Dual ADR Surgery with Dr. Boeree

[Duane Burghard]

Relevant pre-op data


Subject (me); now 46 yr old white male, 6' 2", 200lbs. Non-smoker, non-drinker, exercises regularly (swims 3 miles/week).


New Years Eve 2007-2008. As a small business owner in retail with a number of stores, the end of the year is a *busy* time ... but New Years Eve day itself is a relatively quiet one, followed by a frenetic night (while everyone else is partying, we're running final inventory checks in 10 stores, closing the year's books etc.). We had scheduled to have a good deal of new office furniture delivered on January 2nd, so I thought me and the admin employees at the HQ would kill some of the quiet time during the day by moving furniture to prepare for the new cubicles coming in. You can already tell where this is going. Early on (before 9am), I attempted to move a filing cabinet and in so doing, twisted the wrong way and, whammo, though I didn't know it, I thoroughly screwed up L5/S1.


February 2008. One of our stores is on the island of Hawaii (I know, tough break) and one of my wife's sisters and her husband have lived there for 20 years, so we have business and personal reasons to visit once/year. On Feb 28, I tweaked my back in the same spot, and decided to go swim in Kahaluu Bay to see if I could loosen it up (it turns out that exposing an irritated and degenerating disc to cold water is pretty much the worst thing you can do ... a tip that would have been helpful *before* I did this). After about 1/3 of a mile, it wasn't helping, so I got out, and in walking back to my chair on the beach, the disc failed, the muscles locked and down I went down in a heap and in more pain than I've ever known.


March-November 2008. After some medical assistance just to get me cleared to fly home (ended up staying an extra 10 days I think ... 10 awful and uncomfortable days), I got home and began visiting a D.O. an orthopedic surgeon, etc. to try to find relief. Finally, late in the year, my wife suggested a chiropractor in our business district, and he turned out to be VERY good. With adjustments, LOTS of physical therapy and about 6 weeks of "is this going to work or not?" by March of 2009 I began to get better, a LOT better, VERY fast. By late spring of 2009, while I wasn't completely pain free, I was able to resume pretty much all normal activities.


Summer 2010. As the summer wore on, I began to notice that I was feeling a new, light, occasional soreness in my lower back. Remembering my experience from two years ago, I treated it carefully (having lost the "go work out and push through the pain" philosophy/stupidity of my 20s and 30s) ... but in retrospect, my body was sending up a signal flare.


September 2010 (Labor Day weekend). I was working to get a new store location set up in Wisconsin, and upon arriving, our employees on site were WAY behind, which caused me to work a LOT harder than I should/would have. On the last day, I badly herniated the L4/L5 disc (the disc essentially collapsed).


December 2010. after 2 months of same approach as in 2008-09 (with the same chiropractor), FAR less progress was made (barely able to work 1/2 days because of the pain, intense regular pain from lower back down left leg), and I went for x-rays. X-ray data indicated the L4/L5 and L5/S1 were in very serious condition. My orthopedic surgeon recommended an MRI.


January 2011. MRI data indicated the L4/L5 disc was functionally crushed (no nucleus fibrosus material visible at all) with slight annular protrusion on nerves left side. L5/S1 shows very little nuclues material left and annular protrusion (with minor leakage) on nerve (note: the MRI data indicates a significant number of other problems developing that I will not go into here, but most serious was the onset of facet arthrosis).


(Note: from about November 2010 forward (after it becomes obvious to me at least that I'm going to need some kind of surgery) I go into research overdrive on back surgery options (I had been regularly studying online about the problems and options since 2008, but now I was spending LOTS of time on it ... and once the MRI was done, I went into yet another high gear. Of all the options, because of my age, lifestyle and physical condition, Artificial Disc Replacement (ADR) appeals to me immediately as the best option. In further research, it becomes equaly obvious that multiple level ADR isn't legal in the US, and that I'm going to need to go overseas. Just from the feedback on several of the relevant forums on the Internet, I found Dr. Nick Boeree, one of the world's leading specialists in the field).


February 2011. After a couple of weeks of contact work with Dr. Boeree's office (and sending them all x-ray and MRI data), I have a paid phone consultation with Dr. Boeree, who subsequently agrees to take me on as a client/patient. He requests a CT Scan of the lower lumbar region.


March -April 2011. CT scan reveals little more than the MRI did in terms of my back (data sent to Dr. Boeree), but finds a few small kidney stones in my right kidney and suspicious lesions on my liver. The latter causes a temporary "all stop" as we then had an ultrasound (inconclusive) and then another CT scan (with me drinking contrast ... yuck). This scan confirms that liver lesions are not anything to be especially concerned about (i.e. confirms that they are not cancerous etc.) and we move forward. Surgery date is scheduled for May 18, 2011.


