My experience with lumbar-sacral herniated disc repair

I am writing this essay from the relative comfort of a borrowed recliner chair. The chair was borrowed from a gracious friend upon my return from a week-long hospitalization for emergency spinal surgery. I arrived home only to discover that I could not sit on any of the furniture in our house. Of course, there are those who have visited our house recently who can quite understand why I would not be able to sit comfortably on any of our furniture.

My back problems, disc herniations at L4-L5 and L5-S1, have been steadily worsening for more than one year. I was referred for surgery about this time last year after all attempts at conservative treatment failed. Unfortunately, shortly after I was referred for back surgery last year my wife, Terri, experienced a significant complication with the cancer she has been battling. Terri’s condition quickly de-prioritized my own health care needs. Consequently, my back problems have been escalating in the time since.

Lumbar-sacral back pain, sciatic nerve pain, and numbness and weakness in my left foot and leg have been consistent experiences for the past year. One month ago the sciatic nerve pain worsened though. The new pain was chronic, 24/7 pain that simply never went away. My ability to walk was limited to very short distances. Prescription pain medications that had given me relief over the past year no longer had any effect on the pain.

My wife brought me to the hospital emergency department at Billings Clinic on August 26 because I became unable to walk or sit while waiting for her at a radiology appointment in the hospital. The emergency department physician administered IV morphine to get control of the pain and immediately sent me for a new MRI scan. The MRI showed a considerable worsening in the disc herniation at L5-S1. The disc was completely blown out. At least now I knew why my pain was so unbearable! The emergency department physician scheduled an appointment with a neurosurgeon for several days later and discharged me from the hospital.

My son brought me back to the same emergency department the next day, August 27, because the pain was once again unbearable, and the pain medication that I had at home was completely ineffective in controlling the pain. I was carried to the vehicle by two of my adult children because I could not walk. I was treated at the emergency department by a different physician during my second visit. However, the treatment was essentially the same: IV morphine to control the pain and then discharged with instruction to follow up with neurosurgery.

The morning of Saturday, August 28 brought new levels of pain. I was no longer able to walk at all, and had become unable to void overnight. My wife called an ambulance to bring me back to the emergency department for the third time in as many days. I was treated by yet another physician during this emergency department visit. However, this doctor actually listened to what my wife and I were saying to her. The nurse promptly inserted a urinary catheter (this was the first time I experienced that procedure while awake…) and drained quite a bit of urine from my bladder that I had been unable to void on my own. I was also administered morphine to begin working on the pain. The emergency department physician contacted my neurosurgeon and made arrangements to have me admitted to the hospital immediately. I would now remain hospitalized until the disc surgery could be completed the following Tuesday.

On Tuesday, August 31, I underwent surgery to remove the blown disc. The surgery was a 3.5-hour procedure – or so they tell me. The surgery was successful and was completed without any complications.

My overall experience at Billings Clinic was positive. The medical staff at this hospital are truly a cut above. I rarely encounter a staff member at Billings Clinic who causes me concern. Billings Clinic enjoys Magnet recognition by the American Nurses Association. This designation requires an exceptionally high standard of excellence for a facility to achieve the award. The difference shows.

Despite my overwhelmingly positive experience during a rather tough time in my life, I did have several minor frustrations. Actually, at a lower performing medical facility I would probably expect these types of situations. Perhaps I have just been spoiled by how well things typically happen at Billings Clinic…

My first frustration was that the first two emergency department physicians seemed to miss my point. Both physicians provided appropriate short-term treatment: accurate diagnosis, pain management, and appropriate recommendation for followup care. However, I was at a point where I was not able to care for myself or manage my injury at home. My attempts to communicate this to the emergency department staff seemed to fail. I was only marginally ambulatory, was experiencing increasing difficulty with urination, and was experiencing unmanageable pain with the pain medication that I had available to me at home. Further, my wife is battling metastatic cancer and I am her caregiver. In other words, I do not have someone at home to take care of me if I am unable to care for myself. I believe, given these circumstances, I should have been admitted to the hospital during these emergency department visits because it was not reasonable for me to be discharged under the circumstances.

My second frustration relates to the IV dexamethasone which I was administered while inpatient at Billings Clinic. I am unable to tolerate oral dexamethasone, and I advised the physicians of this fact. Oral steroids cause me to have severe stomach pain that is worse than the back pain they are supposed to treat. Oral steroids also cause me to have unstoppable hiccups for days at a time. Last year I attempted to use a course of oral dexamethasone to treat the back problems and ended up hiccuping for several days until I was experiencing diaphragmatic spasms that interfered with breathing. I am, I will admit, addicted to breathing so this development did cause me some concern. Getting back to my story though, the medical staff insisted that dexamethasone was essential for the surgery that I was preparing to undergo, and the steroids were administered IV rather than orally. I hoped that this would be easier on my gastrointestinal tract. Unfortunately, it was not. The frustrating thing about this experience is that I had to fight to even get Maalox for my stomach. I know by experience with my primary physician that high dose Zantac is fairly effective in limiting the nasty side effects of the dexamethasone for me – and Zantac is ridiculously cheap. If they really needed to administer dexamethasone, the least they could have done would be to provide the requisite 80 mg of Zantac each day to keep me somewhat comfortable!

The surgery apparently went without incident and exactly on schedule. Dr. Eric Schubert was the neurosurgeon who performed my disc surgery. I was amazed on awakening in my room to have absolutely no pain! I had not experienced a day without pain in the past year. My expectation before surgery was that I would probably awaken to terrible back pain from the surgery. Nothing could be further from the truth. I had no pain at all in my back or in my leg! Dr. Schubert took the time to explain everything to me in advance of the surgery, and he did an amazing job with the surgery itself. I would definitely recommend that anyone in the Billings, MT area who is in need of a spinal surgeon consider Dr. Schubert and his staff.

My surgery took place seven days ago. I remained in the hospital overnight and was discharged on the day after surgery. I have been home recuperating in the days since. I continue to have relatively little pain despite having undergone a rather significant surgery. I do need to make judicious use of muscle relaxants and pain medication to stay comfortable but, unlike before the surgery, I am now able to effectively manage this at home.

I am still using a walker to get around the house. My back is still fairly weak and I am not able to stand up without the support of a walker. However, I can feel my strength improving. I am much stronger than I was several days ago. Hopefully within the next week I will be able to progress from using a walker to using a cane.

I am learning to be patient as I heal from this surgery. I prefer speedy recoveries, but this surgery will require time and patience. I will be unable to lift more than 5-10 pounds for at least three months, and I also need to be careful not to twist or bend lest I re-injure my back before it is fully healed. It is frustrating and humbling to need to ask for assistance with so many little projects. Fortunately, my wife and adult children are supportive and willing to help me as I recover.

Back injuries and back surgeries are complex. Each back patient’s journey is certainly unique and, therefore, I am aware that your experience may be quite different from my own. Nonetheless, I hope that this story of my own journey through worsening disc herniation and eventual surgical repair will be helpful and encouraging to many readers. I offer this story with the hope that through it I can lend some strength to another.

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