Within my last blog post I filled my readers with promises of an exciting journey packed with new and hopeful ways to control my back pain. I had visions of writing again a few months later with revelations of how my pain could be managed with diet and modifying exercises alone. If I had written another blog post this time last year (March 2020) then that may have been the case, but by continuing my journey to this day it turned out a little like the road shown in the picture above-full of twists and turns (as any great story should I suppose). A rollercoaster 15 months that has ultimately found me sitting here writing a blog post 3 weeks after ALIF (Anterior lumbar Interbody Fusion surgery). The optimism and hope I had in the previous blog post of tackling my symptoms with natural and non-evasive medical intervention seems like a distant memory.
If we rewind back the previous 15 months I found myself sitting, for the second time, in the office of Dr Guy Barham, spinal surgeon. After a number of failed attempts at getting my GP to help identify the root of my problems, I practically had to beg for a referral to a specialist. Within 5 minutes of our initial consultation I finally had someone who was willing to listen to my triggers and symptoms and not fob me off for being too fit and healthy to really be suffering. He had arranged an MRI scan and I was back for the results. I was genuinely nervous. Not so much of there being a problem as I could deal with that, more because I was doubting myself and worried I was making a fuss over nothing. As he had suspected, I had degenerative disc disease between the S1/L5 vertebra. This in itself is no major cause for concern, in fact many people have degeneration without even realising. But in a few cases it can cause sciatica, nerve problems and referred pain across the whole lumbar and hip region (my ailments). As I stated previously there were a number of things that could be done before medical intervention and I was determined to try them all!
If we rewind back the previous 15 months I found myself sitting, for the second time, in the office of Dr Guy Barham, spinal surgeon. After a number of failed attempts at getting my GP to help identify the root of my problems, I practically had to beg for a referral to a specialist. Within 5 minutes of our initial consultation I finally had someone who was willing to listen to my triggers and symptoms and not fob me off for being too fit and healthy to really be suffering. He had arranged an MRI scan and I was back for the results. I was genuinely nervous. Not so much of there being a problem as I could deal with that, more because I was doubting myself and worried I was making a fuss over nothing. As he had suspected, I had degenerative disc disease between the S1/L5 vertebra. This in itself is no major cause for concern, in fact many people have degeneration without even realising. But in a few cases it can cause sciatica, nerve problems and referred pain across the whole lumbar and hip region (my ailments). As I stated previously there were a number of things that could be done before medical intervention and I was determined to try them all!
For the next few months I genuinely made a real effort to change my diet (which is still modified to this day), and I embraced stretching, foam rollering, Pilates and sports massage. I saw a physiotherapist on a regular basis, warmed up correctly, applied heat and ice after exercise and started taking vitamins for an identified deficiency. These factors initially left me feeling like a new and revived person. I no longer had the urge to snack, had more energy and my back pain was minimal. I went into Lockdown 1, full of hope and the sun was shining. I think the first few weeks of this lockdown left my back in the best state it has been in for 4-5 years!
There was no real trigger for deterioration again. It could have been the zoom fitness classes I had started hosting for online clients. It could have equally have been the fact that I could no longer receive massage or therapy to relieve the aches and pains during lockdown. Also the cake and chocolate was creeping back into my diet, so that could have also been to blame-but I very much doubt it. Nevertheless, I was rapidly going downhill. The strangest thing about a condition like back ache is that no-one else can see anything wrong with you. On the outside I was teaching HIIT classes and going about my daily life with a pretty good pain threshold, and as much as exercise was somewhat bothersome, it was the pain I felt when resting at the end of the day, or at night that really got to me. The inability to sit comfortably in a chair and getting stuck on my back in bed or not being able to turn over or get comfortable, coupled with a feeling of instability in my lower back that prevented me from lifting anything with ease off the ground were some of the things that I was struggling with.
I felt increasingly like I was treading on eggshells trying to prevent my back getting any worse. I daren't run anywhere near mud and even some exercises were off limits for me by now too. Even sitting on the turbo trainer was a recipe for my muscles to seize up and protect my weakened spine. I was longing for a sports massage, but COVID had other ideas. By the time I was able to get any relief it was nearly the end of summer whereby I once again began the cycle of non-evasive treatment to try and alleviate the pain.
I had imagined that 2-3 weeks of the treatments and therapies that I had used at the start of the year would leave me feeling recharged and back to some semblance of my former self. Unfortunately, this was not the case! I had been massaged to the point of tears, bore bruises from shock wave therapy and dry needling, but as soon as one muscle group had been released, another tightened up. Through all of this I still wasn't sleeping well or feeling like I could resume normal activities to the best of my ability.
