Bolted Bionic Woman: Adventures in Spinal Fusion

BURNING SPASMS

2009-09-20T08:46:00.000-07:00

Posts from BBW have been sparse, I know, and I feel bad. I have so much I want to write about the financial and insurance aspects of this surgery and I WILL get to it.

But first, there's been a bit of a setback here at BBW. About two weeks ago, I began to have stiffness between my shoulder blades, nothing really painful, but noticeable. Thinking I was just working the surrounding muscles in Pilates, I didn't think much of it. Then the burning sensation, so common in those of us with lumbar nerve impingement, where it feels like flames shooting from your back down your legs, started.

It began feeling like a white-hot poker was being thrust on the left side of my right shoulder blade, and eventually I started to feel little muscle spasms that would tighten my right shoulder and send pain down my right arm to the elbow. I got a massage, think that releasing some knots in the muscle would provide some relief. While it in some ways felt better, the burning sensation remained. It continued to get worse. I started taking a muscle relaxer hoping that it would help, but to no avail.

By Wednesday it was excruciating. I was sitting in an afternoon class and was in so much pain I could not focus. I am right-handed, and found that writing lecture notes was causing the area around my should blade to throb. During the break I called my physician and had an appointment for the next afternoon.

Based on my description, Dr. BBW thought that the muscle may be inflamed and pressing on a nerve. She won't know much without an MRI, so before I can do that, insurance requires I have an initial x-ray, which we all know will provide zero information about a bulging disk or an impinged nerve, but we play the game. X-ray is scheduled for Monday, but in the meantime, she prescribed a steroid pack designed to reduce swelling and inflammation (above), and Lortab to minimize any associated pain. The steroid seems to be helping which is good news, and I am hopeful that tissue inflammation is causing this nerve pain.

For many of us that have had a spinal fusion, any new pain can cause severe anxiety brinking on panic. While my surgery was very successful, I never want to have to endure it again. It is invasive not only physically, but emotionally. It affects everyone around you, your job, your activities, for months afterwards. I clearly remember my brilliant surgeon telling me that I needed to focus on building my core muscles; that with a spinal fusion came more stress placed on the discs above and below the fusion. Right now, I fear that additional stress has been placed on my thoracic discs, and I am afraid of more herniation.

Jake's Spinal Fusion Surgery is a group on Facebook that has pictures and information about Jake's thoracic spinal fusion. It only took looking at a few pictures to know that I do NOT want to have any thoracic vertebrae fused if I can possibly help it. So I am keeping the faith that this will never be necessary, that all the work I have been doing to build my muscles to protect my spine has just created a minor blip in my normal body functioning, a blip that will resolve itself as the muscle heals.

So I have a question: for those of you who have had a spinal fusion or any back surgery, what runs through your mind when a new ache or pain presents itself?

SIX MILE RIDE AND NO HEAT STROKE!

2009-09-13T09:22:00.000-07:00

My last post talked about my new bike, a Raleigh Comfort Cruiser that is spinal fusion-friendly. Last Saturday I checked the weather and noticed that the temperature would be about 85 degrees at 9am. I thought a bike ride on one of my favorite trails east towards Boulder City was in order (a picture of this desert trail is above). Bolted Bionic Husband even decided to accompany me. Boy am I glad he did.

I should have known better. The ride heading north was wonderful, lots of mild inclines and much of it spent coasting downhill taking in a wonderful breeze. That's when it should have hit me: what goes down must come up on the return trip.

The trail on which we ride is also a horse trail, and there is a rest area with hay and water for the horses which makes a good stopping point. Bolted Bionic Husband asked if I wanted to turn back, to which I replied "only if you need to." Whoops. Do not challenge the intensely competitive. So we kept going, with the trail going downhill for most of the ride. By the time we reached the end of the trail, I was hot, sweating, and almost out of water in my CamelBak.

But I was determined. Using one of the lowest gears I had, I attacked the gradual inclines that were so nice going the other direction. When the light-headedness kicked in, I got a bit nervous and walked the bike for awhile. I got back on and again pumped my legs on the lowest gear to get through the inclines. It was getting hotter and hotter, to the point that I felt my body was roasting and I could feel no breeze.

When the nausea began, I got off the bike and continued to walk it until I reached the rest area again. After putting my head under the horse water dripper to try to cool off, I realized that the rest of the ride was mild downhill if i could just push through one more incline. Hot, tired, sweaty, thirsty and with burning calves, I fought to master that incline and did. After a brief rest to catch my breath, I finally coasted to to the other end of the trail and caught up with Bolted Bionic Husband.

After pleading with him to get my bike in the truck while I sat in the car with the A/C blasting all over me, I started to feel a bit better. One hour and a cold shower later I felt invigorated. All in all, I biked a little over six miles, a first for me even before my spinal fusion. My next goal is eight miles, but I think I will wait until the weather cools down a bit more, perhaps the 70s? All I know is that I would have panicked if Bolted Bionic Husband was not there to make sure I did not rot in the Henderson desert, dead from heatstroke. But I am making progress, and for that, I am delighted.

Life is good.

I LOVE TO RIDE MY BICYCLE, I LOVE TO RIDE MY BIKE.

2009-08-28T09:49:00.000-07:00

I spent a week in the Outer Banks of North Carolina on a family vacation at the beginning of August. We stayed at my Aunt's beach house, a beautiful property close to the beach and other fun places to visit. The house is equipped with about a dozen bikes, most of them simple, gear-less beach cruisers to give visitors an option for traveling to the beach or the nearby shops.

Because of my surgery and that the synthetic bone is in the process of fusing the vertebrae, I am not supposed to ride a bike that requires me to bend forward at the hips, like a mountain bike or a cycle. I can, however, ride a bike on which I can sit up straight with a flat back. I took the opportunity to try out one of the cruisers and was addicted immediately.

I rode it almost everyday, to the beach, to the shops, to the local bakery. It was exhilarating to feel the sense of speed, and the exercise was great. I had so much fun with the cruiser that I wondered if I should get one for home.

After some thought, I bought a beautiful Raleigh Venture (I have no ties to Raleigh folks - just did a ton of research to find the best fit). It was difficult to make this choice: I have a gorgeous K2 T-Nine Series Vista mountain bike that Bolted Bionic Husband gave me for Christmas shortly before my back took a turn for the worse, and it has not been used very much. I felt a bit guilty buying a replacement, but knew this bike would get a lot of use. Someday, after the bone has fused, I may be able to ride the Vista again. Maybe.

Just this week I started a graduate degree program at our local university (more on that story to come). The campus is relatively large and I have significant ground to cover to get to my campus job and to classes. While vacationing with the beach cruiser, it occurred to me that I could ride a bike around campus, not only getting to my destination faster, but also doing it with less impact to my fusion than I could by walking briskly. Since campus is about 20 miles away from home, I've been loading it into my truck, driving to campus, parking and unloading, riding to class, and loading it back in the truck when class ends for the ride home. And riding my bike on campus has been fantastic, despite our oppressive triple-digit temperatures.

The other night after class, after the sun had set and the air had cooled, I rode my bike around campus just to look around and take in the breeze. By the time I got home, my legs felt like jelly and I was totally relaxed, my body buzzing with the post-exercise endorphins that are so addictive. I slept like a baby.

Most importantly, I feel like I have yet another accomplishment under my belt. I am riding a bike!, something I could not consider doing last year. It feels good to push my body to do new things and have it actually cooperate. And I can't wait to push it a little farther with my new bike with longer rides, just as soon as the temperature drops below "broil" in this white-hot desert.

AxiaLIF: NEW SURGICAL TECHNIQUE FOR SPINAL FUSION.

2009-08-21T01:38:00.000-07:00

I still spend a significant amount of time reading whatever I can about spinal treatments. It started before I visited my spine surgeon, when I was trying to gather enough information to make an educated decision about whether or not it was time for surgery. After my initial visit with my surgeon, I spent hours and hours on the Internet researching spinal fusion surgeries: what happens during surgery? what is the surgery designed to alleviate? what are the success rates short term and long term? what are the risks? (I still find it interesting that in all this research, I never did find "the scoop" on spinal fusions, the non-sugar-coated story of what it is REALLY like).

In my latest scan of the most recent news on spinal fusions, I came across this article in the Daily Press of Newport News, VA. After reading it, I reflected on how invasive my spinal fusion was, how there were times in those first few days after surgery when I thought I made a huge mistake, where the pain was so severe that I wished someone would pull the plug (I didn't have that kind of "plug" but you catch my drift). I look at my 4-inch bumpy, ridged abdominal scar that looks like a mini Grand Canyon when I look down towards my toes. And I think about the three weeks I spent in bed after surgery, and the months of recovery afterwards.

It makes me grateful that there are people out there who continue to look for better ways to do these procedures. And I am thankful for those people who are willing to try them so that the rest of us may benefit. Twenty years from now I hope that my scars look antiquated, and that they become obsolete like appendectomy scars.

To those of you out there awaiting surgery: research, research, research. Being informed is one of the best ways to ensure that you choose the right procedures and therapies. Listen to your doctor, but most importantly, listen to yourself and do what is right for you.

GUEST BBW BLOGGER: BOLTED BIONIC SISTER

2009-08-14T08:07:00.000-07:00

As part of a little experiment on BBW, I had a guest blogger, Linda, write about her spinal fusion surgery and recovery (thank you so much, Linda!!!). Continuing this experiment, the post below was written by another guest blogger, my younger sister, who I will refer to as Bolted Bionic Sister (a.k.a. Mama Mia Maria!).

