Wednesday, February 26, 2014

Microdiscectomy: WARNING: not for the squeamish!

A little over a week ago, I blogged about my upcoming back surgery. I wanted to log some details and report how things went. 

WARNING: If you are squeamish, leave NOW! No joke. You might puke, and not in the good way . . . wait . . . nevermind . . . just . . . go.

Alright, for you brave souls who remain, here's how it went down. First, some things I didn't share about what happened before the surgery. I swear the gods of spines did not want me to have this surgery. Before I went in for my final preop clinical visit, I went to the dermatologist to have a rash checked out. It had become painful and had been in my armpit for some time. So I thought, "Let's get it taken care of. Shouldn't be a big deal." Wrong. Turns out I had a staph infection. Lovely. So I got a couple of creams and an antibiotic called sulfamethoxazole-trimethoprim, which sounds like some sort of Klingon insult about your mother's lack of headbumps. So I let the spine surgeon know, and we're all good. Clinic visit goes great with the spine clinic, then two days later, I'm done with the course of Klingon insult meds. Things are on track for surgery on Valentine's day, February 14th (in case you forgot - for shame!).

The Sunday night before the week of surgery, February 9th, my guts basically turn inside out. I'm talking massive pain, somewhere in the 8.5-9 range for me. I've had this happen before a couple of years ago, and that time I went into ER, they gave me some hydromorphone and some kind of medicine to settle my guts down and I was fine. Except I had to pay $75 for the ER visit. And I felt really stupid when it wasn't something spectacular, it just hurt so bad I was crying (though not nearly as bad as when I ruptured my disk). I wasn't about to do that this time, even though my copay has dropped to $50/visit (thank you, spouse's employer!). So I grind through for 12 hours. I did not sleep one minute that night. It's not like the kind of sick where you actually just pass out and then look at the clock and realize that you've been asleep for 5 or 10 minutes. Oh, no. I didn't even get that mercy. I sleep NOT AT ALL that night. But I was determined not to go into ER. Finally, at about 5 AM, I called the 24 hour nurse helpline (my HMO absolutely rocks!), and talked, between groans and grunts and squeals, with the nurse. Urgent Care opened at 8, could I wait that long? I said I'd try, and she told me that if I just couldn't wait, I should go into ER. No way. I stuck it out and suffered through 3 more hours of excruciating pain. Imagine someone punching you in the stomach while you're not expecting it every minute or so. That's pretty much what it felt like. 

So I went into Urgent Care and answered a million questions through my pain. They took some blood, took some stool sample (yeah, it was more red than anything, which worried me a great deal), and did some X-rays. After a while the doctor called me back in and said it could be a couple of things (I can't remember what they were, thankfully - they were pretty horrific) and that I needed to get a CT scan . . . at another clinic! So here, I'm thinking, "how the heck am I going to drive over there in this kind of pain?" The doctor, being an astute reader of persons, immediately noted my perplexed look and said "I can give you something for the pain that won't make you loopy, so you can drive over there." I love it when doctors can read your mind or, in this case, your face. Makes life a lot easier. So I waited a few minutes and the nurse walked in with her tray of injection stuff. It's cool, I don't mind shots, especially given the pain I had been in up to that point. No big deal. So I roll up my sleeve and she says "unfortunately, this one goes in the rear". Sigh. OK. "Can you put it in the left cheek, because the right cheek is where I already have a bunch of pain, hence the upcoming surgery". "No problem," she tells me. "Just drop your drawers and inch or two. So I comply, looking forward to the pain relief. She pops the needle in, not that painful, then sweet mother of heaven! Mike Tyson is in my butt muscle and trying to punch his way out! Augh! "Yeah," she says, "that one's got a little bit of a bite. I don't know why. Sorry about that." Her sweetness prevented me from wrapping the blood pressure cuff around her neck and pumping until something popped. My butt hadn't hurt that much since I dared my mom to spank me with the wooden spoon (she obliged). In fact, I loved my mother for that spanking at that moment, because it didn't hurt nearly as much as this. I was cursing ketorolac, at this point. 

