Microdiscectomy

This post doesn’t really follow the trend of my others. But it does cover, in some detail, a recent fairly major event in my life. My first surgery.

In October 2012 I started to feel some pain in my left leg when sitting. Nothing major, just a fairly dull ache that got worse the longer I sat. This stayed fairly constant until mid-November, now it was quickly changing from a dull ache to a shooting pain in about ten minutes of sitting. Soon I was only able to lay down or stand comfortably, sitting became far to painful.

At this point I decided it would be a good idea to seek medical assistance. So Mos and I headed off to our favourite clinic in Chiang Mai, the highly recommended Health Care Medical Clinic. Earlier in the year I had had some stiffness in my neck which had caused my last visit to the clinic. And because of this the assumption was made that I might be suffering from muscle stiffness, this time in my hamstring. So I was injected with a dose of muscle relaxant and given a four-day course of pills to keep me relaxed.

During the my check-up at the clinic, they mentioned that a few things were not right. If this was purely a tight hamstring some of my symptoms didn’t quite fit. So they suggested that if there was no improvement after my four-day course of pills, that I should visit a physiotherapist at the local hospital. My doctor recommended Khun Took at Rajavej Hospital.

Over the next four days I tried to remain active, take the pills as and when ordered and to make sure I didn’t do anything that could pull or twist my hamstring. But, it didn’t get better, in fact, it got worse. By the end of the four days I was now barely able to walk for more than five minutes and had to spend most of my day in bed. We booked the next available appointment with Khun Took, thankfully it was only a few hours after we phoned.

After a very painful scooter ride I arrived at Rajavej Hospital, headed up to the physiotherapy department and introduced myself to Khun Took. She immediately set to work, strapping me up to machines that stretch my leg, straighten my pelvis and heat my muscles. I also had intensive and very painful massages (which although they hurt, felt like they were doing something good). She also used ultrasound to ease the pain. Once my session was over I felt better. Not Olympic fit, but able to walk without a limp, which was a big step.

I continued on a fairly intensive seven-day course of physiotherapy, but on the sixth day, the results nose-dived. Previously I had ridden my scooter, with Mos, to and from the hospital. It’s ten minute ride. The journey to the hospital was always painful but nothing I couldn’t handle with some codeine and a stiff upper lip. The ride home was always less painful. On the sixth day however, the pain was greater even after the first few meters. By the time we reached halfway I realised that I was going to have to stop the bike. Thankfully I managed to pull over, put the bike on its stand and loosen my helmet before I blacked out draped over a nearby gate. I was only out for about twenty seconds. I limped around in circles trying to get some blood back to my head and pain out of my leg. We got back on the scooter, this time with Mos riding so I could keep my legs straight at the side of the bike, which seemed to help the pain.

On arrival to the hospital I informed Khun Took of the drama that was my commute to the hospital. She said that because of that, paired with the fact I was making nowhere near as much progress as she had hoped, I should see an orthopedic surgeon. Within ten minutes a member of staff was there to whisk me down to the orthopedic section where I chatted to one of the hospitals surgeons. Over the next hour I had an X-Ray and a very large dose of morphine. From this moment on, I would be on a constant stream of the of highest strength painkillers available. All of which barely dented the pain I was now in. The doctor also booked me in for an MRI scan, but that would have to take place at a neighboring hospital due to a malfunction at Rajavej. But to my surprise they managed to fit me in that afternoon.

The following day, with MRI results in hand we went back to see the surgeon. He said immediately that the X-Ray showed to bone damage. So that was a big relief. He was concerned that maybe I had fractured a part of my pelvis. We then handed over the MRI scan and even Mos and I, with no medical training could tell there was a problem. He pinned up the scans on the light-box on his wall and started to circle various parts of it with a red marker. We all know that red markers mean bad things. He went on to explain that one of my discs had ruptured and in spectacular fashion. The cause of my sever leg pain was now apparent, the material that had ruptured from my disc had pushed against and now become wedges against my sciatic nerve. Causing what is commonly know as sciatica.  Well known as one of the most severe pains going. Pregnant women can sometimes get a mild sciatica from the pressure from the womb, this is however less painful due to the direction at which the pressure is being applied, as the surgeon explained.