The summer had promised excellent opportunity for run training in preparation for an ultramarathon in Autumn, but had only delivered a measly 12 mile longest run in preparation. I was totally prepared to cancel the planned Run to the Sea event and spent many days and nights trying to decide what to do. I knew I wouldn't cause any extra harm by taking part, and there was a very generous cut off time, but could I face walking that far and what if I DNF (Did Not Finish). If I was going to do it, I had to fully commit. In proper gambling style, I decided to let the weather Gods decide for me. If the weather was good I was taking part, if it was cold and wet I'd stay in bed!
On a beautiful Saturday on the 10th October, under strict COVID social distancing protocol I set off with Rik to run/walk 50km from Ringwood to Hengistbury Head (Via Poole). Unbelievably, I completed the 31.4 miles (according to my watch) in 5:43:32. the strategy of breaking the first half into sensible goals worked a treat and allowed for a steady walk/run pace that was manageable. Half marathon distance passed by without a problem and every mile past that point was a victory. When I run the pain in my back remains a constant, but it is bearable and never prevents me from putting one foot in front of the other. Half way, marathon distance and before long a view of Hengistbury head from Bournemouth end of the prom-the end was in sight. It was at this point that I knew that I could easily finish and set of with renewed vigour. Rik was struggling with cramps and urged me to go ahead, which was a wise move because the weather was changing and I knew getting cold would be the worst thing possible this far into a race.
Once over the finish line I collected my medal and kit bag then made a socially distanced beeline for some friends I knew who were waiting for there other halves. The body is an amazing thing-as soon as it didn't need to pump energy into moving me forward, it went into protect back mode. I was sitting down eating Peanut M&Ms and it wasn't long before Rik appeared and crossed the finish line, but I was stuck fast. I had no 'helping hand' to scrape me off the floor and I can honestly say that moving from the grass to the car was harder than the previous miles I had travelled. Needless to say, the next few days and nights weren't great for me. I was pleased that I had completed the event (one of only 2 I managed in 2020), but the knock-on effect on my job and own exercise in the next few weeks took its toll.
It was in November 2020 that I once again found myself writing to my doctor requesting a repeat appointment with Mr Barham. I wasn't entirely sure what I was hoping to gain from the appointment, but the fact that he had said to me the previous year that I could stay on his books and would be a candidate for surgery if symptoms persisted or got worse, made me feel like I had no option. I was also spending a fortune on treatments which I knew I couldn't maintain. Being the great list person that I am, I was armed with everything I had tried since my last appointment which also included seeing a hip surgeon (to rule out hip problems-family history) and a rheumatologist who concluded there was nothing she could do for me.
It turned out that I had done more that most people do to try and help themselves. He managed to tick every single box on the 'have tried' sheet and said I was literally running out of options. The next step was to have a SPECT-CT scan to try and identify exactly where the source of my pain was coming from. If, as he expected, it was the site of the degeneration, then surgery was the only other treatment I had left. So on the 30th December 2020 the day Boris announced the latest national lockdown measures, Rik and I drove to Bath for my scan. It was an all day affair with a radioactive liquid being injected into me then a couple of hours later a SPECT and CT scan was booked using the scanner below to see where the radiation had gathered (apparently it is attracted to inflammation).
There was no real trigger for deterioration again. It could have been the zoom fitness classes I had started hosting for online clients. It could have equally have been the fact that I could no longer receive massage or therapy to relieve the aches and pains during lockdown. Also the cake and chocolate was creeping back into my diet, so that could have also been to blame-but I very much doubt it. Nevertheless, I was rapidly going downhill. The strangest thing about a condition like back ache is that no-one else can see anything wrong with you. On the outside I was teaching HIIT classes and going about my daily life with a pretty good pain threshold, and as much as exercise was somewhat bothersome, it was the pain I felt when resting at the end of the day, or at night that really got to me. The inability to sit comfortably in a chair and getting stuck on my back in bed or not being able to turn over or get comfortable, coupled with a feeling of instability in my lower back that prevented me from lifting anything with ease off the ground were some of the things that I was struggling with.
