Dave's ADR 2010

This is the story of my artificial disc replacement (ADR) in June 2010.

My L5-S1 disc had herniated in 1998 when I fell from a standing position to sitting on concrete. In January 2009, I had a discotomy in Toronto, Canada, but by the end of the summer 2009, it became clear that the disc had continued to herniate. I was afraid of fusion because usually the adjacent disc fails in time (adjacent disc syndrome). Artificial discs do not appear to cause this effect.

I solicited the opinions of four ADR surgeons. In each case, I provided them my history as well as the following imagery:

1. lumbar MRI (with and without contrast since I had a previous discotomy),
2. lumbar CT with no contrast,
3. standard set of lumbar x-rays (neutral lateral, flexion lateral, extension lateral, and anterior-posterior), and
4. DEXA of lumbar spine and hips.

The DEXA is very important, as artificial discs must have good quality vertebral bone to support them, otherwise they can subside into the vertebrae. My hip bone density was two sigma below the mean for my age group (very bad), while my lumbar bone density was at the mean for a young person (very good). The hip numbers were alarming and a subsequent blood test by my family doctor indicated a lack of vitamin D. He also pointed out that bone only grows when under strain, and I sit all day in my job, so my spine is under strain but not my hips. I've since been taking 2000 I.U. vitamin D per day.

I decided to go to Dr. Willem Zeegers (now deceased). He is from the Netherlands but performs ADRs at the Beta Klinik in Bonn, Germany.

When preparing for my trip, I found Mitch Anderson's (the film director) experience to be quite compelling. His raw account gave me some idea of what to expect. I also stole his idea of bringing an mp3 player with audiobooks on it.

Like Mitch, I found it essential to have someone there with me. My mom went with me, and she was a great help as emotional support, but also for running errands as necessary.

On the day I left Toronto, I wired the money to Dr. Zeegers (8000 Euro) and to the Beta Klinik (12,257 Euro). The clinic said there may be further charges as MRIs or x-rays might be done during my stay. Be warned, banks do not like people moving large amounts of money from one account to another. They placed a six business day hold on the funds. That is why I couldn't wire the money until the day I was leaving. A tight squeeze. Make sure you get the money into the account you want to wire from as early as possible (weeks before). Although I found that the funds had arrived to Dr. Zeegers and the Beta Klinik, there was a mess-up later anyway (see operation day).

We arrived in Bonn at the beginning of June, which was the peak of allergy season - something to keep in mind if you suffer from seasonal allergies.

The airline lost our luggage, which we eventually received two days later. Quite an annoyance.

Almost everyone in Bonn speaks at least enough English to allow communication. Of course they love it if you try German. On the whole, we had no trouble communicating.

We decided to stay at the Kameha Grand hotel (pronounced, "kam-ee-ah"), which is right next door to the Beta Klinik. While I was in the clinic, this allowed my mom to walk next door to grab something if needed. The hotel and Klinik are located side-by-side on the shore of the Rhein (a.k.a. Rhine) river. My first impression when we arrived was that the Klinik seemed worryingly small and the hotel was not my style. My impression of the Klinik was not warranted, while, at least for me, my impression of the Kameha was accurate. All in all though, we were very happy to have stayed at the Kameha and the proximity to the Beta Klinik justified the expense.

Front of the Kameha Grand, Bonn, taken from in front of the Beta Klinik

Front of the Kameha Grand, Bonn. Taken from the other side (Beta Klinik is on right side)

The inside of the Kameha is made up of an atrium and courtyard, with the hotel rooms on each side.

The atrium inside the Kameha, known as the "Kameha dome"

The walking bridge inside the Kameha dividing the atrium from the courtyard

The Kameha courtyard as seen from my room

Front-left of Beta Klinik from Joseph-Schumpeter Allee. Bonner Bogen is the private drive between Kameha and Beta Klinik.

Front of Beta Klinik from Joseph-Schumpeter Allee (Kameha is to the left)

The Beta Klinik takes up most of the ground floor, part of the second floor, and the third floor will soon be a physiotherapy center for the clinic.

The following four pictures are of the Beta Klinik and neighbouring buildings, as taken from the Kameha. I pan left as I go.

