Made this before I went into the hospital a day before surgery. Enjoy.
Category: sciatica
So We Finally Have A Date
For the surgery, and it’s October 20, at Paranaque Doctor’s Hospital, which despite horrific reviews on Google is my Doctor’s choice because they have more experienced nurses and a more modern x ray machine than at Unihealth where I was confined two weeks ago and which we prefer because it’s brand new and is only 3 kms. away from where we live. To clarify, my Doctor is also going to be my Orthopedic surgeon as well. When I asked him how many he’s done, he says he’s unsure because he’s done it so often already.
Some bad / good news though. Starting with the ‘bad’, I am having ‘Single level laminectomy discectomy with spinal fusion using pedicle screws l4 l5‘, and not microdiscectomy, which I mistakenly announced earlier. Basically it means screws will be put in place along two vertebrae in my spine, negating the need for my L4 – L5. These screws approximately look like this (not sure at all if its EXACTLY like that, but roughly I suppose)
Here’s another image, again I’m not completely sure it’s accurate, but I’m basing it on what my doctor told me, got it from here.
and here’s yet another.
Costs are 3x to 4x more than the earlier surgery we had thought it would be, so it’s in the area of nearly p400k. A lot of it is possibly (not completely sure yet) being covered by my health card and Philhealth, but you can’t be too prepared, especially for incidentals as there is going to be a 5 – 7 day hospital stay to recuperate as well.
I can’t say enough for having a health card. Whatever initial worry you may have about costs will quickly go away when the time comes you need something done, from simple dental procedure to spinal surgery. People need to shop around for health cards if they haven’t already.
I’ve been googling pedicle screws for a while now and I am reminded of how my surgeon was careful to tell me how he needs to let us know when an agent of the surgical equipment is going to come once payment is due. Apparently there are many incidents of people claiming to represent these would come to the hospital room to claim payment. As payment is in cash there is a lot of fraud going on and everyone needs to be on their toes, from the doctors to the patients and possibly even hospital staff, who can help confirm if its them or not. Why does it need to be in cash though? If there’s a way around that (and there are many) I’m sure you can easily beat the fraudsters.
The equipment is apparently ultra expensive and comes in a toolbox, and it looks like this.
That’s it for now. Between now and the 20th I just need to keep busy trying to make some money, read and learn new stuff.
So for the ‘good’ part, I’m super excited to get well as my surgeon is enthusiastic about me being active again once all the pain is gone.
One final and deeply important thing. I cannot say how much I am beyond grateful and indebted to my long suffering wife, who has not decided on separation despite my having pulled both of us into debt so I may go through this, this selfish and self serving thing. For all the world I cannot understand what possible gain she gets from having to stand by and support someone who needs so much attention and care. Needless to say I will never forget how much you are doing for me. I love you so much.
My MRI Report
So here’s the MRI report from Makati Med. Thankfully they were open on Sunday as we would never have had the time or even ability to go pick it up on a weekday. Just one of the many hurdles I want to write about that would point out perfectly avoidable issues if there was a non – paper electronic document system that could save and share these files over the ‘net. But anyway here it is:
General observations:
- Lordosis: Straightened.
- Alignment: Normal.
Vertebral observations
- Vertebral marrow: Normal.
- Posterior neural arch integrity: Intact.
- Cortical definition: Normal.
- Endplate definition: Modic II (fatty) changes are seen along the apposing surfaces of L5-S1.
Interspace observations
- Disc height/hydration: Decreased hydration signals are noted at L3-L4, L4-L5 and L5-S1 disc spaces.
- T12-L down to L2-L3: Normal discs.
- L3-L4: Mild disc bulge with central posterior annular tear.
- L4-L5: Disc bulge with superimposed right paracentral disc extrusion, effacing the right lateral recess and compressing the right descending L5 nerve roots. In combination with ligamentum flavum and bilateral facet joint hypertrophy, resulting to mild spinal canal, and mild bilateral neural foraminal stenosis. Small left paracentral annular tear is also seen.
- L5-S1: Mild disc bulge.
Spinal cord:
- Conus medullaris: Ends normally at T12-L1.
- Caudal roots: No abnormal signals.
Others:
There are several cortical and exophytic T2W hyperintensities in the visualized bilateral kidneys. The largest is in the right and measures 2.8 x 2.2 cm (APxW).
Non-specific, minimal bilateral perinephric fluid.
IMPRESSION:
- Straightened lumbar curvature.
- Lumbar spondylosis and degenerative disc disease.
- Mild disc bulge with central posterior annular tear at L3-L4.
- Disc bulge with superimposed right paracentral disc extrusion at L4-L5, effacing the right lateral recess and compressing the right descending L5 nerve roots. In combination with ligamentum flavum and bilateral facet joint hypertrophy, resulting to mild spinal canal, and mild bilateral neural foraminal stenosis. Small left paracentral annular tear also seen.
- Mild disc bulge at L5-S1.
- Probable bilateral renal cysts. Non-specific, minimal bilateral perinephric fluid.
So I managed to open the accompanying CD with the app that manages the images the MRI generated. My own Orthopedist was emailed a copy of this when I was confined in the hospital and showed me the properly annotated version of this report complete with colored areas where they found anomalies. The images below are ‘raw’ images meaning they don’t have any notes from any specialist whatsoever.
So here’s my spine (say Hi!!)
