Extrusion from one level to another!

mmglobal · #1 (**permalink**) 06-10-2007, 09:31 PM

Shit

My wife Diane has had some minor back pain for a few months. During the last month, it became bad enough to take days off of work. (She's and RN... big suprise that RN's have back problems.) While I was on my last trip, she told me that she had numbness around outside L calf and across the top of L foot. "Sounds just like my L4-5" I said.

Treatment by her local GP and his messed up office is like a primer on how to get screwed up by the 'standard protocol'. GP refused to do MRI... insisted on PT.... wrote note for 2 days off work. (Great for someone in a high-risk job.) PT made things much worse... actually provoked the numbness. Return to work was impossible... she tried, but had to leave work.

We insisted on an MRI which was done on Wednesday. We still have not heard from doctors office even though we have been calling and we know that the report was there Wednesday afternoon. (Sunday now.) If we followed the protocol, she would be trying to work now and do more PT. Good thing we know better.

MRI showed GIANT protrusion at L5-S1. We picked the films up on and by Thursday morning, Regan and Bertagnoli had already reviewed them and checked in. By Saturday, Zeegers and Yeung and reviewed them and checked in. (Nice to have connections.)

Protrusion is so large that extruded nucleus from L5-S1 has traveled up the canal area and is causing compression of the exiting nerve root at L4-5. Bulge, protrusion shows on every saggital slice across the back of the disc... I worry about how severely compromised the disc is. If surgery is necessary (it's hard to imagine that we won't get there), will a discectomy be successful?

The good news is that her symptoms are not that bad considering how bad the films look. Some of the docs have expressed concern about cauda equina syndrome being a possibility based on how substantial the cord compression is. We are well tuned into those symptoms and will consider her case emergent if those symptoms. I have seen too many cases of permanent CES that could have been avoided if treated on a timely manner. It's a shame to watch the recipe for such a disaster occurring in the treatment she's receiving. Again... her symptoms do not rise to that level of concern, but based on her films we should be hearing concern from the docs involved in the normal channels.

We'll know more on Tuesday when we see the local ortho surgeon that we went directly to based on recomendations from other RN's. His office is very nice and he'd reviewed her online profile / films and called us within a day of my presentation.

I don't know what the future brings for Diane... hopefully she'll get some epidirals, the protrusion will resorb and this will be a minor blip in our lives... we'll see in the next few weeks.

Mark

rosedee · #2 (**permalink**) 06-10-2007, 10:36 PM

Hi Mark,

so sorry to hear how bad the problem is turning out to be for your wife's spine. And particularly that she is having such unhelpful and damaging treatment recommended by her GP - the trouble with the protocols that are so relied upon these days is that they are based on "in generals" and patients are individuals who don't all fit into categories neatly.

I just hope that the epidurals will prove helpful and that neither of you need to make much further use of your experience and contacts. I have my fingers crossed for her that her pain and symptoms do not increase further.

All good wishes to the both of you.

rosedee

ans · #3 (**permalink**) 06-11-2007, 01:05 AM

Mark,

I'm sorry that this has happened and wish for the very best. Almost hard to imagine PT before a scan.

Given this, you gave me your time yesterday, regardless.

Best, Allan

dshobbies · #4 (**permalink**) 06-11-2007, 01:21 AM

Mark,

It's said that if you're married long enough, you begin to look like each other. I wasn't aware it pertained to your insides too! I'm so sorry that Diane is in pain and hope that with your combined knowledges and some rest, all will be well. My thoughts are with her and we are all hoping for the best.

Diane, please take care and do what Dr. Mark tells you. Let him take care of you for a few days. From what I've heard, you deserve to be pampered.

Dale

Jim M2 · #5 (**permalink**) 06-11-2007, 02:08 AM

Mark,
Oh no, I hate to hear this. It sounds very extreme, I can't imagine the pain. When I read the thread title I thought, it couldn't mean what it says, ... but it certainly did! Here's hoping the 'minor blip' scenario plays out. Let Diane know we're very concerned and thinking about her.

Jim

sahuaro · #6 (**permalink**) 06-11-2007, 03:53 AM

Mark:
So sorry this has happened to Diane. I too am hoping that this is just a blip. I know you will take the best of care of her.
Barbara

Tim · #7 (**permalink**) 06-11-2007, 11:37 AM

Mark
So sorry to hear about Diane’s back problem. The MRI findings sound worrying.. I hope some time will allow the protrusion to reabsorb and that surgery isn’t required. Why do GP’s recommend PT before they know what the problem is? – you were so right to insist on an MRI.
Look after yourselves.
All the best
Tim

tisury · #8 (**permalink**) 06-11-2007, 12:14 PM

Mark,
So sorry to hear about your wife's spine issues. Hopefully, it does heal on it's own and doesn't require surgery. Thankfully, she has the benefit of your contacts. It does sound serious. Myabe it's a good sign that her symptoms aren't severe though, perhaps time will heal it.

