Six Month Update--Back to Basics

moreicinc in moreSix months ago today I had my back operation (a microdiscectomy and laminectomy of L5, if you don't remember). While the initial recovery had its ups and downs, overall I am reasonably pleased with my progress.  I saw my surgeon a few weeks ago and he told me that I should feel free to resume all of my normal activities, so that is in itself a pretty good sign. If I had to rate my satisfaction with the process of getting the surgery, I would say that I was 90% satisfied.

In the main, I am feeling a lot better.  I had been dealing with a herniated disc and related nerve pain for six years.  The pain would flare up and give me a really bad 3-4 months and then it would go away.  During these six years I have made lots of changes in my life, from sitting on a balance ball as much as possible (both at home watching TV and and my desk at work), to walking much more (3-4 miles per day 4-5 days per week).  I also spend a considerable amount of time off the ball doing "core" strengthening exercises.

In late October of 2011 I hurt my back again, and the pain was so bad, and required so much medication to get through my day, that I opted for the surgery.  I was also totally numb from hip to toe on my right leg.  Well, since the operation, the pain is almost totally gone, and the numbness has improved a lot.  For reasons unknown to me I had a terrible episode from mid-August to mid-September, where the nerve pain returned and combined with terrible spasming of my piriformis muscle.  I had to resume the full complement of medication just to get through the day (which was depressing) but thanks to exercising and patience it went away eventually.

At this point, though, I am doing fine.  Some days the numbness returns to pre-operative levels, but it is getting better all the time (though the doctor told me that it could take another year until my nerves are fully regenerated).  One thing I have noticed is that most days I have an incredible amount of stiffness and pain in bed and upon waking.  Stretching helps, but most days I take two Naproxen in the morning and two Tylenol later in the day to get relief, and some days I still need to take a Percocet (though this is increasingly rare, thank God).Fortunately the stiffness usually disappears within an hour or two of getting up, but I am thinking of visiting my chiropractor again to see if he has some suggested stretches to help with this issue.

So right now, the challenge is to decide just how far I want to take my doctor's permission to "resume normal activities".  For instance, I went to see a movie a couple of weeks ago (Lincoln--I highly recommend it) and after two and half hours in a reclining movie theatre seat I had two days of really bad back spasms.  So the next time I went to a movie I stood--no pain, but not a recipe for date night with the wife!  I have avoided lengthy car rides, though I've begun increasing my time on the road.  I am somewhat dreading the first heavy snowfall of the winter, and am more than a bit nervous about how I will do swinging a bat during the upcoming softball season (I coach a high school team).  When I mentioned my concerns about swinging a bat to the doctor, he said that he would never recommend that activity, but I should try it, and if I get hurt again he'd be happy to operate again.  I guess that passes for humor in the medical profession...

Well, unless something unexpectedly bad happens this will probably be the last post in this series.  I hope that other sciatic pain sufferers have had the chance to read these jottings, and that they have been helpful.  Feel free to leave comments if you wish, and good luck!

Day 34 Update--Getting Back To Normal

Well, I had my "1-month" checkup today following my microdiscectomy operation.  The surgeon wants to see me for follow-ups at intervals of 1 month, 3 months, six months and 12 months post-surgery.  In addition to checking on me, part of the routine involves filling out forms where I assess my current pain status and describe how the disc problem is affecting my life.  I filled out these forms when I first met with the surgeon five months before the operation, then three weeks before, and then on the day of the operation.  I guess they keep track of these self-assessments for statistical tracking purposes.

Anyway, I am feeling wonderful!  No back pain, no nerve pain down my leg, and I feel like I can do anything!  But to be on the safe side I am going to follow all of the restrictions to the letter.  Here is a list of things that I still can't do:

• ride the lawnmower (too bumpy)
• use the weed whacker (too heavy/too twisty)
• run (too bumpy)
• swing a baseball bat (too twisty)
• vacuum (too heavy, too twisty)
• carry anything over 15 pounds

On the bright side, here are the things that I can resume doing:

• pushups
• pullups
• Total Gym exercises
• floor based core strengthening 

and most importantly, now that I can lift more than five pounds, I can play my electric guitars again!