Left side of Beta Klinik from Kameha (Joseph-Schumpeter Allee is at right)

Left side of Beta Klinik from Kameha

Left side of Beta Klinik from Kameha (I think the left building is a law office)

Left again, this time the Rhein is visible

I took a 360 degree series of pictures, progressively panning to the right. They were taken on the Rhein side (as opposed to on Joseph-Schumpeter Allee), at the end of the private drive (Bonner Bogen) between the Beta Klinik and Kameha.

Dr. Zeegers wants lots of walking after the operation and the paths beside the Rhein provide excellent walking.

Both sides of the Rhein are parklands with walkways and bicycle lanes. The German people are very fit, and love to walk and ride bicycles. I walked up and down the Rhein everyday.

I also enjoyed watching the ships going up and down the river carrying various loads.

Bring a hat and sunglasses as the sun can be quite intense.

The Kameha rooms have a bar fridge (with stuff inside which you can buy at high prices). We used it to store orange juice, milk, cheese, and yogurt. The rooms do not have a microwave oven. The rooms have a cable for internet connection, but we did not bring a laptop with us. It seems we were in the minority, because everyone in the lobby was opening their laptops and typing away. You can ask the hotel staff about using the business center, which has iMacs. When we were there, they were not available as someone had stolen them all. They had new ones in the main staff office, but they were still in boxes. As a result, they let us briefly use the staff computers from time to time. The staff of the hotel are very supportive, and they have a business agreement with the Beta Klinik which provides some discount.

The food at the hotel, while very good, is rather expensive. We went very often to a restaurant called Rohmühle, which is right beside the Kameha, also on the Rhein.

The Rohmühle restaurant

Kameha on left, playground in middle, Rohmühle on right.

The playground closer up

I drank a lot of bottled water at restaurants. In general, they don't serve tap water. In Germany, you can get either plain water, or fizzy water. I always wanted plain, non-carbonated water, and so I asked for stilles wasser (pronouced "shteel-es-vass-ah"), also sometimes referred to as "natural water." The food is exceptional at Rohmühle and much more reasonably priced (ranging from roughly 9 to 24 Euro for a dinner menu item). Generally you pay restaurants with cash (although they can usually take credit cards), and tips are not left on the table. You pay the waiter directly (they always carry change belts). Tips are usually around 10 to 15%, and you give it to the waiter when you pay (don't leave it on the table).

There is also a supermarket called Rewe (pronounced, "Ree-va") located about a twenty minute walk away. When you walk out of the hotel front doors, turn right and walk on Joseph-Schumpeter Allee to Heinrich-Konen Strasse and turn left. Walk to Königswinterer Strasse and turn right. Walk along Königswinterer Strasse to Jakob Strasse and turn right. Rewe is a few doors from the intersection. The closest bank machine is at the corner of Heinrich-Konen Strasse and Königswinterer Strasse at the top of the steps of the PostBank. This machine worked for my Mastercard, but not for my mom's Visa. I don't know why. She used the bank machine in the bank at the corner of Königswinterer Strasse and Jakob Strasse, mere steps from the Rewe. Unrelated to Germany, it turns out that if you use your credit card to get cash at a bank machine, the credit card companies call this a "cash advance", and they charge usurious interest. And while I have the credit card company automatically withdraw the appropriate balance at the end of each month, they don't include the cash advance money, so if you don't specifically pay them for that, they'll keep charging you the interest. What a slimy racket! Anyway, you will also find a good bakery at the corner of Heinrich-Konen Strasse and Königswinterer Strasse. They sell bread, but also sandwiches, juice, and milk.

If you have electrical items that need charging, you'll probably want to bring a power converter. This is not just an adapter from one plug configuration to another; it must also change the voltage and frequency. I bought one for about Cd $50 before I left, and I used it frequently for charging my shaver and my mp3 player.

The nearest train train station is Ramersdorf. This is a ten minute (or less) walk from the hotel. To use the train, you buy tickets from the ticket machine (press the English button for English), and then when you get on the train, you stamp your ticket with the little red box that is mounted just inside the door of the train. This records the time you entered the train and uses up one fare. There are two types of tickets we used: long trip tickets (designated 1B), and short trip tickets (designated 1A or K). You can tell which is for long or short trips by the prices. A short trip is four or less stations. Nowhere in the station is this explained that we could see. To buy tickets from the machine, you need coins, as it does not take bills. We changed a 20 Euro note at the bank beforehand. Some train cars have a machine inside for buying tickets. I'm not sure which cars of the train have this, so I wouldn't count on it. Trains are frequent, clean, and very convenient.