I sat down and recovered from my butt-whupping. The pain in my gut actually did subside a little. Enough to drive without fear of driving off the road. My butt still hurt (I couldn't see if it was bruised, but I think so), but I could drive. So I headed over for my CT scan. They introduced me into a waiting room where I drank 3 tall (and I mean tall) glasses of what tasted like crystal light lemonade. I was almost gagging by the 3rd one. You can only have so much of some things. After that (it took an hour), they popped an IV in me and had me lay down on the table. The technician was totally cool. Have I said how much my HMO rocks? And UW hospital, too. Those guys are awesome. Anyway, the technician told me "I'm going to inject some iodine in your IV. It might make you feel a little warm. In fact, you might feel like you're wetting your pants, but don't worry, you're not." Easy for him to say. He hadn't had to guzzle down a half-kegger of crystal light lemonade. So he started the injection and I waited for the possible warmth. "You'll feel it start near your chest and spread . . ." but by then, it had already happened. It was one of the most awesome feelings I've felt, even though it was not terribly comfortable. I felt like the Human Torch, like my skin was spontaneously catching fire and I was full of power and could fly! RAAAAAH!!! Of course, all I could say was "whoa". "Pretty cool, huh?" the technician said. I could tell he had flown like this before, too. I did feel like I wet myself, but I didn't care because I was now this mutant superhero, right? I was ready to conquer evil, and they wasted my superstrength by putting me into the CT scanner instead of unleashing me on the criminal underground. I said I liked these guys, I didn't say they were the smartest . . . Then, when the CT scan was over, I felt my superhero powers leave. I could have cried. Maybe I did. I wouldn't know because my tears would have instantly become steam. Iodine, I love you.

So then came the long wait. After that long wait (I won't bore you with the boredom), the doctor called the radiology section and I talked with him on the phone. The diagnosis? Acute Colitis. I'm not going to elaborate. You go look it up. Nasty s***. Literally, nasty s***. And guess what caused it? The antibiotics that the dermatologist prescribed me. I kid you not. Antibiotics caused this. And the cure? Yep, you guessed it, more antibiotics! At least the doctor had the courtesy of asking if I wanted anything for the pain. I told him I thought that would be best, so he prescribed hydrocodone and the new antibiotic, metranidozole - the most hideous horse pills I have ever had to swallow. 500 mg of pure putrescence cut in such a way that it never goes down with the first swallow. Who thought of putting sharp edges on a pill that big? Stupid, stupid, STUPID! I should sue the pharmaceutical industry for abusing my olfactory and taste senses. 

So I called the spine surgeon again and we postponed until Thursday, February 20th. I was surprised and relieved to get in so early. Keep in mind that this whole time, I'm dealing with pain from the small of my back down through my right leg all the way to my (numb) toes that feels like a really, really bad toothache. Everything is sharp pains and zinging, the kind of thing that makes you nauseous. Thankfully, I was able to keep food down, but it was a chore sometimes. 

The Colitis eventually resolved itself and the day before surgery arrived. I tied up loose ends at work (tough when you work on multiple projects at once and all are important and need a good place to pick up at when you go back). I went home, had a Hibiclens (tm) shower, and crashed out. The next morning, another Hibiclens (tm) shower and I had to have my wife cover my back and butt in another prep solution. Honestly, I've never felt so clean in my life. I think my body was a biological dead zone at this point, at least on the surface. I'd love some of that Hibiclens stuff for the times when I come home after a week of camping. Die, bacteria, DIE!

Since roads were slick, we ran a little late, but it didn't matter. There was a room full of people waiting for surgeries. Seriously, there must have been 20 people getting cut open that morning. I wondered how many would make it, but they were all outpatient surgeries, so I'm guessing at least 19 of us survived. I didn't check the obituary for faces. Who knows? I may have been the only person to walk out of there alive that day. They don't really publicize these things, you know?

