[Artificial Disc Replacement / Cervical] 3 M6Cs 3 Months Out (Dr. Boeree, C4/C5, C5/C6 & C6/C7)

[Researcher]

3 Months Out

Yesterday marked the three month point following the removal of my degenerative C4/5, C5/6 and C6/7 discs, which were replaced with Spinal Kinetics M6Cs by Dr. Nicholas Boeree. My Avatar now shows the x-ray taken during surgery. As other ADR patients may attest, describing the recovery process and how "well" you are after surgery is not necessarily a simple task. That is part of the reason I have been slow to return and start posting to the forum. I wanted to make sure that I really understood my post-surgical condition before I opened my big mouth!

As far as recovery from the surgery itself goes, I am fully recovered and have been for four to six weeks. Full neurological recovery is a different story. Before I continue, I will say that it was the right procedure for me, and I would do it again tomorrow with no hesitancy whatsoever. I am 90+% functional. I can lift weights, mow the yard, work on cars, do landscaping, or just about anything I feel like doing. I do not have any of the debilitating symptoms I had before surgery. I do still have neurological symptoms that could take another year or more to subside. Some of them may never go away, depending on how much damage the nerves suffered prior to ADR. The symptoms I currently have include;

Residual Symptoms

• Left arm partial numbness, tingling and mild weakness
• Left triceps mild ache
• Left leg partial numbness and tingling
• Left pectoral ache
• Tingling under left shoulder blade
• Right neck tension and spasms

All of these symptoms are very mild. I generally do not take any prescription medication at all. If I take any medication, it is only an Aleve or two, and it usually has nothing to do with my neck. Other than the muscle tension on the right side of my neck, I cannot tell that there is anything wrong with my neck at all. I have full range of motion in all directions. In fact, it is better than I had for years before my surgery. I have also noticed in my weight lifting that I can now perform certain lifts with better form, since the biomechanics of my neck are now as God designed them to be.

My Surgical Experience

My surgical experience was nothing short of phenomenal. I had other surgeons in my finalist list that I’m sure are excellent, but I cannot say enough good things about Nick Boeree. He was the finest surgeon, technically, and as a person, that I have ever met. Such an expert, yet so humble and caring. The experience at the Nuffield Hospital in Eastleigh U.K. was also phenomenal. It’s not a new facility, but the patient care was great. Everyone was so friendly. I felt a little sad leaving them. And the food! Five stars all the way. I have not eaten that good in years. Can I actually say that about hospital food? Absolutey! Steak, trout, roast lamb, duck, all sorts of vegetables, salads, desserts, and the list goes on. Words are inadequate.

Recovery from surgery did have its challenges. Having three cervical discs replaced is not trivial, regardless of how good your physical condition is. I had surgery mid-day on a Wednesday. It was Friday morning before I had enough strength to get out of bed and the ability to stand up without getting dizzy. After that I was off and going, but I pushed myself too hard. That is a common temptation, especially when you are in a foreign country with your wife who would like to have a break from caring for her spouse and enjoy the sights (i.e. London on a sunny day). To shorten this dialog, I’ll list our itinerary below along with some helpful hints for those considering travelling overseas for ADR surgery. I have lots of pictures, including pictures taken by a technician during surgery. If you would like to see them, send me a private message and I will forward a link and password to a file sharing site.

Sunday – left for the U.K. around 5:00 p.m. – The flights were uneventful, and I did not suffer too much. Regardless of how well you think you feel, ALWAYS ask them to transport you in a wheelchair. I did not, and I severely regretted it. They don’t mind, even if you don’t look sick.

Monday – Arrived at Heathrow in London around 10:00 a.m. – We had arranged for a driver to pick us up and take us to the Nuffield Hospital in Eastleigh. Unless you are an experienced overseas traveller and familiar with driving on the left side of the road where round-abouts are common, I strongly recommend hiring a taxi. You could go by bus, train, etc., but fellow spine patients will be quick to tell you that you will be in extreme pain if you do. Pay for the taxi. Besides, gas costs $8.00 a gallon in the U.K.!

