Ding Dong the Witch is Dead

Ding dong the witch is dead
Which old witch? The Wicked Witch!
Ding Dong the Wicked Witch is dead!

—The Munchkins, from The Wizard of Oz

If the excruciating and demobilizing pain in my leg from the sciatic nerve pinch in my spine was the Wicked Witch, then ding dong the Wicked Witch is actually dead. The pain is gone. The surgery worked exactly as we knew it would on August 18th, 2025, just after my MRI. I'm up, I'm fully mobile, I can easily tell it worked because I can put full pressure on my left leg with no pain whatsoever in any position. I’m ready to not only walk, I’m ready to run, jump, and fall. Everything corrective anticipated by the surgery, at this point, has easily been observed. No trouble putting my afflicted leg and associated nerve in any position. I am jubilant to begin. My leg feels brand new.

Both the surgeon and my chiropractor warned me of phantom nerve pain, or a rebound in pain as a result of a nerve that has been damaged and in pain for any length of time. Well it didn’t have to be any length of time had we done the correction early. I blame the surgeon as incompetent staff at Fairfax Abysmal and will have my reckoning with that team sometime in the future. As for the phantom pain, I have already felt that happen. It's easy to detect. A pulse of pain in my leg occurs for no reason…in any part, down the length of my sciatic nerve. But it happens for no reason. I'm not putting any pressure on it, it just happens like a spasm. It's not even that painful, like a 1 or a 2 on the linear scale. Easy to ignore…it literally feels like a phantom…a whisper of the pain that was once there. It's not concerning at all. It does piss me off…as well, everyone knows everything about this extended situation pisses me off.

Before I start my full recovery to running and jumping and falling, however, the surgery to correct the condition in my back itself must heal. The surgery consisted of the discectomy on the left of the nerve root impinging discs at my L34 and L45. From what the surgeon and PA have told me they clipped the discs. But also, and perhaps more importantly they clipped a bunch of arthritis they found in there along the way. We’ve always suspected there was more going on than just the bulging discs…so of the bone protruding into the nerve that wasn’t observable on any of the imagery. And or, the impingement from the arthritis wasn’t showing in the imagery because it didn’t happen at rest. I had to have weight on the leg to really show the squeeze, however the imagery was static, not dynamic. There are dynamic MRI machines…but they are few and far between. I did not go down this path. I probably would have looked into it had the surgeon not believed there was utility in going in to do the discectomy. Nothing like using the “Mark-I Eyeball” to assess the situation in real time. Did he trim the herniated discs back? Yes. Did he find arthritis in the regions and clip that back too? Yes. And by clip, I got a bit more understanding of the tool he used in the surgery. It’s like a long skinny nail clipper that they insert through a small hole that they drill in the lamina of the spine. That’s the back portion of bone, not the vertebrae which is in front of the spinal cord. The clipper they use is called the Kerrison Rongeur which I love because rongeur means to gnaw like a rat. So essentially the surgeon was going into my back and gnawing on the bulging disc and associated arthritic bone pieces with a set of rodent teeth. This is not new technology. This instrument was invented in 1904 by Dr. Philip D. Kerrison to do early surgery in the ear while protecting the nerves. It was later adapted to do surgery on the spine. The whole idea is to have a clipper on one side of the instrument while the other side is just a tube that protects the adjacent nerve. I don’t know exactly which instrument my surgeon used as they have been adapted through time with many modifications. However, it is clear he gnawed away in my back like Willard, the hungry rat, having dinner. I’m happy this tool exists.

I do have to deal with the pain from the surgery. It's quite different from the nerve pain. It is significant but totally in the linear region of pain and can be defined as such. Without Motrin and Tylenol pain is probably in the 8 range unless I stretch the area but then it jumps to a 10, but not off the chart. It’s not excruciating. It’s just, “Oh my God I’m ripping my skin open”. I classify that as a 10. But it's localized to the region of surgery right on my lower back where Willard was eating. The rest of my body has no impact. I can walk and I could possibly run…I just don't want to run yet with a tender back. At 11 am on Monday, 72 hours after surgery, I can remove the sealed bandage and take my first shower. I've been warned (Jay C) that surgical pain will peak about 42 hours after surgery, that's today. However I know from experience, that surgical pain, after cutting through muscle tissue actually takes weeks to heal. My last surgery was open surgery to correct a lingual hernia. I vastly underestimated my recovery time and found myself home in bed after trying to heroically travel after the weekend, only four days after surgery. That didn't work out and I had to abandon my trip in the middle and return home in a hurry. We were celebrating Shade’s birthday with Ed and Hucker at Peddler’s. I was not in a good way…and we didn’t smoke cigars. The next day I had the choice to travel to Orlando (from Boston) or fly home. I abandoned the trip and went home to bed. Thanks again to Ryan H for bringing me back to the hotel.

I learned my lesson and I will take it very slow this time. I feel the surgical pain. In two weeks I will meet for my post op with the surgical PA and then, after receiving a clean bill of health that the surgical wound has healed properly…I’ll slowly begin retraining my body for my return to the soccer pitch. And in the Spring, perhaps a return to the Sierra Nevada mountains with Meatball with a planned 24 mile hike into Bench Lake, from the Nevada side. This is the spot Randy Morgenson lived his summers for 27 years. Please join us, if you have the motivation and the means.

I would love to talk more about the surgery because I simply have no recollection. In the past going under general anesthesia I was already in the operating room on the operating table. This time, the initial dose of medication was administered in the prep area. I met the surgical team, the surgeon, the PA, the surgical nurse, the anesthesiologist, and his nurse. In fact it was the anesthesiological nurse who administered the meds through my IV while still in the prep area. And I didn't even know it, or feel it coming. No counting backwards from 10. I was out and woke up in the recovery room. I actually found it quite rude. So I have zero memory of anything surgical except the pain in my back, and immediately after, the pain in my throat. It's standard practice under general anesthesia these days to always be intubated, which means a breathing tube down your trachea. For this surgery I had to lay flat on my stomach so the trach tube must have come out of my throat, then my mouth and wrapped up around my head. I do have bruises on my mouth as well. Whether it is standard or not, I feel like the anesthesiologic nurse was responsible for both acts of rudeness…the one of treachery where I was knocked out before I knew it and then the pain after surgery in my throat and mouth associated with what appears to have been a fairly rough intubation. Asshole. Calling the nurse an A-hole in this blog will probably get it censored by the AI police.

Anyway, the trach pain in my throat is annoying and feels like unnecessary pain. They do it as a precaution in case you throw up during surgery and then inhale your own puke. It's a complication of surgery that requires abusing the patient for our own good…and can be easily avoided by not doing it. I think I am also paying for the nice set of pressure cuffs they put on my calves during surgery to prevent blood clots. I am also supposed to wear them while laying in bed. I'm not laying in bed…so again it’s a wasteful protocol administered for our own good. Just like all those daily injections in Folsom to thin the blood to prevent blood clots. It’s a waste and somewhat of an abuse. I'm active, I'm up, I'm moving around. Even in my beloved wheelchair I was moving around and moving my legs. Sometimes it would be nice for the medical community not to treat everyone with the exact same protocol…it is without a doubt…incorrect to do so medically, and it is dehumanizing in many aspects. It's done for legal reasons and here is the dichotomy of that. The doctors clearly want insurance companies to pay for procedures that the doctors have to balance with their exposure to doing something wrong resulting in a malpractice lawsuit. So doctors are paying for malpractice insurance at the same time. They add protocol that we, the patient, has to pay for to insure they don't run the risk of something bad happening. Sometimes that means our own insurance pays for it. I think my insurance will cover the intubation. I don't think they are covering the pressure cuffs for my legs. I'll find out soon enough.

Regardless, it’s over. Finally, Two months late, but the surgery is done and I would have to say, 100% successful. My surgeon is not putting any weight limits or movement limits on me. I can even take Motrin as they are confident there will be no additional bleeding in the aftermath of the procedure. I asked the PA these exact questions. This medical team is so confident in their procedure that their protocol is different from other doctors I have talked to…including Deep Throat. Nevertheless I will take it easy. I’ll let my body define what I’m capable of doing. I’m not planning anything like going to the gym or working out until at least two weeks have gone by.

Instead I will write this blog and contemplate the second half of this series of essays. I have no doubt I will be assembling a complaint against the treatment I received at Fairfax Abysmal. Whereas I am on the road to recovery the doctors involved in that treatment will have to answer some very important questions. In particular, the pain management doctor at Attica and the Neurosurgeon who denied the obvious on three separate occasions and thus sealed my fate to be removed and sent under threat of security intervention to Folsom for a two weeks stay to learn how to live in a wheelchair. For me, after finally achieving the required medical procedure, the Wicked Witch is truly dead. For the medical team at Attica, I can only say, it’s Goodbye to their Yellow Brick Road…and a plague on them. I’ll be reporting on my progress as I brick by brick, with the help of Chat-GPT 5, dismantle their yellow brick roadway to the Land of Oz.

Hand of God

Twas the night before going under the knife and all through the house, everybody (mostly me) was ready for something that should have  happened  two months ago. Ladies and gentlemen, mostly gentlemen, it's time.  Let's hope the surgeon has steady hands and that I don't bleed out.

