30 minutes, then reclined on the sofa in Jill’s office for 30 minutes (give or take; I had to jump up to answer the phone occasionally). As the days wore on, I sat at my desk until I hurt, then lay down until I started feeling better. Not exactly doctor’s orders, but you have to do what you have to do.

I was supposed to start physical therapy, but I never make things easy on myself if I can help it. Two days after I got the release from my surgeon, my old friend lymphedema paid me a visit, this time in my right foot. It didn’t quite get as intense as it did in January, but I was unable to get my foot in a shoe for two weeks.

In the meantime, I got myself a Get Well present, picture above.

When I was finally got with the program, Chris the Therapist put me on a 3-times-a-week schedule, and gave me a few exercises he wanted me to do three times a day, which I’ve (mostly) done.

The  thing is, though, it’s been six weeks since the surgery, and I’m still having problems. I’m hoping it’s all part of the healing process, because I did wait almost a year after first noticing the pains before getting serious about doing anything about them; that’s a long time to pinch your nerves. I wouldn’t be surprised if they’re pissed off at me and want to teach me a lesson. Fine. Lesson learned. Now go back to doing your job and leave me alone.

To be fair, although it hurts more often that it used to, it’s less intense; maybe a 7 as opposed to a 10. But it still hurts, and I wish it would stop.

I follow up with the surgeon again on August 3.

Convalescence

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It had been arranged when surgery was planned that I would spend whatever convalescent time necessary at my co-parent’s house (divorce counseling taught that this was more polite than calling her my “ex”).

She picked me up at the hospital and escorted me to my new temporary living quarters, which for the first night was on the  ground level of her split-level house. The room was our son’s “getaway”, where he hung out, watched TV, played video games with his friends, and noodled on his guitars. And now, keep an eye on his old man. She had a comfy little setup for me on the sofa. After getting me settled, she ran out and did some shopping for me: prescriptions for an antibiotic and a pain killer, toothbrush and toothpaste, other assorted toilet articles, baby wash, and the all-important plastic urinal. This was something I took special care with: it was one thing to dump my urine in my hospital bed, quite another to dump it on Jill’s couch.

After the first night, I felt like I could make it up the short flight of stairs to her TV room, which had a super-comfy couch, a huge ottoman that I utilized as a bedside table, and, most importantly, a convenient power outlet I could use to keep my iStuff charged.

For the next four days, I felt, and actually was, pretty helpless. Although I didn’t really have any pain, I was still weak enough to require help in getting off the sofa and moving around, which I did a few times a day to build up my strength. I couldn’t sit up (doctor’s orders), so my usual position was flat on my back, staring at a wall. The view I got used to is the picture illustrating “Place Holder”.

When Sunday rolled around, Hallelujah! I found that I was able to get off the sofa without any help. It was quite exciting. I talked Jill into driving me to my place (a second-story condo unit), so I could gather my mail, check email, and get some clean clothes. While sitting at my computer, I discovered why prone was the preferred position: after 15 minutes or so, I started feeling light-headed, and little pain gremlins started jogging from my incision to my shoulders and back. Most of my email was spam anyway, so I gave it up and lay in my own bed until I felt like making the trip back downstairs and out to Jill’s vehicle.

During the next week, I felt stronger every day, to the point where my daily routine began including a martini happy hour and sitting up long enough to have dinner. I quit taking my pain medication unless I was having a tough time falling asleep, because it did help with that.

The more I walked around, though, the more I noticed that my leg still hurt, sometimes (but not often, I’ll admit) as much as it did prior to the surgery. As I’ve mentioned, I was told that it may take a while before I felt any relief, but I was kind of hoping I’d be one of those who noticed the difference right away.

I was getting anxious about my two week followup visit with the surgeon. I was tired of staring at a wall most of my day; I wanted to get back to work. I wanted a proper shower; the baby rinse might have been keeping me fresh-smelling and bacteria-free, but I still felt slimy. While it was nice laying around doing nothing (at first), I was getting bored and ready to return to my normal life, in my own home.

When the Big Day came, the PA took me back to a room in the Pain Center, asked the usual questions, and gave me a nice present: she removed my dressing and stitches. She said everything looked good. I asked if I could shower, she said I could. Yay!

Soon the surgeon came in and asked a few questions, then gave his report: I could return to work 3-4 hours a day; I could drive very short distances (the vibrations wouldn’t do my repair job any favors); my lifting had to be confined to 5-10 pounds, and he wrote me a scrip for physical therapy. A note on my release form said, “Patient can work toward resuming normal activities within 6-8 weeks”.