We arrived about 5 days before the pre-operative visit. I strongly recommend arriving at least a few days early as you will likely want some time to overcome the jet lag (depending upon where you're from). Our time difference was such that Bonn was 6 hours later (e.g., 6 pm in Bonn, noon in Toronto). Dr. Zeegers likes his ADR patients to stay in Bonn for two weeks post-op.

I recommend bringing a camera to the pre-op visit, so you can get your picture taken with Dr. Zeegers. You may find it less convenient after the operation, although he likes to take pictures afterwards anyway.

Prior to the surgery, I was taking diclofenac (Voltaren) 75 mg b.i.d. and pregabalin (Lyrica) 150 mg b.i.d.. Back when I had the discotomy, they gave me some Percocet to take afterwards, but I found it didn't help with the pain, it just made me care about it less. There was also a rebound/withdrawal after stopping. This seemed to be worse than before taking it in the first place. I remember the same experience with narcotics when I was also given Percocet after my wisdom teeth were removed during my teens.

I'm told that diclofenac doesn't help everybody, but it was the most effective drug for me. This makes sense to me since it's an anti-inflammatory and the S1 nerve root was inflamed (leading to sciatica). The Lyrica shrunk down the area of back pain to just my low back.

Pre-op visit at the Beta Klinik

Dr. Zeegers went over my case history in detail to ensure he had all relevent details. He did a physical examination including asking me to touch my toes, bend this way and that, push on his hand, lift my leg, etc. I had promised him that I would reduce my body mass index (BMI) from 25 to 23. I was pleased to report a BMI of exactly 23 on that day. To my great disappointment, he said nothing. BMI can be calculated as your weight in kg divided by the square of your height in meters. Note that there are about 2.2 pounds per kg, and 2.54 cm per inch. All told, we were with him for probably three hours.

At the pre-op visit, I read over and signed the informed consent papers. We discussed the dynamics of the Activ® L disc design and he mentioned that all the improvements made to the Charité® disc were made to the Activ® L disc as well.

He said he has never seen anybody reject an artificial disc in all the time he has been doing them. I don't think this includes those who might be allergic to metals though. He did ask me if I was allergic to any metals. I'm not. The materials are essentially the same as those used for artificial hips, knees, ankles, etc.

I asked about the chances of intestinal adhesions and Dr. Zeegers explained that he doesn't get them because he does not go through the peritoneal sac (he pushes it to the side).

Me and Dr. Zeegers at pre-op visit

Dr. Zeegers warned me not to be alarmed with "blue balls" after the surgery. This was just blood creeping down under the skin. It would be re-absorbed quickly. It did.

Dr. Zeegers asked if I had a cervical MRI available. I did not. I explained that I had no cervical symptoms and that I'd never have been able to get one in Canada. He said that sometimes cervical problems can actually manifest as lower back pain. I had not known about this. He ordered an MRI and within a few minutes I was getting a cervical MRI. The clinic has MRI, x-ray, CT, etc. all available on the premises. I walked out of the MRI room with a CD in-hand. He also ordered up some lumbar and cervical x-rays. Again, I walked out with CD in-hand. Dr. Zeegers said that after surgery, MRI of the lumbar spine was allowed, but that the image would be distorted and blurred around the prosthesis. He promised me the metal plates would not get ripped out of my body by the magnetic field, nor would they heat up and cook my innards.

I also met with the anesthesiologist, Dr. Bochnick. I told him that after my discotomy in Toronto, I found my mouth was very dry and it lasted for about a week. For example, I would wake up in the middle of the night and my tongue had actually dried to the point of becoming painful and crunchy on the outside. He said that only occurs with older drugs and that the newer class of drugs don't do that. He was true to his word.

Finally, I had blood taken by the nurse for three things:

1. sedimentation rate,
2. white blood cells (leukocytes), and
3. cross blood for 2 packed cells. I don't know if I got the name right, but it has to do with blood banking in case a transfusion is needed.

The operation was planned for the next day, and so I was asked to eat only a light dinner, and then Zeegers asked me to perform an enema at midnight. I was able to do this, but just barely. I found it extremely distressing for some reason. A kit was provided. Zeegers said it wasn't strictly necessary, but he liked to have it done just to clean things up a bit.