May 14-15, 2011. I travel to UK. Stay in local hotel.


May 16, 2011. Visit Wessex hospital for pre-surgery tests (blood, urine, ECG, etc. etc.) and meet with Dr. Boeree.


May 17, 2011. Have final meal before surgery at about 5pm.


May 18, 2011- DAY ZERO. Right until the end, I continued to militantly do my twice daily physical therapy exercises to maximize my back health and chances for successful outcome and recovery. In fact, less than 90 minutes before I checked in to Hospital (check in time was 7am) I was in my hotel room a few miles away going through my PT routine which included 30 thorasic rolls (with foam roller), 50 cervical pulls, a couple of minutes on "wobble chair" and 10 minutes on moulding wedges. I checked in to Wessex Hospital a few minutes before 7am. By 8am, my pre-surgery blood test is done and I am taken down to the operating theater. I start a friendly conversation with the anesthesiologist (I remember roughly the first 45 seconds of this conversation before losing consciousness).


Somewhere shortly before 1pm I wake up for the first time and am consciously aware that I have survived the surgery. I slip in and out of consciousness for the remainder of the day. At 3pm I am briefly awake and functional enough to post the news to FaceBook so family and friends will know I'm OK (I traveled alone which I don't necessarily recommend but you can do ... my wife is the CEO of our company and in addition we have two small children). Nurses are allowed to periodically feed me ice cubes, that's it, but I'm taking in large amounts of fluid via IV. I need surprisingly little morphine (about 1/10th of what a patient two days after me goes through), but shortly after midnight it becomes clear that my bladder control is still "asleep" and before the situation becomes dangerous, I agree to having a catheter placed in my urinary tract, after which I immediately drain out just short of a full litre of urine. The pain I am in from the catheter easily eclipses any pain from the surgery and my morphine intake doubles during the overnight period.


RECOVERY: DAY ONE (May 19, 2011)
This is not a day that I would live through again on a bet. It is, in retrospect, VERY clear to me that many of the people on the spine forums who write about the surgery are clearly doing so at such a distance and feel so much better that they are mentally skipping this day. After having gotten very little sleep the sun rises and I find my head suddenly FAR clearer than the day before. Feeling coherent for the first time, I count no less than *12* tubes and wires connected to me (or stuck inside me) in some way. I am in substantially more back pain than before the surgery, can barely move, my abdomen is visibly bloated and VERY sore (not to mention the tube stuck in me near the incision wound to drain off any excess fluids) and, of course, the catheter is amazingly uncomfortable. I am allowed to have a small sip of water and juice for breakfast. It is a frustrating and largely painful morning, made better only by the extraordinaily wonderful nursing staff at the hospital. By noon I am allowed to have a biscuit. Confident that I will now have bladder control (in no small part because my stomach and intestines are growling, which the nurses tell me is a very good sign in that it indicates that my internal organs there are awake, "turning on" again, and returning to function), I plead with the staff to remove the catheter. They agree. I am simultaneously disconnected from the morphine (which I figured I wouldn't really need again anyway, and didn't).


By mid afternoon, the staff is ready for me to try to stand for the first time. The experience of standing up is difficult and I feel *highly* disoriented initially. When I do stand I can immediately feel that there are pieces that are "not me" inside me that move and are helping to hold me up ... the word "funky" doesn't describe it ... but it is not painful (this is NOT to say that there is no pain in the process, only that the new discs don't feel like part of the equation). Within a minute or two I am taking (assisted) steps around my hospital room. I am returned to bed. Very shortly after I ask for assistance in getting up and walking to the bathroom where, mercifully (if hardly normally) my bladder control returns ... and this is key because it means they can take me permanently off the fluid IV and I can start eating and drinking again. I am also wheeled in bed downstairs for post-op x-rays. I get up a few more times that afternoon and sit up in bed for a light dinner. My sleep is less broken, but when they come to give me fresh pain killers shortly after 3am, I am unable to get back to sleep and, after just over an hour of just sitting there, I figure "the hell with this," turn on my light, grab my laptop, log in to my servers at work in the US, and try to get some work done.