All music to my ears.

I returned to Jill’s and packed  up my small store of belongings (including Cameron, because I wasn’t quite ready to be completely on my own yet), and drove my car to my own home.

The first thing I did was take a long, long shower. That seemed to do me as much good as laying on my back for two weeks.

NEXT: Recovery

The Operation

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OK. It’s been almost three weeks since the procedure, so I guess I’d better do some experience relating before I forget the details, or even that it happened. We old people forget a lot.

Arrived at the hospital bright and early as requested. A pleasant young nurse did the checking in, recording all my vitals, making note of all my conditions (macular degeneration, bulging disc in my neck, recurring lymphedema, etc), being all cheerful (because her shift was about over).

I was shown to what would be my room for the next 28 hours, a comfy little private room with the requisite flat screen TV and patient-operated bed. I changed into the stylish gown, slippers and head covering, slipped into bed, and, after suffering an IV needle insertion into the back of my hand, found myself being wheeled into the staging area near the operating rooms.

The gas passing team came in to hook up a bag of the good stuff into my IV, and reaffirm my medical history as I’d related to the earlier pleasant young nurse. I remembered something that I’d forgotten to mention to her: my acid reflux. I never think about it when it’s not bothering me, but when the anesthesiologist mentioned they’d be putting a tube down my throat, I thought back to my first lipotripsy. When it was over, my doctor told me I should have mentioned my reflux, because there was a problem when they started to put a tube down my throat. I mentioned this to my present gas guy, who made a note of it.

A few more folks wandered in and out, “I’ll be assisting the doctor”, “I’ll be with you in the recovery room,” etc., until the pre-ani made me nod off.

The next thing I was aware of was coming to in the recovery room. I was still a little groggy when the doctor stopped by. He informed me that, instead of the simple little discectomy I was expecting, he performed a discectomy on L4-L5, a discectomy on L3-L4, a laminectomy on L4-L5, a laminectomy on L3-L4, and inserted a spacer so hopefully there will be no reoccurrence of my problem. I said, “‘Kay.” He said I was allowed two activities: laying down and walking. Maybe short car rides if necessary.

I became aware of a little discomfort in the groinal area. The nurse attending me said they’d inserted a catheter into my bladder to aid in drainage. I remember asking how long it was going to stay in, because I found it to be very uncomfortable. She told me it might be an hour, it  might be a few hours, it might stay in all night. I said, “‘Kay. It’s just uncomfortable.”  A short time later she reappeared, saying “Good news! The catheter can come out now.” With that, she pushed down on about where my bladder is as she removed the catheter.

Given the choice again, I might consider leaving it in. For the next several days, I felt like like urinating constantly. When I was ensconced in my bed, I was handed a plastic urinal, which I had to maneuver into position between my legs whenever I felt the need, and I pretty much always felt the need, since they were pumping fluids into my body via the IV on a consistent basis. I was not allowed out of bed for a few hours, so I was ringing for the nurse pretty often to empty my jug.

Later in the afternoon, I was given my first taste of food in almost 15 hours, the Clear Plate: apple juice, broth, lime Jello, and tea. Yay.

I spent a literal sleepless night, with only two incidents worth mentioning:

I have already mentioned my constant urge to urinate, and the plastic jug I was using as a receptacle. At one point during the night, I felt the urge come upon me very strongly. I grabbed the jug, which had a goodly amount of previous urges splashing about. I positioned it quickly and opened the lid; but in my haste I held it at an awkward angle, and ended up dumping a cup or two of urine on myself. I’m sure the nursing staff has seen much worse, but it was embarrassing nonetheless.

The second incident was less embarrassing, but more frustrating. The apple juice gave me heartburn. Lots of it. I summoned the nurse and told her the apple juice had kick started my acid reflux, and could I get a Tums or something. She left and returned momentarily with bad news: during my initial check-in, I didn’t mention my reflux to the pleasant young nurse who took my medical info, therefore my approved meds did not include an antacid of any sort. And they couldn’t give me any until they checked with the doctor, whenever they could get in touch with him the next morning.

Hence the sleepless night: the constant urge to urinate coupled with my raging heartburn was not relaxing enough for me to get any shuteye.

When morning had finally broken, my appetite would only allow me some tea and half a piece of toast. By this time, the doctor had responded with an antacid appropriate to my particular condition, and I was told I could leave any time after breakfast.

I called my ride, changed out of my stylish gown into my sweats, and, after receiving some last minute do’s-and-don’t’s, headed back out into the world.

