For Dr. W: Diagnoses and Procedures

For my childhood friend who is a doctor, and other interested and non-squeamish parties:

Here's a (possibly) cryptic post to answer your question about the diagnoses/procedures behind all this suffering.

Excerpts from initial report from the MRI Lumbar Spine and Sacrum without Contrast, 1.17.2006:

Large cystic expansile lesion in the mid and lower sacrum, most likely representing and occult intrasacral menigocele... the S2 and more inferior sacral and coccygeal nerve roots could be affected. CT myelography could be performed to evaluate for the presumed connection of the lesion to the thecal sac if clinically indicated.

The lesion is nearly isotense to CSF on all pulse sequences, with mild remodeling of the adjacent sacrum... the lesion measures approximately 5.9 x 3.6 x 7.0 cm.

3.1.2006, First operation preoperative diagnosis: sacral meningocele/intradural cyst
Procedure performed: Sacral laminectomy and excision of cyst wall, microdissection technique, intraoperative nerve stimulation/monitoring.

3.7.2006, Hospitalized a day or two after discharge for treatment of Clostridium Difficile.

12.22.2006, Second spinal operation: Cyst, subanachnoid (intrathecal) shunt with Delta low-pressure valve.

2.13.2007 (happy valentines day), Nose surgery to repair damage done when Littlest One threw himself backwards and broke my nose; I'd had to put off surgery to accomodate spinal surgery, though the assault occurred in early September.

7.11.2007, Third spinal operation: Laminectomy and closure of cerebrospinal fluid fistula, sacral spine.

7.21 - 7.26, hospitalized for excruciating pain; turns out I'd blown the dural patch right off, but despite my 61-day CSF headache, we didn't find that out until...

9.5.2007, Fourth spinal operation: Repair of cerebrospinal fluid fistula with patch, microdissection technique, placement of lumbar subarachnoid drain.

10.10.2007, Fifth spinal operation, postoperative diagnosis: dislodgement of distal end of subarachnoid shunt. Proceedure performed: Exploration of wound, removal of distal cyst catheter tip and conversion to an Ommaya reservoir. On my back for a week with drains in place to moderate CSF pressure to allow wound to heal.

10.17.2007, Sixth spinal operation: Same hospitalization, repeat of most recent surgery, I think... Here I've lost track of operative reports. On my back for a week with drains in place to moderate CSF pressure to allow wound to heal.

12.14.2007, Seventh spinal surgery: removal of cyst shunt/reservoir, repair of dural opening via laminectomy, placement of lumbar subarachnoid drain. Intensive care section of Neuro Unit, spinal drains in place, etc.

12.21.2007, Upon discharge from hospital, transfer to rehabilitation hospital for monitoring, pain management, and therapy to recover from major muscle atrophe after so many days/weeks in bed. Released for good behavior several days early, 12.29.2007.

Currently under home health care and home physical therapy. In a month, maybe I'll graduate to outpatient therapy.

Quiet victories

I've been thinking a lot about physical therapy, and how subtle and simple but oh so challenging it is.

In the movies, recuperation and triumph after physical injury seems so glamorous, tough, and aggressive. The soundtrack pumps up the audience as they watch the beads of sweat appear on our hero's forehead. Big, bold movements and long grimacing efforts are shot in interestingly edited montages. The hero grunts with pain and trembles with exertion. He has a mentor who eggs him on, pushing him to reach his highest potential. And in the end, the triumphant victory. Hard, hard work results in glorious success.

I'm thinking of Peaceful Warrior, and the gymnast with the shattered leg, and Nick Nolte there to urge his apprentice to overcome his physical challenges. "With some hard work, I'm sure you'll be able to walk again," his doctor says solemnly. "A warrior doesn't give up what he loves. He finds the love in what he does," Nick Nolte rasps.

Flash to any of the Rocky movies. I don't recall what injuries Rocky had to overcome or fight through (I confess to not having seen all of the films), but man, what a soundtrack for his training. Whew. The only similarity to my situation is Adrienne, my amazing physical therapist. But I don't think I'll be shouting, "YO! ADRIENNE!" at any point in my therapy.

Check out this list from Amazon.com of Movies about individuals dealing with physical or mental challenges. I'm sure these films have tear-jerking scores for the revelation of the seriousness of the challenge, and driving scores for the recovery efforts.

"The Eye of the Tiger" isn't resounding in triumphant crescendo to accompany my efforts, that's for sure. The realities of recovery would be way too BOR-ing for any film audience, and the detailed descriptions of the exercises I do would put my blog readers to sleep. Instead of dramatic, sweating exertion, my heroic journey is made up of little steps and stretches and many admonitions from my therapists: stop pushing so hard; take it easy; you won't get there any faster by rushing--indeed you could set yourself back by working too hard. REST!

I suppose the drama in my story lies in the emotional components of recovery. A writer like Philip Roth might be able to do it justice. There is great complexity in my mental and emotional journey from harried wellness and relentless pursuit of the Bottom of the To Do List, to shock at my diagnosis and recommendations for treatment, to the forced acceptance as I am wheeled into the operating room, to the odd timelessness of the hospital, to the mixed joy and anxiety of returning home to examine what I've left undone.

I've had to surrender to this process, and let them have their way with my body in the interest of wellness. Funny how awful these health-building interventions can be. But there's no choice in the matter, so courage doesn't really come into play. Some kind of fundamental strength may be at work here, but it doesn't feel as deliberate as courage must be.

The best I can hope for are daily accomplishments, measured in such small units that it's ridiculous to verbalize them. Just a nod to the fact that I have made the transition from lying in a bed for 14 days to gradually sitting in a chair, then given mobility with a wheelchair, then a walker, then a cane, all in a matter of weeks. Only in taking the long view of my recent history can I measure my quiet victories.

Another Loss

Yesterday I received email notification about the death of a former coworker. I met Gene Wright in 1988 when I took a student worker position for our esteemed organization. He was kind and quietly humorous and we exchanged quips even after he retired whenever he came into the office. He was in charge of the punch at the annual Christmas party. He was a very nice man, and he had interesting things to say. Is it really possible that we shared twenty years of casual professional acquaintance? This points out how fortunate I have been to enjoy long-lasting associations with the people I've worked with all these years.

Here's a little synopsis of Gene Wright's life. http://www.legacy.com/tucson/Obituaries.asp?Page=Lifestory&PersonId=101339837