SCS Trial - Unplugged

My trial is over and I'm unplugged now. I'm a little surprised at how much the Stimulator helped. Some of my problems aren't painful but are annoying nonetheless. Muscle twitches are back and are more unnerving then having the stimulator turned up a little too high. The burning and stinging has returned and I'm back to walking on a river bed of rocks (tender foot).

The stimulator did not reach everything. The deep pain in my ankles was never touched. I talked it over with my Doctor and I have decided to move forward with the permanent placement. This is not to say that I'm doing hand stands right now. I wish I didn't have to go this route. I will never be drug free, at least that's how it was explained to me. What the SCS does is buy me time. I'm still relatively young and hoping I have a lot of miles left on me. The SCS will permit me to keep the doses at my current levels or maybe a little lower. If I opted not for the SCS, I will have to go on the extended release stuff. The problem with that solution is, it doesn't touch the burning/stinging and the tender feet.

SCS Trial - Day 2

I survived the first night. Had a little Princess and the Pea thing going on the morning (slept on the external unit). I did leave the stimulator on all night at a very low setting. My left leg was real good (no pain) this morning but my right leg hurts like the dickens (this might be because of the pea).

I shut off the lead for my right leg. I just couldn't deal with the stim in my butt. The left lead seems to have better placement because it only stimulates below the knee. This is my worst leg and I am getting some relief there. According to the video, its possible to adjust the pulse width and rate.

I met with the Rep in the afternoon where I was granted more control over my stimulation. The Rep also moved the stimulation to a different contact for the right lead. It seams I'm wired a little different then most folks and have to be stimulated a little lower than normal. With the afternoon and the evening to play with the stimulator some more, it's definitely much more rewarding when you get to adjust all 3 values and create your own programs so to speak. I have no way of saving my results. So far I have created 2 laying down settings and a walk setting.

SCS Trial

Got my trial Medtronic SCS this morning. So far it's providing a little relief. I'm taking it slow so I can get used to the feeling. I'm able to control the amplitude separately for each leg or together. I watched the video they gave me, so now I'm a little disappointed. I only have control over the amplitude and not the pulse width and rate. So far the stimulation is from my butt to my toes. I don't really like the stim in my butt right now. I will say, this thing is really positional, so if you go for a trial, be prepared for some tweaking as you change positions.

The lead placement this morning smarted a little, but I survived. Now my back feels like someone kicked the crap out of me.

Post-op Fusion, 2 year(s) - Hardware Removal, 1 Year 2 Months

I'm finally at the 2 year mark since my Fusion surgery. It's safe to say that the surgery was quite successful in that I have minimal amount of discomfort in my back. I still get flare-ups in the SI Joints but I never expected that problem to be corrected. In fact, I would say that the SI problem is a little worse but not by much. I finally have a diagnosis for my nerve issues, Arachnoiditis.

Arachnoiditis is a debilitating condition characterized by severe stinging and burning pain and neurologic problems. It is caused by an inflammation of the arachnoid lining—one of the 3 linings that surround the brain and spinal cord. This inflammation causes constant irritation, scarring, and binding of nerve roots and blood vessels.

The predominant symptom of arachnoiditis is chronic and persistent pain in the lower back, lower limbs or, in severe cases, throughout the entire body. Other symptoms may include:

• Tingling, numbness, or weakness in the legs
• Bizarre sensations such as insects crawling on the skin or water trickling down the leg
• Severe shooting pain (which some liken to an electric shock sensation)
• Muscle cramps, spasms, and uncontrollable twitching
• Bladder, bowel, and/or sexual dysfunction (don't have this symptom)
  

If the disease progresses, symptoms may become more severe or even permanent. This disorder can be very debilitating, as the pain is constant and intractable. Most people with arachnoiditis are unable to work and have significant disability. Thankfully, my condition is not severe enough to prevent me from working. I've tried numerous nerve medications (Lyrica, Neurontin, Cymbalta, Topamax, Sevella) on the market and unfortunately have discovered that I'm quite sensitive to these type of drugs.

I press on taking Oxycodone for the daily pain and Zanaflex to calm the muscle spasms to a low roar. I'm scheduled to have an SCS Trial in October.

Post-op Fusion, 1 year 10 months - Hardware Removal, 1 Year

It's been a year since my hardware removal. I learned some things about my surgery last year that was a little disconcerting in that I had a full revision done at the L4/L5 level. I guess its not that big of deal because my back is very stable. My nerve issues have somewhat worsened over the last 6 months. I had an EMG test earlier this year that indicates that I have significant nerve damage to the nerve roots exiting my spine. My PM Doctor is trying to be optimistic, but is now laying the ground work that this may be as good as I'm going to get. My right leg now causes me a moderate amount of discomfort.

