06/26/14
Date for second back surgery is July 8.The cervical spine surgery was a complete success. I still have wide ranging flexibility in my neck, considering that five of seven vertebrae were fused. The lumbar spine fusion will be more complicated and performed in two stages. First, Dr. Keem will remove the collapsed, herniated and otherwise damaged disks and replace them with composite disks that will eventually fuse together. The placement of these disks must be fairly precise in order to restore normal spine curvature. Second, he will insert titanium rods and screws to straighten my spine and hold everything in place.Then, months of rehabilitation. By the end of this year, I hope to be as back to normal as modern medical technology can make me.
06/29/14
I have cleared all my pre-surgical interviews and procedures as before. No new tests will be necessary. Things feel a bit anti-climatic compared to the first surgery, when everything was new and intimidating. This is a much more complicated procedure with no guarantee of success, and potentially dire post surgical complications. The pain profile will be more severe, but I've lived with chronic pain for the last twelve years, so no biggie. It's the incapacity factor and my dependence on others that concerns me the most. No driving for four months. The need for a walker or cane to get around. No carrying anything heavier than five pounds. Worries about personal hygiene. Confinement to my apartment etc. etc. But, I have an excellent surgeon, state of the art medical facilities, and fantastic and supportive friends who were so helpful the first time around. And the precedent for successful surgery has been confirmed. So, my no worry zone is hereby well and truly established. Heartfelt thanks and love once again to all my friends and neighbors for their help.
07/1/14
Someone has said, "trust that there will be healing." Amen. One day at a time, with increased physical activity as circumstances allow. Be patient. No self pity. Time flies. It's been four months since my first surgery, and I feel fine. And, as a purely personal aesthetic when writing, no platitudes! No cliche ridden horse manure! No verbosity! Whoever reads these words, your feedback is welcomed. Has anyone else undergone serious surgery or illness recently? We can cry in our beer together! }:-) I'm also thinking of travel plans deferred that I can now look forward to when I have recovered, and hikes in the Cascade Mountains with friends. I am lucky to live in such a beautiful place as the Pacific Northwest..I am grateful.
07/3/14
Office visit
with Shantay, Dr. Keem's assistant nurse, who fits me for a back brace. I
must wear it 24/7 (except during sleep) for a couple of months after
surgery. Yuck. I have been notified of the time for the operation on the 8th - 12:45 PM at the Swedish Hospital Orthopedic Center.
04/4/14
Happy Forth of July! Gathering of friends tonight to watch the fireworks over Lake
Union.
07/7/14
Completed last minute chores. Mike and Robin helped me clean up the place and remove tripping obstacles. Mike brought a nice chair over so I can have a comfortable place to sit like a proper couch potato while I watch TV. Tried on the back brace. A bit complicated tightening all the Velcro straps in proper sequence but it works..
01/9/15
It's the six month anniversary of my spinal fusion surgery, and this is my first entry in months. I can happily report that the procedure was a success, with some complications. It was a long operation, divided into two days, July 8 and July 10. I was diagnosed with a pulmonary embolism (blood clot on the lungs) and later, a urinary tract infection that spread to the incision area. I was put on anticoagulants (Coumadin) for the PE and a stringent course of antibiotics for the infection.
Thursday, June 26, 2014
Friday, February 7, 2014
My Wretched Back!
02/7/14
I have begun this blog in anticipation of major back surgery, to be performed soon here in Seattle. I have postponed and procrastinated for twelve years on the issue of surgery, hoping improved technologies would be developed in the interim. And while laparoscopic and laser surgery have come along nicely, the still crude and sometimes ineffective methodology of fusing troublesome vertebrae is still the most widespread procedure available. And my wretched back has grown progressively worse since 2001...
Indeed, it is the increased severity of pain and instability that have driven me at long last to seek surgical intervention. And while "on a scale of 1-10" is simplistic when describing pain levels, mine has now reached a very palpable 9 at its worse. And of course, lower back instability puts me at a greater risk of falling. A fractured hip is not what I need at the moment! To add to my increasingly dire health profile, I have reduced kidney function and can no longer take over-the-counter NSAIDs (naproxen, Ibuprofen, aspirin) which were helpful in my daily regimen for pain control, because these substances are damaging to delicate kidneys and stomach linings (I am also recovering from an inflamed peptic ulcer.)