The outpatient procedure (left discectomy on L3-L5) is scheduled for no longer than an hour and a half. 9:30-11:00 EST.  The optimism shown by the medical staff that I would be pain-free as soon as I woke up just pisses me off considering the resources expended over the last two months to keep me in excruciating pain and bound to a wheelchair.  A lot of people got paid at my expense.  I lost significantly during the last two months.  Not just pain, but money, and lost time. Ironically my medical insurance company has also lost significantly.  Their seeming reticence to approve surgery resulted in a two month long continuous out payment for things I didn't need… yet ultimately it all still results  in the surgery that everyone but me (and Deep Throat) wanted to avoid. We both knew it was going to be a discectomy on 18 August.  

Tonight however I  am finally surgery bound. I want to describe the pre-surgical procedures as they are interesting and have clearly developed over a long history of shit going horribly wrong. 

First you have to sign your life away to the person who's bringing you to the outpatient surgical center. Easy to think of all the things going horribly wrong here. Surgical patient discharged to the parking lot. The car accidents while still on sedation. The sutured surgical wounds becoming unsutured, etc.  Use your imagination here and it's probably happened.   They make sure a responsible adult is on the premises.  So please provide the name, age, rank, relation, serial number, phone number and acknowledge that they are going to stay with you for 24 hours.  

After my sister, I'll always be there for you, said no she wouldn't be there for me. I was left with no choice but to ask  my 60 year old, male roommate Felix Unger.  When his wife kicked him out, with nowhere else to go, he arrived at the home of his friend, Oscar Madison.  Several years earlier, his wife had done the same, requesting that he never return. Can two divorced men share an apartment without driving each other crazy? Cue the theme song from “The Odd Couple” …Da doot da doot da dooo… dat da dooo dat da dooo da… 

Who remembers that show?  Was Felix gay?  They certainly wanted Oscar to be a man’s man.  Felix, as I remember, was fairly pedantic about cleaning around the house. He was also a gourmet cook.  I'm in the same situation. My 60 year old friend and I are this odd couple.  He cares about every detail around the house.  I do not give two shits about any detail.  I think it hurts his feelings although he doesn't appear to take it personally.  For instance this evening after dinner I began hydrating with Gatorade. The next pre-surgical recommendation, hydration.  His suggestion was for me to hydrate with Pedialyte instead.  He even had some Pedialyte he could share with me.   Then he wanted to show me how to change the washable air filter on the hepa air filter in my room.  Recall one of the ways I abused my back the past year was helping him move his stuff out of his apartment.  That move itself didn't put me in the Emergency Room, it did, add to the stack of abuse I was laying on my lumbar region.  It's only fitting that he gets tasked with making sure I get home safely.  There couldn't be a better choice.  

I should have put him in charge of my medical care.  At 60, with no kids, he's the ultimate helicopter dad.  The surgical center will no doubt think we are lovers, at our age, living together, that's just how it has to be.  My sister was my first choice, the ultimate helicopter mom.  The important thing is that I hydrated,  so I stuck to my Gatorade.  Not sure why hydration is a huge thing…I do know it could delay surgery.  They might have to juice you up with an IV bag ahead of time. These guys want no delays.  

Once the nurse confirmed I was going to get to surgery and home safely, we discussed more things. Seven days before surgery no more NASIDS or aspirin. These meds thin your blood. If your blood is too thin it doesn't clot as well.  Bleeding out is a complication they want to avoid. 

Infection is something they want to avoid in all surgeries, it's particularly nasty if they leave you with an infection in your spine.  So they want you to disinfect your skin by washing with Dial Gold antibacterial soap.  I thought I could go with the hand soap and pump bottle, Felix however would not stand for it and thus it was necessary for me to bathe with bar soap…and a new bar of soap for each shower.  Eight bars of Dial Gold appeared on my table the next day.   He did the math right.  A new bar for each shower and two showers the day before. So I've been living the dream with Dial Soap.  You never feel more squeaky clean.  Your skin feels tight after using it.  

No eating after midnight, another important rule. Clear fluids only, including black coffee, no cream or milk.  Nothing at all after 6 am.  This is so you don't throw up during the administration of the anesthesia and breathe it into your lungs. A situation that upsets both the surgeon and the anesthesiologist as now they must stop and save your life during the surgery.  

There is a pre-surgical physical that also was accomplished, in my case, three weeks out. Blood tests, an EKG, all to prevent another emergency from happening while they have you on your stomach with your back cut open.  This is a bad time to choose cardiac arrest, for example.

No contact lenses.  Can't think of a horrible scenario here happening in surgery.  I can think of one or two prior to surgery, if I can't see dick.  The nurse told me to bring my glasses.  She couldn't wrap her head around the fact that I don't have glasses. I'll do my best to make it in from the parking lot. Felix will help.

A strange rule, a problem unrelated to surgery, is that I must  leave all my valuables at home…I wasn't preparing to bring my stamp collection, that seems strange.  But watches and rings make sense.  No wallet though… I can only bring my drivers license and insurance card.  Of course they want that.  Seemingly crime must be rampant at the surgical center. 

The final rule, they don't want me taking any of the meds I am on.  As my pain returns in the morning, that should make it fun laying on my stomach for the surgery.  Perhaps I'll be on my back until they knock me out…then they can roll me onto my stomach exposing my butt in the process.  The good news is, with those eight bars of Dial Soap all used up, my butt has never been cleaner.

Well here we go.  I've never looked forward to surgery more.  No need to wish me luck.  Prognosis is a 100%  certainty. If it's not a 100% certainty my faith in any sort of knowledge about the human body we claim to believe will be shattered.  Barring any sort of mistake this fix will work.  So as you pray for me today, don't pray for the fix, pray that my surgeon has the hands of Diego Maradona during the 1986 World Cup match against England.

Western Medicine for the Win

You better lose yourself in the music.
The moment, you own it, you better never let it go…
You only get one shot, do not miss your chance to blow
This opportunity comes once in a lifetime...

—Eminem, Lose Yourself

There is only one trip to the chiropractor left before D-day.  That's this afternoon.  I couldn't find any more dramatic letter than D… S day for surgery just doesn't have the same kick. As of yesterday I've been to the chiropractor 11 times.  I've been waiting until this week to make the final decision on whether or not to go under the knife. My criteria for recovery  had to include walking, running, jumping and falling. I'm walking fine…I'm up right, I can move pretty well. I can walk over obstacles, I can walk in the yard, I can walk up and down hills, I can walk on different surfaces and I can hit different points of inflection.

However I cannot run. I can pick up the pace as I walk but I'm still not breaking into a run or even a trot. And I'm far from jumping.  So I am a long way from anything I can even call recovery. Remember and this chiropractic care follows 2 weeks of impatient physical therapy which kept me in a wheelchair. As due diligence is called to the stand, I have done mine in every sense of the word. Two full months of conservative care…both conventional and unconventional.  Two rounds of direct epidural injections. A mountain of steroids and enough pharmacological intervention to kill a small horse…if taken all at once of course.

Also I can do none of this physical stuff without the cover of pain medication I am currently taking. I'm still on  600 mg of Gabapentin every 6 hours. 750 mg of Methocarbamol 6. hours. And the same with Tylenol. The only medication I have stopped taking is Motrin. I had to come off NSAIDs on Friday to prepare for surgery. 

Of all of the medications I believe the Gabapentin is having the most effect and in fact I believe had I reached these  levels earlier I would have been walking sooner.  I never reached  600 mg every 6 hours until the outpatient pain management doctor, the one who gave me the cortisone injections after I left Folsom, increased my dosage. He also gave me Tramadol to take if the pain increased after I came off the Motrin. So far I have not had to take the Tramadol.  If I miss a dose of the Gabapentin however the pain returns with a vengeance…it is in fact self critiquing when I miss the Gabapentin, so I know it's the primary actor.

I asked my insider informant, Deep Throat, if the progress I was making was sufficient to avoid surgery and if I should get another set of images ahead of surgery just to see if the chiropractor was making any progress with the mechanical issue freeing the impingement of L34 and L45 nerve roots. Deep Throat said he always makes the diagnosis in the clinical setting and basically described that if I'm still getting numbness down my leg the impingement is still there.  And at this point that has to be fixed by surgery. 

So friends I see no way out of avoiding the knife on Friday. I'm not afraid of the procedure at all, in fact I'm looking forward to it. Those of you who have been following along know that had the surgery been offered to me on 18 August,  due to the level of pain I was in, I would have gladly accepted. 

There's also no doubt in my mind if I were to come off of my medications entirely I would quickly return to that same level of pain I was in when I entered Attica on 17 August.  The practical magic of chiropractic has seemingly and magically lifted me from my wheelchair and put my belief in those  manipulations as always just temporary. They've created some space between my vertebrae because there's been less impingement on the the nerve roots but this condition is only temporary…once  gravity takes back over it's only a matter of time before the vertebrae drop back into an offending position. Should I continue with chiropractic I will be caught in the purgatory of weekly chiropractic care (Allison K). That is the grift of that community (Champ G). I'm not saying it doesn't work. I'm not saying many people do feel relief from the physical manipulations. I'm just saying that they seemingly must continue, indeed,  without end. Thus it is Western Medicine for the win (also Champ G).

