Pain in the Neck

On Thanksgiving weekend, 2009, I awoke with what felt like a pinch in my neck, between the tops of my shoulder blades and a little left of center.  I didn’t think too much of it, and chalked it up to a little heavier swimming schedule over that long weekend.  I assumed that continuing to swim through it would be the solution as it had been when I had felt these things before.  Over the next couple of days, however, it was getting noticeably worse, to the point where there was significant pain shooting down my left arm that left my first two fingers numb.

I went to a local orthopedic surgeon who chose a conservative plan, with anti-inflammatory and muscle relaxer pharmaceuticals, cortisone shots and lots of pain killers.  Ultimately, I had an MRI that revealed a severely herniated disc between cervical discs 6 and 7 that was impinging on a long nerve that went down my left arm.  Of course, all of this was happening over the holidays, and more than once I thought “maybe I can just have the shot in Aruba; that is where all the doctors are.”  Unfortunately, nothing worked to address the pain.

I had been told that, absent any relief from the epidural shots, surgery was an option that would need to be explored.  We scheduled appointments with the staff at Rush Presbyterian and Northwestern Memorial in Chicago, both of which concluded that surgery was necessary because (1) the size of the disc herniation made it susceptible to rupture (which sounded bad enough that I hoped to avoid it), and (2) the pinched nerve in the left arm caused a significant loss of strength that could be arrested or turned around with earlier surgical intervention.  The two choices for the surgery were spinal fusion, where C6 and C7 would be locked together with titanium plates and screws, or total disc replacement with a synthetic insert.

There were, of course, upsides and downsides to each.  The fusion is the “gold standard” of the business, and is treated by the professionals like a routine walk in the park.  The downsides to a spinal fusion are recovery period (two months alone to get the bones to fuse to the device, then slow comeback to more strenuous activities) and an 8 degree loss of mobility in the neck.  As for the replacement disc, the downside was that it was a relatively new procedure in the US and that the insurance companies balk at reimbursing for it.  To me, the ability to be back on my feet sooner and to not lose the mobility in my neck led me to conclude that the replacement disc is the way to go, which was corroborated by both surgeons.  A quick look at this replacement disc gizmo, made by the magicians at Medtronic in Minneapolis, can be seen here:

It turns out that, when it comes to cervical disc replacement surgery, the insurance company and the company that makes the replacement device itself have a lot to say in how it gets done.  It was several long and painful weeks before the approval finally came through.  The ace in the hole was Northwestern, where the doctors could essentially assure me that I would get the replacement device.  Nowhere else was certain, so Northwestern was the choice.

In the meantime, the trail of pills continued.  This was my first go-round with an extended period on painkillers, and it was a crazy ride.  All jokes aside, they do not make you feel better, but just bearable.  On the one hand, I hated being tied to them in the first place; on the other hand, I really knew when my four hour cycle was up.  One of the kookiest side effects is the weird dream cycles I went through.  It was like I would hook into a dream story line, and just couldn’t shake it, even after I woke up and went back to sleep.  It was a little like the Groundhog Day movie.

In the meantime, Susan continued to update her embarrassingly thoughtful blog about the whole episode, the link for which is  Susan is a very clever writer and photographer, and her patience through the whole mess was simply amazing.  She clicked around the Internet long enough that she found some animated renditions of this TDA surgery itself and posted them on her blog.  Watch these little film clips to understand this incredibly cool device of which I am the grateful recipient.  Even the tool that they use to insert it and screw it down is designed with elegance.  My father, to whom I am dedicating A Long Swim, was a veterinary surgeon and would have loved to learn about Medtronic’s device, and would have wanted to perform this procedure himself.  It would be right up his alley.

It would be incomprehensible to go through the process I have described by yourself.  The only way I could possibly conceive of doing such a thing is with the support system I have.  The pain made me a whining puddle of self-pity for a few months, but it also reminded me of how I am the luckiest guy in the world.  Susan, in particular, was the champion of all, and I am reminded always of how my relationship with her is part and parcel of my immeasurable good fortune.

Finally, the day of the surgery arrived.  We were notified by the person who really runs Northwestern Memorial (that is the lady with the calendar) that we should be there at 6:00 a.m. on a Monday and to be ready to go.  Knowing that Susan was going to be my driver, and having had extensive experience with her punctuality for time-sensitive things like airline flights, I knew that we would surely report well before 5:30 a.m.  Perhaps if we were first in line, we could be the first through the door.  I had been told that that the surgery itself was only 90 minutes, and that I will be hospitalized for a day or two.  It made sense to me, seeing as how I don’t have spinal surgery every day.

We reported well ahead of schedule and the staff began to put us through the pre-op jumps.  After about an hour of horsing around, the doctors and surgery nurses recited their grave warnings about all of the bad things that can happen. Vicoden or no, it was a pretty sobering list, but we were there to get a job done. The questions were over when the anesthetic lady said, “Ok, this is going to feel like a martini flowing into your arm.”  More like a ton of bricks falling, I would say, and all I could do was give Susan a smooch and send her to the fancy Starbucks that is the waiting room.

The surgical procedure was supposed to take 90 minutes. Apparently, my neck was a little more crowded than expected, and it took longer to crank everything open, but once they made it to the “disease site” all went smoothly. The procedure took a little over three hours.  They sent me to recovery, and along about 2:00 p.m., I asked if I would be sent to an overnight room.  To my great surprise, I was told that if I could “walk around the floor and pee,” I would be released that afternoon.  As unsteady as I was, I managed to accomplish both of those feats, and they kicked me out.  We were home almost exactly 12 hours after we left that morning.  We returned home to a house that friends had filled with food and kids who thought that they had a night off from homework.  They put me in bed, Susan made me a mango smoothie (that tasted great and felt good against a sore throat that had spent the morning being stretched all over the place).  She and the kids all got plates of food and all sat around me, looking at the gash that was between my throat and my collarbone, and hoped that everything would be okay.  It was snowing outside.

So, I had drive-through spinal surgery on Monday, I went to the polling place out to vote on Tuesday (on the way there, we heard a radio advertisement for “Medtronic, helping athletes stay at the top of their game”) I participated in multiple conference calls starting Wednesday, and I threw away my pain pills on Thursday.  Six weeks later, I was back swimming, albeit slowly, for the start of a long road back.  Now, even the scar on my neck is hardly visible.

On the one hand, it was Medtronic’s medical device technology made this possible.  Really, though, it was Susan who made it possible, and there is not a limit to the depth of my gratitude to her.

The picture below is me, with my Medtronic device implanted in my neck.  You can see the profile of the spring device and two of the four titanium screws that anchor it down.  Just to get a perspective, the screws are just a little longer than the diameter of a quarter.