Cincinnati, Ohio; Day 6 (Back Surgery)

Today’s post will be a little different. Typically our posts will use “we” and “our” despite being primarily written by Brian or Tiffany and then edited by the other. This post will use “I”, “me”, and “my” because of the nature of today’s adventure.

I (Brian) had back surgery performed today. Specifically, a Micro Lumbar Discectomy.

I have been keeping a secret from the blogosphere these past few months. I have degenerative disc disease and a herniated disc in my lower back (between the Lumbar-5 and Spatial-1 vertebrae). This was initiated by a combination of injury and age and created sciatic pain for me on my left leg.

For months, I have been unable to fully extend my left leg and to take full strides while walking. During our visits to National Parks this summer we were unable to take lengthy hikes and I satisfied my pride by indicating that “those longer hikes would be tough on the kids”. But I knew that I was really the limiting factor.

In Costa Rica, I was able to enjoy so many of our fun activities on the beach or at the pools but my mobility was limited. I was proudly able to climb the 500 steps to the La Fortuna Waterfall but couldn’t the follow the family to a cool spot in a river cave.

Tiffany was always protective of my activity and managed my limits well. She found time in our busy schedules so that I could do exercises meant to relieve the sciatic pain and to improve flexibility. Those exercises seemed to help for awhile…until they didn’t.

When we got to Boquette, Panama and knew that we would stay there for nearly a full month, I found an orthopaedic specialist in the nearest large city’s medical center. He was an excellent young doctor who spoke English well enough that my Spanish wouldn’t become a weak link in our chain of communication and comprehension.

He heard the description of my situation and history before ordering an X-ray. The technicians performing the X-ray forced my legs into a postion ideal for the requirements of a good image but produced some of the worst pain imaginable for me.

The doctor suggested that the discs between the vertebrae in my lower back appeared to have less mass than he would have expected but that it could be normal. His recommendation was to prescribe medications to relieve pain, relax the muscles, and to reduce inflammation. He also prescribed physical therapy for two weeks and to schedule a follow-up for two weeks later to re-assess the situation.

The physical therapy was to include the following elements. Neuromuscular electrical stimulation, ultrasound, massage, and exercise. He gave me the name and number for a physical therapist in Boquette.

I had 6 sessions over two weeks between September 21st and October 2nd. Immediately after each of these sessions I would experience elevated pain and fatigue. By the evening though, I would feel more relaxed and would have increased flexibility in my left leg.

I met Dr. Julio again on October 4th to report that medications and therapy have not improved my situation very well. He asked some additional questions regarding the nature of my pain then prescribed an MRI (imagen de resonancia magnetica) which could be taken the same day elsewhere within the Centro Medico Mae Lewis.

If you haven’t ever had an MRI (like me) you might be surprised to learn that you have latent claustrophobia which may emerge if you are put into a tube and told to hold very still. The roof of the machine is within a fist of your face, not that you could move your arm to prove that. You are also provided with a set of ear plugs because the machine contains a set of magnets which spin at high speed around your body. Moving this mass requires power and generates a lot of noise. The entire 30 minute experience was disquieting to say the least.

The neuroradiologist would read the imaging and produce a report for my orthopaedic specialist a few days later. The results were in Spanish but Google Translate was used to create an English-language report that I carried around for the next month or so.

The doctor’s recommendation would be to perform an epidural steroid injection (ESI) at the point where the herniated disc was pressing upon the nerve. This could stimulate the disc to absorb the herniation and relieve the pressure. Once the nerve pain was released then I would be able to improve my strength in my lower torso and reduce the risk of future herniations.

The idea of surgery would be considered as a “last resort” and that we would try all of our other options first. This plan to perform the ESI next was perfectly agreeable to me and I would have gladly had that procedure done by that doctor in Panama. Unfortunately, we were ready to move out of Boquete and go to Panama City the following week and since I was still pretty mobile, we decided to keep our schedule. So the 5 Adventurers continued on the journey to the next destination and I limped along.

Our intial plan was to return to the US for a short period of time in order to get the kids the Covid vaccine. This would faciliate our future travels and provide Tiffany and me with some comfort regarding the kid’s chances of catching or carrying the virus. Now we had to add fixing my back to the list. By the middle of October, I was not able to carry anything heavier than jug of milk without searing pain in my back, rear, and left leg. I was also not able to walk more than 100 meters before requiring a chair to lessen the pain.

My wife is amazing as all of you are aware. She carried all of our luggage through all of the transportation stops between Panama City and Milwaukee. Our short stays in Wisconsin to pick up Jerry Picklepants and to Illinois to visit were mildly painful for me to stand and walk. At some point while visiting Tiffany’s father and step-mother in Georgetown, my situation changed and I was no longer able to stand for longer than 5 minutes and could only find true pain relief lying on the floor in a prone position with my legs elevated. At this point, we settled into Leesburg for a while and I scheduled a consult with an orthopaedic specialist in Cincinnati.

Unsuprisingly, after his review of the MRI and listening to my history, he also recommended the ESI and gave me the name of a doctor to could perform it. On November 2, I had the ESI done and was told that I would know within two weeks whether it was effective. In the meantime, I remained extremely limited in what I could do because of the pain.

Here’s a quick description of my pain. Think of a tea kettle on the stove. If my pain was the water then I am always at least at a luke warm level of pain. When I stand with weight evenly distributed, then the kettle begins to boil. In October, my kettle would take a long time to boil and I could do a lot of things on my feet until the boiling point. Additionally, once I relieved pressure on my spine, my kettle would cool to luke warm fairly quickly. You get used to luke warm. In November, my kettle boils quickly and stays hot longer. Plus, it now boils when I sit upright for a few minutes creating a situation where prone is the best position for most of the day.

The two weeks after the ESI I reported to the doctor that my situation was unchanged. Instead of performing an additional one or two steroid injections, we both agreed to undertake the discectomy to remove the hernation altogether.

So here I am on my way out of the hotel. I’m hobbling with Tiffany’s grandfather’s cane found in the attic toward the surgery. There’s a cool video which shows the procedure (no blood, just drawings). Recovery will mean that I will need to limit my twisting, bending and lifting for a period of up to 12 weeks.

Today’s surgery was successful according to the surgeon but we will need several days to learn the extent of the “success”. Don’t worry, we don’t plan or desire to spend anymore time on health updates but will let you know if any of our plans get impacted.

We remain eager to get on a plane to Southeast Asia at the beginning of December and to continue to travel the world but we need to get through today’s Adventure first!