RECOVERY: DAY TWO (May 20, 2011)
Tired of "buzzing" the nurses (who are, again, REALLY wonderful), I get up and find myself able to walk unassisted down the hall to ask for a drink. I discover that this isn't difficult for me to do all of a sudden, and resolve to leave the hospital gown behind today and begin wearing clothing and returning to normal. I eat a full breakfast. By mid-morning, I am taken down for my first "hydrotherapy" session (as a swimmer, this is a big deal for me). I surprise the nurses by refusing a wheelchair and walking to the elevator and to the pool. The experience is mercilessly short (maybe 20 minutes) and I am a bit sore for the rest of the day ... but still determined to do as much walking as I feel my body can comfortably do. I have a full lunch. The nurses ask me more and more frequently about whether or not my bowels have restarted and tell me that, if they haven't by dinner, it's going to be time to introduce laxatives. Fortunately for me, this time my body responds, almost on cue and, again, while hardly normal, mid-afternoon my digestive system is now fully functional again. As the day goes on, I am in progressively *less* pain and beginning to feel more optimistic. I am also coming to terms with the reality that I have just survived MAJOR surgery and that any thoughts I had of just walking away from it were just stupid. Dr. Boeree visits me that evening and is nearly beaming with how happy he is about how my surgery went (I have not before or since seen him quite so pleased). He examines the x-rays, which only further improves his enthusiasm. He is also very pleased with my progress.


RECOVERY: DAY THREE (May 21, 2011)
Now I'm making MAJOR progress. I start the day by walking off the distance from end to end of the ward (the south doors by the elevator to the north doors that are an emergency exit) and determining the distance to be roughly 83 yards (making each "lap" about 166 yards, making it roughly 11 laps to a mile). I resolve to walk at least a mile in 2 lap increments every two hours. I am able to shower and dress myself (though I can't bend at all, and I mean at ALL, so the process is ... well, pretty tricky). I need assistance from the nurses only to get my DVT socks on. I shower and shave, I eat normally, my bowels return to a far more normal state (as my bladder has now long since done) and I am able to get work done on my computer, video chat to my wife and children ... and by the end of the day I have walked that mile and feel like I'm recovering well. I also meet with a physical therapist who gives me exercises to do (and I start doing immediately).


RECOVERY: DAY FOUR (May 22, 2011)
I should note that the hospital is a VERY different place over the weekend, which is to say it is *quiet* and nearly empty compared to during the week (they schedule surgeries and visits so that most people are gone by the weekend). I am now far more comfortable walking 3 laps at a time (and going over a mile). I am still taking Paracetamol regularly to manage the pain, but with it, there is comparatively little pain to manage and, when at rest, I am now easily in less pain than before the surgery. I still can't bend worth squat and I remain very, VERY sore, but it begins to dawn on me that all the pain I'm in is soreness pain and not nerve pain, and I begin to grasp things like the fact that I am now 1/2" taller (as tall as I've been since probably age 26) and that my body lost that height incredibly slowly over a period of 20 years, then got ALL of it back in a period of just 2 HOURS, and that it's just plain ridiculous to expect my body to not have to do some real work to react to that. My S-I joint region remains especially sore (particularly at the iliac crest), but I continue on doing my exercises (carefully, NEVER pushing myself, but also being equally careful to not allow myself to get sedate, lazy or depressed) and continue to improve.


RECOVERY: DAY FIVE (May 23rd, 2011)
I am now getting up and around on my own pretty easily, walking regularly, working from the sitting position on the side of my bed. The weekday day shift nurses are all happy to see me and impressed by my progress over the weekend (most of the nurses know me at this point because I'm a naturally friendly person and I am so regularly in the hall using my iPhone as an iPod and listening to music as I walk). After breakfast I have another hydrotherapy session (this one is longer and more fun, but still too short and I tell the therapist that I could pretend to be a difficult or just plain stupid patient if I need to in order to stay longer ... I often find that humor warms people up to me and that people are nice to people who are nice to them). By afternoon we begin to talk about the possibility of my being released by the end of the day (I have a plane reservation to return to the US the next day, but I was careful to book a fare that could be changed at any time for medical reasons, and I tell the Doctors that I don't want to be "medically cleared" to fly (because I've done that before and it was the worst and longest flight of my life), I want them to not have any concerns about me flying (I tell them, "I want you to be so unconcerned that you say 'we love you, but get out!' ")). I walk more than a mile again and I am now able to do pretty much anything while vertical, but I simply can't bend at all, and that's really my only concern. Earlier in the day the PT Staff has loaded me up with some toys; a grabbing tool to help me reach things (though, as I'm 6'2", I still need to bend my knees a little to get at anything on the floor), a roughly 2' long shoehorn, and the most interesting and useful toy, a plastic triangular thing with two long strings on the ends ... which is used to help put on socks (and, with a little practice, it even works!). Earlier in the day I arranged to have a private car on stand by to take me up to the Heathrow area (I took the bus down to Hampshire, which wasn't that bad and saved me a ton of money ... a private car will run you about $100 US, the bus was under $25). I knew I had to survive a one hour car ride to London and be in good condition or I'd never make a 7 hour flight back to the mainland. I met with Dr. Boeree about 6:30pm and he said that he thought I would be "perfectly fine to fly at this point." He continued to be very impressed by the speed of my progress and said that I was either "at or way ahead" of anyone else who had ever had the surgery. I left the Hospital just after 7pm. The car ride to London was uneventful; there was noticeable but manageable discomfort from both the incision wound and my lower back. At the hotel, I determined that I was probably well enough to fly.


