Category Archives: Journey through Spinal Fusion Surgery

A chronicle of my journey through chronic back pain, diagnosis, treatment, ALIF spinal fusion surgery and beyond

Bone Growth Stimulator/Supplements

********update, if your insurance company does not pay for this device or you have a large co payment in order to get it I would say save your money, it turns out that the claims that this device makes are not proven medically or scientifically so I would not recommend it.  The best thing you can do is make sure you do your physical therapy, make a decision to lead an active lifestyle after surgery for example, walking every day.  Exercise will help you recover and rehabilitate more in the long run than expensive devices and or supplements.  Spend time strengthening your core because a strong core will also do more in the long run in managing pain and providing the strength of the muscles around your spine and therefore reducing pain and the chance that you will have further damage to discs in the future, I am  4 years out from surgery now and this is my own advice I am offering and taking.  I am happy to answer questions of anyone currently or having experienced back injury and or surgery so feel free to email me at c.reed.cate99@gmail.com or by posting a comment here, I will respond as quickly as possible.

The newest addition to my recovery from the ALIF surgery is a CMF Spinalogic bone growth stimulator .  It is worn like a belt around my waist for 30 minutes a day.  I will need to wear it for at least the next 6 months.  According to what I have read about it, it creates a magnetic field that apparently increases the rate of new bone growth by 21% vs patients who do not use one.  It is really not hard to fit it into my day, right now I usually put it on after my shower but before I get completely dressed, in fact I am wearing it right now over my bathrobe.  After I return to work, I plan to put it on as soon as I get home.  You simply wrap it around your waist like a belt and there is a circular part that sits right over the discs that you had fused and fasten the Velcro so it fits snugly, then you press and hold the button on the controller which is attached by what looks like an old style phone cord until it beeps. Then it times your session and beeps again after 30 minutes.  That separate piece has a belt clip that attaches to the belt part so you can walk around during the treatment.  The only thing I notice when wearing it is a feeling of warmth on my lower back, there is no pain involved.  It was covered by my insurance company which is BCBS Anthem but they required a prior authorization by my surgeon’s office which took about 2 weeks to complete. I believe it is probably very expensive for people who do not have insurance or whose insurance company doesn’t cover it because I have seen them on Ebay for $200-500. I just got it this week and have not missed a day yet.  The nurse that told me about it told me that I am to bring it with me to my follow up appointment and that they will check the timer unit and it will tell them if I have used it faithfully or not.  Of course as far as I am concerned if I don’t use it I would only be holding up my own recovery and I want to do everything I can to regain my normal activity level so what would be the point of cheating? This is what the device looks like:

So between this, the daily walks for at least 20 min and taking extra calcium supplements I think I am doing all I can to promote the bone growth between the vertebrae that were fused (L4-S1 in my case which are the lowest 2 discs in the lumbar spine).  I have also added a new supplement called Dolomite powder by KAL.  It contains 1100mg/110% of calcium, 2mg/11% iron and 630mg/150% magnesium.  I am mixing 1tsp into OJ and a little milk to make it palatable since its rather chalky, this mixture makes it taste like a creamsicle.  I take this  in addition to the OsCal calcium supplement with D3.  It contains 600iu/150% of vitamin D3 and 500mg/50% of calcium.  The drawback with all this calcium with my pain meds causes Miralax to be a daily supplement as well since these things all cause constipation.  I hope all of this information helps those of you out there going through the same condition as me and I know there are a lot of us.  If we all help by sharing information hopefully we can look forward to a pain free and more active future!  Thanks as usual for reading and please feel free to share your own stories or tips by commenting on this post.

Resources:

https://www.djoglobal.com/products/cmf/cmf-spinalogic

http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=KA-1135

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Curcumin for Joint Pain and my new best friend

I just stumbled upon a new remedy for joint pain and overall inflammation, well the idea is new to me.  Apparently Turmeric, the spice, has anti inflammatory and anti oxidant qualities when taken regularly.  There are several ways to use it.  One of the ones that interested me was as a tea but you can also take a supplement called curcumin extract.  I found the curcumin extract at Walmart made by “Pure Health” it contains 95% curcuminoids and also has vitamin C 80mg, the curcumin extract amount in it is 500mg.  At Walmart this was $9.95 for 30 of them and says to take 2 of them 3 times a day although the article I read said you only need 200 mg per day.  I looked online today and found a better deal at Amazon, they had a 700mg curcumin supplement $14.99 for 120 of them so I ordered those.   If you are interested you can find them here:    http://www.amazon.com/gp/product/B00AQLGFHK/ref=cm_cr_ryp_prd_ttl_sol_0

I read an article yesterday written by a Dr Mercola

http://articles.mercola.com/sites/articles/archive/2011/01/31/curcumin-relieves-pain-and-inflammation-for-osteoarthritis-patients.aspx

who said that he found that his patients found more pain relief from taking curcumin than from taking

“In the latest study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility, whereas the control group, which received no curcumin, had no significant improvements.