I have completed all of my pre-op appointments and my interview with the surgical nurse. I've got a clean bill of health and I'm ready to meet the surgeon at 12:00 noon on the 17th.  A clean bill of health is defined as good blood work, a nice EKG result,  and an interview with the surgical nurse to describe how I've handled anesthesia in the past. Luckily I've come through two surgeries in the past 3 years…the emergency appendectomy in 2022 and my hernia surgery in 2024. No problem whatsoever with the anesthesia. Many already know that the hernia surgery created problems for me not because of the anesthesia but because I decided I was well four days following the procedure. I had elected open surgery and not the orthoscopic  fix.  That means they carved through three layers of muscle to reach the herniated area requiring the fix.  I didn't realize that it took weeks to recover rather than days from the orthoscopic remedy.

As for the discectomy on Friday if all goes as planned  the pain on my sciatic nerve bundle  will be gone immediately and I will only be suffering with the pain of the surgery and the recovery beyond cutting and drilling into my back. 

Believe it or not it's outpatient surgery. I'll be sent home directly after for recovery.  Deep Throat tells his patients they cannot lift 5 lb for at least 4 weeks. That will be my downfall.

Recovery is what I fear the most because I've been sitting there for exactly two months now and it's time for me to go do things and there's a lot of stuff I need to get done. I'm chomping at the bit to do shit and as soon as my leg pain is gone I'm going to want to get to it. I must keep reminding myself and hopefully people around me will continue to remind me,  I must not over do it. I don't want to fuck up the surgery because who knows what's in store if I  mess up in this department. As with my hernia surgery which I fucked up by traveling four days after I went under the knife…I'm going to do my best not to make that mistake again.  I've got one shot. I’m down to one surgical shot. I better own it. I better never let it go…this opportunity comes once in a lifetime, yo…

Practical Magic

Do you always trust your first, initial feeling?
Special knowledge holds true, bears believing...

—Stevie Nicks, Crystal

My first visit to the chiropractor was painful. Both mentally and physically.  I’m familiar with the types of treatment and I want to add this to my options for treatment but how do you let a doctor of chiropractic perform black magic on the most sensitive part of your body? Even though it's not accepted by mainstream medicine, manipulations have been going on for many years. I had success in 2013 doing traction to relieve the pinch in my C56, and I've been going on and on about my inability to receive an alternative care when I was an inpatient at Folsom. So, for the sake of my captive audience,  I better go get me some alternative care or I should STFU about it.

My first job was to seek out a reputable wellness center.  Don't just go to any corner chiropractor.  Hard to tell who has any experience or skills whatsoever. Horror stories abound. So I went back to the one I visited in 2013.  Not the same doc, but the wellness center seemed reputable to me as business looked good, judging from its size.  We will call this wellness center, Practical Magic.  Not just because it seems practical, but because Nicole Kidman has been in the news recently.  I called and made an appointment, didn’t really choose a doc, but they assigned me one.  I already knew their location so at the time of my appointment I drove over, parked in handicapped, and pushed my chair to the curb outside the main door.  There was no ramp and nothing but steps in front of me.  I looked left and right and found no means of getting up to the front door.  So I pushed down the parking lot and found a small sign that said handicapped entry in the back of the building. Pushing my wheel chair towards the front door, I realized there was no entry for the handicapped.  Not wanting to get back in the car I pushed around to the sidewalk heading to the rear of the building.  Once on the sidewalk I realized the back of the building also meant downstairs…so quickly I was zooming down the sidewalk wondering for one of the first times, how I was going to brake a wheelchair on a hill.?  With the wind in my hair, I was able to slow my roll and make a turn at the lower point of the sidewalk and roll up to the back door of the building.  Of course the door was locked…and there I was.  Locked out and faced with a long climb back up a hill. There was a button on the door so I pressed it.  Nothing happened.  So I pressed it again.  After a few minutes of sitting there, someone came to the door.   Hello, can I help you, yes I want to get into Practical Magic on the second floor, I have an appointment.  Oh, they moved out about seven years ago.  Classic, I should haven’t assumed I knew where they were… and now I was stuck in a wheel chair at the bottom of a long hill.  

I looked at my phone…since why wouldn’t I, I have Google Maps.  I did a quick search for Practical Magic and behold.  Their address.  Exactly a one minute drive from my location.  They had moved to an office building right across the street.  But now I was still a long push up a hill and a one minute drive from their location.   I only write about this because I’ve got a long blog. I need to write about how so much of what I’ve witnessed from a wheel chair gives me a very new perspective on how nothing is compliant with the Americans with Disabilities Act.  I guess people give it a nice try when buildings are constructed, but after that, I don’t think any enforcement is done.  It’s all done by complaint.  I suspect.  Anyway, I was going to be late for the appointment.  I pushed back up the hill, threw my wheelchair in the back, hobbled into the car and drove over to the correct office building.  I still needed to do all the things…hobble to the back of the car, pull the wheelchair out, and roll into the building, and find the right floor.  

I rolled into the wellness center and found Practical Magic as I had remembered their lobby and as a wellness center should be.  Aesthetically pleasing, with rock walls and water features, with very soothing music playing in the background.  I had arrived for my appointment with witchcraft, I mean, alternative medicine.

I met with the warlock to whom I was assigned.  He looked fairly senior so I suspected he had some experience. I went through my long story.  He read through the notes I had brought on the results of all my imagery.  He stayed focused on  my x-rays, he was more interested in the condition of my vertebrae and less interested in the discs and nerve impingements.  To my amazement he didn't do much. No grand cracking of my spine.  No super manipulation of any kind to get me out of discomfort.  And no traction.  Getting on his table was hard enough.  Having to lay flat  on my stomach was almost the end of the visit. But I made it onto the table.  After examining my spine for a few minutes, he broke the table at about my waist level and the back part of the table lowered and my legs.  He started to press on my spine with his hands  as he slowly articulated the table side to side very gently.  The pain and numbness immediately shot through my left leg and he stopped.  That was all the manipulation he performed.  He said my spine can't move.  Everything is stationary from the S1 up.  Until we can release the spine and get it moving again there isn't much he can do.  

He then hooked me up to a machine that ran an electrical current through the muscles in the region.  That felt weird.  Electrical simulation of the muscles can release endorphins, release the muscles, reduce inflammation, and stimulate repair.  Is that true?  Keep coming back, as another group would say. I am committed to alternative care after the conventional care, PT, did very little, if anything, to help.  Twenty minutes of electrical stimulation and I was on my way home.  After paying the bill of course, out of my own pocket. However the warlock wanted to see me again that week.  He asked me when the surgery was and I told him we have about two weeks for something to happen.

Two days later I was back for the second visit  and it was very  similar.  I lay prone on his torture table.  He dropped my legs again and pressed on my spine with his fingers.  He swung the table back and forth.  As before…I could feel the pain and numbness building in my leg. He stopped. Then he put 20 minutes of current through my spinal region…the L34 and L45.  I paid the bill and went home.   To say I was uncomfortable that night is an understatement.  I felt pain at rest when normally I can find a position without pain.  In those same positions I was experiencing paid and couldn’t get comfortable.  

The weekend passed and I was in for my third visit. Again it was a repeat but this time when I got up on his table it was easier to roll on and lay prone.  That was different and a pleasant surprise. He started pressing on my vertebrae with his fingers and then grabbed a massage gun which started pounding gently next to my spine.  He dropped the table and my legs dropped down and as before he articulated the table left to right and he pressed on individual vertebrae.  This time…amazingly…there was far less pain in my leg.  We stopped that and he brought me up to a sitting position. As I sat there he had me straighten my back and he used the massage gun with two fingers on it…meant to get at those little wings of your vertebrae.  Those wings are also joints just as the vertebrae themselves are joints.  Your spinal column articulates in all directions but those tiny little joints also articular back and forth. Then there was more electric shock for twenty minutes, and this time with a heating pad.  He gave me a few exercises to do at home.  I didn't do them.  I experienced pain that night as I had after the previous treatment, I was beginning to wonder if I should continue with the treatments, but since I was all in, I was all in.  So I endured the night and went back the next day for treatment number four.

The fourth visit, as I lay prone on his table with my legs hanging down, most of the previous pain was no longer there.  He swung the table back and forth pressing on my vertebrae.  Then all of a sudden, Pop!  My spine released something.  I don't know what, he explained it…something about cavitation.  It sounded like bullshit to me.  Another round of electro shock therapy and I was released.  The day following this fourth treatment, I can stand up straight.  Something has happened in the L34 area.  I no longer have to hunch at my waist to relieve pain and bend at my waist.  I still can't put pressure on my left leg without pushing my pelvis out but the fact that I can't stand erect is amazing, it also means I can lay flat.  The weekend was upon us but I looked forward to the next treatment on Monday.  