RECOVERY: DAY SIX (May 24th, 2011)
One thing I had read MANY times on several spine forums was to spring for the first class/business class upgrade on the transatlantic leg of the flight home ... so I did. I can only say two words; GOOD DECISION. Yes, everyone was *extremely* right about this call. First of all, the new Delta Airlines "lay flat" seats for long haul flights are actually flat (as opposed to the Air France ones on the way over which were at about a 20 degree angle or so and weren't anywhere near as comfortable) ... so that if my back or incision wound got to bothering me, I could lie down. When I got sore, I got up and walked around (which I did frequently). I also arranged for wheelchair service at Boston to get me from the Intl terminal to my next flight. This was another GOOD decision as the two terminals are "hell and gone" from one another and I would have been required to get my suitcase and get it between terminals etc. by myself (no way) plus, even if I could have survived the walk (not a given), I never would have made it in the time alloted. While en route to Boston, my connecting flight was cancelled, but upon arrival (and turning on my iPhone and having it answer up for the first time in 10 days ... I felt like I was reconnected to the world!), my Delta app popped up and told me they had already rebooked me on alternate flights (sending me through Atlanta). Not a big deal, though I can say that not having lay flat seats for the next two legs was much harder ... after which I still had a two hour car drive to get home. Suffice it to say, while not terribly comfortable (and we did stop a couple of times on the way home for me to walk around a bit), I made it.


RECOVERY: DAYS SEVEN-THIRTEEN (May 25-31, 2011)
I spent these days at home. The most immediate change (which I had already noticed in the hospital but wasn't sure if it was unique to being there) was that, without the incessant nerve pain, I was sleeping better, feeling more rested, in less pain, etc., and that all of this had the effect of giving me more energy and making me a generally more happy person (I knew I had been in a permanently (24/7) exhausted state for years, which had the side effect of making me a Grade A "grumpy bugger" a lot (certainly every night from about 5pm on, and made it hard to get up in the morning). I suddenly found it easy to get up at 6am with my wife and go with her walking the dog. More than that, I didn't feel an incessant sense of fatigue. This is not to say there weren't problems, jsut that overall it was encouraging to see that my life really could be about to get better. It has become obvious in recent years that my tolerance for something in the air in central Missouri has degraded, and upon returning home, within 24 hours, I had to deal with a minor sinus issue (which was frustrating). On Friday, I went to the local city pool for hydrotherapy (walking laps, doing the exercises I learned at the hospital) where, despite warnings from the PT staff at the hospital and a friend of mine who had back surgery several years ago, I overdid it a bit (my friend said, "be incredibly careful not to overdo it," and I said, "I'll be fine, I won't push or anything," and he said, "you won't think you're doing it, but you will," ... he was right). I was very sore by Friday afternoon and resolved that I just wasn't ready for that yet. So on Saturday I stepped up my walking to 2 miles, and by Monday I was doing 3 miles ... and again my body complained (I should note that I hadn't been walking any farther than I had to for the previous several years, and in the three weeks since the surgery, I have already walked at least 30 miles ... probably farther than I've walked in the previous *decade* ... so it should NOT have been surprising to me that there were muscle groups in my body that were complaining). My right hip, which had *never* bothered me in all the time I had back problems, began complaining rather loudly ... but again, not a nerve related pain, but more a feeling that I had just finished running a marathon. My right leg (again, not a problem before surgery, where all the pain had been localized to my left side) began hurting a lot, with regular "charlie horse" pain in my right hamstring and calf. By the 31st, I had stepped back the walking to 1.5-2 miles/day.