A past study also found that a turmeric extract composed of curcuminoids (plant-based nutrients that contain powerful antioxidant properties) blocked inflammatory pathways, effectively preventing the launch of a protein that triggers swelling and pain.” Dr Mercola’s statement

NSAIDs and it’s definitely a lot safer and gentler on your stomach which is why I am so willing to try it.  Lately, on top of the back pain I have had a lot of pain in my joints like wrists, knees, ankles and hips.  Rheumatoid arthritis runs in the family but I have tested negative several times for it, most recently 3 months ago although 30% of people with RA do test negative.

I have also started walking almost every morning on my treadmill. I have known for a long time now that I needed to be moving more and that exercising would decrease my pain level and increase my mobility it’s just hard to imagine moving more when you are in so much pain all the time so I admit I have been procrastinating.   I got the deal of the century on Craigslist about a month ago.  There was a Nordictrack treadmill listed for $100, I contacted the seller within hours of him listing it and offered him $75 and he said yes.  When I saw it I couldn’t believe my eyes, it is like new, has built in fans, 12% incline, pre-programmed workouts, pulse reader, a port to plug in your laptop or Ifit device all the bells and whistles.  Check it out:!

My new best friend!

So now I set my alarm for 4:55am instead of 5:30 3 days a week so I can spend 30 minutes interval training as physical therapy for my back issues and believe me the last thing I want to do at the hour of the morning is work out but I can’t deny that once I am done I feel so much better and my pain is decreased not only then but for the whole day, it must be the exercise endorphins.  I have also incorporated hand weights for my upper arms while I am walking to help with those tricep muscles, I really don’t want those flappy old lady arms HAHA.    I am on week 3 of consistent exercise and I do feel better on the days when I walk so I really need to push myself to “just do it” every morning.

Here is the recipe for the Turmeric tea tincture, you mix this up and keep it in a jar in the fridge and mix about a teaspoonful into a cup of hot water for tea.

1 cup honey, 2 ½ tablespoons Turmeric, 2 tablespoons ginger, 1 ½ teaspoons black pepper

There is also a recipe for Turmeric milk to relieve cold symptoms and for healing from surgery or traumatic injury.  I haven’t tried it yet but plan to keep the recipe on hand.  I am sharing it here in case anyone reading this wants to try it now:

2 cups milk, 1 teaspoon turmeric, 1 teaspoon ginger, a sprinkle of black pepper, honey to taste

Mix all ingredients in a saucepan, heat to simmer, keep stirring for 2 minutes, cover and shut off heat and let sit for 10 minutes before serving.

The next step in my pain management treatment is another rhizotomy, it’s been 6 months since my last one (I had hoped to be the one it lasted a year for) and the pain has been slowly increasing since May and at this point has worked its way back up to about a 7-8 daily on the pain scale.  I am on 2 new medicines, Nucynta and Topamax and off of the Butrans patch.  So far this combination is working fairly well but I do have enough breakthrough pain that the rhizotomy is warranted as much as I dread having to go through that again.  It’s not scheduled yet but it will be the same as I wrote about in February of this year, I will re-post that when I have it done.

As usual, thanks for reading, I will let you know if I feel like the curcumin is helping with the joint pain and please feel free to let me know if you try it as well what you think of it or if you are already taking it please share what you think of  it.

My Rhizotomy story as it really happened

X ray of my actual rhizotomy

X ray of my actual rhizotomy

My Rhizotomy  story. 

As everyone knows, I put off this procedure out of fear for months.  The description sounded very scary to me and I have already been through a lot or different treatments trying to fix my back pain, some helpful, some not as much. 

So, back to the rhizotomy, 2 weeks before the actual procedure,  I had what they called a “test injection”, they inject lidocaine in multiple locations, in my case on both sides of my spine, and for about 24 hours you see how you feel.  If you get pain relief from that it makes you a candidate for rhizotomy because it shows them that the pain you have is coming from the nerves.  I had some residual pain after the surgery as well as from a car accident last fall.  So the test injection was not painful at all, it’s just little sticks when they inject the lidocaine and the lidocaine itself stings a bit going in but overall not a painful procedure, nothing to be afraid of.  I was a bit sore that night but when I woke up the next morning, it was amazing, I had no pain, I spent a lovely pain-free day for the first time in a long time and then that evening, I could feel it wearing off.  By 930pm the pain was back but at least I knew I was a rhizotomy candidate.  I called the doctor’s office that afternoon to report my result to them.