The clinic has seven patient bedrooms and two nurses working during the day. I think there was one night nurse. All the nurses were terrific and very compassionate and helpful.

Operation Day

At 8:00 am, I was taken to my room, where I was asked to put on the usual hospital gown. I was handed a pair of anti-thrombosis stockings to put on. These are just tight stockings. At 9:40 am I was moved to the operating theater. A nurse walked me there. No matter how fast I walked, she was always walking faster, pulling my arm. I guess they're in a hurry to get going. It was quite an intimidating room with a rather loud sound of the air circulation and filtration system. It felt a bit cool in there as well. Inside, an O.R. nurse immediately starting positioning me, connecting up I.V.s and so forth. He was very efficient.

Within a few minutes, Dr. Bochnick, the anesthesiologist appeared sitting behind my head. He said he was ready to begin and that I'd feel a pain in my arm as the anesthetic went in. He was right. It was a burning pain flowing up my arm from the injection point. I went under in about 10 seconds.

...self explanatory

I'm told that the first hour in the operating theater was spent preparing me. I guess this involved shaving the area of incision and slopping on the Betadine and so forth. They also connected up several I.V. lines to be used if need be. The first cut made by Dr. Zeegers began about an hour after entering the operating theater. The surgery itself took three hours.

The implant was an Aesculap Activ® L artificial disc of size M, i.e., medium. Dr. Zeegers uses the spike version, as opposed to the keel version. He says this makes revision, if necessary, much easier and less traumatic. I always had reservations about artificial discs with keels, so I found this pleasing. He said the disc was sized so that it was large enough to rest on the boney rim of the vertebrae (it's like coral inside and not as strong) but not so large as to impinge on nearby nerves.

The disc end-plates

The disc's polyethylene core ("inlay"). The inlay he used for me achieves an overall prosthesis height of 8.5 mm measured at the posterior end (the spikes are at the anterior end).

Manufacturer's stock photo example of the disc system fully assembled

Two brochures are available on the disc system: a Patient Brochure, and a Surgery Technique Brochure.

I woke up in the recovery room which is just adjacent to the operating theater. I was lying on my back with the torso/head part of the bed slightly inclined.

Just after operation in the recovery room. Note the drainage tube and container.

My mom was there, as was Dr. Zeegers (back in his suit again). He showed me some images on a roll of paper from the fluoroscopy done during the surgery. He used the fluoroscopy to guide the exact positioning of the implant.

At this point, mess-up #1 reared its ugly head. I was told that although the wire went through, the bank charged the Beta Klinik 15 Euro for receiving the money.

In the recovery room, I had a blanket over me and a machine pumping warm air under the blanket near my feet. I commented that my wife would love one of these. It felt great.

The machine that pumps warm air into your recovery bed

Zeegers then asked me to walk to my bedroom. Note the anti-thrombosis stockings.

I got up and walked towards the room, but was feeling very faint. Eventually, they plopped me into a wheelchair and rolled me the rest of the way. I'm not sure what caused the fainting spell. Regardless, it slowly went away as the day wore on.

During the first day, I had a drainage tube coming out of the abdomen. It was at the same height as the top of the incision and to the left of center, but not on my side. The tube was connected to a clear plastic container. This, I'm told, drained away blood and fluids. I estimate it probably contained about 750 ml. It would eventually be full at the time of removal.

There was some pain at the site of the wound, which was an incision from about the beltline down to a few cm above the penis. The incision is low enough below the navel that it is covered with shorts or pants. There was also a low back ache. I was attached to one of those patient-controlled drug administering machines. I was to press the button if the pain became too much. The machine was kept for the rest of the operation day and then removed sometime in the morning of the next day. In total I pressed the button something like eighteen times. I find that narcotics don't help me that much with pain. They just make me not care as much about it.

Day 1

I slept quite well the first night. During this day, I was asked to walk over to the x-ray room to get some lumbar x-rays so we could ensure everything was in its proper place.

I had a fair amount of bleeding at one part of the wound. The nurses kept changing the gauze and bandage ("plaster"). At one point the pain became quite intense and the nurse brought me some liquid pain medication in a tiny plastic cup. This was generally effective at controlling the pain (or making me not care as much) about an hour after taking it.

I walked a bit in the courtyard behind the clinic. I walked very slowly with my mom. It was nice to get outside, and the weather was warm and sunny.

