Green Light Means Go! Six Weeks Post Op...

Went to see Dr. Tatsumi for my six week post surgery appointment this past week.  One of the first things he asked me was "Do you have a blog?"  It seems that one of his patients had read my blog after a Google search and had told Dr. Tatsumi about it.  Wow.  He said that she wanted to make sure that when I came in again, that he told me how much she appreciated being able to read about someones experience with the Artificial Cervical Disc Replacement Surgery. 

We chatted about how I felt (which is pretty darn good), he tested my strength and feeling in my hands, and he showed me my X-rays.  I had had the X-rays taken right before this appointment. 

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The artificial disc is that bright white piece in the middle of my neck!

He said the device was sitting in the exact location it should be.  He assured me that it won't set off the airport metal detectors! He took his time with me and answered any questions I had.  I was given the green light to return to my normal activities.  I won't snowboard until next season, and I'll save my extreme downhill mountain biking for next summer, but other than that I'm going to back to my normal exercise routine.  This includes yoga, running and working out with a trainer once a week.  I know I'll be a little (or a lot) rusty, but am looking forward to using my muscles again!

I am feeling about 95% at this point.  Still have some muscle soreness and tightness in the left side of my neck and shoulder, but not as bad as pre-surgery.  This gets better as time goes by.  Also, I sometimes feel the burning in my left arm and hand that I had pre-surgery.  Again, this is SO much better than it was and is very infrequent.  I am taking an Aleve in the morning and nighttime to help with this soreness.  I did get a chair massage a week ago to help with some of the tightness in my neck and shoulders.  I have also scheduled an appointment with Tara Nikzi, Acupuncturist, http://www.therapiaclinic.com/practitioners.html, to help speed the muscle relaxation and promote the scar healing.

I have been prescribed six weeks of Physical Therapy, and I went to my first appointment the day after my appointment with Dr. Tatsumi.  I am seeing Matt Onderdonk, PT at OHSU Center for Health and Healing which is conveniently located two blocks from my condo. http://www.ohsu.edu/xd/health/services/providers/onderdom.cfm  He is being assisted by a PT intern named Laura.  They did an assessment and gave me some exercises to do a couple of times a day.
 
We were at the mountain this past weekend, and the snowboarding conditions were perfect.  Hated to miss out on a bluebird powder day on my board, but I strapped on the snowshoes and did a four mile snowshoe from Timberline Lodge to part of the Alpine Trail which leads down to Government Camp.  Coming uphill from the Alpine Trail at 5,500 ft. elevation was a good workout!

A gorgeous day for a snowshoe!

While I was waiting to meet up with Mark after my snowshoe, I chatted with Nick, the lift operator of the Mile Chair at Timberline.  We compared scars when I found out that he had a similar surgery a year or so ago.  His injury was much more exciting than mine though.  He was a Emergency Rescuer for the Army, and during a rescue, his rope snapped while he was dangling from a helicopter.  He dropped to the ground and broke his neck!  He is now retired and living the dream working at Timberline!

My next appointment with Dr. Tatsumi is in another six weeks.

Two Week Post-Surgery Update

Two weeks out from Artificial Cervical Disc replacement surgery and I have to say, I think it was a success!

After a few rough days right after surgery dealing with pain meds (and my body's dislike for them!), it has been a relatively smooth ride. The toughest part for me is acknowledging that my body needs time to heal and taking it easy. I returned to work this week for two days, about four and 1/2 hours each day. Next week I'm going to give it three days, hopefully full time. We'll see how the body feels : )

After trying both Vicodin and Tylenol 3, I have decided that I am sensitive to pain relievers and they don't work for me. Both worked OK for a day or two, then other symptoms kicked in like nausea, vomiting, migraine and insomnia. Sounds fun, huh? So, I have had to reduce the doses and take anti-nausea medication to help cut the pain.

