December 16, 2015

Hello from the Other Side (of back surgery)

Been wanting to post an update ever since I survived back surgery 16 days ago (morning of Nov. 30th). I've started writing about it and had to stop a couple times in the past couple weeks, and today is the first bit of time that I am finally able to share the initial story.

I say initial because the day of my surgery was pretty much in the middle of the 6 month span that this process is likely to affect my life. On the front end, since mid-August, I've had >3 months of worsening symptoms from my sciatic nerve root compressed my herniated L4-L5 disk (plain English: burning, numbness, pain, and weakness in my right leg and foot, and up to 12 pain pills a day of 3-4 different types of pain medication to allow me to continue working). And now, ahead of me, 3 months of recovery (fine print: 3 weeks of temporary disability from work, 6-7 weeks of physical therapy to restrengthen my right leg and foot, back and abs, a month or two of no driving, two months of no strenuous exercise, an indefinite amount of time with no bending over, and 3 months for my sciatic nerve to gradually heal and the nerve pain to go away completely).

On one hand it's nice to know that there's a 3 month post-surgery recovery window in which I can relax and not feel like I have to be immediately better. On the other hand, since I am not particularly patient nor disciplined by nature, I have to work at controlling my mental reactions to the speed of my healing process.  But anything that doesn't kill us makes us stronger, right?

I had to breathe deep when I saw some initial reactions from friends to my posts about surviving surgery, to the effect of, 'of course you'd survive, but how's the pain now?' On one hand, very few people experience immediate and total relief of sciatica symptoms, and EVERYONE who undergoes surgery has a recovery period where the word pain-free is a joke. On the other hand, I really was terrified of surgery. I was partially afraid I'd end up worse, worried about general anesthesia, local anesthesia, you name it. And the truth is it's not always pleasant to be hospitalized in a foreign country, even a top-notch one, because when you're in your deepest throes of needing to feel safe and secure, a foreign language, even one that you're fluent in, can push you to the edge of anxiety when no matter how you express yourself, folks just aren't getting it, or in the least, they're just not able to communicate their reasoning to you.

On the day before and the day of my surgery, that was precisely what happened: language/culture blunder #1 began with an anti-anxiety and leg pain medication that was given to me the night before, but not the morning of. Every day for 3 months, I've been on pain medications for my sciatic nerve pain in my leg, but somehow it got left out on the morning of, and so during my wait to go into the OR I was suffering and this compounded my nervousness about surgery. So when he finally arrived in the OR, Language/Culture Blunder #2 ensued, and instead of giving me the two meds and putting me on local anesthesia like we'd agreed, in the end, the anesthesiologist ended up putting me on general anesthesia. And later told my surgeon that I'd asked for it, who of course believed him. At least that was the response when he boasted that the surgery had only taken 35 minutes, and I complained that how could that be when I'd been unconscious for 3 hours.

Putting those blunders aside, I set about firming up my mental state to go through the first few tough days of recovery. Truth be told, I was amazed that my back muscles did not hurt. The incision site stung a bit when I moved funny, and I had some serious weakness in my lumbar/sacral area for the first week, but beyond that, I was able to walk, sit, and stand completely unassisted within a couple hours of waking up. To me, that proved the claim of endoscopic surgery that's it's much less invasive and permits faster recovery and mobility than traditional open back surgery, where muscles are sliced by a scalpel rather than perforated by an endoscope. Sure, it was hard to walk the first two days, and I did not really want to, but with the urging of the nursing staff and my doctor, I hauled myself out with my IV stand and did my laps in the 1st floor lobby. Walking a few minutes every hour since the day of my surgery has contributed greatly to my recovery process.

Unfortunately, there were two more hiccups in my first few days. The first could also be considered a cultural blunder of sorts. I thought I'd prepared my small mountain of pre-surgery paperwork as thoroughly as possible. The insurance company had requested a quote in writing from the surgeon and his team (which was mostly adhered to, with the exception of a couple members whom insurance didn't end up covering) as part of the pre-surgery approval process, but hadn't requested a quote in writing from the hospital. I had a choice of two or three hospitals that the doctor operated at; I was told one wasn't covered by the insurance, and another didn't answer my calls. So I went with the third hospital that answered my phone call and gave me a quote— although it's known as one of the most high-end and pricey hospitals in the area, the amount quoted over the phone sounded totally reasonable. In retrospect, I really should have gone in person to get a written quote.

I started receiving phone calls from billing to my hospital room only a few hours after my surgery on Monday afternoon, telling me that Dr. so and so had left his invoice, and what would my form of payment be? I told them to call my insurance. They informed me insurance wouldn't be covering. I was annoyed but didn't think it was too big of a deal because I could probably take some more cash out. I told them we'd deal with it tomorrow. But on Tuesday, after my doctor had discharged me and Margo went to billing to cash out, came the biggest surprise. The total for the hospital's portion of services ended up being about 18 times (Yes, 1800%) more than I'd been quoted over the phone. This huge discrepancy was one that we weren't prepared to pay, even 14% of it, which was my copay. To our dismay, they were also unwilling to bill us, in other words, I had to pay in full immediately prior to leaving.

I didn't have enough cash to cover it, nor was my credit card limit high enough to charge it. So less than 30 hours after my surgery, I spent about 6 hours sweating profusely and making calls in an attempt to raise those funds. Those 6 hours were enough for another entire blog post. Then I pleaded with billing to accept the 70% we were finally able to raise by Tuesday evening and bill me the rest, but the heads of department refused. So my discharge was cancelled, and the hospital held me hostage for another night until we could deliver the rest the next day.