I think the MRI thing is a standard. At least it was with my insurance. They did the same thing, made me go to PT first - before any MRI was done. When PT kept increasing my pain, the PT insisted on one. Was told insurance would not pay for an MRI until AFTER PT was tried. When the MRI came back, the PT even told me, if he had seen the films beforehand, he would never have had me doing some of the exercises that he did. Nice, huh?

Hopefully, it is not as bad as it looks. Best wishes to Diane and you.

KL Aguilar · #9 (**permalink**) 06-11-2007, 02:46 PM

Dear Mark,

I am so sorry to read this! Keep us informed.

fireyangel76 · #10 (**permalink**) 06-12-2007, 04:43 AM

Please tell your wife from one RN to another...So sorry about her back! It sounds much the same as how my problems started 9 years ago. I hope she has a speedy recovery without surgery. I will say my disectomy helped tremendously in the beginning. I had no pain after until I must have lifted something the wrong way and I was herniated again. Now thats a surprise isn't it! A nurse that goes back to work and reherniates!
My thoughts are with you both! You are so lucky to have connections and not have to put up with years of the run around and BS!

dshobbies · #11 (**permalink**) 06-12-2007, 04:59 PM

Mark,

You didn't mention what all your consultations revealed. What do your conglomerate of doctors suggest?

You know I personally feel that a discectomy is the beginning of a downward spiral but then again, those who have achieved long term success have no need to post of these forums so they may out there, going about their business without a back care in the world.

Anyway, how is Diane doing? I do hope a few days rest have lessoned at least some of her pain. I'm finding a couple of hours in my zero gravity chair can undo a difficult day. I hope she's using yours.

My best to both of you, Dale

Maria · #12 (**permalink**) 06-13-2007, 06:56 PM

Mark,
Hope Diane is doing better and/or has gotten authorization for ESIs and either has had or will have relief with these. I too hope this will be just a blip in the life of Diane's spine~

I don't want to jinx anything so won't say more as my spiney life story isn't so hot~ as you know!!

Give Diane my best and I do hope she's feeling better and will get the care she deserves within the network of doctors designated but thankfully, "you da man" when it comes to spine connections!!!!

Poncho · #13 (**permalink**) 06-14-2007, 02:05 AM

Mark,

I am soooo sorry that your wife is going through this. Unfortunately, for us nurses this is the "cost of caring". And they wonder why there is a nursing shortage?

I know that you will take good care of her - the hard part is getting the nurse to accept help and take it easy...

Take care Diane!!!

We are thinking of you!!!

Sue

mmglobal · #14 (**permalink**) 06-14-2007, 04:14 PM

We met with Dr. Ram Mudiyam on Tuesday. I knew he was going to be good because of our interaction with his office before the meeting. We were able to speak to knowledgeable and kind staff who were responsive followed through. I was able to incent them to order plain x-rays w/flexion-extension so we had the benefit of them at our first meeting. Even though he was clearly busy and squeezing us into an already packed schedule, Dr. Mudiyam took his time and we had a COMPLETE dialog with all of our questions answered... never with the 'one foot out the door' feeling.

Even though he feels that Diane stands a 50% chance of requiring surgery, he still recommends proceeding cautiously. Since Diane's symptoms are not severe and she does not have any of the 'red flag' neuro symptoms that would indicate immediate surgery... we will take his advice and proceed with ESI and see how things go. Unlike the GP, he recognizes that being an RN on a surgical floor is a high-risk job for someone in her situation and will keep her off work for a month.

As you can imagine... before her MRI was 24 hours old, I was already reviewing her films with many of the top spine surgeons in the world. All agreed that even though her films are very ugly and in most cases would generate a recommendation for surgery, her problem is so new and the absence of severe symptoms - waiting is the best option. It was great to get such unanimous alignment of so many medical opinions... probably the first time this has ever happened!

Diane did not want me to go outside normal channels to assist with getting the ESI. Normal channels took 2 days to get a nebulous, first eval appointment with needle jockey... not an appointment for ESI. Appointment was so far out that she would not have even gotten the ESI before her follow-up appointment to review the results of ESI. (I wish this crap didn't sound so familiar... it's amazing what we face as spine patients.) I was able to do my thing and she will now have the ESI tomorrow!

We'll keep you posted.

Mark

PS.... check out the large fragment behind L5.

mmglobal · #15 (**permalink**) 06-16-2007, 11:23 AM

Just to keep everyone in the loop... Diane had ESI today and tolerated it well. Local pain doc is very good... Dr. Medhat Mikhael.... we liked him a lot.

We'll keep posting. We are hoping to avoid surgery... the top docs say it's about 50/50 with a herniation this size. Some say 0% chance of avoiding surgery, but still recommend a try at conservative treatment...

Mark

Maria · #16 (**permalink**) 06-18-2007, 05:26 AM

Mark,
This was my PM while in Long Beach (before moving to Fla and then coming back to CA. and using San Diego PM). I think I only had one ESI w/him as I utilized his office for PM since I had already been seeing Dr.Karp for ESIs by way of referral from Dr.Spencer.

I hope Diane has good results w/the ESI and am glad to hear she'll be off work one month.

Maria · #17 (**permalink**) 06-20-2007, 12:06 AM

Mark,
I could have just added this to my last post but this time I wanted to inquire how Diane is doing with the ESI? I thought about her as soon as you had posted she got her ESI and was hoping that if it works as well for her as it did for me that she wouldn't overdo as I did initially as I set myself back a bit several times.
Well, here's hoping the thing worked for Diane and she is going to feel decently at least for this month, and hopefully much longer.

ans · #18 (**permalink**) 06-20-2007, 03:15 AM

Also wishing the best for Diane re: her ESI and future outcome/determinations.

Alastair · #19 (**permalink**) 06-20-2007, 03:38 PM

Hi Mark,
Its a while since I logged in here but just to say how sorry I am to learn of your wifes "Back Probs" -- - anyway she couldn't`t have a better chap to advise her about it and you have all the right contacts for this.

Good Luck,
Best
Alastair

mmglobal · #20 (**permalink**) 06-20-2007, 09:50 PM

Thanks for all the well-wishes. Diane's 5 days out from ESI and is much improved. A few days ago it was much improved but she was realizing that even with the improvement, she'd be accepting living at a very low functioning level. Now with a few more days and more improvement, she's doing much better.

We don't know how functional she'll be... we don't know if she'll be living on eggshells like a 'disaster waiting to happen'.... fearing the next sneeze, trip or lift. Will she be able to work? All unknown, but I guess that now, things are as good as we could have hoped for at this early stage.

I'm here in Straubing... trip is going well. It's beautiful here if you are in the shade and there is a breeze. (Or if you are in your nice air-conditioned hotel room... well not beautiful, but at least cool.)

Talk to y'all soon...

Mark

fortitudine · #21 (**permalink**) 06-21-2007, 01:09 AM

Good news on Diane. Let's hope it just keeps getting better. One spiney per family is MORE than enough!

dshobbies · #22 (**permalink**) 06-21-2007, 04:17 AM

Diane & Mark,

My fingers are crossed and hope she continues to improve.

All my best, Dale

Blairsara · #23 (**permalink**) 06-21-2007, 07:56 AM

Mark
I'm so sorry to hear about your wife. I hope that you guys can bypass surgery for a while without an extraordinary amount of pain. Glad to hear the ESI went well.

Blair

paindoc · #24 (**permalink**) 06-27-2007, 03:06 AM

Mark-what an impressive disc sequestration! Like I advised earlier on the phone, I agree that she should wait in the face of minimal symptoms. The first rule of spine menicine is "less is more", and the second rule is d"don't treat an x-ray." She still has good disc height and hydration, and I wouldn't be too anxious to dive into surgery. Let's face it...surgeons keep me in business because of their carelessness or lack of knowledge beyond performing the actual procedure itself. For all the reasons we dicussed earlier I do agree with the folks you've already talked to-wait and see how this progresses. Good luck and let me know if I can be of any help.

marijo · #25 (**permalink**) 06-28-2007, 02:44 PM

I hope Diane is feeling better. I agree with pain doc, hydration good, disc height good. I can understand you when you say about living on eggshells, and a disaster waiting to happen. That is just one of the things you become v3ery aware of after you've had serious back problems. Then you think, 'well I'm not going to let it rule my life'. It is a bit, with me, but I am finding other things I can do instead.
Long may the improvement continue.
Regards,
Mary.

mmglobal · #26 (**permalink**) 06-29-2007, 08:58 PM

Met with Dr. Mudiyam earlier this week. While Diane appeared to respond well to ESI, she thinks she was responding well to zero activity in the days following ESI. Unfortunately, the respite from symptoms was less than 1 day (the day I wrote the 'much improved' post.) He thinks she's a non-responder and recommended surgery... microdiscectomy scheduled for mid July.

Met with Regan today... it was great to get an unbiased opinion (as he is not a possibility for surgery) from someone we trust. Remember that Diane knows Regan since 2001 when I was seeing him as a patient and has seen him over the years at GPN events. I asked Diane to see him because over the years, I've sat in Regan's office with many clients who faces similar decisions. In some cases, he told them that they must wait and doing early surgery is not appropriate. In other cases, he's recommended surgery. I knew many of the issues that color his opinion, but this was a great opportunity to get into even more depth. Just a few of the issues....

>> While some surgeons expressed that working on 'fresh' herniation is better than one that's sat for a while, Regan thought that waiting another month or two is not significant in terms ease of surgery or a significant change in potential success rate.

>> Diane is very concerned about permanence of neuro deficits. While she does not have any of the red flag symptoms, she does have mild to moderate symptoms including some strength loss. (not severe enough to cause foot drop or to keep her from doing multiple heel raises, but there is loss of strenght in a few areas. At this level of impairment, Regan does not think that she's at risk for permanent loss, but he expressed that the longer you leave it, the longer the recovery. Again... not too important in the big scheme of things... waiting OK

>> How long do we wait to see if she's a non-responder? His take was 2 to 3 months. If not improving at a couple of months, it's unlikely that the patient is going to have a stellar recovery. Certainly, it's OK to wait a 3rd month and even do another epidural, but in his experience, if she's getting worse at 2 months (which she is), then the risk of damage, inflamation, scar tissue, etc... associated with the ongoing painful situation is increased by waiting. (obviously, this is to be balanced against the risk of surgery.)

>> Microdiscectomy at L5-S1 is a straightforward and easy operation with little collateral damage and high chance of success. While it's a great idea to treat conservatively to see if she's a positive responder, continuing to treat a non-responder conservitavely implies months of suffering and higher risk down the road... compared to 'nipping it in the bud' and getting on with healing from surgery instead of dealing with the ongoing inflammatory process.

Diane has been leaning towards 'nipping it in the bud' as soon as she saw how severe the herniation was. I've been leaning towards giving it a chance to resolve on it's own. She's new to being a spine patient and sees months of suffering as highly important. I've lived it for years and feel that a few months of suffering is completely insignificant in the big picture.... only the highest chance of long term success matters. As with all things spine... there is no clear answer. She may be a long term success no matter which path she chooses. She may have more problems down the road no matter which path she chooses.

It's very interesting going through this process with my wife. I face many of these issues every day with my clients... this is different. It is similar in that as with my clients, I am sticking to my guns and only seek to help her to make an informed decision... not to persuade her one way or another. I think she's choosing early surgical intervention. If it were my spine, I'd do more ESI's and wait longer, but her approach is every bit as valid. She understands the issues and has done a good job in becoming informed. It's actually a relief to me that she's not following what I'd do for myself... so I'm sure that it's her decision and not mine.

This is a good operation with good results. We get a bad view of things in the patient community because the folks that have successful micro-d and never look back are not here... only the ones who graduate to more surgery and more problems are represented here. We are both comfortable with her decision and are looking forward to success.

We'll keep y'all posted.

Mark

sahuaro · #27 (**permalink**) 06-29-2007, 09:18 PM

Mark:
Wouldn't it be wonderful if there were solid statistics and clear variables which determine outcomes? I fully understand Diane's position; in fact, your report of what Regan had to say was a bit alarming for me. As you know, I, too, had a large extrusion (but not as large as Diane's); I have done the conservative route for 6 years; there has been significant resorption and yet I am still struggling with symptoms and the issue of surgery. And yet, your informed advice must be really difficult to ignore...
Whichever course Diane chooses, I wish her all success and relief.

Maria · #28 (**permalink**) 06-30-2007, 12:21 AM

I'm glad she's making her own decision as I don't have anything valid to offer except I waited 7 years from point of diagnosis on L5S1 to point of surgery which was open (not considered microdiscectomy at the time) and it was very successful. 2nd surgery (percuteaneous on L4) I thought would go well and I only waited 9 months from point of symptoms to point of surgery and it failed miserably..

One can never know, take the best most educated leap of faith that you can and go with it~ and hope and pray the results are going to be what you want them to be!

Good luck to Diane and hope her surgery will be one of the ones that yields the most excellent of results!

BTW, probably only too true re the failed results mostly posting at spine forums except for the successes that come back to post and tell us how great life is or what other health probs/surgeries other than spine are being experienced!!!

ans · #29 (**permalink**) 06-30-2007, 12:55 AM

Mark,

I'm sorry that you guys are in this quandry and that the epidural did not work. My 9mm extrusion diminished to 5 mm over the years and from complete foot drop I have mild permanent numbness instead. I hope that Diane finds relief, either way.

ans

dshobbies · #30 (**permalink**) 06-30-2007, 05:03 AM

Mark,

When you have several directions to go in, choosing the 'right' one is nothing more than a guessing game. Only those of us who encountered further problems are familiar with ADRs, etc.

I am curious... past surgeries and scar tissue diminish the success rate of ADRs, if one becomes necessary in the future. A discectomy weakens the disc, putting and increased pressure on adjacent discs. Though I had no choice and was more concerned with ending my pain quickly, today I'm not sure I would have made those same decisions. Am I wrong in the above assumptions? Also, as I have been told, first discectomies have an 80% success rate, as did mine for 8 years and then I became ADR material.

Diane has a large heriations and won't the removal of that much disc material substancially weaken her disc? I did see that her discs were hydrated and healthy. Does that indicate a better chance at long term success? Is her doctor giving her a successful percentage?

My hat is off to you for not directing her choice. I do understand that though you don't want her to make a mistake, you also can't be responsible for her ultimate outcome. Having watched you suffer for years is almost assuredly part of her decision making process.

My kitchen should be done within the next month (almost 2 months late), so I'll freeze the stuffed cabbage. It tastes better that way anyway!

I do so wish her a successful surgery and speedy recovery. And please let me know if there is anything I can do to help. My heart and hands are open to the two of you.
Dale

Bobb0 · #31 (**permalink**) 07-04-2007, 02:36 AM

Mark, is Diane's condition one where you would consider SED?

Bob

mmglobal · #32 (**permalink**) 07-04-2007, 03:30 AM

Hey Bob... nice to see you.

