Key Learning So Far

  • Understand the side effects, if any, of the drugs you'll be taking after surgery - especially possible withdrawl symptoms
  • Make sure whoever picks you from the hospital brings a paper and pen to take key notes from the nurse discharging you
  • If you have a job, organize your STD (Short Term Disability) as much as possible before surgery

Pain Chart - Post Surgery

Pain Chart - Post Surgery

Thursday, January 31, 2008

Post Surgery - Day 7

Pain Rating:

Woke up at 4am to take the painkillers, otherwise a good nights sleep. My back felt pretty good this morning, so immediately after breakfast and my usual dosage of pills, I went for my longest walk yet (around 20 minutes). I also managed to do some work from my computer as well - at this point I'm relatively comfortable sitting for an hour or so, but after that I need to get up and move around.

The area on my back where the surgery was done is starting to itch today, as the pain seems to wears off. The muscles still feel tight and tender.

Found out today that I should have completed my STD (Short Term Disability) forms prior to going into surgery. Apparently I'm entiled to use 5 of my "sick days" for recovery and after that I need to claim STD, which is 75% of my salary. I hope to have the relevant people (surgeons, company representatives etc) fill these forms out with me by the end of tomorrow, so that I can fax these to the insurer, who will hopefully then verify that I'm covered for STD.

I managed another 20 min walk in before dinner, before heading to bed around 10pm.

Wednesday, January 30, 2008

Post Surgery - Day 6

Pain Rating:

I neglected to take my painkillers at 4am this morning and I'm certainly feeling a sore today - worse than yesterday. During breakfast, I took my 2 painkillers and muscle relaxant.

Finally had a bowel movement this morning (which might explain the stomach pains last night) - it appears my bowel movements are every 2 days or so - given my combination of prune juice and painkillers).

Back started to feel better once I was back on schedule with my painkillers.

I managed to get two long walks in today.The rest of the day was pretty un-eventful, although I did have another 2nd bowel movement around 8.30pm that evening

Tuesday, January 29, 2008

Post Surgery - Day 5

Pain Rating:

Back feeling slightly better this morning, so decided to get 3 walks of 10 minutes in today. Did my first walk around 9am - bitterly cold out. I took a 2 hour nap just before lunch and then walked for 10 minutes after lunch. Back is definitely not as painful, however the muscles surrounding the surgery area feel tender and aggravated. Still drinking prune juice and taking all the medicines.

Just before dinner, I took my last 10 minute walk. At the end of the walk, the back felt slightly strained --- I have a feeling I might have pushed it a little too much.

At 8.30pm I took my very last antibiotic (4 pills a day for 5 days) - thank goodness, that was a big pill :)

Read for about 30 minutes before going to sleep. My bowels felt tender all night - I think it's the fact I haven't had a bowel movement for a couple of days.

Monday, January 28, 2008

Post Surgery - Day 4

Pain Rating:

Woke up a few times during the night to urinate and had the sweaty spells as before. Probably got the most sleep of any night since surgery. Had a light healthy breakfast (oatmeal and toast) and another glass of prune juice. After breakfast, I finally had another bowel movement (almost 2 days between this and the last one). Went for a slightly longer walk this morning (probably 12 minutes). The pain seems to have subsided slightly and it's more soreness and tenderness than anything else.

Took a very much needed 3-4 hour nap today and again took the full dosage of pills today.

Later that evening I had my 2nd bowel movement of the day. Went to bed around 9.30pm and read for about 45mins. Given the sweaty spells from the previous night, I had the ceiling fan running most of the night. I woke twice to urinate, but didn't have the sweaty spells. Turned the ceiling fan off after the last visit to the bathroom

Sunday, January 27, 2008

Post Surgery - Day 3

Pain Rating:

I woke up 4-5 times last night to urinate and noticed that I was sweating quite a lot as well. I continue to wake around 2.30am to take the painkillers, with crackers and water.

My back feels a little better this morning. My wife made the whole family a full English breakfast (bacon, eggs, sausages, toast, beans), which went down a treat. I also took one glass of prune juice.

Spent a couple of hour during the day taking power naps. Since there still hasn't been a bowel movement since yesterday morning, I'm taking an extra glass of prune juice today.