Unlike Linda and me, Bolted Bionic Sister has a totally different perspective on spinal fusion surgery and recovery: she was a family member watching the chaos of surgery and recovery from the outside. I asked her to write about her perspective in the hopes that it will help family members understand what to expect during their loved one's surgery and recovery. I have to admit, however, that I have been procrastinating posting her piece; it is difficult for me to read what my family went through to help me. I hope it helps you.

BOLTED BIONIC SISTER'S STORY

Even before my sister's spinal fusion surgery, she was working on the Bolted Bionic Woman blog. I mentioned in passing that people might find it helpful to read about the surgery from a family member's point of view: I thought family members should know what they may experience so they could prepare themselves for it, as our family was not prepared at all for what we saw. So here is my account of my older sister's spinal fusion surgery and recovery.

I thought I had already seen my sister, Bolted Bionic Woman, at her worst, wincing in pain as she tried to walk and participate in the smallest and simplest activities of daily living. I remember her telling me how her leg would often go numb while walking at work so that she was limping and could no longer feel her feet, and what a bizarre feeling it was. I thought it could not get any worse than watching her hobble around with one of her hips at least 4 inches higher then the other one, not being able to straighten herself out and walk fully upright because of all the pain. As bad as all of that was, nothing could have prepared me for seeing her in the recovery room after her spinal fusion surgery.

I was accompanied into the recovery area with my mom. As I walked through the double doors I must have audibly gasped and froze on the spot. I vaguely remember hearing my mom say that she was pretty swollen. Pretty swollen was an understatement, as her face was perfectly round with little slits for eyes, but it was only the beginning of what I was about to see. She must have been hooked up to every machine and tube possible. I can understand the need for an IV and oxygen, but the catheters in her neck took me by surprise - I was aghast at the way they looked.

I grew up in a medically-oriented family (Dad is a physician and Mom is a nurse), and my career as a social worker took me on a path where I saw the very sickest of sick children, but when it's your family, your flesh and blood, your sister, it is a completely different experience. The image of her in the recovery room is ingrained in my mind so vividly that I don’t think I will ever forget it. As I approached her bedside, she said she was doing well, asked where her niece and nephew were, and we had a few fun minutes talking about the hottie of an anesthesiologist she had, and how having him that close during surgery was well worth going through it. Unfortunately, those few minutes in the recovery room would be the best I would see my sister look in the weeks to come.

The hospital stay was an absolute nightmare. The first night, a few hours after surgery, they moved her upstairs to a private room. I got a call early the next day from my mother saying she had been crying in pain most of the night and had not been able to get any relief. When I came to the hospital I was still surprised she was so swollen. I expected to have somewhat of the same light-hearted conversation as we did in the recovery room, but she could only mumble a few words, and when she wasn't crying, she would lay quietly. Her pain was completely uncontrolled, and to find a nurse on her floor to get any kind of attention was close to impossible. At times my sister would turn and hold onto the bed rail with white knuckles and cry. The nurse call light was useless - it either could not be found or would not been answered.

I spent three evenings at the hospital to make sure that my sister got her last dose of pain medication for the night before I went home; if I knew I could stay overnight I definitely would have. One night in particular is seared into my mind about the lack of pain control and the totally inattentive nursing staff. It was past her time for more pain medicine so I tracked down a nurse who gave the standard reply of "I will be right in." After a half hour, I tracked her down again, and got the same line, "I will be right in." When she finally did arrive, my sister had tears running down her cheeks. The nurse said, "her eyes are closed and it looks like she is sleeping." I told the nurse that she is in severe pain, and she has tears coming out of her eyes. When the nurse woke up my sister and asked her if she was in any pain, she said she was and the nurse finally gave her some medication. Everyday was a constant battle with the nursing staff to attempt to manage her pain. And I say attempt, because they never did get it managed.

On day three at the hospital I was so impressed with my sister. Even with the lack of pain control and the disastrous nursing care, she did a great job working with the physical and occupational therapists. During the first session, it took all her effort to sit up in a chair and have help putting on her back brace. The next day she had help with her back brace and was able to stand and walk a few steps down the hall. I knew watching her walk down the hall that once we could get her out of the hospital and at home, she would do so much better.

After her week long stay at the hospital she was finally discharged, a process that was also a nightmare. The entire staff kept blaming another department for why she could not be discharged yet. First it was because of the physical therapist neglecting to do something, then the blame shifted to the nurses, then to the discharge planner and then to the doctors. After a long day of solving problems we should not have had to solve, my sister finally got to go home to the comfort of her own bed, the familiarity of her own things, and the loyal companionship of her dogs.

For the first week-and-a-half at home, she needed help to shower, dress, prepare food (for what little appetite she had), and to take care of three back incisions, a long vertical stomach incision, and three neck and back wounds from drainage tubes. She had my help as well as the assistance of our mother and one very worried five-year-old nephew. He would carefully examine his aunt's incisions daily, and rub Vitamin E oil on them while giving his assessment of how they were healing that day. (He still does this, almost 10 months later. He will ask to look at her "marks," rub them a bit, and tell her they look much better). Her three-year-old niece was a constant source of entertainment and soon became her aunt's little walking buddy when it was time for my sister to start moving more. Her niece would hold onto her aunt's walker as they first mastered walking to the driveway, and little by little, walked to the neighbor's house, then the mailbox, and finally around the block.

Through all this, I am so happy to say that my sister has done very well. She has been faithful about attending doctors appointments, going to physical therapy and Pilates classes, which she still continues to do. I am proud of all she has accomplished in this period of time. She thoroughly researched all of her treatment options, endured numerous painful procedures, and had a great attitude through the worst of this surgery and its subsequent recovery. I am so glad she is out of the pain she was in, and she now seems to have a new lease of life.

However, I do owe her an apology. As I mentioned before, we had discussed doing a family point of view post for this blog a while back, and I offered right away to write about the experience. I procrastinated and procrastinated, and now 10 months later I have finally done it. It is not that my sister's surgery was in any way unimportant in her life or mine, nor was it something to be brushed aside; but I knew that writing about my experience with her surgery and recovery would bring up emotions that are still very raw and vivid. I finally told myself that after all she went through, not only physically but emotionally and mentally, I owed it to her to sort through my feelings and emotions and write this account, as she has endured more than I will ever know to get to where she is now.

I wish I could conclude this post with some articulate words to describe my thoughts about my sister through this ordeal, but PROUD TO BE HER SISTER sums it all up.

Bolted Bionic Sister is a licensed clinical social worker (L.C.S.W.) who works with parents and children on behavioral and emotional issues. As a Supermom to two awesome children, she epitomizes patience and grace, and is one of my favorite people in the world.

GUEST BBW BLOGGER: LINDA HANDEL

2009-08-05T21:44:00.000-07:00

LINDA'S STORY.

July 13, 2009. Today I had my four month doctor’s evaluation.

On March 11, 2009 I had a spinal fusion of discs L3-L4-L5 posterior. The surgery was 4 1/2 hours long. The surgeon was sure about fusing L4 and L5 but said he wouldn’t know until the actual surgery if he was also fusing L-3. Dr. Lucas said that the nerve roots were pretty tangled up with ganglion. The nerves were very inflamed. L-3 was involved and fused as a result.

I have titanium rods, spacers made of my own bone material and screws that are drilled into the bone. There was also a bone graft taken from my left pelvic bone. Some people get donor bone material rather than a bone graft. In retrospect, I may have preferred the donor material. The site of the graft was tender for a long time and added unexpected discomfort.

Like many who need this surgery, I did everything possible not to!! I got temporary relief from cortisone shots…meaning just a few hours of relief at a time. I took ibuprofen and went to my chiropractor who gave me e-stim with cold packs, cold laser, and ultrasound for temporary relief. He was very supportive of the surgery.

Since the surgery, I have zero pain in either leg. Before surgery I doubled over walking up stairs, was exhausted from managing the pain, and unable to work out, which is a big part of my life. I do not regret having the procedure and I’ve stopped blaming myself for needing it to begin with. I’ve always followed a good workout and diet routines. I go for chiropractic treatments, take my vitamins--what went wrong? Dr. Lucas said it could be from anything…an injury from my more sporting days or from being rear ended in a car accident, to crashing around in the ocean. Whatever the incident or groups of small incidents, it doesn’t really matter. There is nothing I regret nor do I think… “I shouldn’t have carried my kids in a front pack, I shouldn’t have done weight lifting or I shouldn’t have played field hockey.” The damage to those discs was going to be the way my body finally gave in to the stressors of my everyday life.

Apparently, the L4 and L5 take a beating. Happily, the surgical technology has changed dramatically from when patients had to wear a “turtle shell” brace for many months and remain immobile. Dr. Lucas said that the rods and spacers in my back are actually a brace and I didn’t need to wear another brace when I left the hospital. I did get one at his suggestion in case I felt I wanted to wear it to feel more secure. I never did!

I wasn’t fearful of the surgery itself. I had full confidence in Dr. Lucas who is a gifted man with a big heart. I was concerned how I would feel after. While the surgery was smooth, my hospital experience the first night was not too great. I read blogs about post surgery experiences so I hoped to be prepared.

My experience does not mean yours would be the same. Individual physiology is different. I had low blood pressure after surgery most likely due to anesthesia and the number of hours I was in recovery. As a result, the pain medicine my doctor expected me to receive was not in place and I wasn’t dosed by my pain level but rather the number of hours between IVs. I had to receive the three units of blood that I pre-donated at the blood bank. Dr. Lucas came the day after surgery and insisted that I be dosed according to the pain I felt, not the hour of the day. This made a huge difference.