The fifth visit was more of the same, however, I was much more flexible.  Laying down was easy.  When he dropped my legs there was no pain.  He articulated the table back and forth and my spin popped in two locations seemingly at the L34 and L45.  This time he rolled me onto my back and did some work with my knees and pelvis…however that wasn’t very successful.  He pushed my knees back and we once again had pain.  He put the massage gun right on the soft spot behind my hip (my ass) and fired away.  He did both sides, gave me some pelvis exercises to do at home (I didn’t do them) and sent me for more electric shock and home.  I had two more visits that week and looked forward to both of them.  The sixth visit was very similar, articulating the spine why laying on my stomach.  Work on my pelvis while laying on my back.  Eclectic shock therapy, pay the bill, go home.  The seventh was exactly the same.

It's the weekend after the seventh visit.  I'm walking everywhere.  I'm effectively out of the wheelchair.  I don't even need my cane. What order of mad science is this chiropractic shit. I mean, I've been telling everyone I wanted alternative care but did I really believe in it? I think I do now.  The warlock has six more sessions before surgery.  We are two weeks out.  Everything is complete for the surgery.  I’ve had all my pre-surgical appointments, blood tests, and EKG.  My primary doctor cleared me for surgery.  And I had my pre-surgical appointment where the surgeon explained exactly what he will do and I signed all my consents.  This was before I could walk of course.  Now I’m walking 12 days before going under the knife.   My surgeon literally said, if there is any improvement whatsoever I'm not doing the surgery.  We will watch it and wait and see if you experience improvement before then.  Well, my decision might have been made for me.  However, my criteria for wellness is not just walking, it’s running, jumping, and falling…at least falling on the field. I’m going to do the exercises the warlock assigned from now on.  John Boyd said, “Do your homework”, so now I will.  

I'm walking, and walking erect, but enduring moderate 4- 5 pain in my leg. I'm also still taking a lot of meds.  I'm still on Motrin, Tylenol, methocarbamol, and gabapentin…a lot of gabapentin.  Seems like my wellness criteria must include getting off the meds as well.  Regardless, special knowledge holds true, bears believing...Stay tuned.

Hindsight is 20/20

Since they say that hindsight is 20/20 let's look back six weeks and see how crystal clear we examined the cause of my pain and the reason I'm in a wheelchair.  Then how we sought to avoid what has happened.  Because  I have a bulging disc impinging the nerve root at the L34 and the L45 I am unable to walk.  The surgeon has now offered me surgery to remove the hernias that are bulging onto the nerve roots at both locations. Basically do both of them. Genius.  But is it really? Am I the  only person in the history of back pain to have two herniated discs?

The joy of this 20/20 hindsight is stripped away when looking at the report from the MRI on the evening of 17 August. The radiologist who wrote the report says impingement of the L3 nerve root and impingement of the L4 nerve root caused by a bulging disc at both locations. Fuck me. Am I the  only person in the history of back pain to have two herniated discs? Deja-fucking-Vu. Warning, due to six weeks of pain my use of the “F” word has increased from occasional and random to frequent and the most sought after word in the English language. I’m tired of pain.  

As I look back to my week in Attica three physician assistants met with me and examined both my MRI and my physical condition and told me surgery was indicated. All three said they would talk to the doctor and advocate for surgery. None of them expressed anything specific about the surgery, just that it was indicated.

If there has ever been a case of Deja Vu it's right now as I write this blog.  Call it déjà vu now or call it Groundhog's Day but  in those early days during my stay in Attica… each day I  knew exactly what was happening and exactly what would need to be done.  And each day the medical team refused treatment.  And as we got closer to Folsom, each day I held out hope for the surgery…or someone with any sense to come to a surgical solution. 

Four Inova Fairfax doctors are complicit in this failure to provide treatment.  I would implicate the PA’s too for not taking a stand against their boss.  The four primary doctors include the ER doctor. The two doctors are running pain management at the Observation Unit (Attica). And the neurosurgeon whose decisions were invalid and who never appeared in person to talk to me or to examine me despite what, at least what I was told by the PA’s, his decision to ignore their advice.

As I wait for the result of my complaint at Fairfax Inova patient services I remain exactly the same as I was on the day I showed up six weeks ago in the emergency room with a level 10 pain and the inability to walk.  The only thing that has changed is my skill using a cane to walk 10 steps and a wheelchair to maneuver around the pain.  During every transition it is impossible to move in a manner where I don't push the herniated discs onto either one of the nerve roots. And we know what happens then. 

When the sciatic pain showed up last year I had done damage to the disc that then impinges on that nerve root. I was able to maneuver about that year by simply adjusting my posture.  Then in the closing weeks of August, again my fault was doing too much, I  herniated the disc that then began to impinge on the L3 nerve root. This is speculation but the result is certain.  Combined I have two bulging discs both pressing on nerves creating my condition of extreme pain which we will call a 10 as well as my inability to walk. 

Psychologically I've been questioning the experts telling me that pain is subjective and I've been wondering to myself if I just can't handle the pain. It's pretty clear now that the pain I'm feeling is not some  phantom.  It is both  real and it is excruciating. Having endured the pain of the L4 herniation for 18 months I have created a situation for myself that made it even worse. Basically pushing through the pain of the bulging disc on the L4 I  undoubtedly created more stress on the vertebrae above which eventually gave up the ghost at  the L3 and pinched the nerve.

It don't feel any better to know, myself, that I have not created some fictitious suffering.  I’d like to believe that…but each time I try to take a step, I’m reminded that my body doesn’t work.  It’s self critiquing.  I sit back down in my wheel chair.

Houston, We Have a Solution

They say, the holy water's watered down
And this town's lost it's faith
Our colors will fade eventually
So, if our time is runnin' out, day after day
We'll make the mundane our masterpiece

—Alex Warren, Ordinary

Houston, we have a solution. That seems too cliché for me, even if backwards--did I mention that I have dyslexia? That's a different story. And that story is either a success or a failure of our educational system.  Different story, different blog. The Educational Industrial Complex…Ike’s list grows yet again.  

But today's story is not a moon landing, I have the problem, Houston does not.  Yet finally, I do have a solution, and it's pretty simple.  I went to see the pain specialist on surgeon number two's consult team.  I was equipped with  two new  CT scans for my  pelvis and my lumbar spine that the doctor requested only two days prior.  I was able to get in for the CTs quickly because I agreed to pay the cost myself. I thought it was odd that I got in so quickly but I thought it was even stranger that the radiology company said I would have to sign a waiver agreeing to not submitting their cost  to my insurance company.  I didn't understand this until a friend told me they would give me a discount since I was paying out of pocket and the insurance company doesn't like to pay more than what a human has to pay… so they don't like to tell them.  I guess the radiology place was motivated to submit the insurance as quickly as they could so they could get the higher rate they charge the insurance company.  And then I wouldn't have to pay at all.  A win-win? Twenty-four hours after making the appointment I was pleasantly surprised to find out the insurance company approved the two CT scans. I'm not sure what to think regarding who's getting screwed by the medical industrial complex, but I'm thankful I still have $800 in my checking account.

The two CT scans did not reveal anything remarkably different from what we already knew from the original MRI five weeks ago. Let me say that again.  The two CT scans did not reveal anything remarkably different from what we already knew from the original MRI five weeks ago.  What dimension am I living in?   I have a hernia in the disc at the L34 pressing on the nerve root as well as a hernia on the L45 pressing on the nerve root. I also have five weeks of additional conservative care,  four weeks in a wheelchair,  three weeks at the hospital doing physical therapy, two different epidural injections of steroids directly into my spine, and one mountain of oral painkillers, muscle relaxants, and neural-shit to try and ease my pain. Nothing worked, so here we are. Same place we started five weeks ago.  Absolutely nothing has changed with me physically…but now I have a surgeon willing to take the hernia off of those nerve roots.

Through my own understanding of how nerves originate in the spine and run out of vertebrae to the various parts of our body, and the complex way in which our spines bend and twist, it was pretty clear to me that this problem has always been a mechanical one.  I've had hours and hours to study this issue. It hurts when I do this or that.  It doesn't hurt when I'm in this position or that. I've described this many many times to health care professionals and I've demonstrated it hundreds of times to myself or the health care professionals in the room at the time.

Equipped with all this imagery, this new medical professional got the same story from me. I think the imagery provided sufficient proof that all we had to do was isolate the nerves at the locations they were being impinged and a safe decision could be made with regard to a mechanical fix.  She performed all the same strength tests, pressing on my limbs as I pushed against her force. But then she had me get up and try to walk…which was difficult enough. I had to assume the position of bent over at the torso along with the posterior pelvis tilt in play at the same time to remain upright and out of pain.  But then she wanted me to walk on my heels, then walk on my toes, then twist my body left and right.  Whoa Nelly.   I did it…but not without holding onto her for dear life.  I sat back down in my wheel chair.  She left the room to consult with the surgeon and wasn't gone long.  As a team they concluded they could  offer me surgery to remove the herniation at the L34 and the L45.  It's a miracle of medical science.  As Alex Warren would say, “Hopeless Hallelujah…The angels up in the clouds are jealous knowin' we found…” a solution so simple, yet so un-ordinately.

