Tweedle Beetle Tri-Atheletle

• Name: Prodisc-C Total Disk Replacement
• http://us.synthesprodisc.com/EN-US/
• Description: 
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  The Prodisc-C total disc replacement has been determined to be safe and effective in the treatment of symptomatic cervical degenerative disc disease. The Prodisc-C total disc replacement surgery is intended to: – Remove the diseased disc – Decompress the neurological structures – Restore normal disc height – Preserve motion in affected vertebral segment – Improve patient function Since December 2007 the Prodisc-C total disc replacement is approved for use in the US by the FDA after an IDE clinical study.

  Photo: 

• My Photos:

• My Results Thus Far:  Wow!!!  Exactly one week after surgery, the radiating pain down my arm is gone and has stayed gone.  I am back to work and plan on starting into PT early next week.  The soreness around the surgical site was always minimal but has improved substantially from that.  My range of motion has improved significantly but I am still stiff.  God, thank you, I can finally sleep at night... and in any position I want!!!! I preyed for a really good outcome of the procedure and thus far, the outcome is exceeding my expectations significantly.  I am going to continue to be conservative and stick with the "Don't pick up anything more than a coffee cup" philosophy until the doctor gives me clearance (regardless if I think I "could" go for a run). If anyone is considering this procedure, I welcome you contacting me and asking questions but know that as long as your doctors see you as a good fit for the surgery and you trust them - I have no complaints!
• What I learned from all of this:

1. Take your health into your own hands!  Do not let anyone (Doctors especially) tell you how you are feeling.  You have the right to call them time after time after time to try and get in and see them.  If they tell you their first availability is in two weeks - take it and call back that afternoon to see if there has been a cancellation.  Call back EVERY day until they say "Yes, we have an opening!".  Your your disk was anything like mine, the impingement is killing your nerve and atrophying your muscles.  You are responsible for protecting yourself.
2. This surgery was not that painful - the drugs afterward were worse.  If I have to do this again I will tell them up front - in writing that I do not want anything more than Tylenol with Codeine.  
3. Have a good support network before the surgery.  My Dad, Step mom, Mother In Law, Step dad, Friends from my wifes Moms Club and friends made this such an easy time to take care of my self.

Oh to sleep again!!!

That's right, I went to bed at 11:00 PM and slept in until 7:00 AM.  Eight hours, haha!  I feel like I am on vacation.  Overall, I feel so much better today.  The pain in my throat has decreased substantially (although I am not eating any Nature Valley Granola Bars).  I am still stiff but really feel improved.

Now all I need is to... GET OUT OF THIS HOUSE!!!

I really do like my work but I would be lying if I said that I was running out the door every morning to get to the office.  Now I can't wait for my conservative half day tomorrow.  My associate Judy has been holding down the fort for me and I really feel bad about all the stuff she has been doing on my behalf.

Anyway, I am really looking forward to getting back to life.

“Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever.” - Lance Armstrong

Photo: AP
OK, OK...

I think I got a little ahead of myself in thinking I was out of the woods.  This morning I woke up feeling like I had just been pulled out from under a Mac Truck.  My esophagus felt like it had swollen substantially, my neck felt like it had been cemented into place and the muscles surrounding the incision were sore, sore, sore.  I was told to expect this but I was a bit spoiled yesterday as I felt very little pain.  Maybe the remaining adrenaline and other shock related hormones that came after the surgery helped in the 24 hrs after?  Regardless... it hurts now.

That said, I do believe it is time to reevaluate some of my fitness goals and acknowledge what the next 6 months are really going to look like.  For one, I think it prudent to rethink the Pacific Crest long course triathlon - and maybe target a long course triathlon later in the year.

OK - here are how things look:

• Jan 21st - Recovery from surgery begins.
• Feb 4th - Follow up with surgeon - hopefully relieved from "coffee cup lifting limit". Start back into cardio training on recline (granny) stationary bike. Start physical therapy to regain strength in tricep and maintain/increase range of motion safely. Start water running.
  
• March 4th - 6 week mark - hopefully relieved from "milk jug lifting limit".  Get started back into Spin (stationary bike) bike and road trainer.  Start back into swim training. Start light running.
• April 4th - 10 week mark - hopefully relieved to full duty.  Ease back into full training and begin racing.
• May 15th - Run 10K at Pole Pedal Paddle (Defend title with the "Innovators") PR - 35:42.
  

Getting back to training on April 4th, gives me 10 weeks to be ready for the Pacific Crest Long Tri and looking at this realistically, I think it foolish and irresponsible to try and force my body into such a grueling race on such a short training schedule.  I don't want to give up on the idea of racing though so I am revising my goal to compete in the Olympic Distance Triathalon on June 26th, so...