While all this might seem like too much information, I have decided to document these events as fully as possible except for the names of the individuals involved in this ongoing story, for the record...
02/10/14
Another MRI scan at the Madison Polyclinic. Dr. K, the orthopedic surgeon who is supervising my treatment, has detected possible disk deterioration in the cervical spine, and wants a closer look.
02/13/14
Reviewed the latest MRI scans in consultation with Dr. K. More bad news. The cervical disks are mush, every one of them. They look like jelly rolls that have been stepped on, with the jelly oozing out from all sides. And yet I have not experienced neck pain or lack of mobility at all. Why didn't earlier doctors catch this? One squished disk in particular at C5 is pushing ominously towards the spinal cord. Impingement is imminent, with serious implications for respiration and upper body functioning and mobility if there is a collision. For this reason, Dr. K has decided that surgery on the this area will take precedence over lumbar surgery. But that's where it hurts! Ah but It is the things you don't feel that often kill you, Dr. K. gently admonishes.
Here's the bad news from an MRI scan report, spelled out in hideously concise medicalese:
"Severe spinal canal stenosis with spinal cord flattening/compression and moderate to large posterior disc extrusion and probable osteophytes combined with minimal posterior ligament thickening. Severe neural foraminal stenosis (greater on the right) due to uncovertebral spondylosis and moderate to severe right facet spondylosis."
Swell!
02/14/14
Surgery on my cervical spine has been scheduled for March 7. Dr. K is an expert on minimally invasive surgery and will conduct the operation using laparoscopic techniques. I begin pre-op clearance with my primary care physician, Dr. B. to make sure I am hearty enough to undergo the proposed surgery. Another complication. An EKG reveals an abnormality called "T wave inversion." According to Dr. B, this may be caused by insufficient blood flow to the heart. I've googled it and it appears to be a fairly harmless, non-life threatening condition. Nevertheless, at Dr. B's recommendation, I have scheduled an appointment with the resident Polyclinic cardiologist, Dr. H.
02/16/14
My chronic back pain has become an old crony over the years. I say "crony" because I don't necessarily regard it as evil or bad. It has helped me understand the natural process of deterioration that every physical body is subject to. It has acquainted me with the many nuances of pain and the body's natural reaction to pain. In respect of pain, my body is functioning very well - it reminds me daily and insistently that something is wrong. If only it knew when to stop...
Unfortunately, the body's response to the loss of spinal disks is ugly, as it attempts its own stupid version of vertebral fusion. Nature abhors a vacuum! It is a clumsy, haphazard affair, and the outcome is always more of a obstacle to recovery then a solution. Large portions of my spine have become congealed in bone, and it has lost the natural S shaped configuration of normal spines, and therefore, much of its load bearing capacity. Body weight tends to be concentrated more forcibly downward, without the natural curve of the spine to distribute it evenly amongst the surrounding ribs, muscle and connective tissue. Sagging musculature tugs at collapsing vertebrae, causing more stress on disks that are soon transformed from resilient little cushion pads into (as in my case) useless paper thin detritus. And I'm wondering if any operation can really fix this.
02/18/14
Phone conversation with S, Dr. R's assistant. Surgery on 03/07 is scheduled for 11 AM pending go ahead from cardiologist. May be held a day or two for observation.
02/26/14
A long day of pre-op clearance interviews, first with the folks at Swedish Hospital, then with cardiologist Dr. H. at the Polyclinic. He has scheduled a cardiac stress test and new EKG for Friday the 28th in order to unravel the mystery of my "T wave inversion" reading. They don't want to subject me to a standard treadmill workout, so they are going to "artificially" stress my heart, inject me with a radioactive isotope and watch the show via fluoroscopic camera. This should be interesting. Plus, they give me the paperwork for assigning medical and financial power of attorney, should anything go awry. One of the receptionists shows me the small laparoscopic scar on her neck from similar spinal surgery preformed last November. She claims to have recovered completely and her pain is gone. What doesn't destroy me makes me stronger!