Post surgery was painful but not the kind that made me cry. For me, it was the kind of pain that was immobilizing. I was afraid to move. I couldn’t move. I was sure the rods would come poking out of my back! The searing pain was from the surgical site and before the pain meds were administered by need. However, I noticed immediately that there was no other pain…my legs were already pain free from the moment I woke up and could assess my status.

The first day after surgery my inability to get up on my own was discouraging. What was I thinking? I just had major surgery, was not conscious for twelve hours...Did I expect to get up and dance? I had no pain in my legs but I couldn’t move or roll over without help. I was not patient with myself. Instead of rejoicing, I started counting the seconds to get this healing business over with. Thankfully my roommate was a chatter box filled with hilarious stories. How could I not laugh with her? Nonetheless, I was a grump, stubborn and wouldn’t walk when the physical therapist came by to get me up. I was groggy and out of sorts and agreed only to “roll and sit up.” My family was happy to see my stubborn personality was still up and running!

The second morning I let myself be coaxed out of bed for a walk down the hallway. By the afternoon I was sitting in the chair. Hospital politics became interesting as various nurses and patients came and went. Day three I used the walker for about 5 minutes then realized I felt good enough to go up and down the hall without it. I waved at my family taking a break in the lounge. I climbed the little stairway and was ready to leave.

The morning of the fourth day I was mobile on my own, and with my mood lifting, I finally rejoiced at being pain free from the throbbing pain down my legs---I was released by my surgeon to go home. Dr. Lucas often suggests his patients go to local rehabilitation facility but he was impressed with my mobility and determination. I also have family who helped with meals and keeping the house peaceful. I was pretty tired and slept a lot the first week! However, I could climb the steep stairs to my room and look out of the windows into the yard. I could go downstairs and rest during the day. I was totally amazed at my mobility. No more one leg at a time and pulling myself upstairs by the rail. No more one leg at a time to get down. I went for slow walks around the block with my partner’s help. I knew that healing was going to be a function of time but actually experiencing the healing process is quite different then just thinking about it!

I have to say, being physically fit paid off post surgery. Dr. Lucas suggests to patients who are not fit to attend physical therapy prior to surgery. Recovery is faster if you have a strong core and have a routine in place for post surgical care. I went to physical therapy the second week after surgery. It was a shocking experience for me. I couldn’t even lift my leg, do a bridge - nothing. I was very emotional as I realized the path of rehabilitation was going to be months long. I was stiff, sore, and tired. I needed help with my socks, couldn’t carry the laundry basket, and couldn’t work. It was overwhelming but I had no choice if I was going to get my life back. There is a women’s soccer league with my name already in place… but clearly not this year.

Four months post surgery my pt and I are parting ways. I’ve gone through all the stages of physical rehab and can do pushups along with the stretches. My stamina was nonexistent at first but I was back to work in three weeks part time. I’ve gone from two pound weights to ten pound weights for some exercises. I was determined to do whatever it takes to get strong again.

Whatever you do - please do your physical therapy homework every day. By the third week of going three times a week I was strength tested, exercises added and having scar tissue massaged to the point of tears. I was on the recumbent bike for 10, then 15 then 30 minutes. At first I was doing goofy exercises like the “swimming bug” and the “knee march.” Goofy, maybe, but I could hardly do them the first time or the second. Now when I see others in the workout room doing this little march on their knees I realize the squats and planks I’m now doing were hard earned over these last four months. I am reminded, as I watch new patients with my old struggles, not to be discouraged. Collagen formation needed to heal the site takes about a year to sixteen months to complete the fusion. It’s two years for the bone to actually finish forming. And there is Absolutely Nothing You Can Do To Make it Go Faster Then Nature Intended….period.

Do I test this beyond my limits? Yes. Am I sorry? No. Did it hurt? Yes. And I backed off and tested again but less so.

Today was my four month exam with the surgeon. I have lost some flexibility but this doesn’t deter my daily living routine. I am still stiff but less so each week. I thought I could feel the rods on the right side of the surgery. Dr. Lucas explained that it is the muscle not the rod I feel. He retracted the muscles to do the surgery so they are still swollen and tender and still healing. I have various aches and pains but I was told that month four is still the beginning stages of the healing process. The aches and pains I feel will continue to diminish. Just go about living and start slowly to build back core, stamina and strength. Walk every day!

Good luck with your surgery. I hope this small piece helps you make the best choice to be pain free. Stay positive. There are so many stories on the internet that are disheartening. We, as patients, have to take responsibility and do our part in staying in shape, keeping our weight in control and doing physical therapy. Get more than one opinion and research your surgeon. Find others who have had similar surgery. I was amazed at the number of people I know who either had lower back disc surgery or had a parent, a friend, or a relative that did and who are pain free and as active as ever after many years.

I am very grateful to BBW and her blog. I felt her successful experience could also be true for me. I somehow knew, after reading BBW's thoughts and feelings, I would get through surgery and someday I would also write something of my experience in support of others.

Linda Handel had a spinal fusion March 11, 2008. She is a licensed psychotherapist in private practice for 25 years, the founding director of the Blackstone Shelter for abused women and their children, and is the recipient of the Charles Potter Award for Public Service. She is a mother to two married children in their early thirties, and a grandmother of a wonderful granddaughter.

SOME BIG STEPS.

2009-07-30T03:19:00.000-07:00

For the first time since my surgery, I did something other than Pilates, the elliptical or the treadmill - I did a three-mile hike at Mt. Charleston on a trail called Mary Jane Falls with my friend, Mike, and the Bolted Bionic Dogs, Diesel and Greta. This was a big deal for many reasons: it was the first time I had participated in activity not related to physical therapy, and it was the first time that both dogs had participated in any major activity since their cancer surgeries and chemotherapies.

So here we were, me and the dogs, all of us survivors of one surgery or another in the last eight months, ready to take on a three-mile hike with several inclining switchbacks. I don't know about the dogs, but I was nervous - what if I couldn't finish? What if one of them couldn't finish? What if my back started hurting? Will I really ever be able to do activities like this again?

We started off on the incline and within ten minutes my hamstrings were screaming. Greta was galloping all over the trail, so excited to be able to explore and search for birds. Diesel stayed close to Mike and me, the typical loyal Boxer that likes to stay near his people. The switchbacks started and got rough - not only were we constantly on an incline, but the switchbacks now included stair-like climbing on rocks to get to the next switchback. My hamstrings were sore and my back and abdominal muscles were working overtime.

As is characteristic for a Lab, Greta was a champ and navigated the switchbacks with grace and ease, despite having surgery just four weeks ago. Things were a little tougher on Diesel, and a couple of times we had to coax him up the rock stairs to the next switchback, and Mike had to lift him onto the path if the rocks were too steep. But he faithfully kept with us while I was debating if I was going to make it and would have to head back down the trail with Diesel.

It was during one of these moments I decided that if Diesel was willing to do this, push through whatever pain or strain he was experiencing, I could certainly do it. As we inched towards the trail summit, I kept telling Diesel he could do it and what a trooper he was, sometimes in an effort to encourage myself more than him.

But boy, was it worth it. We came to a clearing with two small waterfalls surrounded by thistle, where the temperature dropped and a cool breeze brushed over us. Both dogs ran for a waterfall and drank some of the coldest, mineral-rich water there is. After awhile both of them put their bodies underneath the running water for a well-deserved cool off. They were content and happy.

I sat on a log at the summit, watching these resilient creatures playing in the water, and wrapping my head around what we had just accomplished. As I looked out onto the mountains, vast and full of possibility, I started to believe that this was just a first step of many steps to come. My body and I were working together again, called a truce, kissed and made up. I was highly aware of the muscles that had propelled me to this beautiful summit, something they could not have managed over the last couple years. And I became excited as I thought of future hikes, ski trips and bike rides, activities that are within the realm of possibility.

I was not what one would consider "athletic" before my back went bad. I would use the treadmill a couple of times a week to keep the pounds off, but rarely did any more than what was minimally required. But these days? I WANT to use my body. I want to push its limits, feel its muscles contract, feel the power of my limbs cooperating with my brain, and feel the euphoria that settles over me after intense activity.

I do wonder if I am beyond an age where becoming athletic for the first time is possible. But I realize athleticism is not a point to be reached but a state of mind. And I have thought of some great examples of this: I see Diesel, my 106-pound Boxer moving steadily towards the trail summit (although he would much rather be napping on the couch); I see my parents, 74 and 69 years old, skiing the slopes last winter; I think of the story Mike told me on our hike of a 63-year-old man that frequently RUNS the trail we were struggling to ascend. There's so much inspiration out there.

I plan to keep at it and see how far this new body will take me. Thanks, Mike, for being a part of my first post-op hike and making it fun. And thank you Bolted Bionic Dogs for reminding me we are capable of anything (and for snuggling up with me for a nap afterwards.)

ACHES & PAINS.

2009-07-23T07:53:00.000-07:00

With all the attention I was giving the Bolted Bionic Dogs' health during their illnesses and recoveries, I realized I have severely neglected my own. After missing almost three weeks of Pilates sessions, I got back on the reformer Tuesday night. It was difficult and uncomfortable, and I had to work really hard to get back in the groove. When I woke up Wednesday I ached all over: my armpits, triceps, inner thighs, quads and calves were screaming. But it is a good sore, the kind of sore that reminds me that I cannot let that much time lapse between my Pilates sessions. They are vital to keeping me strong and limber, and they improve my mood significantly.

