Days 2, 3, 4 & 5 post-op - the nitty gritty

I never really expected this much pain. You know - being a male and all - come on life, I can take anything you throw at me, bring it on sucker, I can handle it, and all that BS. Well that attitude is unrealistic, and is not going to go far in this predicament, so let it go. Be prepared to let out the little schoolgirl in you, and just face the fact that you`re going to hurt, and whimper, and squeeze out a few tears from the corners of your eyes, and wonder why you ever made the decision to go ahead in the first place. However there are words to give hope, and they come from the "Sharkman of the Delta", a favourite character and Navy Seal in Richard Marcinko novels.

To paraphrase; "All I could feel was blinding pain. I had no idea where I was or what may have happened`- it didn`t really matter. I was feeling pain, and that was good. That meant I was still alive."

(Note - if there seem to be quotes missing or funny characters that`s because my stupid laptop keyboard has decided to go into French character mode, and I`m too bagged to hunt down the problem and kill it right now)

I mean, at first it's all balled up together in one big massive pain, the boundaries of all the little parts that comprise it are completely blurred by the morphine, which by the way seemed to be a waste of time. Well maybe it did work, but it was not a complete solution by far. I am however, still glad they let me play with the pump for a day or so, because I think it psychologically soothed me.

By the second day post op I was starting to distinguish the individual steady pain contributors. The giant lower backache of course, the trauma surrounding the incision site, the recurring pressure in my bladder and twisting catheter, the wrinkled sweaty & irritated skin surfaces next to the mattress, some kind of cerebro-spinal fluid related headache thingy that lasted well over a week, the cramped muscles from having to lay in one position for hours at a time, and the mental pain and frustration of not being able to do too much to distract myself or do anything about it.

The bladder catheter was interesting, and nothing I can ever recall experiencing before. Whenever it decides to, the bladder spasms and stuff starts to flow. Allowing this to occur goes against every ounce of potty training we had to go through as a teenager. What, don`t tell me you were all off the diapers before your teens. Darn, I thought I was a fast learner too! Just kidding, I was really potty trained by age nine :-) Then, after they remove the catheter, it seems like you have to force your bladder to actually let go. Go figure! Not knowing, I asked the nurse who removed it, how long the catheter was. She held up a sorry looking (short) piece of rubber tubing and said with a smirk - It depends! OK let`s not go there.

Having a number two, well that is a different story altogether. Talk about letting go of some modesty and pride. Being in bed meant the brace didn't have to be worn, and trust me you didn't want to anyway because it is quite uncomfortable while in a reclined position. Going to the toilet meant the brace had to be put on, something I was not able to do on my own at that stage. In fact the brace is to be worn at all times while out of bed, or in the shower, whenever I'll be permitted to do that, for most of the next three months. Given that the delays in getting a nurse's assistance, the time to put the brace on, the slow shuffle with the walker to the bathroom and the time to settle down onto the commode, there could be no such thing as an emergency bowel movement. The sad thing is that often, by the time you got seated, the pain and stress had destroyed any urgency in the whole plan and 5 minutes of trying to relax usually resulted in a disappointing shuffle back to bed. After a while the staff was starting to whisper about things like "stool softeners", "Fleet enemas" and "disimpaction". Am I the only one that has visions of groups of huge battleships passing very quickly through a narrow gap, when fleet enema is mentioned? Did I mention we were cautioned not to push or strain? I mean, isn't that just a normal part of the whole activity?

Thank God they started with the first option, because the other two scared the crap out of me! Pun intended. Eventually we were able to do our business. For some reason the staff always use the word we to mean me! "And how are we doing today?" You look fine nursey, and you can walk out of here at the end of your shift, and you can eat a wonderful meal, and get a great night sleep, and have a refreshing shower, and wear clean clothes, and not feel any pain, and have a crap on your own. Don't talk about we! I, on the other hand, haven't felt worse in my life, and now I have to depend on cheery little you to come into the bathroom and help me wipe my butt and pull up my pants and get me back into bed. We are doing OK, thank you very much!

