New Member Introduction - Reddy2ride

[Reddy2ride]

This is my introduction on the SPS forum and I'm hopeful that this can be of use to those currently having cervical issues as I am about 8 hours away from boarding a plane to the UK for surgery from the USA. Like those brave men and women before me that gave me courage to take on this journey with a non-guaranteed outcome I have to admit that I am very nervous about what lies ahead of me. However, my quality of life has deteriorated and I'm going to be giving this my best shot making the best of my future on this earth so I can continue to be a good husband and father of two young children.

I will be turning 44 shortly after my surgery on Dec. 14. My history is not unlike many others in that I experienced a herniated disc originally in my mid- to late 20's while exercising in a gym (I think I was doing pull-ups or overhead presses). The pain was terrible after the injury and over the course of several months the pain subsided. I've had many, many flair-ups of neck pain and arm/hand tingling for many years....but just kept on going as we all do. Several times along the way I had appointments with doctors and imaging/diagnostics and I was certainly well on my way to having DDD. Along the way I have done PT, chiropratic (namely curve restoration attempts using CBP, Pettibon, & CLEAR), injections, etc. Most notably the things the helped the most were rest, mild strengthening/stretching, NSAIDs, and time....but like most these things were temporary until I did something which caused another pain episode. My symptoms are namely typical DDD whereby my pain is worsening during the day with physical movement but I feel good resting and in the morning unlike more cervical arthritis symptoms. From my signature you can see I have multilevel issues which is typical of letting single diseased levels continue to degenerate whereby adjacent segments begin to be affected. This is actual similar to how the fusion process affects adjacent segments over time. Fortunately some people with recent injuries (unlike me) have new options with ADR's to address initial injuries prior to the beginning effects to adjacent levels. The difficulty is knowing how long to try conservative measures before having the issue fixed vs. nursing it for years and years whereby adjacent level considerations need to be taken into account. This is not me and not like many others so hopefully others will listen to these words and take action more quickly (but not too quickly) and have excellent doctors to guide their path which unfortunately is not always the case. It's a daunting journey and not one I'd wish upon my enemies.

So here I am today after learning from all the wisdom, knowledge, education, and experiences from all those brave souls before me. I've had many consults with local, national, and international doctors. I've read the excellent and terrible outcomes of both ACDF and ADR patients which provides both hope and worry about my future. Of course you always have to struggle with the probability of improvement vs. further complications or deterioration. When you have a job that demands all the facts and a high probability of expected outcomes this becomes a very difficult decision to make concerning one's life. This is surely the most difficult decision I've ever had to make as is the case for many I'm sure short of having Myloepathy or loss of feeling/nerve function in the arm. Those of us which have conditions heading in that direction but not quite bad enough for emergency surgery have more difficult decisions to make and we really have too much time to contemplate and worry about what to do while we further deteriorate and bake in ups and downs of our decisons and what could go incredibly right or wrong based on outcomes of those before us.

In my case I have had the following doctors opinions on what I should do as follows:

Local doctors (I'll add these are good doctors but they no experience in ADR):

1) Too young for ACDF so just live with it knowing you will get worse and neck symptoms will create added pain and stiffness in neck and arm over time. Likely to need surgery later. I've heard this one before and it's one of the reasons I've just lived with it.

2) 2- or 3-level ACDF (two are bad and one is good now but showing degen so let's take care of it now)

Nationally/Internationally Recognized Surgeons (all manner of treatments)

3) One level ADR (Prodisc-C) C5/6 which has lost 1/2 disc height and is narrowing foramin and has some mild compression of cord. Don't worry about C4/5 at this time which is really a degenerated soft disc not well holding up to flexion. Would do either ACDF or possibly ADR if dealt with 4/5 but after looking at my images again he said he wouldn't do it yet (I do respect conservative doctors)

4) 2 level ADR and 4/5 and 5/6. 5/6 looks structurally sound enough for now so don't think we need to address it but not guaranteeing it won't need to be corrected in the future. Risks of post-surgical issues increase with more levels.

5) Same as 4 but just wanted to address 6/7 now.

6) Basically same as (4) but they'd also do a discogram during surgery to check health of 6/7.