And the humidity we are experiencing here in the desert is not helping either - the moisture is attacking all my joints and I have pains all over, right down to my fingers and toes. So my sore muscles and achy joints are giving me the one-two punch today, and I plan to deal with it by doing my Pilates stretches and exercises at home tonight. You have to push through it to get to it.

As part of a little BBW experiment, my next two posts will feature guest writers. One is by Linda, a wonderful woman I met in a spine fusion chat group who recently had a spinal fusion and has recovered well. Her story will not only give readers a different perspective from my own on spinal fusion surgery and recovery, but also give you hope that people DO have successful outcomes with this surgery.

The second is by Bolted Bionic Sister, my 33-year-old sister and best friend, who was with me for the surgery and has been there throughout my recovery. Her story provides a family member's perspective on surgery and recovery, and will certainly give your loved ones a picture of what THEY can expect if you decide to proceed with a spinal fusion. Like I have said before, you cannot do this on your own, and a supportive network of family and friends is imperative to getting you the best care in the hospital and at home during recovery.

Stay tuned . . .

I'D RATHER MUSE INSTEAD: THOUGHTS ON KINDNESS & THE FUTURE OF BBW.

2009-07-16T02:43:00.000-07:00

I have been promising a post on the more tedious and grueling aspects of a spinal fusion - the financial impact of the procedure and its long recovery period - and I do have a half-complete draft for which I have lukewarm feelings. But I just cannot face this aspect quite yet. This feeling may be related to the migraine and other headaches that took me down for much of last week.

Or perhaps it is related to the call I received from a bill collector who, in a patronizing tone asked me when I planned to pay my bill for Dr. So-and-So's services. (I honestly don't remember this doctor, but it is not at all unusual to have doctors you don't know assisting in the operating room and then getting bills from them.) When I very nicely told Ms. Collector that I did not remember receiving a bill from said surgeon, but would be happy to pay it if she would kindly send me another billing statement, she snarkily replied that she "guessed" she could do that but "only this one time."

I get it though. She was probably thinking I was just another person on the other end of the phone telling her what she wants to hear, most likely without the resources to follow through. And she probably has these kinds of conversations often, as many people these days are finding it difficult to pay their mortgages and grocery bills, let alone the medical bills that pile up.

So I am sure she was caught off guard when, in confirming my mailing address, she realized the wrong address was in the system. Her tone changed immediately, she apologized for the error, and she politely requested the correct address. I kindly thanked her for her help and told her I look forward to receiving the bill at my actual address.

It made me think - shouldn't we all try to start our interactions with others with kindness and compassion, and without assumption? There is no way for us to know the life circumstances of another or what he or she is going through at a given moment. The quiet, unsmiling cashier at your local supermarket that appears disengaged may be suffering through a rough divorce or the death of a loved one. The attitude Ms. Collector adopted and the assumption she made about my unwillingness to pay that bill may stem from hating the job she must keep to have health insurance.

But in these situations and many others like them, kindness and compassion towards another can create a shift in energy, and a smile can lift a heavy heart. Since my spinal fusion, I remember every act of kindness offered me: the hospital food service woman, a girl in her early twenties, who went out of her way to bring me fresh coffee in the hopes it would help me feel better; the woman at the grocery store who offered to help me fill my cart with items I could not bend over and pick up while wearing my back brace; the gentleman who gave me his seat in a crowded doctor's waiting room after noticing the clunky back brace I was wearing. These moments have heightened my sense of compassion, filled me with gratitude, and inspired me to practice kindness.

Another thought: at some point, BBW will naturally come to an end as I come closer to total recovery. I will no longer have experiences to post. But I am just not ready to give up BBW. I have enjoyed writing about my spinal fusion, not only because I now have a written account of all my family and I went through to reclaim my life, but because it has helped others. I have received wonderful emails from people who have a renewed sense of hope about getting their quality of life back. I have people I now call friends who endured spinal fusions and have offered their support in the middle of their own tough recoveries. It has given me back more than I gave.

So what do I do? This thought occupies the back of mind all of the time. Do I put BBW in a basket and send it down the virtual river for others to discover? (Please pardon the "Moses and the reeds" reference but this blog, in a way, is my baby.) Do I transition BBW into some sort of resource blog with new and interesting info about spinal fusions? If you have any thoughts, reader, please feel free to leave a comment. I am open to ideas.

DANGERS OF CONTINUED NARCOTICS USE AFTER SPINAL FUSIONS.

2009-07-10T14:36:00.000-07:00

I have written here and here about my personal experience with medication, and have also received several emails and comments with opinions and questions about taking a variety of pills to get through the day. Some of the questions include what are the benefits of having surgery if you still have to take medication afterwards, and many of the statements I get are from people who desperately want to be taking fewer pills. Much, much fewer pills. I got curious and starting poking around.

I came across some articles about the dangers of narcotics use after spinal fusions here, here and here. For those of you who are battling this issue, please read. It is good information.

My personal opinion (from a non-medical practitioner point of view) is that the less medication you have to take, the better. If you can feel 50% better using 50% less medication, that's fantastic. Also, ALWAYS get a second opinion if you are told to get a spinal fusion - this type of surgery is a very big deal.

Talk with your doctor about various diagnostic procedures (like the one I wrote about in Second Opinion) that can better identify what is causing your pain so that the very best treatment can be provided to you as an option. Most of all, be your own best health advocate, and if you can't, please find someone who will; someone who has the energy, the stamina, and the chutzpah to fill this important role. Ultimately you need to make choices that are best for you, and for what you are experiencing at any given time.

Please take care of yourselves.

SETBACKS.

2009-07-04T03:47:00.000-07:00

It was bound to happen - the moment when I eventually twisted or turned or bent the wrong way. But still, I am worried.

After enduring a spinal fusion and the months of recovery that follow, the potential for re-injury or the pain to return has always been on my mind. I often feel like I am on borrowed time, and that quite suddenly, this relatively pain-free state in which I live can change in a moment.

If you have read the latest BBW post, you know that Bolted Bionic Labrador had surgery to remove a malignant tumor from her leg. Keeping her calm and relatively immobile has been a challenge, as she is just internally wired to be enthusiastic and excited, if not a little bit out of her walnut-sized mind. Unfortunately I left the house for 45 minutes, and in that fraction of an hour she ruptured some of her stitches and was bleeding from the incision.

My first reaction in this case was to call Dr. Dad, a.k.a my father-slash-physician, to come over and survey the damage. I also debate calling Nurse Mom, but make an effort to balance my medical emergencies between the two of them (I tell myself it is so neither is overly burdened by my issues, but in the back of my mind I think it is so that neither gets a full picture of how clutsy and prone to injury this family is).

Back to Dr. Dad: his conclusion was that the bleeding would stop with pressure on the wound, but being as he does not specialize in treating animals, he recommended I call The Specialist tomorrow to determine whether or not the sutures need to be replaced. After a stressful evening of visible open wounds, I called The Specialist the next morning and was told to bring in her for an evaluation. To make a long story short, she stayed overnight to have another surgery to put her leg back together with even stronger sutures.

But to back up a bit, while waiting for Dr. Dad to get to the house after calling him frantically, I tried to get Greta turned on her side on the kitchen tile so I could get a good look at what had happened (have I mentioned she is 84 pounds?). And that is when it happened: I felt a tug and then a burst of pain in my lower back area. By the time Dr. Dad arrived at the house, I was laying on the kitchen tile with Greta, unable to straighten my body without great difficulty and strain. I was afraid of this happening, had worked so diligently to prevent it, and began constructing a daisy chain of what ifs.

I may have dodged the bullet this time. My back is fairly sore, but it is not throbbing with the stabbing ache that used to inhabit my lumbar area. If I am lucky, all the core work I have been doing for the last several months paid off; that when my body sensed a wrong turn or twist coming, the core muscles tightened their corset strings to brace for impact. If I am lucky, what I feel is muscle strain and that the pain will subside as the muscles heal. If I am lucky, I will not have to visit Bolted Bionic Surgeon to ensure that there is no damage to the hardware planted in my lower spine.

I will give my body a few days to right itself. As patient as it has been with me, it is only fair that I offer up a little patience with it.

INTERNET PRAYERS.

2009-06-22T02:39:00.000-07:00

I am about to do something I said I would never do when I created this blog, and that thing is veering from the subject matter of Bolted Bionic Woman. This is a blog about my life, but only a sliver of that life as it relates to my spinal fusion and my recovery. I don't blog about my family, or what happens during my day, or my feelings, unless it is something that specifically relates to the reason for BBW's existence. But I am going to go back on my word, just this once.

Within the last couple of months, both Bolted Bionic dogs were diagnosed with mast cell tumors, a type of cancer that is common among the canine species, especially boxers and Boston Terriers. Diesel, our five-year-old boxer, was the first to be diagnosed by the family vet, and after being referred to a specialist, has undergone two surgeries to remove the tumor and has completed three of four rounds of chemotherapy. Two weeks ago I was crushed to learn from the specialist that he has another tumor behind his left ear. After giving his body some time to heal after the last round of chemotherapy, Bolted Bionic Husband and I will most likely have this new tumor removed and put him on a drug recently approved by the FDA to control existing mast cell tumors and prevent new ones.

