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June 2023 TABLE HOPPING

A REAL PAIN IN THE NECK

I ask patients about their hospital experiences all the time and usually the stories are not very encouraging. Recently I was in a hospital in New York City having some surgery. My take on spine surgery is that it may help initially but down the road the parts of the spine that were not worked on wear down sooner than if you hadn’t had surgery. This isn’t a universal finding but between the occasional lack of relief of symptoms, significant infection or new complication , surgery should be reserved until you have tried lots of different modalities. Surgery should be a last resort and yet here I was.

It all started about 5 years ago when I noticed the grip on my dominant right hand wasn’t as tight as I wanted and it affected my racquetball game. After that, I noticed weakness when I was trying to carry heavy objects and pain in my neck and shoulder. The pain and numbness would vary depending on recent activities…sometimes the dojo helped..sometimes it did not…it would bother me intermittently during the day but bother me more consistently at night. It prevented me from ever getting a pain free night. I tried grounding. I tried the PEMF machine. I tried physical therapy and a variety of traction devices. Of course I tried the chiropractor but he said I was “too old” for an adjustment. That was disappointing. I never tried pain pills because I take care of people who have had problems with this class of drugs and dont need more problems in my life.

It all came to a head when a very thoughtful patient gave me a Christmas present. It was a device that allows you to quickly measure hand grip strength. Grip strength reflects overall strength ;which reflects your ability to stay out of the nursing home. In the past I just asked pts to squeeze my fingers but this tester is far more accurate. Imagine my dismay when I tested myself and got a respectable 90 lbs on my left side but 35 lbs on my right side. That’s a very big difference. That convinced me to put myself through the standard workup including an MRI and Nerve COnduction Studies. The therapist technician was so alarmed at my readings he immediately suggested traction and a particular surgeon in NYC that “all the other doctors go to.” The MRI showed lots of arthritis, bulging or dry discs, bony changes where the particular nerves leave the spinal canal etc. Nothing that an injection from the pain specialist would give a long term fix to. I arranged a teleconference with Dr Daniell Riew in New York City. We reviewed my symptoms, my scans and nerve studies and likely outcomes depending on how much surgery I wanted. I could just fix the worse stuff and wait for the rest to give me trouble down the road or fix it all now and hopefully never need surgery again. THe main difference seemed to be in how much pain you could tolerate. The more aggressive the surgery the more pain postoperatively and apparently we are talking some real intense pain here. I reviewed with the surgeon and his team that I had both rotator cuff surgeries done over the years and was back to work in less than a week. I didn’t mean to challenge him.

It all came to a climax last Monday when I had surgery on my neck. Plenty of people had neck surgery from the back side of the cervical spine. . Lots of surgery is done today from the front side of the neck. I had surgery on BOTH sides of my neck AND extra work done on the sides. The authorization from the insurance company ran to 3 pages which I had never seen before. The paperwork mentioned 8 hours of anesthesia which also had me worried because I know that prolonged anesthesia time is not a good thing as you get older. Furthermore, a plastic surgeon would be involved in the last hour to splice some of my m;uscles across my neck to get better surgical outcomes. There will be two drains in me when I leave the hospital. The usual hospital stay is 4 days but many people who have the less extensive surgery gohome the next day. The paperwork they give you mentions that the post op pain can be “excruciating” but not to worry because it goes away in 3-4 weeks. Yikes !

Excruciating pain and prolonged anesthesia time were worrisome but in the week leading up to the surgery I watched a video of a guy doing jujitsu who was rolled wrong and suffered a broken neck with paralysis. Two days later I am doing some optional continuing medical education via the internet and they prominently featured a case of neck surgery going wrong with resultant paralysis. So, as surgery got closer my anxiety grew and I am guilty of having second thoughts. These second thoughts were banished from my mind by having an MRI of my neck done before surgery. Just the act of lying there flat for the scan was causing increasing neck pain and reminded me of how this chronic nerve impingement was affecting me on a daily and nightly basis and I decided then and there to go ahead and let them try to heal with steel. To cut to cure. I could have had surgery in Syracuse but I had a recommendation from someone in the know and, when I checked it out , Dr Riew only does cervical spines and is recommended by other spine surgerons.Lets commence with the cutting.

I had one question for the surgeon during our pre surgery visit: Doctor …are you excited to be doing this operation? He looked at me quizzically with that ” where are we going with this line of questioning” look. He finally replied that although he liked doing this extensive surgery it wasn’t exciting. That’s the answer I was looking for. If he admitted he was excited it would have meant he still found it very challenging and I want my surgeon to be very comfortable with the procedure but not yet bored by it .

Post op I woke up next to a paralyzed guy. He wasnt paralyzed by the surgery …He was just a paralyzed guy having surgery but I thought it put any complaints I might have after surgery in perspective. The pain wasn’t that bad, I was moving everything , the drains were working, etc. They have a very aggressive pain management program which starts preop and continues post op and includes the pain-med-on- demand I.V. My blood pressure was running high and they actually took one of my suggestions regarding what meds to use and I thought that was unusual and welcome. The meds really screwed up my sense of time and my wife reports that I texted her at 1130 at night that I was ready for discharge. I thought it was 1130 the next morning.

When the surgical teams rounded the next day I confirmed that if some other people can be discharged the next day then unless there is some problem I would like to get out under the same timeframe. Usual length of stay is 4 days. My length of stay is 1.5 days. I wanted to show everyone that I had a high pain tolerance, that I was in good shape, clean living, clean liver etc etc. When I awoke from surgery I could feel that the chronic numbness and intermittent spikes of pain were gone completely. I could lie on my back without the increasing pain down my shoulder and back and neck. I didn’t press the pain med button more than a couple of times early in recovery. Sure I felt stiff and swollen but wasn’t feeling any real pain. Good to go.

WRONG ! Big Mistake ! I knew that the next day the pain would be worse but with so little pain after the operation what could that look like? My wife drove us back from the city and I dove into bed but when I got up the next morning the pain was indeed excruciating. Breathtaking at times despite an array of meds to help me. I should have stayed in the hospital and would have used that pain buzzer until it buzzed like I was a jeopardy champion. . They had great care in the Hospital …nice room, semi healthy menu , great nursing care…I was treated like a king. Most of the people taking care of me didn’t seem aware that I was a doctor so that did not affect my care. I rushed out of the hospital thinking that would mean getting back to work quicker but that did not work out at all. I needed a full two weeks to get back on my feet and wasn’t pain free for a month. Ice has made a big difference as it did with my shoulder surgeries. Besides the pain , because I had such extensive surgery there was a lot of swelling in my neck and throat and I felt on the verge of being choked for weeks. I could not swallow any solids for over two weeks and even liquids challenged me on a regular basis but that’s also mostly in the rear view mirror.

Being on the patient’s side of the doctor patient experience was interesting. It’s good to get different perspectives. I hope I don’t get the opportunity to get any more new perspectives in the near future. Next month back to the science of wellness.

Get Well…Stay Well

JT BARRY