I continue taking the prescribed dosage of pills throughout the day.

Temperatures were in the 60's today, so went for a very pleasant, albeit slow, 10 minute walk. Since I didn't feel a lot of discomfort during the walk, I decided to repeat the walk later that day.

Took another glass of prune juice before bed , along with my assortment of pills.

Saturday, January 26, 2008

Post Surgery - Day 2

Pain Rating:


While I did get a better nights sleep last night, I did wake a few times in the night and noticed that I was sweating quite profusely - again I decided to put this down to my body fighting the pain.

We set the alarm for 2.30am to take the painkiller pills and make sure I had some crackers and water nearby.

Around 8.30am this morning, I finally had my first bowel movement. It was slightly painful, but was most definitely loose.

"When it rain it pours" , bowel movement #2 around 9.30am.

My back is definitely a lot soarer today than yesterday. I did manage to get a few 2-3 hour power naps in today and did the same 10 minute walk.

Spent most of the day either walking around, sitting on the couch and writing this blog or sleeping in bed.

Since my initial bowel movement was pretty painful, I decided to take less prune juice today.

I took my first shower today - unfortunately limited to 3-4minutes as per the nurses request - but felt good. Actually managed to read in bed for a while before taking my last dosage of pills

Friday, January 25, 2008

Post Surgery - Day 1

Pain Rating:

Around 3am the day after surgery, I woke up in some discomfort. While I had the painkillers and water available next to my bed, I had neglected to bring up any snacks (it is recommended to take the painkillers with food), so I decided to work through the pain. In hindsight this was probably a mistake as the pain intensified. Finally around 5am I asked my wife is she could grab some crackers from the kitchen and bring them upstairs. Having taken the painkiller with food, I was finally able to get some more sleep around 30 minutes later. From now on, I'll leave some crackers by the side of my bed.

There is definitely more discomfort in my back today than yesterday - I have a feeling this is due to the morphine finally wearing off. Given that I'm 6'3" and weigh around 195lbs, I've decided to take two painkillers every 6 hours, instead of one. I've also started the rather large antibiotic pills and I'm taking the muscle relaxants too.

The hospital called around 9am to confirm that everything was okay and wanted to know if I had any questions. Since I haven't had a bowel movement yet, I wanted to know if this was an issue. I was told I should expect this to happen in the next day or so. As a precautionary measure I have some muscinex ready to "accelerate the process".

Most of today has been spent writing this blog and watching TV. My plan is to walk around during the commercial breaks on TV, to keep my back active.

Since I'm taking a myriad of pills at various times of the day, my wife put together an Excel spreadsheet to keep on top of things i.e.



The nurses at the hospital had mentioned the importance of loose stools, so I also started drinking plenty of prune juice as well.

In the afternoon, I decided to go for a short walk outside - thankfully I took the walkie talkie with me as the surgeon called a few minutes into my walk, and my wife notified me via the walkie talkie. Dr V (Villavicencio) wanted to know how I was feeling and if I had any questions. Since I wasn't completely sure about the length of surgery, he told me it took only 45 minutes. He also re-iterated the importance of not bending from the hips and not lifting anything that weighs more than a gallon of milk

After this conversation, I went for a 10 minute walk outside -- it felt good to get some fresh air.

Around 9pm, I did start getting some chills and I put this down to my body fighting the pain, as it didn't last long. In the evening, my wife removed the dressing from my back and I took my regular dosage of pills before going to bed.

Day of Surgery

Pain Rating:


My wife and I arrived at the Outpatient department of Boulder Community Hospital (BCH) around 10.30am and were taken to a Pre-Operation room. Here I un-dressed completely and put on a hospital gown. As required, I also removed my wedding ring (as no jewelry was permitted) and put all my clothes in a plastic bag with my name on it.

The nurses then proceeded to put compression stockings on my legs as well as compression straps - this would be used to simulate blood movement around my body, while I was under general anesthetic.

Around 11.30am, an IV was administered into my right forearm - it was placed in this location as I would be laying on my stomach for surgery with both my arms facing forward. A saline solution was added to the IV (as I hadn't drunk or eaten anything for almost 12 hours) and a bag of antibiotics made ready for use with the IV.