We arrived at Nuffield Hospital around 1:00 p.m. Although my surgery was not until Wednesday, we had arranged to stay in the hospital to simplify the logistics and avoid unnecessary travel. There was a little confusion about having our room ready, but it was straightened out quick enough. We were given the largest room in the hospital, all by itself at the end of the hall. We had an elegant dinner that night, then put a sign on the door that we were going to sleep in the next morning.

Tuesday – We did not sleep too late, however, as an internet acquaintance picked us up at 9:00 to tour southern England. It was absolutely freezing! I could not get warm. It was very interesting (forts, old churches, restaurants, ship yards), but physically challenging for me. I did it mainly for my wife. Along the way, we also got to experience a genuine English Tea Room with crackers (cookies) and other English words that have totally different meanings than they do in the U.S. Just so you can prepare mentally if you do travel to southern England, it is rarely sunny and it is frequently damp.

That night we rested and enjoyed another five star meal in the hospital.

Wednesday – In the morning, they came to officially admit me into the hospital. They took x-rays, blood, etc. and asked me some questions. It was administratively much simpler than in the U.S. After breakfast, my wife moved to a room across the hall from my room. We had made arrangements for her to stay in the hospital with me rather than stay in a hotel. Their procedures require that guests stay in a separate room once the patient is admitted for surgery. It was actually cheaper than a hotel, included the five star meals, and she was right across the hall.

Around 10:00 a.m., they took me to the Theater prep area. “Theatre” is the operating room. In a very fast paced, but very organized fashion, several technicians and doctors scurried about prepping me for surgery. In a matter of minutes, I was out cold.

Later that day, I became conscious in my room again, with my wife (and others I think) present. It’s a bit foggy at this point. I heard stories about conversations I had with nurses on the way back to the room, but I do not remember any of them. I do remember my wife sharing about her conversation with the Anesthesiologist (they say Anesthetist, pronounced Ah-nees-thu-tist) who, in response to my wife’s question about how the surgery went, replied, “Everything was all Tickety-Boo”. We learned that this meant that it all went really well! They said that my surgery took about three hours.

Wednesday night was rough, since I normally require a CPAP machine to sleep. I had the CPAP machine, and I think I did use it, but I was so limited by my condition that it was difficult. I was on a morphine pump, and I used it quite a bit that night.

Thursday – Thursday was rough also. I started to wean myself off the morphine as best I could, but I was in pain. At some point, in the afternoon, the physical therapist and a nurse came and tried to see if I could get out of bed. I was able to eventually sit up, but I was so dizzy that they did not even have me try to stand up. I was told by a variety of people that the anesthesia takes a long time to get out of your system, perhaps even weeks for some people. For me, I would say that it was several days before the “chemical” feeling left.

As another point of mental preparation, you will be required to use lower leg compression sleeves all the time while you are in the hospital. You have to keep them on any time you are in bed, even before the surgery. You have to get used to the Darth Vader sound constantly cycling as they alternately inflate and deflate, pressing against your lower legs. You also have to wear compression stockings from the time you leave the U.S. to depart for the U.K. and for six weeks after surgery. I did good making it five weeks after surgery, before putting them in the drawer for good.

Friday - Thursday night was a rough night of sleep. I was not sleeping well, but felt physically better and was awake, so I got up around 4:00 a.m. I tried to watch TV, but there is no good TV in the U.K. I eventually paged a nurse to help me get out of bed. I felt good, and after I had demonstrated to the nurse that I could walk without getting dizzy, she left me on my own. I actually walked part of the way down the hall several times. I eventually got a shower which was wonderful after two days in bed, even though I had received one nurse-provided sponge bath on Thursday. I don’t care to repeat that process any time soon!

Later that day, they removed my stint and discharged me from the hospital. We took a taxi to a local bed and breakfast, and I laid down to rest. The taxi ride to the bed and breakfast was awful. I was in so much pain. I had a collar on (can’t remember if it was the soft or hard one), but it offered no help at all. I was practically in tears by the time I reached the room. Later that night, we ventured out on foot to get something to eat in town, which was only a five minute walk. It actually felt good to get out, as long as I could control my body motions carefully.

At this point, I was taking a variety of oral pain medications to survive.