OK....so I've had a lot of opinions at that stage and I could have kept on going to more doctors in NYC and LA and I was attempted to do so. I did pay all these doctors for detailed discussions including the international doctors which were very, very helpful. To name a few doctors that a frequently mentioned on this forum and which I really, really respect: Dr. B. in Plano, TX, Dr. B in the UK, Dr. B in Germany, Dr. C in Barcelona. Each gave me unique perspectives of my issues and their experiences.......certainly a lot of commonality but also some differences in opinions or contradictions in some areas. Yes...I wish it was black and white since dealing with shades of grey is hard for me!! Insurance was a consideration for me although fortunately I had the ability (with sacrifice) to overcome the cost. I did have some concerns about the Prodisc-C (non-NOVA)...at least at multilevels and some of its metals namely Nickel that I'd had some skin reactions to previously. However, the Prodisc is proven and FDA approved so I wasn't going to let that stop me from this direction. However, healthcare approval for this has not yet been approved but I think I could fight it out if that was the direction I was headed. Certainly doing this in the USA...even thought I had to travel.....would be nice and a big plus was the ability to have post-surgical support in the USA. Decisions/decision!!! The other really hard decision that makes me lose sleep at night are the possibilities of poor outcomes that we read about on this sight. Post-surgical ADR infection (biofilms), subsidence, device misplacement or failure, life of device, adjacent disease, and the possibility of device explantation and revision if problems occur. These things have made the decision very, very difficult and I've had trouble sleeping for the last week to the point that I was still considering my decision up until yesterday long after I made plans.....and I reserve that right until I'm under anethesia heading into theatre!

Alright....so I sort of gave a hint at my final decision above for those sharp folks that picked it up! By the way, I want to really give a thanks to Researcher (Phil) directly as I reached out to him based on his excellent posts to this community of his prior decision making and results of his 3-level cervical ADR by Mr. Nick Boeree in England. Phil let me reach out to him and and very quickly responded giving me background research, suggestions of his experiences, and a lot of support. I have to admit that I see a lot of this type of compassion for us humans with spinal problems on this forum very often and quite honestly this makes me have faith in our race despite the times I feel that everything related to my problem is driven by money. So thanks to Phil for allowing me to reach out and to everyone else that honestly posts their questions, information, and especially their story and recovery or problems post-surgery so others can learn.

So that's my story.....and very shortly I'm heading over to the UK on a scary journey but one of hope. I have confidence I've selected a good surgeon with lot's of experience at multi-level and not too many negative outcomes that I've read about anyway. I'll have to trust him to make good decisons during surgery and understanding my outcome may not be exactly what I want but what is best for my future. I don't want a fusion but we always need to understand that it could be a fallback plan if the ADR's don't seem to be working like they should when you're put through range of motion flouroscopy during surgery. I have to admit that the whole medical tourism is strange. I'm taking my wife and two kids with me on this journey so they can hopefully get to see some of the old motherland while I'm stuck in the hospital and rented flat while we are there through Dec. 23. In the several days prior to surgery I am planning to see a few sights...definitely stonehenge. You know those folks had a lot of back problems in those days moving those rocks (assuming they didn't get help from UFO's :-).

OK....so can't look back but only forward now. I'll post how things are going as I generally want others to see how this tough process is done by others. Not meaning to offend anyone, but I am a Christian and I have a lot of people praying for me and very, very supportive family and friends. They are the very best and I think that support has been tremendous in strengthening our relationships. I am positive I will get better but I'm also peaceful that if the outcome isn't perfect we'll tackle that obstacle as it comes (although that's just not a possibility as far as what I can consider right now!!!!!). Once again......for those that have been in pain and have overcome it and have given of themselves on this forum I just can't say how courageous you all are. You all are certainly my hero's. I have a lot of packing to do and a golden retriever to take to the kennel. Wish me luck and I'll update you when I'm over the pond!

R2R

[ajj1001]

Welcome to the forum and hope everything goes well with your upcoming surgery. Its gone really cold the past weeks so make sure that you have packed plenty of layers, though Southampton is warmer than where I am further north. Will pray for a good outcome.

