The first cut is the deepest

I haven't really posted anything since the operation so I apologize. Quick update is as follows. The operation was fantastic, best 7 hours of sleep I've had in months. No pain whatsoever. I didn't need any pain medication except for the general anesthesia of course. I spent the first night in the Intensive Care of Critical Care Unit as they called it. That was to make sure no blood clots formed or that the swelling in my throat and trachea didn't suffocate me. I got up 3 times that first night and got to walk around with the assistance of a nurse because I had all these wires and hoses and tubes hooked up to me. Next day the doc saw me and said I was doing amazingly well and if it kept up I could go home Thursday morning less than 48 hours after the operation was completed. That night I had trouble with breathing and choking due to lung congestion and a swollen trachea/throat/esophagus but I was still able to get up and walk for 15 minutes at a time, three times. So I was discharged Thursday and went home. Sleeping has been very difficult due to the swollen throat etc. but last night with the help of some sleeping drugs and decongestants I got 6 hours of sleep on and off. Still having trouble speaking because my wind pipe gets blocked and I have lung congestion as well. The images attached are from the operation. On the multi image picture, the upper left image is "before". You can see that my neck had an unnatural S curve in it from when I fractured a couple vertebrae as a kid. The new neck has a nice C curve to it. You can't tell from the images but there is a plate in there as well which holds the whole mess together and it enforces the proper curvature to the spine. For the first time in a very very very long time I don't have numbness, burning, and pins and needles throughout my arms, neck, legs etc. I am still lacking a normal pain system and I don't seem to have much feeling in some of my fingers and hands but I can use them without discomfort for the most part. I tire easily I think from anesthesia after effects but I am able to walk 2-4 miles a day at a 20 minute a mile pace. The doc said walking is good but not too fast (no problem) and keep my head and neck stable with a brace. I'm going to call it quits for now. I'll come back and add color commentary to the whole affair in my next post.

I'll keep you posted
-The John

We set a date

I will be having my neck operation on September 29th. I will be in Saint Francis Memorial Hospital (I really wish they could do away with that memorial part), 900 Hyde St. San Francisco CA 94109. It is supposed to be a 4 1/2 to 6 hour operation which I will have to sleep through according to the doctor. Two to three days in hospital and then 3-5 weeks recuperation....I'm guessing I'll have plenty of time to write. I've said it before and I will say it again, I'm having great trepidation, fear and scairdy catness about this but everyone of my friends and family have assured me it will be just fine. More to the point, I am told I need to get my game face on and face this like a man because attitude is everything (I think that was Andre Agassi actually). So the next two weeks I will spend getting my attitude in order. Please no stories about friends or relatives who had a horrible experience. I can use that after the operation but not before, ha.

I'll keep you posted

-the John

The Unkindest cut of all

Went to the doctor yesterday to review the "options" for my neck. Ginny went with me as usual to provide adult supervision. It started out poorly when the doctor said "I have the results of your electrical conduction tests and I've highlighted in yellow the abnormal or poor results". Two thirds of the page was highlighted in yellow. I immediately suspected that this wasn't going to be a cheerful conversation. I was right. So after reviewing the results, I said, I assume this is a buildup to telling me that I can't have minimally invasive surgery and he said "that is not an option". Well it turns out there were no options except to have fusion of the vertebrae.

I told the doctor that I would like to discuss some of the risks of the operation and Ginny volunteered that I was afraid of paralysis (which is true but I'm not sure I would have lead with that question). The doc said that if I was concerned with paralysis, then I should have the operation because there is a greater chance of being paralyzed from not doing anything and letting the spinal cord continue to be damaged. He took us through the MRI photos again and pointed out how there were compromised nerve roots going to the arms (hence the arm numbness and burning sensation in the hands), a few vertebrae out of alignment and pressing in on the spinal cord causing the nerve signals to be delayed (hence the high pain threshold that I have suffered/benefited from), and peripheral nerve damage which causes a lack of feeling altogether in some instances (maybe that is how I gave myself a third degree burn a few years back).

So I asked the important question "doc, will I be taller and more handsome, when the operation is over?" he responded that I was a pretty handsome guy already.....I took that as a "no" on being taller.

So the operation for those of you keeping score at home involves taking out the disc material between the c4-c5, c5-c6, and c6-c7 vertebrae, putting in bone shims between those four vertebrae, putting in a plate (not fine china) and attaching the plate to the c4, c5, c6, and c7 vertebrae making it effectively one bone. At the same time he would fix the backward angle of my neck which is part of what is impinging on the spinal cord.

I asked if I had to be totally anesthetized for this and he just rolled his eyes and said three or four different ways, yes you have to be totally out. Why would you even want to be awake. I tried to explain that I would like to make sure they don't screw up and remove a leg or something but I could tell that wasn't going to make points with the guy who would have a knife at my neck in the very near future. I dropped that line of discussion.

The doctor said it would be a 4+ hour operation and that I would be out of commission for "a minimum of three weeks" which was a mild surprise because I was afraid it would be much longer. He said he was back at work 2 weeks after having a similar operation and I said "I'm a pretty tough guy, I will try to come back in less than 2 weeks". He said he would be keeping a close eye on me to make sure I don't screw something up.

