Chapter Six: The Plan (Part 1)

After my second consult with Christine, I had at least a sketch of a plan going forward. Physically, I had to do five things: reduce (and ideally eliminate) the loads on my spine (sitting primarily) in my life, wake up the muscles located deep in my spine, use a crutch when I needed to, be open to taking pain medication, and keep moving. Mentally, I had to be aware of negative thoughts masquerading as worry and wonder and give them no energy; no life. Emotionally, I needed to remain open to feeling whatever stirs around inside of me; not run from it or squash it or explain it or defend it. Just feel it and let go.

Honestly, it was a lot.

I fought the issue of eliminating sitting at home for a day or two. I had convinced myself that sitting for a short period of time, like sitting at the dining room table for dinner, would be ok. And, this is not a conscious sort of discussion. It's not like I'm standing in the kitchen having a conversation with myself. No, I just decided that I wanted to eat dinner with my wife at this awesome dinner table and visit with her. So, I did. I think what I need though is a Dick Tracy watch with my own channel directly to Christine so I can tap the watch and say,"Hey, C - I'm going to sit down and eat dinner. Just to let you know," which then gives her the opportunity to yell through the watch, "Are you crazy? " Oh, yeah. I am. Right. I'll stand. But, that's not what happened. I sat through dinner shifting my weight, moaning and grunting and groaning, which, by the way,  creates a lovely dinner ambiance, and then when I went to stand up, I couldn't. I had to slide out of the chair onto the floor like as if I had been magically turned into a snake and lie face down on the floor for nearly fifteen minutes. And, there is nothing notable about the smell of carpet except that it just doesn't smell very good.  I then was able to get up and walk away leaving all dignity behind embedded in the carpet fibers.

I stopped sitting after that dinner.

I take my meals at a bar, glad we have one now, in my favorite room, the Man Cave (the Man Cave is a dark, cold, room with a big screen tv, great sound, and cool furniture). At first, it didn't seem so bad to stand up for meals. But, after a few, it lost its appeal. In order to work on my Powerbook, I created a set up so I could lie down. I should tell you though first, that I normally work in a Zero Gravity Chair but the term is not actually true. It's not zero gravity as my spine quickly let me know. So, I had to abandon the chair for a position that has an even lower pressure.  I have a few props though to make this work. I have a wedge under my knees and an adjustable Aerobed. By flipping a switch on the bed, I can prop the head of the bed up and change the angle as needed (one of the keys to keeping the pressure in my spine low is to keep from staying in exactly the same position for too long). I use a LapGenie (seriously, NOT the branding image I would choose if I owned the company, but they didn't ask me) which is a very cool device. It's an adjustable aluminum frame that holds my Powerbook and rests over me. I place a partially inflated beach ball (about 12" in diameter) under my lower back. If I don't my right leg gradually goes numb and feels as if there's a small campfire buried in it somewhere. I place two smaller pillows under each arm to prevent my shoulders from working too much and thereby overloading my neck. And, finally, I have a pillow under my head. Whew. In this position, I can work for about an hour or so then I need to get up which is when I wish I had a crane in the room.

The reason that I am so vigilant about decreasing the pressure on my spine is that too much pressure interferes with the natural healing process of a herniated disc and it can worsen the degree of the injury (in medical terms that is often called, "extending the lesion"). The disc is a blend of a tough, fibrous outer ring (called the annulus) and a softer, gelatinous inner core (the nucleus) and sits in between two vertebral bodies or bones . Its job is to absorb force of everyday life (like sitting, walking, etc.) and guide the complex, three-dimensional motions of the spine (as in bending and twisting). Along the outer edges of the annulus, on each side, are nerves that come together to supply sensation and movement to your lower body (from the lumbar spine). A herniation happens with you tear the outer layers giving the nucleus an unrestricted pathway to the nerve (in the image below, the pink is the nucleus while the red is the nerve). So, as you add pressure to the injured disc, the nucleus can ooze its way out. And, the more pressure you place on it, the more it oozes.  Fortunately, it moves slowly because it's thick but your nerve is haphephobic (fear of being touched) when it comes to the nucleus. It treats the nuclear material like our body reacts to a sliver in your finger: inflammation. You then develop pain in your leg or back or both. Sitting isn't the position with the highest pressure on your spine but it's close. And, since it is something that permeates our lives, trying to eliminate it really impossible and reducing it is tough to do.

The research on disc healing suggests that the herniated disc will reduce in size by 50% within 6-9 months (assuming you do not make the injury worse) and nearly 90% of people will have a good to excellent outcome. So, why do people end up in surgery then if in 9 months, the problem has resolved? There are two main reasons: neurologic compromise and severe disability. If your nerve isn't functioning properly (so, your muscles are weak and you're leg feels numb or you have lost bowel and bladder control), allowing the disc to continue to press on the nerve may lead to permanent nerve damage. Surgery is required.

I have a high level of disability according to the Oswestry questionnaire. This is a widely accepted instrument to identify the degree of disability following a back injury. The higher your score, the worse the disability. My score fell in the "severe" category. Most people cannot tolerate the severe disability because it just wrecks their life. They can't tolerate standing to eat dinner, not sitting, not going out to dinner, to see a movie, to visit with friends, etc., for 6 to 9 months so they opt for surgery.

There are days when I'm sure I can ride this out for 6 or 9 months and then there are days following nights of burning leg pain and 3 hours of sleep that I'm not so sure. I know it can be done. A friend of mine and former student had a similar problem (his MRIs are below). It took him a year but he recovered and returned to cycling and a very active lifestyle.

(If you look near the bottom of the image on the left, you can clearly see a dark glob protruding into the region of white. That's the nucleus - the herniation.)

 

(In the image on the right, notice how much smaller the "glob" is a year later.)

 

 

It's been a physical and emotional roller coaster and there are some days, hours, that I wonder if my reaction is unusual and then I remember all of the people I've interviewed and examined and realize that, no, what I'm going through is not unusual. I'm just sharing it and that might be unusual.

Some people have asked me, "So, what do you do in therapy? Is there anything that can really help this?" The short answer is, "Yes." The long answer is next.