T minus 8 days and counting...
02/28/14
Cardio stress test at the Madison Polyclinic. Treadmills are passe. Nowadays, they hook you up to an IV, inject you with a radioactive isotope and instruct you to drink lots of water. As the isotope circulates, you are given a second injection of something that stresses the heart. The effects are immediate and unpleasant. You are briefly left gasping for breath, your face and upper extremities become flushed, and the heart beat accelerates dramatically. Blood pressure and EKG testing hums away in the background. You are then wheeled under a servo controlled fluoroscopic camera that takes a series of moving images of your heart in action at different per-determined angles, illuminated by the isotope. The result is a highly accurate profile of heart functioning. Has the cause of my mysterious "T wave inversion" anomaly been pin-pointed? Stay tuned.
03/5/14
Cardio stress test results reveal a perfectly well functioning ticker. No T wave inversion. Left ventricle behavior is A OK. Somehow, I knew this would be the case.
03/6/14
I would like to take this opportunity on the eve of my operation to thank the many people who have come forward with their offers of assistance during my recuperation. In particular, I am grateful to my good friends at the Seattle Shambhala Meditation Center. Heartfelt thanks to Robin Willett and Bonita Quiroz-Cantu for creating and coordinating a care team for me, complete with offers of meal preparation, transportation, help with small chores around my place, and good council. Many thanks to my dear friends Michelle Ringgold and Mike Higdon for their ever generous beneficence and cheerfulness. Thanks to Iris Tansman, Casey Fortenberry, and Kristi Anderson for their offers of help. To my old friends in Baltimore who have sent healing vibes my way, much gratitude. And to all of you who have offered to practice the Medicine Buddha chant on my behalf, my sincere appreciation. Believe me, it has made a difference.
03/7/14
Mike and Michelle drive me to my surgery appointment at the Orthopedic Institute on 1st Hill. I have just assigned them medical power of attorney, which is asking quite a lot if they are called upon to make tough decisions. The intake process involves signing yet another set of consent papers, whose fine print I don’t even bother to read. I change into the familiar ugly hospital scrubs. Bonita arrives and she and Michelle help get me properly fitted.
I meet with Ben, the anesthesiologist, a friendly young man who puts me immediately at ease. I’ll be in good hands with this garrulous and gracious fellow. A gurney arrives and away we go, down a long corridor, around a corner and through a set of double doors. The operating theater is an exquisite showcase of modern medical technology. It has the weird verisimilitude of a TV or movie set, but this is for real. Monitoring equipment whirrs, beeps and clicks. LED screens flicker blue and green. An array of stainless steel surgical instruments are precisely laid out. The entire room is awash in fluorescent, almost garish light. They hoist me onto the operation table. I feel a reassuring pat on the shoulder from Ben, who begins the anesthesia process, and then, oblivion.
When I awake in the recovery area, I hear the familiar voices of my friends. I’m still loopy from the anesthesia. I notice with amazement that a wall clock indicates that it’s almost seven o’clock PM. Mike explains why it took so long. Several hours into the surgery, Dr. K runs into a problem: the C3 and C4 vertebrae, along with the disk that separates them, have fused into a solid mass of bone. He cannot separate the vertebrae, remove the old disk, and insert the composite replacement disk as planned. He is faced with the extraordinarily delicate task of sawing through the bone mass, removing it one piece at a time from around the spinal cord, and replacing it with a titanium plate and basket assembly. This adds an extra three hours to the operation. Fortunately, he foresaw this contingency and has all the necessary hardware at hand, which is firmly fitted and screwed into place.They wheel me into my room for the night, but I barely get a wink of sleep.
03/8/14
The day after surgery, all the anesthesia has worn off and I feel pretty shity. I’m nauseous, the incision area hurts, and it’s painful to swallow. Mucous gathers in my throat that I can neither swallow nor spit out but I still try to swallow anyway and it hurts like hell. My head is throbbing and my throat is raw from intubation. I can only talk in a hoarse whisper. I am stricken with anxiety that these conditions could become permanent. Michelle, who has undergone three open heart surgeries and knows all about the misery of post-surgical pain, reassures me that things will get better. Be patient. You’ve just had major surgery...yup.
