Tuesday, February 23, 2016

Log of a Discectomy

This is the story of a painful part of my life. I am writing it for the unfortunate few who have to deal with lumbar disc herniation. This story gives hope to people who suffer from sciatica, and it gives encouragement to people who are in the recovery phase of their discectomy surgery.

Today, several years after my sciatica started, I am sitting in my chair, writing this story pain free. Memories of that October morning when it all started are fading.

--------------- Pre-Discectomy

October 2013
I woke up with a dull pain in my back. Sitting down makes the pain worse. I continue with my daily activities. It has happened before so I ignore it.

December 2013
Months later, my back is still sore. This is unusual.

March 2013
The back pain has increased in intensity. Some days, my calf has a dull pain. I can relate this dull calf pain to growing up pain I had when I was in my teens.

April 2014
I tow a light aircraft by its strut, and suddenly I have a sharp pain in my back. I have to sit down. My friend drives me back home. The sharp pain is gone the next day, but the dull pain remains.

May 2014
I am standing in my office with my hand on a cubicle wall. I sneeze and have a sharp pain from lower back to upper thigh that knocks me to the ground. It takes me fifteen minutes to get back up.

I see my family physician who recommends physical therapy. I do four weeks of physical therapy. The dull pain remains.

I am sitting and suddenly, I have sharp pain in the same general area. I take the day off from work. At night, I am watching Pulp Fiction for the twentieth time, and I am in tears. When I laugh, my abdomen muscles cramp up.

My family physician recommends me to get an MRI. The MRI shows slight disc herniation/protrusion of L5-S1. Nothing to worry about.

Slight disc herniation of L5-S1. S1 Right nerve is slightly compressed (on left side of image)

June 2014
Life goes on. I have accepted these occasional flare ups. I am particular about PT which I do at home now.

December 2014
The pain in the back has decreased. The pain in the upper thigh area remains but is manageable. I travel to Utah and do bunch of driving and hiking.

April 2015
I travel to Turkey. I walk ten miles a day. The back pain comes and goes. I can deal with it. I am still on physical therapy. My core is rock hard.

May 2015
The pain is gone from back and thigh. I feel cured. Then after one week of no pain, I have another flare up and the pain is moving downward in the leg.

July 2015
I hike Mount Washington.

August 2015  
I have a bad flare up. Sitting now brings a full blown leg pain on the right side, all the way to the calf. Standing or lying down is not an issue.

September 2015
I am unable to drive now. I grind my teeth while driving. The pain has moved down to the foot. I am still doing PT but it is painful. I am walking on treadmill to keep my cardio health.

October 2015 
I travel to Italy. It is painful in the airplane. Advil does not help much. I am in pain throughout the trip. Pain runs from lower back to foot.

November 2015  
The pain is now unbearable. I cannot walk/stand for more than ten minutes without pain. I cannot sit at all.
I see a neurologist and have another MRI.
Right S1 nerve (left on the image) is pushed out of view due to large herniation. Left S1 nerve is in correct location.

The herniation is pushing the S1 nerve. The herniation is much larger than a year ago. The neurologist recommends McKenzie exercises. I try McKenzie for a couple of weeks with no change. I am taking Medrol, and Advil. I have a lumbar epidural steroid (Depo-Medrol) injection.

The ESI is painful but has no effect even after several weeks. Two weeks after ESI, I have had enough. I decide to go for discectomy surgery.

Depo-Medrol Shot: It was a painful experience. You lie face down, while the doctor inserts a needle in your spine epidural area. It sounds painful, and it was painful! It did not help, and I later found out that this is a risky procedure with a small chance of relief.

November 16, 2015   
I have stopped going to office. I am working from home, lying on the bed. Lying down is the only pain free position.

--------------- Post-Discectomy

I had a rocky recovery from the L5-S1 discectomy.
Surgery Day
Life halts today completely. I have a L5-S1 discectomy operation. The operation was not painful. I enjoyed the medications that knocked me out.
I am up and chatty a few hours after the operation. I will stay in the hospital for one night.

I walk, then feel the same sciatica pain I had before the surgery. I have good amount of incision pain. The sciatica pain subsides in the next 24 hours, but incision pain is quite annoying.

Day 1 after surgery
I am at home. I am taking 30 mg of Oxycodone, and 3900 mg of Tylenol mostly for incision pain.

I walk around the house.

Day 3 after surgery
I am walking outside on the road. I walk 1/4 miles. I have little sciatica. Sometimes I feel a little stretch in the sciatic nerve.

Day 4 after surgery
I walk a mile outside. I have no pain.

Day 5 after surgery
I walk three miles outside. I have no pain.

Day 6 after surgery
I walked five miles outside. I have no pain. I love my new found freedom. Freedom from pain. But I am naive because what lies ahead will change this. This was my last walk outside for next one month.

Week 1 after surgery
I go out for lunch and feel sciatica. I think I have re-herniated. I relax in the bed for next two days but sciatica intensifies. It is less than what I had before operation. I am pretty sure that I have re-herniated.
I call my surgeon's office and am given Medrol (steroid). I take Medrol and the sciatica pain subsides on the last pill.

Incision pain is gone.

Week 2 after surgery

I am off of oxycodone and taking 1300 mg of Tylenol. My sciatica is gone (once again), so I did not re-herniate.

I am lying down. I sneeze and hear a pop in my back. Sciatica comes back the night of the sneeze and now my back hurts too. Getting out of bed is quite painful now. This time I am certain that I re-herniated. I call my surgeon's office and was prescribed another steroid Decadron. I do not take it because I am beginning to hate pills by now.