[New-disc]

Reddy2ride,

Best of luck with your surgery.... please keep us all posted!

Todd

[Justin]

R2R,

Welcome to the Spine Patient Society.

Thank you for sharing your detailed experience regarding your pre-operative research and decision-making. I do believe that your research will pay off and you will be able to be the best husband and father you can be. Your post is an inspiration to others.

Please post updates as you are able--I'm excited to read about your successful surgery! I wish you the very best and please let me know if I can help in any way.

[Reddy2ride]

Update from the UK

All is going well since we arrived in the UK from the USA on Sunday morning Dec. 11. Thanks for everyone's support and private messages as well as preparatory advice for the weather which just turned a bit cold and misty right now. The trip over was just fine although we only were able to sleep a few hours at most so plan to be very tired until you get a good long slumber the first night. We rented a car for this trip since we had worked in the UK many years ago although it always take a bit of reorientation. On our day of arrival we made a quick trip to Stonehinge for the kids and then made our way to a charming cottage we rented in Twyford which is only about 5 minutes from the hospital. We opted for a self-catering location which was peaceful with a kitchen. My advice for anyone not familiar with driving in the UK or not having family/children is to take the easier path of hiring a car (which The Spine Clinic can arrange if you like) and staying at either the hospital or a local hotel for simplicity. I admit I am a bit concerned about the logistics of getting back to the airport the day we leave since I don't know how much pain I'll still be in. We planned to stay 8 days after my surgery for a little more time in healing. I had a long talk with my two boys about how much I was counting on them to be mature men in helping me get home with the luggage. I'll let everyone know how tough that 5,000 mile trip home is. I opted not to fly home in the comfort of business class and spent that money on tickets so my children could experience of bit of England. I think that's worth the added discomfort (but I may have a different opinion afterwards:-) ).

On Monday we slept really, really late and all woke up recovered from the jet lag . We stayed close to home base learning the local area and village shops. My wife and I found a local supermarket and stocked up on food for our kitchen. We love eating out and talking to the locals but it will really be nice while I'm recovering to not have to go out to eat all the time. Late in the day I had my pre-surgical appointment at the hospital for blood tests (two tests by different nurses for redundancy), ECG, and urine tests. After the tests I met with Mr. Nick Boeree and spent a lot of time covering his expectations of my procedure (2-level C4/5 and c5/6). Nick is very honest and very conservative which I really like. He is also very easy to ask any questions you may have and he knows I always come loaded with lots of questions! Nick knows my case very well and has studied my X-ray, MRI, and CT scans thoroughly and he recalls the details of our prior conversations and e-mails which comforts me. He was also very honest when he noted that there was a very small possibility that an ADR at my C5/6 may not work properly due to the degeneration I have at that level. This is due to the fact that as avdisc looses height the supporting ligaments tighten up that segment and ultimately motion becomes limited. He did show me that it still has motion but had to warn that he reserves final judgement during surgery and ultimately has patient safety and longevity in mind in his decisions. I respect that and note that no other surgeon out of the many I have seen (USA and abroad) had noted these possibilities. Of course I didn't want to hear that.....I just traveled 5k miles. I'm certain the first thing I'll be asking after I awaken post-surgery is how everything went and what I have in my neck. Nick did show me the fusion cage he developed which has integrated stability screws whereby you do not require the typical titanium plate on the anterior vertebrae which can possibly interfere with your throat. This is very clever.....although again I don't want one if I can help it:-) Something else to lose sleep over for now. One thing I can recommend to my fellow spine sufferers is to really think hard about how long you are suffering before making decisions. For me I had only one choice many years ago when I first injured my C5/6...it was only ACDF back then and I chose to endure the pain for many years. In that time my C4/5 suffered and now my C6/7 is showing some signs of wear and tear. Had ADR's been available back then I could have had this performed at C5/6 and ......theoretically.....the rest of my cervical spine would not have had so many degenerative changes due to 5/6 disc height loss and more adjacent stress to the other discs. Don't rush into anything but just remember that waiting to take action results in technology improvements at the likely expense of further damage. Get many opinions from the best of the best, even if just within your local area get lots of recommendations. However, also remember that DDD is something everyone will have over time.....but some people develop more severe symptoms for various reasons than others (injuries from trauma, genetics, poor posture, etc.).