I think it is time now to acknowledge the doctor who performed this operation: Dr. Sean Keen of the Seattle Polyclinic, orthopedic surgeon extraordinaire.
03/9/14
I’m fitted with a neck brace by a fast talking young man who admits that I will learn hate it very quickly. The delightful day nurse Lilia comes in and insists that I get out of bed for a walk down the corridor. I use a walker and she braces me on the right as I walk as far as the nurses station and back again. I immediately feel better. It loosens the congestion and I manage to spit out a few wads of bloody mucous.
I told a friend on Facebook that the operation was a complete success. What I should have told him was that it was a conditional success. The vertebrae and hardware still need to fuse and that could take two to three months.
I receive my discharge papers and Mike and Michelle take me back to my apartment. I am relieved to be in familiar surroundings once again. The pain and discomfort have lessened considerably and I can walk about unassisted after only two days which I hope bodes well for a quick recovery.
03/14/14
Follow up appointment with Dr. Keem. He is pleased with the pace of recovery a mere week after the operation. He shows me the latest x-rays and I am impressed with what meticulous care the titanium hardware has been affixed to my cervical spine, filling in where useless bone extrusion existed before. A titanium basket of bone chips has been placed between the vertebrae, replacing the worn out herniated disks, which will facilitate the fusion process.
03/19/14
Good news! Latest scans show spinal fusion in progress. Still, at least a month to go before I can resume normal activity. Still not driving.
I have begun this blog in anticipation of major back surgery, to be performed soon here in Seattle. I have postponed and procrastinated for twelve years on the issue of surgery, hoping improved technologies would be developed in the interim. And while laparoscopic and laser surgery have come along nicely, the still crude and sometimes ineffective methodology of fusing troublesome vertebrae is still the most widespread procedure available. And my wretched back has grown progressively worse since 2001...
Indeed, it is the increased severity of pain and instability that have driven me at long last to seek surgical intervention. And while "on a scale of 1-10" is simplistic when describing pain levels, mine has now reached a very palpable 9 at its worse. And of course, lower back instability puts me at a greater risk of falling. A fractured hip is not what I need at the moment! To add to my increasingly dire health profile, I have reduced kidney function and can no longer take over-the-counter NSAIDs (naproxen, Ibuprofen, aspirin) which were helpful in my daily regimen for pain control, because these substances are damaging to delicate kidneys and stomach linings (I am also recovering from an inflamed peptic ulcer.)
While all this might seem like too much information, I have decided to document these events as fully as possible except for the names of the individuals involved in this ongoing story, for the record...
02/10/14
Another MRI scan at the Madison Polyclinic. Dr. K, the orthopedic surgeon who is supervising my treatment, has detected possible disk deterioration in the cervical spine, and wants a closer look.
02/13/14
Reviewed the latest MRI scans in consultation with Dr. K. More bad news. The cervical disks are mush, every one of them. They look like jelly rolls that have been stepped on, with the jelly oozing out from all sides. And yet I have not experienced neck pain or lack of mobility at all. Why didn't earlier doctors catch this? One squished disk in particular at C5 is pushing ominously towards the spinal cord. Impingement is imminent, with serious implications for respiration and upper body functioning and mobility if there is a collision. For this reason, Dr. K has decided that surgery on the this area will take precedence over lumbar surgery. But that's where it hurts! Ah but It is the things you don't feel that often kill you, Dr. K. gently admonishes.
Here's the bad news from an MRI scan report, spelled out in hideously concise medicalese:
"Severe spinal canal stenosis with spinal cord flattening/compression and moderate to large posterior disc extrusion and probable osteophytes combined with minimal posterior ligament thickening. Severe neural foraminal stenosis (greater on the right) due to uncovertebral spondylosis and moderate to severe right facet spondylosis."
Swell!