A very nice nurse came in and he asked me the same questions I had answered probably 50 times in the last two months. When I get old, I might just have my medical history tattooed on my back, then roll over and go to sleep when they start asking. They can take notes from there. Seriously, I thought electronic medical records were supposed to make these questions less frequent. That's what they told us when I worked at Epic. Not that Epic is the paramour of honesty . . . but that's a different story. After the nurse was done I met with the anesthesiologist, who was an MD resident. Since anesthesia was my biggest concern, I was really happy to find that she was a straight shooter who told it like it is, but with a sense of humor. She told me that there was a very low chance, less than 1%, that the sheath around my spinal column might get torn and leak spinal fluid. If that happened, there was a chance I could get a really bad headache, so I had to be on the lookout for that. And if it did leak too much, they might inject some of my own blood into the spinal cavity, which somehow helps. I'm guessing it dilutes the spinal fluid or something and keeps you from having headaches, or maybe it stops things up so you don't lose more fluid, I dunno. I said "so what you're telling me is that there is a far greater chance of me dying as I walk out to my car after surgery than there is of this happening, right?" We had a good laugh, then she told me about how they'd to the epidural. I asked what they would use for sedative, and she told me Fentanyl, which is scary because that stuff is 50 times stronger than heroin (I knew this how? From listening to a story on NPR about heroin addicts dying because their street dope got laced with the stuff and they OD'd). But, I thought, great, I'll be good and out. She had me sit up and the room flooded with anesthetists and anesthesiologists (anesthetists are like the techs, anesthesiologists are like the doctors). The anesthetist standing directly in front of me was from Ethiopia, so I told her about my degree in African History and we talked a little Ethiopian history (I knew just enough to not sound like a fool). They started the epidural, which wasn't uncomfortable, then I looked over at my IV tap and saw the Fentanyl syringe being slowly plunged . . .

And I woke up in another room. My wife was just walking in as I woke up, I think. The spine surgeon came in and told me something that I half understood, something about me needing to stay overnight for them to observe me. I was like, whatever, doc, I'm BAKED right now! Woohoo! Well, I didn't say that out loud, but I was sure thinking it.Anyway, it was something about my spinal sheath or rather. I didn't hear the rest, just felt that my leg was a LOT better, even though some pain remained.

So then, yeah. Long day full of morphine and hydrocodone. Late in the morning, the nurse comes in and says "you haven't urinated yet today". I didn't think much about it until she brought over this nasty looking tray with red rubber . . . objects. "We're going to have to catheterize you to get things going." Now, catheterization is something I've joked about fairly frequency, like "I'm so busy. Catheters would make me even more efficient," that sort of thing.

People, catheters are no joke! I thought they maybe just popped a needle in your belly and drained the bladder or something. I didn't know any better.

Now I know.

I will never joke about catheters again. Ever. I think I'm going to get the area around my urethra tattooed with "One Way: Do Not Enter!" Because a tattoo there couldn't hurt much more than the catheterization, and it might buy me enough time to escape from the hospital next time. Or at least to beg them for whatever local anesthetics they have in their cabinets.

Needless to say, I drank a LOT of water and had a LOT of juice with every meal. I had a deadline: 5:30. If I coulnd't get the whizzer going by then, they were going to do it again. I was going to have none of that. Problem is, epidurals relax your bladder sphincters, so you kind of have to wait for it to work through your system. Furthermore, the shock from the urethra on the initial catheterization was enough that whenever I thought I could start (Oh, by the way, I had to do this lying on my back in bed. Couldn't sit or stand up), my little buddy just winced. At 5:29, I was able to generate a trickle. The nurse shift had changed, and the new nurse said "That's good! Now so long as you have less than 400cc in your bladder, we won't have to do the catheter." So she got this sonogram-type device, probably the same thing submarines used to search for depth charges underwater or something, and scanned my bladder. I was thinking "holy crap, I drank the Ganges river today. No way that's going to be under 400cc." Thankfully, I was wrong. 319cc. Phew! All that water must be hiding up around the bend, somewhere. Then she said "next time you pee, we'll check again. You have to have voided (meaning had to be under 400cc in the bladder) three times in a row for you to have passed."