The surgery consists of an incision above my L34 and L45, a separation of the tissue and muscles exposing the spine. They then drill a hole through each  of the vertebrae, and through this access hole they can pluck out of the herniated tissue of the disc, at both levels, removing it from pressing onto the nerve root.  The disc will heal over and I will recover.  I asked about outcomes, and she said the chance of reherniation of the disc is identical regardless of my activity.  It's exactly the same whether I am active or whether I am sedentary.  I asked, “Did you just say I can return to playing soccer after I recover? “  And she said, “That's exactly what I just said.” And I said, “Book it Dano!”  I didn’t say that…but I should have.  I will schedule the surgery on the next business day.   Hopefully just a few weeks from now…if not sooner.

Why is this such an unordinary decision just like Alex Warren’s song? I still feel like this decision could have been made 5 weeks ago.  We knew I had two herniated discs at midnight on the 17th of August. I was in excruciating pain and I couldn't walk. They still don’t want me to say excruciating pain.  It can only be a 10 on the 1 - 10 scale.  The MRI of the lumbar region clearly showed the herniations and the impingements on both nerve roots.  The decision for conservative care was not made by me.  The decision for physical therapy was not made by me. In fact I was against it.  The three PAs who examined me at the Attica holding cell all said surgery was indicated. Yet surgery was never ordered or offered.  The only decisions I have made were to happily complete my stay at Mount Vernon rehab and participate in the physical therapy that was offered as was my sentence. And to seek a second opinion once I was released.  I have now done those things. Yes I am seeking two other opinions, maybe three. This will all play out in the next several weeks ahead of my surgery before any cutting occurs.  The decision analysis that I promised is still forthcoming. But still the question lingers in my mind, with five weeks of pain under my belt, why was I never examined by the actual neurosurgeon making decisions about my life.  I think I hate that guy.  Someone I've never met. A plague on him, just like the other doctors at Attica General who consigned me to this fate, and you to reading this blog.  

In this case the decision is quick and the same decision I would have made five weeks ago.  Sometimes the hardest part of a decision analysis is defining the problem.  To define the problem in this case we had to have a proper diagnosis.  I am now equipped with a proper diagnosis. Yet, that was a phantom.  We were chasing red herrings.  Occam's Razor told us that on day five of my ordeal when speaking with PA number three, we had the solution, firm.  It was obvious to all of those present.  The surgeon’s PA and myself.  The PA said to me, he could not go against the wishes of his surgeon, he was his boss..

But, since I promised a formal decision analysis, here are my options as they have gotten more refined:

1) Rest and hope it goes away on its own 

2) Additional physical therapy

3) Chiropractic manipulation including electrotherapy and possibly dry needling

4) Use of the McKenzie Method

5) Single level disc surgery at the L34 

6) Single level disc surgery at the L45 

7) Multi-level disc surgery at the L34 and L45 

8) Continued pain management including oral medication and additional epidural injections to settle down the discs (without narcotics)

9) Injection of Fibrin to seal the discs

10 Something else

Please note there is no fusion, removal of discs, or orthopedic hardware of any kind, indicated in the surgical procedures recommended. I think we have a huge data point regarding the orthopedic spinal surgeon I have chosen to perform this procedure. Ironically, I missed the appointment with my third opinion, an orthopedic spinal surgeon from outside the Inova network.  However, I will reschedule and get that third surgical opinion.  The fact that we have an orthopedic surgeon not recommending hardware might restore my faith in humanity.  

Which decision would you make? I would love to hear from you.   I think it's a pretty ordinary decision given the five weeks of pain I anticipated. It’s ordinary that I had to wait.  I'm not looking forward to enduring the next few weeks before surgery…but here we are.  Should we be back in the era where narcotics ran freely, two things emerge that run counter to one another. If the surgeons back then were pursuing 4 weeks of conservative care before moving to surgery they had the option to treat their patients pain with narcotics.  This solved the first problem of determining if the back pain could not be solved with conservative care…but brought about the problem of treating their patients with narcotics so they could remain comfortable during that four week period.  I wanted the surgery early. I did not want to go through 4+ unknown  weeks of pain. That’s going to expand to six, seven, or eight.  The cowardly neurosurgeon did not give me that option. Narcotics were also not an option. Human suffering was the only option I was presented with, along with the additional forced torture of PT, learning to live in a wheel chair, lost income, etc etc.  The only thing I have to show for it is this blog. Plague on that guy.

As I waited for the doctor to come back in and give me the good news I was waiting for…I was staring at a large poster displaying the anatomy of the human body and in particular the nervous system.  The question that I will now research and answer for everyone in real time: When nerves form in our bodies do they form in place or do they grow like a vine? Seems creepy that our bodies form the vines of our internal communication systems which would  include nerves, blood vessels, the lymphatic system.  The nervous system that  perhaps originates at our brainstem and grows? The reason this question came to mind as I was examining our anatomy is that I  noticed that the particular nerves causing issues for me originate off the spine and go through holes in our pelvis. To go through holes they kind of have to hit that target blind if they grow like a vine.  But they're not just lined up and kind of folded into our internal spaces like our intestines fold up inside our gut. These long nerves have to run through holes. How did they hit the target? 

Okay the real time answer is simple, or the most complex part of our bodies, which I'll attempt to simplify.  They do grow in place. Which is the only way to explain how they get through the holes in our pelvis. Our nervous system is the very first thing that forms in our bodies.  The tissues that become the actual nerves start as tissue that folds into tubes in the places that they will be.  As this tissue folds into a tube at the top of it will become our brain and the lower portion will become our spinal cord. The horrible disease known as spina bifida Is the direct result of that tube not closing in that early formation. Then nerve cells begin to fill the void in these tissue tubes. Eventually those tubes are full of nerve cells and then multiple coatings grow around the nerve cells…finally the myelin sheath being the last layer to grow.  Voila, a nervous system that extends throughout the body, like a web of vines, that is grown in place. As is everything else in our body that has grown in place courtesy of our DNA map. It's clear both Lorenzo Zoil and Paul would be proud of me for doing that quick research.  I’ll let you all go for that Easter Egg. 

One more thing.  Make sure you get your Shingles vaccine. Apart from the outward symptoms of the Shingles virus, in some cases the virus can attack the  myelin sheath of your nerves.  This is how it travels and lies dormant.  In these cases nerve pain and long term effects can accompany the disease.  Our medical community is not equipped to deal with nerve pain or neuralgia on any level. It’s greater than 10 I can assure you.   Stay away from nerve pain at all costs.  Go get vaccinated today. And always bend at the knees, even when picking up your underwear off the floor.

Do No Harm

I will not be ashamed to say, "I know not",
Nor will I fail to call in my colleagues when the
skills of another are needed for a patient's recovery

—Excerpt from The Hippocratic Oath

Two great books I’ve read pertaining to the medical industry have been written by the same guy, a surgeon named Dr. Atul Gawande.  It turns out he’s a keen observer of the world around him and a good writer.  Two necessary things if you are going to be reporting on things, obscure to most of us, from the front lines.  The two books, “Better” and “The Checklist Manifesto” explore a few things Dr. Gawande believes are crucial for the medical industry to improve.  The book, “Better” results in a set of rules that any of us can use to improve ourselves through the active participation in the world around us.  I surmised his rules in a book review I wrote a few years ago that we must,  “Ask an unscripted question, don’t complain, count something, write something, and change.”  To some extent I am doing many of those things as I evaluate what’s happening to me at the hands of the medical industry right now, as I go through this medical winter.  I’m trying to do everything right, and nothing is working.  So, according to Dr. Gawande’s script, I can definitely ask an unscripted question, “What the fuck is happening?”.  I am definitely in the mood to count.  We are already deep into the analysis of subjective and objective patient pain.  And I’m definitely writing, you guys are witness to that fact as this is blog number 20 on this subject.  However, I am going to leave the script, my apologies Dr. Gawande, I’m going to have to complain,  I’m definitely complaining this round.  We will see what brings about change.  I am changing.  I hope many of you are too.

His second book, “The Checklist Manifesto” describes how the medical industry took the great “checklist” mentality from the United States Air Force and took a huge bite out of the problem of removing infection from surgery in the medical business.  The checklist is one tool the USAF has used and perfected, throughout the years, out of necessity.  To become a lethal fighting force, a force necessary to violent and ridiculously unsafe things, like dropping bombs from the air, in a somewhat safe manner, they had to figure out how to do it over and over again.  For example,  loading bombs and refueling jet aircraft while the engines are running might be considered one of those ridiculously unsafe things. Hold my beer.  How about reloading, nuclear weapons, on a nuclear bomber, while refueling, with the engines running?  In my early days I led the USAF group certifying the combat loading of the Common Strategic Rotary Launcher, CSRL, for just such an operation.  I did this for and with the Department of Defense Nuclear Weapons Safety Board.  A checklist is key.  As are other things, such as highly trained maintenance and operations personnel.  An insane amount of crew coordination. Leadership. All the things.  And we got those procedures approved.  Of course that’s a very specific break glass scenario.  If B-52 bombers are returning from a mission having already unloaded their nukes and are coming in to “reconstitute” (reloading) more nukes as quickly as they can, all hell has already broken loose.  A crucial mistake on the flightline that might result in another bad day, probably would not be noticed in the big scheme of things…yet we still want to prevent that bad day, so we put in the time to get the procedures approved.  After the reload, of course, the crew has to take off, fly to their target, and do it all again.  They use a checklist.  Dr. Gawande correctly identifies the checklist as key to the success of such a complex situation.  Adopting them isn’t unique or ubiquitous to everything yet.  It is however essential if the job is dangerous and complex. 

A checklist is always the best way to complete a mission with the best outcome.  The Air Force also does an extremely good job at providing feedback after a mission.  The debrief at the end of a mission is the best way to affect change.  The medical industry should also adopt the debrief after surgery to critique what happened during the medical procedure.  In these settings there is no rank. The surgeon doesn’t get to call the shots.  Everyone gets to walk through what happened and provide feedback without fear of any reprisal.  If a physician's assistant sees something differently then the surgeon they need to be able to change that surgeon's attitude or behavior.  Gawande points out that many times, surgical teams may be working together for the very first time, and have never met each other before.  To me, this is a ridiculous construct and an immediate red flag of danger.  Be that as it may, the medical industry has made that work, for the most part.  Until a serious problem shows up.

When a problem does show up, preferably not in the middle of a mission, they might be something that occurs that the Air Force would describe as “self-critiquing”.   This is when feedback comes immediately.  Do something wrong and you know about it immediately.  Self critiquing behavior could show up during surgery, for instance, if the patient starts  bleeding because the surgeon cut  something he shouldn’t.  In the case of most surgeries, for things that are happening, the  patient is under anesthesia.   The success for failure of the activity is going to come later…partcualrly in the business of neurosurgery when operating on the brain, spinal cord or around the nerves of the patient.  The neurosurgeon is not going to know if something went horribly wrong.  Maybe they inadvertently nicked a nerve.  The issue is not self critiquing.  The problem is not going to show up  until much later.  If you want to read another book specifically about neurosurgery I recommend, “Do No Harm”, by John Marsh.  Neurosurgery is one of those things where the surgeon shouldn’t be a cowboy.  I freely admit that in the case of what’s going on with me, taking a conservative approach is a safer option…for the surgeon.  It’s not necessarily the best option for the patient.  It may be.  However, under more extreme conditions, in cases where for instance, the patient can't walk, the doctor should take a closer look at what’s going on. Nothing seems normal about my condition.  Failure to walk should be suggestive of something more extreme.  I argue, in this case, it should be self-critiquing for the medical team vying to do something better for my outcome in this case.  They failed in that regard, so here we are.

Enough about books today. It’s time to figure out what’s really going on in my lower back, my L34, L45 to be exact.  Yesterday I noted improvement given the epidural I received last week.  The same can be said today, but things are changing fast.   I’m experiencing some ability to stand erect and put more weight onto my left leg.  As of this morning, I was nowhere near free of the wheelchair.  My ability to put weight on my leg allows me to use a cane to hobble into the bathroom and shower…where I will remain seated on a bench to shower and clean “my bottom area” as the PT who came to the house referred to it.   This evening, however, my direct impression is that the steroids have already begun to wear off.  Tomorrow I will go to see an orthopedic spinal surgeon who hopefully will make recommendations to seal my fate. Or at least complete what I am classifying as my full 2nd option.  I will meet with another spinal surgeon on Friday for a full 3rd surgical opinion, completely out of network.  I will also see a chiropractor for the second time and hopefully begin traction.  The chiropractor hopes that the second steroid injection would provide some relief in order for me to begin traction.  We shall see if the steroid holds into tomorrow.  Yet another option is a product called Discseel, which is a direct injection of a biological agent called Fibrin that is supposed to literally seal and cement the disc providing a stronger disc.  All of this out patient consulting and alternative medicine was not available to me while I was an inpatient.  It’s also a full time job trying to coordinate all of my care…and doing so myself, for the most part.  Once again…it troubles me greatly to ask what a patient would do without my level of participation and or faculty to be a part of my own treatment.

With all of these options, what is beginning to take shape is the very essence of what I have done my entire life…shaping a complex decision into a space where an actual competent decision can be made.   There is actually a scientific discipline known as decision analysis.  Sometimes, good engineers might just say that decisions are just good engineering.  In reality, good engineering requires good decision analysis for this statement to be accurate.  System engineers have the tools at their disposal to make good decisions, such as optimization and simulation.  But local optimums discovered on the slope of a mountain that indicate higher ground, for instance, doesn’t always mean you’ve reached the highest ground.   And if the flood waters are higher than that local high ground, you still die from breathing in water.    

I have a decision to make.  We make decisions everyday…we actually make them second by second…humans just become very good at the very close-in decisions we make…almost by instinct we navigate the close ones without much trouble. Crossing the street. Avoiding high water, for the most part, we stay on the sidewalk.  Since we are not dying continuously, when it’s raining outside, we don’t realize we are making these decisions (unless we try and drive our car into a creek that has overflowed the road).  However, it’s my contention that most of us would die in the very early minutes of an actual Zombie Apocalypse, or some other form of all-encompassing natural disaster.

I know this because, yes, we can cross the street without dying.  We can cook our food without dying.  We can warm our homes without dying.  But everyday there are people out there winning the Darwin Award.  Every winter someone is tragically warming their house with a Hibachi grille and killing their entire family.  I mentioned in an earlier blog, my friend from Uganda who literally had to swim across a crocodile infested river everyday to get to elementary school.  No joke, no lying, no exaggeration.  Another one of my friends simply couldn’t comprehend this as a reality someone else faced, would face, or could face.  Second nature for someone growing up in Africa 50 years ago.

But here I am…I believe…in my own personal ZA.  How could not being able to walk be anything but apocalyptic to my way of life? I have to navigate this situation.  But, I am also someone trained in actual decision making.  Can I make the right decision?  Will I actually be able to play soccer again?  Will I be able to go sky diving, rocky mountain climbing?  Will I be able to go 2.7 seconds on a bull named “Fu Man Chu” (I don’t want to do that).  

Thirteen years ago, I had to make the same decision, just hours before fusion surgery on my C56.  I had already completed the pre-op testing.  Surgery was scheduled.  I was ready to go.   I waived off the surgery…and felt guilty telling the surgeon after all the preparation.  Never feel bad about doing so.  As a result, I continued to play soccer for what appears to now look like an additional 13 years.  I actually went sky diving (tandem) a few years later.  And I hiked in Kings Canyon with Meatball.   Arguably, my L34 and L45 are currently in worse shape, and more crucial to soccer, for many reasons.  

What will drive my decision this time?  Before we get there I still need more information.  It’s coming in bits and pieces but soon I will have a river of information to decide--will it be accurate?  But ultimately I will decide.  I have to--I’m sitting in a wheel chair.  My ability to walk again will be taking center stage.  I hope you will stay tuned.

Human Decency and Respect

Monday, Sept 15, 2025

Medical status update.  

Steroid epidural injection  performed on September 10, 2025 in both my L34 and L45 vertebrae has reduced pain in my left leg during movement by 30%.  I am able to stand fully erect without pain for a limited time.  Still unable to put full weight on the left leg without posterior pelvic tilt however reduction in pain enables significant more mobility options when transitioning from wheelchair to other activities that remain in seated position such as driving or moving onto bed, etc. Pain is tolerable for limited movement (up to 6 steps) within mechanical straight line bending of the left leg at ankle, knee, and hip.  Chiropractic traction begins 17 Sept and I have consultations with orthopedic spinal surgeons on both 17 and 19 September.

Begin Blog about Rehab.  

My experience with the Inova medical system has been horrible and I  believe the medical care that I received at Inova Fairfax Hospital to be particularly appalling and warrants investigation, which has been started through a complaint to Patient Services. The first week at Fairfax Inova Adult Observation Unit (a.k.a. Attica) was so appalling and the subsequent, ultimately unnecessary and resulted in, through pressure, threats, and coercion, the wasteful time I spent in rehabilitation--due to the dimwitted recommendations of the medical team at Fairfax Inova Hospital.  That two week stay resulted in ridiculous expenses and a major waste of medical care, lost wages, and failed recovery time as a result of their recommendation to send me to physical therapy and the time I spent in rehabilitation.

That said, the time I spent at Mt Vernon,  was in fact, somewhat  pleasant due  to the dedicated medical personnel at the facility I previously called Folsom Correctional, who treated me with human decency and respect.  In stark contrast to the care I receive at Fairfax Abysmal.   I now retract the name calling and correctly call Mount Vernon Rehabilitation Center by its true name.   I do not hold Mt Vernon responsible for the improper hospitalization in their facility.  Being sent to their facility under unique threats and other improper use of pressure and coercion are strictly on the hands of an incompetent and potentially vindictive medical staff at Inova Fairfax Hospital and hopefully will be uncovered to the full extent of their poor nature and corrections initiated.

This blog today however is to thank Mt Vernon for the time I spent with them and  to commend the medical team, led by Dr. P, his administration, the nursing staff, the weekend doctors, the medical techs, the therapists, and the nutrition team, all of them, who were if nothing else, fully dedicated to their jobs, extremely friendly, and humane in their treatment.  Many of them have worked decades together at Mt Vernon. They treated me with respect and decency as should any medical care professional.