Around this time, Dr V's Clinical research director and representatives from Abbott Laboratories appeared and answered some questions I had regarding hospital costs, surgical procedure and recovery information (The representatives from Abbott Laboratories would be present during surgery itself to assist in anyway necessary - this was done since I was one of the first patients to receive this treatment at BCH).

My surgeon, Dr V (Villavincencio), was running late with a prior surgery so my surgery time was put back until 12.45pm. At this time, the Anesthesiologist appeared and explained about the general anesthesia that was going to be administered. In addition, since I'd had prior heart surgery and because of my low resting heart rate, the Anesthesiologist explained that electrical pads would be stuck on my body to force the heart rate if necessary. Before being wheeled into the operation room a sedative was given to me, through the IV, that would relax my state of mind.

Around 1pm I was taken to the operation room, still in a conscious state. Around ten minutes later the anesthesia kicked in and I have no recollection of anything else until I woke after surgery. As I understand it, the surgery took about 45 minutes - from incision to stitching and I was moved back to the post operation ward at around 3pm.


Example of surgical procedure with Wallis Device
(Image courtesy of Nicholas Boeree, FRCS)

At this point, my wife was notified that the surgery had been preformed successfully. Around 3.20pm, I woke from anesthesia and the resident nurse confirmed that the surgery had gone well.

Since I seemed to have recovered very well from the anesthesia, they took me to the X-ray room at around 3.30pm to take several X-rays of the back and confirm that the device had been placed correctly. Below is copy of that X-ray:-

(X-Ray courtesy of Boulder Community Hospital)

Since I was still experiencing some pain from the surgery itself, I was given a dose of morphine to help relieve the pain.


Between 3.30pm to 5pm, I continued to drink plenty of fluids and perform some deep breathing exercises to help oxygen circulation. At 4.30pm, my wife and kids came to see me and the nurses finally removed my IV. At 5pm, while I was given clearance to go home, one of Dr V's assistants wanted to review my condition before releasing me. Around 5.30pm, we left the hospital, with the following conditions:-
  • I was to take one or two painkillers every 6 hours, whenever necessary
  • I was to take a one muscle relaxant no more than 3 times a day, whenever necessary
  • I was given antibiotics to be taken 4 times a day, for 5 days
  • I was not to bend forward from my hips, while the pain persisted
  • I was allowed to walk around as much as tolerable
  • No lifting of anything over 5 to 10lbs for 4 to 6 weeks
  • No sitting on hard surfaces
  • No sitting in general for more than 2 hours
  • I was to start on light foods and move to more regular foods, if everything was tolerable
Once at home I lay on our couch and ate some chicken noodle soup with a bagel and drank plenty of fuilds. Around 10pm that day, I was able to urinate for the first time. At approximately 10.30pm I went to bed.

Pre Surgery - Day before Surgery

My surgery time was set for 12.05pm on January 24, 2008.

After midnight on January 23rd, 2008 I was told not to eat or drink anything - this included water, chewing gum etc. On that same day before, I made sure I was well hydrated and ate a light, easily digestible meal at dinner. I also snacked on a bagel around 9pm and finished drinking water around 11.30pm.

Considering the events that were going to transpire the next, I got a pretty good nights sleep.


Pre Surgery - Pre Surgery Testing

Prior to surgery itself I had to provide the following diagnostic information:-
  • Cardiac consent (This necessitated a EKG and in my case an echo cardiogram - due to prior heart surgery)
  • PCP (Primary Care Physician - my family doctor) consent (This included a physical exam and some blood work)
  • Neuro surgical consent (This necessitated a visit with one of Dr V's assistants, running through a series of tests and signing a surgical consent form)
  • Pre Surgery testing (This included visiting the Pre Surgery department of the hosptial I was having surgery at - BCH (Boulder Community Hospital) - and having some extra blood work done, an additional chest x-ray and a "walk through" of what would happen on the day of surgery, including what I would need to do the day before surgery)
The cardiac consent, EKG and echo cardiogram were faxed to the Pre-Surgery department, as was the PCP consent letter and the blood results.

