Depression Recovery

Question:

I had a cervical spinal decompression and fusion at C3 through C6; also called anterior cervical  discectomy with fusion and posterior laminectomy with fusion and fixation on July 23, 2001.  Before my surgery, I had very little conception or idea of what to expect; therefore, in hope that my experiences and frustrations might help others contemplating such surgery, I offer my story. I am a Caucasian male, age 64, in good physical condition.  I live with my wife of 44 years in Columbus, Ohio.  Until recently, I played tennis at least three times each week.  Several years ago, I noticed a strange feeling like a cuff around my wrists.  As this progressed, I started noticing tingling and later numbness in my hands.  The left side, my dominant side, was the worse of the two, and eventually I had difficulty writing and had to regress to printing.  My left arm, at the elbow now has a permanent bend of perhaps 20 to 30 degrees.  Over time, the same feelings of tingling and numbness spread to my feet, causing balance to become a problem.  Because of these and other physical problems – it seemed as if I was watching my body slowly wither and deteriorate before my eyes – I developed a serious, debilitating depression.  After looking for help in Columbus, and finding very little – after months of looking, I was unable to find even one psychopharmacologist in Columbus – I eventually discovered McLain Hospital in Boston.  I checked myself in for two weeks, and had outstanding results.  The staff at McLain was extremely supportive and caring.  Of particular interest and help was my daily consultation with a psychopharmacologist who monitored and regulated the psychotropic drugs I was and am taking.  Both he and my psychiatrist remain available to me by telephone which is both comforting and reassuring. My primary care physician in Columbus correctly diagnosed my problem as cervical stenosis.  I had no accident or other trauma to cause this condition, just age and gravity.  He told me of a mutual friend who had the same condition that had progressed to the point that he was confined to wheel chair; and later, I am told, he chose to die.  This friend had been offered surgical intervention which he refused.  It was time for me to look into both my surgical options and surgeons. At this juncture, I must discuss various doctors.  For their anonymity and  protection, as well as mine, it is necessary that they be given pseudonyms as follows: Dr. PCP    Primary Care Physician in Columbus Dr. NC     Neurosurgeon in Columbus Dr. N Cle  Neurologist in Cleveland Dr. O Cle  Orthopaedic Surgeon in Cleveland Dr. NB1    Neurosurgeon in Boston who performed my surgery Dr. NB2    Dr. NB1’s partner PA         Dr. NB1’s Physicians’ Assistant I discussed my probable surgery with Dr. PCP, and I did a great deal of research on the Internet.  I discovered this is BIG surgery.  It is also difficult, long, technical and tedious. One small slip of the surgeons hand and I could become an instant paraplegic, or worse.   Since I had only one chance, I had better find the finest surgeon possible. Dr. PCP suggested I see Dr. NC, a well-known neurosurgeon with a very good reputation in Columbus. I made an appointment, saw Dr. NC, and he ordered a myelogram, which I scheduled.  At the appointed time, I presented myself at the hospital radiology department for the myelogram.  Dr. NC injected the contrast dye in my spine and proceeded to complete taking pictures of my spine.  Several days later I received a letter from Dr. NC suggesting one of two procedures, and giving me an appointment to come in and discuss his suggestions.  I showed up at the appointed time, and we discussed my options based on his physical examination and the myelogram.  I told him it was a big decision. I needed some time to think about my options, and I would get back to him.  To fast forward several months, before I went to Boston for another opinion, I collected all of my x-rays, MRI’s and of course my myelogram for which I received a bill from Dr. NC for about $900.00.  When I asked for the myelogram at the hospital radiology department, I was told it did not exist.  When I pressed them, they admitted that Dr. NC had injected the contrast dye into the wrong sheath in my spine, and the resulting pictures were of no use. At this point, I must interrupt the narrative to discuss, but not debate, two, of many, medical issues. The first issue concerns the turf war over the spine.  Both neurosurgeons and orthopaedic surgeons operate on the spine.  Which speciality is more qualified for spinal work?  I do not know.  The second debate concerns spinal grafting, surgeons must choose between using an allograft and an autograft. Which is better?  All I know is when using an autograft, another surgical site is created with its pain and infection potential. However, surgeons who use an autograft feel that a graft from the patient’s own body will knit better than one from a cadaver or a piece of titanium. Returning to the narrative, my next trip was to Cleveland to see an orthopaedic surgeon who successfully operated on my wife’s lumbar spine perhaps 15 years ago.  Dr. O Cle is a wonderful man, is in the book, "Americas’ Top Doctors," and has specialized on spinal surgery for at least the past 20 years.  He recommended a cervical corpectomy with strut graft which is also called a verterectomy.  The strut graft was to be an autograft, and I was to wear a halo for three to six weeks after surgery. While in Cleveland, I saw Dr. N Cle, a good man, a gentleman and a friend of Dr. O Cle.  Dr. N Cle told me the surgery Dr. O Cle was purposing would work well and that it would prevent any further loss of function due to the spinal stenosis; however, any recovery of previous loss of functionality would be a gift. During my quest for the best surgeon, the name of Dr. NB1 surfaced several times.  I downloaded his curriculum vita from the Internet. Dr. NB1 is Assistant Professor in Surgery at Harvard Medical School Division of Neurosurgery and Director, Section of Spinal Surgery at Brigham and Women’s Hospital.  In addition, he has published and spoken extensively.  First hand reports indicate that he is in his mid 40’s and at the top of his powers.  I may have found my surgeon, time to go to Boston. It took about three months to get an appointment with Dr. NB1.  My wife and I arrived at his office in Brigham and Women’s Hospital (BWH) and endured a three-hour wait, which I now understand is not unusual. He did not need a myelogram; the MRI’s were satisfactory.  He took the time to show us on the films where my spine was impinging on my nerves at C2 and other sites.  He recommended a spinal decompression, of which he does several each month.   I agreed and scheduled a surgery date. The day of the surgery, my wife and I arrived at BWH at 5:30 a.m.. Shortly thereafter I changed into a hospital gown, was hooked up to an IV and put to sleep.  I understand the surgeon did the anterior part of the procedure first, making an incision in my neck, moving my esophagus and operating on the higher cervical vertebra.  Then I was rolled over, and a centerline cut was made in my back, and the procedure continued on the lower cervical vertebra.  A lot of titanium hardware was installed; eleven screws, eleven plates, two rods. Specifically, the procedure was the following: C3-4  anterior cervical discectomy with fusion, C4-5 anterior cervical discectomy with fusion, C3-6 posterior fusion.  I was in surgery about seven hours. MY MAJOR COMPLAINT and the main reason I am writing this is No One Told Me What To Expect (NOTM).  My recovery would have been much easier for me, my wife and all of the staff attending me if someone, anyone, had taken 15 minutes and told me before the surgery what to expect.  Even if Dr. NB1’s staff had developed a hand out for me to read, it would have been immensely helpful, but NOTM.  With the exception of NOTM, I have no other gripes. BWH is a preeminent hospital; they are currently listed among the top ten hospitals in the country.  The staff is trying to archive 110% patient satisfaction and care at all times.  My nurse, Ellen, was a 90-pound dynamo of energy and personnel caring for me.  She bathed me, fed me and told me I was going to get well.  Ellen even called about a week after my hospital discharge to see how I was getting along.  She was sensational as were the other nurses who cared so skillfully for me. I awoke from the anesthetic wearing a Miami J neck collar which I must wear 24/7 for three months.  It is surprisingly comfortable and easy to sleep in.  The only problem is that it is hot, about equivalent to a neck gator.  One trick I eventually learned is to pad it with two handkerchiefs, one in front and one in back.  NOTM The first day after surgery is lost to me.  By the second or third day, I discovered I could not feed my self.  My hands would not raise high enough to reach my mouth.  I could feed myself before the surgery.  I asked why.  The answer I was given is that the nerves at C5 come out a different angle than the others, and sometimes this causes problems in lifting the arms.  I was assured that the problem would eventually go away.  NOTM The next problem was eating and drinking.  I quickly discovered that simply eating or drinking almost anything caused the food or drink to "go down the wrong pipe" causing severe coughing and inability to breathe.  My son said I turned blue several times.  It was easier not to eat or drink, but I could eat yogurt and drink milk with some difficulty.  The reason for this is that my esophagus was moved during surgery, and it would take a while to return to normal, maybe as long as several months. NOTM   This problem did resolve slowly over about four weeks. On Friday, I was released from the hospital to go "home."  In my case home was the Four Seasons Hotel in Boston, a wonderful hotel with … read more »