• My ankle stings 24/7 with it being very minor in the morning and getting more severe by the end of the day.
  
• Still have some numbness in the big toe and a little bit of burning in that toe occasionally.
  
• Numbness and stinging on the top of the foot

My left leg just plain sucks to have. Its very frustrating, cause that leg exhibits all of the same symptoms that my right leg has but more extreme.

• From the arch forward, approximately 75% numb
  
• Numbness and stinging on the top of the foot
• Numbness deep inside the ankle
• The ankle gets very painful as the day progresses (about 6-8 on the pain scale)

As stated above, my PM Doctor wants to be optimistic that my nerves will get better. Today, he made the suggestion that I might have to consider going the route of a Spinal Cord Stimulator. My biggest problem is that I'm having difficulties taking the nerve prescriptions out there. They have adverse effects on my memory and mental state. It should also be noted that I hate having to take opiates to control the pain in my legs.

Post-op Fusion, 1 year 5 months - Hardware Removal, 6 months

It's been some time since my last update. Not much has really changed, or I should say that progress is measured very slowly. My right leg only causes me some minor discomfort.

• It gets a little achy in the evening.
  
• Still have some numbness in the big toe
• Numbness on the top of the foot
• Numbness deep inside the ankle

For the most part, I don't notice it after a while. My left leg is a different story. Its very frustrating, cause that leg exhibits a lot of the same symptoms that my right leg has but more extreme.

• From the arch forward, approximately 75% numb
  
• Numbness on the top of the foot
• Numbness deep inside the ankle
• This ankle gets very painful as the day progresses (about 4-6 on the pain scale)

My Doctor still seems optimistic that my nerves will resolve over time. I suspect the window of opportunity is starting to close now. I've tried several prescriptions out there but so far nothing has seemed to help. Lyrica helped a little but caused my ankles to tighten up so bad that its starts to become painful to walk. My most recent attempt was Cymbalta. I think it really was helping, unfortunately I had a case of undiagnosed BPH (enlarged prostate) when I first started taking the drug. Cymbalta is a Serotonin-norepinephrine reuptake inhibitors (SNRI) and is not recommended to be taken if you have BPH. Sometimes I think I'm dammed if I do and dammed if I don't. I'm back to my tried and true Oxycodone to provide me relief.

I don't want to sound like a complete whiner here, cause it should be noted that my back is doing great.

Post-op Fusion, 1 year - Hardware Removal, 2 months

The title says it all, as I have finally reached my 1 year anniversary. Basically my back is 85% better with bouts of SI Joint Dsynfunction and an achy back (I still have pretty severe arthritis that fusion does not address) sometimes. The SI problem is a little worse then prior to my surgeries, but is manageable. Since my hardware removal, my right leg is finally recovering. My right ankle is a little weak and very similar to the discomfort I felt when I hyper-extended all of the ligaments in that ankle many years ago due to a motorcycle accident. All in all, I believe my right leg will fully recover with the exception of some minor numbness. My left leg is a different story, where I have suffered some nerve damage that has resulted in daily pain in the left ankle and of course some numbness. The pain in my left leg is much less than what I endured in my back and legs prior to my surgery.

All in all, my surgery was a success. Its unfortunate that I exchanged one problem for another but it is a risk we all take when under going this type of procedure.

I hope anyone considering a fusion weighs the risks and realizes that after this surgery you can come out on the other side with new problems.

Post-op Fusion, 51 weeks (11+ months) - Hardware Removal, 7 weeks

Had a great vacation last week. I took my pain meds on a regular basis and they did their job. Managed to ride roller coasters, go down water slides, and walk the entire day. It was a busy week, but was nice to get away.

Post-op Fusion, 50 weeks (11+ months) - Hardware Removal, 6 weeks

The second steroid injection has managed to completely calm my left SI Joint down. What a relief!!!!!

My right leg is still improving, but the left leg did not show any improvement after the injection. Looks like I'm suffering from some neuropathy on that leg.

Post-op Fusion, 49 weeks (11+ months) - Hardware Removal, 5 weeks

The steroid injection has managed to completely calm my right side down. The left side is still off the charts and my surgeons office has scheduled another injection later this week in hopes of calming everything down.