But then, after having a new bump on her left shank biopsied, the vet confirmed that Greta, our seven-year-old chocolate Lab, has a mast cell tumor as well. We were stunned, as Labs are not on the list for Most Likely to Develop Mast Cell Tumors like Diesel is. She is being prepped for surgery to remove the tumor as I type this post. After the tumor is removed, the specialist (who has to be the kindest person I have encountered in quite some time) will confirm the grade of the tumor which then determines what type of post-operative treatment is needed.

Here's the thing: these dogs are our children, the closest thing to kids that Bolted Bionic Husband and I will ever have. There is no love like That Love that comes from nurturing another living being: ensuring they are well-fed, well-rested, healthy, clean, groomed, exercised, and happy. It creates a binding relationship built upon responsibility and accountability towards another; an agreement that states "I will take care of you no matter what;" a contract we often take for granted with dear friends and spouses, as well as people we don't even know who share the world with us. I take this bond with Diesel and Greta very seriously and would do anything to give them that happy doggy existence that carefully balances what I need from them (unconditional love and companionship) and what they need from me (quality of life and the freedom to be a dog, not an extension of my human self).

So I have a favor to ask. If you can spare a little time and energy from your already hectic and busy life, full of your own problems and sorrows and challenges; a life overflowing with doctor's appointments and soccer games and dances lessons and meetings with your boss and dinner to get on the table and bills to pay; would you please take a moment and send a good thought or prayer our way? It will be appreciated more than you know.

[Post-publication note: thank you, everyone, for your thoughts and prayers. Greta's surgery went very well and we pick her up today. A dear, dear friend of mine wrote me something so beautiful that I must share it here (I hope he does not mind): "No one can overestimate the power and influence of our life companions, and to equate our fellow creatures as family is to realize how much living things help one another. I believe that help extends beyond the face of this earth." Thank you again everyone.]

INSURANCE PAPERS: CAREFUL, HEAVY LIFTING REQUIRED.

2009-06-20T03:58:00.000-07:00

My next post will focus on an aspect of spinal fusions I have not yet covered on BBW: the financial impact of this major surgery. If you do not have insurance, bless your heart. May God be good to you if you proceed with this surgery.

If you are fortunate enough to have good health coverage, bless your heart. Prepare to embrace your explanation of benefits statements (my stack is almost two inches thick now) and bills, as well as never-ending calls to physicians, physical therapists, health insurance companies, pharmacies, human resources leave of absence coordinators, bosses, disability insurance case managers, and your sister, with whom you commiserate on how dysfunctional these entities are while crying for the fourth time before noon. (Thank you, Moe, for being the best sounding board I could have ever asked for).

Stay tuned . . .

AN HONORABLE DISCHARGE.

2009-06-14T07:56:00.000-07:00

I have been officially discharged from physical therapy, 30 weeks after the spinal fusion. It has been a wonderful experience made better by a knowledgeable physical therapy clinic and a fantastic Pilates instructor. Because of this, I have healed faster than I could have imagined, and I have learned new ways of moving and strengthening my body to prevent further damage to my spine.

During the last six weeks of PT I was doing 30-minute Pilates sessions with Shane, two to three times a week. One day, just to see what would happen, Shane had me do an hour session. Not only was I able to handle it, the hour went by in a flash. (I have determined that the reason I can commit to Pilates as a form of exercise is because one spends much of the time doing it while lying down. You just can't beat it). We decided that since my insurance was only willing to pay for two more physical therapy sessions, we would do two more half-hour sessions, register me as a private client, and move forward with one-hour sessions that I will pay for out-of-pocket.

I cannot give a full account of my Pilates sessions and how central they have been to my recovery without throwing in some information about Shane, Pilates Instructor Extraordinaire. At 28, Shane is a certified Pilates instructor - she can do the splits on a reformer that will make your jaw drop. Before becoming an instructor, she was a Vegas showgirl in some of the classic Vegas productions. Growing up as a dancer with a degree in dance performance, she has those long, lean lines you usual see on a dancer's body, but she is strong. Behind those lean muscles are some serious fire power! She runs or swims or cycles everyday and to me embodies everything that is looking and feeling fit. When I die, I want to come back with her body. Bolted Bionic Husband would like that too.

Beside being a knowledgeable instructor, Shane has a warm, inviting personality and the ability to motivate you in a way that works for you. I always look forward to class and never get that "I don't want to go" feeling. Since working with her my legs have become incredibly strong and I see muscle where there was none before. My arms are stronger and have taken shape. My tushy actually has some lift (after years of buying the same brand of jeans, I had to buy a different brand this year that would accommodate a more "pronounced" booty). And my abdominal core is stronger and has some definition - I have noticed the muscles engaging and protecting my back during the most basic of movements, and I often feel as if I am wearing a protective corset that supports my body and my posture.

So when my physical therapy sessions had to come to an end (thanks Bolted Bionic Health Insurance Company!), it was an easy decision to continue to do Pilates with Shane, even if it is an out-of-pocket expense at a time when money is tight. I look at it as a continued investment in a body that can now be monetarily valued at more than $150,000. But the value of feeling strong and living without pain? Priceless.

SEVEN MONTHS POST-OP.

2009-06-13T14:13:00.000-07:00

The picture on the top is of the fusion incisions one week after surgery, while the picture on the bottom is how they look after seven months. The scar left by the drainage tube has really minimized, and the lengths of the scars have decreased. The pinkness is starting to fade and the scar tissue has increased.

All in all, they don't look so bad. They are obviously healing and that is a wonderful thing. I can still feel outlines of the hardware underneath, and occasionally I cannot feel the skin between the incisions being touched. Must be a nerve issue. But folks, they're getting better and that's a good sign!

PHYSICAL THERAPY: PART TWO.

2009-05-28T07:23:00.000-07:00

Physical therapy has been going great. Doing Pilates exclusively on the reformer. I have developed some solid muscle, especially in my legs. People with lumbar spinal fusions have difficulty bending forward, so the best way to pick up something I dropped is by squatting. Thank goodness for those quads and hammies!

I am taking much less medication than ever before. Still taking Cymbalta everyday and Tramadol as needed, but that's it. Things are clearer now, and I notice things I never noticed when I was in a drug-induced stupor. I am also doing 30-40 minutes on the treadmill (not running though) and the elliptical three times a week. My quality of life and health have definitely improved.

I still have some physical goals beyond what I am doing now. I really want to ski next season, and I figure if I stay on the groomers, stay cautious, and maybe wear my old brace to prevent twisting, I can. I want to start cycling, not just riding my mountain bike on paved trails. The drawback of cycling is that the position itself does not allow for a flat back, but I figure if I get really strong and build my abdominal corset, it may be a possibility. We'll see what happens but this is my hope. For now, I am so happy to be walking without pain and doing Pilates.

I have received a handful of emails on my Facebook account from people who are contemplating a spinal fusion or have already had them; sharing their stories with me or telling me that what I have written has given them important information they have not heard from their doctor; has made them feel less scared and hopeless about having this surgery. Thank you so much to all who sent emails: this is the reason I started this blog and I am so pleased that people are reading it and taking something from it. I wish you all the best and will continue to update with new information and my status.

Remember: it takes 12 -18 months to fully recover from a spinal fusion and I plan to document it all.

PHYSICAL THERAPY: PART ONE.

2009-05-27T08:26:00.000-07:00

About six weeks after surgery, my surgeon said it was time to start physical therapy. I had been done some basic leg stretching exercises given to me by the home health physical therapist, but this was the big show.

I did quite a bit of research about where to go. I wanted to go to a clinic that had Pilates equipment; my last round of PT three years ago included Pilates and it was extremely effective (until I stopped). I also wanted to go to a clinic that was privately owned by a former physical therapist - these clinics tend to be more patient focused and more invested in your treatment and recovery than PT clinics that are operated by large health systems focused on volume. Just a personal choice.

I was fortunate to find just the clinic I was looking for, even though it is a 30 mile round trip. I started PT in January when temperatures in Las Vegas hovered in the 50s. My sessions always began with 1o minutes on a big heating pad (my favorite part of therapy!) The PT would then come over and do some mobility exercises, then assign me various exercises to do in clinic. Each visit started with heat and each visit built on previous exercises along with new exercises. I noticed that some of my stamina and energy was returning and that I was feeling stronger. At this point, I was faithfully attending PT three times a week while still doing exercises at home and 20 minutes of the elliptical at the gym.

About four weeks later, my PT recommended I start the physical therapy version of Pilates, a thirty minute session using a Pilates reformer to further strengthen my core. As the physical therapist described it, I want my abdominal core muscles to form a corset that will hold my spine in place and prevent it from moving when I move. All of my movements should engage those core muscles whether I am emptying the dishwasher or braking when I drive. I was pretty excited to get started.

I arrived for my first official session and met Shane, a lovely former Las Vegas showgirl who has been a dancer since she was two. After tiring of dancing on the strip she delved into Pilates study and became a certified instructor. The combination of Shane's knowledge of Pilates, her understanding of the limitations of my condition, and her incredible personality was an instant match.

I cannot stress the importance of finding physical therapists and other people involved in your recovery that you click with. These people will see you on good days and bad, and need to inspire and motivate on the bad days and celebrate the good days - if your preferred method of motivation is bootcamp style, know that, and the same goes for those who prefer a more nurturing form of motivation.

Do what works for you - a good relationship with your "partners in recovery" helps you get to the clinic on days when you want nothing more than to settle in on the couch with a couple extra pain pills; days where the pain is worse than it was yesterday and you distinctly remember being told you would feel "so much better" after surgery; days where you just don't have any extra energy to face your recovery and would rather reflect on life before your body became your worst "frenemy." Shane has been that person for me and I owe much of my recovery to her. Her optimistic attitude and wonderful sense of humor made me commit to never complain during therapy and to push through the soreness and fatigue. I was lucky to be here so this is a No Bitching Zone.