Response:

– Hide quoted text — Show quoted text -> I had a cervical spinal decompression and fusion at C3 through C6; > also called anterior cervical  discectomy with fusion and posterior > laminectomy with fusion and fixation on July 23, 2001.  Before my > surgery, I had very little conception or idea of what to expect; > therefore, in hope that my experiences and frustrations might help > others contemplating such surgery, I offer my story. > snipped > This narrative has extended to much more length than I had originally > intended.  If you are still reading, you have probably had experiences > comparable to mine or possibly you are contemplating similar surgery. > As stated previously, my intention for writing this disquisition > (statistical sample size of one) is that hopefully this effort might > be helpful to a few cervical surgery patients.  Possibly, even a > support group might be started.  If you want to communicate or > Good luck and Godspeed.

You’re absolutely right, it’s so important to know what to expect, and this can have a big impact on your recovery. I hope telling your story will help other people in a similar situation. I hope things go well for you! — Katharine S. spamblock in action

Response:

> I had a cervical spinal decompression and fusion at C3 through C6; > also called anterior cervical  discectomy with fusion and posterior > laminectomy with fusion and fixation on July 23, 2001.

I faced a similar situation a few years ago. After networking with numerous "survivors" of cervical spine surgery I decided it wasn’t for me. I still have DDD in my neck but the pain is well controlled with medication. I regularly exercise and work with a PT and I have managed to remain relatively stable for a couple of years. I also have ms, which does complicate things a bit, but I thank god when I hear stories like yours that I turned my back on surgery. Good luck to you. Jim

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