BTW, I got to play around with implants at my meeting with Mr. Boeree today; specifically the Charite, Prodisc (don't know if it was original or Nova), and the M6-c. The M6-c was soooo tiny about the size of a dime. Tyler mentioned previously it was about the size of a nickel and that was just hard to believe. Looking at the size makes me cringe to think of how much pressure our discs take when I played football all those many years. We do some crazy things to our bodies while we are young without thinking about how long we are on this planet stuck in these incredible life support systems.

Tomorrow we are going into London with the kids to take advantage of my last day prior to surgery. I am scheduled to be at the hospital early Wednesday morning. Apparently there is another American scheduled for surgery as well as another from Asia. That gives me comfort that only 3 are scheduled for surgery that day as I want my surgeon to spend all the time he can with me and each of the other 2 patients. I would find it difficult to believe that any surgeon would feel rushed with spinal surgery if they were scheduling too many patients in one day. However, I'm sure it happens and just take that into account when you are interviewing surgeons and having their opinion of your options.

Can't say when I'll update everyone again but I do have my iPad and they have Internet access in the hospital. I'll update everyone on what Mr. Boeree tells me post-surgery and how the pain feels. Thanks so much for everyone that is praying for me!! I'll see you all on the other side of surgery.


R2R

[ajj1001]

Glad to hear you are settling in well and enjoy your day in London.

[Reddy2ride]

Update

I wanted let everyone know I'm about 2 hours out of theatre nd so far so good.

This morning I woke and scrubbed with antibacterial and was at the hospital by 7am and meeting with Mr. Boeree, nurses and the aneethetist? The surgeon goes over the procedure again and reiterates the potential complications that may come up. I've heard these before but my mind went fuzzy and my knees week when I heard it this time. There was a 3 level patient prior to me so my family waited in my assigned private room until they were ready for me at a bit after noonish and then it was goodbyes and tears with my family. It was my wife's birthday too....so wonderful way for her to spend it. All the staff here are wonderful and I have always liked the cheerful, witty nature of the English people. Being a small hospital everyone comes to your room to introduce theirselves including even the administrative and financial reps whoch makes it nice to put faces with names you've talked to or emailed previously. The surgical suites are as modern as an American hospital. My aneethetist worked in the USA for many years and I appreciated his calming me down during Prep by understanding I was anxious not only about the surgery but just being so far away.

As quick as that I came to in recovery around 4pm and mr Boeree was right there to calm me saying the procedure was difficult but went great. To my relief he said I received the two level with the M6-C's and no fallback to fusion was required!!!!!! I have all the feelings in my hands and feet so I am so very relieved. Mr Boeree had also personally briefed my wife and kids after the operation and showed them the X-rays they did after completion while I was under. They looked so great and it was so satisfying to see some restoration of lordosis. I could see he was proud to show me these much like an artisan shows off their work!

Certainly I have a bit of pain which is both from the incision in my throat and how they pulled over my gullet. Also a bit of pain in the posterior of neck from the procedure all controlled with a self controlled morphine pump. I dislike morphine and it makes me sick when I withdraw so I am being very conservative with it although I have to use it some to ensure I keep the pain down.

It is good to have the first major milestone behind me now! All in all the posts by those adventurers that came before me were spot-on and it really helps to have someone's prior experience to help them. I just took some oral pain medicine and an NSAID from the nurse. The NSAIDs are also precautionary to reduce the chance of auto fusion and HO. I'll provide more detail on this regimine later as well as post surgical precautions and PT routines. Now off to slumber some more! Hopefully in the days to follow I can make friends with the other two patients of mr Boeree today....a 3- and 1-level procedure .