Courtyard between Beta Klinik and neighbouring buildings.

Another view of courtyard between Beta Klinik and neighbouring buildings.

For lunch I was given asparagus and potatoes. I ate this without any consequent problems.

Eating my first lunch of white asparagus (never seen that before) and potatoes. Drainage container sitting at base of table.

I asked for a second little cup of pain medication later in the day.

Also, sometime near evening, they removed the drainage tube. Something I was glad to be rid of. Removal didn't hurt; it only felt unpleasant.

The nurse very delicately removing the drainage tube.

Close-up view with the bloody bandage peeled back.

By this time, Dr. Zeegers had driven back home to the Netherlands. He drives a twelve year old convertible beater. Not what I expected. I guess I would've expected a Porsche or something.

He called my at the hotel every day until I went home. We had extensive discussions and he answered any and all questions in a clear and frank manner. He pointed out that I had waited a long time since the initial herniation before getting this thing fixed, and that as a result the recovery time could be significantly longer. I must be patient. This is amazingly hard to do. He also said that 50% of his patients say they regret the operation in the first month, but eventually they invariably send him thank you cards saying he gave them their lives back. I didn't have any feelings of regret, but had worries about whether the sciatica would ever go away. Eventually I drove him a bit crazy with my repeated questions about the sciatica. He assured me that it could take a long time, but it most likely will resolve. He suggested thinking in time spans of six to nine months. He also pointed out that, although the surgery didn't actually touch the nerve root, it would be irritated by all the activity in the vicinity.

During the phone call, we also talked about thrombosis and he told me that 99% of thrombosis cases occur during or a couple of hours after surgery. Nevertheless, he wanted to keep his immaculate record and this sounded good to me. Plenty of walking and use of the stockings continued.

On day 3, I began major walking along the Rhein. I stopped for lunch and dinner, but most of the time I was out walking, albeit slowly, depending upon the pain level.

Day 4

The lower back ache and sciatica were quite intense this day, but I did my walks anyway.

Dr. Zeegers asked for us to email him pictures of wound to be taken in sunlight, from 5 inches away, with no flash, using the camera's macro setting. My mom took pictures with us hiding in the courtyard behind the clinic. Luckily, this was a Sunday and few people were in the surrounding buildings. Otherwise, we could've been locked up for making porn or something. These buildings have glass exteriors and so you can see the people in each office room. Since we didn't have a way to transfer the pictures out of the camera, we waited until the next day and asked at the clinic for help.

Day 5

Pain same as day 4. Did walks anyway.

I also noticed a hard lump under the wound near the bottom of the incision.

Changed dressing after shower. Zeegers said bandage wasn't necessary after seven to nine days. I kept it up until day 10. However, I no longer put bandages on the location where the drainage tube was. It had healed up completely.

On this day we saw a sundog at about 7 pm. It stayed for at least ten minutes at which time my mom decided to run into the hotel and grab the camera. By the time she returned (maybe 5 minutes), a cloud had rolled over it and we couldn't see it anymore. I took some pictures anyway. I have a knack for seeing sundogs. I've seen probably ten in the last fifteen years.

The remnants of the sundog. The sun is hidden just behind the edge of the Kameha (on right).

Day 6

Didn't sleep well. Strong left leg sciatica and left buttock pain. Regardless, I did major amounts of walking.

The clinic helped transfer the wound pictures from the camera and then they emailed them to Dr. Zeegers. Dr. Zeegers also asked us to have Dr. Jung take a look. Dr. Jung is a neurosurgeon at the clinic. Dr. Zeegers is a close friend of Dr. Jung, and he said they have similar medical philosophies. I didn't asked what philosophies. Dr. Jung said the wound looked great and that the lump was a small haematoma. He said it would go away on its own. In severe circumstances, they can use a syringe to suck some of the lump away, but this situation didn't warrant such action. I was relieved.

Day 7

Got almost no sleep as sciatica was very bad with left buttock pain as well. Felt discouraged.

Day 8

More bad sciatica. I found I couldn't sleep on my right side or the sciatica became unbearable. So I slept on my back or on my left side.

Now, mess-up #2 was being set up: In our daily phone call, Dr. Zeegers asked me to consider going to Dr. Jung for an infusion to calm down the sciatica. I said I'd think about it. I said that in Canada we use cortisone and he said, "Yes yes cortisone."

