X-Rays taken at the Three-Month Mark

Sorry, I've been slacking with this blog.... It's been exactly 4 months since I had the 2-level ADR surgery. I had x-rays taken last month on 11/28/12 and had sent them in for review, but I have yet to hear from Dr. Clavel. I had hoped to hear from him by now considering it's never taken this long to get a response. I'm assuming it's because of the holiday season.... Anyways, I had the x-rays taken at my orthopedic surgeon's office. Dr. Asdourian said the images looked great; the implants are settling in nicely with the vertebrae. Of course that was great news. The only thing I'm slightly concerned about is the fact that I've been having constant pain in the anterior tibia muscle. This has been going on for the past 2 months now. Dr. Asdourian is not quite sure why I'm experiencing pain in that part of the leg. He gave me a plethora of reasons from scar tissue to possibly a pinched nerve, etc. He wants me to get either a MRI or a CAT scan (it depends on Dr. Clavel's recommendation) just to make sure a nerve isn't pinched. In the meantime, he prescribed Neurontin and Meloxicam in hopes it will help alleviate the pain.

Frontal View

Lateral View

Once I hear back from Dr. Clavel, I'll post an update. Thus far, I've been doing relatively well aside from the pain. I have already gone back to work full-time and have been driving around without any issues (yes, I still wear my back brace for safety precautions). I've regained most of my strength and flexibility...thanks to my awesome little family at Active Physical Therapy. (Tomorrow I'll be going in for another reevaluation so there is a good possibility my PT sessions will be coming to an end). I'm not as ecstatic as I thought I would be for hitting this milestone...perhaps my celebration will happen once I hear back from Dr. Clavel and get the reassurance I need that everything is going as well as expected.

12th week Physiotherapy Reevaluation

My physiotherapist did another evaluation. From his standpoint, I'm well on track with my range of motion. His assessment is as follows:

• Flexion - 51°
• Right Side-Bending (RSB) - 30°
• Left Side-Bending (LSB) - 32°
• Core Strength - 4/5
• Hip Flex/Abduction - 4+/5
• Straight Leg Raise: Right - 87°, Left - 86°
• Sit and Reach to Ankle

According to his assessment, I have improved in all areas. After I voiced my unrealistic expectations of wanting to attain the same level of flexibility prior to surgery, he recommended another 4 weeks of therapy. Thus, I am still going 3 days a week. There has been a slight change in my workout routine. All the weights I've been working with have increased by one pound. Additionally, two exercises have been incorporated to work on my core strength: walk-out and push-ups on the medicine ball, and walk-out with leg raise, again on the medicine ball.

Wicked Scar

It's been exactly 10 weeks post surgery. The scar still looks pretty wicked even though I've been using Mederma (gel applied topically to diminish the appearance of scars). Most of the swelling has gone down around the incision. To the touch, there are certain areas along the scar that is completely numb and you can definitely feel the scar tissue. I believe there is some permanent nerve damage along the incision. It has been more than 2 months and the sensation has yet to return. Oh well. The scar looks unsightly for sure, but on the upside the pain and itching subsided. Here's what it looks like:

Wicked Scar

8th Week of Physiotherapy

This week marks the 8th week of physiotherapy here in the states. And yes, I'm still going 3 days a week. Since my last reevaluation not much has changed. At least from my standpoint. My range of motion feels about the same, but I will know for sure when I go in for another evaluation. The only thing that has changed since then is my workout routine. Weights have been incorporated to build up the strength in my legs and my abdominal muscles.

Here's my current workout routine:

• 10 minutes (3.3 miles) on the recumbent exercise bike 
• 3 sets of sidesteps with green resistant bands around ankles = 60 sidesteps
• 20 squats on bosu ball with 2 lbs weights in each hand
• 40 repetitions of alternating leg and arm lifts on medicine ball using 2 lbs weights on each ankle and 2 lbs weights in each hand
• 40 pelvic tilts on medicine ball simultaneously with bicep curls - 4 lbs dumbbells for each hand
• 2 sets of 10 for three-way leg lifts with 4lb ankle weights
• 20 reverse crunches with ball
• 40 (20 for each side) upper body rotation using red resistant bands 
• 10 cat and camel stretch
• 3 sets of hamstring stretches for both legs (30 secs per stretch) 
• manual stretch for hamstrings by the therapist

My current routine lasts about one hour. I opted out for the heat and electro stimulation simply because I've never felt any relief from it. In my personal opinion it was just a waste of time.