Oh yeah, getting the brace on. That was quite honestly some of the worst pain I have ever felt in my life, and I have had kidney stones, gout in both feet at the same time, plantar faciitus, hip surgery, dislocated hip, severed ACL and subsequent knee surgery etc. The brace is a combination of ballistic nylon, stretch bandage, Velcro fasteners and metal strap adjusters, and a big hunk of hard plastic inserted into a pocket in the back. The plastic had been previously form-fitted to my lower back and upper gluteus area, so it has some custom curves and indentations in it. Note - it has absolutely no flexibility, it is hard as a rock. Getting into it entails rolling back and forth on your back while your assistant (nurse, physiotherapist and later Heather) tugs the parts through underneath you. All the while you are rolling over this hard plastic onto which you are trying to center in the correct position before you tighten up the straps. Did you actually read my earlier post about what was done in surgery? Do you realize what went on back there? Let me refresh your memory while I refresh my drink. They made about an 8 inch incision, stretched and clamped the skin and muscle tissue back, removed sections of bone from the outside of 4 vertebrae to expose and add space around the spinal canal, reamed the nerve outlets in a few of them, removed extraneous nerve tissue from around the spinal cord, trimmed some intruding disk fragments out, placed bone and artificial coral implants, drilled and inserted at least 8 screws tied together with a few rods, then stitched and stapled me back up. And afterwards you think it won't hurt much when rolling over a lumpy piece of hard plastic, the purpose of which is to place pressure on the region so as to help stabilize and protect it. Think again, Grasshopper!

After being discharged I learned a little trick about managing the pain spikes while putting the brace on. As it turns out most of what I was feeling was nerve pain, meaning pain felt as a result of pressure on the nerves. When the pain spiked I was tensing all my back muscles up, an instinctive reaction by the body to protect the nerve and other tissue from further damage. That instinct can sometimes work against you by causing the pain spikes to prolong indefinitely while you are tensed. When this happens, eventually your pain threshold is torn down and your will to continue trying ceases and you have to give up. This conditions you very quickly into fearing the activity, which further works against you. The longer the muscles are tensed, the longer it takes the elevated pain to dissipate. Here's the trick - do everything in your power to remain relaxed as the pain is spiking, and if you are successful you will momentarily be back to a manageable level of discomfort.

I wish some expert in the hospital had told me this in the beginning. I shouldn't have had to figure it out myself. So here's my little bit of wisdom for you should you find yourself in a similar situation. That, and the Sharkman's thoughts above.

In summary, the hospital stay was unpleasant, the staff especially the nurses earn every penny of their salary for the crappy job they have to do and patients they deal with, and keep believing that things do get better every day.

Next - 7 days post-discharge.

 

 

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Days 2, 3, 4 & 5 post-op - Part Uno

As promised I am back again, this time with all the gory details of the rest of the hospital stay. I'm not suggesting it will be amusing or even comfortable to read, but just brutally honest, maybe a bit gross at times, but this blog is here to provide information to those who are interested, and as a release to me.

This post covers Sunday, Jan. 20th through Wednesday the 23rd, the day I was discharged. I keep wanting to say "released" like it was some kind of prison, rather than "discharged". Maybe it was. The comments in here are a bit all over the place, but I think it covers just about everything.

Roomies - Ha ha (or LOL to you texting maniacs) - certainly entertainment in its rawest form. By the way I was in a 3-bed ward. This was not so much of a problem as everyone in there was not in any condition to care.

Ray, an 85 year old in for a hip pinning, snored, coughed and complained his way through every night. He pressed his buzzer about every 20 minutes for meds, bedpan and subsequent bedpan cleanup and subsequent bedpan damage control, or to fix up his sheets which either got kicked off his bed or twisted around his feet. The sheet thing was understandable because he also had an unrelated groin injury which caused him a lot of pain and thrashing around. It was like Jekyll & Hyde. In the daytime other than needing assistance in and out of bed to his wheelchair, or onto the commode, he was most pleasant and talkative, and was so outgoing that he would glide over uninvited and join just about any conversation I was having with guests. Once when Kathy, a former Ottawa neighbour was visiting he stuck his nose in and I told him that I fully expected his being able to keep a secret from my wife about a visit from my old girlfriend. He kind of did a double-take and eventually slinked off. Later I saw hime in the hallway after another "girlfriend" vist by Kathy, and reminded him "what goes on in the hospital, stays in the hospital". Obviously I'm not capable of following my own advice. Thanks for playing along Kathy. (wink-wink)