I do not feel like eating. I feel tired. I know its the stress from not getting well that is making me feel sick.

I will be wrong in everything I assumed.

Week 3 after surgery
Its day before Christmas morning. My back pain is so bad that I call my surgeons office again. They tell me to come to ER for an MRI. I am excited as now from the MRI they could tell if I re-herniated.

I am admitted to ER, and am taken for MRI. I am barely able to stay on the MRI table due to back pain. After I return to ER, they admit me indefinitely. I start shivering uncontrollably. I get up to get some water from the ER bed and faint. I am confused as to why they admitted me. I just need to be assured that there is no re-herniation, and then be sent home.

They took blood samples and fluid from my back to check for infection. They admitted me for three days till infection culture comes back, and put me on Vancomycin IV. They told me they suspect infection because CRP was eight times the maximum limit, and Sed rate was quite high too.

Week 4 after surgery
After being on Vancomycin for a day, my back pain reduces. I stay on Vancomycin for three days in the hospital. I am walking in the hospital with little sciatica and little back pain.

Since the MRI is done so close to surgery, it is inconclusive. The radiologist suspects a small re-herniation, scar tissue, inflammation, and a fluid collection that might be infected.
MRI at week 4. Right S1 nerve is not visible.

Culture from my back comes positive for Staph (MSSA). I am excited to learn that its not MRSA. Surgeon's assistant assures me that I will be sent home with couple of weeks of oral antibiotics.

Then the nurse comes in with an X-Ray machine, and an ultrasound machine. She  breaks the news to me that I will be put on IV antibiotics for 6 to 8 weeks. The machines are brought to insert a PICC line in my arm. I will be tied to a pump 24/7 for the next 6 weeks. The pump will continuously pump Oxacillin near my heart.

Sometimes it takes time to digest all this bad news, and I lash at the nurse for I was told something else.

PICC line is inserted and I am discharged from the hospital. An IV company comes home to hook me up with the IV pump and medication.

PICC line. It goes from arm to top of heart. It "bites" for a couple of days but then you do not feel it. Used for Oxacillin 6 weeks course.

Back home (Week 4)

I am beginning to digest the reality of being tied to a pump for next 6 weeks. This night I wake up with excruciating pain in my leg. The sciatica has returned and this time its several times worse than before the operation. I am screaming with pain. I cannot move an inch on the bed. The pain is equal in intensity to the pain I had when I fractured my elbow. I call surgeon's office and am told by the surgeon's assistant that I probably re-herniated and I need to come back to ER. I hate hospital by now so decide to wait a couple of days. I take full oxycodone, and other pain killers. I wake up the next morning and am afraid to get off the bed. It takes me half an hour to get off the bed, then on to my dad's walker. I am barely able to walk.
I start Gabapentin 300 mg, three times a day.

Week 5 after surgery
Sciatica is manageable again. I get another MRI. There is no change from last MRI. I am happy that a small herniation from the last report has not increased in size.
MRI at week 5. Right S1 nerve is barely visible, and still compressed/displaced. The inflammation/collection is reduced compared to last MRI.

The surgeon assures me that all this is temporary, and I am one out of a hundred that have a rocky recovery.
I hate the sound of the IV pump. Its hard to sleep when the pump is going. I make a box for it to mute its sound. The IV incision site of the PICC line oozes blood all the time but does not hurt.

Week 6 after surgery
I am coming off medication. I still have constant sciatica. Good sleep is a distant dream now. I get Charly horses at night. I feel like there is something crawling in my feet under the skin along with awful cramps.

Week 7 after surgery
Sciatica is gone for a day then comes back. Its manageable but I cannot walk much. I cannot sit for long either. I cannot sleep due to back discomfort and IV line. I am in worse shape than before surgery.
Nurse from IV company comes for blood draw, and gives me cold. I am hating myself.

Week 8 after surgery
I had my wife drive me to work so I can say hi to my colleagues. I show them my pump and gather sympathy. I have not worked for two months.

Week 9 after surgery
Sciatica is ON and OFF. The duration of ON is getting shorter than the duration of OFF. I work for 4 hours in office on Friday.

Week 10 after surgery
I work in office for five days, four hours each day.

Week 11 after surgery
I get another MRI to confirm that the infection has not affected the bone. It has not.

MRI showing Right S1 nerve almost back to its original place (place where it is supposed to be).
The doctor decides to stop my IV, and remove the PICC line on Wednesday. Is this the happiest day of my life?

PICC line removal day. Removing PICC line does not hurt.

I am told by the surgeon that I will make full recovery and the nerve will heal. The ON/OFF pain, and cramps is the nerve healing. He thinks that the earlier MRI report of a small re-herniation may be incorrect.

I go out flying with friends. This is my first day out for fun after first week of surgery. Sciatica bothers me for next two days.

I have started swimming and PT. Both these physical activities irritate the nerve. I am trying to figure the right amount of activity through experiments.

Week 12 after surgery

On the pain scale I am at 1, but sometimes it goes to 3. Before surgery it was 8. For some days after surgery it was 10.

I worked 35 hours this week at office.

I am swimming 30 minutes (14 laps of back stroke), and doing light PT every day. I am not doing PT portions that irritate the nerve.

On the weekend, I am out and about all day long, walking in Newbury street, flying aircraft with friend, and eating out. I have one instance of sciatica (3 out of 10) that lasted half hour.

The more I am out and about, the better I sleep. I am off of ALL medication for one week.

I am sitting, typing this from my chair pain free. I get up and walk about. I feel a stretch in my sciatic nerve. I know it will hurt again, but I know it will get better like it always did.