RECOVERY: DAYS 14-20 (June 1-7, 2011)
I continued walking every day (and doing my exercises). Well before the surgery was scheduled, my oldest daughter was selected to meet a group of talent agents in Kansas City over the weekend, and she very much wanted me to be there for moral support. So, while I didn't think I was necessarily up for a couple of hours in the car, I said I would go. The trip out on Friday was especially difficult, even with breaks, the seatbelt seemed to put pressure on my incision wound and I was just generally not happy seated for those periods. Throughout the day on Saturday I was attempting to recover (and continued walking, using the hotel's hallway as I did the hospital ward's a couple of weeks ago, just doing laps), and eventually took my younger daughter to the hotel pool, where I did *very* little walking around (a lot of standing in the water, occasionally floating), and when that stopped feeling good, I stopped. By the time we left for home on Sunday afternoon, I was not sure how I would get through the car ride home ... but to my surprise, it was *much* easier than the trip out. In fact, we stopped *once*, and while I would have probably chosen to stop 15 minutes before getting home if we hadn't been so close, it wasn't difficult at all. As the next week starts, I start to get frustrated by the things regarding my work that I cannot accomplish from my bed at home, and I make another attempt to use my home office (which is already equipped with a special chair for my back). This time, I am able to effectively work for at least an hour. The next day I walk to our company's headquarters building (2.5 blocks from our condo) and attend staff meetings before returning home.


RECOVERY: DAYS 21-27 (June 8-14, 2011)
On the 8th I meet with my GP physician who asks me a great deal of questions related to my general health (verifying that "everything works" basically). He too seems genuinely surprised by the speed of my progress and recovery. I ask him if I am good to return to work full time and he indicates that I'm probably not yet, but when I ask him if I am good to start swimming laps in the pool again, he says yes, and that in fact the lap swimming will probably place less stree on my back than the hydrotherapy. I am in the water at our neighborhood pool less than 90 minutes later (I had done some water walking the previous two days and felt none of the ill effects that I did during the first week home). I did my water walking and stretching and resolved to try to swim about !/4 mile in roughly 1-200 foot increments (our neighborhood pool is about 50' long). Not only do I experience no difficulty doing this, but I experience a curious side effect; when getting out of the water, for a time (10-15 mins), I am in ZERO pain of ANY kind in my back, hips or legs. On Thursday and Friday (yesterday) I do the same (though I add 1-2 laps each day). Same result. While swimming, my chest, arms and lungs are *screaming* at me to go farther (keep in mind that I am used to swimming 3-4 miles/week), but I am obsessed with not pushing and restrain myself (though by Friday, I am swimming the distance in 5-600 foot sets). I am currently noticing a lot of "workout" pain in my feet (particularly the bottoms of my feet, and especially when I first get up), and while my hamstrings no longer bother me very much, my calf muscles are now incredibly sore. I als had (early in the week) a couple of odd instances of shooting pains in my left foot which, strangely, went away as soon as I *stopped* "babying" it and put some genuine pressure on it (after this happened the second time, I intentionall put pressure on it again right away and again, the pain left immediately ... strange).




General notes at this point:
Emotionally this is a VERY confusing time. While I feel so much better, I am clearly still in regular pain, still dependent on Ibuprofen for relief (and yet still in some discomfort). The two parts of my brain argue loudly with one another, the one that says, "it's been three weeks now, why are we not all better, there's work to do!" and the other that says, "you've just survived *really* radical surgery where they opened up your stomach and replaced actual *pieces* of you ... it's gonna be a while before any rational human should expect to be 'all better' don't you think?" The fact that Dr. Boeree and my Doctor here are both so very pleased with the speed and level of my recovery helps a lot. My wife is clearly VERY happy with my progress and my children feel like they "have their Dad back" for the first time in years (while I am not always able to keep from having an occasional surly moment, I am clearly far more able to be my "old self" the vast majority of the time, which means I am a lot more pleasant and loving person to be around). Still, I do still have pain, and my business has *suffered* without me able to be at full speed for now nine months. Employees have had to be laid off because of issues that are a direct result of things I haven't been able to do. My life is, to some degree, "on fire" and I have a sense of urgency about getting back in the game. I have known all along that this recovery is going to take a LOT of patience and rest ... and I have also known that those two things are about as far from my natural skill set as any two things could be. But in the end, I am most cognizant that I am FAR more emotionally healthy and equipped to deal with this dichotmy of issues specifically because of the absence of the nerve pain and because I feel so much better. This was easily, and far and away, the single most researched decision of my life. Three weeks is early, but it's also the first "benchmark" time ... and so far, it's really obvious that, overall, this was the right decision.