Protrusion with large sequester that goes so far from annular tear makes her a poor candidate for Yeung's endoscopic technique. He says that he'd try if we wanted, but his recommendation was to go with microscopic discectomy.

I'll have more answers later to other questions posted on this thread.

Diane takes exception with my dry reporting of the facts... "you are not telling the full story!" Oh well... I'm the only one telling the story so she's either going to have to come and explain what I'm leaving out... or I'll continue to make it up as I go!

Mark

Maria · #33 (**permalink**) 07-04-2007, 03:42 PM

Mark and Diane,
I would love to see you post Diane as I can only wonder what you're thinking and feeling in terms of your Nursing career (since I was one for so long) and the upcoming surgery. I think it must be great to have Mark in your back pocket so to speak and access to the most renowned opinions there are but I understand going thru insurance channels as I've tried working this route as long as I can (yet being too chicken for more surgery).

My back went out yesterday while packing and I'm telling you I just hate that! It is so frustrating and so limiting but ho hummm... more surgery ~ will just have to roll me in there unconscious I guess or loaded up on Versed~

I hope you aren't in great pain ~ hope you guys have a great 4th!

mmglobal · #34 (**permalink**) 07-14-2007, 02:05 AM

Diane cancelled her surgery. We are going to investigate options further. Her condition is still not dire, but her level of function is severely impaired and her pain levels along with a whole host of radicular symptoms have her ready to have surgery ASAP... but the need to fully investigate and make informed decisions trumps the need to do surgery right away and also trumps the wish to do the convenient thing because we think we'll be successful. 'Oh it's just an ordinary surgery that anyone can do', is great in theory... not always in practice.

The Bully

fireyangel76 · #35 (**permalink**) 07-14-2007, 06:47 AM

I so well remember the first time my back "went out". I was laid up and off work for 3 mos....mri showing only an annular tear and no big deal. So I fell for it hook line and sinker. Being a nurse I did not want anyone to really know just how bad I was hurting because nurses with bad backs don't get jobs. So I sucked it up and continued to work and lift patients as if I was "normal" all the while doing more and more damage. The things I wish I would have done was take care of myself first. With that I mean take my back giving me that warning and make changes in the way I did things. I was a nurse and we just don't get sick or injured we just take care of those that do! I can not work now and because I kept everything on the "down low" I also never filed workers comp and I discovered that there is a statue of limitations on that.
I finally herniated after about 8 years of back and right leg pain. However I was treated for many months for muscle strain and it was 10 months before I had a microdiscectomy. I have read many places that if conservative measures don't help in the first 3-4 months that sugical intervention has a higher chance of success the sooner it is done. Mark I am sure you are in a better palce to know if this is true or not, but for me I always have wondered if I would have had the microdiscectomy sooner would it have worked. Anyway my nursing career had never been quite the same since that first injury. I hope Diane heals with conservative measures and goes back to a wonderful fullfilling nursing career....but I hope she really asks for help when lifting and turning patients and I know how hard that is to do for a nurse...to ask for help is not really in our nature! We give care...hard to be the recipient of care!

Poncho · #36 (**permalink**) 07-14-2007, 03:13 PM

Betsy,

I couldn't have said it better myself

Maria · #37 (**permalink**) 07-14-2007, 06:17 PM

Mark,
I think Diane's decision to cancel surgery and continue to check out options is wise. I say this mainly because my 2nd surgery failed and what I lived with long afterwards was a constant reminder that I had felt I hadn't made the most well thought out decision or one that I was even fully comfortable with or confident about.

Spine surgery can go this way or that it seems although the one thing I am certain of is that I want to feel like when I do it, it will be with the person I feel is best able to do whatever it is I need~ and who actually is passionate about his or her work, not just the $$$... I don't want to be Case # XYZ.'

Plus Diane has all the best resources at her feet thru you~ wishing you guys the best possible decision/outcome in a timely fashion.

dshobbies · #38 (**permalink**) 07-15-2007, 06:14 AM

If I had it all to do over again and knowing what I know now, I'm not sure I would have had my first surgery because it started me on a downward spiral. Does this happen for everyone? Of course not. Some go on to live their lives as normal but other develop DDD. Any statistics would be skewed to favor the surgery as the old addage 'the surgery was a success but the patient died'.

All our minds work in what if scenerios, kind of damned if you do and damned if you don't. Is Diane making the best decision to postpone her surgery? Absolutely but even exploring the possibilites doesn't guarantee that the right decision will ultimately be made. We have no crystal ball and can only look at what is available.

Mark, I envy Diane's ability to access her best route but can only wish her luck with whatever her final decision. Of course, having your own guru helps!

My best to you both, Dale

fireyangel76 · #39 (**permalink**) 07-15-2007, 06:30 AM

I think you sum that up pretty well Dale. We make the best decision we can at any given point in time. Sometimes hind sight tells us whether it really was the best decision.
I get so frustrated with all the what if's. I am starting to feel like it's a lotto system and I am not the lucky winner! I am at a loss for what the right decisions are. I am facing a possibility of fusion because my dynesys is not doing too much for me. I really don't want a fusion because I only have a problem at l5-s1 and a buldge at l4-l5. I would prefer not to stress other levels to fix the few I have problems with.
If anyone has a crystal ball they are not using I would like to borrow it!

Maria · #40 (**permalink**) 07-15-2007, 04:52 PM

Yes, and I'm next in line for the Crystal Ball~
I have to yell STOP at myself when I start what if-ing. I drove myself completely nutz with this after the 2nd surgery but the first one I really felt was warrented as my back was "out" every other month, missing 4 weeks of work at a time lying in bed to recover. After the first surgery I was able to have a normal life and I do believe it left L4 weakened though I had great relief from my symptoms for the first time in nearly 7 years after the first surgery so I feel that surgery was a good decision. Maybe I waited too long to have that surgery but honestly I never even thought of it that way~

mmglobal · #41 (**permalink**) 07-19-2007, 05:48 AM

Diane is coming to Germany with me. In a few weeks, we'll be at the AlphaKlink with Doctors Hoogland, Zeegers, Baumbach, Blome. It's a big sequester to be addressing endoscopically, but Hoogland has new tecniques that allow him to do more than he used to. I've spent enough time with him in the OR that we are very comfortable with him as one of the top options when considering endoscopic surgery. While I believe that any discectomy type is likely to be successful, I also believe that a quality endoscopic procedure will do less collateral damage and enhance her chances if future surgery is ultimately needed.

Wish us luck!

Mark

Maria · #42 (**permalink**) 07-19-2007, 02:35 PM

There you go... I was wondering if this would be the decision that would be made and glad to hear it. You know how I feel about doing surgery here Mark even tho it's been authorized and I have benefits to lose and so forth. Just seems that in Diane's case if there's a chance to have surgery done with the most best and most experienced surgeon, then why not go for it....
Wishing Diane the best whatever is done~

dshobbies · #43 (**permalink**) 07-20-2007, 02:44 AM

Ditto to Maria,

I know there are extemely fine doctors here in the US and she would probably be just fine but you've been around the block too many times to know the ups and downs and it doesn't hurt to play the just in case game.

I wish Diane the absolute best of luck and a safe journey.

Dale

annapurna · #44 (**permalink**) 07-20-2007, 03:04 PM

Mark and Diane,

Congratulations on making the decision to go to Germany and get all the opinions and diagnosis you can. Regardless of what you decide to do, you will know that you did everything in your power to optimize your outcome - no regrets!

Although I still struggle with spine pain, I know that I have received the best care possible in this mortal world when I have traveled to Germany. Not just the quality of surgical care, but the thorough data analysis and testing have been better than anything I could have gotten stateside.

We will all be praying for your success and comfort during your trip, decision-making process, and, if you decide so, your upcoming procedures.

Best of Luck!
Laura

Tim · #45 (**permalink**) 07-22-2007, 02:24 PM

Hi Mark and Diane
Wishing Diane the best the best of luck for her upcoming visit to the AK.
You're in safe hands..
All the best
Tim

fortitudine · #46 (**permalink**) 07-26-2007, 02:30 PM

Best wishes for a happy outcome for Diane.
Hope

mmglobal · #47 (**permalink**) 07-28-2007, 03:08 AM

All our bags are packed, we're ready to go... I'm standing here outside our door...

Actually we are leaving tomorrow afternoon, so Diane's bags are packed and I won't even start thinking about what I'm bringing until it's time to leave for the airport.

I don't know what the future brings... don't know exactly what surgery Diane willl have, but Monday morning, we'll be with Hoogland and Zeegers... hoping for endoscopic resolution. This has been a tough road... I'll keep y'all posted.

Mark

Hucky :) · #48 (**permalink**) 07-28-2007, 03:30 PM

I hope all goes wonderfully for Diane. She couldn't be in better hands. IF I ever submit to surgery, I'll be flying there all the way from Oz, because I would have to pay for any op out of my insurance payout, I may as well spend a couple of thousand more and get the best in the world.

She is sooo lucky to have you on her side Mark.

Take care

Hucky

KL Aguilar · #49 (**permalink**) 07-29-2007, 01:38 AM

Wishing you the best!

Maria · #50 (**permalink**) 07-30-2007, 05:39 PM

Diane and Mark,
Are you guys there yet? If you are, hope you're rested and that Diane's consultation goes well. Take good care~ Maria A.

mmglobal · #51 (**permalink**) 07-31-2007, 08:36 AM

Diane has surgery in a couple of hours.

Good news, bad news....

New MRI (never would have been done anywere else) shows dramatic shrinking of sequester... completely different situation. Symptoms are still getting worse, but the size and shape of the fragment is way different. It has shrunk down to the immediate protrusion outside of the bulge.... hence the still worsening symptoms as the bulge should be much denser now and it is still on nerve root ganglion.

Armed with the new MRI, she's no longer an extremed case and they don't have to fish around where the fragment used to be.... doing surgery open or endoscopic based on the old MRI (just a couple of months old) would have meant a lot of unnecessary looking and poking.