I do feel much better as a result of the surgery, but want to emphasize the point that I am not 100% pain free. I still have lots of pain in my sciatic nerves, glutes, and in my calf. With the exception of the glutes, the pain seems to be isolated primarily in the right leg. I have absolutely no idea why that is, but I've already come to terms that the existing pain will most likely last forever. It's not a shooting pain, but more so a throbbing pain in isolated areas. Now it's not constant, it is intermittent which is something I can deal with.

Tomorrow I will post a picture of the scar. :) For any of you whom are interested in getting an artificial disc surgery please feel free to ask any questions you may have (either about the surgery and/or recovery, about Dr. Pablo Clavel, Barcelona Spine Center at Quiron Hospital, or about Stenum Hospital).

One Month Reevaluation with Physiotherapist

Today I had my one month reevaluation with the physiotherapist and I've had some improvement with my range of motion and strength in my lower extremities. On flexion I went from a 36° to 40°, extension is the same at 10°, and both side bends remain the same at 15°. The strength level has increased in both my legs, but the left side is slightly weaker (there is still inflammation from where the incision was made); my core has gotten stronger as well. Since my goal is to regain the flexibility I had prior to the surgery the physiotherapist recommended at least one more month of therapy sessions.

Aside from that I am driving on a more regular basis. I do use a back brace to maintain a proper posture. The pain increases (in my glutes or calves) when I'm driving for more than 30 minutes. I will admit I have slacked on my home routine as far as going on a daily walk. It's been about a week since I last went for my usual 3 mile walk. Hopefully, I'll get back into that soon. I continue to take my daily supplements to support my bone health and joints (Vitamin D, Vitamin D3, Calcium, Vitamin C, Fish Oil, and Glucosamine) along with drinking lots of water. The pain in my facet joints has been sporadic so I can only assume it's the result of the Fish Oil and Glucosamine intake. Overall, I'm happy with how things are progressing in terms of my physiotherapy treatment and my level of pain which is at a 3 on my worst days. In a few weeks, I will take another photo of my abdomen so you can see how the scar looks. Right now I think it looks the same even though I've been religiously applying Mederma on it to minimize the appearance of the scar. Hopefully, it'll start to look better.

7 Weeks Post Surgery

It's been almost 7 weeks since I had the ADR surgery. I've been going to physiotherapy 3 days a week for the past 5 weeks now. I'm slowly regaining my strength and flexibility in my legs. When I originally started physio here in the states my physiotherapist checked the level of flexibility in my hamstrings. The left side was at a 36° angle and now it is at 78°; the right side was at a 40° and now it is at 81°.  I'm definitely making progress. Naturally, I'm still experiencing pain in different areas of the right leg from the glutes to the hamstrings to the calves. From what I've been told the pain is expected to last at least a year. Also, the past few weeks everyone has been commenting on how I appear to be taller than before so I finally had my height measured. I now stand at 5'3 1/2" (161.29cm) which means I actually got taller by an inch and a half. :)

About 3 weeks ago I had a follow-up with my orthopedic surgeon. He didn't have much to say because he's not familiar with this procedure in the lumbar spine nor has he had any experience using the M6-L. During the appointment I pretty much brought him up to speed on what took place in Barcelona. My next appointment with him is not until the end of November. At that point, I will be hitting the 3 month mark so I will be getting another X-Ray done (to see how the implants are settling in with the vertebrae).