02/14/14
Surgery on my cervical spine has been scheduled for March 7. Dr. K is an expert on minimally invasive surgery and will conduct the operation using laparoscopic techniques. I begin pre-op clearance with my primary care physician, Dr. B. to make sure I am hearty enough to undergo the proposed surgery. Another complication. An EKG reveals an abnormality called "T wave inversion." According to Dr. B, this may be caused by insufficient blood flow to the heart. I've googled it and it appears to be a fairly harmless, non-life threatening condition. Nevertheless, at Dr. B's recommendation, I have scheduled an appointment with the resident Polyclinic cardiologist, Dr. H.
02/16/14
My chronic back pain has become an old crony over the years. I say "crony" because I don't necessarily regard it as evil or bad. It has helped me understand the natural process of deterioration that every physical body is subject to. It has acquainted me with the many nuances of pain and the body's natural reaction to pain. In respect of pain, my body is functioning very well - it reminds me daily and insistently that something is wrong. If only it knew when to stop...
Unfortunately, the body's response to the loss of spinal disks is ugly, as it attempts its own stupid version of vertebral fusion. Nature abhors a vacuum! It is a clumsy, haphazard affair, and the outcome is always more of a obstacle to recovery then a solution. Large portions of my spine have become congealed in bone, and it has lost the natural S shaped configuration of normal spines, and therefore, much of its load bearing capacity. Body weight tends to be concentrated more forcibly downward, without the natural curve of the spine to distribute it evenly amongst the surrounding ribs, muscle and connective tissue. Sagging musculature tugs at collapsing vertebrae, causing more stress on disks that are soon transformed from resilient little cushion pads into (as in my case) useless paper thin detritus. And I'm wondering if any operation can really fix this.
02/18/14
Phone conversation with S, Dr. R's assistant. Surgery on 03/07 is scheduled for 11 AM pending go ahead from cardiologist. May be held a day or two for observation.
02/26/14
A long day of pre-op clearance interviews, first with the folks at Swedish Hospital, then with cardiologist Dr. H. at the Polyclinic. He has scheduled a cardiac stress test and new EKG for Friday the 28th in order to unravel the mystery of my "T wave inversion" reading. They don't want to subject me to a standard treadmill workout, so they are going to "artificially" stress my heart, inject me with a radioactive isotope and watch the show via fluoroscopic camera. This should be interesting. Plus, they give me the paperwork for assigning medical and financial power of attorney, should anything go awry. One of the receptionists shows me the small laparoscopic scar on her neck from similar spinal surgery preformed last November. She claims to have recovered completely and her pain is gone. What doesn't destroy me makes me stronger!
T minus 8 days and counting...
02/28/14
Cardio stress test at the Madison Polyclinic. Treadmills are passe. Nowadays, they hook you up to an IV, inject you with a radioactive isotope and instruct you to drink lots of water. As the isotope circulates, you are given a second injection of something that stresses the heart. The effects are immediate and unpleasant. You are briefly left gasping for breath, your face and upper extremities become flushed, and the heart beat accelerates dramatically. Blood pressure and EKG testing hums away in the background. You are then wheeled under a servo controlled fluoroscopic camera that takes a series of moving images of your heart in action at different per-determined angles, illuminated by the isotope. The result is a highly accurate profile of heart functioning. Has the cause of my mysterious "T wave inversion" anomaly been pin-pointed? Stay tuned.
03/5/14
Cardio stress test results reveal a perfectly well functioning ticker. No T wave inversion. Left ventricle behavior is A OK. Somehow, I knew this would be the case.
03/6/14
I would like to take this opportunity on the eve of my operation to thank the many people who have come forward with their offers of assistance during my recuperation. In particular, I am grateful to my good friends at the Seattle Shambhala Meditation Center. Heartfelt thanks to Robin Willett and Bonita Quiroz-Cantu for creating and coordinating a care team for me, complete with offers of meal preparation, transportation, help with small chores around my place, and good council. Many thanks to my dear friends Michelle Ringgold and Mike Higdon for their ever generous beneficence and cheerfulness. Thanks to Iris Tansman, Casey Fortenberry, and Kristi Anderson for their offers of help. To my old friends in Baltimore who have sent healing vibes my way, much gratitude. And to all of you who have offered to practice the Medicine Buddha chant on my behalf, my sincere appreciation. Believe me, it has made a difference.