[Reddy2ride]

Day 2 post-op update

My surgery by Mr. Nick Boeree was yesterday afternoon and today was an extraordinary day of recovery. I don't think I slept more than 10 minutes at a time last night due to a combination of pain, meds/insomnia, throat swelling, beeping from all the machines connected to me as well as the nursing staff checking me regularly. This is very, very typical after spine surgery. The staff at the Nuffield Wessex Hospital in Eastleigh were simply outstanding and so caring and attentive to both me and my family. Early in the morning they weened me off of the self-controlled morphine pump and disconnected me from the IV and helped me up on my feet for the first time. I felt stable enough to make it to the restroom after which I was able to get my face washed, teeth brushed and change into some of my own comfortable clothes which felt great. Mr. Boeree and Dr. mcGill came by afterwards to talk to me about how the surgery went........which was difficult but turned out great and the positioning of the implants were wonderful. You can see my post op X-rays and make out the implant at 4/5 being a smaller width than 5/6 which was a better fit for my vertebrae against the uncovertebral joints. I took another set of X-rays later in the day to check against the ones done while under anesthetic. I still cannot believe these are my images!!! The disc heights and graceful lordosis are simply incredible and something I never dreamed I'd see again in my painful looking pre-op images. There is something to say about attention to detail with spinal surgery and ADR placement. Light Physical therapy started today as well with instructions on 5 different range of motion exercises 4-6 times per day. Taking it slow and easy is the rule here. I still have a soft collar but it is not required but more precautionary to make you be careful or to have others aware you are injured. I plan to wear mine while sleeping or traveling. Other than pain medicine as needed I am taking 50mg of an NSAID 3 times per day to reduce swelling and also possiblly lower the risk of auto-fusion/heterotropic ossification which I have a higher likelihood of getting since my degeneration of c5/6 was more advanced (although my facets were in pretty good shape from the CT scan according to Mr. Boeree). He is really a straight shooter and he gives you all the facts and the pros and cons which I really appreciate. He made some decisive calls from my images that no other doctor picked up.

Listed below is some good information on my rehabilitation regime:

- avoid heavy lifting for 6 weeks
- respect your pain and rest if you feel tired
- wear soft collar for comfort only
- driving allowed after about 6 weeks....ensure you can comfortably look over shoulders for traffic
- return to work after 3-4 weeks depending on what you do for a living. Ensure you take regular breaks from sitting and do your exercises.
- can begin light aerobic exercises after 4-6 weeks but wait min. Of 3 months to resume serious (non contact) sports.


All in all an amazing day of recovery considering I just had major surgery yesterday. I've had no more arm symptoms but only time will tell me how my neck pain issues have been improved once the surgical healing has occurred and pain meds eliminated. (I'll upload my images later since I can't seem to do this with the iPad).

[ajj1001]

Its really good to hear how well its going, a real answer to all the prayers for you. Hope the cold isn't getting to you too much.

[Reddy2ride]

C4/5/6 M6-C - R2R Update


Day 2 Post-Op - Healing well and doing my PT about every few hours. Looks like I'll be in the Nuffield hospital through Sunday which is nice as they take very good care of you. There are menu items you select for each meal (like a restaurant) and I really like the tea cart which comes by several times each day. Mr. Boeree did his rounds today to check on me and I have an appointment at the hospital on Monday to remove the staples and a final appointment with Mr. Boeree on Thursday before heading back to the USA. The operative pain is still present but I'm taking less and less pain meds and I'm now on 50mg of _______ (anti-inflammatory) 3 times per day. They provided me about 6 weeks of meds which is nice since the names are different in the UK than in the USA.

I've attached pics of my post-operative X-rays as well as the incision right before the drain was removed. Beauty is in the eye of the beholder. My youngest son made me card that showed my very straight, degenerative neck before surgery and my nice curved neck now. Mr. Boeree did indicate today that you will experience ups and downs during recovery and it is not unusual to have blues (depression), neck pain, nerve pain in arms/hands that is typically from inflammation, etc. In other words, give it time and understand there are ups and downs. I also attached a picture of the Nuffield Hospital and also the recently completed entrance to Mr. Boeree's Spine Clinic within the Hospital which still has some construction to complete (disregard my two children in the picture that discovered the hot mocha machine).

I'll provide another update once I get back to the States and then periodically as I heal letting everyone know how I am improving. I really appreciate all the help and support from those on this site!