Reevaluation with physiotherapist

I had my reevaluation with my physiotherapist, Yonas, yesterday. He was shocked at the startling contrast of my range of motion prior to surgery and what it is now. He said my level of flexibility before was beyond the normal range (he asked if I was a gymnast...sadly the answer is no) and for me to reach that level again it'll take months. :(  Because of my limited flexibility in the lower extremities he suggested I go in for physiotherapy three times a week. For now, we'll be doing exercises to work the hamstrings, quads, glutes, and abdominal muscles. Yonas reassured me that the workout will get more rigorous after 6 weeks.

Oddly enough, during the reevaluation he inquired about my flight home. When I mentioned the swelling he was not surprised. Yonas actually said it was perfectly normal and I shouldn't be concerned about the implants. :) He said the numbing and tingling sensation I have in my feet should go away permanently in a few days. Yonas said it was a residual effect of the swelling and inflammation of the nerves.

I also made my first attempt at driving again. I must say I am not ready. It was the most uncomfortable ride I have ever experienced. It was mainly due to the fact I couldn't comfortably reach the pedal. My legs felt too short. :D

Bandages are off!

I woke up this morning with absolutely no pain. It was an amazing feeling that I got a little carried away and started doing some cleaning, moving things around, and doing lots of bending. Once I finished I realized it wasn't the smartest decision. The pain had returned in my arse and legs with some minor backache. And now I'm back to taking it easy. But alas, the bandages have finally been removed from my abdomen. The wound is still healing and it itches like crazy. I made an attempt of putting on a pair of jeans, but quickly realized it was irritating my skin. So, I'm back to wearing comfy pants with an elastic waistband.

No more bandage!

Trying to regain some normalcy back into my life

The past few days have been a bit of a blur. It's already Friday and I don't know how I managed to lose track of time. I'm still having difficulty adjusting to life here in the states. As most of you know, I work as a caregiver for developmentally disabled adults. The job itself is taxing on the body because three of my guys need total care (two of them are wheelchair bound). Since the job is physically demanding I am not able to return to work for another 3 1/2 months. It's a strange feeling to not be working, to not be taking care of someone else.... One thing I do have is plenty of time to make some major life changes.

Today I managed to schedule an appointment with my physiotherapist. I will be having a re-evaluation on Monday with Yonas. Luckily, their location is within walking distance so I won't be having any issues getting there. Also, I have an appointment with my orthopedic surgeon at the end of this month for a follow-up.

As for me and what I'm experiencing physically, I'm doing quite well. I managed to go for a three-mile walk around the lake and do two reps of my daily exercises. All the swelling in my lower extremities are gone. I have noticed some tingling and numbing sensations in both feet, and the pain comes and goes in my sciatic nerves (I'm not concerned about that at all). On the flip-side, my back feels great; the QL muscles are 100% relaxed and I have yet to experience any pain in the lumbar region. :) Oh, and one more thing, I have not taken any pain medication since Monday.

Terrible flight experience caused major swelling

On Monday, I flew back home to the states. The one thing I regret is not flying back First Class which is what other ADR patients recommended...I now understand why. Sitting in the aircraft for about 9 hours and trying to maintain a proper sitting position was virtually impossible. I was lucky enough to have an additional blanket and pillow supplied to me by the gentleman sitting next to me, but with the two blankets and two pillows I was extremely uncomfortable. I took pain medication prior to my flight as well as two more pills during the flight, but it was not enough. After the flight, my legs and feet were ridiculously swollen and I knew the inflammation of the nerves had returned. I was a little concerned I might have damaged the placement of the implants, but won't know for sure till I see my orthopedic surgeon. I am still somewhat jet lagged and have not settled in to a routine here yet. I have been slacking on my exercises and this morning I decided I need to be more cautious and more vigilant about taking care of my body. So, I finally went for a two-mile walk around the lake and it was exactly what my body needed. I noticed the swelling had gone down immensely in my lower extremities. My legs feel better, but my feet are still noticeable swollen. I just need to remember to drink lots of water and to keep exercising.

