Surgery It Is

Today I saw the back sur­geon Dr. Bobby Tay from UCSF. I had to get up bright and early at 7:15 am for an 8:30 appoint­ment. I don’t think I’ve woken up that early since I last worked, back on the 19th of May. I remem­bered late last night that I had to fill out forms so I was up quite late mark­ing where my body hurt. One of the things I had to do was place  ‘X’s and ‘O’s on a sketch of a sex­less per­son, indi­cat­ing what type of pain I was suf­fer­ing, and where (burn­ing, sharp, throb­bing, pen­e­trat­ing, con­tin­u­ous, etc.). I actu­ally had Leanne read the ques­tions out to me and mark the sheet up. I was fairly exhausted and it was quite dif­fi­cult to fill out the form while lying down. It was a good thing Leanne took a look at the forms, too. She dis­cov­ered a num­ber of mis­takes and miss­ing infor­ma­tion. It’s the pain and Vicodin, right?!

Dr. Tay was quite pleas­ant this morn­ing. He made sure to explain every­thing to me, look­ing me in the eye. He began by ask­ing how I was doing and look­ing over the sheet I had filled out. He then spent a lit­tle time tap­ping, prod­ding, flex­ing, and hold­ing my foot in dif­fer­ent posi­tions as I pushed my foot against his pres­sure. He noted that my foot and leg reflexes and strength on the left foot were a lit­tle weak, but not too bad. Dr. Tay did a nice job of explain­ing what had prob­a­bly hap­pened to me, using the MRi images. He used a pen to point out where the disc rup­ture and extru­sion had occurred, and where the disc mat­ter had pushed against the nerve sac enough to dis­fig­ure it. In my pre­vi­ous views of my discs I hadn’t noticed how the disc between the L5 and S1 was squished flat. All of the oth­ers had a nat­ural arc to them.

I was sur­prised to learn that when a disc rup­tures and disc mat­ter comes out, there is a chem­i­cal com­po­nent to the event as well. Dr. Tay said the chem­i­cals add to the pain at the on start. begin with. Dur­ing the surgery to get the disc mat­ter out, they also suck out any of the chem­i­cals they can in addi­tion to blood that came as a result of the orig­i­nal rup­ture. I have to admit that my legs got a lit­tle queasy at the men­tion of blood. That was the first time I had heard any­thing about blood being involved. Sud­denly my back felt worse. The blood seemed to make it all that much worse.

After exam­in­ing me and tak­ing a look at my MRI images, Dr. Tay looked at me and began to explain that usu­ally when peo­ple get this type of surgery, they are in a lot of con­stant pain.  He con­tin­ued, say­ing that disc issues like this can heel them­selves over a year or two with­out surgery. ‘Did he really just talk in terms of years, not months?,’ I thought to myself. I was a lit­tle con­fused as to why he was talk­ing about non-surgery options. It kind of sounded like he wanted to explore the non-surgical route for me. While I have made some improve­ments after the epidural shots of cor­ti­sone, I couldn’t last longer than a day with­out nar­cotics before I was crip­pled from the pain. I had tried phys­i­cal ther­apy but made lit­tle progress and was still show­ing leg weak­ness from the ongo­ing nerve dam­age. I had exhausted all other options. How could I not be the text­book case for some­one who needed surgery?!

Dr. Tay then stopped what he was say­ing, looked more intently at me and said, “you are smil­ing but I can now see that you are suf­fer­ing from a lot of pain.” It sud­denly made sense. I had been so happy that this day had finally come, now being only one step away from finally get­ting relief from the pain that had held me its cap­tive for so long, that I was smil­ing and even giddy (when you’ve been suf­fer­ing for this long it doesn’t take much to excite you). I read­ily agreed with his assess­ment of my pain level, explain­ing that I was smil­ing because I was glad to see him and had just popped a Vicodin. After get­ting that sorted out, he told me the pros and cons of the surgery.

The good news is that the surgery is an out­pa­tient one. Appar­ently, I show up in the morn­ing and am home by early after­noon. The actual pro­ce­dure usu­ally only takes less than an hour, though in some cases, can last for an hour and a quar­ter. He said that peo­ple tend to feel good from 1 to 6 weeks after the surgery. The longer amount of recov­ery time is usu­ally due to the nerve need­ing more time to return to its nor­mal posi­tion after being crowded and pinched for so long. Regard­less, I would be able to walk soon after the surgery. He likes to give the back 6 weeks to fully heal before start­ing phys­i­cal ther­apy, but then go at it with aggres­sive phys­i­cal ther­apy to loosen up all the mus­cles that have become tight through the ordeal. I am look­ing for­ward to resum­ing phys­i­cal ther­apy and actu­ally get­ting to do more than the slight­est of move­ments. I know I will also learn stretches and exer­cises that can be applied through­out my life.

The poten­tial down­sides are few. There’s between 5–10 per­cent chance that the disc doesn’t heal itself shut and more disc mat­ter oozes back out, caus­ing a sim­i­lar prob­lem. Dr. Tay said that the higher per­cent­age reflects the fact that older peo­ple tend to not heal as well. He added that I am young enough so I should heal well. There’s also a chance that the nerve gets dam­aged when it is moved aside so he can pull out all of the ‘gunk’. While this could hap­pen, the chances are exceed­ingly small, and there’s no chance of paral­y­sis, he explained. I asked him about going under gen­eral anes­thetic and the dam­age this can have on the brain. He said that if I opted for local anes­the­sia, I would need to be sedated which still affects the brain. And, if I stopped breath­ing dur­ing the pro­ce­dure, they wouldn’t be able to revive me since I would be sedated. I’m fine with the gen­eral anes­the­sia as even with some brain dam­age, I’ll be more coher­ent and func­tion­ing bet­ter than I am now on the mind-numbing and fatigu­ing com­bi­na­tion of Vicodin and nerve pain!

I am anx­iously await­ing a call from Dr. Tay’s sched­ul­ing depart­ment. He said that he would have them call me today to sched­ule an appoint­ment. I am con­cerned, how­ever, that there will be a long wait time for the surgery like there was to see him in the first place. I am sure that if I keep bug­ging them like I did with the con­sul­ta­tion appoint­ment, I will also be able to get slot­ted in a can­cel­la­tion spot. Here’s to hoping!