Day 9

Strong left leg sciatica. Still couldn't sleep on right side.

I was sent to x-ray to have some baseline lumbar x-rays taken. These would serve as our reference for comparison in the years to come. Back in the recovery room after surgery, Dr. Zeegers warned me that, although it may appear to be too far back (in the lateral view), it's precisely where he wants it.

Lateral reference x-ray

Anterior-posterior reference x-ray

30 degree angle anterior-posterior reference x-ray

To follow the condition of the disc in the future, Dr. Zeegers said he would want the following x-rays at 1 year, 5 years, and 10 years after surgery, or if symptoms should change in a worrisome manner:

1. neutral lateral,
2. flexion lateral,
3. extension lateral, and
4. anterior-posterior taken looking up at 30 degrees.

These should be taken while standing (not lying on a table), and he said to make sure they label the a-p shot to say how many degrees.

I then saw Dr. Jung and he said the x-rays looked great. I also told him I felt I shouldn't get the infusion, which I referred to as an "epidural", as I had already had three in the five months preceding the surgery. I said I could tolerate the pain. He said that sounded conservative and reasonable. This was mess-up #2 still being set up.

I gave the Beta Klinik overseas client contact person an envelope with 30 Euro in it and asked that they use 15 Euro to replace the money they were charged for the wire transfer. I then asked that they keep the other 15 Euro until Dr. Zeegers next shows up at the clinic (typically every few weeks) and give it to him. He never did tell me how much he was charged. On the phone he told me that whenever he does international wire transfers, his bank tells him he has three options:

1. sender pays both sending and receiving fees,
2. sender pays sending fee and recipient pays receiving fee, or
3. receiver pays both sending and receiving fees.

Evidently, my bank doesn't know what it is doing, as they never gave me any options.

At this point I paid the Beta Klinik (1042 Euro) for my x-rays and MRI.

Day 10

Got little sleep due to sciatica during the night, but it improved during the day.

Today, my mom went on her own to see a ruin of a 12th century castle (Drachenfels) at the top of the mountain (also called Drachenfels) in Königswinter. To go up the mountain, she took the funicular.

The funicular rail-line

The view down the Rhein from the mountaintop. Bonn is off-image to the left at the top, and the Kameha, while in the picture, is too small to be seen except with a full resolution picture.

Day 11

This was my last day in Germany, and I had planned to just take it easy with gentle walks. It did not turn out to be so.

Dr. Zeegers called me in the morning and suggested I meet him in person one last time. He said we could meet in a town called Aachen, which has a spa with natural hot springs. We took a taxi to Aachen and met him at the spa. On the way, I mentioned to the taxi driver that a famous hacker named Mixter (real name Kemal Akman) was from Germany. He immediately said he knew about him and also some great Turkish hackers. I acknowledged the great Turkish hackers. I had suspected he was plugged into the scene. Anyway, after we arrived we went up to the restaurant and everyone had a coffee. Then we got down to business.

He said I looked depressed. I told him that people always think I look upset, but I'm usually not. He didn't believe me. I said that I was anxious about the sciatica. He said I need to wait six to nine months and then re-evaluate if it is still lingering at that time. He repeatedly told me I was worrying about nothing. I said that the position dependence of the sciatica disturbed me. He said that meant nothing. I said that I was also worried that the guy who had done the discotomy had caused some minor nerve scarring and perhaps that was irreversible. He said that they only tell you the pain is from nerve scarring to get you out of their hair. This was quite surprising to me. When I went to the clinic in Toronto for follow-up visits after the discotomy, I heard other patients being told their pain was due to scarring and nothing could be done ("that's surgery"). Seems it was all BS to get the patients to go away.

Now mess-up #2 was revealed: He asked if I had done the infusion with Dr. Jung. I said that I had already had three epidurals recently and that I felt I should not have anymore for awhile. At this point he got upset with me and told me that it was not an epidural (which is done blind). He implied that going in blind was barbaric. He said that Dr. Jung would use CT to insert a needle right into the nerve itself and inject not only cortisone, but also some other drugs to ease the pain and reduce swelling. He said it was such a shame because I could've been pain free for the flight home the next day. What can I say? Major screw-up. Don't make my mistake.

