Back Augmentation

After a recent visit with the back doctors, I am struck by the marked contrast between how great I feel on the outside and how thrashed I look on the inside!

After nearly three months of convalescence, last week was the first follow-on visit with the back doctors since surgery.  We compared "after the fall" x-ray film with film they took on the day of this recent visit.  The before surgery film showed a lower-down vertebra completely exploded and a higher-up vertebra pretty-well cracked.  The doctors explained that had the upper vertebra experienced damage similar to the lower one it would have been game over for my spinal cord.   Toward the base of the spinal column our spinal cords divide into several smaller nerve bundles that continue down to the lower extremities, and the exploded vertebra they replaced was below this critical junction.  Yet again, a very lucky dude.

The x-rays from the recent visit showed significant scaffolding they had installed on either side of my backbone like a ladder but with screws attached and extending into either side of each of four vertebra.  I'll save you the doctors' blow-by-blow of the surgery, but given that this blog is all about being a "cautionary tale" (please skip the rest of this paragraph if you're sensitive to graphic surgery descriptions) I will leave your imagination with the doctors being far from gentle with me while peeling back muscle and scouring bone prior to drilling screw placements to prevent infection.  

Because it hasn't felt like there's much of anything new back there, I was expecting to see not much more than a series of screws holding the vertebral together. Surprise! I wasn't aware they had installed that much hardware and that it will remain in place for the duration.

The doctors were pleased with what they saw and indicated I should gradually test the boundaries of BLT (bending, lifting, and twisting) restrictions established at the outset of the first three months after surgery.  Initially while still bed-ridden I was cautioned countless times to treat my legs & torso like a solid log and roll en-masse from one side of the bed to the other for position shifts to avoid pressure sores, linen changes, sponge baths, and other vital functions.  After gaining the freedom of my power wheel chair I was allowed to sit up throughout the day and carefully reach out with the slightest bit of back twist & bend.

Eventually, and within the limits of the range of motion resulting from the hardware, I should be able to do just about everything I was doing before the fall.  It's not that I might yank something loose by trying to do too much, but rather it will probably be a little bit more difficult to reach down and tie my shoes. The doctors suggested looking into shoes with Velcro straps, . . . but you still have to get down there to strap them, and I haven't seen Mountaineering boots with Velcro straps in any case.

Other good news is that I shouldn't be overly concerned about the numbness I feel in my lower left side where they went in to replace that one lower vertebra.  They explained that in moving a lot of stuff around during surgery the nerves in the area tend to shut down but that eventually they would likely settle down and start reporting feeling again.  OK, so I'll suspend disbelief on this aspect of recovery until the next visit with them three months hence.

Potential bad news is that because I'll be bending/twisting with only a subset of vertebra those that remain in action will get much more wear and tear then they would have otherwise, and there's a chance---even a likelihood---that within a decade or so they will be done and will need to be fused as well.  The doctors said that everyone is different and there's really no single protocol for long-term recovery from this type of surgery, so I'll just move forward with the assumption that my body will adapt and build muscle to support the weakened areas and everything will be just fine. 

Harborview redux - shower time!

Beginning to settle into a quasi routine. Returning each evening to an apartment at the Ballard Landmark with spectacular views of both the Olympics and the Cascades has been very welcoming, but with only a bed for furniture I was motivated to visit Ikea to select a table and chairs, bedside tables and lamps. Taking the two hour Metro trip down to Ikea was quite an adventure I can tell you, and I probably shouldn't have had that second cup of coffee before heading out.

This week a group of friends came over for pizza and beer and afterwards assembled the furniture. It was a very fun evening filled with laughter and gentle ribbing about furniture assembly skills. Now the apartment looks a little more civilized and I have more flat spaces to lay things out on at the end of the day. Thanks guys!

Also this week Marijane and I went back to Harborview for another round of X-rays and evaluations. It felt marvelous having the casts removed from my arms and leg, but kind of gnarly looking.  We've come to make very good acquaintance with the cast team and they give us a hard time.  Coincidentally a patient and spouse who had seen Marijane and me on a previous appointment were there again, and they indicated I was looking very much better, . . . less like a train wreck anyway.  

After reviewing the x-rays the hand/wrist/forearm doctor decided I no longer need casts, so now I am in removable braces and can wash my hands and forearms properly. Likewise the foot/ankle/shin doctor decided I didn't need to be in a full-on cast so now I have matching removable boots.  In theory, I can take them off to thoroughly wash my legs, . . . if I could only reach the velcro bindings. (Note to self: it is OK to ask for this kind of help.)

So today was the really big day. It had been almost nine weeks since I had last taken a shower; by mid-morning I had taken the plunge and it was fantastic, like all the national holidays rolled up into one!   This first time needed to be on a weekend morning so that I had plenty of sleep and was fresh and able to think through all of the logistics associated with this first attempt. Also, Marijane nèeded to be on hand with plenty of time just in case something didn't work out and I needed an extra hand. 

Thankfully the logistics came together, catastrophe was avoided, and for the first time in nine weeks I feel wonderfully clean.  And without putting too fine a point on it, I just want to allude to how much doesn't naturally exfoliate when it's been trapped in casts for nine weeks or so. Pretty ripe.

Next visits to Harborview are at the end of the month for a first follow-up visit with the back doctors (one replaced vertebra and four fused as you may recall) and an additional follow-up with the hand doctors so that they can remove plates which will require surgery and more anesthesia. Oh joy!  With the plates out, however, I anticipate being able to start light physical therapy on my wrists and forearms by mid October. It will be interesting to learn what the back doctors have to say. From my point of view it feels pretty good and I just hope I haven't been doing too much and screwing it all up.

The heels, ankles, and shins will need quite a bit of additional convalescence time. We compared x-rays just after the surgeries to the most recent set and although we could see the wispy beginnings of new bone growth it was very apparent that there's quite a bit more that needs to regenerate before I can begin physical therapy.

All in all it was an excellent follow up visit to Harborview with lots of good news and the great joy of knowing that showers, many showers, are in my near future.