So as I lay on his examination bed, fully dosed on morphine and a cocktail of other über-strength, but ultimately useless painkillers. Shaking and sweating with pain. He continued to describe in great detail just how painful sciatica is. But then he paused. And made a very careful and very deliberate red circle on a different area of the scan. Then, to himself he muttered ‘Oh, that’s interesting’. He looked at me and then back at the scan. Then he peeled the scan from the light-box and showed it to me. The material from my ruptured disc was not only crushing my sciatic nerve. It was also putting pressure on my spinal column. The surgeon went on to explain that I would need surgery to remove the ruptured material from my back, this would cure the sciatica and remove the possibility of the material causing permanent damage to my spinal column. And he didn’t need to detail what exactly ‘permanent damage to my spinal column’ meant.’ We all know that at best wheelchairs would be involved. We went on to discuss what the surgical options where, quite simply, there are two. I could have a Discectomy or a Microdiscectomy. They are both ultimately the same procedure, however the ‘micro’ option is a form of what most people call keyhole surgery. Whereas the regular Discectomy involves a far larger incision and a much longer recovery time.

Both procedures have the same objective. Cut a whole in your back, where on your back depends on where your damaged disc is. They will move your sciatic nerve, guard your spinal column and then the surgeon will pull, scrape, cut and burn the excess material away from your disc. That’s it. A fairly simple procedure in a potentially dangerous area.

From my fairly extensive research on the internet, many people seem to think that they have had the micro option but they have in fact had the regular option. The scar from Microdiscectomy surgery is between 2-3cm in length. And is almost always glued, not stitched or stapled. My scar for example is smaller than a ten pence piece.

The orthopedic surgeon at Rajavej Hospital went on to say that they do not have the specialists or equipment to perform the Microdiscectomy, but could perform the regular surgery with four days notice. He advised however that I have surgery as soon as possible. And that the best option would be to travel to Bangkok to see one of the major hospitals.

Mos and I immediately thought of Bumrungrad International Hospital. We had been there previously during a visit to Bangkok about a year previously. Mos had come down with a kidney infection and they treated her like royalty. Superb service, excellent facilities and one of the best rated hospitals in the whole of Asia. We didn’t even need to discuss it. That night Mos called Bumrungrad and explained the situation. We knew that I would need to travel to Bangkok by sleeper train, as this was the only option that meant I could lay down. So the following day we boarded the sleeper train in Chiang Mai, I swallowed a handful of multi-coloured, prescription-only painkillers and we set off.

I managed to sleep for a few hours. I’m pretty sure it was pure exhaustion rather than lack of pain. But as we pulled into Bangkok I was very happy to see an ambulance team from Bumrungrad who had been sent to collect me from the station. Unfortunately they had not been allowed to bring the stretcher onto the platform so the two taller guys held me on either side as we slowly hobbled to the station exit and the waiting ambulance. The driver helped Mos with our bags.

It was a short trip to the hospital, and as soon as we arrived I was whisked up to the twelfth floor, which is the Spinal Center. Although we had arrive four hours early, my surgeon came to meet me within two hours. He looked over my MRI scan, poked and prodded me, and then told me that I must be in a lot of pain. Surgeons seem to like to point that out here.

My surgery team would be led by Dr. Surapong Anuraklekha, who was brilliant. He could see that I was fairly nervous and in a lot of pain. So he described the surgery to me and asked me when I wanted to have it. I was expecting to have to wait maybe a week, or two. I had heard of people in the UK on the NHS waiting list having to wait up to three years! But not here. By this point it was 13:30, and we had scheduled my surgery for 17:00. Which was brilliant, as soon my pain would be gone! But also because it meant I didn’t have enough time to get worried.

I was taken to my room, which was far more like a luxury apartment than hospital room. The nurses positioned my fully electric robotic bed into an ‘s’ shape, which was amazingly comfortable. Then, just as I was still sinking into the bed, two nurses came in, introduced themselves very politely and then proceeded to strip me naked. Before I had a chance to buy them a drink I was in a hospital gown with a morphine drip in my left hand. Mos arrived after completing some of my paperwork and we talked for a few minutes before I fell asleep. Again, out of exhaustion rather than lack of pain. The next thing I knew my surgeon was waking me up, it was 16:00 and time for me to move into the special room for people about to have an operation. I’m sure it has a more catchy title, but I don’t know it. Mos walked alongside my bed as I was wheeled to this new room. And she said good luck and ‘I love you’ at the door, quite tearfully. I’m not sure if I replied. I was in a different world, a world of morphine on tap.