He asked when I wanted to go under the knife and I said what do you have open? I was appalled when he said the 25th.....of this month. I reacted poorly saying that I had to check on my disability insurance and all that. How about January I replied, he said in an ominous tone " you should have this done sooner rather than later if you don't want to do further permanent damage. You have to hand it to him, he doesn't sugar coat things.

I left the office with a little tear in my eye, I'm tough but mostly in the abstract. You can take off my leg, remove my foot, or even replace my knee while I am awake, but put me to sleep and mess with my spine????? I'm not that tough.

I will finalize the operation date on Tuesday or Wednesday next week, I'll keep you updated.

the John

Houston we have a problem

Well I heard back from my doctor about my spine test. He says "the preliminary results are quite suggestive for both a spinal cord conduction delay and some sort of peripheral nerve compression in your arms". What the hell does that mean? I tried goggling it and don't get much specific information. The doctor did tell me that my historically "high pain threshold" may in fact be somewhat attributable to the nerve and spinal cord trauma that I suffered from jumping into that hay loft oh so many years ago. The doctor then went on to say, "Clearly there is an objective explanation for your complaints and you will require specific treatment which we can discuss at your next appointment". And finally "It is highly unlikely you will do anything to worsen your problems as long as you avoid any overhead lifting, prolonged neck flexion or extension or any contact/collision sports".

Ok, why couldn't he just tell me what the "specific treatment" would be. And I know he has never seen me play guitar but some people swear I do that as a contact sport. This also means I probably won't be doing any off road motorcycle rides in the near future. That was definitely a contact/collision sport the last time I did it.

Either way, I now have an appointment for this Friday the 4th to see what this specific treatment will be. I'll keep you tuned in.

the John

Clem Jones, M.D.

Of all the nerve!

Well, I took my spine test today and I'm not sure how well it went. The technician who administered the test said there are some "significant issues" with my right arm and the nerves that serve it, and there are some "symptoms" of problems with the left arm. The good news if I was looking for it was that the left arm wasn't as bad as the right. I don't know what this means in terms of the type of operation I will need but it wasn't the bright cheery, "hey you are doing just fine" that I was hoping for. Such is life, I'll find out in a week or so maybe what the report says.

the john

Neck News

I just saw an article today in the San Jose Mercury News about Geron's spinal chord medicine for people with severe spinal chord trauma. Evidently it is a gene therapy or stem cell derived medicine. They had to put on hold the release of the medicine but it doesn't say why. I'm attaching the final paragraph from the article because it explains roughly what I'm being tested for this week.

By Steve Johnson

sjohnson@mercurynews.com

Posted: 08/18/2009 11:20:22 AM PDT

Updated: 08/18/2009 11:20:23 AM PDT

sjohnson@mercurynews.com

In a setback for Menlo Park-based Geron, the company announced today that federal authorities have placed on hold its ground-breaking test in people of a spinal-cord injury treatment it developed from human embryonic stem cells.

When a spine is damaged, myelin — a fatty substance that provides insulation important for motor function — often is stripped off. That can disrupt the body's ability to transmit sensory signals, similar to the way an electrical cord shorts out when its insulation is peeled away, resulting in paralysis. Geron coaxed embryonic cells into becoming oligodendrocytes, cells that help nerve fibers replace myelin.

the john

Living at break neck speed

Well as they say if it isn't one thing, it's your mother. Or something like that. Well my mother is now willingly going to an assisted living facility in Pennsylvania where she will be close to my aunt and cousins. I'll discuss that whole adventure in a separate post. Today is going to be about my neck, or lack thereof. You see when I was about 14 years old, I broke my neck. It was a diving accident, I was diving into a hay loft in a barn and got my foot stuck in the ladder and well, I broke my neck. And to paraphrase Joe Pesci from the movie Goodfellas, "if I hadn't done what the Doctor told me not to do, I wouldn't need neck surgery now". You see I was advised not to do anything.....that is anything, that would put a strain on my neck, not even diving off a high dive at a swimming pool.

So I went on to wrestle in high school and the air force, I played football, I did anything but avoid putting pressure on my neck. The consequences are that I have a slightly deformed spine now with bone spurs and a "pinched spinal chord" for lack of a better term. The doctor walked Ginny and I through the X-rays and MRI pictures yesterday and it actually made me a bit squeamish. You could see where the spinal chord was being deformed and restricted. And there was at least one nerve channel leading to the right arm that is almost completely blocked which is what is causing my arm pain and numbness.

The good news is the doctor said we are going to do some electrical tests to see if my spine is damaged and restricting the nerve signals to the brain. (I can leave some blank space in this posting for people that want to make wise comments now). If there is no major spinal chord damage, he thinks we (I) can just have the minimally invasive surgery to rebuild that part of the vertebrae that is cutting off the nerve to the arm, then they can clean out a little bit of the bone spurs on the back of the spinal chord and maybe patch up or remove a bit of the herniated disk that is in there. All of that through a hole the size of a drinking straw. On the other hand if my spinal chord is damaged, they will have to go in for a more dramatic surgery to fuse vertebrae and clean out the spinal column.

I did ask the doctor if these problems would account for my history of not feeling very much pain and he said yes that is a very likely result of the broken neck and spinal chord trauma.

So I'm going to get tested possibly as early as next week. I'll keep you posted as to how that goes and what surgery I will be having. You talk about a pain in the neck.....this is the epitome.

the john