Back From Hell

My arms were numb from the shoulder down - never a good sign. Somewhere in the back of my mind I half coherently mused to myself that the Doctor’s warnings against mixing opioids and alcohol were probably wiser than I had given her credit for. I said as much to my wife who was sitting next to me on the fifteen-hour flight from San Francisco to Dubai. Her response, as she calmly motioned to the flight path on the screen in front of her, was less than comforting, “Babe, we are somewhere over the Arctic Circle so there isn’t going to be any emergency landings…probably best not to die right now.”

What followed were three hours of fighting to stay awake and trying, really hard, not to slip into what I was sure would be a coma that I would never wake up from. I only remember one thought running through my mind at the time: if I survive this trip, I need to sort my shit out. I would like to lie and say that this event occurred after a little too much partying on my private jet. The truth is rather more mundane. I was flying coach. I was headed to meet my wife’s family in a small Southern African country not known for its socio-political stability (Zimbabwe). The pills were prescription, the Johnnie Walker was not, and, although I was unaware of it at the time, I had two severely herniated discs in my lower back.

 If you ask anyone who has suffered a low back injury, they will tell you how debilitating the experience is. Worse, they will often tell you that the pain becomes chronic and can last for months, years or even life. Even worse, there is a tremendous amount of conflicting information about how to treat these injuries and a quick google search reveals that options include; doing nothing, crystal healing, and surgery. It is my hope that by honestly addressing both the good and bad decisions I made in my own rehabilitation process, others can avoid my mistakes, learn from some of the overarching principles that emerged, and enjoy a more rapid recovery than I did.

 This is going to be a two-part post. In this first part, I am going to recount how my injury occurred, the bad decisions that led to it worsening and the eventual diagnosis. Part two will deal with the methods I used to restore my back to full function.   

At this point, I feel compelled to say that I am not a doctor. This is not medical advice. This is an anecdotal recounting of my self-administered rehabilitation. There are a myriad of different ways to injure your back and what worked to fix my specific injury may very well make yours worse. Be smart and talk with your doctor before you try any of this.

Ok, disclaimer over. Let’s start at the beginning.

 Timing in life is everything. Sometimes you win the lottery the day before you are due to pay your bookie and sometimes you destroy your back constructing the gym you are opening in three days. Most likely, the event that started the entire ordeal was a nasty fall off a ladder. I was able to finish working that night, but when I woke up the next day I could tell something wasn’t right. When the pain began to worsen after several more days I was faced with two options:

Option One: Face the reality that I had seriously injured myself right before opening a business that required me to move and lift heavy things constantly and delay the opening.

Option Two: Deny reality and plow forward in the hope of “working through it.”

Anxious about the gym opening and unable to bear the thought of any delays I made a very bad decision and went with option number two. After all, I am a lifelong gym rat and any gym rat worth their salt has had plenty of injuries that they were able to train through.(1) Spoiler alert - this was not one of those injuries. Predictably, the following months were a slow descent into hell. The cycle looked something like this:

Viscious Cycle.jpg.png

This is a very bad feedback loop to be stuck in. I was approaching my recovery completely wrong which meant my pain continued to increase. The increase in pain meant I was more restricted in my movements and was becoming increasingly desperate to be out of pain. That desperation eroded my ability to look at the situation objectively leading to even worse attempts at recovery. Rinse and repeat this cycle several times and you are in for a very bad trip.

Fast forwarding several months to the airplane fiasco we began with, I was in a level of pain I had hereto thought would be impossible to endure. Sitting or lying down in any position for longer than a minute was agonizing. This meant that sleeping quickly became a thing of the past. Often, seventy-two hours would go by with me being able to sleep only in forty to sixty-minute increments which, any new mother can confirm, is not ideal for great quality of life. Looking back, what kills me the most is the knowledge that a lot of this could have been avoided. Had I made a good decision and gotten my injury diagnosed right away, the resulting “virtuous cycle” might have looked something like this:

Virtuous Cycle.png

So, what would I do differently next time?

Lesson One: Embrace the reality of the situation.

In other words: find out exactly what you are suffering from so that all your subsequent decisions can be adjusted accordingly, and you can begin the “virtuous cycle” of recovery. There is a reason I put this lesson first. One bad decision begot dozens of other bad decisions. Had I just embraced the hard truth up front, it is likely that the herniations I originally suffered would have healed in a more typical amount of time shaving potentially a YEAR off of my recovery. Having had my “come to Jesus” moment over the Arctic Circle, I was finally ready to accept reality.

