My body, Chapter 4: Post-surgery

This is an ongoing story about my back and my body and yoga. I began posting the story on Jan 24, 2009. Scroll back to that date if you want to begin at the beginning. Otherwise, just jump in.

I woke from the anesthetic and felt like I had been run over by a large truck. I hurt everywhere. The very idea of walking seemed an impossibility. It felt as if the surgeons had placed a steel plate in my lower back, rather than rods and screws. I remember asking the nurse if that had happened. She said “nah, that’s what everybody feels like.”

I was in the hospital for 5 days. The first three on was on self-administered intravenous morphine. I didn’t like the morphine. Every time I closed my eyes I’d have horrible visions: a personalized horror movie of being cut up into pieces, mutilated and tortured. I used as little of the morphine as possible. They switched me to high doses of oral codeine on the 4th day.

Here is what I remember from the hospital: My friend Maddie brought me fancy teas to drink and a book with photographs of flowers and beaches. My friend Susie spent the first night = with me. Jay brought the boys to visit. Summer, just 9 months old, was horribly sick and wasn't eating anything. Watching mindless daytime television including a cooking show where they demonstrated how to impale a chicken on a beer can and then BBQ it. My Vanderbilt Dean thought that I should bring my computer into hospital with me, that it would be a good time to get some writing done. Twelve years later I can finally laugh at that suggestion.

The nurses made me walk everyday. I swore at them, but I walked. By the time I left the hospital I could walk, maybe, 40 feet at a stretch. I could get to the toilet by myself, but using it was excruciating. My bladder remained frozen from the morphine and I was self-catheterizing to pee when I left the hospital. I was afraid the bladder damage might be permanent. Opiates really bog down my digestive track. All I wanted to eat was prunes and prune juice, just to keep things moving along. When I had a normal pee I sang halleluiah.

Some friends flew out to Tennessee to help out. Doris, Kate and my Mom each came to stay for a week, one after the other. They helped me through the worst of it. They’d bring Summer to me to snuggle, help get the boys down to bed, help with dinner and cleaning and all those normal life things. They rubbed my feet, my back and my shoulders, helped me in and out of the shower. (Thank you!

Our house was laid out in a circle and my exercise for the first few weeks was simply to walk the loop inside my house every few hours. When I finally made it outside and walked to mailbox I considered it a major milestone. To keep myself entertained I did 'bed yoga,' read books, watched TV, and felt guilty for not writing like my Dean expected me to. I slept as much as I could.

Recovery was slow. I did my physical work religiously: walking, abdominals, physical therapy, stretching. I wore a full body brace for the first 6 weeks. I remember someone who had had the same surgery telling me “I still use the brace when I do heavy lifting.” That scared me, I did not want the brace to become a permanent fixture in my life. I did gradually get stronger, I could walk farther and do more. My life began to look normal. But I still had sciatica. In addition I had peripheral neuropathy that I didn’t have before the surgery. The sciatic nerve must have been injured in the surgery. The neuropathy resulted in numbness and ‘voodoo’ pains in my left foot: sudden sharp shooting pains between the long bones of the first and second metatarsals that would stop me in my tracks. I wore a brace on my left foot for a quite a while. I didn't stop wearing it at night until 2004.

The orthopedist said that it would take a year to completely recover. At the end of the year he pronounced me better, prescribed amitriptyline for the lingering neuropathy, celebrex for the back pain and dismissed me from his care. I guess I felt better than I had before surgery, but I didn’t feel great. My life appeared normal, but I wasn’t who I wanted to be. I was depressed and grieving my old body. I was still pretty weak. I still had sciatica and back pain. I couldn’t sit for more than 30 minutes at a stretch. I couldn’t stand still for more than 15 minutes. Movement, slow movement, felt best. I wasn’t in good health and could not embrace my job. In fact, I struggled alot with my job because it was so painful to sit at a desk all day. My frustration with the orthopedist and where he left me drove me first to a therapist (officially diagnosed with situational depression.) and then to better self care.

This is the remains of my body brace, with the straps removed, resting quietly in the garden. I'm thinking maybe I should add a cross over them to mark their passing.

My Body, Chapter 3: Surgery

This is an ongoing story about my back and my body and yoga. It begins on Jan 24, 2009. Scroll back to that date if you want to begin at the beginning. Otherwise, just jump in.

In 1996 the Spondylolithesis had become sufficiently pronounced to limit my life. I was managing to get to work everyday and do the fundamentals of my job, but I wasn’t doing all the other parts of my life that kept me vibrant. My family, friends, home and spiritual life were bearing the brunt of my disability.

I had used yoga and exercise to keep the condition manageable for most of the preceding decade. Having two young children and a 60-hr/week job left no time for self care. The pregnancies and childbirth pushed my back to the edge. I was hiking one day in 1996 with my son in a back pack on my back. I twisted my ankle and fell. That fall was the injury that pushed my back over the edge.

First I went to see a chiropractor. He did his adjustment magic but everything just seemed to worsen. He took more x-rays and told me I should see an orthopedic surgeon.