RECOVERY: SURGERY PLUS 35 DAYS
Medication
I begin trying to step down the Ibuprofen again (instead of 400mg twice/day, I switched to 200mg with each meal, for a total of 600mg instead of 800mg). I am concerned by the considerable body of medical opinion here in the states regarding Ibuprofen (and other NSAIDs) and their effect in retarding healing. It seems to me that the sooner I can be off all medications the better I will heal. With that said, I have heard at least one Doctor tell me that there is some medical debate regarding the voracity of this claim. How am I doing on this new, lower diet of Ibuprofen? Well, I was in a little more discomfort and a little grumpier, but it was certainly inside my ability to tolerate it (ironically, the best solution for aching or irritated muscles seems to be getting out and walking around a bit).


I also notice that the DVT socks are starting to more regularly cause discomfort in my calf muscles, so I start staggering my wearing them.


Physical Activity
I continue to walk at least 1.5 miles/day (though I no longer go on the evening walk to take the total over 2 miles if I've been swimming that afternoon). I had stepped up my daily swim up to 1/2 mile (in 3 equal sets of, obviously, 1/6 mile each), and I have held there every day since (I figured that I stepped up from 1/4 to a 1/2 mile pretty quickly, so it's best to stop here for a week and see how I adjust). So far I have had zero issues with this change. At some point next week I may try to step up again to 2/3 or to 3/4 mile (by increasing the number of sets and not the distance per set). I'm trying hard to make sure that I am NOT assigning goals but rather waiting until my body feels bored by my workout before stepping up again. Finally my weight gain appears to have stopped and begun returning to normal (normal for me is anywhere between 195-202 lbs).


Pain
In terms of pain, there have been three significant changes.


1. Nearly ALL feeling has now returned to the left side of my groin area. Additionally, there is now no burning or itching. The incision wound is occasionally a little sensitive to pressure or scraping of clothing, but that's it.


(note (added in September 2011): MEN! I have no idea what women go through that's similar or comparable in this experience, but if you notice after surgery a significant numbness, burning, itching, etc. in the left side of your groin area, this is normal and apparently has to do with the irritation of a particular nerve during the surgery, for most (including me) this starts to seriously fade after a month and is gone in three months. ALSO, you may notice that one of your testicles is "riding low" after srugery (while it is medically true that this is true of almost all men, it's not like this!) this too is temporary and not anything to worry about ... no one ever talks about this sort of side effect so hopefully I've just alleviated some man fear here).


2. The pain in my S-I joint is *greatly* diminished over the last week, and when I do feel pressure there, it seems concentrated on my right side. I am again basically completely relieved by simply applying an ice pack to the affected area.


3. The pain in my right hip has dramatically decreased (and other than some soreness when I massage it, it's nothing compared to what it was), however, the pain has migrated down to the lower potion of my right leg (from about halfway between the calf and the ankle to the outside and top of the ankle area) and to the right foot, particularly the middle toes on my right foot, which for the last few days have been in regular and rather intense pain (I would put the pain level at 4-5, which for me, as you know, is pretty significant). Ibuprofen seems to have little to no effect on this pain, and today I began to remove my shoe and place a bag of ice on those toes because the pain was actually strong enough to begin interfering with my ability to work. The ice seems to remove the pain entirely on a temporary basis, and I will continue its periodic use while I go through this "phase". The pain is constant (i.e. 24 hours/day) and has made it very difficult to sleep for the last two nights in particular (though I note that I can step down the pain with some activity ... after waking up again at about 2:45am this morning, I walked around the bedroom for about 5 minutes, and was then able to sleep the rest of the night). The pain is also present regardless of sitting, standing or lying down. In fact, oddly, it seems worst when I am lying on my back and the toes are pointed upwards.


It seems to me that this pain in my toes (and the pain in my lower leg) must be a nerve issue and related to blood flow in some way. (note from Sept 2011, this pain was related to nerve path "rewriting" on the right S-I joint area and ended about 3 weeks later ... which was good because there were several days there where I was ready to amputate).


There have been minor moments when I have (almost always accidentally) tried to do something my body isn't ready for yet (I tried to help hold my youngest daughter up in the pool yesterday and had a momentary twinge telling me that I hadn't healed enough to take that load on whatever muscle group I was taxing). But these moments have not yet ever resulted in a feeling that lasted longer than a few moments or felt as though they were resulting in anything other than a momentary feeling of, "yeah, don't do that."