This had me worried. What if I didn't pass? I had chugged a prodigious amount of liquid. I felt as bloated as a week old dead horse on a civil war battlefield. I probably didn't look much different. But at least the dead horse didn't have to face The Catheter. I might.

Thankfully, the river gods blessed me that night. In fact, they might have cursed me. I drained 700cc on my next try and passed! The (new shift) nurse told me that you'd expect somewhere between 200-300cc to be "normal". So I had gone great gonzo on the urination front. Next time, 700cc more! The nurse came in and said: "Geez! What monster have I unleashed?" But when he measured my bladder, it passed muster! I was home-free. Except that I hadn't banked on how much more liquid was in me. Next try: 500cc. Then 400cc. Then 600cc. Then 600cc again. This was all in the course of one night, mind you. 3500cc in one night. That's 3.5 liters of piss! 3.5 LITERS! I don't even think I drank that much! My bladder opened a door to the elemental plane of water!

So after I dismissed the water elementals, I waited for a while (didn't sleep much that night, by the way), and the spine surgeon showed up to let me know they were done observing me and were ready to let me go home. I asked him, "so I didn't really hear what you told me yesterday, because I was still flying on Fentanyl. So why did I need to stay overnight?" He smiled and told me "there was a little tear on the sheath surrounding your spine and a few drops of fluid dripped out." "So," I responded, "that thing that happens less than 1% of the time happened to me?" He shook his head and rolled his eyes. "Yeah. I've never seen that before. We patched it up, though, and you should be okay." I said, "given everything else that was conspiring against this surgery happening, are you surprised?" He shook his head and smiled, then gave me instructions that I was to take it very easy over the next week, just stay in bed, and then we'd meet in 2 weeks instead of the previously-scheduled 5 week follow up.

I probably should have gone out and bought a lottery ticket. I know that he does hundreds of these surgeries a year, and he's been at it for a while. Never saw that before. Just my luck.

So I came home. The first day, after I had been home for a few hours, I felt like a truck hit me: a nausea and aches truck, like the flu and a bad hangover mixed up in a blender. I started shaking and just wanting to puke (that would have been fun). Just felt like crap. Then I realized, oh my gosh, I had 2 mils of Morphine every 2 hours for the last day. And they cut me off. I'm going through withdrawals! Seriously, I was. That was horrible. I can see why junkies keep on shooting up. It's not to feel good, it's to not feel bad. Seriously felt like the flu just pinned me down and punched me repeatedly in the kidneys. That sucked. I don't ever want to feel like that again. Thankfully, my next dose of hydrocodone leveled me out. I slept and had the freakiest dreams, but the withdrawal symptoms eventually faded.

 So I have been resting as much as possible since I came home, which is not like me. I've tried to resist the temptation to overwork myself, but it's tough. I probably shouldn't be sitting here typing this, and have had to do it piecemeal, taking a bunch of breaks in-between typing sessions. Sitting hurts if I do it too long. And my doctor told me I really shouldn't be sitting at all. So I'm sort of following those orders. Sort of. I'm mostly laying down or standing, but I can't really type doing either one of those. I think I'll be alright, though, so long as I continue to lay much longer than I sit.

So it looks like this ordeal is over, right?

Wrong.

Last night, I was brushing my teeth. I looked at my tongue and felt panic shoot through me - it looked like chunks of my tongue were coming off! Seriously, there was something very wrong! So we went into Urgent Care last night and they did a culture. Looks like I have a yeast infection on my tongue (another medical discovery for me - I didn't know such a thing was possible). Guess what brought it on? Wait for it . . . you guessed it, antibiotics! The ones that were supposed to cure my colitis, which had been caused by antibiotics, caused this infection, as well! I said to the doctor: "Don't tell me. The cure for this is more antibiotics." She assured me that, no, it's not. Instead I'm taking an antifungal agent. I'm guessing mushrooms are going to sprout out of my ears and eyes at any moment.