Oh and here are the links I mentioned in an earlier post:

This video shows how the M6-L is implanted into the spine

http://www.youtube.com/watch?v=867iiQDQhfI

This clip shows you the mechanics of the M6-L (of the material used and how it operates). Oddly enough, the M6-L was devised by Spinal Kinetics, a California-based company, but the FDA has not approved the use of this implant here in the states

http://www.youtube.com/watch?v=qzSyvxdA-Oc

This is the hospital where my surgery was performed; I absolutely loved everything about this place :)

http://www.youtube.com/watch?v=_TCOFN6AA1g

This is my last night in Barcelona and I can't sleep...So much has happened in the past few days and I regret not keeping up with my daily entries as I had intended. I just wanted everyone (friends and family) to know I've been doing extremely well post-surgery. So let me recap the past few days for you...

On Thursday, I had my last meeting with Dr. Clavel at Quiron Hospital. He had removed my bandages and said that my suture was healing nicely. The incision itself is not what I expected; it is relatively small compared to the caesarian style incision they use in the UK. Dr. Clavel explained the different types of incisions which can be made on the abdominal. The approach he uses causes less inflammation and scarring of the tissues which obviously allows the patient to heal much quicker.

The frontal view

My abdominal is still swollen where the incision was made and it's quite painful to the touch and a little itchy at times. I have another week to go before the bandage can come off altogether. (Dr. Clavel was kind enough to supply me with some waterproof bandages as it was impossible for me to not get it wet with the kind I got from the pharmacy).

Tried to capture it from a different angle to show you the inflammation around the suture

 

Meeting Dr. Clavel for one last time was bittersweet. While I was there he made a point to check up on me at least once a day to see how I was feeling. He has great bedside manners and he's an awesome surgeon. I really am going to miss seeing him, but am very happy I'm well enough that I have no need to meet with him anymore. But of course, I'm not 100% cleared. After 3 months, I need to have x-rays done again and send it to him so he can see how the vertebrae is healing around the prosthesis.

Me and Dr. Clavel - he is extremely camera shy which is why you see the big cheese on my face because I was laughing at him; he was awkwardly adorable

Here's another shot :)

According to my physiotherapist, he's one of the best in Spain. Most of her previous clients had procedures done by him and through word of mouth she decided to meet him. She now collaborates with him to help with the ongoing treatment of his patients. As a result, she deals with lots of international patients. Laia, the physiotherapist, is able to tailor her techniques specifically to each patient because she and Dr. Clavel discusses the ins and outs of the surgery prior to her first meeting with her client. This way she is able to understand the mechanics of which nerves and muscles need to be exercised and which areas to avoid. This level of communication allows her patients to regain their strength and/or flexibility more quickly. Anyhow, I had my last session with her on Friday. Laia said that she was happy with the level of flexibility I had reached...she was able to get my body at a 90 degree angle. She said my hamstrings are well enough that I can advance to working on my abdominal muscles. Yay!

There is one more person I need to mention and that is Yolanda. She is the Barcelona Spine Center assistant. She handled everything from transportation to and from the hospital, the paperwork, the translation, and much more. For me, she was my source of comfort in an unfamiliar place in an unusual circumstance. She is one of the loveliest people I have encountered. She, along with Dr. Clavel, Laia, and all the nurses especially Izan will forever hold a special place in my heart. (Unfortunately, I was unable to get a picture with any of the nurses...Thursday was a very strange day for everyone and the nurses that worked on the sixth floor in the VIP suite were unavailable).

Me and Yolanda

The first part of my journey has come to an end. So bye bye Quiron Hospital.

My second home in Barcelona

I will post links at a later time to show you the device that was implanted in my spine as well as information about this hospital. Just so you know, I've never been to a hospital that was as people friendly and efficient as this one which is why I extended my stay...I didn't want to leave.