Jim, also 85 or so was in for a hip replacement. The complete opposite of Ray, he never complained about a thing. The only time his buzzer was pushed was when he needed to use the commode. I still haven't completely figured Jim out. At first I thought he had some dementia, or Alzheimer's. Every time a nurse came in he would ask things like "Who are you?", "Are you my daughter?", "Where's my car?" and on and on, laughing as he said it, causing the nurses to laugh as well. He must have had a giant sense of humour (at least in his head??) because chuckled about just about everything, and always had a grin on his face. He said and did little things that also caused his wife to laugh. But maybe they were both a little crazy - who knows. On the last day and a half he was there he was completely normal, except for the occasional chuckle, which kind of raised my spirits I'll have to admit.

After JIm was pardoned, I mean discharged, he was replaced by Marsha, and I'd have to guess also around 85. Marsha had a knee replacement. There's not too much to say other than she must have had a different ringtone on her cellphone for each of her (seems like hundreds) of her contacts. Well, there was this "Help, can someone please help me?" soft plea that arose every few hours. I must have told her 3 or 4 time to push the call button on her lap, as did every nurse or other person in the area or coming to her assistance. The funny thing was sometimes she was pushing the morphine button as it turned out, eventually resolving the problem for everyone else around. Marsha made no bones about how crappy the food was, and she was very well spoken and articulate which made it impossible for anyone to come back with a good counter-argument. She was right by the way about the food, but then again, you all knew that.

I think I need to break this up into a serious of smaller posts, because the more I write the more comes to mind.

Later.

P.S. #1 - the use of acroynyms/abbreviations predates you texting/messaging punks by several years. In fact, back to the days when there were only dialup modems, BBSs and Usenet newsgroups - long before the World Wide Web was conceived, and probably back to morse code, teletypes, etc..

P.S. #2 - If you think ROTFL always meant "Rolling On The Floor Laughing", you may be interested to know, that before it was sanitized by the Politically Correctness Police, it actually stood for "Right Out To F***ing Lunch" and was used to describe a person or opinion that was utterly ridiculous.

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Day one post-op, what delights will it bring?

It was a choppy night's sleep after surgery. I still had a lot of the anaesthetic narcotics in me that was catching up to me in waves. About every 15 minutes I awoke and was fairly lucid for another 15 or twenty minutes then once again lost contact with reality. This went on pretty much all night long, with sporadic shots of morphine from the pump. They also had me on continuous oxygen and saline, and occasional massive anaesthetic doses, stool softeners, and other unknown meds, too many to remember.

The overnight and day shift nurses, who were fantastic by the way, and so, so young checked my vitals regularly, refilled my water glass and emptied my urine catheter bag regularly. Between the saline IV drip and the cold water (my throat was so dry) they told me I passed three litres overnight.

Around mid-morning they pulled out the urine catheter - boy was that a relief. I had to concentrate considerably to get things flowing naturally again. It's hard enough peeing lying down anyway. It seems like there's some kind of built in float valve down there to prevent it from happening

In the morning the nurses noticed I was not using the morphine pump much, and debated amongst themselves about when to wean me off. I didn't really want to lose the best pain fighter that was available to me, but I also dislike falling off to sleep unannounced. As it was the pump stayed with me until about noon while they started giving me a pill substitute, Dilaudid, a morphine derivative. I was also sent down for a few X-rays on a stretcher just before removing the morphine, which was good because it was a stiff stretcher (no shocks) and quite a bumpy ride.

Anyway I felt pretty good Saturday morning and changed into some fresh clothes after they disconnected the IV line. Here's a picture of me looking fairly perky.

 

 

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What they did to me on the table

Once they knocked me out they moved me onto a special table used for spine surgery.

 

The first procedure was a laminectomy, during which they essentially remove the outer rearmost layer of the spinal column, exposing the spinal canal and spinal cord.