I've said in other posts that many of their patients in their care were in really bad shape and this team  is set up to take care of the worst of them.  Patients with new amputations.  Patients experiencing recovery from traumatic brain injury.  Patients who have not only lost their ability to walk, they have lost the knowledge of their ability to walk.  None of those things applied to me. I have my wits about me.  I have my balance.  I just lost my ability to walk due to the pain in my L45 when standing or attempting to walk. Many of the patients who go through there are not going to ever regain normal function of their bodies.  The patients must be trained and the families that care for them must go through this with them.  I have complete confidence I will return to full function and will visit those care givers, walking through the front door with the ability to hop, skip, and jump.  I should have never been placed in the position to be among those patients, I felt like an imposter, I was an imposter, all due to the incompetence of doctors at Inova Fairfax.

I'll try to thank them all here but I'm going to miss some of them to be sure.  Without a doubt every single one of them treated me with the humanity that any one of their patients deserved.  They made up for significantly for the in human treatment I received in the Fairfax Inova facility.

Doctor’s:

Dr P,  who comes from PR, is a very friendly and knowledgeable man who was very willing to accommodate all of my crazy requests as I struggled to turn his medical unit into my own personal medical performance unit and my primary office space. I fell short of getting all of my performance indicators tested, such a T, but Dr. P. was willing to accommodate the testing I needed to move my actual diagnosis forward…at the recommendation of the external doctors I was consulting, my primary care physician,  and my own research I was conducting.  I did manage to turn most of the ward, my room, and several common rooms into my personal  office space for reading, writing, working, and meeting with many friends and guests who visited during my stay and brought prohibited items such as Twix Bars, Popcorn and Monster.  Other doctors such as Dr. C and Dr. W,  were in on the weekends. They always talked with me and conveyed my wishes to Dr. P without mistake…despite the fact that the weekend docs have way too many patients. I was told they had to make the rounds to see 57 patients one weekend.  That’s too many.

The nurses were my front line of support, and I met them daily first thing in the morning…with shift change happening about 7 am.

My primary nurses were:

Mercy, Karla, Mangesh, Alex.

The nurses changed with every shift and had to respond to all of my whims and outbursts and wild ideas I wanted to present to them Dr. P about my treatment.  They were always happy and cheerful and provided my medication accurately and in a timely manner…unlike the nursing staff at Attica…which it was never accurate, never timely, and always under some dubious circumstance…and to me, always seemingly under duress.  The nurses at Attica simply didn’t want to be there.  At Attica, if I refused a medication it was signaling something bad…if I took want they were offering as “optional” (narcotics) it I was signaling something else…this was the no win scenario I was placed in.   At the rehab center I was specifically told I could refuse any of the medications I was being given.  The only one I refused…and only on two occasions, was the injection of blood thinner to reduce potential for blood clots in my legs.  I was very active in rehab…I wasn’t laying in bed 24/7.  I never took a single narcotic at the rehab center although it was prescribed as optional, and could be requested.

The next part of my medical team consisted of the Medical Technicians:  

The ones I remember the most were Jane, Harriet, King George, and there were others…

Med techs have the thankless job of taking my vitals every four hours, seeing to my every wish, and unfortunately removing the urinals I had to use repeatedly every night during the early days when I was not permitted to leave bed.  I thanked them often. The techs from Ghana were my favorite and I included Jane, Harriet, Mary, and King George.  King George was taking care of me at the age of 75 and has worked at the rehab center for 30 years.

There were other techs from Jamaica, Nigeria, and Sierra Leone but alas I have already forgotten their names.  But I thank them nonetheless. 

Actually rehabilitation fell into the realm of the Physical and Occupational Therapists.  Unfortunately, due to the nature of my medical condition it was clear to me and the beginning, and reinforced during they attempts at physical therapy, that range of motion and pushing into the pain was not going to rehabilitate what was fully a mechanical manifestation of a herniated disc impinging on a nerve with the very significant possibility of further impingement on a bony vertebrate during motion.  This impingement would be unobserved during a static MRI.  Also, further, during an static MRI when there is no pain.  Pain occurs during movement.  Any diagnosis of reduced strength or pain would have to be observed, diagnosed, imaged, whatever, during the exact period of impingement. The first physical therapist, and primary, was the only medical person to note the reduction in strength at my great toe, during an exact moment of pain when the impingement was occurring.  All other times, strength has been observed during the period of correct alignment and no pain.

Principal Physical Therapists were Kaitlyn and Bethany.  Both of them, with good nature and good hearts, took me through the extent of pain I could endure attempting to apply the skills they learned as Physical Therapists.  I was always willing to work with them, despite my ever increasing knowledge that the root cause of what we were dealing with was not going to disappear without some sort of intervention.  If the disc were to shrink through the use of steroids we had a shot.  Beyond that a mechanical intervention to move the disc was necessary.  This will occur through a surgery or something alternative such as traction.  Neither had been offered to me at the time.  Both are being evaluated this week.  Four weeks after the onset of my condition…and I continue to sit in a wheel chair, even as I write this.

It was clear to me from the earliest days of physical therapy, what was going to happen at the rehab center, is that I was going to be trained to live at home, in a wheelchair, and be discharged.  That, of course, was exactly my fate.  Now at home, however, I am free to pursue the necessary care, throughout patient intervention, to heal and move forward.

Beyond Physical Therapy, the Occupational Therapists would be evaluating and problem solving for the eventual movement home via a wheel chair to begin my life with a disability.

Elizabeth, would provide most of my Activities for Daily Living, which mostly included showering…Elizabeth provided at least 6 showers during my stay…just saying…and a lot of wheelchair transition work.  Other OT provided upper body exercise and a lot of use of the recumbent bike.  I spent a lot of time on that bike.  I also had an OT who was a stickler for posture…change your posture and she was on you like flies on stink.  Elizabeth was the same with brakes on the wheelchair, forget the brakes and you thought you had just kicked her dog she was so disappointed in you.

The Admin Team consisted mostly of Sharon.  She would make sure everything was on schedule.  Admin was the team that snuck into your room in the middle of the night and updated your white board with your schedule.  It always surprised me when I woke up and I had ADL at 7 am…followed by 3 plus hours of PT and OT.  We were busy…it filled the days.

The Nutrition team came in every morning.  My food service favorites are Nika and Demetria.  Eventually they grew tired of me always ordering exactly the same thing for breakfast lunch and dinner. Sugar frosted flakes with an egg and sausage burrito, chicken fingers and chicken soup, grilled chicken with mashed potatoes and carrots… but trust me, I had plenty of Five Guys, Rocklands, and Chipotle on the side.  Thanks to everyone who snuck everything in for me.

Recreational therapists provided the music.  I already thank them in an entire blog post entitled, “Bring me to Life” if you want to go back an read it.

The normal day would begin at 4:00 a.m. That's the first blood pressure, temperature and oxygen saturation I typically remember.  The technician comes in and wakes me up and then does the necessary business of emptying the urinal should the patient have used the bottle during the night. They would also take blood at this time if tests had been ordered the day before by the doctor. 

The nurse would make her first rounds a 5:00 a.m. for the first medications of the day.  

Breakfast was delivered about 6:00 a.m. 

First occupational therapy would occur at 7:00 a.m. activities for daily living and could include eating breakfast but in my case most of the time included taking a shower and getting dressed. 

The rehabilitation center requires at least three hours of therapy a day so the first PT could be 8:00 a.m. If I was lucky it was 10:00 a.m. and I had a few hours to write the blog or at least check email and communicate with one or two folks.  I was rarely lucky…and would get thrown straight into my morning pain.  I would never turn it down.  Some patients on the ward turned down their therapy…I never wanted to be that patient.  Ironically, I knew the PT would be doing me no good…but…I wasn’t going to say no after the experience at Attica.

I did visit the psychiatrist once.  I think this was a requirement for all new patients.  I never saw her again.  I guess she judged me as sane.

Eventually I ran out of clothes to wear and King George and Harriet showed me how to use the washer and dryer in the common room.  I spent most of my time down in the common room where I have my two laptops set up and I would read books, surf puppies on IG, and write this blog.   Even though I had access to TVs everywhere, I never turned the TV on once.  I think television might be dead.

Tech’s or admins would come find me in the common room for lunch…I would never tell them if someone had already brought me Rockland or Five Guys…But a few times I did have friends showing up for lunch and for dinner and we would go out to the recreational pavilion and ordered Door Dash whatever we wanted…they never came looking for me outside.  On one occasion a Chinese Crested visited me…thanks Francine.  That was the only dog, I did not have enough dog visits, considering I like dogs more than people.

Days grew much the same, and the only other thing that was unique, as the one patient on the ward  who had 24/7 security…For the first week he had one security guard stationed at his door after a morning incident for the second week he had two security guards stationed at his door…was never sure what was going on with him…I never saw him outside of a wheelchair so it's not clear exactly what he could do from inside his wheelchair.  I never engage with that cat during my stay and I never make eye contact.  I could see his crazy eyes from my peripheral vision and that was enough…that and his continual obscenities he screamed at the staff…most of whom I’ve mentioned above.  All of whom do not deserve treatment like that…but all of whom treated him with human decency and respect…just like they treated all of their patients.  I hope some of that will eventually rub off on that particular patient.