I still have some concerns about how I'm healing. I anxious for mid-August to come so that I can get the "post 3 months" x-rays and verify that the discs and bones have grown into the ideal positions (I keep thinking that I'm capable of accidentally, even if incredibly slowly over time) letting them slide into a bad spot by sitting in bed or some other use of perhaps less than ideal posture. I'm also concerned about what long term effect my pre-surgery condition had on my facet bones (and specifically the onset of facet arthrosis) and, of course, I am concerned that I take the best care possible of my remaining discs (the last thing I want to do is to so stress out my L3/L4 as a result of this that it begins to degrade ... though hopefully what we've done will make that less likely instead of more likely).


Business
My wife has decided that I am now well enough to begin traveling for the business. This decision is in part driven by her observations and because we're going to have a manpower problem in our Illinois store next week. So I will be driving over there for a few days to assist. This will give me experience with a 3 hour car ride (and driving no less) just 10 days before we leave on our summer vacation to Michigan (which will involve days of driving). I am obviously nervous and will be careful (we've built in extra time for rest breaks). I am also not sure how I will hold up to sitting in a kayak once we're in Michigan (but again, I'll be careful).


Overall, I would continue to rate my recovery as truly remarkable.


INTERIM SETBACK
(there is no exact date in my notes for this, but it's around surgery plus 6 weeks)
I have a setback that causes the return of moinor nerve pain. I eventually learn (again) that the setting on my Sleep Number bed can affect pain (firmer for me is better). The pain in my right foot also returned. While perhaps not as amazingly painful as a couple of weeks ago, the pain is enough to both wake me up and keep me up in the middle of the night. The greatest amount of pain is centered on the middle toes of the right foot, but also underneath (the arch), at the outside of the right ankle, and above the ankle area. Pain has also returned to the right hip area, though again, not as bad as it was several weeks ago. Finally, I begin a several day period of suffering from "icepick" headaches, which you can Google, but they are ridiculously painful (like a super migraine) that hits you in an instant, lasts 20-30 seconds, and then is *completely* gone. This is scary and causes me to call a GP and make an appointment (Sept 2011 note: these headaches never return and may have been related to a sleeping position ... don't know).




SURGERY PLUS TWO MONTHS
The strain on the right side of the sacro-iliac region is *GREATLY* reduced. The pain in my right foot is now basically completely gone and I no longer wish to amputate any of my toes (there is some *very* minor residual pain in those toes in my right foot ... so small that half the time I think it's just "phantom pain" that I'm imagining from the memory of it). The pain in my hip area has also gone down. There is some new discomfort in the area of the discs themselves (well, the S-1 area, not the L-4/L5), but it is minor and appears related to stress as it is easily and completely relieved by simply resting for a few minutes). I am feeling some significant new soreness in the upper thoracic region which radiates out to the shoulders, particularly the left one.


My back's first involuntary stress test:
First, a congratulations to Dr. Boeree for allowing me to fulfill one of my two key promises to myself regarding the surgery. Not only did I survive the trip to Michigan fairly well (we took breaks when needed, and I'm glad we broke the driving into a 3rd day from two days), but I managed to make it down the Crystal River ... *twice*. The second trip was a bit more harrowing. Having demonstrated to my family that I could survive the trip down the river (they ALL came with me for the first run, and I did have a couple of extra pads, and we did stop 3 times for me to get out and walk around a bit), I decided (and they agreed) to let me run it solo a couple of days later.


Now, before I tell you what went wrong, I should tell you that only a few days earlier my wife and I had been talking about how it was inevitable that, at some point, I was going to fall down or trip or *something* would happen that would be the first real test to how much I've "really" recovered.


I rented the rental version of the same kayak I own, which is very slightly smaller than the commercial version (it's about 6 inches shorter but several pounds lighter ... unfortunately, what they trade for shorter length and lower weight is stability (you already know where this is going). I was barely 1/4 mile down river from the source (just a couple of turns away from where I put in) when the lip of the cockpit hit a stick that turned out to be attached to a much larger and more secure log below the surface and, for the first time in (ironically almost exactly) *7* YEARS, I rolled a kayak on the Crystal River (incidentally, that last time, in July of 2004, I was renting the same model kayak ... you'd think I could remember that sort of thing). As I rolled, the cooler carrying my food etc. for the day slid over and pinned my left foot between it and the fiberglass side of the kayak. As the current was quite strong in this particular spot, the flow of the water accelerated the kayak flipping over and I was suddenly trapped under water (in fairness, the water is barely three feet deep here ... the whole thing was more embarrassing to me than anything). For a moment, there was some question about what would "give" first, the plastic of the cooler, the fiberglass side of the boat, or the bone in my left ankle. Fortunately, as the cooler had more air in it than anything, as everything began to sink, it moved, freeing my left leg and allowing me to get up.