 

 

Then they did both a foraminotomy, widening the holes the nerve roots pass through to help decompress the nerve, and also removed ganglion (scar tissue, extra unwanted growth) from around the spinal cord also relieving compression.the ganglion may have been caused by my fall years ago.

 

Then artificial coral is mixed with the cleaned and ground lamina which had been removed, and turned into a paste which acts like a bone graft, and becomes part of the fusion.

 

 

The rest of the fusion/stabilization process is a little more high tech than coral. Stainless steel screws are placed into both sides of each vertebrae involved, and the a rod on each side connects the head of the screws together. In my case, 4 vertebrae were fused together

 

After getting all closed up with sutures and 27 staples, this is what it looked like:

It all improves from here on.

 

 

 

 

 

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No, I didn't see the bright white light

Obviously!

It's been a long and a short day all in one - so far.

Last night we had a fantastic dinner at Moxie's here  in Ottawa. We were celebrating Marie-Claude's birthday and jokingly referring to it as my "Last Supper". So as you can see, it wasn't. Well, only until I start farting again - nurse's wording not mine! No, they won't give you solid food until things start moving around again in that department.

Anyway, it's been long because I was awake half the night with a Christmas Eve kind of excitement. Up at 4:30 am to shower etc and scrub with a special disinfecting cleanser soap, and buzz over to the hospital for a 6am admitting.

Short, because when the anesthetist injected the narcotic into the IV line at 8:00, I instantly lost 6 hours of  my life and arrived in Recovery at 2pm. I think it's a kind of time-travel deal. At 4 they wheeled me into my room, called Heather and here I am.

I've been drifting in and out of sleep since, and nodded off half a dozen times while I was typing this post, tryng to fulfill my obligations to my loyal readers.  Oh yeah, they have wireless Internet here and Heather brought my iPad in with her.

Other than that I'm pretty ugh useless at the moment so it's time to sign off, get a hit of morphine and get some sleep.

See y'all later.

Now we're heading up the right path ...

I saw Dr. Bernie, as everyone apparently calld him, at the SSIC in late August 2011. He checked me over and was fairly concerned after he had asked me to stand on my toes, and I couldn't. Neither could I lift my toes off the floor and stand on my heels only. While he had me lying down he held gently onto my toes and asked me to flex them up and down. I really couldn't. Right away he said he believed I had significant spinal stenosis, and would schedule an MRI.

We got the MRI done in less than three weeks at the Children's Hospital (CHEO) in Ottawa. It was fairly quick since the unit at CHEO was under-utilized and they were taking bookings early. Another visit to Dr. Bernie confirmed the diagnosis during which he referred me to Dr. Don Chow. Well, we sort of chose Dr. Chow since a) he had a great reputation, b) he is the Ottawa Senators' team doctor, and c) Heather had worked with him before when she was in the Diagnostic Radiology (fancy new term for X-Ray) department at the Ottawa Civic Hospital. He's the cream of the crop in Ottawa.

Br. Bernie also recommended some physiotherapy. Not that it would reverse the nerve deterioration in the lower legs, but that it might strengthen my back and core muscles which would help take some pressure off and protect things a bit better over the long haul.

The consultation with Dr. Chow was a few weeks later, and re-confirmed the diagnosis and he spent a lot of time showing me the damage to the spinal cord and vertebrae in the MRI views - like I would know the difference.

The last thing that was needed was to get into a pain management center to start getting cortisone shots in the spine. Unfortunately the waiting list is lengthy so it wasn't until January 2012 that I was able to get the first injection. The cortisone shots were administered by Dr. Stephane Legault at the Montfort Hospital.

I have to say that Dr. Legault is amazing - really I did not feel a thing - it was less painful than a regular blood test. Here's how the procedure goes: you sit on the edge of a bed bent over with your feet on a stool and a pillow across your knees , your shirt pulled up and your pants loose and down over your hips - just so you show your plumber's crack :-),  the area is swabbed with a topical anesthetic, then a small needle with a local anesthetic freezes the tissue, then finally the big boy 4mm howitzer needle is driven into your spine with a ball peen hammer and a half litre of cortisone is squirted into your back blowing out a few disks in the process and forcing cerebro-spinal fluid shooting out your ears and causing temporary blindness, vomiting and a C4-level explosion of pain in the brain which makes you scream like a little schoolgirl!