Coming next: Convalescence.

The Time Has Come

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Got the phone call I’ve been waiting on this morning.

The hospital called to say that I should be there at 6:30 A.M. tomorrow (June 8). Nothing to eat or drink after midnight. No aspirin, Alleve, etc. Leave all valuables at home, but bring my ID and insurance card. I can take my blood pressure med and whatever I take for my acid reflux, but with a minimum of water to wash it down.

I can bring a book, and a change of clothes if I desire, since I’ll be staying at least one night, but they can provide me with anything else I need: a fashionable hospital gown, toothbrush, shampoo, TV, etc.  Yes, I can bring my iPod if I want, but they’re not responsible if anything should happen to it.

I think that about covers it.

Wish me luck!

I Passed!

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On Monday, May 17,  I went for my Pre-Admission Test in preparation for my upcoming discectomy, date TBD.

My PA was a lovely young lady by the name of Angela, who had been on the job for about a month. She took my blood pressure (“Excellent!”), stethoscoped me (“Wow! Your lungs sound clean!”) and asked me the usual questions about my basic health: “Nausea? Dizziness? Alcohol use? Drug use? Depressed?”  To this last, I responded that I was a little bit bummed because Lost was ending, but other than that, life is good.

She asked me what type of surgery I was going to have, and when I told her, she waved it off as if I’d said I was going to have a splinter removed from my finger. I’ve gotten that response from just about every medical-type I’ve talked to, which eases my mind somewhat.

When Andrea was finished with me, I went over to the hospital building of the little compound, where they took four or five vials of blood, a few chest x-rays (why they took pictures of my chest when it’s my lower back that’s getting cut open is a mystery to me), a container of urine, and did an EKG.

The end result, as far as I can determine, is that I’m healthy enough to go under the knife.

Now all I need is a date and time.

Updated: Just got a call from the Doc’s office. Surgery is scheduled for June 8.

Updated: Got a call an hour later. The office girl said, “If there’s a cancellation, would you mind moving your surgery up?” I said, “To when?” She said, “Tomorrow.”  Sorry, Misty. I need at least a couple of days notice if I’m going to have back surgery!

What If I Fail The Test?

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So the wheels have been set in motion for my back surgery.

I met with the surgeon a couple of days ago and told him the nerve block wasn’t blocking out my nerves too well, and, as I mentioned in my last post, I’m not willing to spend whatever time I may have left shuffling around in pain. Let’s do this!

He agreed that all nonsurgical methods have been explored, and this really is the only way I’m going to get any relief.

He’s aware from our previous conversations that I do a bit of MMA training, and he knows that I really don’t want to be away from it for any length of time. He used to train himself years ago, and knows that if you’re away from it too long, it’s tough to get back up to speed.

So he told me Tuesday that he’s going to do the minimum amount of surgery that I need to relieve my problem, which is the open discectomy  that I wrote about previously. This would require only a day or two in hospital, and I wouldn’t be laid up a significant amount of time.. The absolute minimum, he explained, would be endoscopic surgery, but that may be only a short-term solution in my particular situation.

More intense options would be fusion or disc replacement, which would pretty much be overkill, and stretch my convalescence time out way too far for my taste.

(Keep in mind as I explain this that I tend to hear doctors the way dogs hear humans in that Gary Larsen cartoon:

which is to say, it mostly goes in one ear and out the other. So if you’re reading the above exchange and thinking the doc doesn’t know what he’s talking about, don’t; I might be remembering the conversation incorrectly.)

Anyroad, the surgery will be done sometime in June (“Everybody wants it done in June,” he said when I made my request). He’ll have to check his schedule and get back to me with an exact date.

The first step, though, is pre-admission testing, which is all sorts of blood work and so on. I report to the testing station on May 17.

I Got Nerve! (And It’s Pinched)

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Those of you who have been enjoying my medical adventures for the past year or so are in for a treat: I’m having back surgery! And I’m going to be sharing the details along this journey with my faithful readers (me and one other person).

I may have mentioned elsewhere in these incoherent ramblings that I have a herniated disc at L5-S1, which is pinching a nerve running down my right leg, causing me large amounts of pain when I’m on my feet for too long (“too long” varying  from 10 minutes upward, depending on circumstances).  The discomfort can be barely bearable; if I know I’m going to be on my feet for a goodly length of time, I bring along a walking stick.

Over the past few months, I’ve had a pair of steroid epidurals, a nerve block, and been prescribed Neurontin, none of which has provided any relief. It appears that the only option left for me is surgery.