19 days post surgery I don't have a lot of pain anymore. So, I'm not taking anything other than muscle relaxers. Mostly just discomfort in my neck when I have been "vertical" too long. My throat feels "thick". The soft tissues around the surgery site getting swollen. Also, the muscles in my shoulder and lower neck still have residual tightness from the years of guarding my pain and that will take a while to loosen up. And, it was re-traumatized with the surgery. I'm on muscle relaxers for that, as well as ice and heat, and in a week if it isn't better, may have to do a course of steroids. I would love to really stretch this part of my body, but can't do that for another month. I have been walking pretty much every other day since one week out from surgery. Walked 4.8 miles on Thursday and even found a geocache! I must be back :)

My first walk. Out with my friends Buddy and Bear from the 14th floor.

I had my two week post surgery check up with the Physicians Assistant to my Surgeon, Zach Knight-King. I have been impressed with his thoroughness and the time he takes with me at each appointment. I don't feel rushed like you sometimes do at Dr.'s offices. Talked to him about my insomnia and we came up with a plan. Hopefully it works! I will start PT at six weeks post surgery and at that time I can start back to yoga and weight work. Boy, that will feel good! I don't have to wear my bandage over the incision anymore, but until the steri-strips (and accompanying dried blood) fall off, I will be the chic scarf lady. No one needs to see that. I was able to give him some feedback on their office procedures. On the days when the Dr. is in surgery, there is no one in the office to "triage" patient calls. So, when I was reacting to the pain meds two days after surgery, we waited about 5-6 hours for a call back from the Dr.'s office after three calls from Mark.  He said that they had visited that issue already and had a new plan in place. I am the first person to avoid conflict, or tell someone something "bad", so I felt good about letting my feelings be known : )

Thought I would read a lot more and watch a bunch of T.V. Didn't really do that, but did watch Season Two of Mad Men, and am now totally addicted. Thanks Guido! And, the highlight of my recovery, I did our taxes.

I have been so lucky in this past few weeks to have friends and family check in on me with visits, phone calls, FB messages, e-mails, and food delivery! It really made the time go buy quicker and I feel loved. Thank you.

The view back to the 'hood on my second walk. I love where I live. Those blackberry bushes are where I see my hummingbirds.

Relief at Last! Cervical Artificial Disc Replacement Surgery

First a history...

I've suffered with neck, shoulder, and arm pain for the past four to five years. Burning, stinging, aching pain in the neck and shoulder that radiated down to my bicep, wrist and fingers. Two rear-enders in my car, numerous severe whiplash falls on my snowboard, and, I think, the final blow was riding headfirst into a metal crossbar on my bike. Through those years I have had numerous x-rays and one MRI to determine the source of my pain. Nothing ever showed up. So, I pressed on with physical therapy, acupuncture, massage, weight training, yoga, chiropractic care, cervical traction, a TENS unit, and a couple of steroid injections. All provided temporary relief, but I lived with constant nagging pain every minute of every day. I learned to push it to the back of my consciousness, and had almost accepted that it was my lot in life to live with pain. I continued to be active because really, it was when I was active that I was able to forget the pain. It was when I was still that it was worst.

Last summer a good friend of mine injured his neck in a motorbike accident and finally sought the opinion of a spine surgeon, Dr. Robert Tatsumi. He had surgery to replace a disc in his neck with an artificial disc. The surgery was successful and he is pain free.

I connected the dots when he said that his symptoms had been similar to mine. Even though I had been told that x-rays and MRI's showed nothing, I gave it a shot and saw Dr. Tatsumi. I left his office kicking myself that I had not seen him earlier. It took him just minutes to give a probable diagnosis. Cervical disc degeneration. This degeneration was causing disc fluid to leak out on my nerve and irritate it, causing my symptoms. To prove this theory, however, I needed to undergo a test to pinpoint the source of the degeneration. The test is called a Cervical Discogram. Unfortunately, my insurance company Aetna, classified this test as "experimental", so would not cover it. I decided that no matter the cost, the test needed to be done.

The Cervical Discogram...

