L4/L5, L5/L6 (S1) Prodisc-L - treefrog (aka Cathy)
 

SURGERY DATE: May 26, 2009

AGE AT SURGERY DATE: 46

SURGEON: Dr. Bertagnoli

SURGERY LOCATION/CLINIC: St. Elisabeth in Straubing

DEVICE(s), LEVEL(s): Prodisc-L at L4/L5 and L5/L6 (or S1)

COST = EUR 34.550,00 (US $47,676.00)
AMOUNT BILLED:
INSURANCE ALLOWED:
OUT OF POCKET: All (so far - but I am submitting a claim to my insurance company)
TRAVEL: US $1054.80 for two tickets + US $564.00 for one upgrade to first class + EUR 1427,50 (US $2,011.26) for hotel for two people = Total US $3,630.06
EXPLANATIONS?


ONSET OF LUMBAR PROBLEMS, DATE OF INJURY, CAUSE, ETC...: DDD intermittent from early 1990's, became chronic in 2007.

PRIOR SPINE SURGERIES AND PROCEDURES (IDET, ESI, etc...): Several ESI's, and a facet block.

PRE-OP MEDICATIONS: Opana-ER 20 mg 2xday; oxycodone (~7.5 mg [1/2 of 15mg pill]) as needed; gabapentin 300 mg 4xday; diclofenac 75mg 2xday.

PRE-OP DIAGNOSTICS (discogram, nerve root blocks, etc...): facet block; discogram.

PRE-OP NEUROPATHIES (what, where, & degree of pain, numbness, tingling, sexual/bladder/bowel symptoms, etc.): Slight numbness in heels, up right calf and shin, and right knee.

PRE-OP CONDITION (Please include %leg pain/% back pain, pain levels, type of pain, ability to work and function, disability status, etc.... be direct, but be as verbose as you need to): ~20% right leg pain, 80% back pain. Still working full time up until surgery, but with reduced duties. Very little social life.

TIME POST-OP AT ORIGINAL POST HERE: 9 days post-op

DESCRIBE YOUR SURGICAL EXPERIENCE: Dr. Bertagnoli said my anatomy (the end plates and my blood vessels crossing over my spine that had to be moved) caused the surgery to be a little more complicated than he had anticipated. But, he used AMP ceramics (bone cement), and said that everything came out beautifully. At 3 days post-op, went to ProSpine office to meet with Dr. Bertagnoli, had x-rays and asked how long till I could leave the hospital. He replied that I could leave whenever I felt ready. I left later that evening, to go back to the hotel Theresientor.

RATE FUNCTIONALITY / SATISFACTION AT INTERVALS BELOW:

FUNCTIONALITY:
1. Very poor: much worse... disabled after surgery.
2. Poor: worse after surgery.
3. Neutral: No improvement, or improvements offset by new problems.
4. Fair, some improvement, limitations are still serious.
5. Good, substantial improvement, some limitations.
6. Excellent: no limitations.

SATISFACTION:
1. Very sorry I had the surgery.
2. Somewhat sorry I had the surgery.
3. Too soon to tell, or I'm ambivalent about the surgery.
4. I'm somewhat glad I did my surgery.
5. I'm very glad I did my surgery.

Don't forget the detail update section below!

DATE UPDATED: 07/07/09 FUNCTIONALITY: 5 SATISFACTION: 5 [6 WEEKS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [3 MONTHS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [6 MONTHS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [1 YEAR POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [2 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [3 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [4 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [5 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [6 YEARS POST-OP]

DATE UPDATED: _________ FUNCTIONALITY: ___ SATISFACTION: ___ [7 YEARS POST-OP]

6 WEEKS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ECT... (discuss surgery induced symptoms [leg pain?]):

3 MONTHS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

6 MONTHS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

1 YEAR POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

2 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

3 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

4 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

5 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

6 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

7 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):

Sorry I hadn't posted sooner. I have all these notes from every day starting from the day of admission, but haven't had the time to transcribe them yet.

But, I am doing really well. The pain I had pre-op, in my back and leg is completely gone. I have different pains, that are mostly just uncomfortable. I have been able to keep my pain meds to the same level as pre-op. And I expect that shortly after getting home I will be able to start reducing them.