And here’s a zoomed in image of the L4 – L5 area where there’s a noticeable bulge.
Here’s another view:
The app comes with 4 sections, I only chose the first one on the upper left. I DON’T KNOW HOW TO INTERPRET ANY OF THEM. I AM NOT A DOCTOR SO IF YOU ARE EXPERIENCING THE SAME THING AND HAVE ANY QUESTIONS ASK YOUR DOCTOR FIRST.
There’s also a part that says ‘Probable bilateral renal cysts’, which my nephrologist had already pointed out previously. He told me these are perfectly normal for people my age and is nothing to worry about. In the light of the fact I may be facing possible kidney disease however, he would have wanted me to take a kidney biopsy. But the fact I had these cysts is keeping him from recommending it because a biopsy may hit a cyst and things could get unnecessarily worse from there. So he’s happy with using other tests instead.
But anyway, the issue here is my back. I am going to give my Orthopedist a copy of this because he’s asking for it, but to date he hasn’t given me a possible date for the surgery yet.
Update – My Ortho Cannot Commit A Date For The Surgery Within The Month
So I finally have the certifications from my nephrologist and cardiologist, the two certifications my Orthopedist requires before I proceed with the surgery. I texted his secretary to tell him about it, and she did, but it took a day and two other follow up texts for her to tell me some bad news, which is that her boss’ schedule is filled up and she can’t even promise a date within October.
This is a bummer because I had been looking forward to this so I can essentially get on with stuff I’ve wanted to do, such as a pending project.
The good news however is that the pain has subsided quite a bit and I am thankfully mobile enough to go ahead with the project anyway. As long as I take the pain meds it’s fairly manageable, and even short drives are okay. Driving longer than an hour would start hurting though, and in today’s traffic an hour to get anywhere is normal.
So that’s where I’m at for the moment. Just this minute the secretary texted again to ask me to send copies of the original MRI and certifications to their office, which although is only 15 minutes away without traffic, is in reality a 45 to 60 minute drive away, then having to look for parking, then hobble with my limp up the building just to give these pieces of paper to him.
I’ve been planning on a long – ish post about how IT can improve this situation, and I’m going to write it soon.
Finally, the cardiologist also recommended more medicine called Rosuvastatin Fenofibrate (10mg / 160mg), 1x a day for three months. It is supposed to help lower bad cholesterol and increase good.
A side effect however is dizziness, and this is extremely evident in the mornings. I usually wake up at 6:30, and now I have to drag myself out of bed at 8am. A fire could be raging beside the bed and it wouldn’t wake me up. I’m fortunate that we’ve invested in a new nice foam bed which has allowed me to sleep as long, because even if I stay in one position I don’t seem to feel any aches and pains like I usually do with our old mattress. Also, once the dizziness is gone I feel much better after having slept so well and so long, so all is not lost.
That’s it for now. Till the next.
Update on Update
It’s 939 am Oct. 3, Monday and I am waiting to go to meet a cardiologist at Hi Precision Sucat. This lady doctor will then prescribe lab tests that will help me get the one of two medical certificates that will allow me to finally get the microdiscectomy I need to finally get the pain out of my back. I had finally gotten the first one from my nephrologist a few days ago, and I’m glad to get that over and done with.
My pain level right now is very manageable, in fact it is the same pain I had been feeling before the surgery. Pain I had learnt to ‘deal with’ because all along it had been because of bad posture or whatever reason. It never occurred to me that I had a slipped disc. I knew there was something wrong because I had experienced the same traumatic event of the past week even further in the past, but it did not seem that serious.
Back Surgery Update
In order for my back surgery to proceed, my orthopedist required me to get clearances from A.) my nephrologist – because as per my records I have been shown to be close to having kidney disease because earlier tests showed I only had 30% of my right kidney functioning (90% – 80% would be normal for my age), and B.) a cardiologist, which is normal since one always asks these for advice before any surgery.
To understand why I have a nephrologist, it’s apt to go back a bit in my medical history. Back in 2010 I blogged about discovering I had diabetes. I ate healthy and worked out and my blood numbers improved. A year or two I got worse again, then I got back on the wagon and improved again. Yes it’s crazy. Continue reading Back Surgery Update
I Will Be Having Lower Back Surgery
Yesterday I was told that I needed to have spinal surgery to remove a herniated disc that had protruded onto veins in my back. These veins go down my right leg which because of the protrusion makes it painful.
Three weeks ago I tried to lift something too heavy for me and I felt an immediate sharp pain at my lower back. The pain subsided after some rest but there was lingering pain days after. I thought it would go away after more rest.
In the weeks previous to this I was walking briskly and swimming nearly everyday. Then we went on a weekend trip and on the 3 hour drive back the pain was back.
Finally a day or two after that after a trip to the bathroom I tried to take a small jump into my bed like I usually do but this time I felt sharp excruciating pain across my lower back, after which the slightest movement from my legs and hips caused similar pain. I was taken to the hospital via ambulance that evening.
After a lot of pain killers and an MRI the doctor said that the three of the lower discs on my spine were ‘dessicated’, meaning they were devoid of liquid that allows them to be flexible. This happens naturally as one ages. The middle of the three (L4 – L5) though had ruptured into nearby veins and this was causing the intense pain I felt across my back and right leg.
This video helps explain what’s going on: