You've seen me post on Diane's surgery blog that she had hit a plateau. This is based on my observations that she reports the same pain levels and I still see her needing to rest with her knees up because of some mild sciatic pain that is activity-induced.
The other night, we were walking Zoey to the park and I just couldn't keep up with Diane. I started asking more questions about her pain and her activities. What I discovered was that while her pain had hit a plateau, her progress had not. She was doing more and more each day. While I observed her at this plateau, she said that for the past several days, she had been out and about all day... no meds... little rest... activities increasing daily. Not much of a plateau, huh?
I've discussed with several surgeons, the theory that each patient has a pain level that they consider tolerable. The moderate their activities to keep them within this boundary. This is why some people are severely disabled with only moderate pain, while others are only moderately disabled with severe pain. Some patient limit their lifestyles because they must avoid the pain level that they can't tolerate. If the limitations are severe, they are disabled. Regardless of their pain level, they can't function well because they must avoid that threshold.
I was speaking to a client who was 5 months post-op from a very dramatic surgery.
His patient story page is not ready yet, but you can see his films at the bottom of
this page. This was one of the most amazing surgeries I've seen... there is much more here than meets the eye, with a wedge osteotomy to correct a deformity caused by a misshapen vertebral body. In any case, at 5 months post-op, I spoke to him and he was describing pain levels and medication levels that really gave me pause. Here is what our conversation was like:
Mark: "Ken, it sounds to me like you are describing an unsuccessful outcome. But, you were out of breath when you answered the phone... what were you doing?"
Ken: "I was out in the backyard throwing the football with my sixteen year-old!"
Mark: "Could you do that before the surgery?"
Ken: "Hell no! Mark, I was in bed 22 hours a day before the surgery."
Mark: "What is your life like now?"
Ken: "I can get out and run errands, I can drive, I can go to my sons football games, I can do things on my own, I can function so much better than before!"
My point is that clinically, he sounds the same as he was. Talking to him, we discussed severe pain that makes it sound like the surgery was not successful. But, it's a smashing success.
I'm hoping that this provokes an interesting discussion on pain vs. meds. vs. activities, vs. relative disability levels. This even goes to how the data is reported. Many surgeons have expressed frustration that they see patients who go down in the books as failures when they actually have good outcomes. What do you think?
All the best,
Mark