The Pain Will Continue Until Morale Improves

“I wanna run through the halls of my high school
I wanna scream at the top of my lungs
I just found out there's no such thing as the real world
Just a lie you've got to rise above”

—John Mayer, No Such Thing

There's this elephant in the room that's so big it's starting to take up space in my head. I joked about it early on.  “Don't you stick that knife in your leg Ricky Bobby”.  In the event that this was all in my head…psychosomatic…it always seems kind of funny, that that might be the case.  But it hurts too much to laugh. 

I wrote an entire chapter on the pain when I started this journey.   The pain I was feeling  seemed uncategorized and way off the chart from what I was being asked by the medical community.  The pain seemed to be unwritten, in some nonlinear region, not described by their “tell me you pain on a scale of 1 to 10”.  Now a few weeks later with more knowledge and pain under my belt, and the more and more reading I do that says pain is subjective the more and more  pissed off I get.  Not so much for me but for anyone out there experiencing nonlinear pain that is being ignored by the medical community and being pigeonholed into some belief that their pain is subjective and they are, at the end of the day,  being pussies (it's my blog I get to say what I want to say).  By saying pain is subjective the community is basically saying that the pain I am feeling is not the same pain someone else might be feeling and since it's subjective someone else may not feel the pain as severely as I am and that they could potentially be walking, and not in a wheel chair,  because they would be able to endure the pain differently and would be able to walk simply by enduring it.  I thought as we went through this the credibility factor as we got closer and closer to a diagnosis would in fact prove the pain is real. Instead what I'm experiencing is more and more discussion of the subjectivity of my pain, and that, In fact the longer this drags out and the more it looks like the pain is all in my head.  Well anyone who thinks that can kiss my ass. To me the evidence that is being ignored has become more and more compelling. I don't like to see surgery as the only option but unless we have a few more breakthroughs happen, and happen very quickly…I don't see anywhere around a surgical solution.

I've heard this bullshit about subjective pain throughout my life as I've dealt with various bouts of pain in different ways, shapes and forms when trying to understand the pain of others. For sure I have friends who have jumped out of airplanes and/or landed hard on aircraft carriers and should be feeling the pain of compressed vertebrae in their spine far  more than what I have been feeling. I've read Sarno's book and believe there are times certainly when motion is lotion and getting out on your feet and moving will take care of some of what may be wrong, and this includes stress and giant forms of anxiety. Muscles get tight. I've played soccer my entire life.  I've pulled multiple muscles. I've sprained my ankles. I've had twisted knees.  As I discussed in 2013, I went through this with my C56 after taking a pretty hard hit from the side. I know when it's time to rest, ice, and compress a muscle.  I also walked you through my motorcycle accidents which tend to account for perhaps a lot of arthritis in my spine.  I know when pain is a phantom and when pain is pain, and it hurts.  

Some pain is indeed a function of nature versus nurture and past trauma and can be included as a significant influencing factor based on your past and what you've experienced.  As doctors struggled to figure out and attempt to treat what might be going on, scales were created, and words were used. This apparently is why words are so important to the diagnosis.  Over the past month I've been asked those words so many times in so many different ways it's clear to me the well-intentioned medical workers asking those words have simply no idea what they're talking about.

Basic searches for pain show up in two categories,  and when I'm being asked about my pain by most of the medical staff I'm being asked about whether this pain is somatic or visceral. Somatic pain being what we typically feel from my household injury such as a cut, or stubbing a toe or spraining an ankle. Visceral pain normally occurs from an internal disease or surgery. Both of these categories of pain seem to be the types of pain that can be addressed on a scale of 1 to 10…they are very linear. And there are specific words that mean specific things in either both categories.  Visceral--deep, throbbing, aching, diffuse.  Somatic--stabbing, sharp. That's what the mental community is looking for. There is a third type of pain that doesn't seem to be addressed in these simple queries. I am not being asked about nerve pain, which strangely when dealing with anything related to your  spinal column, should immediately be singled out as nerve pain. At a minimum it should not be left out of the assessment.  Trauma that affects the spine should be the first indicator, since I had not fallen off my roof, I believe that type of trauma was ruled out in the ambulance. Autoimmune diseases create a huge amount of nerve pain, metabolic diseases, and infections such as shingles. When patients present in these categories the 1 through 10 scale should be thrown out and patients should be met  where they are…probably with a level of pain that can't be categorized or understood so the medical professional shouldn't even try to assess pain.  Rather they should assume that it is off the charts and simply ease their suffering so they can begin an actual dialogue about what may be going on and how to treat the condition…not the pain…

Having been an analyst all of my life with an engineering background, measuring what's going on has been my natural state.  I measure everything to the annoyance of most people around me. Everything has a scale and I evaluate everything on that scale. But you have to use the right scale for the job.  When I brought up pain in my early chapter, “Pain goes to the Moon” I was addressing nerve pain. Since I personally felt this level of pain previously when I had a pinch in my C56. It wasn't something that could be endured and if I wasn't on my way to the emergency room I was heading upstairs to jump off my roof.  Somatic and visceral pain can easily be placed on a scale of 1 to 10 since it exists in a very linear region. Nerve pain on the other hand clearly is not linear. Pain from nerve damage, pain from arthritis, pain from things like other immune diseases such as shingles, should never be addressed on a linear scale. I would go so far as to say if a medical professional addresses nonlinear pain with a linear scale it's time to bring up the “M” word. Which I most definitely will do before this journey I am on is over.

I've had another affliction where I can safely say if you consider what I'm talking about you might have a more profound understanding of where pain can come from that could be off the scale. Gout is one such affliction. I like to talk about gout because in the literature it is referred to as the disease of kings. And since I have it occasionally, mostly likely from eating pounds of steamed shrimp in one sitting… I must be some type of king.  Typically it manifests in the big toe…but to understand what's going on here is to understand where significant pain can come from. Simply put, uric acid is going to crystallize in the joint of your big toe.  Think about that as if all of a sudden as someone has inserted broken glass into the joint of your big toe. This is an emergency situation and something that cannot be ignored. That's a level of pain that is going to be necessary to address and quite possibly runs higher than a 10. Nerve pain runs significantly higher than a 10 but gout is going to drive you straight to the emergency room. If someone tells me gout is subjective and I can show you the crystalline uric acid in my joint I am going to place most of my foot straight up your ass.

The same is true when I can show you an MRI with a bulging disc that is impinging on a nerve root. If you can see a herniated disc pressing on a nerve and a doctor is telling you that your pain is subjective I'm going to tell that doctor to go straight to hell. 

We learn as analysts that correlation is not causation. Yet sometimes correlation is exactly causation. Such as when you can see crystalline uric acid in the toe, or a shingles rash, or a herniation that's pressing against a nerve root.  Sure steroids and NSAIDS may shrink it…bring them on.  But also, there are mechanical ways to remove that herniation from the nerve root.  Traction springs to mind…yet that is alternative care.  Physical Therapy is what was prescribed.  Range of motion…nothing to remove the herniated disc from the nerve.  Alternative care, such as chiropractic care, can manually manipulate joints to try to decompress what’s going on.  WHat wouldn’t that be acceptable care?  Surgery, for sure, will be manipulating that nerve…either by trimming the disc to get the impingement off the nerve, or ultimately removing the disc altogether and fusing the vertebrae.   

I've had my second epidural this week…another manual method to try to reduce the size of the herniation and get it off the disc. . The effect of lidocaine had on my L34 and my L45 was almost immediate.  Yesterday I had a decent report but today the lidocaine seems to be wearing off so I'm hoping the steroid will kick in shortly. The point I'm going to make is that we believe my pain is coming from this area…this area was addressed with a very specific needle and a very specific amount of painkiller that very specifically changed the level of pain that I was in. There was nothing subjective about it. This was a highly objective procedure and it was highly targeted and carried out in an extremely precise manner.  And it had a very precise and immediate effect.  The same kinds of things have been occurring and have been observable throughout this three week ordeal…if I expand the L45 by bending my torso, I can remove the pain.  If I do a posterior pelvis tilt, I can remove the pain even more.  Yet I remain without a diagnosis with the medical community relying on some strange hope that my condition will either disappear on its own or I should begin coping with my own pain and stop bothering them. 

If I can feel the pain come and go it is not subjective.  It is clearly objective.  So to me it is incumbent upon the medical community to come up with a better way to assess pain.  They take our blood pressure and pulse every four hours whether we need it or not.  How about, take our pulse when our pain is induced, as a base line?  Measure something.  It’s random and disassociated it they don’t deliberately try something as novel as doing this.  The faster I pound on this back the more he sounds like a motor boat.  Cause and effect.  He puts pressure on his foot, his pain goes up, his pulse goes up accordingly.  Simple. Objective. Measurable.  There are other ways to do it.  

I’ll continue to take the meds as prescribed.  Methocarbamol to relax my muscles, Motrin and Tylenol to combat some of the pain, and Gabapentin to do the rest for my physical nerves being affected.  The pain will continue until morale improves.  Never has that been more true when defining pain as subjective in the individual.