When I talked to the surgeon today, he agreed that my hives were caused by an allergy to chlorhexidine, which was used as the antiseptic wash during my operation.  Furthermore, he said that my allergy was a "type 4 reaction", indicating that it was delayed onset (two weeks post-op) and NOT histamine related.  Which suddenly explains why I had no relief despite taking two Benadryls every four hours for two weeks (all I got relief from was ice).  It turns out that these reactions are related to the T-lymphocytes, and antihistamines are not effective.  

I did a little reading on the subject, and found an article that explained this in medical jargon (I've included a quote below).  Anyway, after reading about the serious reactions to chlorhexidine (some have died from anaphylactic shock!) I am definitely going to make sure that every doctor and dentist I see in the future knows that I am allergic to this substance.

There are four mechanisms of hypersensitivity, which are classified according to the components of the immune system involved. Type one, hypersensitivity reactions/anaphylactic reactions: This occurs in individuals who have inherited very high levels of a type of antibody called immunoglobulin E (IgE). When exposed to an antigen, these high levels of antibodies activate mast cells and basophils, which release their granular contents. Physiologically the most important substance released is histamine, which constricts smooth muscle within the bronchioles, activates vasodilation and increases vascular permeability (leading to exudation of fluid and proteins into tissues). Examples of type 1 reactions include allergic rhinitis (hay fever), allergic asthma and penicillin-induced anaphylaxis.

Type two, hypersensitivity reactions/cytotoxic hypersensitivity: when an antibody reacts with an antigen on a cell surface, that cell is marked for destruction via a number of mechanisms, for example: phagocytosis, or destruction by lytic enzymes. This is the usual procedure in the elimination of bacteria. If antibodies are directed against self-antigens the result is destruction of the body’s own tissues (autoimmune destruction). Conditions of particular concern within this area are blood transfusion reactions and haemolytic disease of the newborn.

Type three, hypersensitivity reactions/immune complex mediated hypersensitivity: Antibody-antigen complexes are usually cleared efficiently from the blood by phagocytosis. If this process fails; the complexes can be deposited within the body’s tissues, where upon an inflammatory response is initiated. The kidneys are often affected because they receive a large proportion of the cardiac output, and filter the blood. Immune complexes block the glomeruli, impairing renal function (glomerulonephritis). Penicillin sensitivity can also lead to a type three reaction; the body’s antibodies bind to penicillin, which is the offending antigen, the symptoms are the result of deposition of immune complexes in the tissues. Examples include, rashes, joint pains and haematuria. Infectious diseases such as malaria and viral hepatitis can lead to a type three hypersensitivity reaction. This form of hypersensitivity has been implicated in causing systemic lupus erythematosus (SLE) (Taylor and Reide, 1998).

Type four, hypersensitivity reactions/delayed hypersensitivity: unlike the earlier mentioned reactions, type four reactions do not involve antibodies. The reaction is mediated by T-lymphocytes, which overreact to an antigen. When an antigen is detected in the blood it provokes clonal expansion of the T-lymphocyte cells and large numbers of cytotoxic T-lymphocytes are released to terminate the antigen. If the T-lymphocytes are over stimulated and the response becomes inappropriate the aggressive cytotoxic T-lymphocytes will damage normal body cells/tissues. Examples include contact dermatitis, and organ rejection. It is important to note that all of the above hypersensitivity reactions have the potential to induce a state of physiological shock to the individual affected by them.

Day 18 Update: It's the Itchy and Scratchy Show!

For the most part, things have been going very well since my back operation.  I haven't had to take any pain medication beyond some over the counter Aleve and I feel like a brand new person.  Until suddenly on the 15th day after the surgery, I broke out in hives all over my back.  I have been taking two Benadryls every four hours, plus spraying on Lanacane plus smearing on hydrocorisone cream to no effect.  I have also spent a lot of time with ice on my back to cool things down. The itching and the pain is terrible!

I went to see my family doctor today and he speculated that it was related to something that was used on me during the surgery (or, less likely, a reaction to the dissolvable stitches inside me).  He prescribed me 5 days worth of Prednisone, and suggested I take Claritin and (believe it or not) Zantac as well.

Interestingly, I tried to find more information about this on Google, and it seems somewhat common!  The query "hives after surgery" yields 73,000 hits and "post surgical hives" has 1.3 million.  Some people seem to be plagued by this for a long time.  I hope I am an exception!

Meanwhile, at least I don't have to go see THIS doctor:



Itchy And Scratchy Show : Dr House