Since my last post, which was back in July, it seems that I have taken one step forward, and two steps back.
A few things have happened:
1. My wonderful daughter was married in September. Her husband Wade is an incredible young man, who has taken on the role of not only a husband, but of a father to my grandson Jonny. He is a welcome addition to our family.
2. I am still waiting for my paramedic internship. This has been frustrating, but I’m not the only one. Internships are finally starting up again, and I am studying hard to ensure success. Getting my paramedic licensure is a major goal in my life.
3. I learned more about my back problem. A lot more. Again, it is called spondylolisthesis. A special Facebook group dedicated to those of us with this condition has been an island of hope in a sea of occasional despair. My back pain has gotten worse. Not something I want to admit, but it’s true. I still am able to work in EMS, but I’ve had to make changes in my day-t0-day life to be able to continue doing what I love.
I was referred to physical medicine, whose primary goal is essentially pain management. This physician ordered a few different x-rays, including extension and flexion studies, and an MRI. Which showed that my particular issue is considered unstable. That’s why my back has clunked for the past few years. It moves nearly 13 cm, depending on what I do. He explained that extension is not a good thing for me to do. Flexion actually puts my back in alignment, as does lying supine (on my back). He immediately realized that this cannot be medically managed alone. Surgery would be needed to correct this. So I was referred to orthopedic surgery for a surgical consult.
I saw an orthopedic spinal surgeon, who strongly advised a procedure called a Transforaminal Lumbar Interbody Fusion (TLIF). This is an open surgical procedure, which uses hardware and bone to stabilize the area at L4/L5 that is unstable. When I met with him, I discussed what I do for work and for recreation. He happens to also be a bicyclist, and felt confident that I could return to both EMS and cycling after I recuperated from surgery. But this is an open surgery, which would be done through a 9-12 inch incision in my back. In this day and age, it seems, well, old school. And I was correct.
I researched and learned that there are other procedures available to do this repair, including:
- Anterior Lumbar Interbody Fusion (ALIF) – Goes through the abdomen, but frequently also needs to go through the back as well. This is also old school.
- Extreme Lateral Interbody Fusion (XLIF) – This goes through the side, through small incisions and going through a muscle called the psoas muscle. This is one of the newer surgical methods used. Recovery is faster (from the surgery itself).
- Minimally Invasice TLIF – Uses small incisions, and does the same as an open TLIF. As with the XLIF, the immediate surgical recovery is faster than an open TLIF or ALIF.
There are variants of these, but the outcome is the same. A stable spine. And hopefully, freedom from pain.
I wasn’t happy that the other options weren’t mentioned to me. I asked him why. Well, it turns out he just does it one way. OK. I’m OK with that. But I want to find out if the other options, or a variant, would work better for me. He referred me to a neurosurgeon, who does this procedure other ways as well.
I finally got to meet him in October. Right away, I felt a calming when he introduced himself to me. He had already made himself very familiar with my issue, and listened to me as I explained what I do, how I do it, and that I want to continue doing it.
And then he spent over an hour with me, explaining the different options to repair my spine. He felt the open TLIF wasn’t warranted, as this is a single-level fusion. He presented 5 ways to do the surgery, and then explained that he felt minimally invasive TLIF was the way to go, or XLIF. Essentially, it is my decision as to which one to do. The outcome will be the same. And I can continue in EMS and cycling, or just about anything I want to do. He did recommend against parachuting. I’m good with that.
So, I am down to deciding between the XLIF and minimally invasive TLIF. He presented the positives and negatives to each. The biggest negative to the XLIF is the possibility of injuring certain nerves. But both avoid cutting through muscles “against the grain”, and going in the direction of the muscles, which will improve post-op pain and recovery.
I feel very confident in his abilities. While the surgery can be done today, I will have a much easier post-op recovery with weight loss. Which I have been doing. That and “pre-hab”; getting my body in good shape before surgery, which will also improve my post-op period. He is the surgeon for me.
Which brings me to today.
Over the past few months, I’ve tried a few things with my physical medicine physician. Non-steroidal anti-inflammatory medications, which help a little. I don’t want narcotics, and told him so. He recently recommended an anti-depressant medication that helps with nerve pain. I tried it for several weeks, with no real improvement. Tapered off of that. What bothered me more about this medication was once I tapered off of it, I realized that it took away my interest in doing things. ANYTHING. I would just go home and want to do nothing. This medication really impacted me physiologically as well as psychologically. I wasn’t on it for depression, but it seems that I became depressed as a result of it. I am quite glad that I stopped it. Now, I feel like myself again.
What I’ve found that helps is ice packs, and NSAID meds, and movement. Takes it down to a level where I can function.
The next step is to try epidural cortisone injections. Yeah. Needles in my back. Officially, it is called bilateral transforaminal steroid injection. No way to say it easily.
I did also make a decision to get back to the gym and begin working out, pain or no pain. As I said earlier, I had no will to do anything when I was on the anti-depressant. But I realized that I MUST DO THIS. More importantly, I WANT TO DO THIS. Personally, I want to be down to 170 for the surgery. And improve my strength.
Today was the first day back. It wasn’t long, but enough for me to remember that my body likes it. I like it. Exercise produces endorphins, mother nature’s natural painkillers. So, perhaps it isn’t one step forward, two steps back. I think it is two steps forward, one step back. I will keep moving forward.