Saturday – We had to go back to the hospital, supposedly for physical therapy and prescriptions. We took the bus, which turned out to be a long painful trip, followed by a long walk from a not-so-close bus stop. The bus was smoother than the taxi, though. My general advice is for all cervical ADR patients to stay out of any kind of vehicle for several days after surgery if possible. Walking is not a problem, but riding does not work, regardless of what type of transportation it is. The hospital trip turned out to be rather unproductive, and I was confused as to why it was ever needed.

We walked to town for dinner after I recovered some from the bus trip and got some dinner.

Sunday – We slept in and rested. Eventually, we met out internet acquaintances in town for coffee and conversation. Knowing that we would be checking out on Monday, we packed some and went to bed.

Monday – We checked out of the bed and breakfast and took a taxi to the hospital, hauling all of our luggage with us into the hospital outpatient waiting room. The receptionist, who we had gotten to know a couple of days earlier, let us store our bags in a side room. Fairly quickly, they called me back, and in about ten minutes, my bandage was off and my staples were out. The scar was so minimal, that most people could not even tell that I had surgery. It’s actually more noticeable now, not due to the physical feature, but due to a darkening of the tissue along the scar line. It’s no big deal though. I never think about it. For those that are worried about the potential appearance of a scar, I would encourage you to focus on your relationship with God and your relationship with others. Leave your appearance and what others might think about you if you had a scar completely off the list. It’s simply not worth being concerned about. Besides, Nick does a fantastic job. I like having some visible scar. It gives me something to talk about!

We had timed it so that a driver would arrive to pick us up at the hospital and take us to Wimbledon after they had removed my staples. We had the same driver, so he was already comfortable with us. Also, he was a very careful driver and was very considerate of the fact that I had just had neck surgery.

We arrived at a bed and breakfast in Wimbledon around 1:00 p.m. After unpacking, we left on foot to take a prearranged tour of Wimbledon. This was for my wife, who was a college tennis player and is an ardent Wimbledon fan. I was in pain, so I popped some pills and sucked it up. The tour was interesting, but I crashed into the bed upon our return. We later walked in to Wimbledon for some dinner and just squeezed into a Subway (the sandwich shop) at 8:00 as they were closing. After that, we both passed out in our room.

Tuesday – We slept in on Tuesday some, but got up and headed for the Tube (the underground train) into London. We had studied the routes and had no difficulty at all emerging at the base of Big Ben. It was an absolutely gorgeous, clear, sunny day in London. I did enjoy seeing the sights, but I was in pain and taking lots of pills. Again, I did it for my wife. I eventually recovered, and it did no permanent harm.

Wednesday – We got up early and took a prearranged taxi to Heathrow. It was a tough ride through 500 or so round-abouts between Wimbledon and Heathrow. It was uneventful, however, and we eventually took off for the U.S. Once in Atlanta, we walked about five miles through the airport to follow the customs path. Again, ALWAYS ask for a wheelchair, regardless of how well you feel. I was macho (or more appropriately, stupid), and it was a BIG mistake.

After one plane change, we ended up back in our home town. A very considerate friend picked us up at the airport and took care of all our bags. We made it safely back to our house after a long, painful return trip. Then the real healing process started.

I’ll take up that part of the story another day.

Encouragement

For those of you on the front end of an adventure like this, I encourage you to have hope, do your research, do whatever you have to do to come up with the money, and get it done. Of course, that is only if you do not have any significant contraindications to ADR. I highly encourage all those considering ADR to contact Nick Boeree or his assistant Jo Haley. You won’t be sorry.

Your friend,

Phil

[spinches]

Phil, I have read your previous posts because I also am headed for cervical surgery. I am happy to hear that your surgery went well and that you are now on the healing side of it.

After consulting seven surgeons in this country and overseas I decided this week to work with Nick Boeree. I will fly to the UK in August for M6 ADR at 2 levels, C 5-7. I was deeply impressed by the phone consult I did with him, but my decision was also based on the recommendations of people on this website. The personal information you shared here will really help me to prepare for my experience in the UK. Thank you so much.

[Gilbert P]

Hi Phil

Thanks so much for your post It is great to see you had such great care, I an also considering going to have surgery with Mr Boeree if insurance does not approve surgery here in the states.