As for me and what I'm experiencing now is minor pain in my right sciatic nerves which is perfectly normal. I've decreased my pain medications to once a day as well. And I haven't felt this good in so long. :)

Making progress in regaining my flexibility

I had a wonderful physiotherapy session earlier today. The physiotherapist has been doing a lot of exercises to stretch my hamstrings and the other muscles in my lower extremities. I have noticed the sessions are becoming less painful. To date, I have only had three sessions with her and I'm already making remarkable progress. (Of course I'm doing my daily exercises once in the morning and again in the evening). She was extremely surprised on the notable difference I had made in 24 hours; the level of flexibility had increased incredibly in my right leg. The left side had shown minor improvement. She did inquire about my level of physical activity and what I'm able to endure. Once I told her that I had walked for several hours the night before she was impressed and advised me to keep walking as much as I can for however long I can (as long as the pain is manageable). As far as the lower left extremity goes, she said it was typical for the left side to be slow to show improvement. The reason is because of the location of the incision; there is more inflammation which will delay the healing process.

On a really good note, my lower back feels great. The tension in the quadratus lumborun (QL) muscle is completely gone. After 10 months of having extremely tense QL muscles 24/7, it has finally relaxed. I am now able to massage the muscle and put lots of pressure on that area without feeling any pain. 

Finally discharged from the Barcelona Spine Center at Quirón Hospital

Leaving the hospital was bitter sweet. My stay there was very pleasant due to the excellent care I received from all the nurses and staff there. The food there was also delicious. I am absolutely going to miss the 24-hour round-the-clock care I received; I must say I was getting spoiled. Nonetheless, I was well enough to be on my own. I met with Dr. Clavel this morning and asked a few pertinent questions relating to the aftercare of the surgery: what I should/should not be doing and the timeline of when I could add physical activities back in to my lifestyle. Sadly, I still have a long journey ahead of me.

Shortly after my arrival to the hotel, my physical therapist stopped by for a session. She did several exercises to strengthen and lengthen the muscles in my back and legs. Unfortunately, as a result of the surgery I have lost a lot of my flexibility. As long as I remain diligent and follow through with the recommended daily exercises I should regain my flexibility in no time. The pain I'm experiencing in my lower extremities should decrease as well overtime.

When I was discharged from the hospital, Yolanda, the Barcelona Spine Center assistant, was kind enough to supply me with a photo from the operating table.

Just to give you an idea of what my spine looked like prior to the surgery, here is an MRI taken on 6/7/12. Notice the darkness and the protrusion of the last two discs, and the how the spine had lost its curvature.

Day 3

I'm still in the hospital. I met with Dr. Clavel again this morning. He reassured me the bloating in my stomach as well as the pain in my buttocks and legs are perfectly normal. He said the pain in the legs could last for up to 3 months and the duration of it varies from person to person. Due to my inability to sleep during the night because of the excruciating pain he has increased the dosage of my medication. I also met with the physiotherapist today. She taught me a few exercises that are to be done while lying in bed. She showed me the proper way to sit, to reach for things in high places, and to pick up items off the floor. My only concern was I was instructed to not put any weight on my back (backpacks) nor should I be carrying a purse of any kind; anything I hold should be either centered in front of my body or evenly balanced in both hands. Aside from that today has been an uneventful day. Most of the day has been spent resting in bed.

Day 2: Post ADR Surgery

The M6-L is perfectly intact along the midline

X-Ray of the lumbar spine; notice the healthy curvature

Dr. Clavel has decreased my pain meds and it has been quite noticeable. I slept terribly last night because of the pain in my lower back extending all the way down to my legs. I've spent most of the day trying to sleep the pain away as well. Dr. Clavel said he would adjust my medication and I should be able to leave the hospital either tomorrow or on Monday.

Recovery at Quirón Hospital in Barcelona, Spain

I embarked on this journey alone. As terrifying this whole experience has been I know it has been the best decision for me and for a better back. I had the 2-level anterior total discectomy with an ADR surgery yesterday. It was performed by Dr. Pablo Clavel, a neurosurgeon. The first day post-surgery was spent sleeping.

Today, I have been up and walking around with minimal pain in my back and leg. I was told pain in those areas will persist for a few more days because my spine is getting adjusted to using muscles and nerves that were once neglected. In the picture above, you can see the curvature in my spine is back (prior to surgery, I had what you call a flat back; the spine was completely straight because of the degenerative disc disease in the lumbar spine).