While startled, embarrassed and, of course, completely soaked to the bone, the experience was highly instructive in that I had my first significant mishap since the surgery. Even "worse", the event happened when I was completely alone, yet I managed to gather myself and my things and (more relevantly) had enough lower back strength to get the kayak to shore, flip it and lift it to get the water out. Even more interestingly, as I continued to go down the river, I found that I felt *better* from that point forward.


"New/Old issue"
Beginning in 2008 (the summer following my first major back injury) I was at my Dad's cabin in Wisconsin (subsequent to a week of *major* kayaking in Michigan) and I found myself distracted by an intermittent, pulsing, very low pitched humming sound. I asked everyone in the room if they heard it, no one did. It was distracting and made sleep difficult and persisted for several days. When it happened again 2009, I knew it was related to extended time kayaking ... I had also learned that a couple of chiropractic adjustments to my neck and a few days of exercising and bingo, it went away. Well, this year, it came back again, and it seems to coincide with the significant stress I feel on the area between my shoulders (slightly more on the left side ... and my left arm hurts at night). I recall a chiropractor associating this condition with "forward head posture" and certainly the act of kayaking causes some odd posture issues, but this condition is highly disturbing when it happens. It causes disruptions in my ability to concentrate and sleep, and it can get quite loud (and because it pulses it's annoying). It appears to be restricted to my left side and I would think that it's related to my hearing except that it most often happens with activity like kayaking and that, in the past, a couple of corrective treatments to my neck combined with exercises an it goes away .... that seems pretty bio-mechanical to me.


(Sept 2011 note: returned home, saw chiropractor, he pops neck and a couple cervical vertebrae ... two days later, humming gone and hasn't returned ... evidently this is going to be a price to pay for kayaking).




SURGERY PLUS THREE MONTHS (X-RAY TIME)
I'm a little disappointed that the x-rays don't show more correction to the scoliosis than I feel ... but in comparing it to previous x-rays it does appear that some of the curvature is, at least a little bit, working it's way out (I am certainly staning noticeably straighter at this point, and the position and angle of the scar seems to have changed). The Doctors never promised me this and I realize that some of it is "just me" and not particularly a problem, but it's still been nice to get a straighter look and feel to my back.


In comparing these x-rays side by side with a similar view from December 2010, I have to say that there is in fact quite a difference. The S-I joint looks noticeably different and my right hip is now noticeably higher (maybe as much as a centimeter). There also does appear to be less curvature in the thoracic region. My most major concern is that one of the x-rays makes it looks like the L5-S1 disc is slid out of position (the back edges are not "lined up". As I'm in basically no pain in that area, I have to assume that the M-6L is designed to take this kind of stress and that the artificial "nucleus" area of the disc (I have no idea what it's formal name is) is not only able to handle this "sliding" action, but in fact can handle staying in that slid position for a LONG time (hopefully many years).


(Sept 2011 note: subsequent conversation with Dr. Boeree confims that this is nothing to worry about and is in fact normal).


I also have to add that it was equally encouraging to see that there is no evidence of any kind of adjacent level stress or degradation of L3-L4 or L2-L3 ... in fact, they appear to me to be very well spaced and as though they have an excellent chance of serving me well for the rest of my life.


Recovery update:
Easily survived my first "road trip" in August (6 days, 3 states, 3 store visits, 4 flights, hours of driving) without any real trouble at all. In fact, after returning (last week), I found that I felt better and was more productive at work than I've been able to be for about 4 years (I can, for the first time in years, mentally juggle multiple programming tasks simultaneously). These past few days however I seem to be dealing with a small, new, intermittent nerve pain which is centered, as nearly always since the surgery, on the top of the sacro-iliac region. I have also noticed significant discomfort in my left foot for the first minute or two that I am vertical each morning (the pain is in the arch area of the foot and it "walks off" fairly rapidly). I assume that once again this is most likely part of the healing process that will still be going on for months to come yet (that's fine ... I mean, it's a little disappointing to feel worse again after having several days of feeling so well, but I understand).


The following week I flew to Chicago for a 3 day conference. No problems.




SURGERY PLUS FOUR MONTHS
Well, that's next week ... so stay tuned.

[tyler]

Hi Duane,

Checking in and glad to see that you're doing well! And an incredibly detailed report.

Keep us posted - and here's to a continuing smooth recovery!

Best,
Tyler