• June 26th - Compete in the Pacific Crest Olympic Distance Triathalon

I will be adding some more events to the schedule but even more than all of this - I am simply looking forward to being a Dad again and a Husband.  It kills me each time my son asks me, "Is your back feeling better Dad?" I am so excited to say - yep! and snatch him off his feet and tickle him as he dangles mid air from my shoulder...

The worst is over...

Overall, the surgery (Complete Cervical C6/7 Artificial Disk Replacement) was a complete success (at least 2 days later). After gowning up, it was simply a waiting game.  The surgery before me was delayed by about an hour which in most circumstances would be a real bummer as you anticipate the worst.  Actually, though - it gave me time to meditate and get centered before the procedure was done.  I went in feeling very calm, collected and centered.  Here are some of the before photos showing everyone in a nervous but good spirit...

It's not the camera that adds the extra 40 lbs - its the gown... terribly unflattering especially when they pump it full of warm air.  That said, its like sitting in a sauna at the gym and a huge improvement over past surgeries where your nerves seam to turn you into an icicle.  You also may notice my uncommonly unshaven face.  I had a truly grand plan of shaving the morning of the surgery.  I failed at reading the "pre-opp" direction which are fairly clear - no shaving two days before surgery as it may increase infection.  I was stuck with the Itchiest face ever going into the procedure.

The procedure started at about 4:30 and I finally came out at about 6:30 and woke up around 8:00.  I can't remember much except talking my wife's yoga class up to the recovery nurse.  It was a long night - walking up every few hours and getting restless sleep between.  Overall the effects of the surgery paled in comparison to the side effects of the drugs they were giving me in fairly high dosages.  First they started me out on Dilaudid.

For me, the worst of my night started with my second dose of Dilaudid where it felt like my chest was being compressed with a 250 lb weight.  It took all my focus to raise and lower my chest and it scared the crap out of me.  While this effect eventually died off, it meant that the nurses hooked me up to all the machines again to send an alarm if I did go into respiratory arrest.  Later, the nausea and vomiting kicked in.  To combat this, at about 8:00 the next morning they gave me some sort of anti-nausea drug which brought on the worst of my recovery - I had uncontrollable twitching, leg muscle spasms and shaking.  On top of that, I had the worst anxiety - I would have done anything to get out of that hospital bed.  It was the worst feeling on the planet and one that I would never want to repeat again.  I finally got relief with more drugs, some sort of anti-convulsion/anti-seizure drug and Valium which helped me sleep a bit more.

Finally they asked me if I was in pain and I flatly lied to them saying NOPE - I FEEL GREAT! In hopes that they wouldn't give me anything else to make me feel worst.  The good news is that they then prescribed good old Tylenol which I have been on ever sense.  Sometimes I think it better that you just endure the "real" pain as opposed to the more awful side effects of the drugs they give you to cover it up.

All the worst said, I am soooooo relieved at the outcome of the surgery.  The radiating pain in my shoulder and arm is GONE. The numbness in my fingers has lessened and the strength in my triceps has increased substantially.  Am I sore?  Yes - especially the muscles around my incision on the front of my neck.  Honestly though, I have been in worse pain after a solid lacrosse game.  I really can't complain and feel so blessed that I could get this surgery as soon as I did.  I am looking forward to a 100% complete recovery!!!

I spoke with the surgeon after the procedure and he said I was a text book example of the perfect surgery.  The herniated disk was one of the top 3 largest that he had seen in the cervical spine and hernias of this size are usually reserved for the larger disks in the lower part of the back  It really justified the amount of pain, numbness and paralysis that I was feeling.  A very heart felt thank you to the expertise, caring and excellent skills of Dr. Keenen and Dr. Tatsumi of Oregon Spine Specialist (www.orspine.com).

My wife has been fantastic - she has been so strong through this and so caring.  I couldn't be a luckier husband.  My mother-in-law Susan, my Dad and Step Mom have all been out here spoiling my boys and keeping them from using their delicate daddy as a jungle gym.  Thanks to all who send their thoughts and prayers during and after the surgery and the meals coming in from Shannon's friends at "Mom's Club".  You have all made this difficult time so much easier to bare.

I am looking forward to taking my first shower after my surgery - although with my Dad's help, I did shave last night to great relief.  It also made me feel good that "Dad Duties" don't ever end :).

