“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
Posted on 6:38 AM
by Tweedle Beetle Tri-Athletle
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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.
Posted on 3:29 PM
by Tweedle Beetle Tri-Athletle
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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.
Posted on 2:49 PM
by Tweedle Beetle Tri-Athletle
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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
Posted on 1:36 PM
by Tweedle Beetle Tri-Athletle
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Hi All,
Well it has been a long week since my last post where I was officially diagnosed with the herniated disk. I am so glad to know what I am dealing with - and that I now know it is not some strange inflammation that takes years to recover from and no one can treat. That said, I am also feeling frustrated and impatient with our wonderful world of Western Medicine. In this world, you can get seriously addictive drugs at the snap of a finger to treat the symptoms, but it takes weeks (if not months) to actually determine and treat the true cause.
It will have taken me a full month to finally get an appointment with a Neurosurgeon and maybe longer to get the issue addressed and fixed. During this time, I have been prescribed everything from Steroids to Percocet - but nothing has been done to actually get me back on track with recovery... AND I AM A BLOODY PAIN IN THE ASS!!! I call my doctors daily because if I don't, it may be a week before they get to me in their pile of patients...
One word of advice to other who are beginning this process - BE YOUR OWN DOCTOR, the internet is available to us all and don't let a doctor (who doesn't really care about you) tell you about your body. Second, BE A PAIN IN THE ASS. I have found that in this world, the squeaky wheel gets the grease and I have been screaming like a worn fan belt.
Well, I also refuse to become a pain med addict, I refuse to habituate to muscle relaxers and I refuse to carrode my Kidneys and Liver dealing with the pain. So what I have I done (or am beginning to do) - train my brain.
Time to get honest - three nights ago, I realize that I was inappropriately using my muscle relaxers to get some sleep. I would take two before bed (regardless of whether or not my muscles were cramping) just for the narcotic effect. The pain didn't diminish - I just didn't care about it as much. This would ware off at about 4:00 AM anyway and I would wake up getting only 4 hrs of sleep. What did I do? I quit!
The first night was brutal - I was wide awake until about 4:30 (watched "We Were Soldiers"). I woke up again at 5:30 and felt like a zombie the rest of the day. I did allot of mediation that night but to no avail, my body (in just 3 weeks) had become habituated to the drug.
The next night I took things seriously and spent an hour mediating before bed and got to sleep at 10:30, waking at 5:30 - this was like sleeping in for me at this point and I was ecstatic. Last night I did the same, adapting a mediation technique I read about from a book by Deepak Chopra. This technique was called (or is referred to as) the So Hum Mantra Meditation. It was absolutely amazing!!! Further research today into the mantra reviled that it geared to the Spine Chackra - here is some instruction:
The traditional method from what I understand incorporates 108 repetitions of So Hum mantra in about 17 minutes of meditation practice, at a rate of about 6 1/2 breaths per minute, which is extremely relaxing both for meditation and reducing stress in the autonomic nervous system. The Hummmm... sound is intentionally somewhat longer than the Sooooo... sound, as this increases the effect of the relaxation and meditation by releasing the autonomic nervous system.
I slept last night for 7 hours - much longer than I have slept in the past 3 weeks with drugs. The pain I am experiencing has not decreased or abated.
The feeling of freedom from the prescription drugs is so liberating - I am so terribly excited about this new found tool to not only control pain but decrease stress, quiet my mind, get present in my life and eventually (once I am through my recover of this) adapt my meditation to my training and competing.
If you are a doctor out there - please consider the power of Eastern meditation and homeopathic ways of healing. If your a patient - please know, there are other alternatives that allow you to deal with pain/sleep/stress without the little understood but terribly powerful world of pharmacological treatments.
Note - I am still on the anti-inflammatory (non-steroidal). These really do seem to decrease the amount of constriction on the nerve, minimizing the paralysis in my triceps and the amount of radiating "fire" pain down my arm.