I have been getting out for walks every day, some longer than optimum, but none that have really put me out of action.

We have today and tomorrow here, then we leave for home early on Saturday. With the time changes, we get home Saturday afternoon, but it will be about 13.5 hrs travel time. I really can't wait to get home. I am trying to enjoy as much of Germany as I can, without taxing myself. So, Straubing is as far as we have explored, but it is beautiful here, and I love the relaxed pace we have been observing while here.

Hi Cathy!
 

I was just going to call you! So glad to see that you're doing well! Be careful on that flight home...I don't know about you, but I'm still having trouble with my feet and ankles swelling, and in the short flight from there to Paris, my feet swelled bo bad that by the time the plane landed, I couldn't move them...I was so scared that they were going to split open and I'd have little fountains of water spewing from them! :eek: I took the compression hose and used them like ace bandages to wrap my feet and then put a pair of socks over them. If you're having any problems with swelling, you may want to try to get some ace bandages for the trip home, just incase.

Just a quick note to say I am home. The flight was not too bad. I ended up getting a first class seat on the flight from Heathrow to Raleigh. After realizing it was going to be very difficult to sit in coach, on the flight from Munich to Heathrow. I think it was worth the extra money. I was able to sleep for part of the trip.

I am doing much better than I ever would have imagined possible. I have distraction pain, but it is far more manageable than I thought. The only thing is just being uncomfortable most of the time, laying down or sitting. And making sure not to move the wrong way. I think I am doing pretty good with it. Though it is helpful that my sister is here helping me and doing things for me. I don't know how well I will do after she leaves, I'll have to rely on my boyfriend more, when he's home anyway.

Well, I don't have the time right now, to do much reading. But I hope everyone is doing well.

Hi Cathy

Welcome home:)

Please take it easy and we are fine.

Rest, Relax And Heal life is waiting for you.

All The Best

Gil :D

Cathy,

What a relief to be home, huh? Glad your trip wasn't that difficult and ditto on your pain. The whole process takes awhile so settle in and enjoy your new back. Keep us posted and let us know how things work out once your sister leaves. Just remember, if you can't do it, don't... nothing is all that important.

Dale

Cathy,

Thanks for keeping us posted .... surgery sounds like
it went well.

Be good to your-self :)

Todd

2.5 weeks post-op, and I am doing amazingly well. My boyfriend measured me last night and I am now an inch taller than I was pre-op (though only 1/2 an inch taller than my "normal adult" height), at 5' 4".

My sister is here this week, though she will be leaving Sunday. We have been cooking up a storm, mostly her, in preparation for me being on my own more after she leaves. My boyfriend will be around, but he's not much on cooking, and doesn't always have much time for it. I will have lots of great, healthy food in the freezer for the coming weeks.

I don't have much pain, only what I think is distraction pain (an aching from my hips down to my feet), certainly not the pre-op pain.

Constipation is not much of a problem, though is still there a little (much like pre-op), as I have been able to keep my pain med to the same level as pre-op. I go to see my PM doc on the 22nd, and I will see about starting to lower my meds then (if I haven't already started - I have started reducing the amount of gabapentin I am taking) and get x-rays.

Welcome home
 

I'm so glad everything went well. It's amazing how there is so much leading up to it. We on the board hear when someone is going then boom they're back. I am wishing you the very best and glad the trip is over!!!!

Well, this coming Tuesday will be 4 weeks post-op, and I still can't believe how well I am doing :D. That aching I had in my legs is gone, I now think it might have been a side effect of the lorazepam. I haven't taken it, and I have slept on my side, which were two things I thought might have been causing it, and that pain is gone.

I still sleep more than normal, but I figure that is par for the course. I go to sleep around 11, and don't wake up until 9 or 9:30. Though I don't typically take a nap, today was an exception, and it was only a slight bit of dozing really.