As a result of the stress, my temperature rose and I immediately came down with the cold that my daughter had had a few days earlier. Aside from stressing out me, my husband, our friend who was taking care of our daughter, our daughter, my family, Margo's family, and other friends, being kept prisoner by a hospital was incredibly embarrassing. Margo had to go home and collect our daughter and I spent that third night alone in the hospital. Before he did, he got me a coffee and a chocolate glazed donut, which helped me feel a tad more human for a moment. After he left, at nightfall, I worriedly tried to send away the nurses who came to my door offering to check my vitals, fearing I'd be charged more. Their eyes widened when I explained the reason why I was still there even after I'd been discharged. They, and the dietician in charge of my meals, assured me that it was "all included," and to not worry. I accepted. Then I remembered my surgery bandages hadn't been changed since Monday morning, and got freaked out that my fever was from a surgical infection. The nurse on call assured me my temperature was low enough to not cause concern. She mercifully helped me change the bandage free of charge. The meals kept coming. My fever got under control. In the midst of such a degrading experience, I felt fortunate that some hospital staff still had my best interests in mind, and I will always remember their kind faces and words.

I finally went home on Wednesday around 11 am. Whereas I had turned my nose up at the Krispy Kreme stand when I was admitted, I gobbled down another chocolate glazed and bought another couple boxes to give to the people who had helped with our daughter in our absence. It took a few days for my fever and cold to disappear, thankfully, because their symptoms was making recovery harder. I kept walking a little every hour, forcing myself out of bed even though all I wanted to do was stay there and watch Netflix.

The first week flew by. Aside from getting in and out of bed, sitting down for meals, walking, and showering, I was pretty much totally dependent on Margo for everything around the house and for assistance getting dressed and changing my bandage. My back didn't hurt but I kept getting shooting pains down my right leg every time I'd get up from sitting or laying down. They were so strong I'd have to grab something to hold on and use my deep breathing. But they'd subside in a few seconds and then I'd be fine. I was only on paracetamol that week, which is saying a lot when you compare it to how many meds I'd been on prior. After speaking with friends who'd had back surgery before or knew others who had, they were shocked that I was up and about so quickly and that my incision was so small. That made me feel a little better. But at first, I was still spending more time resting (laying down) than up and about (sitting or walking).

On Day 5 or 6, I was finally able to lay on my back without pain in my wound area.

On Day 7, one week after surgery, things started getting better fast. The weakness in my lower back was gone, and I was walking normal pace. I was upright for 5 hours without laying down.

On Day 8, Monday the 7th, I quit using a bandage—the gauze and tape were driving me nuts—and my wound seemed to be healing well. I went for a ride in the car for the first time since a physical therapy consult, and was told I was doing very well. I started Lyrica for the nerve pain, which I was told shouldn't last for more than a few weeks.

On Day 9, I was finally able to completely dress myself (including socks, which are still challenging). I was upright for the majority of the day, and only had to lay down a few times.

Day 10, I stopped taking paracetamol. So I was completely off the morning pain meds. It was a watershed day for me, and the first time in over 3 months that I hadn't taken pain medication upon waking. I had my first beer in 3 months too, man was it good! :-)

On Day 12, I went "out" for the first time (aside from physical therapy)—to our office holiday party—I was mostly fine but by the end I was feeling pretty tired, and achy in my lower back.

On Day 13, I went "out" again, this time to the mall, to get some lightweight walking shoes. I was out for a good chunk, and felt pretty darn tired afterwards. The morning after, I was achy in my hips.

Day 14 was my last day of antibiotics (Cipro), and a day of rest took the edge off my aching hips. I finally was able to lay on my stomach for a few moments, something I haven't done for a few months (it's almost always made my nerve/leg spasm bad). The lesson learned was to be active but to increase my activity gradually, not in large amounts.

Day 15, my physical therapist added a few new exercises, and my hip was sore the day after, and my nerve pain shifted from up high to down low in my calf. I have a hard time with backslides, but I tried to stay optimistic. I was given another week of disability, and am thinking I will probably be good enough to go back to work next week. I saw my neurosurgeon for my 2 week checkup, and whereas he is happy with the results, he prescribed me more exercises for my right foot and shin, which are still pretty weak (I have a hard time walking tiptoe and on my heels on the right side—am basically unable to do so).

Day 16 (today), I got up from bed without any shooting pain down my leg. To me that's huge progress. They say that if you are improving consistently during your first 3 months, that you will only continue to get better.

Now, as my neurosurgeon is trying to impress on me, it's more important to focus on my overall health rather than worrying about the consequences of my surgery (i.e. that a spacer was inserted, that I might have any mobility limitations). He's urged me to take steps to care for my other remaining, unherniated disks, by losing weight and, once I'm further along in my recovery, by exercising. He assures me that I won't have any limitations in my activities once I'm recovered, and I am trying hard to trust him. Based on my progress so far, I am inclined to keep the faith. Margo says I am walking much more upright and without a limp, and for my part, not having to take 10 or 12 pain pills a day is a big enough difference for me.

In retrospect, even though I would have preferred not to go through this, I am compelled to count my blessings in terms of having had access to insurance that covered the majority, a clearcut and supportive Mexican workers' comp system that allowed me sufficient time off work for recovery (and  free follow-up care parallel to my private doctors), family and friends who've lent big helping hands in these last two weeks, and most of all, my husband who has been taking care of every last detail and listening to my every last peep during my recovery process. My recovery has been a straightforward trajectory without any complications so far. I am truly grateful.

Any major surgery is an experience that brings your mortality and aging into clear focus, and of course for someone who loves life and being incredibly active, it's a hard thing to face and deal with. But considering that I am only one of billions who deal with this on a daily basis, I'm going to keep focusing on the positive, the small victories, and the sweet things in life that help us rise above the pain. Although I still have the road to recovery in front of me, it feels good to be emerging on the other side.

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