We went to a change room and he looked over the wound and then had me do various bends to see how things were. He was very pleased with the wound and he told me that at this point the disc was very secure and I could fall or crash my bicycle and it wouldn't move. He pushed me around to demonstrate how secure it is. He later pushed my 70 year old mom around to show what tests he did. She was startled.

It was during this visit that I realized how flamboyant Dr. Zeegers can be. Regardless, he's very likeable and is a very compassionate and caring man who answers all questions and addresses all concerns. He spends A LOT of time with the patient and genuinely cares. A one-of-a-kind extraordinary human being.

A view inside the hot-springs

His assistant, Dr. Zeegers, and me in restaurant above the spa

One of the last things he said to me about my pain levels was, "Time is your friend. Time is your friend." So with that, I promised myself to do my best not to get too greedy for quick improvement; anything before six months is gravy.

On the way back to Bonn, we stopped in Köln (a.k.a. Cologne) to see Köln Cathedral. It was huge.

Köln Cathedral

Köln Cathedral

Day 12

Plane ride home today. Sciatica was there, but not too bad. I continued to wear my anti-thrombosis stockings as instructed. I got up and walked around the plane about once an hour. The artificial disc did not alarm any metal detectors in the airports. We went through metal detectors at both the Frankfurt and Amsterdam airports. I had brought the operative report, just in case.

Day 13

Sciatica still there. Sore muscles in low back and intense low back ache.

Jet lag sucks.

Day 14

Sciatica still there and low back ache is quite strong.

Day 17

Today I really think I got a small taste of the future. I went grocery shopping with my son and I picked up a carton of almost eight liters of orange juice. Prior to the operation I would have aggravated my sciatica and low back and would have spent some hours lying in bed to let things settle down and still the sciatica was worse for usually one more day. This time, it had no effect on my pain levels at all. I guess the intervertabral space is now maintained by the new disc and so the nerve root and surrounding tissue is not getting squished.

Based on the pain levels of the day, I decided to reduce the Lyrica dosage from 150 mg b.i.d. to 75 mg b.i.d.

Day 18

Well, obviously I need to take it slow. Last night at 4 am my back went into spasm. I couldn't move or speak it was so painful. Eventually I rolled onto the floor and then slowly starting moving limbs and after a while the pain lessened to the point I could stand up. Walking around limbered things up and eventually the spasm went away.

Did a lot of walking during the day.

Day 19

I still feel residual muscle tenderness from the strain/spasm.

Did lots of walking.

I think the sciatica and low back ache are slightly better today, but I've been tricked before, so I don't want to make any definitive statements.

Day 22

The sciatica and low back ache have not gotten noticeably worse, so perhaps they have improved a bit since immediately post-op.

Did a lot of walking.

Getting tired of keeping track of each day's sensations and updating this web page. I will update less frequently, as things are changing more slowly now.

Day 26

Reducing the Lyrica to half dosage (on Day 17) has not caused me any significant increase in pain. This is very promising. Sitting for more than half an hour can be somewhat uncomfortable (both for sciatica and low back ache), but it's not like it was pre-op. I used to describe the sciatica as being like someone standing on your spinal cord, grinding it with their heel, and lightning shooting down your leg. The low back pain was like someone had swung a baseball bat into my lower back.

Day 40

The sciatica is still about 90% gone, however, the lower back ache remains. It is sometimes quite intense and continues to disrupt my sleep. I have no trouble going on long walks and these don't seem to aggravate either the sciatica or back pain. Similarly, I can lift moderately heavy things without consequence. Looks like things will improve very slowly from here on.

Day 50

The sciatica is still 90% gone. Minor tingling can usually be felt. The lower back ache remains, but to a lesser extent. Heavy activity does make it worse, but lying down for twenty minutes helps. Sleep is still not great, but my experience tells me this can take a few months to get back on track. I still feel best first thing in the morning.

At this point, I should make a comment on gauging pain. The doctor who used to give the epidural injections would always ask what my pain level was on a given day. He used a 0 to 10 scale, with 0 meaning no pain. I always found it nearly impossible to come up with an objective number. Am I a 7 or 8? Surely, if I say 10, there could be a day that's worse. Would not a 0 to 5 scale be more realistic? Even after the discotomy (before re-herniation), I would sometimes say I felt worse than before the discotomy, yet I was much more active. This has all led me to the conclusion that pain numbers are silly and the best measure of pain is level of functionality. I am way more functional now than before the ADR, so my pain is better. Simple as that.