Posted on 2:41 PM
by Tweedle Beetle Tri-Athletle
| 5
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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:
Photo 1
Photo2
Photo 3:
Both photo 2 and 3 show the tell tale signs of a herniated disk and I guess it is fairly large which does correspond to the fairly large amount of pain I have been feeling!
Here is what I have learned thus far about Cervical Radiculopathy (Herniated disk)...
All of the information below was accessed from (http://www.spine-health.com and was written by:
By: Richard Staehler, MD)
Arm pain from a cervical herniated disc is one of the more common cervical spine conditions treated by spine specialists. It usually develops in the 30 - 50 year old age group. Although a cervical herniated disc may originate from some sort of trauma or injury to the cervical spine, the symptoms, including arm pain, commonly start spontaneously.
The arm pain from a cervical herniated disc results because the herniated disc material “pinches” or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present due to a cervical herniated disc.
Fig. 1: Disc herniation of the cervical spine
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
The majority of the time, the arm pain from a cervical herniated disc can be controlled with medication, and conservative (non-surgical) treatments alone are enough to resolve the condition.
Once the arm pain does start to improve it is unlikely to return, although it may take longer for the weakness and numbness/tingling to improve. If the arm pain gets better it is acceptable to continue with conservative treatment, as there really is no literature that supports the theory that surgery for cervical disc herniation helps the nerve root heal quicker.
All treatments for a cervical herniated disc are essentially designed to help resolve the arm pain, and usually the weakness and numbness/tingling will resolve with time.
First line of treatment 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:
pinching of the nerve root, and;
inflammation associated with the disc material itself.
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.
Spine Surgery for a Cervical Herniated Disc
Fig. 2: Bone graft
Fig 3:
Titanium plate and screw device
Most episodes of arm pain due to a cervical herniated disc will resolve over a period of weeks to a couple of months. However, if the pain lasts longer than 6 to 12 weeks, or if the pain and disability is severe, spine surgery may be a reasonable option.
Spine surgery for a cervical herniated disc is generally very reliable and can be done with a minimal amount of postoperative pain and morbidity (unwanted aftereffects).
With an experienced spine surgeon, the back surgery should carry a low risk of failure or complications. The success rate for back surgery for a cervical herniated disc is about 95 to 98% in terms of providing relief of arm pain.
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.
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.
Potential risks and complications of spine surgery for a cervical herniated disc
Although any major surgery has possible risks and complications, with an experienced spine surgeon serious complications from cervical disc surgery should be rare.
Possible complications from spine surgery for a herniated disc include:
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
For anterior surgery, there usually is not a great deal of postoperative pain. The surgery is done through a small incision in the front of the neck, and the spine can be accessed in between tissue planes that do not require cutting. This type of surgery usually can be done either outpatient (going home the same day as surgery) or with one overnight stay in the hospital.
The pain in the arm usually goes away fairly quickly, although it may take weeks to months for the arm weakness and numbness to subside. It is not uncommon to have some neck pain for a while.
Postoperatively, most spine surgeons prescribe a neck brace, although the type of brace and length of usage is variable. Also, most spine surgeons will ask their patients to limit their activities postoperatively, although the amount of restrictions and the length of time tend to vary. Ask your spine surgeon before the surgery what his or her usual protocol is regarding postoperative care.
Ya, lots and lots and lots of information, I know. Anyway, I hope this blog can be a resorce for others going through this. I will hear specifically from my doctor tomorrow and I will be seeking other opinions - I will fill you all in when this is done.
Posted on 2:12 PM
by Tweedle Beetle Tri-Athletle
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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.
Posted on 9:52 PM
by Tweedle Beetle Tri-Athletle
| 1 comments
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.
I am a father of two wonderful little boys. I am blessed with a incredible wife and they are my number one priority. In order to keep sane in this insane world I depend on my fitness. I have started this blog to journal about my training, concentrating on Olympic Distance Triathlons, my injuries, my recoveries, my trials, my victories and hopefully put a humors spin on the entire thing.
