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

Back in the High Life Again

48 hours after the surgery was completed I am still feeling pretty good!  The midpoint of my back feels very bruised, though  nothing is evident on the skin.  And I have absolutely no nerve pain.  My throat is still sore from intubation, but the more water I drink the better it gets.  I am incredibly optimistic, but I am also quite aware that this could be the result of the medications I have been given.

I was given pretty healthy amounts of some powerful drugs.  To control muscle spasms I was prescribed cyclobenzaprine, and to control pain, Percocet.  They have been doing a good job, but I am more than a little woozy on the medicines.  I find myself sleeping a lot, which is probably a good thing.  "Tired Nature's sweet restorer" is what Shakespeare called it, and I could use some restoration.  But it makes me feel like one of the cats--I am up for a few hours, sleep some, wake up for a few hours, sleep some more, etc.  When I woke up this morning at 10:00 I had no idea what day it was.

The medicine is definitely helping, and I am trying to get active, but I am not rushing anything.  Besides walking around the house a bit, Courtney and I took a stroll around the yard this morning.  It was only about  a tenth of a mile all told, but I was pretty shaky at the end of it.  I will try the walk a couple of more times today, and keep it going in the coming days.  I would like to be up to a mile by the 10 day marker, but if I can't make it that far I won't be too upset.

Anyway, the main takeaway here is that the surgery seems to have been very successful.  So long as I can dot the i's and cross the t's during the recovery, I should come out of this in great shape.  Thanks for reading!

Get Back

Jojo was a man who thought he was a loner, but fortunately, I am surrounded by people who care for me.  I have previously written about my back condition and about my worries about the surgery I had yesterday.  As the time for the operation approached, I was getting more and more nervous.  But some friends invited the Sassy Librarian and me to dinner the night before, which helped take my mind off things.  And the Sassy one did her best to keep me calm. I also had phone calls and messages from friends and family expressing their support, and willingness to help out.  What a wonderful feeling, to know that people care!

I had my operation at Geisinger Wilkes-Barre, which is a very nice hospital. Having many family members who have had serious health problems, I have spent a good bit of time in doctor's offices and hospitals, and this place is one of the nicest I've seen.  And every single person, from the check-in attendants, to the nurses and doctors to the food service staff is cheerful, friendly and eager to help.  I am so glad that such a good hospital is so nearby.  I have heard of people making the 2.5 hour drive to NYC or Philadelphia for operations like this, but I don't think that is necessary at all.

What follows is a detailed recounting of my experiences yesterday.  They may not be applicable to everyone, but I hope that maybe someone else out there in the Internets might have their own worries calmed down by hearing about my operation.  Well, here goes!

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Due to discomfort and nerves I only slept for about 2 hours the night before the surgery, so I was in that "tired but wired" state when we got to the hospital at 6am.  At around 6:15am we were taken to the pre-surgery area.  Fortunately, Courtney was able to come back with me, which was a great help.  While I was there I changed into this really cool hi-tech surgical gown, which was designed to keep patients warm; it had pockets for warming pads to be inserted, and a hose plugged into the gown to blow warm air inside.  They also put surgical stockings on my legs to control swelling.  This sounds like a lot of extra precautions for a 20 minute operation, but it was as good idea, as things turned out, because my operation took an hour (as I will explain later).  Then they set me up with an IV in my right hand and I met the anesthesiologist and the nurse anesthetist.  Both were very friendly and helpful and made me feel more assured.  Or at least, that is what I thought.  Courtney was watching the pulse rate machine, which showed my heart rate jump from usual resting 60 BPM to 90 whenever one of the medicos came into talk to me!  But I've always had "white coat syndrome" so this shouldn't be a surprise. Shortly after my surgeon came by to go over last minute details (such as circling the proper location for the incision on my back with his pen) the nurse anesthetist came by to put some Versed in my IV so I could start to relax before the wheeled me back to begin.  I had never had this medicine (which among other things makes you sedated and takes away your memory of what happens next), but Courtney had been given it in the past, and couldn't stop talking about how helpful it was. Well, I remember saying something like "I don't think this stuff is all that great", and then next thing I know it was 4 hours later!

