Thursday, June 18, 2015

Microdiscectomy, 16 Months Later

It's surprising to me, downright shocking, that one of the most read blog entries at Forrest for the Trees is my entry: Microdiscectomy: WARNING: not for the squeamish! I suppose I shouldn't be so surprised - when I was researching the procedure, in order to make an informed decision about what course I should take, I found that most of what was out there on the interwebs was either (appropriately) clinical descriptions of the procedure or people in comments about the procedure sharing their horror stories.

But, while my story did have it's share of horrors, most of them were not related to the surgery itself, but the things that happened before and immediately after the surgery, mostly due to infections that had nothing to do with the surgery and everything to do with conditions I had before the surgery and their treatment. Given all the negative press that I read out there, I wanted to provide an update on how I'm doing, how I'm feeling, and a few limitations that I'm experiencing, in an effort to give a balanced view to the whole thing.

Now, as I said in the original Microdiscectomy entry, I had a fantastic surgeon. I can't speak for your surgeon, hospital, or attendant staff. But I can speak to my own experience. As with any assessment, this is highly personal - you are not me, I get that. But you are also not that guy who complains about every little pain and wants to blame his back surgery for all of his problems. Or maybe you are, I don't know. Yes, some people encounter complications - I did - but I'm willing to bet that the vast majority of these operations are safe and successful as long as you temper your expectations of success with a little reality. So here's my reality.

People are most shocked when I tell them that, after my injury and surgery, I am running again. I was lucky to have a physical therapist before and after the surgery (same guy) who is a running expert. He slowly helped me build back my leg strength, which took about nine months, until I was able to begin running again. And I mean begin only. We started off with simple things like leg lifts and stretches. I've learned, through all of this, that stretching is one of the most critically important things you will do or not do in your recovery. I guarantee that you will cramp up when working your way back to health, and you'll want to have your muscles as pliable as you can have them so you can work out those incredibly painful kinks. For months after my surgery, I would wake literally screaming in the night from a painful leg or foot cramp. Every once in a while, I still do, though it only happens every month or so now, whereas it was happening every other night or so at the beginning. If you take nothing else away from this post, take this: stretch and stretch and stretch some more and don't skip stretching! Believe me, you'll hate it at the time, but you'll thank me for it later. Or you won't take my advice and you'll pay the price. Your choice.

Stretching was followed up by toe raises, which probably did more than anything else to prepare me for running. After being more or less bed-ridden for a month, your leg muscles will become weaker. Don't kid yourself into thinking you're going to spring out of bed at the "end" of your recovery and be walking like you used to. You won't. It takes time. And in that time, you're going to have to push yourself a bit - not too much, but a bit. Be patient. I know, it sucks. I'm not patient, either. But push through it, grit your teeth through the pain of toe raises (and they will hurt way more than you think they ought to), and make . . . it . . . happen. Do it!

Beginning running meant that I worked on a schedule to get back to running not only as long and far as I had before my injury, but longer and farther. And keep in mind that my herniation was significant. An orthopedic surgical resident friend of mine, who had seen the MRI of my back, asked me "what the heck did you do to your back?" To which I replied: "I herniated my disk". "I know," he said, "but that's seriously one of the worst herniations I've ever seen!" So, we're not talking about a routine snip and scoop here, there was some serious tissue to remove in this process.

Before my injury, I was running around 2 1/2 miles two days a week, taking about 25 minutes to run that far. Now I'm running over 3 miles (maybe a touch more than 5K) in 30 minutes. I'm no speedster, but I can make it the whole way. I did this, post-injury, by acclimatizing myself to running again. For the first two runs, I ran for 30 seconds, then walked for 4.5 minutes, repeated 6 times. The next two, I ran for 1 minute, then walked for 4, repeated 6 times, and so forth. It wasn't a steady progression. There were a couple of times where I had to go "back" to a more limited run time. There were other times when I skipped a run and walked instead, then fell "back" again a step. But, over time, I was regularly running 4.5 minutes and walking 30 seconds, then running a full 15 minutes, then walking 30 seconds, then running another 15 minutes. Now I'm able, most of the time, to run the full 30. There are exceptions when my leg just can't do that, but it's usually my lungs that give out way before my legs (I'm asthmatic, so that doesn't help much).

In all honesty, if I could run ALL the time, I would. Running gets my endorphins going, and my body really likes endorphins. I don't get a "runner's high" like some runners - I'm never running long enough for that to happen - but my pain is dramatically LESS when I'm running than when I'm not. Seriously.

The thing that hurts the most on a consistent basis is driving. Yes, I get sharp pains in the foot every once in a while, really sharp, stabbing pains in my toes, on the sole of my foot, on my heel - anywhere, really. But I figure this is just my nerves recalibrating and trying to re-establish some form of communication with the brain. I don't look at it as a bad thing. In fact, I think it's good. It just hurts like heck. But that pain is intermittent, not regular. It will strike when it wants to (which can be pretty inconvenient when I'm, say, driving). Oh, and it never strikes while running, ever. But driving is painful over long periods of time. I can hold up for a couple of hours and deal with it, if the car is "right". Our minivan is way more comfortable for me to drive than our Buick. Something to do with the way my legs are positioned. The minivan kind of forces me to sit more upright and that's better than the slouching, on one extreme, and the folding over, on the other, that I get in the car.

Which brings me to sitting. Sitting of any kind, over long periods, is not good. I have a standing desk at work and my writing area has a standing desk, as well. I'm glad for both. I experience far less pain standing and I burn a few calories, too. Of course, I get tired, and it's okay to sit, but if I'm sitting for more than a half hour or so, I can feel it, and it hurts. Not excruciating pain, but it gets your attention.

Which brings me to the last thing: I've learned that being healed doesn't mean being pain free. I hurt every day, 24/7. It's just a question of how much I hurt at any given time. But I hurt far less than I did before I got my surgery - FAR less! I'm really blessed. I know that some people don't recover as well as I have. And some recover even more quickly. The thing with backs is that they're really tricky, winsome things. My back isn't your back. My surgeon (probably) isn't your surgeon. There are surgical mishaps and some people are worse off after surgery than they were before surgery. But that hasn't been my experience. Is my back perfect? No. I'll never rake the lawn again, never pull a lawn-mower starter (yeah, I'm super sad about that one, let me tell you. Ha!), never golf (which is okay, I hate golfing - it's not a real sport, anyway), and might not participate in some physical activities that I could in my more youthful days (incidentally, THAT physical activity, the one you really want to know about; nine times out of ten, it's just fine, so long as I'm careful. Again endorphins are wonderful things. And, again, stretch!). But my quality of life isn't diminished too much. A smidge, yes, but not terribly so. The real trick is managing the pain (and narcotics are not the way to go - if nothing else, get yourself addicted to Ibuprofin, not hydrocodone), and it's doable. You will hurt. You've screwed up one of the most critical parts of your body and the resultant nerve damage may never heal. But you can manage it.

Alright, I've been sitting at my computer long enough. Time to stretch and then hit the sack. Oh, yeah - sleep. You'll be fine most of the time. If not, roll over. You may have to get used to sleeping longer in positions that used to be not as comfortable before your injury. Don't worry. You'll adjust. Humans are amazingly malleable beings!

If you have any specific questions about any of this or about my experience, feel free to post them in the comments below. I don't have all the answers, but I have mine!

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