I really don't have pain, though I was more uncomfortable yesterday afternoon, and last night. Even this morning I was still feeling it, but this evening I am feeling better. I took amitiptyline last night, to help me sleep. I am still taking pain meds, 20 mg Opana-ER 2xday and ~7.5 mg oxycodone 3xday, but I've already cut down my gabapentin to 300 mg 1xday (from 4xday pre-op). I am only waiting to see my PM doc on Monday to start tapering off the pain meds. I will need a lower dose Opana-ER, and find out how long to stay at each reduced dose. I don't think the oxycodone will be as difficult, and I think that will be after the Opana, but I'll see what the PM says.

Before surgery, I thought that my day would be spent sleeping a lot, or at least laying down a lot. With short walks to break up my day. I did not think I would be sitting at all. But, since getting back from Germany, I pretty much only sleep at night. I sit at the computer, and I lay down on the futon in the living room, but I get up much more than I every would have thought to be doing. I can walk farther than I ever thought I would be doing post-op, and that was something I did a lot of in the days post-op in Germany. I am just super amazed.

I am not concerned about my ability to go back to work. But I still plan on waiting, to let my body heal. Because even though I am feeling great, I know that my body still has a lot of work to do. Now, I am hoping that the job I want will be there when I am ready to go back to work. I guess I do worry a little bit, will I be able to sit all day (well with short breaks to get up and walk around), since I do break up my sitting now with laying down or walking. But, it isn't even 4 weeks yet, I'm sure I will be feeling even better in the weeks ahead.

Cathy,

This is wonderful news. You sound right on track and seem to be doing everything right.

You wait and wait and then voila, you're on your way to getting your life back. Poster ADR girl - you now give others the courage to go for it.

Hope all continues to be good. There may be a few bumps here and there but that's all normal stuff, especially if you overdo - though the panic rears its ugly head. Common sense goes a long way but I think you've already figured that one out.

Keep up the good work, Dale

Last Monday I saw my PM doc, it was just a day before my 4 week post-op date. She was very impressed with how well I was doing, and how nice my incision looked. She said that ADR patients can return to work at 4 weeks, and asked if I was okay with that. I told her I wanted to wait until after 6 weeks, just to get to that point of time when the bone is supposed to grow into the disc.

She had x-rays done, though they didn't do extension/flexion, I'll ask her to do that next time. From what I can see they look good, but I can't see that the bone is growing into the disc. Of course I don't know what to look for either.

She prescribed a lower dose of Opana-ER, so I have started tapering off that. I went from 20 mg 2 x a day to 10 mg 2 x a day, will stay at that level for 2 weeks, then go down to 5 mg 2 x a day. Two weeks of that, then I will start tapering off the oxycodone, as long as I am not feeling pain.

She did say she thought I should stay off the diclofenac (NSAID), for a couple of months, saying there was conflicting thoughts as to whether they interfere with healing. I had been taking it, since just after surgery, but I stopped. If I can stand not taking it, it's probably better to be off it. But I know Dr. Bertagnoli prescribed diclofenac to another of his patients, so he must not feel that they interfere with healing.

Tomorrow I will be contacting a person about a job opening at my employer (Duke Univ). I am hoping that I can start working part time anytime from July 8th on (that will be 6 weeks post-op). My PM doc suggested working 4 hrs/day for 2 weeks, then 6 hrs/day for another 2 weeks, before going back full time. I would still have intermittent FMLA, and leave time, so I could get paid more than 4 hrs/day (so I can keep my benefits). I am hoping this person is willing to give me a shot with this position, it is a new career path for me, but something I think I can be good at.

I have some pain, but it is minimal. I would rate it as a 1 (sometimes a 2). The most annoying pain right now is just at my incision, but internal. I know the internal takes longer to heal than external.

Hi Cathy,.......I sometimes feel like calling you Froggy like Miss Piggy did with Kermit ...he he.
I am glad to see you are doing well and improving nicely. I have observed that you have a very positive and well thought out approach to the whole thing. I wish my head was that organised!
Overall was it a big hastle to go to Germany or well worth it for the peace of mind? Did you have any problems with the travel? I guess everyone has to travel bussiness class dont they for the lumbar? Would you do it again?
Do you feel at this stage that you will be pain free or a little too soon to tell?
Before you had the surgery was your joint still pretty mobile? Mine is very stiff and locked up and I think I would be worried to have ADR because of this facet locking. How much disc height did you still have? and do you know the sizes of the prodiscs that were put in?
Sorry for all the questions, I probably should have PM'd you but others might like to know some of your answers aswell.
Thanks Froggy, (im in a silly mood,too much oxy I think.):p
Michelle.