Overall, though, the pain has lessened. I get some shooting nerve pains that are pretty spectacular once in a while (I feel one brewing right now, in fact, and am going to have to lie down soon), but overall, much better. I can walk without using that stupid cane and, as long as I don't overdo it, I think I'll continue to improve. Today was really good, in fact. I've dosed down on the narcotics, which is making me feel a lot more confident about potential withdrawal symptoms. Don't want that mess again!

And now, the part you've all been waiting for: the pictures. Well, they're nothing spectacular, to be honest. First, there's the doctor's initials on my side. He owned me for the surgery, I guess. No sense getting us mixed up. "Your forceps are in my patient!" "Your patient is in my forceps!" (cue Reeses Peanut Butter Cups music). Second, the incision. This is a couple days later, when my wife changed my dressing. Nothing spectacular. It's about 2 inches long and hurts. Other than that, not much to say about it. The white stuff is steritape, which helps to hold things together. The stitches are under the skin, and are dissolvable. I know, I was surprised, too. I was expecting to have those suckers plucked out, but they don't have to do that, for which I am very grateful. Third is me, not long after waking up from surgery. If you've ever wondered what I look like when I'm really, really high, this is it. I don't do drugs or drink at all, so this is the only party shot you're getting of me. And I don't have a needle in my hand, so you can't call me out on Facebook as a druggy. But that day, I was. Finally, I'm including a link right here to a video of the type of procedure I had. This isn't mine, of course. I asked if the doctor could film it, but he said "No. You can just go to YouTube to see what it looks like." It's pretty gross. and the chunk they take out on that video is pretty comparable to the one they took out of me, though mine was a little bigger. So, yeah, that's what was pressing up against my nerve and causing so much pain. An orthopedic resident friend of mine who saw my MRI said "I've never seen one so big". Now, he *is* a resident, so he's got a lot of them to look forward to, but for now, I hold his record for biggest herniation he's seen on an MRI. I'm #1 at something! Anyway, here are the pictures:


Maybe the surgeon was claiming my kidney for himself ahead of time. See those fat rolls? Those are going to be gone as soon as I can get back to core workouts and running. Those didn't used to be there.


Purty, huh? Keep in mind I was on my side for this photo. My head is to your left. I'm not sure if the incision is a little jagged or if the stitches and steritape make it just look that way. Oh well, chicks dig scars. Or so I'm told. My wife definitely digs scars. I told her "when you take the wrapping off, DON'T TOUCH THE WOUND!" She said "I won't," as if I shouldn't have raised my voice. Sorry. I know her. She wanted to touch it. She wanted to.


Here's some appropriate music for this picture. Here's some more. Yeah, I was feeling alright. I kind of look like Steve Martin in this picture. I wonder if he'd give me, say $5K, just for giggles. Or maybe Russell Crowe. I get told I look like him all the time (not so much in this picture)! He's got a cool $5K to spare, right? Just for me being me? OK, maybe I'm still high. How about a nice dinner? That's not unreasonable.

4 comments:

  1. Dude... no sitting! Seriously, there's a reason they tell you not to. Supported reclining is fine, because it doesn't stress the surgeried area. If you don't have a recliner (I went out and bought one when my wife was facing her lumbar fusion), a wedge for your bed works, and best of all, you can still type whilst reclined.

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    1. Hrm. I'm unknown to blogspot, apparently. Bernie from the infamous bug-zine here...

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  2. Ouch. As one who's suffered from a herniated disk (albeit sans surgery and any antibiotic-induced infections), I feel for you, Forrest. Hope you continue to heal up nicely.

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  3. Goodness gracious, you have been through so much! Glad to read, though, that through all of your trials and tribulations you are still in good spirits and that the back surgery you underwent ended well. Hopefully, none of the other issues you experienced come back again. You deserve some peace for once.

    Jesse @ U.S. HealthWorks Saugus

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