                Less than a week after returning from Zimbabwe I was in an MRI machine. For those of you who are unfamiliar, magnetic resonance imaging basically allows a doctor to get a picture of the body’s soft tissues that an X-ray cannot capture. The results of the scan were not promising. They showed significant damage to two discs in my lower back.

Back.png

Without getting too bogged down in the details, the discs in your back are comprised of two basic components. The soft interior of the disc is called the nucleus pulposus and the fibrous rings surrounding the nucleus are called the annulus fibrosus. The analogy one of the doctors I saw used was that of a jelly donut (I shit you not) where the nucleus is the jelly and the annulus is the donut. I had what are referred to as extruded discs. After some research, I gathered that this meant the proverbial jelly from my vertebral donuts was leaking out the back side of each disc. At least I finally knew what was wrong with me and could work with the doctor to come up with a treatment plan. Which brings us to lesson number two.

Lesson Two: You are ultimately in charge of your recovery.

 Doctor’s and back specialists exist to provide you with expertise and treatment options. While you should absolutely take what they say seriously you should not take any one individual’s diagnosis as the word of god. They are doing their best to render an opinion based on their education, experience and the facts at hand. Two qualified, intelligent doctors can look at the same MRI and disagree about what the issue is. Even if they do agree on the issue they may disagree on what treatment is appropriate to prescribe. The course of treatment you pursue will ultimately be determined in large part by your personal situation.

For me, surgery was not an option. I had spent time extensively researching spinal surgery and was less than impressed with the efficacy for relieving chronic pain in both the short and long-run.(2) Being laid up for several months also meant that my brand-new business would die. Which meant that I would be left with a nice chunk of startup capital to repay and no way to repay it. Which meant that I would probably have to resort to smuggling drugs over the border. Which meant I would get arrested and sent to federal prison. Which meant I would eventually get shanked to death over a candy bar…like I said, I hadn’t been sleeping much for months at this point. My thought process was getting a little shaky, to say the least.

Luckily, I found a very good doctor specializing in spinal injuries who agreed that surgery was the wrong course of action in my case. He reasoned that I was young enough that my body would heal on its own, given time. All I had to do was avoid irritating the injury and adjust my life to be as “lower back friendly” as possible. There was still one minor problem remaining. Namely, the constant searing pain in my back and sciatica shooting down my left leg.                   

Lesson Three: Reduce pain to manageable levels

When we are in pain we are vulnerable. Not just physically but emotionally and mentally as well. There are entire industries designed to take advantage of people in some type of pain. Loved one die? A psychic will be happy to help you reconnect and take your money in the process. Anxiety about hitting middle age? We have a shiny red corvette just waiting for you. The point is that you need to reduce pain to a tolerable level to make good decisions. Yes, I think that can even mean opioid painkillers as a stop-gap for extreme pain.  

I am the type of guy who refuses to take Excedrin when he has a headache. Call it a meathead tendency but it always seemed like a cop-out. It is a testament to the level of pain I was in that I didn’t even blink when the doctor suggested a corticosteroid steroid injection into the injured site and a course of oral prednisone to follow. Yes, there are potential side effects that must be considered when dealing with corticosteroids. In this case, it did not matter. My pain was sufficiently crippling that I was willing to deal with any side effects that might occur.  

Since having the injections done, I have spoken to roughly a dozen people who have also had them in their backs. The results seem to vary from ‘limped in and skipped out’ to a ‘complete waste of time’. Fortunately, my result was closer to the former. The day after the injections, I woke up with less than half the pain I had previously. I also slept more than an hour for the first time in what seemed like decades. My pain was not gone but it had become manageable. This relief allowed me the clarity of mind to calmly strategize ways to begin my rehabilitation.

I was finally ready to start on the road to recovery and being the intelligent gentleman I am it only took me half a year to get to the starting line. 


References/Footnotes:

(1) We are often the worst at taking our own advice. Had anyone else come to me with the symptoms I was experiencing I would have sent them straight to a doctor.

(2) There are many studies going over the efficacy of spinal surgeries. However, I hesitate to link to any specific studies as it can be difficult to deduce if the given review is relevant to your specific condition, the proposed type of surgery, age, etc. Instead, I would recommend you read "Crooked, Outwitting the Back Pain Industry and Getting on the Road to Recovery" by Kathryn Jacobson Ramin. While there is definitely a specific point of view being voiced, the book nonetheless offers a well-researched outsiders view on treatments for back pain. Personally, I used the resources the author cited as jumping off points for my own research.