More later..... gotta go now.

dshobbies · #52 (**permalink**) 07-31-2007, 06:59 PM

Wishing Diane the best. My thoughts are with her.

Dale

mmglobal · #53 (**permalink**) 07-31-2007, 08:31 PM

Here is the update I just sent to my family....

New MRI shows that disc has shrunken dramatically. I'm so glad we came here. Nobody else would have gotten a new MRI and they would have been poking around, looking for something that is no longer there. New configuration made her a very average case... no longer pushing the limits of endoscopy.

Her surgery was about 2pm today... done before 3pm. She was awake for much of it, but doesn't remember any of it. She walked out of the hospital about 5pm and has been resting comfortably ever since. Pain medication is almost nil... just some Tylenol and codeine. We'll see how she is after their medications wear off.

No significant event from surgery to report.... no new pain or neuro deficit. Legs appear to have normal feeling on both sides.... still too early to tell. We'll see how she is tomorrow. All good so far.

There is some potential for cervical issues... I'll have more to say later in week. Lumbar went great today.

Love to all... send pictures of Zoey!

Dad

Jim M2 · #54 (**permalink**) 07-31-2007, 09:55 PM

Mark and Diane,

Good news so far!(fingers crossed) I'm so glad to hear how it's going. Hope the good news keeps coming. Take care and God bless.
Jim

fortitudine · #55 (**permalink**) 08-01-2007, 01:26 AM

Good news! Hope the rest of your recovery goes as well as the first few hours, Diane!
Hope

Maria · #56 (**permalink**) 08-01-2007, 05:27 PM

I was thinking about Diane and hoping all would go well~ I'm so glad she had her surgery there vs. here where a new MRI would not even have probably been done since it had been done so recently.. insurance probably wouldn't have authorized it again so soon.

Thanks for the update Mark and continued best wishes for Diane's recovery!!!

fireyangel76 · #57 (**permalink**) 08-01-2007, 11:27 PM

Great to hear Diane is doing well! Wonderful she was able to have a new mri. When I had my last surgery my MRI was 9-10 months old. I really didn't realize that things could change that much.

I really hope Diane continues to have a great recovery and success!

Poncho · #58 (**permalink**) 08-02-2007, 01:20 AM

Hi Mark,

I certainly hope that Diane feels much better in the days to come. The only thing I remember with the endo was a series of tapping while attempting to access the site.

Sending healing vibes.

Poncho

KL Aguilar · #59 (**permalink**) 08-02-2007, 04:05 AM

Diane--you go girl! What great news! I have hazy memories of my endoscopic surgery. I remember being told not to swallow, and asked if I could feel certain things. Having endoscopic surgery gave me my life back for almost seven years until I had a new injury.

Mark, I saw a Cedar Sinai surgeon and he has a completely different take. (Eight surgeons and five surgical/non-surgical recommendations so far!) I would love to share when you get back.

ans · #60 (**permalink**) 08-02-2007, 09:11 AM

You guys made a very wise decision. Wishing D. my best for an enduring spine-problem remission. - Allan

mmglobal · #61 (**permalink**) 08-03-2007, 11:14 PM

Just after midnight Friday in Munich. Day 3 today. All is well. Leg symptoms still at bay, although Diane had some minor twinges this morning that went away as soon as we went for a walk. No reason to worry.... we expect some of this and hopefully, all this will just fade away and become fond memories.

It seems that Diane only has surgery pain now. She still moves slowly and when she forgets and takes a long step or moves too quickly, she gets a jab. It's getting better by the hour. She was only taking very low levels of meds. Now, she's on a few codeine/tyelenol a day and has been stretching them out to 8 or more hours.

Munich is wonderful. We have been taking several outings/day into the local area... meals out... fairly long walks.... outings that last an hour (or 2 if there is a meal involved.) Today we took a cab into Munich looking for her favorite beer garden and sausage stand. We didn't find it... we'll have to keep looking. We still had a blast... met some very interesting folks during lunch. The husband works for a company that makes lasers used in cutting metals... including spine implants. His family also owns a winery in Northern Germany (www.drloosen.com - wines available in the US). After lunch we spent some time in Hugendubel bookstore (www.hugendubel.de). It's 6 floors that all overlook Marienplatz and the Glockenspeil.... very cool view... coffee and cake on the top floor. It also has a fairly large English book section. We can't wait to read Zoey the German baby books that we bought.

I got to spend some time with Sam Perroni. It's great to see him again and he's looking better and better each day... now a week post-op. I hope to update his patient story soon.

Last night I had dinner with Zeegers at an outdoor cafe'. He waived a couple that I'd seen at the clinic and walking around the square many times. Talking to them at less than a week post-op from her 2-level active-L was very uplifting. It must be incredible for Zeegers to watch this happen over an over. We come to the AlphaKlinik afraid and desperate. He gets to see most of them leave in much better shape, and knowing that their lives will be much better. For many of us, it's not just better... it's returning from the living dead, back to life. It must be tough for him to watch the few failures, but the large numbers of successes must make it so incredibly rewarding for him.

Here are a few pics... more later...