This second surgery is starting to mirror the recovery of my original fusion surgery. This is a highly unexpected turn of events but one that I will continue to push through. I have started to gain strength back in my right leg and have little to no discomfort in it. My big toe, the top of my foot and ankle are still a little numb. Unfortunately, my left side is another story. The numbness remains in my foot and ankle plus the pain has returned on a daily basis. As it stands right now, I feel that the inflammation in my back is just wreaking havoc with my left side. I hope that this next injection will help get things back down to a manageable level.

Post-op Fusion, 48 weeks (11 months) - Hardware Removal, 4 weeks

This past week has just been plain awful. The pain in my lower back has been excruciating (about a 7 on a scale of 1 to 10). Talked with my surgeon, and he scheduled me for an immediate steroid injection. The thought was that my SI Joints (both left and right) were highly inflamed. Once they had me under the fluoroscope and I pointed to where the problem was, they indicated that my L5 Facet Joints and my left SI Joint was inflamed.

This was by far one of the most painful injections I have ever had cause they did not want give me any lidocaine to numb the are so they could be sure to get the right spot.

Post-op Fusion, 47 weeks (10 3/4 months) - Hardware Removal, 3 weeks

Nothing major to report except that I returned to work full time last week.

Post-op Fusion, 46 weeks (10 1/2 months) - Hardware Removal, 2 weeks

Still progressing very nicely. I have limited my activities to walking 5 miles a day. Legs really itch a lot late in the evening just before I go to bed. I can only assume that that is a sign that nerves are starting to heal.
Also got my stitches out today.

Post-op Fusion, 45 weeks (10 1/4 months) - Hardware Removal, 1 week

Its been a good week on my road to recovery. Returned to walking 5 miles a day 2 days after surgery. I could easily have gone back to work today but decided to take the extra week and let myself heal. Sitting in a car is very uncomfortable still. Hind sight being 20/20, I should have gone to work. I have contractors putting in a new deck at my house today and saw an opportunity to tear out the old swing set and let them haul the wood out for that also. Like I said hind sight being 20/20, left and right SI Joints are not pleased with my actions. My spine being stiff now, they picked up the slack for my activity and are very angry. I was actually down to 1 perc before bed, and have had to take the max dosage the rest of today cause I exceeded my limitations.

The good thing is that I have established a baseline to what I can physically do. It sucks that I will never be able to just let go and live life without any worries. I guess this is a small price to pay to live life without pain.

Post-op Fusion, 44 weeks (10 months) - Hardware Removal, 1 Day

Hardware is out !!!!!

I survived the surgery yesterday. Looks like the drop foot in my right foot is gone. My surgeon said it will probably take a couple of months if the other issues in my legs are going to clear up. Back to the waiting game again. This surgery is much easier than a fusion, but still don't like being sore. I didn't get dis-solvable stitches this time, ugh. Went for a mile and half walk this afternoon.

Post-op, 43 weeks (9 3/4 months)

Had my surgery preop appointment today. I'm only having 3 procedures this time:

1.) Instrumentation removal
2.) Revision lamenectomy
3.) Refusion. They will be packing the vacated screws, adding to the bridge on the right side and repacking the left side of my L4/L5 disc space with cadaver bone.

Post-op, 42 weeks (9 1/2 months)

Had my 9 month check-up today, couple weeks late due to scheduling. My CT Scan came back showing that I am completely fused at L5/S1 and only half fused on the right side at L4/L5, plus the bone bridge on the right side is solid. All in all, I am fused. I did however grow a new bone spur in the vacated area that is pressing on the L5 nerve root which might explain the problems in my legs. The nerve issues were also verified by the dreaded EMG test a couple weeks ago which left me with a huge charlie horse in my left calf for a couple of days.

The prognosis is very upbeat, I will be having my hardware removed on June 16th which should alleviate the minor back ache I get in the evening and the occasional pinch I get from the hardware. My OS is also going to do a revision Laminectomy, so I'm hoping that will clear up the remaining issues with my legs, and fill in the holes (a little spackle never hurt anyone) left behind by the screws. There is no guarantee on the leg issues but I'm determined to be optimistic.

I'll be glad to hopefully get rid of the remaining issues that I have even though I have not let them put a damper on my life to this point. For the record, I rode every roller coaster at Busch Gardens a month ago and had absolutely no problems. I don't recommend the 4D rides for those with back issues, man did that hurt and I couldn't wait for the ride to be over. I played my first round of golf a week ago and for the first time in my life I broke a hundred with a score of 95. My goal is to play bogey golf which would be under 90.