I stayed in that room for what seemed like ten minutes before a nurse said that I need to go to the toilet before my operation. So she helped me hobble over to the toilet and thanks to the many grab handles and safety rails I managed to do the rest on my own. Minutes after getting back on my bed I was met by my surgeon, this time dressed in surgical scrubs and looking far more like a surgeon than a doctor. He and his team wheeled me out and into the operating theater. The pulled my bed up next to another bed which had a large triangular object in the middle which it quickly became apparent I was to be placed over, naked and arse in the air.  Before I have the chance to take a second glance the anesthetist introduced herself through her protective gear. Placed a plastic mask over my mouth and nose and told me to count out-loud from ten to zero. The last number I remember was six.

I woke up in the same pre-operating room as I was in previously. A nurse was monitoring my oxygen levels, and as I woke up she removed my oxygen mask and told me to breathe slowly and deeply. I managed for a few breaths, looked at my oxygen monitor which was dropping from 99 down to 98 and then 97, but then fell back asleep. She re-applied the oxygen mask and we tried again. On about the fourth time I managed to stay awake, I looked at my oxygen monitor and proudly, and I think quite loudly, declared ‘I did it I’m at 99’. The nurses laughed got me ready to leave. As I was wheeled out of that room The first person I saw was Mos. Leaning against the wall and looking tired. Apparently I’d been in there for nearly six hours. The operation took just under two hours, the rest was preparation and waking up. I was very happy to see her and squeezed her hand as tightly as I could, which I imagine was very weakly. The nurses used a spinal board to move me from the transport bed to the bed in my room. They reset the bed and arranged my blankets, I think I managed to stay awake for about an hour before falling asleep.

Every hour the nurses would sneak into the room like medical ninjas to measure my blood pressure, temperature and my various bags of liquid drugs that were being fed drip by drip into my hand. Mos was fast asleep on the sofa, I imagine this time, she was sleeping thanks to exhaustion.

In the morning, just after I’d been served breakfast, my surgeon appeared. This time looking like a very smart doctor, not a surgeon. He told me that everything had gone very well, and despite taking slightly longer than expected, the operation had gone perfectly to plan. Then he handed me a small plastic pot. This pot contained a pale transparent liquid, and in it was white lumps of hard and soft tissue. This was what he had removed from my spine only last night! Mildly disgusting but completely fascinating. He also gave me a DVD video of the procedure. Which I had asked for previously when I found out that the keyhole procedure was done using a remote camera.

Then, after I had played with my ruptured disc in the plastic pot, he asked me to stand up. Now, for three months I had not been able to walk without pain, and for the last two I hadn’t been able to stand up straight. For the last two weeks I had been completely unable to walk without people helping/carrying me. So to ask me to stand up only hours after surgery seemed a bit much. But I shuffled out of bed and a nurse helped me to my feet. Aside from the slight tightness and soreness from the incision, I felt no pain. None. Not even an ache. My left leg was slightly numb, but my surgeon explained that this was normal. My sciatic nerve was simply readjusting to not being crushed. All of the pain had gone. I no longer had to drag myself off the bed, onto the floor and to the toilet. I could walk! No more sleepless nights. No more painkillers and morphine drips. No more blacking out through pain and exhaustion. I felt completely normal.

I opted to stay in hospital that night, just to make sure everything was as it should be. I thought that surgery on my spine deserves that extra bit of caution. After all… it is my spine!

The following morning we headed back to Chiang Mai, again on the sleeper train. I slept like a baby. I enjoyed a week of bed rest mixed with regular exercise, light walks, mostly between 5-10 minutes. After a week I was feeling great. Fairly week, but that’s to be expected after being stuck in bed for months prior to my operation. We headed back to Bangkok for a checkup, my surgeon was very happy with my progress. And signed me off as able to continue normal activities from March. In the meantime I should continue with light duties. Which meant not sitting on the floor, at all. Not sitting on chairs for longer than twenty minutes at a time and not lifting more than five kilograms.

I had my surgery on the 25th January 2013. It’s been twenty days now and I am improving everyday. Most people wouldn’t even be able to notice that I am still in recovery. I am living a perfectly normal life. And I’m still on ‘light-duty’.

Here is a picture of my scar. Taken today, 20 days after surgery. For people not familiar with Thai currency, that coin is the same size as a ten pence piece. For you Americans, the coin is about an inch in diameter.