Below is an MRI scan of my back, prior to surgery. I've added some comments to it:-


(MRI courtesy of Boulder Community Hospital)

Pre Surgery - Signing up for Wallis Trial with Abbott Laboratories

In order to sign up for the Wallis Trial I had to accomplish amongst other things:-
  • Sign a consent form that I was applying for the Wallis Trial and would commit to the trial requirements
  • Fill out a multiple choice questionnaire to verify that I qualified for the trial
  • Provide X-rays (showing hyperextension and hyperflexsion of the back) taken in the last 60 days
  • Provide MRI scans of the back taken in the last 60 days
  • Show that I'd tried Physical therapy for at least 6 months
One this was done, I was signed up for the Wallis trial. The trial included a control group, who would receive the alternative disc replacement surgery, and as such I had a 50/50 chance of being part of the Wallis procedure. A few days later, I was notified that I was assigned to the Wallis surgery group.

Abbott Laboratories would be paying for all the surgery costs, but this didn't include anything that would be standard for any kind of surgery i.e. pre-testing for general surgery etc.

Pre Surgery - Surgical Options

Given the conditions below, I decided I should see several back surgeons to review my options. The general consensus was that I would ultimately need back surgery and the best option was disc replacement (essentially cutting out the disc between L4 and L5, inserting metal plates between the two bones and sliding an artificial disc between the two). This is a pretty evasive type of surgery as it is performed anteriorly, involves moving the stomach to one side and comes dangerously close to some key areas of the spine, namely the spinal code and nerves.

As you can imagine, this is the type of surgery you don't approach lightly. To make sure I'd covered all my bases, I started researching the internet for other options. Around the same time, I happened to read an article in a triathlon magazine about a world class athlete that had somewhat similar conditions to me and had undergone surgery in nearby Boulder, Colorado. Further research indicated that the surgeon's name was
Dr. Vilavincencio. During my appointment with Dr V (Villavincencio), I was made aware of a new treatement that was being trialled for the FDA by Abbott Laboratories. The solution was called "Wallis Stabilization System" and was far less evasive than disc replacement surgery and has been performed successfully in Europe for the 14 years or so. Dr V. believed that I qualified for the trial - some of the requirements are listed below:-

(Image courtesy of )

The Wallis device is a small grommit looking object that is inserted, from the back, between the two spinal bones where the degenerative disc disease occurs.


Wallis Device
(Image courtesy of )
Two straps are tied securely around those two bones and attached to the Wallis device to allow for flexibility. Essentially the Wallis device acts as a shock absorber and sets the spacing between the two bones as it should be with a clean disc.


Wallis Device inserted between bones
(Image courtesy of )

Based on the information I was given on the Wallis Stabilization system and the fact that the procedure was reversible (since nothing is altered or removed from your body, you can remove the implant and be back where you were), I decided to sign up for the trial

Pre Surgery - Diagnosis of Condition

In the early summer of 2006, during a long bicycle ride, while dismounting from my bike I felt a painful twinge in my lower back. At the time I didn't think much about it and continued with my triathlon training.

Over the course of the next few weeks, the pain intensified so I started getting some physical therapy treatment which while alleviating the pain, didn't resolve the underlying issue ... whatever that happened to be.

I continued through the pain and successfully completed my first half ironman race and started training for my first marathon in the autumn of 2006. During my marathon training, for some reason, I felt little to no back pain. I successfully finished the marathon (3:45hr for those interested) and decided to take some time off from training after that.

At this point the pain intensified and I started seeing the physical therapist more and more, including some acupuncture treatment. Some days I won't feel any pain at all, other days I'd have sudden sharp pains in my lower back - very much like someone stabbing me in the spine. The pain didn't last long, but was intense and debilitating.

The physical therapist agreed that while we were temporarily relieving the pain, we weren't fixing the underlying condition, so we decided to get an MRI scan to investigate the cause further

The MRI scan revealed that I had the following conditions:-
  • Mild degenerative disc disease between L4 and L5
  • A bulging disc between L4 and L5
  • Mild stenosis

Introduction

This blog is a diary of my back surgery experience. The reason for this is that I was fortunate enough to be part of a FDA trial using a new back implant, called a Wallis Stabilization device. At this stage, in Phase 2 of the trail, I'm one of the first few people to receive such an implant. As such, this is aimed at anyone else that is contemplating this type of surgery and would like one man's insight into the procedure and recovery

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