In all honesty, I am really looking forward to the surgery... well maybe a better way of saying it is that I am tired of being in pain and ideally, the surgery is going to fix the worst of the pain and hopefully cause less than I have now. This last month has been bloody awful, plagued with sleepless nights, constant fatigue, constant nerve pain, paralysis in my triceps and numbness in my fingers.  I really feel for people who are struggling with cronic pain - without relief it really wears on a person.

My surgery today was bumped up from its original time of 6:00 PM to 3:30.  I need to be at the hospital for preparations by 1:30 and hopefully I will be out by 5:30 PM.  Most likely I will be discharged from the hospital the following day but I am planning on being a "slow" recovery so that I can be pampered for another day so :).

Dr. Keenen, a very experienced neurosurgeon (30 years) and Dr. Tatsumi (a neurosurgeon and an instructor for implantation of artificial disks and has done 100s of these) will be working on me for what should be 1.5 hrs or so.

During my recovery, my beautiful and wonderful wife will be keeping my blog up to date with my recovery status. 

Check back to see how everything goes!

Well,

I am scheduled for a Cervical Disectomy and artificial disk implant on Thursday at 6:00 PM.  I had my pre-opp appointment this morning with the doctor and really feel good about the procedure.  As my current surgeon (Dr. Keenen) has only done 15 of these surgeries, he will be joined by his partner, Dr. Tatsumi (http://www.orspine.com/doctors.html) who has done over 50.  I am hoping that this will help me over the long term to prevent other disk injury which could have been caused by a total vertebrae fusion.

I don't have much time now but wanted to share the following video as a way to describe the procedure.

I am not sure why... but I was totally prepared to schedule a surgery on this herniated disk.  I had come to terms with it and was ready to move forward.  I have to say though, I was taken by surprise when I was told that they would be cutting through my throat to access my spine from the front!  It doesn't take a engineer to figure out the shortest distance between two points is a straight line and if you have two straight lines of different length, it is generally easy to figure out which of those straight lines is the shortest.  Well... where is your spine???  On the the front of your neck? Nope - even I know this one, your spine runs down your back.  It seems logical to me that to get to your spine, you should probably cut through the back not the front!!!

Enough sarcasm, here are the stats on what the Neurosurgeon says:

• Severely herniated disk C6/7
• Disk degeneration C6/7
• Bulging disk C5/6
• Disk degeneration C5/6
• Bone spurs forming on C 5/6/7 (the body's natural way of fusing these joints to protect the spine).

Plan:

• Cervical discectomy and fusion (C5/6 and C67)
  
• Cut into the neck, through the throat to access the spine from the front.
• Remove all of the disk material from C5/6 and C6/7 (maybe - but definitly C6/7)
• Utilize a cadaver bone graph to facilitate bone generation and cervical vertebral fusion.
• Attach a titanium plate to the two vertebrae to support the bone graph.
• Surgery take 1.5 hrs and then overnight stay at the hospital for observation.
• There are lots of good to gruesome videos out there (just Google the Cervical Discectomy and Fusion

Recovery:

• Initially, things won't be fun with 4 or 5 days of local pain (at the surgical site and throat).
• The Nerve pain should be gone but this will be replaced with the surgical pain.
• The doctor suggests getting up and moving around in the first few days anything out of bed will require a C-Collar for neck suport.
  
• For the first 2 weeks - picking up nothing heavier than a cup of coffee.
• For 6 weeks nothing heavier than a milk jug (try this on for size when both of your toddlers are much heavier than a milk jug)
• After the first couple of weeks, I should be able to get back to the gym and sit in the recline (granny) bike and peddle to keep my heart rate up.
• After the first couple of weeks, I will be engaged in controlled physical therapy.
• I should be back in business by 12 weeks (3 months) able to train for all of my endurance sports.
  

I am awaiting the actual surgical scheduling but should know more on Monday.  I will keep you all posted!

OK... I DID IT!!!!

Through focused meditation and visualization... oh and 2 Percocet, 500 mg Naprocin and a muscle relaxer - I was able to grit through 20 min of real pain.  The meds took a bit of the edge off but it still really sucked.  The good news is that we got good images which at this point confirm that this IS NOT BRACHIAL NEURITIS!!! Unfortunately, it is not my imagination either :).  It looks to be a herniated disk and by the looks of it a "huge one".  I quote an orthopedic surgeon who is a family member of mine.

Here are the MRI images:

The two most common levels in the cervical spine to herniate are the C5 - C6 level (cervical 5 and cervical 6) and the C6 -C7 level. The next most common is the C4 - C5 level, and rarely the C7 - T1 level may herniate.
The nerve that is affected by the cervical disc herniation is the one exiting the spine at that level, so at the C5-C6 level it is the C6 nerve root that is affected.