As I mentioned above, the operation took about three times as long as was expected.  When the surgeon drilled into the vertebra to get room to work, he found that things were highly calcified (indicating that I had been injured at least 5 years ago, which fits with my previous experience).  So he had to use miniature hammers, chisels and drills to remove the calcified area.  Once that was done, he carefully lifted the nerve away to remove the herniated disc material. Then he closed me up.  I have no stitches or staples and the incision area is still no more than 2 inches long.  

I woke up in the recovery room at around 11:30 and nurses and the surgeon all came by to update me and check on me. I was still loopy from the drugs but I was awake and not paralyzed, so I felt that things had gone very well.  I had a very sore throat because I had been intubated during the operation, but they gave me some water and ice chips which helped (plus I hadn't drank anything for over 12 hours by then).  There was one issue, however, that was not ideal...

During the operation they had to insert a Foley catheter to collect urine. This had been the ultimate fear in my life and the thing I was most nervous about leading up to the operation.  It was inserted and removed while I was sedated, but there was a terrible burning pain in my private part. Before I was taken to my room, the surgeon told me that I could avoid an overnight stay if before 4pm I could meet the following four goals:

1. the pain was under control
2. I could walk
3. I could eat
4. I could urinate

Over the next few hours I rested in a very pleasant hospital room with Courtney and her mother.  I drank about five big cups of water and noshed on a soft pretzel.  Swallowing was still hard, but the water helped.  The pain was greatly diminished--before the operation it was around a 4 on a scale of 10.  By 3pm it was a 1 (and that was coming from my front, not my back, if you catch my drift). Finally, at 3:15 I decided to try to urinate.  I stood up with the assistance of one of the nurses and went to the bathroom.  When I tried to "let it rip" I was greeted with the worst pain I have ever felt.  It was easily a 15 on a scale of 10!  But I was successful.  Since then it has gotten better each time, but let's just say that, unlike my phobia of deserts, this was a highly rational fear.

Anyway, the surgeon came by to check on me at 4:15 and cleared me to go home. It still took a couple of hours after that to get the IV out and go over the discharge paperwork, but we left the hospital at 7:10, and I walked out--no wheelchair necessary!  We drove to the local pharmacy to pick up the Percoset and muscle-relaxer prescriptions, and I hobbled around the store for 15 minutes, getting more steady every minute (though I felt totally exhausted).  It was great to get home at 8:00, whereupon I called my mother to give her an update, got ready for bed, and went to sleep.

As I write this it is about 24 hours after I woke up in the recovery room, and the pain is pretty much non-existent.  I am trying to be very deliberate in my movements, and I am super optimistic that this will do the trick!

Bringing It All Back Home

So as I wrote in my last post, I am due to have microdiscectomy surgery on my L5 vertebra in a couple of days.  As the time draws closer, I have been getting more and more apprehensive.  To list my fears in order:

1. Waking up dead (not waking up at all)
2. Waking up paralyzed
3. The operation is a success, but I screw up the recovery

This is a very common surgery, and as I am in otherwise good overall health, it is unlikely that I will die.  Similarly, my doctor does this operation all the time, and seems to have a steady hand, so it is unlikely that he will slip and leave me in a wheelchair for the rest of my life.  It is #3 that has me the most spooked.  The recovery process for this operation is rather drawn out, and the directions are very specific. The highlights (a/k/a the parts that worry me the most) are as follows:

1. no exercising except walking for the first month at least
2. no twisting or bending
3. no lifting anything heavier than 5 pounds for the first month
4. only adding 10 pounds to the limit every four weeks afterwards

I am not exactly a fitness freak, but I  like to move and do physical activity.  It is not that I think that I will pine for lack of exercise, but I worry that I will inadvertently move in a way that causes the disk to re-herniate.  Also, for the last six years not a day has gone by that I haven't done exercises to strengthen my midsection (to support the spine better).  For at least a month I will have to avoid these exercises, and I am worried that I will forget myself and wind up injured.  Ditto with the twisting, especially in my sleep.  People tell me that I just need to be conscious and deliberate, but if you know me, you know that I am rather absent-minded.  Well, we will just have to see...