I scheduled the test for January 8, 2011. I had it done at Providence Portland Hospital very early in the morning. No food or drink after midnight was the only preparation needed. We showed up at the hospital and the nurses settled me in. Mark was there with me as well. I changed into my hospital gown and waited. Dr. Joseph Stapleton, the Dr. performing the test, came by to say hi. Turns out my Dad used to give his dogs shots when he was alive. I loved making that connection. He explained the test. They would sedate me (Versed), but not too much so that I could be conscience enough to answer questions. He would then inject fluid into each of my cervical discs and then ask me to express my pain level. The disc with the most pain that mimicked my symptoms would be the disc that had the degeneration. I remember chatting with the Dr. and his assistant in the procedure room, but not much else. The results of the test proved that it was my C5 C6 disc that was the problem. One side effect of this test was that the pain in the disc became worse ongoing afterwards.

So, now we knew the source of my pain. Dr. Tatsumi called me and said, "Well, the best thing to do is to get that disc out of there!" I know that major surgery is not something to wish for, but I was actually excited to have a solution to my pain. The next hurdle was to see if Aetna would pay for the surgery. I was not encouraged by their lack of payment for my Cervical Discogram. Also, my friend who had had the surgery done had had to pay for it himself because United Healthcare would not pay for it. "Experimental". This is ridiculous...The surgery was approved by the FDA in 2007 and in all research I came across, it states that the surgery is a much better alternative than the other surgery that has been done to alleviate this problem in the past, spinal fusion. Fusion is much more invasive and leaves the vertebrae on either side of the disc fused together, which doesn't allow for movement. Also, there is a much higher chance for additional degeneration as the bone grafts fuse. The artificial disc replacement mimics the actual disc in that it provides for full rotation just like a disc would. This video is an animation of the actual surgery:



After a few tense weeks of waiting, we got the notice that Aetna had approved the surgery! I scheduled it for Tuesday, March 8, 2011. The month of waiting for the surgery was the worst. My pain seemed to get worse each day.

I had several calls from Legacy Meridian Park Hospital prior to my surgery to pre-register me and ask if I had any questions. I have nothing but good things to say about the hospital and their staff. I also had a pre-op appointment with Dr. Tatsumi where we went over the surgery and any restrictions both pre and post-op. At this appointment I also met with a nurse at the hospital for detailed instructions on pre-op restrictions regarding medications, etc.

The weekend before surgery we went to Bend for my last hurrah of the winter on my snowboard. We stayed at the elegant Oxford Hotel in downtown Bend and boarded at Bachelor on Thursday and Saturday. On Friday, I met up with college friend Sarah Swaney for an afternoon of ski-o-caching at Meissner Sno Park. I went to work on Monday and went to bed Monday night knowing that the next day would bring me relief from the pain that had been my constant companion for too many years.

The Day of Surgery

I had stopped eating and drinking at midnight the night before. Luckily, I was the first surgery scheduled at 7:30, so I didn't have to suffer too long. I was able to take my Thyroid medication and a Zantac with a sip of water in the morning. I had also taken a Zantac the night before. This is a new requirement to help alleviate nausea caused by anesthesia. I typically have had a bad reaction in this area, so I was glad to take the Zantac! Up with the birds at 4:45 a.m. to dress in freshly laundered clothes (another new requirement) after a shower and disinfecting of the surgical area. We arrived at the hospital at 6 a.m. Bonus about getting there that early, is that you get the primo parking spot!

We checked in, I got my bracelet and then went to Day Surgery. My nurse, Jan, introduced herself. I changed into my Bear Paws gown. Another improvement since my last surgery! This gown hooks up to a hose and hot air is pumped in! Cocoon-like heaven on earth in a cold hospital. It has been shown that a warm body is easier to operate on. Who knew? I could even control the level of air being blown in. Nice. The nurse put in my IV and my Scopalamine patch behind my ear (for nausea) and I was ready to go.

Dr. Tatsumi came by to check on me. He was wearing the same Oregon Ducks Columbia jacket that Mark had on. He is a graduate of Sunset High School, and the University of Oregon. Can't go wrong with a local boy. Dr. Good, the anesthesiologist, came in and introduced himself. He wondered if Mark was my Dad. I am going to take that as a compliment to me, not a slam to Mark : ) He wheeled me over to the operating room and just as he was saying that he had slipped me a "cocktail" to relax me I instantly felt "relaxed". Next memory was the mask coming over my nose, then nothing....