Not really - just checking to see if you're paying attention. I'll bet you were wincing back there eh? Your sphincter tighten up just a bit? Come on, admit it!

Actually there is only a mild sensation of pressure in the area of the shot, which is administered with a fine needle and only a few CCs of cortisone.

They can only give the shots 3 times a year, so I had my second in July and the last in November. The effect on the shot was for me, immediate and lasted a good 4-6 weeks before some of the old pain started to return slowly. It was indicated that your level of activity or strain may dictate how much relief you get and for how long. I tried it both ways active and passive, but it was fairly even for me.

The pain is mostly managed by Naproxen for inflammation (spiked with the odd Ibuprofen) and T3's. Initially in 2011 I was prescribed Percoset, but stopped taking them after falling asleep everywhere - in the middle of a conversation, driving, on the john, in bed - whatever. I decided I was not comfortable with those side effects and opted for extra T3's. Right now it's been almost 8 weeks since the last shot and I average only 1-2 T3's a day.

For me, the pain is no longer the big concern. It's there and constant so you kind of get used to it. My concern is the slow and steady deterioration of the motor controls of my lower legs. I guess it's that part of the spinal cord & nerve roots that are compromised. My inner sense of balance is still very good, but my nerves are unable to properly utilize the little muscles in the lower legs and/or be aware of what they are doing so as to control them. As a result my thighs and buttocks are constantly tensing in an effort to maintain my centre of gravity, a job they are not designed to do and which explains why they are always aching and throbbing.

I was also getting numerous full-on muscle spasms (cramps) in my lower legs, usually at night lying in bed. It seems that once intentionally or accidentally causing a muscle to contract, e.g. by stretching or flexing, or just the weight of the sheet, the nerves do not know the muscle position and allow the muscle to continue contracting until it spasms. Man - those suckers can be painful, I tell you. Watching your foot arch into a curve so tight you look like an ape and think you could hang upside down on  branch with it, or the muscle in the front  along the shin bone bulge out like an egg - again squeeling like a schoolgirl. Well between the tears squeezing out and the cursing and hopping around like a maniac one can get a little frustrated. No?

Lately I've been so aware of every tiny little muscle twitch I've been able to wake up and move my leg or foot around back and forth quickly, which seems to confuse the nerves and eventually things seems to settle back down to quiet chaos. Having to be that aware does not help in getting a good nights sleep.

So really, surgery is not an option at all. At the rate at which I am losing muscular control, I could be in a wheelchair in a few years. So here we are, three days before surgery. I'll toss in one more post tomorrow summarizing my pre-op visit last week and the brace fitting.

Later.

Going green wasn't such a great idea!

For several years I drove my Chevy Venture minivan for the business, and after realizing I was spending waaaay too much on gas, I sold it and bought a nice new little Honda Civic Hybrid in the fall of 2009. I was doing my net income and the environment a big favour, or so I thought.

Virtually immediately, as I realized in hindsight, I started having mild lower back discomfort, but figured I was merely getting old. Just lump it Ken and take more Ibuprofen. I'm 6'1" (or used to be until my spine started compressing and my arches started falling, so I had to bend over and scrunch down quite a bit to get into the driver's seat. Once in there was plenty of headroom so no worries, right?

Well the fact is I have a 31 inch inseam, the same as Heather who is only 5'4". Therefore I'm really disproportionately (I don't know if that's a real word but it works) longer in the trunk so I've had to scrunch up more than the average person. (No wise cracks about what I mean by trunk guys!) There was lot's of extra wear and tear on the back as a result over the next one and a half years, with the pain steadily increasing.

Then I challenged the odds and the gods by going back to Portugal for another vacation. There was lots of walking on cobblestone streets, up and down hills, and a lot of driving in a sub-compact rent-a-car. When I arrived home I was in considerable discomfort with frequent bouts of stabbing pain shooting through my buttocks and down my hamstrings and quadriceps.