Post-op, 28 weeks (6 1/2 months)

It's been a while since I posted an update. Thought I'd post a recap from my 6 month post op appointment I had this past week.

All my screws and rods are in place and the height between the vertebral space has not changed on either level since my surgery. My xrays show signs that I'm fusing. My Doctor was a little disappointed in how the L4/L5 space appeared on the xrays but the L5/S1 space is really nice and fuzzy. He told me not to worry to much about the xray results cause you need a CT Scan to verify how you are fusing. We had some discussions about my surgery where I learned some interesting new facts. The spacers used between the vertebrae were cadaver bone and not metal or plastic. They only built a fused bridge on the right side, leaving the left side open so there would still be access from that side in case I ever needed further surgery down the road.

We discussed the issues I have been having with my legs and feet. He recommended that removing the hardware might help with those issues. The hardware removal is completely dependent on whether or not I have fused and is also my option since its another surgery. I have a scrip for a CT Scan which I need to do just prior to my next appointment in the beginning of June. I'm also scheduled to do another EMG in May to determine how much more nerve damage I have. So good news, I might be getting my cast off (yes I call the hardware my cast) soon. So the next time someone asks how I'm doing, I can say, "Great, I might be getting my cast off this summer", that should give them something to think about.

My Lyrica scrip was bumped up to (300 mg a day now) earlier this month by my PM Doc and that has really helped me to reduce the amount of pain meds that I have to take. I basically take pain meds in the evening after my walk. All in all, I'm doing much better and only have a few issues that need to be ironed out now.

A quick note to those that are considering or are planning on having fusion surgery. It's highly likely that you will experience a whole new set of aches and pains as a result from the fusion. This procedure can dramatically change your posture which will effect how you sit, stand, and walk. I have experienced a multitude of new symptoms which are finally just starting to calm down. My knees and ankles were really in a bad way as I created new wear patterns in the joints. I've also developed a nasty case of plantar faccitus in both feet, from all the walking, which I'm working through now. It never stops does it.

For those interested, I've been given permission to partake in one of my favorite past times. As soon as the weather gets better, I expect to be on the links chasing balls and cutting grass once again. The only physical restrictions I have is to not be stupid. That's a tough one when you're a middle age man who thinks he's still 20 years old.

Post-op, 21 weeks 2 days

Talked with my Doctor today after he reviewed the films from over the weekend. All screws and rods are exactly where they are supposed to be. The spacers between the discs have not moved. I do have some inflammation from what is being termed some soft tissue damage. This will pass by taking the anti-inflammatory meds and continuing my PT.

Good thing that I'm not a Doctor cause I put out some misinformation. I am not completely fused at L5/S1 yet. Am I showing definite signs that I am fusing? Yes. The term thrown out there was that the bone between the discs is knotting (definition: a bond of union). Never heard that one before. I asked when I would be completely fused and he said I was on track to be done prior to my one year anniversary. I was told that its not possible to fuse this quickly and I need to continue to be patient.

Post-op, 21 weeks

The nerve pain is definately subsiding, so the Lyrica is working. My Physical Therapist recommended I shoot a small bucket of balls, 9 iron and wedge clubs only this weekend if the weather holds up. Lucky for me, the weather was agreeable and I now grow hungry for when my doctor says I can do nothing more for you. It was a lot fun getting out there and acting like a normal person again.

Now on to some bad news. On the way back from the golf course a Chevy Suburban decided to see what it would be like if he could drive through my car. It didn't work. My poor car is in a bad state of repair now and I ended up having to make a trip to the ER cause the pain in my legs and back were in overdrive. After some Xrays were taken, I was assured that I did not break any screws. I did however manage to sprain my back. Trauma to your back over titanium rods results in a fair amount of internal bruising. I suspect I will be very sore from this encounter for the near future but am glad that the hardware stayed in place and nothing broke.

Now the GOOD NEWS. The Xrays from the ER show that L5/S1 is completely fused. You can't even see the spacer anymore. L4/L5 appears to be on its way but is moving at a slower pace. I think the ER staff were happier than I was when they saw that I was fused at 1 level. You'd think they never saw a fusion in process. The Doctor offered to give me a script for my usual meds (Percoset......) but I told him no can do. He asked why, and I explained that I have a contract with my PM Doc and that would be a against the contract. He said I was the first person who has ever done that to him and thanked me. He told me that he has encountered loads of people with back problems who come into the ER, with pain contracts from some other doc, looking for more meds. He said it was refreshing to see someone take the contract so seriously.