 

The Rhizotomy was scheduled February 5, 2 weeks after the test, the doctor I work for was planning to be off that Thursday and Friday so it seemed like a good time to do it.  I went in and went through the usual check in process, I got there early just in case they could get me back early.  First, they inserted an IV through which they would put the Versed.  Versed is a twilight sedation also used for colonoscopy, you are not asleep but you are relaxed and usually don’t remember much afterwards, although I do.  I walked into the procedure room myself and my doctor asked if I had any questions.  I did and he patiently answered everything I wanted to know which included how much pain to expect after and if I would need medication for that.  He said you can expect increased pain from the procedure for a few days up to a week and yes he gave me an RX for medicine for that.  Then they made me comfortable with a pillow under my chest while I lay on my stomach.  I wore yoga pants and loose shirt, this is a good tip, always wear something stretchy and comfortable or they will make you change into a gown and no one wants that!!!!  My back was exposed and draped.  I could feel what he was doing and it was uncomfortable, but not really painful, he made 5 openings on each side of my spine through which he cauterised the nerve roots.  The nerves coming out of the vertebrae are like the trunk of a tree and branch out from there so if the trunk is deadened, the branches can’t feel either.  At one point I started to cry so he told his nurse to put more versed in my IV, I don’t remember much after that until it was over and they put me in a wheelchair to take me out to the car.  Right before I left the room, I saw the x-ray picture on the screen and asked the tech if that was mine, he said it was and I asked him to print it which is how I got the picture above.  Even under the influence of Versed I was thinking of my blog. Ha ha, now THAT is dedication.  This is the last x-ray shot he took.  He used the x-ray throughout the entire procedure to guide where he put the canulas that he used to thread the cautery wires  through.  The picture also clearly shows one of my titanium discs which is kinda cool as well as some canulas (the dark lines that look like needles on the left of the picture). 

That night at home was rough, I was extremely uncomfortable and CVS took hours to fill my medication, apparently they are short-staffed.  I iced it for 20 minutes at a time, this had to be an hour apart according to their instructions and I slept in my back brace, propped up on a very elaborate pillow formation, it was the only way I could be even mildly comfortable.  In fact I am still wearing the brace at work during the day.  I wore it at night for about 3 nights and the first 3 days after I wore it all day as well.  It helped the pain by giving support so I can’t move in ways that would cause pain.  This is day 6 and I already have far less pain going down my leg, so fingers crossed this worked he said I might not know the full benefit for 4 weeks so we shall see.  According to my doctor we are hoping for 12 months of relief from this before the nerves regenerate.  Unfortunately, that is the downside to this, it is not forever, the pain will come back to some degree when the nerves grow back and that differs by individual.  I am glad I went forward with it and I am looking forward to being able to do more of what I want to do physically and especially to feel better living without all the pain.

Thanks for reading, and if anyone out there has had this done or is thinking about it, please feel free to comment. We can share our thoughts and ideas.

Having an infiltration anesthesia test and probable Rhizotomy

Syrinx Asylum

***** 1-30-14: Update #2, I had the test last week and it worked, I was pain free for the first time in 17 years, it was injected lidocaine so it only last 24 hours but it means I can have the Rhyzotomy that has not been scheduled for February 5th.  The doctor I work for is off the 6th and 7th so if I need those days to recover I can take them easier than if she is here.  The website said it may take a week to recover and it is considered a surgical procedure.  I will have more pain for the first week at least and it will provide about 6 months relief.  I have new insurance so that if I have it done at the hospital I work for there is no copay so nothing out of pocket, so much better than last year.  I will keep you posted but…

View original post 1,433 more words

Having an infiltration anesthesia test and probable Rhyzotomy

***** 1-30-14: Update #2, I had the test last week and it worked, I was pain free for the first time in 17 years, it was injected lidocaine so it only last 24 hours but it means I can have the Rhyzotomy that has not been scheduled for February 5th.  The doctor I work for is off the 6th and 7th so if I need those days to recover I can take them easier than if she is here.  The website said it may take a week to recover and it is considered a surgical procedure.  I will have more pain for the first week at least and it will provide about 6 months relief.  I have new insurance so that if I have it done at the hospital I work for there is no copay so nothing out of pocket, so much better than last year.  I will keep you posted but the test injections were nothing to be worried about, no pain after at all.Click below for a link for the description given by the practice I go to and who will do the procedure.

