An Employee and a Patient

A year ago, I was skiing with my family in Montana. I was securing my ski boot into the binding when I felt a pop in my lower back. It felt like a lightening bolt that traveled from my tailbone down my right leg. It was definitely an "Oh no" moment. I proceeded to ski on it, but my leg and foot were numb for the rest of the day.

After a few weeks, the leg pain subsided and I was back to doing normal activities, but the back pain remained. By July, the leg pain had returned. I am convinced that people can live a long time with back pain, but radiating leg pain is unbearable. It's practically impossible to function. Even the simplest motion like bending down to tie my shoes, or picking up toys that my daughter on the floor became impossible. At work, we arranged my office so that I could stand to work on my computer, and I paced back and forth during meetings because I couldn't sit comfortably.

I met with a local spine surgeon – he said I had degenerative disc disease at L5-S1. Because of this degeneration, the "trivial" move of pushing my ski boot into a binding became a serious event that caused the popping out or herniation of my damaged disc. I shouldn't have been surprised by the degenerative disc disease diagnosis - I had been having axial back pain since I gave birth to my daughter six years ago. In fact, since her birth I hadn't been able to lie on my stomach without pain and numbness in my legs.

My surgeon gave me several options, both non-operative and operative. I tried the non-operative options first. It became clear that the epidural steroid shots and exercises only gave me minimal help. I had heard that other people received quite a bit of relief, and I was very optimistic as I went into each session. But, they just didn't work well for me. During the process, I was struck by the number of patients with similar symptoms that I would see at the interventional radiologist's surgery center. It occurred to me that herniated discs are somewhat of an epidemic.

My surgeon said I was an excellent candidate for an artificial disc, a single level fusion (i.e. minimally invasive TLIF) or a staged procedure which entailed a discectomy to fix my leg pain then a subsequent procedure consisting of a fusion or an artificial disc in the future to fix my back pain. He kept asking me what percentage of my pain was in my leg versus how much was in my back. This was an important distinction because it helped us determine what the priority would be on deciding on whether or not I could have a staged procedure. (If most of the pain was in my leg than a decompression would be a smarter choice, if most of the pain was in my back, then a decompression alone wouldn't help my back, and a decompression with a disk or a fusion would be a better choice.) In my situation, the leg pain was clearly getting in my way of being able to function in the most basic activities, like unloading a dishwasher, picking up an item off the floor, tying my shoes or tying my daughter's shoes. Getting in the car was almost impossible.

One of the interesting anecdotes about being part of the industry, and working for the largest spinal device maker in the world, was that I found myself trying very hard to do everything possible to avoid surgery. Looking back it was kind of a ridiculous fear. After all, I had first hand knowledge of the good (and bad) side of spinal surgery. And I had a benefit that so few patients have - I personally know some of the best spinal surgeons in the world. They were all empathetic toward my MRI results and stories of not being able to tie my daughter's shoes. Each encouraged me to exhaust non-operative care. But they all said that I needed to make the decision with my surgeon, as a full partner in my care. Of course, they had some great advice about surgery, which I appreciated very much.

After several meetings and discussions about options, my surgeon told me that the decision was totally mine to make. In fact, I was surprised when he said that I would need to tell him when I was ready for surgery, that he wouldn't tell me when I was ready. I sensed that he had made that statement hundreds, if not thousands of times before. He was right, when I reached a point where I was missing out on life; I went straight to him and said I was ready.

On Monday, October 10th, I had a minimally invasive discectomy and was home that same evening. After two weeks, I was back at work. And last week, a few months after surgery and one year after "the pop," I was skiing again.

The airplane trip was harder on me than the skiing. I still get back pain if I am in a sitting position and bend down to pick up something on the floor. No leg pain. The problem we fixed was a great solution for me. The problem we didn't fix, my degenerated disc and back pain, is only a mild problem if I make the wrong motion.

At this point in my life I've learned these few problematic motions, have modified my movements and am doing fine. I'm running 12 miles a week, which is not as far as I did before my injury, but I'm getting there. And, most importantly, I skied with my family, without incident, this past week. I'm working on my core strength, and I'm keeping in contact with my spinal surgeon.

This experience has given me insight into what our patients go through as they exhaust conservative care, live in pain and struggle with the decision to have surgery. I've had patients tell me that surgery gave them back their life. Now I know exactly what they mean.

Funny Conversations Post-op with My Surgeon

During each of my follow-up visits, my surgeon would ask how my pain was. I would tell him, I don't have any pain. (In fact when I woke up from surgery I immediately could feel my leg again - without pain.) It was like a funny conversation that he and I would have during each visit. I thought I would share it with you…

My doctor:	Are you having any leg pain?
Me:	No.
My doctor:	Are you having any back pain?
Me:	Occasionally with certain motions.
My doctor:	What motions?
Me:	Bending down without bending my knees.
My doctor:	Don't make that motion; you shouldn't make that motion even with a good disc. Let's keep an eye on it. Are you having any incision pain?
Me:	What is incision pain?
My doctor:	You don't have any pain right where we put in the minimally invasive tube?
Me:	No, I don't know what you're talking about.
My doctor:	Of course you don't, we did this minimally invasive so you shouldn't have any incision pain.
Me:	That's good, because I have no idea what you're talking about, my scar is teeny tiny.
My doctor:	You can probably go back to work ˝ days next week.
Me:	Um, I already went back this week.
My doctor:	Oh! You're colleagues are going to think that this is an easy surgery and recovery.
Me:	When can I start running again? I am skiing in March (5 months post-op), you know that don't you?
My doctor:	Wait until you're 4 months post-op before you run, I would rather you swam to build up your core muscles. How about Pilates instead of running? And, yes you can ski in March if you promise not to do anything crazy.
Me:	Define crazy.
My doctor:	No double black diamond mogul runs, and no extreme skiing.
Me:	How about single black diamond runs with small moguls? And can I please run if I run slowly?
My doctor:	Tell the physical therapist your goals, and have her help you get there. If you run, keep your belly button pulled toward your spine. That will keep you in the right position. I would rather you swam.
Me:	How about an elliptical?

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