We started off with very basic reformer exercises and the importance of breathing, scooping the belly button into the spine, and pulling in your pelvic floor (which has other benefits, ahem, I might add). These movements train you to stabilize your core, that all-important cluster of muscles, with every movement. Although the sessions were 30 minutes three times a week, it was a quick thirty minutes. I realized I LIKED this kind of exercise! And I felt muscles I didn't know I had after each session, slowly feeling stronger and more aware of my body, a body that had turned its back on me (for lack of a better word) a long time ago, a body that was finally deciding to call a truce.

POST-OP: WEEKS TWO THROUGH FOUR.

2009-05-22T10:45:00.000-07:00

I had an appointment with my surgeon during Week Two and to the left is my X-ray. He was very pleased with the placement of the hardware and how the rest of my vertebrae looked. I was still using my walker and easily fatigued, and sitting in a car was very uncomfortable. But by this time, the severe pain the accompanied that first week after surgery had subsided significantly. What was left was much more bearable and was minimized with pain medication.

I was already off the Percoset and the antibiotics and taking Tramadol and Soma as needed. I was finally able to sleep through the night with the aid of a sleeping pill. I was really hopeful and was able to stay awake a little longer throughout the day. And my incisions were healing perfectly - my home health nurse made a funny comment that they were the cleanest sutures she'd ever seen!

I have to give all the credit to Nurse Mom, a real Registered Nurse, who observed and monitored my incisions like a hawk. Trust me folks: you do not want infection to further complicate the pain stemming from holes in your vertebrae accommodating screws and bolts (giving the phrase Drill Baby Drill a whole new meaning) and the perpetual sting from the incisions you already have. Take care of them like you would a newborn baby or cashmere sweater and do EXACTLY what your surgeon and your home health nurse tell you to do. Don't make an already sucky situation suckier by allowing infection.

Things continued to improve through these first four weeks. I put on a little more weight but not so much where my brace was uncomfortable. I would wear a tank top underneath the brace and a shirt or sweater over it. (I actually bought a few maternity tops and sweaters from Target that fit over the brace perfectly!) The average observer could still tell there was something going on under there but at least it was totally obvious in public. During week two I was visited by a physical therapist at home who taught me three basic exercises to do everyday to keep strong until I could go to outpatient physical therapy sometime around week six.

By week three I was moving around without the walker and showering without supervision (I still used the shower chair though). I even took my first non-medical-related trip out of the house - Bolted Bionic Husband took me to see Twilight on opening day, and I was able to sit through the two hour movie fairly comfortably. I remember being so excited to get out of the house that day (as well as shocked that Bolted Bionic Husband would even set foot in a crowded theater to watch a just-released movie about teen vampire lust). The only drawback is that I had lost quite about of strength in the first few weeks and had lost alot of stamina. By the time we got home from the movie I was exhausted, but I was out! In public! Walking without assistance!

By week four, per my surgeon's instructions, I started exercising on the elliptical machine 20 minutes a session three or four times a week. For those of you unaware of this exercise machine, it simulates the action of running without the impact. It is very easy on the joints and with a spinal fusion, impact is your worst enemy. The benefits of starting exercise were clearly gaining stamina and strength and keeping weight down, but the best benefits for me included keeping the depression at bay that had been hovering over me for years.

Things were getting better every week and I had more hope than I had had in years that things were going to be OK.

POST-OP: WEEK ONE.

2009-05-22T10:25:00.000-07:00

The first four weeks after the spinal fusion are a little fuzzy due to the large volume of medications I was taking - Percoset, Tylenol, Soma, Lunesta and antibiotics - but I will do my best to describe those brutal weeks. (This picture is the abdominal incision that was required to perform the anterior fusion - the scars on my back in the picture below are from the posterior fusion. Take note: the abdominal incision develops significant scar tissue and leaves a solid bumpy ridge down the belly that will eliminate the possibility of that flat, sexy stomach for the rest of eternity. Sigh.)

My first week home was miserable, but I was so happy to be out of the hospital. I am so fortunate to have a mother who is a registered nurse, a father who is a physician, a sister who would do anything for me (and is also a therapist - score!) and Bolted Bionic Husband, who takes no prisoners when it comes to solving a problem. While I was assigned a home health nurse to perform daily evaluations of my incisions (all four of them) and the area on my neck where three catheters were inserted and removed, my mother and sister were truly the ones who took over my daily care. I could not do anything on my own - I needed help showering, getting dressed, brushing my hair, using the bathroom. I needed all sorts of tools to make these taken-for-granted activities possible including a raised toilet seat, shower chair, a grabber tool and a walker. I needed the walker to move anywhere, and anytime I was not showering, I was required to wear the brace. I owe my family a debt of gratitude for all their help in my recovery.

The first week was difficult. The pain was constant and often kept me awake at night despite the medication and sleeping pill. I could NEVER get comfortable, and every couple of hours I would elbow Bolted Bionic Husband who, without really even waking up, would bring me more medication.

I spent most of my days sleeping after having a shower because that minimal amount of activity was exhausting. My mother would change my dressings, which were weepy and draining the entire first week, and then I would fall asleep until mid afternoon when my home health nurse would visit to examine my sutures. After that I stayed awake enough to visit with my family in the evening, and was usually asleep again by 7pm. There was never a comfortable position to be in that first week, and everything hurt. I had dropped 15 pounds and all my clothes sagged, although the up side was having more room for the back brace which was worn almost 24 hours a day. I was generally very weepy alot of the time, but hopeful I would feel better soon.

THE HOSPITAL.

2009-02-24T09:58:00.000-08:00

Well, recovery is a million times worse than I thought it would be. I don't remember everything that happened in the hospital, and maybe that is a good thing. What I do remember is this: an unfathomable kind of pain that never stopped. I felt it from the moment I woke up to the moment I attempted to sleep.

A significant amount of pain came from the incisions. The incision on my belly is about 5" and verticle to the left of my naval. Because the surgeon cut through the abdominal wall, muscle, and arteries to expose the anterior vertabrae, I came out of surgery swollen, as if I swallowed a watermelon or was suddenly eight months pregnant. I am not exaggerating. Also to access my posterior vertebrae I was hanging downwards from the waist; my face swelled to moon-sized proportions. I was full of tubes: oxygen tubes, catheters, drainage tubes. I asked my family why they didn't take any pictures. Their response: We couldn't bear to ever see you like that again.

If you are contemplating this surgery, prepare to be your own advocate for post-operative care, and make sure that someone in your family or a friend will be your advocate when you cannot. I kept running out of morphine and was in terrible pain all the time. I remember being on my side hanging to the hospital bed rails with white knuckles praying that someone, anyone, would make this stop. My family was tenacious and unstoppable when it came to getting me the things I needed and I can never thank them enough. My family is the reason why I can have a hopeful outlook on life today; the reason why I healed so well; the reason why I made the tough decision to proceed with this surgery. I knew they'd be there.

It took the entire time I was in the hospital for the severe abdominal swelling to subside. I was in so much pain I did not have much of an appetite - I think I had some ice cream with cherries on top and a piece of French toast with syrup the whole five days I was admitted. I also got a chest rattle due to the morphine - it slows your respirations and makes it easy to contract pneumonia - and had to go on respiration therapy. A therapist came in every four hours and had me breathe a mixture of medicines through a tube. Hard to do when you are knocked out on morphine.

Speaking of therapists, I saw a slew of them. I had a respiratory therapist, an occupational therapist and a physical therapist visit me over those five days. The occupational therapist taught me how to put on my brace (see previous posts for a picture of that sexy little number) and get in and out of my bed and chairs. The physical therapist (who was absolutely darling) visited every day to teach me to move with my shiny new walker and the brace. This was the hardest thing I had to do: you lose a significant amount of muscle and stamina after surgery, more than you can imagine. The first walk I did only got me two rooms down the hall and back before I was exhausted. A "hospitalist" visited every day, although he never came within ten feet of me. My anesthesiologist visited the day after surgery, and my doctor visited a few times to write orders (I had a catheter in my neck and a drainage tube coming out my back above the three verticle lumbar incisions that needed to be check, removed, etc.). I remember my anesthesiologist, an extremely attractive man, saying to me before surgery "I will take care of you as if you are my wife, and I really love my wife." I am certain it is mutual, sir.

I was finally discharged (after dealing for hours with a totally incompetent case manager who wanted to admit me to a rehabilitation hospital - my husband put a quick end to that idea) after fulfilling some important post-operative criteria (urinating). It was great to know I was going home to my own space, my own bed, anything familiar.

If you are contemplating this surgery: prepare to have as much back pain or more than you did before, prepare to have significant pain at the many incision sites, prepare to be weak, prepare to drop some weight from lack of appetite (I dropped 15 pounds). Most importantly, don't expect to feel better instantly - it doesn't work that way. Feeling better takes some time and some patience, but I did feel better.

WELL THAT WAS FUN.

2008-11-24T10:40:00.000-08:00

I have so much to report about how surgery went but I just can't right now. For those of you that think that four weeks to get feeling better seems extreme - you have no idea.

It is important to know that this surgery and the weeks after it involve a significant amount of care, and I know that my family was very invested in my recovery with their time and energy. They did everything: from getting me out of bed and showered, to housework, to driving me to medical appointments. I will recover because of all their loving help. For anyone who is thinking about having a spine fusion - you absolutely cannot do it alone.