http://www.southeasternspine.com/procedures-treatments/rhizotomy/

*****Update 6-27-2013 These 2 procedures have been put on hold for financial reasons.  I had no idea how expensive they were and the practice wants me to pay me entire balance even though I have been making regular payments to them and really my insurance is excellent, they have collected tens of thousands from my insurance in the last 18 months I have been there.  So I have an appt with a PA (the same one I have been seeing who really doesn’t understand pain) on July 3rd at 230pm.  I will update more on what my other options are after that appt.  I was very disappointed by having to postpone this potential for relief.

Well I am so disappointed to report that the news at my spine doctor’s appt yesterday was not at all what I was hoping to hear.  I was really hoping they would say that I still have pain because I was originally told it would take a full year to recover completely and to expect it to taper off and in the meantime we can just treat it with medication albeit lower strength medication than before which is fine with me and actually preferable. I want to avoid all of the oxy-codones at all costs.

Instead, the PA took out my MRI report and told me something I didn’t know before I had the surgery back in October.  What I knew then was that I had 3 herniated discs L3, 4 and 5 as well as some facet joint damage from these discs being herniated and that L4 also had a tear in it.  I could only have 2 discs repaired in a surgery so they replaced the worst ones, L4 to S1 with titanium implants and told me that L3 was damaged but not as severely but I could expect it to cause pain in years to come and actually it is now with pain in my left thigh.  With all this being said, apparently I also have problems from L1 all the way down.  The vertebral joints all have arthritis (most likely from the years of having the injury putting more stress on them than would be normal for my age) and she used the term Spondylolysis: “A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward (spondylolisthesis), it can compress the nerve roots causing pain.”   So, this is the reason I am still having pain all these months after surgery.  I have tried so hard to will it away, stay active (those of you that know me know that sitting still is not something I am good at) and was beginning to feel that this was a weakness in my character that I couldn’t rise above the pain and was still resorting to medicating it.

rhizotomy-chart

So here is the game plan, next Wed the 19th, I am having a procedure is called infiltration anesthesia  where local anesthesia is produced by injection of the anesthetic solution in the area of terminal nerve endings.  In my case L1-3 since they can’t do anything with the ones that have had surgical intervention.  If this produces pain relief, I am supposed to call the next day and tell them, if it does relieve my pain, then I am a candidate for a Rhizotomy.  This is the scary part; if it doesn’t relieve my pain at all then I don’t know what the Plan B is.  But the following is a description and indications for Rhizotomy as found on this website: 

http://www.espalda.org/english/divulgativa/dolor/como_tratar/informacion_paciente/rizolisis.asp

“Basis, indications and risk

 

Rhizotomy

It is the destruction of the nerves in the facet joints, normally by burning them with radiofrequency current.

Objective

To improve pain in instances of facet joint degeneration.

Theoretical base

There are no nerves in the cartilage of the facet joint. These are located in the bone placed underneath. This is why joint degeneration may not cause problems until the bone is affected. When this occurs, pain nerves are activated, with the subsequent onset of pain.

Conceptually, rhizotomy aims at destroying the nerves in the facet joint to eliminate pain sensation. It is usually performed by burning the joint nerves. Obviously, this procedure is only considered in those cases in which pain is due to activation of these nerves by facet joint disorders.

However, each facet joint enfolds nerves from two, and in some individuals three, different vertebral levels. Thus, for example, the facet joint between the fourth and fifth lumbar vertebrae may receive nerves that originate from, for example, the third, fourth and fifth lumbar level. Therefore, nerve destruction of only one of these levels may have no effect, or have a temporary effect until the remaining nerves take on its nerve field.

Also, it was traditionally believed that all pain nerves reached the medulla through the posterior root, which permitted the localization of the site where nerves had to be destroyed to eliminate the pain originated in the facet joint. However, recent studies show that, although there are individual variations, in some individuals up to 20% of pain nerves reach the medulla through the anterior root. Muscle nerves also pass through this root so it cannot be destroyed since, in doing so, it would cause paralysis of the innervated muscles.

