Pain

I had curvature of the spine when I was a teenager.  The technical term is kyphosis, which means a front to back curve.  Usually people with curvature of the spine is scoliosis, a sideways tilt.  The treatment for curvature is to take the spine apart and fuse the vertebrae together.  Then the surgeons install a steel rod on either side of the backbone to help hold the fused section.  Because I had kyphosis, my fusion needed to focus on both the front and back of the vertebrae, instead of the sides.  This required two surgeries, two weeks apart.  The first surgery addressed the front of my spine.  To reach the front, the incision started about an inch or so below my navel, then went diagonally up to my left side, vertical to my armpit, and around my back to a spot to the inside below my shoulder blade.  To get at my back, they cut through all the ribs and basically opened me up like a clam.

They harvested bone chips from my left hip bone.  These chips were placed between the vertebrae to rebuild them to the right thickness to correct the curvature.  I spent two weeks in halo traction after this surgery, then had a second surgery fusing the back of my vertebrae and installing the steel rods.

After another two weeks in the hospital, they sent me home in a plaster body cast.  I spent nine months in a body cast, spending about half of my senior year of high school popping Tyelnol 3 like candy.  The part that hurt almost more than anything else was the hip.  After all, the plaster cast pretty much rode on the where they took the bone chips.

After I got out of the cast they said I was fine, I could do anything except play football or go on a trampoline.  And for the most part, I was fine.  I rarely had any back pain, and if I did I simply took tylenol or ibuprofen.  I went to nursing school, worked the floor lifting and moving patients (always being careful about body mechanics), backpacked, water skied (that was a mistake...), and built and roofed a garage, drywalled two houses, and pretty much anything else I wanted to do.

Then in September of 2007 everything changed.  One of the things that happens when a spine is fused is the removal of the disks between the vertebrae.  One of the functions of the disks is to absorb shock.  I had about 14-16 inches of solid bone in the middle of my back, which meant no shock absorption for my lower vertebrae.  In August of 2007 I hiked 11 miles through Glacier National Park.  No problem.  But in September, 2007, I hurt my lower back at work, despite using the "right" lifting techniques.

On Labor Day I woke up unable to walk.  My legs simply quit working.  I had to crawl to get out of bed and to the bathroom.  My boys and wife had to carry me to the van so I could get to the ER.  The ER doctor initially accused me of being drug seeking (Are most people with bad backs druggies?)  He later apologized when the x-ray showed that I had broken one of the steel rods that was supposed to be holding my fusion together.

I ended up going home and had a wheelchair delivered.  I went to an orthopedic specialist on Wednesday (first day I could get in) who described the problem.  The front of my fusion was collapsing, the vertebrae under my fusion were turning into powder, and I had compression on all the nerve roots causing my weakness.  I got a brace, oxycontin, an order for physical therapy, and a probable surgery date.

I was out of the wheelchair by the end of September, but by November it was clear that the predicted surgery was unavoidable.  By the way, oxycontin is pretty incredible stuff.  Theresa thinks it made me crazy, but I was able to work half time and when I look at some of the stuff I wrote during that time it's pretty lucid, so I doubt it was that bad.

My surgery was early in December.  The orthopedic surgeon and a neurosurgeon worked together to basically take my back apart and rebuild it, from the joint where the first sacral vertebra joins the hips up to about the middle of my chest.  They cut all the muscles away from my back, straightened everything, including notching the front to straighten things up, reattached all the muscles, and then woke me up.  While the incision was still open.  They wanted to make sure that before they finished they hadn't left me paralyzed.  Once they were sure, they put me back to sleep and then finished.  They probably carved their initials in one of my bones, I wouldn't know the difference (that was supposed to be a joke).

I've got a handful of screws, clips, and broken rods from my 1978 surgery sitting in a bowl on the mantle in my living room that my surgeon gave me.  My back is now held together by a combination of screws (ranging from 70mm to 35mm in length), plastic mesh, titanium, clips, hooks, and probably some other stuff.  I've seen the x-rays, it sort of looks like I could open a True Value hardware store.

So now we get to the point of this post.  Pain.

While I was in the hospital the worst of my pain was caused by muscle spasms.  You have to realize that the surgery straightened me out, and added almost three inches to my height.  That's how much my back was collapsing by collapsing vertebrae and forward tipping.  So when my muscles got reattached, they got stretched three inches or so.  Which causes spasms.  And those hurt.

They called in the Palliative Care Specialists to develop a pain management plan for me.  The Palliative Care people usually deal with advanced cancer patients, hospice cases, and the like.  After tinkering with a number of different muscle relaxants, they found a mix that worked.

I took myself off oxycontin in December, a few weeks ahead of the plan.  I was back to work in February, a month ahead of time.  I had very few episodes of pain over the next couple of years.  The two worst were at the Gathering of Friends in 2010, which I'm blaming on the bed, and in the spring of 2011 when I hiked on steep hills.

Until now.  I have been dealing with intense, excruciating pain since last Thursday.  I thought it might be related to backpacking two weekends ago.  Except I got back from that trip on Sunday and would have golfed Monday night if I didn't have a staff meeting.  My back didn't start hurting until Wednesday.  The most likely explanation is stress, coupled with carrying a few relatively bulky (but not too heavy) things at work.

Stress?  I can blame work and my daughter's wedding coming up this Friday.

So how am I managing?  First off, I had a supply of muscle relaxants left over so I started in on them Thursday.  On Friday I got a few refills to make it through the weekend.  Then I got in to see my orthopedic surgeon Wednesday to make sure I hadn't broken anything.  Most of the pain has been high up, so I was worried about maybe some loose hardware or a broken rig.  Thankfully, nothing is wrong.  He also gave me prescriptions for some of the things that the Palliative Care specialists had put together but I no longer had refills available.  And he told me this is probably going to take three or four weeks to go away.

My life for the last week or so has been centered on the list of meds I have taken so far today, and shorting out when I can take the next.  The pain is slowly going away, but I'm still on schedule.  But I'm not looking forward to four weeks of this schedule, but since it worked before, I'm confident it will work again.