03/7/14
Mike and Michelle drive me to my surgery appointment at the Orthopedic Institute on 1st Hill. I have just assigned them medical power of attorney, which is asking quite a lot if they are called upon to make tough decisions. The intake process involves signing yet another set of consent papers, whose fine print I don’t even bother to read. I change into the familiar ugly hospital scrubs. Bonita arrives and she and Michelle help get me properly fitted.
I meet with Ben, the anesthesiologist, a friendly young man who puts me immediately at ease. I’ll be in good hands with this garrulous and gracious fellow. A gurney arrives and away we go, down a long corridor, around a corner and through a set of double doors. The operating theater is an exquisite showcase of modern medical technology. It has the weird verisimilitude of a TV or movie set, but this is for real. Monitoring equipment whirrs, beeps and clicks. LED screens flicker blue and green. An array of stainless steel surgical instruments are precisely laid out. The entire room is awash in fluorescent, almost garish light. They hoist me onto the operation table. I feel a reassuring pat on the shoulder from Ben, who begins the anesthesia process, and then, oblivion.
When I awake in the recovery area, I hear the familiar voices of my friends. I’m still loopy from the anesthesia. I notice with amazement that a wall clock indicates that it’s almost seven o’clock PM. Mike explains why it took so long. Several hours into the surgery, Dr. K runs into a problem: the C3 and C4 vertebrae, along with the disk that separates them, have fused into a solid mass of bone. He cannot separate the vertebrae, remove the old disk, and insert the composite replacement disk as planned. He is faced with the extraordinarily delicate task of sawing through the bone mass, removing it one piece at a time from around the spinal cord, and replacing it with a titanium plate and basket assembly. This adds an extra three hours to the operation. Fortunately, he foresaw this contingency and has all the necessary hardware at hand, which is firmly fitted and screwed into place.They wheel me into my room for the night, but I barely get a wink of sleep.
03/8/14
The day after surgery, all the anesthesia has worn off and I feel pretty shity. I’m nauseous, the incision area hurts, and it’s painful to swallow. Mucous gathers in my throat that I can neither swallow nor spit out but I still try to swallow anyway and it hurts like hell. My head is throbbing and my throat is raw from intubation. I can only talk in a hoarse whisper. I am stricken with anxiety that these conditions could become permanent. Michelle, who has undergone three open heart surgeries and knows all about the misery of post-surgical pain, reassures me that things will get better. Be patient. You’ve just had major surgery...yup.
I think it is time now to acknowledge the doctor who performed this operation: Dr. Sean Keen of the Seattle Polyclinic, orthopedic surgeon extraordinaire.
03/9/14
I’m fitted with a neck brace by a fast talking young man who admits that I will learn hate it very quickly. The delightful day nurse Lilia comes in and insists that I get out of bed for a walk down the corridor. I use a walker and she braces me on the right as I walk as far as the nurses station and back again. I immediately feel better. It loosens the congestion and I manage to spit out a few wads of bloody mucous.
I told a friend on Facebook that the operation was a complete success. What I should have told him was that it was a conditional success. The vertebrae and hardware still need to fuse and that could take two to three months.
I receive my discharge papers and Mike and Michelle take me back to my apartment. I am relieved to be in familiar surroundings once again. The pain and discomfort have lessened considerably and I can walk about unassisted after only two days which I hope bodes well for a quick recovery.
03/14/14
Follow up appointment with Dr. Keem. He is pleased with the pace of recovery a mere week after the operation. He shows me the latest x-rays and I am impressed with what meticulous care the titanium hardware has been affixed to my cervical spine, filling in where useless bone extrusion existed before. A titanium basket of bone chips has been placed between the vertebrae, replacing the worn out herniated disks, which will facilitate the fusion process.
03/19/14
Good news! Latest scans show spinal fusion in progress. Still, at least a month to go before I can resume normal activity. Still not driving.
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