The lifting has me concerned for two reasons.  Partly because I am worried that I will accidentally lift something heavy (like one of our cats) and hurt myself.  But mostly because I worry it will put too much pressure on my wife, the Sassy Librarian and require her to have to do too much physical work.  Not only that, but for the 19 years we've been together, my household duties have all revolved around the "heavy lifting" (carrying the laundry, taking out the trash, vacuuming, carrying groceries, etc.).  Now that I won't be able to do this for several months, it is making me have a bit of an identity crisis.  I am sure it will work out, but right now, this is the kind of thing keeping me awake at night.

Back And Badder Than Ever

After a long hiatus I am back to blogging.    While the usual work and "life getting in the way" reasons apply for my five month absence from the blogosphere, there is another reason I haven't been writing lately: my back is seriously messed up.

I first injured my back six years ago.  "How?" you ask?  That's a good question, but I have no earthly idea.  One day I was fine, and then the next I had sciatic pain all down my leg. When this first happened in 2006 I had an MRI, pursued physical therapy and chiropractic care and had two cortisone injections in my spine.  The therapy and chiropractic helped (my chiropractors are also physical therapists, and they taught me many exercises that have helped me to strengthen my "core" muscles to prevent further injury). The first shot did nothing for me, and since the second I have been numb in my right foot, though it did help me get back to physical work.  During this initial attack in 2006 the pain was almost literally unbearable--I thought that I had previously understood pain, but what I used to consider a "8" on a scale of 10 pain was now relegated to a "3".  It was bad...

Over the years I have had several more "flare ups" of the sciatica.  These have happened after a sneeze, after a cough and after getting out of bed. In other words, there was no way to prevent them.  And over the last six years, I have averaged about three and a half months per year in rather intense pain.

At the end of October, 2011 I injured myself ducking my head under a low doorway (see what I mean?).  As of now it has been over seven months and the pain is still there.  More MRIs have revealed a displaced L5 disc which is sitting on the nerves that go down my right leg.  Since October I have been numb from hip to foot on the outside of the right leg. For the first two months the pain was excruciating.  I could barely sleep, sitting was torture, and the only thing that helped was walking on our treadmill.  I found that while I had to limp slowly for the first two miles, after that I felt pretty good--so I walked on the treadmill for about 4-6 miles every day.  I am proud that I have only missed two days of work due to back problems in all these years, but things were getting so bad that I yielded to the logic of having surgery to attempt to repair the problem. 

One of the problems this time was the amount of medication I had to take.  During the early winter I was taking three Vicodins a day, and I felt pretty tranquilized all the time.  It helped, but the pain was still considerable (now I only take one occasionally as needed, but it still works out to about once per week).  In December I started taking Gabapentin, a nerve suppressant. This helped a lot (and is the reason I was able to coach softball this spring), but the side effect was a pretty total loss of short term memory, which made it hard for me at my job (I am a history teacher).  In May I upped the Gabapentin dose, which totally eliminated the pain, but then I started getting obsessed with suicide (a known side-effect), and had to reduce the dosage, which brought the pain back.

So finally, on June 8, 2012 I am scheduled to have microdiscectomy surgery.  The surgeon will make a 1-2 inch incision in my lower back, and using microscopic tools will spread apart the back muscles to locate the protruding disc.  Then he will snip off the part that is sitting on the nerve (leaving the rest to function as intended) and sew me up.  That is, if all goes well--who knows what they might find when they get inside. I have decided to make regular blog posts describing the experience and the (hopefully) smooth recovery process.  Stay tuned, and wish me luck!