It may only be indicated in cases that comply with the following criteria:

Indications

The existing evidence based recommendations do not recommend rhizotomy, essentially because they are focused on the treatment of acute cases and rhizotomy can only be considered in chronic cases.  It may only be indicated in cases that comply with the following criteria:

 Characteristics of pain:

    1. local pain with no radiated pain nor signs of nervous compression (such as loss of strength or reflex or sensibility alterations)
    2. Pain resistant to non-surgical treatments for more than 12 months.
  1. Pain origin:
    1. Rhizotomy should not be performed on patients whose other organic alterations of the spine may explain the pain.
    2. – It must be assured that pain results from alterations of the facet joint. This is the most important criterion to recommend rhizotomy and also the most difficult one to prove. The detection of signs of joint degeneration through radiological test is not enough, since many healthy persons have it. To verify it, a test with anesthetics is needed (see below).
  2. Test with anesthetics:
    1. – Before a rhizotomy treatment, an anesthetic infiltration test at the joint should be done. If pain is due to the activation of nerves at the joint, pain should disappear completely. Some authors recommend doing three infiltrations spaced out in time; two with anesthetics and one with a placebo (substance of similar appearance but with no effect), without letting the patient know which is which).
    2.  ***** this is what I described above and will be having the 19th (next week)
    3. – Rhizotomy should only be performed on those patients in whom pain disappears completely with the anesthetic injections and remains unchanged with the placebo shot.
  1. Patients:
    1. – An adequate selection of patients is the key criterion to assure that Rhizotomy has acceptable chances of success.
    2. – It should only be considered on patients whose pain complies with the above described characteristics, after discarding that it may be due to any alteration different from that of the facet joint and where pain disappeared with the anesthetic infiltrations.
    3. Technique:
    4. – The destruction of the root should be performed under radiologic control, to assure it is done in the right place.
    5. – The roots of, at least, two segments should be destroyed and two or three lesions should be made at each location, to accommodate personal variations in the course of the nerve.”

So knowing all of this, I am worried, I really had hoped I would have much less pain than I do at this point being 8 months post surgery and have done all I can do myself to try and alleviate and relieve it so apparently this is the next logical step and I will definitely let you all know how these tests really feel.  Of course, I was told that they were “easy” and “not any worse” than the epidural injections and the discography test that I had before surgery.  I will keep you posted 🙂  Thanks as always for reading and I hope that the information I share is helping someone out there going through similar situations with chronic back pain and injury.

Physical Therapy is even more important than I thought!

I am amazed at how much physical therapy is helping me.  I have to admit I was skeptical about it.  I was feeling pretty good and having people tell me that they couldn’t even tell I had any surgery because my mobility is so good.  However, when the therapist evaluated me she found some problems with my gait (the way I walk) that are easily solved with stretches and exercises.  My hip flexors have shortened because I have been over-compensating when I walk from when I was in pain and now it’s a habit I have to break. 

I have progressed to the point that I now have about 6 different exercises to do every day.  There is the hamstring stretch, the hip flexor stretch and pelvic tilt to strengthen my lower abs.  Two new ones are designed to strengthen my thigh muscles;  using a medium sized ball between my knees with a belt around my ankles I pull my ankles apart and squeeze my knees together at the same time and hold for a count of 10, then put the ball between my ankles and the belt around my knees and this time pull my knees apart and squeeze my ankles together.  It’s important for both of these that your ankles, knees and hips be in perfect alignment.  My thigh muscles are probably going to end up better than they were before so it’s dual purpose exercise just in time for swimsuit weather! J  The other new one is called “the clam” you lie on your side with your knees bent, do a slight pelvic tilt and while pushing the leg that is on the bottom down, you lift the other leg so you look like a clam shell opening.  This one I am supposed to work up to doing 3 sets of 10.  She also taught me a great hip stretch but you need a buddy.  You lie on your side as if you are going to do “the clam” you have someone strong stand sideways in front of you, put the upper leg around their waist so the back of your thigh is against their side, they provide resistance for you to push against, when you push against them it stretches your outer thigh, hip and glutes. 

We are also still working on thinning out my scar through massage, now I am massaging it side to side now, this is kind of graphic and I’m sorry but what I am doing is to “pick it up” and slowly move it back and forth to break up the scar tissue underneath that has been causing all the pain, I do this twice a day morning and night.  I really wish I had known about massaging the scar earlier than this, for anyone reading this who has yet to have surgery, scar massage is safe to do as soon as you are healed so about 6 weeks.  The earlier you start it the less likely it is that you will have adhesions like I did, this is a good preventative treatment for that.

All in all I am continuing to improve although am still on pain medication daily at least for now but it’s not as strong as the one I used to be on and I will continue to try and reduce that at each visit with my pain doctor, Dr. Netherton.  Thanks for reading and if anyone has any questions or comments feel free to post them I am happy to help if I can!