I won’t know all of the details for certain until next week, when I have a second meeting with my surgeon. At our first encounter, he examined my MRI and showed me what he suggested: a discectomy (at first I thought he said “vasectomy”, which caused me no small consternation). I told him I’d think it over and give him a call in a week. Only a few days earlier, I’d had a nerve block injection, and I wanted to give that a shot at working.

I hit up the internet for a little research, and found this at About.com:

A discectomy is a surgery done to remove a herniated disc from the spinal canal. When a disc herniation occurs, a fragment of the normal spinal disc is dislodged. This fragment may press against the spinal cord or the nerves that surround the spinal cord. This pressure causes the symptoms that are characteristic of herniated discs

The surgical treatment of a herniated disc is to remove the fragment of spinal disc that is causing the pressure on the nerve. This procedure is called a discectomy. The traditional surgery is called an open discectomy. An open discectomy is a procedure where the surgeon uses a small incision and looks at the actual herniated disc in order to remove the disc and relieve the pressure on the nerve.

How is a discectomy performed?
A discectomy is performed under general anesthesia. The procedure takes about an hour, depending on the extent of the disc herniation, the size of the patient, and other factors. A discectomy is done with the patient lying face down, and the back pointing upwards.

In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminotomy.

Once this bone and ligament is removed, your surgeon can see, and protect, the spinal nerves. Once the disc herniation is found, the herniated disc fragment is removed. Depending on the appearance and the condition of the remaining disc, more disc fragments may be removed in hopes of avoiding another fragment of disc from herniating in the future. Once the disc has been cleaned out from the area around the nerves, the incision is closed and a bandage is applied.

What is the recovery from a discectomy?
Patients often awaken from surgery with complete resolution of their leg pain; however, it is not unusual for these symptoms to take several weeks to slowly dissipate. Pain around the incision is common, but usually well controlled with oral pain medications. Patients often spend one night in the hospital, but are usually then discharged the following day. A lumbar corset brace may help with some symptoms of pain, but is not necessary in all cases.

Gentle activities are encouraged after surgery, such as sitting upright and walking. Patients must avoid lifting heavy objects, and should try not to bend or twist the back excessively. Patients should avoid strenuous activity or exercise until cleared by their doctor.

What are the potential complications of a discectomy?
The most common problem of a discectomy is that there is a chance that another fragment of disc will herniate and cause similar symptoms down the road. This is a so-called recurrent disc herniation, and the risk of this occurring is about 10-15%.

Most patients find relief of much, if not all, of their symptoms from a discectomy. However, the success of the procedure is about 85-90%, meaning that 10% of patients who undergo a discectomy will still have persistent symptoms. Patients who have symptoms for long periods of time, or severe neurologic deficits (such as significant weakness) are at higher risk of incomplete recovery.

Other risks of surgery include spinal fluid leaks, bleeding, and infection. All of these can usually be treated, but may require a longer hospitalization or additional surgery.

What is endoscopic microdiscectomy?
Newer techniques may allow your surgeon to perform a procedure called an endoscopic discectomy. In an endoscopic discectomy your surgeon uses special instruments and a camera to remove the herniated disc through very small incisions.

The endoscopic microdiscectomy is a procedure that accomplishes the same goal as a traditional open discectomy, removing the herniated disc, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, your surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia, and is done through a smaller incision with less tissue dissection. Your surgeon uses x-ray and the camera to “see” where the disc herniation is, and special instruments to remove the fragment.

Endoscopic microdiscectomy is appropriate in some specific situations, but not in all. Many patients are better served with a traditional open discectomy. While the idea of a faster recovery is nice, it is more important that the surgery is properly performed. Therefore, if open discectomy is more appropriate in your situation, then the endoscopic procedure should not be done. Discuss with your doctor if endoscopic microdiscectomy may be appropriate for you.

While this may seem like minor surgery to some (including the doctor who had been treating me), you have to realize that I’ve never had invasive surgery. The only procedures I’ve been in an operating room for were lipotripsies, and those involved pounding my kidney stones with sonic waves, not scalpel blades.

But by the time a week had passed, I found that the nerve block was ineffective, and decided that I didn’t want to spend the rest of my days hobbling about in pain if I didn’t have to. When the surgeon’s office called to follow-up with me (I know I said I’d call him in a week, but couldn’t bring myself to pick up the phone and say,”Please stick something sharp into my spine.”), I made an appointment to talk things over with him.

That’s next Tuesday.

I’ll let you know how it goes.