I woke up in the Recovery Room after surgery. I say woke up loosely, because I could NOT keep my eyes open. And looking back, why did I think I needed to? Spent some time there and then they took me to my room at about 10:30 a.m. Don't remember getting into the bed. Spent the next four hours again, trying, to keep my eyes open. They brought me "lunch". I ate some of the cherry jello, but could NOT keep my eyes open long enough to eat : ) Finally, around 3 p.m. I seemed to snap out of it. The nurse helped me to the bathroom and then I took a stroll on the hospital floor with Mark. At this point, I was not feeling a lot of pain. One strange thing on the walk was my propensity to hiccup with a nice healthy burp at the end of it. Could not control it, so didn't fight it. My nurse, Meghan, was great. Dr. Tatsumi came by to check on me around 4 p.m. and I asked if I could go home. He said no problem! I was impressed with the speed of "checkout" at this hospital. Usually, it takes forever for all the paperwork to happen and you hurry up and wait to leave. I got dressed, again in another set of freshly laundered clothes that I brought in a plastic bag. I was escorted out in a wheelchair and Mark drove me home and promptly deposited me in bed in freshly laundered sheets (to fight infection). I don't remember much about that evening : )

Home:

My incision is on the front of my neck on the left side and should be about an inch long. Haven't seen the actual incision yet. The most painful part has been my throat for a few days after surgery where they put the tube down, and now swallowing. I think everything is swollen around my windpipe and esophagus, so I am having difficulty swallowing things. I do have pain in my neck and shoulders that the Dr. says are my muscles reacting the trauma of surgery.

So far recovery is better each day. The only setback I had was the Thursday after the surgery. Wednesday I felt great! Vicodin was working, muscle relaxer was working, I was resting comfortably. About 2 a.m. Thursday morning I got up with a horrible headache and feeling not so great and in pain. So, I took a Vicodin. Woke up in the morning and could barely open my eyes the headache was so bad. I'm thinking it was a migraine. Made myself a smoothie and sent Mark off to work and went back to bed. Darkness was good : ) Had to make a run for the bathroom when my smoothie came back up. It really is no fun throwing up when you have just had surgery on your neck. I texted Mark and he turned around and came home.

He spent morning trying to reach someone in Dr. Tatsumi's office who could possibly prescribe another pain med that wouldn't make me sick, or at least just to ask what other OTC pain relief I could take.  Finally Mark convinced me to take half a Vicodin. And of course, literally two minutes after that the Physician Assistant at Tatsumi's office called back. They prescribed Tylenol 3 and an anti nausea med. The Tylenol 3 did nothing for me, so I went back on the Vicodin (usually half a pill) with the anti nausea pill. This has worked as I wean myself off of the pain med.

Home care and Restrictions:

I was given a collar to wear at home when I am not laying down. This is to support my neck so there isn't so much pressure on the neck to be supportive. I have been pretty good about wearing it, but sometimes it feels so much better not to have it on. I need to keep the dressing on the incision until I go in on March 25 for a two week checkup. In the meantime, I am to change the dressing every other day after showering. During the shower I put a waterproof bandage on the site. We had gotten a new Tempurpedic bed a few months ago along with Tempurpedic pillows. Both the bed and the pillow have been heavenly in my recovery. I have taken two weeks off of work and I am glad I did. Sitting at a desk for 8 hours would be really painful at this point. I am sure I will go a little stir crazy during this time, but I hope to get out and start walking soon. Tonight may be my first walk with Mark : ) I am not to lift more than five pounds for the first two weeks and I am not allowed to drive during that period as well. I will post after my two week visit to the Dr. with a status report!

I have been so lucky to have Mark as my caretaker. He knows how I am about doing things I shouldn't do, so he has been on top of the housework so I am not tempted. He also doesn't take it personally when I snap. I also have great family and friends! Lots of goodies have been brought by so that Mark doesn't really have to think about what we will eat. And special thanks to my neighbor Carol for all the beta and the goodie bag. Buster has been a great nap companion too.