Symptoms of a Cervical Herniated Disc

A cervical herniated disc will typically cause pain patterns and neurological deficits as follows:

C6 - C7 (C7 nerve root) - Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation (see Figure 1).

  It is important to note that the above list comprises typical pain patterns associated with a cervical disc herniation, but they are not absolute. Some people are simply wired up differently than others, and therefore their arm pain and other symptoms will be different.
Since there is not a lot of disc material between the vertebral bodies in the cervical spine, the discs are usually not very large. However, the space available for the nerves is also not that great, which means that even a small cervical disc herniation may impinge on the nerve and cause significant pain. The arm pain is usually most severe as the nerve first becomes pinched.

Treatments for a Cervical Herniated Disc

When the initial pain from a cervical herniated disc hits, anti-inflammatory medications (NSAIDs) such as ibuprofen (e.g. Advil, Nuprin, Motrin) or COX-2 inhibitors (e.g. Celebrex) can help reduce the pain.
The pain caused by a cervical herniated disc is caused by a combination of:

1. pinching of the nerve root, and;
2. inflammation associated with the disc material itself.
3. Therefore, taking anti-inflammatory medications to remove some of the inflammation can reduce this component of the pain while the pressure component (pinching of the nerve root) resolves.

For patients with severe pain from a herniated disc, oral steroids (such as Predisone or a Medrol Dose Pak) may give even better pain relief. However, these medications can only be used for a short period of time (one week).

Additional conservative treatment options for a cervical herniated disc

In addition to anti-inflammatory medications, there are a number of non-surgical treatment options that can help alleviate the pain from a cervical herniated disk, such as:

• Physical therapy and exercise. Just as in the lumbar spine, Mckenzie exercises can be used to help reduce the pain in the arm. In the initial period a physical therapist may also opt to use modalities, such as heat/ice or ultrasound, to help reduce muscle spasm.
• Cervical traction. Traction on the head can help reduce pressure over the nerve root. It does not work for everyone but is easy to do, and if effective the patient can use a home traction device for pain from a cervical herniated disc.
• Chiropractic manipulation. Gentle manipulation can help reduce the joint dysfunction that may be an added component of the pain. High velocity manipulations should be avoided as they can make the pain worse, or worsen any neurological damage.
• Osteopathic medicine. Osteopathic manipulation and special techniques to restore normal joint motion can be helpful in reducing pain from a cervical herniated disc.
• Activity modification. Some types of activities may tend to exacerbate the herniated disc pain and it is reasonable to avoid these activities to keep from irritating the nerve root. Such activities may include heavy lifting (over 50 pounds), activities that can cause increased vibration and compression to the cervical spine (boating, snowmobile riding, running, etc.), and overhead activities that require prolonged neck extension and/or rotation.
• Bracing. In some instances a cervical collar or brace may be recommended to help provide some rest for the cervical spine.
• Medications. In addition to the anti-inflammatory medications mentioned above, narcotic agents (pain killers) might be used on a temporary basis to help reduce the pain and discomfort from a cervical herniated disc. Also, muscle relaxants or certain anti-depressants may help reduce the nerve-type pain (neuropathic pain) and help restore normal sleep patterns.
• Injections. Epidural steroid injections or selective nerve root blocks can be helpful to reduce inflammation in cases of severe pain from a cervical herniated disc, and can be very effective if accompanied by a comprehensive rehabilitation program that may involve a number of the above conservative treatments.

Physicians who provide the above treatments for a cervical herniated disc may include family practitioners, physiatrists (physical medicine and rehabilitation physicians), osteopathic physicians, neurologists, and orthopedic spine surgeons or neurosurgeons. Chiropractors and physical therapists may also provide some of the above treatments for a cervical herniated disc in their respective areas of specialization.

• Anterior cervical discectomy and spine fusion. This is by far the most commonly preferred method among spine surgeons for most cervical herniated discs. In this surgery, the disc is removed through a small one-inch incision in the front of the neck.
After removing the disc, the disc space itself is fused (see Figure 2). A plate can be added in front of the graft for added stability and possibly a better fusion rate (see Figure 3). For more information, see Anterior cervical decompression (discectomy) back surgery
• Anterior discectomy without spine fusion. This is basically the same procedure as above except after removing the disc the space is left open and no bone is added to get a fusion. The disc space will still often fuse even without a bone graft but the healing seems to be longer and when and if it does heal, it tends to heal in a deformed position.
  For more information, see Anterior cervical decompression (discectomy) back surgery
• Posterior cervical discectomy. This is similar to a posterior (from the back) lumbar discectomy, and for discs that occur laterally out in the neural foramen (the “tunnel” that the nerve travels through to exit the spinal canal) it is often a reasonable approach. However, it is technically more difficult than an anterior approach because there are a lot of veins in this area that can result in a lot of bleeding, and the bleeding limits visualization during the surgery. This approach also necessitates more manipulation to the spinal cord.
  