I think it was definitely well worth it, in my mind, to go to Germany and have the worlds expert on ADR perform my surgery. The travel back to the US was uncomfortable, and I am glad that I was able to get a first class seat. I didn't book business or first class when I made the arrangements, instead I waited to see if I would be able to handle sitting in coach. There are some people who have been okay flying back coach, but I don't think I would recommend it.

I would definitely do the surgery again. I have no doubt that I will be pain free in the coming months.

I was still pretty mobile and flexible pre-op, though I did have pain.

My disc height was still pretty good, in comparison to other people's. But I don't know the exact height.

The ProDiscs I had put in are both size M, 10 mm core, both upper plates and one lower plate are 3 degrees, and the other lower plate is 8 degrees.

Today is 6 weeks post-op!! I was able to drive today, get my hair done and do a little shopping. I was out of the house for about 3.5 hours. I don't feel like I have extra pain, and hopefully it won't sneak up on me overnight, since I have an interview tomorrow morning.

I am waiting until after my interview to reduce my pain med dose again, and to reduce the stiffness of my brace. But I am ready to go back to work, though I don't think I am ready to handle full time yet.

Amazing!!!...... unheard of in the world of fusions. You are very lucky.
I wish I had have trusted my intuition earlier and gone to Germany 2 years ago before my facets degenerated. But I listened to doctors and physiotherapists and Pain Management who want you to put it surgery off untill it can be too late. This is usually o.k with fusions but with ADR it can put you out of the race for good.
You really do have to be your own advocate through all of this and do the research find out for yourself whats best because sometimes the discouraging people you come across really dont know!!!!!
Kudos to you Cathy for having the wisdom and strength to have a vision for yourself and working towards it. Because it can be hard enough to organise to get to the surgeons in your own town when youre in pain let alone across the other side of the world.
Congratulations on the start of a bright new future,
Michelle.

Can anyone tell me why my dot is red?

......Oh,yup just worked it out.:rolleyes:

Hey Cathy!! I'm SO happy to see that you're doing so well!! I'm still on the Arthrotec once a day, and I can really tell if I don't take it...not pain wise, just a stiffness that isn't there normally...

I just had my flexion and extension x-rays done, and they looked really good. Everything looks nice and straight, and the discs appear to be moving like they should. I follow up with my neurosurgeon (the one who did my first surgery) next Thursday. I was very happy that he decided to keep seeing me for follow-ups...

Let me know when you're ready to come to Charleston and hit the beach with us!! :D

Jess

Update:

My interview went well, though by the time I got home my body was pretty tired. I was up and out of the house by 8:00 am, and got home around 12:30 pm. And I spent a lot of time standing and walking around, visiting my old lab, as well as sitting for an hour during the interview.

Later that evening is when I reduced my Opana-ER dose again, and reduced the stiffness of my brace. By the next day I started having severe nausea and a terrible headache. I was pretty much incapacitated by the withdrawal symptoms. The day after that I found that the anti-nausea med my PM had prescribed for me to take to Germany, could be used for withdrawal, so I started taking it. And it did help. I have found that it takes about 4 days of withdrawal symptoms, before I start feeling like myself again. The reduced stiffness of the brace was inconsequential in comparison, though I did have a little extra back pain. But again that pain is not constant, and doesn't last long.

Today is 7 weeks post-op, and I am still doing very well.

Cathy,

Withrawal symptoms can be difficult but it is what it is. Withdrawing slowly can help but that's an individual decision.

Also, walking, standing and sitting for too long can cause an increase in pain levels but at this point in time, shouldn't be anything more than temporary.

Hope it all continues to improve and you can soon forget you even had surgery:D. What a great day to look forward to.

My best, Dale

Cathy,

I have basically stopped taking everything but Ibuprofen and it fairly well. I weened down. The only hitch is that I am having insomnia which is brutal. It is a boon to amazon.com and barnes and noble, but fairly awful for me! Hope you feel better soon.