The Definitive Back Injury Update Post

Well, the jury   neurosurgeons are in, folks! Over the past few weeks, I have been to various doctor’s offices and imaging centers hoping to get an answer about what is going on with my back and how to deal with it.

Brief recap for those just joining my pity party: I have had back issues since I was 16 and have two bulging discs at L4-L5 and L5-S1. I have constant mild-moderate pain and sciatica most of the time as a result with several more severe flare ups per year. The most recent flare up occurred on the morning of the Charleston Marathon – January 18, 2014 – which I was unable to finish as a result of the pain.

The first stop was a neurosurgery/spine center in Greenwood that I had never been to before. For those of you not from South Carolina, Greenwood is definitely not the city in our state that one would think of when one thinks of outstanding medical centers, but it was recommended by a very helpful reader and received high ratings, so I figured I’d give it a shot.

My appointment was on March 17, the day after I got back from Chicago. I had an amazing appointment – my doctor was so caring and helpful. He not only gave me a thorough exam and lots of new information about the symptoms I was experiencing, he also answered all my questions and didn’t make an annoyed face when I told him about all of my running (much more rare than you’d think). He said that he had a pretty good idea of what was going on but wanted to get an updated MRI (my last one was from May 2012 after the Flying Pig Marathon incident). He also wanted to get some x-rays of me bending over in various positions, which surprised me because out of all of the spine doctors that I have seen over the years, no one has ever suggested that. I left feeling really hopeful that I would get some new insight.

I went the next morning first thing for an MRI and x-rays and was, for once, actually given the images on a CD when I asked for them. Normally, they just lie and say they’ll send them to you but never actually do until months later after you’ve fought them tooth and nail, at least in my experience. Anyway, I got a call the next day from the nurse at the office I had been to on Monday, and the news wasn’t good.

“You have degenerative disc disease,” she said. “The doctor is recommending that you see a neurosurgeon because you will likely need surgery.”

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I have to say, I was pretty floored. My last MRI just showed my same old dumb bulging discs, pressing on my same old dumb nerves and generally being annoying. I never expected to hear that my condition had worsened, even though I was in more pain. Yes, I realize that doesn’t make sense. I spent the next few days reading every article I could find about degenerative disc disease. It turns out it’s not actually a disease – it just means that your discs have deteriorated and are basically disintegrating, causing your spine to compress. My google search history looked something like this:

“degenerative disc disease”

“degenerative disc disease treatment”

“degenerative disc disease surgery”

“degenerative disc disease running”

“running after spinal fusion surgery”

“how to control a panic attack”

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One of my millions of searches took me to the website for the Boulder Neurological & Spine Associates in Boulder, Colorado. I had read (ok, fine, on a triathlon forum) that Dr. Villavicencio, also known as Dr. V, was doing incredible research on minimally invasive back surgeries AND IS ALSO A 32-TIME MARATHONER who has competed multiple times at Ironman Kona. As luck would have it, BNSA does free MRI reviews, so I overnighted my images to them (which I actually had, thanks to the CD!) in hopes of having one of their surgeons take a look at them. I thought Dr. V would be way too busy for my nonsense, but the very helpful office manager called me and asked if I had a specific physician in mind for my case and then suggested Dr. V based on my running history. Amazing! And Dr. V himself called me the next day. Note: This entire situation was as shocking to me as when AJ and I started dating and he actually did the things he said he was going to do at the exact time he said he was going to do them. Finding the right doctor is not unlike dating.

At this point, I hadn’t been told many details about my MRI since I was waiting for my appointment with the neurosurgeon down here, so he went over the whole thing with me, issue by issue. I was a bit taken aback by the list:

  • Serious degeneration at L4-L5 and L5-S1 (the bottom two discs of the spine), the worst of which is at L5-S1
  • Bulging discs at L4-L5 and L5-S1
  • An annular tear at L4-L5

Sounds horrible, right? Well, it’s actually “moderate” in the world of back issues, which is just crazy to think about since I can’t do anything without pain right now. I’d hate to see what “severe” looks like!

Dr. V explained that I will need a two-level spinal fusion to fix the pain and nerve issues I have, which was my worst fear. He also explained that because I’m 28 years old, he hopes we can avoid doing that for awhile, because basically, fusion is hell. He suggested trying a microdiscectomy first, which is much less invasive and requires much less recovery, to see if that would help enough to put a fusion off for a few more years. He was confident that I will be able to run again regardless because an elite triathlete (and 5 time Kona winner) that he operated on had the exact same issues I have, received a two-level fusion (at age 42), and continued competing professionally for 2 years before choosing to retire to spend more time with his kids. On a related note, I am somewhat concerned that he thinks I am an elite athlete, but it’s fine.

My appointment with the neurosurgeon in South Carolina was today, and I have to say, I am so glad I spoke to Dr. V first. There was nothing wrong with this guy at all – he was perfectly nice (from Canada, after all) – but holy crap, it was like he thought of ways to break the news to me in the most depressing possible fashion before he came into the room. Examples from the conversation:

“If I didn’t know any better, I would think I was looking at the MRI of a 60-year-old, but here you are!”

“You’re not going to be running anymore, so go ahead and get that out of your head now.”

“The only thing that will help you is a multi-level spinal fusion.”

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Thankfully, I was prepared for the conversation thanks to my discussion with Dr. V. All my research came in handy as I asked this doctor about other surgical options, which he agreed did have some chance of success, but admitted that he was not the most qualified to perform them because of the complexity of my case. He was impressed/possibly disturbed by how informed I was about the various procedures and latest research, and I found myself so glad that I love compulsively googling things. He was very friendly and honest but came across so much more pessimistically than Dr. V. If I had spoken to him first, I likely would have considered running/hobbling directly out of his office and into oncoming traffic because it seemed like my life was over. Perhaps I will write him an email with suggestions on patient approach, to include lines such as “You are so pretty; it’s amazing how degenerated your discs are!”

Isn’t it funny how it seems like nothing happens for such a long time and then everything happens at once? That is kind of what this feels like. I’ve been dealing with this issue for 12 years, and then all of a sudden, in the span of a week and a half, all of this happens. It’s nuts. 

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The end result is this: I scheduled a microdiscectomy with Dr. V in Boulder on April 24, assuming the pre-operative exam goes as anticipated. If it works, I’ll be able to start running verrryyyyyyy lightly about 6 weeks after that (beginning of June) and resume training around the beginning of August. If it doesn’t, I’m looking at a fusion at the end of the summer.

My best friend asked me bluntly if I scheduled the surgery with Dr. V because he told me I’ll be able to run again. It’s a fair question, but one that I can answer definitively – no. As we know, nothing in life is certain, so just because he says I will be able to run again doesn’t mean that I will for sure, and just because the other guy says I won’t doesn’t mean that I couldn’t. I think as a runner and an athlete, Dr. V definitely views mobility and activity differently than the other surgeon, but I picked him because he’s the most qualified and made me feel extremely at ease with my options and the entire process. Too bad I have to go to Colorado to see him, but it is what it is.

While the diagnosis and the treatment options certainly aren’t what I had hoped for, I already feel much more at peace about the entire situation simply because I have a definitive path forward and a doctor I feel comfortable with. It doesn’t hurt that it looks like my running career isn’t over just yet, either.

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June will be here before I know it!

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