On a cute note, I used my walker so much that Bolted Bionic Niece, pictured above, turned one of her toys into a "walker" so she "could walk like Auntie." I thought my heart would burst from the pure unadulterated adorableness.

T MINUS 24 HOURS.

2008-10-13T08:07:00.000-07:00

It all starts at 5:30 am tomorrow. It was a busy week of getting prepared for the spine fusion surgery. I had to get another set of labs done as well as a new EKG. I got my post-operative prescriptions filled - one for Percocet and another for Soma. I also was measured and fitted for my new back brace which I will spend the next two months wearing. It's a sexy little thing.

I was measured for the back brace at a prosthetics clinic. After measuring my waist, ribcage, hips, and the distance from my breastplate to my belly button, the prosthetics specialist sends the measurements to a company in Florida that custom-makes the brace in about a day and ships it back to the clinic. I went back to the office Thursday to try on the brace and make sure that it fits well. To be honest, it is very comfortable, much more so than I would have imagined. It feels really supportive, and I feel like it gives my muscles a much needed break from supporting my weak frame. I will take it with me to the hospital, and the surgical team will put it on me right after the surgery. It is much thinner and lighter than I thought it would be and fits nicely under a hoodie or a larger t-shirt. Plus ladies, it lifts and separates if you catch my drift . . .

I had my pre-operative appointment Tuesday and my surgeon went through what to expect Monday and the days following the surgery. He explained the risks, including but not limited to stroke and heart attack during the surgery that could cause paralysis and blood clots (he did say that he does NOT believe this will happen as my EKG and labs were normal). He also wanted to make sure I understood that I may or may not get the results I want from the surgery, and that once he made the incision and starting working on my spine, he reserved the right to change the care plan based on what he finds.

The surgery will take 7-8 hours, and the nurses will get me up and walking once I awake from anesthesia. After that, he recommends I spend about an hour a day walking to keep mobile and reduce the chances for blood clots. As soon as I am able to perform basic functions (pass gas, urinate, walk) I can be discharged from the hospital and go home. (The gas issue may seem a bit strange, but apparently the removal and replacement of my lower organs to fuse the anterior vertebrae causes an influx of air and bloating.)

[A post-publication note: the surgery was not 7-8 hours, it was closer to ten. The nurses did not get me up and walking afterwards. I was in so much pain that could not be managed that the focus was more on pumping enough morphine into my body to make me stop moaning in despair. I could not walk for more than a couple minutes because of pain and exhaustion, certainly not the previously recommended hour, and to prevent clots the nurses put these little booties on my feet that sent electrical impulses through my legs. They would constantly wake me up. Although I was able to meet the three pieces of criteria for discharge within a couple of days, I developed respiratory issues that kept me in the hospital. I also was in terrible pain - did I already mention that?]

So the agenda today consists of stopping any solid foods at 1:30 and start drinking a magnesium citrate cocktail at 4pm and another four ounce cocktail at 8pm. I recommend buying the lemon flavored magnesium citrate and chilling it for a couple of days in the fridge. Then, add it to some Crystal Light lemonade and drink that over ice. The Crystal Light is clear enough that it can be consumed until the few hours before surgery when you cannot have any liquids.

In case you have never had the opportunity to participate in this pre-operative ritual, magnesium citrate is a powerhouse laxative that clears out the digestive tract so that moving my intestines around will be easier. So I will be spending my evening in the bathroom. It is well stocked with bottled water, the latest issues of Oprah and Shape, and my laptop. At least this is a chance to catch-up on my reading.

In rereading previous posts, I have noticed that the majority are technical explanations of what has happened over the past four years and what is about to happen in the next four months, and that I have not spent much time writing about the emotional aspects of what is to come.

I'll be perfectly honest: I am very nervous and scared. Some of my fears include waking up paralyzed and spending the rest of my life in a wheelchair, a fear dispelled by my surgeon. Another fear is waking up from anesthesia during the surgery, feeling everything the surgeon is doing, and not being able to communicate to anyone about it. I also have no idea how much pain to expect after this and that scares me. And I do not want to leave the hospital with a prescription for OxyContin - that drug scares me to death. I hope that whatever pain surfaces post-surgery can be controlled with Percocet, or my drug of choice, Tramadol.

But despite this, I ready for surgery. I am ready to feel better. I am ready to be able to walk and ride my bike. I am ready to walk my dogs. I am ready to ski and hike and do all the things I haven't been able to do for some time now. I am ready to put this behind me and I am ready for my life (and my family's life) to revolve around something other than my back problems. I am ready.

I am lucky though. Despite anything that may happen, I can take comfort in the knowledge that I have a great family and a wonderful group of friends that would do anything for me. And that makes anything that comes along easier to bear.

I CAN'T WAIT FIVE YEARS.

2008-10-08T10:25:00.000-07:00

Met with Dr. X from the University of Utah Orthopedic Center on Monday to get his perspective on my physical condition. Dr. X seems very conservative in his approach and does not perform many surgeries. I started the visit with new sets of X-rays, and since I sent him the CD of my most recent MRIs, I have to assume he reviewed those as well.

Dr. X was very much on the fence with his recommendations: he suggested I get a discogram, a procedure where the discs are injected with dye to better identify the ones that cause the pain. Unfortunately, discograms carry inherent risks, including the fact that the injection of the dye can cause an already weak disc to rupture, creating additional damage or a new herniation. Also, the dye can leak into damaged disks and make identifying damaged discs difficult if not impossible. And lastly, it is an extremely painful procedure for the patient that ultimately culminates in a somewhat unreliable outcome.

Dr. X spent a good deal of time talking about the risks of surgery and the fact that many surgeries do not relieve the pain as well as patients hope or are led to believe by their doctors. He talked about artificial disc replacement, and that this surgery is effective only in cases where one disc is creating pain (since I have four herniated discs, this type of surgery would be useless). In addition, there have been no long term studies into how much wear and tear artificial discs can take in a human body, and once an artificial disc is inserted, it can be life-threatening to replace it because of the arterial vein scarring that occurs in the original surgery. Hmmmm.

Upon discussing a spine fusion, Dr. X informed me that the outcomes are extremely unpredictable, with many patients getting 50 - 75% relief from pain. He also reviewed what I already know - that the surgery is very invasive and carries with it a long recovery.

By the time the consult was over, I wasn't sure if I had learned much more than I had already learned before the visit. However, something Dr. X said really resonated with me. He said that I could always wait five years to see what kinds of new technologies and therapies are available to help me. The more I thought about this, the clearer my options were: I am a 33-year-old woman who can barely dress herself, let along participate in other activities (skiing, hiking, walking my dogs, playing with my niece and nephew) I used to love doing. I do not have five years to spend like this.

And that's when I decided that I would go ahead with the surgery. I do not expect a perfect outcome, and I do not expect to be 100% pain-free. What I do hope for is to feel 50- 75% better than I do now, using 50 - 75% less medication than I take now. I want a piece of my old life back, and I am willing to face these odds to get it.

ABOUT SPINE FUSION SURGERY A.K.A ARE YOU @#%!*#@ KIDDING ME?

2008-10-01T09:40:00.000-07:00

There is quite a bit of information out there about what a spinal fusion operation is, and there are many different ways to do it depending on your physician's opinion and preferences.

In a nutshell, here is what Bolted Bionic Surgeon told me: he will be in the operating room with a vascular surgeon and two other general surgeons that will assist. The vascular surgeon will create an incision in my lower belly area, move my lower abdominal organs onto a tray to clear the lumbar spine area, and seal off any arteries and veins that were opened and bleeding.

At that point, my spine surgeon will come in and begin the anterior entry portion of the surgery: he will remove what is left of the two discs, and insert synthetic bone where the discs were. After that, he provides a support system for the vertebrae using bolts and screws (I think he may have purchased them at Lowes the night before). Once that is complete, the general surgeon puts my organs back into their original locations and sews me up. Then they flip me over and the real fun begins.

At this point the posterior segment of the surgery begins. The spine surgeon makes an incision in my lumbar area and drills bolts and screws into the back of my vertebrae. these bolts and screws support a kind of "cage" that holds up L3-L4-L5. He then sews me up and the rehabilitation begins.

Why the two incisions front and back? Well, according to my surgeon, there is less blood loss and thus less blood tranfusion required by doing it this way. After this description of the surgery, which sounds abominable and extremely painful, I am sure interested to see what I learn from Dr. X in Utah next week during the second opinion.

A SECOND OPINION.

2008-09-30T16:10:00.000-07:00

Today is my last day at work before officially going on a medical leave of absence. To be honest, I am relieved beyond words. I am relieved to not have to navigate airports and lift luggage and deal with client visits right now. I am relieved to not be limping around the office hallways with people thinking whatever it is they are thinking bout me. I am relieved to not have to focus on solving crises and interact with uncooperative colleagues while hopped up on pain medication. I am relieved to not have to go through my morning routine of getting showered and getting dressed, which leaves me exhausted before I even get into my car. I am relieved that I do not have to squish into work clothes like a sausage in its casing - the last few months of physical inactivity have left me with a good extra 15 pounds on my frame.

The outcome of the diagnostic procedure mentioned in the last post was interesting. For the first time in a long time, I hardly had any pain, but the procedure itself was extremely painful. I have had several lumbar epidurals over the years that were performed under sedation; I was completely unaware of what was going on and didn't feel anything other than some tenderness after the procedure.