  For more information, see Posterior cervical decompression (microdiscectomy) surgery

Potential risks and complications of spine surgery for a cervical herniated disc

• Damage to either the trachea/esophagus or one of the major blood vessels in the anterior spine (front of the neck). This should happen in less than 1 in 1,000 cases.
• In about 1% of cases, retraction on the nerve to the voice box (recurrent laryngeal nerve) can cause hoarseness. The hoarseness usually resolves in two to three months.
• Fusion rates run about 95%. Occasionally, there may be a postoperative nonunion that requires a re-fusion. Without a cervical plate there is a possibility (less than 1%) that the anterior bone graft will displace.
• With either the anterior or posterior approach there is a 1 in 10,000 chance that there would be either nerve root or spinal cord damage.
• Infection or cerebrospinal fluid leak happens less than 1% of the time.

Postoperative Care Following Spine Surgery for a Cervical Herniated Disc

Hello All,

Good news and frustrating news today.  Yesterday, I was able to see a Neurologist.  He confidently believes that my initial diagnosis of Brachial Neuritis was incorrect and I am actually struggling with a Cervical Radiculopathy (Herniated Disk).  He described it to me this way... "In 25 years as a practicing Neurologist, I have seen one case of Brachial Neuritis whereas I have seen countless cases of herniated disks.  We won't know definitivly until the MRI but if it quacks like a duck, looks like a duck and walks like a duck - it is most likely a duck."

Great! Phew... we can do something about that right?

I sceduled the MRI for the first available oportunity - this morning at 7:00 AM and I was right on time.  After getting ready, I layed down on the sled and BLINDING PAIN begain coursing through my shoulder and arm... BLINDING... I honestly didn't appreciate that discriptor until today.  Blinding pain is truely Blinding.  Even thinking about it as I write this churns my stomach.  I told myself, "OK - 12 min... I can do this..."  Within 2 min I was whimpering like a baby, all the blood had left my face, bile begain to build in my throat and I was madly squeezing the little "GET ME THE F**K OUT OF HERE" ball that they give you for the truely panic stricken.  There is a reason why I am still sleeping sitting up.  Hell, laying down on a bed (down comforter and a pillow top matress) hurts me - the hard plastic sled they gave me today was worse than torture.

End result... I still don't know definitively what is wrong back there but if nothing else - this morning was a brilliantly painful reminder that something IS wrong.  I have left three messages with my doctor to evaluate other options.  As far as I am concerned, put a mask on my face and a IV in my arm because I can't do that again with any resemblance of consciousness.

Hello Everyone,

Happy new year!  I wish I was starting things out in a bit of a stronger way but I am telling myself, "I am getting the worst of the year over with in the very beginning."  Today was a struggle for me - it started with a realization that that the paralysis is setting in in my left triceps. I am having trouble extending my left arm from the elbow when held over my head.  This was a realization that this is real and it is not going to be like the rest of the injuries that I have worked through over the last 30 years.  This was followed by shaking and tremors while trying to do simple things with my left hand (shuffling a deck of cards for instance).  In all honesty, I am feeling scared.

I wasn't sure if the pain medication was working or not.  The anti-inflammatory and muscle relaxant does allot to irritate my stomach but the pain didn't seem to have diminished.  I thought I would try and entertain myself today and put it to a test - stopping the medicine and see how I was fairing towards the end of the day.   The result was allot more pain which was frustrating in its own right. 

Tomorrow I am looking forward to a appointment with a neurologist.  I really am looking forward to it - maybe (I am preying) I will have an answer as to what is going on.  While there has been a written diagnosis of Brachial Neuritis, no one can really confirm it without a MRI and Nerve Conduction Test.  I am hoping that the neurolgist can make this happen for me quickly - confirming a diagnosis, giving me a prognosis (so I know what I am up against) and a agressive plan of attack to overcome this.

Lastly, the gift of feeling grateful for the rest of my life, and my family is still with me.  I think of Pablo and his father Jeff everyday when I feel the frustration and doubt set in.  I realize that I would live everyday with this pain if it meant that I could continue to be with my wife and children.  Thank you Pablo.

May we all have a happy 2010.