Day 3... 3 hour outing to Munich

Day 2... farmer's market in Araballa Square

Day 2...

dshobbies · #62 (**permalink**) 08-04-2007, 12:57 AM

How great to see Diane up and around with little pain. I so hope she continues on this recovery road. My best to the both of you,

Dale

JeffreyD · #63 (**permalink**) 08-04-2007, 06:10 AM

Mark & Diane,
You are both in our thoughts and prayers as you move forward in these crucial post-op days.
Diane, may you be blessed with less pain each day. Munich is such a wonderful place to enjoy while you are healing and recovering. We truly hope that things go smoothly for you.

God Bless,
Jeff & Pauline

LC in UK · #64 (**permalink**) 08-04-2007, 06:52 AM

Well done Diane, wishing you an excellent recovery.
Glad you're enjoying Munich, was there a couple of years ago, the beer gardens are great aren't they?
Lynette

Maria · #65 (**permalink**) 08-05-2007, 04:34 PM

That smile on Diane's face is worth a million words! Great photos and glad to read that Diane's recovery is going so well, best wishes, thoughts and prayers that all continues on an upward spiral re recovery!

take good care you two, keep having a blast and thanks for the update! Maria

Poncho · #66 (**permalink**) 08-05-2007, 05:39 PM

Diane looks great! Like Maria said - the smile on her face says volumes!

Good to hear that you two are enjoying the sites and local festivities.

I hope Diane can come on board and post on her experiences soon.

Someday, I hope we can get back to visit Germany, Europe and other countries as tourists and not as patients.

Wishing for a speedy recovery.

Sue

letteski · #67 (**permalink**) 08-06-2007, 06:37 AM

Wow I am so sorry I have been out of the loop. Sending good thoughts your way for a speedy recovery Dian. We all know you are in the best of hands.

Mark I just thought this was just another trip but I was wrong. Lets catch up when things get a bit back to normal if that is posible.

Eddie G · #68 (**permalink**) 08-06-2007, 10:41 PM

Wow Mark I totally missed this thread. My thoughts & prayers are with you both.
She is fortunate to be in such capable hands both here and across the pond...

Geeze Mark I didn't think back pain was contagious!

I hope you both feel better.

Justin · #69 (**permalink**) 08-07-2007, 01:04 PM

Diane,

I just wanted to wish you well in your recovery. The key to a quick recovery is great German beer.

ans · #70 (**permalink**) 08-07-2007, 06:55 PM

Diane looks great. Never knew anyone could have such a broad smile so soon after back surgery. Enjoy..

Maria · #71 (**permalink**) 08-07-2007, 07:03 PM

I was going to mention that the only way I can look that happy is with some Cadillac Margaritas, a lumbar ESI and my meds!!!! Even your description of your outtings with sitting and walking that Diane is doing is astounding to me but then again it always is whenever I read about the persons that are walking about enjoying the sights after a major spine surgery in Germany!!

Hope you're doing well Diane with little to no pain and able to continue to enjoy the trip! How long will you be wearing the brace?? Hope it's not too hot with that on!

mmglobal · #72 (**permalink**) 08-12-2007, 10:22 PM

Hey everyone.... all is well. We are still in Bogen. I've been working 24/7 (it seems and have not had time to post.) I just wanted to pop in and say that Diane continues to recover nicely. She's walking many miles, several times/day. She's discontinued using the brace. She's stopped pain meds except for an occasional Celebrex. Once in a while she gets a twinge of leg pain or LBP, but it's not too serious and goes away shortly.

Things look great from here... She does not like being a spine patient and I hope this is the end of her career as one.

Keeping my fingers crossed....

Mark

sahuaro · #73 (**permalink**) 08-15-2007, 03:10 AM

Just catching up after being away and wanted to add my good wishes and hopes for Diane's early retirement from spine patient-hood.

fortitudine · #74 (**permalink**) 08-21-2007, 02:19 AM

I am so glad that Diane is recovering well. I bet you are too, Mark!!
Cheers,
Hope

Maria · #75 (**permalink**) 08-21-2007, 09:18 PM

Diane,
This is a heartfelt congrats on the success of surgery and hope you and Mark are enjoying yourselves greatly! I'm glad as a fellow nurse to hear you've had success with surgery and I do hope you will never have to have more surgery or know what it is to linger endlessly (or so it seems) as a spine patient.

Enjoy your new found spinal relief and best wishes for continued (infinity) relief from spine pain and a GREAT trip! Hope Mark has some time to enjoy it with you!!! Maria

ClassicZippo · #76 (**permalink**) 08-28-2007, 05:24 PM

Hi Mark
I am pleased to hear your wife Diane is doing so well. She is lucky to have your guidence and connections to have her problems resolved so quickly.

I must admit with my new back, I am busy living again and I rarely spend much time on the computer. We just returned from a 10-day camping trip to northern Ontario without internet or phones! It was fantastic; we hiked 4 or 5 km daily on some very challenging trails and I got to put my trekking sticks (a souvenir from Germany) to good use. Sarah, our golden retriever loves the new me. I will update my story here shortly.

Best regards,
Deb & Doug