He would do a four lumbar procedure fusion with ADR?

I have sent you a P.M.

Thanks

Gil

[Justin]

Hi Phil,

Thanks for posting such a detailed account of your surgical experience and the first 3 months post-op! Posts such as yours really help Spine Patients contemplating surgery--I remember "hanging on to every word" others would type on the Forum before my artificial disc replacement operation in 2003.

I wish you the very best and I (and I'm sure many others) appreciate your "pay it forward" attitude. Please post updates when you are able!

[Researcher]

I got my three month post op x-rays today. All three discs appear to be in the same location where Dr. Boeree placed them in March. That is a very good thing.

I attached one cropped closeup for your viewing pleasure. Pictures of my scar are coming soon. You can hardly tell the difference between it and my normal wrinkles. Now I know why God gave me wrinkles.

Phil

[spinches]

That's great to hear, Phil. And thanks for the pictures of your M 6's. They have an attractive tailored look relative to the appearance of a squished, herniated natural disc. Since I will have 2 of them myself soon, it's reassuring to know they stay where they are supposed to stay and also look good!

Sandra

[Researcher]

Several of you had asked to see pictures of my cervical ADR scar. I'm sorry it has taken me so long to post a picture. The scar is not all that noticeable. When they perform cervical ADR, they have to work around the muscles in the neck. Since they come in from the front of the neck, one of the major muscles they have to avoid is the SCM (Sternocleidomastoid). So, the scar tends to follow the line of the SCM (the big linear bulge in the attached photos). As you might expect, wrinkles in the neck tend to follow these same structures. In dim light, my scar looks like just another wrinkle. Wow, finally a good reason to have a few wrinkles!

I have attached two versions of the same picture, one plain and one identifying the ends of the scar.

Some patients are opposed to staples, thinking that they will worsen the appearance of the scar. I followed the recommendations of Dr. Boeree and stuck with the staples (pun intended). The staples were taken out five days after surgery. I could not even feel when the nurse took them out. After a few weeks, you could not tell that I ever had any staples in my neck.

Don't worry about scars. Get fixed if you can!

Phil

[speedyralph]

Thank you Phil for providing these pictures. I cant tell at all if it wasn't for those arrows indicating it...

Ralph

[julesd]

Thank you so much for your reply and the link to your post op thread. It seems like the US doctors say ProDisc is best b/c there is a proven track record with it, but I also realize there's nothing else for them to recommend since they can't use anything newer. I read somewhere that M6 has been used in 14,000 patients. That seems like a pretty good track record too. Dr. Bouree said he prefers M6 and is not paid to use it or say that. Your post-op account was so very helpful and moved me one step closer to Southampton. May I ask about how much it cost? We did not discuss that since I will require a vascular surgeon to join us.
Jules

[Researcher]

Jules,

I have not kept up with the number of M6's used since I had surgery in March. It was at about 10,000 in January of this year, so 14,000 now sounds reasonable. Remember that this represents the combined volume of lumbar (M6L) and cervical (M6C) implants. While there are different physiological challenges in lumbar and cervical ADR, the basic physics is the same, and the M6 address the physics of the natural disc better than any other (my opinion based on my personal research).

I do not know how costs have changed since I traveled to England in March. At the time, my three level cervical ADR, excluding travel costs, was about $41,000. The exchange rate can fluctuate wildly, so put some time into educating yourself on overseas payment options to minimize the impact of the exchange rate. My final three options were Germany, England and Spain. The cost in England was in the middle, with Spain about $5,000 less and Germany about $5,000 more. Not to sound like I'm rich, which I am not, cost was irrelevant to me. I went with the surgeon and implant that I felt offered the highest probability of success and that I felt the most comfortable with. I have absolutely no regrets, and I am doing spectacular, considering the magnitude of what I had done. However, I was an ideal candidate, with absolutely no other contraindications and a long history of fitness training and overall focus on health.

Lumbar ADR is more expensive that cervical ADR for obvious reasons. I suspect that the lumbar discs are also slightly more expensive, although the cost of the discs is a small percentage of the total cost of ADR.

I hope this helps.

Phil