Like any other internet-savvy 21st century geek I did a lot of Google-ing and self-diagnosed myself with sciatica. What - don't tell me you don't do that as well, be honest. And that was really weird because I always thought the word was Sci-Attica, and meant some freaky futuristic outer-space maximum security prison from something like the Blade Runner movie???

My family doctor tappity-tapped my knee joints with that dumb little reflex hammer then prescribed an industrial strength anti-inflammatory and Tylenol 3 - AKA T3, neither of which helped much. After also trying lots of stretching and spending a small fortune on chiropractor, massage therapy and acupuncture sessions I pretty much decided nothing was going to help and that I better learn to live with it.

So in 2011, in a fit of self-destruction I spent a week's vacation in Key West, and later another week in Orlando, naively half-believing that I just needed a little more exercise. Hah! What an idiot! All you do is walk in those places. Fortunately there were a lot of bars and liquor stores, and frequent stops to self-medicate were required.

My good friend Paul convinced me to seek out another professional opinion for my problem, and directed me to the Sports & Spinal Injury Clinic in Ottawa. What's great about the SSIC is that you need not be referred by a doctor - just phone and make an appointment. I was met by Dr. Bernie Lalonde, who essentially performs a preliminary diagnosis and triage to recommend physiotherapy or get you referred to another specialist such as in my case, an Orthopedic surgeon.

Things were finally starting to look promising...

Hold On There! What is Spinal Stenosis?

Sorry, I assumed anyone reading the blog would already know what spinal stenosis was, but in case you just accidentally found me ....

From PubMed Health (first hit on Google search)

"Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.

Spinal stenosis usually occurs as a person ages and the disks become drier and start to bulge. At the same time, the bones and ligaments of the spine thickens or grow larger due to arthritis or long-term swelling (inflammation).

Spinal stenosis may also be caused by:

• Arthritis of the spine, usually in middle-aged or elderly people
• Bone diseases, such as Paget's disease of bone and achondroplasia
• Defect or growth in the spine that was present from birth (congenital defect)
• Herniated or slipped disk, which often happened in the past
• Injury that causes pressure on the nerve roots or the spinal cord
• Tumors in the spine"

And now back to our regular blog programming ....

So when did things turn really bad?

Other than the hip replacement my health has always been pretty good. Considering the extent of the stenosis the doctor wondered if there had been some kind of precipitating event. The only thing that comes to mind is a very hard fall I took about 10 years ago.

My wife Heather, and I were vacationing in Portugal, and I was the last in a line of tourists exiting a large motor coach tour bus at a place of interest. My old running shoes, the bottom, worn smooth and hard, slipped off the steel top step at the rear exit, both feet went straight out in front of me and there I was, falling belly up in perfect V position, out the exit door. I caught the bottom steel-edged step, about 2 feet down, right across the lower lumbar area of my spine.

It hurt like hell for a few days and the bruise lasted a few weeks, but there didn't seem to be any long term effects at the time. The really remarkable thing about the fall was that I remember very clearly, falling in what seemed slow motion. I was completely aware of what was happening to me and having time to examine two distinct thoughts that sprung to mind. One was OK, now I'm falling - I hope I don't kill my self and can walk away from this.

The second thought, seemingly much more important than my physical well-being relates to what I was doing just before I slipped. That is - I was holding my new (expensive at the time) digital camera in my hands. When I slipped, my hands, along with the camera flew up into the air in an instinctive but futile effort to regain my balance. The net effect was that my camera was flying up and out of the bus ahead of me, like a little comet with the strap trailing behind.

The second and most important thought was something like "Geez, I have to save my camera!" As I was approaching my landing, the camera, trailing the strap was plummeting toward the ground just ahead of me. In a desperate but extremely lucky move I snapped my legs together on the strap, catching it in mid air between my ankles. I bounced off the bottom step and landed on the pavement with my feet still out and up, and the camera dangling by the strap a few inches off the ground.

Since most of the rest of the tourists were waiting for the last passenger, me, to get off the bus before the tour began, they were looking in my direction. Several people applauded and when I could finally stand, patted me on my shoulder and commented on what a fantastic save I had made. Unbelievable! I was happy and could almost forget the pain for a while.

All was good, for several years.