Friday, January 4, 2013

UPDATE: Slice and dice Jan 18 - it's time to (hopefully) fix this spine

UPDATE: Just heard back from the scheduler -- the big day is January 18...

My fun on New Year's Eve? I went to surgeon #2 (who will operate on me). Where things stand since the last post is that my disc herniation at L5-S1 he said on a severity scale of 1-10 is a 9.5. Lovely, but it's reassuring to know just how bad it really is on some sort of continuum. I've had 5 doctors look at the MRI and all say variations of "oh, that's bad," but this was the first time one put it in the perspective of their experience over thousands of operations.

Geez at a 9.5 it's no wonder that I'm still limping and can't feel most of my weak left leg and foot ( my right leg is affected as well, just not as bad). He was actually surprised I had done the three rounds of epidural steroid injections considering the severity of the herniation; he would have just operated. Sigh.

So what's going to happen is that I will undergo a bilateral open discectomy - the herniation is so big that he will have to cut it away on both sides of my spinal cord at L5-S1. I'm going to schedule it hopefully during the third or fourth week in January.

That means I've been in the midst of a sh*tty quality of life since late August 2012, when I suddenly had the acute, shooting, pain down my left hip and leg and then spent six horrible, fruitless hours in the Duke ER where they didn't even do sufficient diagnostic tests to find the obvious herniation. That came a few days later, thanks to the intervention of my rheumatologist, who got me in for an MRI.

Major risks of the surgery? The usual  - infection (1%), the surgery doesn’t “fix” the pain, etc. Many patients experience pain relief (the acute shooting pains from the herniation)  after surgery, but that issues related to numbness, weakness in legs may not resolve for up to six months. There is a chance that this will never resolve. Also, the recovery from the trauma of the operation itself can affect the nerves since they have to be moved aside during surgery, which can mean more uncomfortable sensations and yes, even pain.

Full recovery I was told, is usually six weeks. Assuming there are no complications.

One recommendation is to get up and walk gently ASAP for as much as you can stand it to avoid scarring around the spine. am hopeful that the acute pain will be resolved, but I'm realistic that the weakness and numbness from nerve damage could likely remain.

After the operation there is a roughly 15% chance of reherniation. The key is not to lift more than 5 lbs and no twisting of the spine during recup. The chances of reherniation go way down if you allow it to heal properly. My major frustration will be the limitation of not being able to drive. The doctor optimistically said if you can get into the car (by not twisting AT ALL) and not hurting, you can drive. I'm not going to even try for a good while.

It also means no lifting groceries or laundry; Kate's going to take over my laundry lifting patrol; I'll have to settle for just folding if I'm feeling OK. Fortunately we live in a ranch, so it's all one floor, with only about 10 stairs to get into the house.

As far as work goes it's complicated, I only have about 5 weeks of Family and Medical Leave Act (FMLA) time available for the operation and recovery; prior to surgery I have to apply for accommodation under the Americans With Disabilities Act for the ability to take extra time without the risk of losing my job.  And it's not granted that the request will be approved.

Yes, that's how tenuous employment is -- no matter how hard or long you've worked at your job -- when you have chronic disabling illnesses that eat away all your paid time off and unpaid leave afforded by FMLA. The rheumatoid arthritis over the last year has just robbed me of my health in so many ways; this herniated disc just added to the nightmare. So the stress of illness is compounded by wondering whether you can remain gainfully employed -- with the critical health insurance tied to your job. Even so, I'm more fortunate than many.

But right now I am focused on getting under the knife for the slice and dice. That tells you how tiresome it is to be in this level of constant pain when you want to put yourself in even greater short term pain and disability in order for a chance at an improved existence.

So I'm ringing in 2013 with anticipation and hope, along with a healthy bit of apprehension.

1 comment:

  1. I had this same operation last January. It turned out very well (though I'm not dealing with the RA like you are). I had the shooting pains down my leg and my knee, and that was gone after surgery. I had two discs trimmed down, plus they had to do some work on the vertebrae because I also have spinal stenosis.
    I was up walking around the hospital about 6 hours after the surgery (mainly because they gave me a sleeping pill that had the opposite effect). By the end of two weeks post surgery, I was walking a mile a day.
    Good luck, Pam, and please keep us posted.