Day 74

Today, the sciatica returned with a vengeance. The problem is, I'm not sure anything has really changed. Pain is tricky. It could be that the lower back pain around the disc area finally went away and now my brain can focus on the sciatica. This wouldn't surprise me. It may be that the sciatica is what was disrupting my sleep all along.

Day 86

Sciatica is still very strong and is causing me some trouble sleeping. I have to get into weird positions to minimize the sciatica. I went to get a set of x-rays to make sure nothing has moved. The x-rays show everything is in the right place.

I noticed some strange linear structures in the x-rays today. They were not there prior to the operation (as seen on x-rays taken one day before) but appear on x-rays one day after the operation.

I emailed Dr. Zeegers and he said they were titanium clips on sacral vessels. They won't move and have nothing to do with the sciatica.

Day 113

The sciatica settled down to what it was prior to day 74. Sleep is still disrupted, but sitting at work is not too bad.

7 Months

It's the beginning of January and I shoveled the snow from the driveway. I had no ill effects that day. At night I was a bit sore (general muscle soreness), but the sciatica was not worse.

A week later, I again shoveled the snow from the driveway. Again I had no ill effects and there wasn't even muscle soreness. Indeed, I slept better for having exercised. I do have to make sure I put myself in a pelvic tilt as much as possible in order to protect the facets.

I have a rowing machine (fan type) but haven't used it in years because it would aggravate the sciatica. I don't plan on using it again as I can see how the mechanics of it would likely be hard on the facets.

I recently obtained and tried out an exercise bike. I worked up a good sweat (did 45 minutes). It didn't bother the sciatica and I felt energized that day. I slept a bit better too.

A few days later, I did another 45 minutes on the bike. Same good results.

1 Year

At the one year mark, I had my follow-up x-rays taken. Specifically:

1. neutral lateral,
2. flexion lateral,
3. extension lateral, and
4. anterior-posterior taken looking up at 30 degrees.

These should be taken while standing (not lying on a table), with the a-p shot labelled to say it was taken looking up from below at 30 degrees.

The x-rays show nothing has moved and I've been quite active.

The sciatica continues, but is not aggravated by lifting things like it used to be. My most comfortable position is lying on my back with pillows under my thighs. My second-most comfortable position is standing, and my least comfortable position is sitting. This is unfortunate, as my job requires sitting at a computer all day. I stand up frequently to walk around the office and that's helpful.

I continue to take 75 mg Voltaren twice a day, and Lyrica 75 mg twice a day. If I stop the Voltaren, the sciatica becomes much worse in a few days. The Lyrica helps with general lower back pain but isn't as crucial as the Voltaren.

I found that after a few sessions, the exercise bike would aggravate the sciatica, so I've stopped that for now.

1 Year, 4 Months

Nothing has really changed. I'm no worse and no better. Sciatica continues as usual.

I should point out that I consider this to have been a massive success. I'm just mentioning the sciatica because that's all there is to report. The mechanical stability of my spine has been restored and it appears to be robust. I've done rather strenuous activities and nothing has moved and symptoms have not gotten worse.

NO REGRETS I got as good a result as I could've reasonably hoped for. If the sciatica eventually fades, that'll be icing on the cake. I walk briskly now, where I used to slowly shuffle with a grimace and a groan. I can work on the car, work on the house, carry stuff like anybody else, and bike a bit (but not too much or the sciatica gets angrier). I don't worry all the time about whether I'll be laid-up for days if I carry something. In a nutshell, it has restored my life - not perfectly, but close enough.

1 Year, 8 Months

I was able to stop taking the anti-inflammatory (Voltaren) with only a slight increase in discomfort. I have been off it for about one-and-a-half months. This is an added bonus success I hadn't expected!

5 Years, 7 Months

I haven't updated this page in a long time because I have essentially moved on with life and don't spend much time thinking about my back anymore. There has been no change since last update. i.e., my condition is very stable. The sciatica is always there to varying degrees and I occasionally take one-half of a 75 mg Voltaren if I've done something to aggravate it. Typically this is due to riding a bicycle for a long ride or lifting something really heavy. Sometimes just lying down for 20 minutes is sufficient. Otherwise, I don't feel my activities are in any way restricted due to my back. Again, no regrets.