I don’t remember the orthopedist’s name. He clearly found himself to be important and well known. He looked at my x-rays and advised me to have surgery. He said that the next time I took a fall, got in a car accident, or had some other minor trauma to my spine I was liable to lose bladder and bowel control. He said that if I left my spine untreated I would eventually wind up in a wheelchair.

I went to a neurosurgeon for a second opinion. The neurosurgeon also found him self to be important and well known. Jay went with me to the appointment, so I could have another set of ears in the room. The neurosurgeon said I could probably postpone the surgery for a while, but that I would eventually need it. He didn’t offer any way of dealing with the ongoing pain. He didn’t even talk to me, he addressed all of his comments to Jay. I left that appointment angry and still in pain. He offered little hope for change.

I called my old friend Agi for advice. She concurred with the orthopedist: it was time for surgery. There was at least some hope of improvement with this solution. I don’t know how long it took me to make the final decision, but on April 1st of 1997 I had a spinal fusion with bone graft and instrumentation. The orthopedist placed 6 titanium screws into my vertebra, two each into L4, L5 and S1. The screws are joined together by two long titanium rods that run along either side of my spine. The orthopedist shaved live bone from my right illium and laid the bone between the wings of L4 and L5, and L5 and S1. The surgery fused together my spine from L4 to S1 and is referred to as a spinal fusion with instrumentation. I think of it as if I just had a very large sacrum. I have no mobility in my lower back. All of my bending here arises either above L4 or below the sacrum.

The image below is not my spine but comes from an online website. I once had copies of the x-rays of my own back, but they got left behind in one move or another. This is the closest image to my own surgery that I could find.

My Body, Chapter 2: Some History

The first time I remember seeing a doctor for low back pain I was in graduate school, maybe 1985. We had moved from one apartment to another and the day after moving furniture I couldn’t move. I had a deep low pain in my back and I knew that something was wrong. I went to Stanford University Health Care. The doctors looked at my back, made me to a few forward bends while they examined me and told me to take anti-inflammatory meds and come back if the pain didn’t go away within a week or two. It was a generally unhelpful session. I felt like something more was wrong, but didn’t know what else to do. If the doctor’s said it was okay, it must be okay

About 5 year’s later as a new faculty member at UC Berkeley I took an aerobic exercise class. At the end of the class the instructor lead some abdominal exercises. We began with a ‘reverse crunch,’ or what I would now call a partial Pilates Teaser. We began in a seated position with our knees bent and our feet on the floor, our hands clasped behind our head. She had us hinge backwards about 30 degrees and then return to sitting. I don’t know how many reps she had us do, but before we were through I had sudden severe back pain and I just lay down on the floor. I was embarrassed, the pain was in my body but my mind went into self criticism: I was out of shape, fat, bad. I stayed still on the floor for a little while, then tried to get up and sneak out of class without anyone noticing. I tried to pretend that nothing had happened. I took Tylenol, or something similar, but the pain didn’t go away.

I don’t know how long I waited before calling my friend, chiropractor Agi Ban. Maybe it was a few days but more likely a few weeks. Denial was not making the pain go away. I have to admit, part of me still thinks denial is the best medicine.

So, I called Agi. She looked at my back and took x-rays. She diagnosed that I had spondylolithesis, grade 1 or 2 at that point. I don’t remember. She did her chiropractic adjustments and gave me exercises. She encouraged me to start taking yoga classes, to get fit and to lose weight. There wasn’t a fix for this condition, only maintenance. I needed to learn how to live with it. I used my denial medicine liberally. I acted as if nothing was wrong.

No one knows for sure how I came by this condition. It can be genetic but no one else in the family has it. It can be caused by trauma and that I did have in fair measure. Somewhere I read that backs are particularly vulnerable to a spondylolthesis rupture in the age range of 7, 8,or 9ish. And somewhere in that age range I had a major a trauma.

I don’t remember how old I was. Grade school. My sisters were at least walking age (they are 4 and 5 years younger than me). We had gone to the beach for the weekend. We had a second floor apartment with a balcony over the sand. My Dad and I had gone pier fishing in the morning and I remember it being cold and that we had to bundle up. Dad and I were the early birds in the family and we’d do early morning things together, watch tv or explore.

Dad liked to ‘tease.’ You could call it ‘extreme teasing’ or you could call it sadism. He did leave bruises and I remember being shocked to learn in therapy that leaving bruises qualified the teasing as abuse. Dad also liked to drink. I assume he was drinking on this day.

He was teasing my sisters and I, pretending that he was going to drop us off the balcony. There was some struggling. Squeals of fear and laughter combined. He was dangling me from the balcony and he dropped me. I don’t know if it was on purpose or an accident. I never asked him. He was dead before I started having serious back problems. I really don’t remember anything else from the day. I know that I wasn’t taken to see a doctor and that no x-rays were taken. I know that I never went pier fishing again. My story was “pier fishing isn’t fun, all I ever catch is starfish.” I believed that story and conveniently forgot being dropped from the balcony.