With this particular procedure, the doctor needs you to be awake to comment on any pain you feel. Let me tell you - it hurts. I had ten injections of anesthetic between the vertebrae , all of which I could feel. Afterwards, the doctor advised I treat this as a "test drive" of what to expect with a spine fusion. He asked that I do something physical within the next six hours that I would not normally be able to do.

Bolted Bionic Husband took me to the mall and we walked around, something I would not have been able to do on a normal day, and interestingly enough, I only felt pain in my thoracic area (the upper back) but none in my lumbar. However, when the anethetic wore off, it really wore off: I was in tremendous pain. The doctors request that patients stop taking pain medication one to two days before this diagnostic procedure so that the outcome is more realistic of your actual pain level. And as many of you trying to manage chronic pain know - it is all about being ahead and in front of the pain with your medications. In addition, there were so many injection sites that when I showered for the next three days after the procedure, the injection sites would burn and sting.

My doctor called the next day and asked for my report. I told him that I had less pain than I had had in years. And during my next appointment he advised that I seriously consider a spinal fusion.

The next step is the second opinion which I decided to get at the University of Utah Orthopedic Center. My father is a physician and believes that the University of Utah Medical Center is a Medical Heaven on Earth. His physician referred me to Dr. X, who is considered an expert in spinal conditions. If he tells me I need to do more stretches or yoga or Pilates, I think I will truly lose my composure right in his office. There is nothing that I can physically do, not enough downward dogs or sun salutations, not enough consumption of green leafy vegetables or supplements or acupuncture or aromatherapy that I can do to make this better. But something tells me that once he sees those two discs that barely exist anymore, he'll at least have something to say.

THE LAST RESORT.

2008-09-25T14:25:00.001-07:00

After trying what has seemed like everything, I finally visited a spine surgery specialist who sent me for new MRIs. The findings:

"Progressive 3-4 mm L1-L2 subligamentous disc extrusion extending to the L1 inferior endplate and causing central canal stenosis (8-9 mm AP canal diameter). Disc protrusions at L3-L4 and L4-L5. Multilevel lumbar central canal stenosis due to discogenic disease and congenital short pedicles (8-9 mm AP canal diameter at L1-L2, L3-L4, and L4-L5)."

In layman’s terms, I have five discs in various stages of herniation with significant spinal stenosis. Two discs were barely visible in the films (see black vertical stripes in picture above). In addition, my gelatinous disc goo in these two discs looks as if it has melted around the spinal cord and the nerves, causing significant impingement (see the masthead picture above - that is my L3).

My specialist's recommendation: undergo a diagnostic procedure where the two worst discs are injected with a powerful anesthetic. If I am pain free for up to six hours afterwards, than we can determine that these discs are the culprits. And the most effective treatment for these virtually nonexistent discs is to remove them and fuse the vertebrae around them together to support the spine and relieve pressure on the surrounding nerves. This is called a spine fusion.

Whoa.

TAKE SOME PERCOSET, NEUROTIN, TRAMADOL, CYMBALTA, AND SOME SOMA AND CALL ME IN THE MORNING.

2008-09-25T14:25:00.000-07:00

This is the morning pain pill cocktail I have been throwing back for almost four years now, the only variance being that the dosages of these medications have continually increased since they were first prescribed. Let me clarify: this is what I took to start the day and does not include any medications taken during the remainder of the day. IIt can certainly add up, can't it?

Despite all I was doing and had been doing, the pain returned with a vengeance. I can no longer twist or bend - no more yoga or Pilates. I didn't finish the ski season and spent the last day of it knitting in the lodge while my husband and friends partied on the slopes. I don't walk my dogs now - walking at a brisk pace causes bone to grind on bone in my lumbar area which panics me to no end – what if it severs something I really need? What if I end up in a wheelchair? What if it creates even more pain?

At the time I was working for a software vendor and was traveling at least once a week. I would wake at 4am and immediately take the Cymbalta, Tramadol and Soma, even before I had my coffee. That way, it could start working while I took a hot shower to soften my muscles surrounding my spine that are always tight. I would haul a laptop and a rolling suitcase to the airport by 5:30 am, lifting both on the security x-ray, taking off my belt and shoes, walking through x-ray, putting my shoes and belt back on and lug my gear to the gate (by this time I couldn't wear any kind of shoe that wouldn't slip on. Anything with buckles or laces were impossible as I could not bend forward to buckle or lace them without tremendous pain).

By 6:30 am, I was in alot of pain and exhausted. Once I boarded the plane I would lift my suitcase into the storage bin, and lift it back down at the end of the flight. Once I arrived wherever I was scheduled to be, I would then take a Percoset and the Neurotin as needed (and it was always needed) throughout the day. I would repeat this entire process - airport, security, lift suitcase up, lift suitcase down - around 7 pm the same evening, taking an additional Tramadol or Soma with a plastic glass of cheap Chardonnay.

I was exhausted, in tremendous pain, and clinically depressed. To be perfectly frank, there were several times I wished a semi would run the red light of an intersection and hit me. Other times I hoped to slip on the kitchen tile and quickly break my neck or trip and fatally split my head open on a blunt object just to not have to deal with this anymore. Plus the added pressure of trying to perform to my previous standards at work while I was having this physical and emotional meltdown was taking its toll, and I began to feel like I could not do anything well. At this point only a handful of my coworkers knew I was sick. Then, when pinched nerves in my left leg created a significant limp, it wasn't as easy to hide how I felt physically when walking around the office. I was also becoming less capable of keeping my opinions to myself and took issue with things that would not have bothered me in the past. FYI, coworkers and bosses, especially, do not appreciate this. Things were going downhill in a hurry and I knew it was time to try something else. This was no way to live.

AND BACK TO THE DRAWING BOARD.

2008-09-25T14:24:00.000-07:00

When the pain unexpectedly crept up again a few months later, I added acupuncture to the mix, thinking that Eastern medicine would do the trick. While I believe that there are many positive and effective outcomes to Eastern therapies like acupuncture, I personally experienced no relief.

Again, I increased my medications and even began a controversial therapy of injecting human growth hormone, shown in various research to speed healing and cellular regeneration, into my abdomen on a daily basis. I started testosterone therapy as well, with the goal of building more muscle to support my spine. Every morning like clockwork, I rubbed testosterone-laden cream on my body like Jergen’s lotion. One thing about these therapies? They are EXPENSIVE, and due to their controversial nature, they are not covered by insurance.

When the pain grew worse I started doubling some of the medications prescribed by the pain management physician. I would frequently do this while putting on my ski boots, determined to participate in "normal" activities with Bolted Bionic Husband, while chasing my “pill cocktail” with a Bloody Mary - extra vodka - at the lodge’s bar. This may work for rock stars but for me, not a good quality of life choice.

MERRY CHRISTMAS AND HAPPY HANUKKAH!

2008-09-25T14:22:00.000-07:00

The following December I was in a MRI chamber, willing myself not to open my eyes while the machine drummed away, knowing that if I opened my eyes to complete darkness I would freak out and embarrass myself in front of the staff. It occurred to me, a little too late, that I could have sedated myself just with what I had in my home medicine cabinet.

The result: four discs in various stages of herniation and/or degeneration, with the beginnings of spinal stenosis (for those of you new to “spine-speak” that means "marked narrowing of the spinal canal"). I began physical therapy which consisted of traction three times a week to decompress the discs and take the pressure of the nerves that were sending severe bolts of pain down my legs. I also began doing basic Pilates exercises to strengthen the abdominal core which supports the spine.

At the same time and over the next few months, I endured four sets of lumbar epidurals in each disc to reduce the inflammation that was putting pressure on the nerves, and to anesthetize the radiating pain. I attended a yoga class twice a week to augment the twice weekly Pilates sessions I was also doing in physical therapy. And to wrap these therapies all up, I visited a pain management physician who prescribed a combination of drugs to manage the break-through pain.

I was in less pain for the first time I could remember since June 2004, and felt almost normal: I was walking my dogs regularly, still doing Pilates and yoga, and skiing regularly with Bolted Bionic Husband. Due to the Pilates and yoga, I was also in the best physical shape I had been in since college and my body took on a beautiful new shape. I felt like I had put this behind me. I felt that I had recovered.

I was wrong.

AND IT BEGAN . . .

2008-09-24T18:00:00.000-07:00

June 16, 2004.

I woke up to indescribable back pain I had never before experienced in my lifetime. Stabbing pain in my lower back layered over a dull, throbbing ache. I had burning in my legs that rushed down to my feet, often resulting in loss of sensation in my feet and toes, making walking and driving difficult since I could not feel what my feet were doing. Years before, I had bouts of back spasms that would crumple me to the floor until they subsided, but this was a hundred times worse.

At the time I was working over 65 hours a week implementing new computer systems in a very large company. It was a fast-paced, stressful environment that I had thrived upon, but now, everything I did caused pain and moving around was simply exhausting. I would come home after work, take some pills, chase them with a glass a wine, and stretch out on the couch until I could summon the resolve to move to the bed. Life became not so fun.

I knew I had a serious problem when my assistant, who was such a kind soul, would do everything she could to prevent me from having to get up and walk: picking up documents from the printer, getting office supplies, a cup of coffee, sometimes lunch. I still love her for it.

Since I was so busy with work I put off seeing the doctor, thinking I must have twisted wrong or pulled a muscle unloading the dishwasher or something, and that the pain would eventually go away given some time to heal. Little did I know at that time that this pain would transform my life over nearly a five year period. This was just the beginning.