I felt increasingly like I was treading on eggshells trying to prevent my back getting any worse. I daren't run anywhere near mud and even some exercises were off limits for me by now too. Even sitting on the turbo trainer was a recipe for my muscles to seize up and protect my weakened spine. I was longing for a sports massage, but COVID had other ideas. By the time I was able to get any relief it was nearly the end of summer whereby I once again began the cycle of non-evasive treatment to try and alleviate the pain.
I had imagined that 2-3 weeks of the treatments and therapies that I had used at the start of the year would leave me feeling recharged and back to some semblance of my former self. Unfortunately, this was not the case! I had been massaged to the point of tears, bore bruises from shock wave therapy and dry needling, but as soon as one muscle group had been released, another tightened up. Through all of this I still wasn't sleeping well or feeling like I could resume normal activities to the best of my ability.
The summer had promised excellent opportunity for run training in preparation for an ultramarathon in Autumn, but had only delivered a measly 12 mile longest run in preparation. I was totally prepared to cancel the planned Run to the Sea event and spent many days and nights trying to decide what to do. I knew I wouldn't cause any extra harm by taking part, and there was a very generous cut off time, but could I face walking that far and what if I DNF (Did Not Finish). If I was going to do it, I had to fully commit. In proper gambling style, I decided to let the weather Gods decide for me. If the weather was good I was taking part, if it was cold and wet I'd stay in bed!
On a beautiful Saturday on the 10th October, under strict COVID social distancing protocol I set off with Rik to run/walk 50km from Ringwood to Hengistbury Head (Via Poole). Unbelievably, I completed the 31.4 miles (according to my watch) in 5:43:32. the strategy of breaking the first half into sensible goals worked a treat and allowed for a steady walk/run pace that was manageable. Half marathon distance passed by without a problem and every mile past that point was a victory. When I run the pain in my back remains a constant, but it is bearable and never prevents me from putting one foot in front of the other. Half way, marathon distance and before long a view of Hengistbury head from Bournemouth end of the prom-the end was in sight. It was at this point that I knew that I could easily finish and set of with renewed vigour. Rik was struggling with cramps and urged me to go ahead, which was a wise move because the weather was changing and I knew getting cold would be the worst thing possible this far into a race.
Once over the finish line I collected my medal and kit bag then made a socially distanced beeline for some friends I knew who were waiting for there other halves. The body is an amazing thing-as soon as it didn't need to pump energy into moving me forward, it went into protect back mode. I was sitting down eating Peanut M&Ms and it wasn't long before Rik appeared and crossed the finish line, but I was stuck fast. I had no 'helping hand' to scrape me off the floor and I can honestly say that moving from the grass to the car was harder than the previous miles I had travelled. Needless to say, the next few days and nights weren't great for me. I was pleased that I had completed the event (one of only 2 I managed in 2020), but the knock-on effect on my job and own exercise in the next few weeks took its toll.
It was in November 2020 that I once again found myself writing to my doctor requesting a repeat appointment with Mr Barham. I wasn't entirely sure what I was hoping to gain from the appointment, but the fact that he had said to me the previous year that I could stay on his books and would be a candidate for surgery if symptoms persisted or got worse, made me feel like I had no option. I was also spending a fortune on treatments which I knew I couldn't maintain. Being the great list person that I am, I was armed with everything I had tried since my last appointment which also included seeing a hip surgeon (to rule out hip problems-family history) and a rheumatologist who concluded there was nothing she could do for me.
It turned out that I had done more that most people do to try and help themselves. He managed to tick every single box on the 'have tried' sheet and said I was literally running out of options. The next step was to have a SPECT-CT scan to try and identify exactly where the source of my pain was coming from. If, as he expected, it was the site of the degeneration, then surgery was the only other treatment I had left. So on the 30th December 2020 the day Boris announced the latest national lockdown measures, Rik and I drove to Bath for my scan. It was an all day affair with a radioactive liquid being injected into me then a couple of hours later a SPECT and CT scan was booked using the scanner below to see where the radiation had gathered (apparently it is attracted to inflammation).
Christmas came and went then I was invited back to see Mr Barham mid January. Once again I was feeling nervous about the outcome. What if there was no sign of inflammation and my muscles were just weak? What is the only way to cure my pain was to stop exercising and give up my job? On the flip-side, if inflammation was found would I be making the right decision by opting for spinal fusion? I was just going to have to wait and see.
Rather than beat around the bush, I was invited to sit down and was immediately shown the picture of my lumbar spine from the SPECT-CT scan. Now I am no medical expert but I could clearly see a different colour visible over the vertebra around my damaged disc. This was then immediately confirmed by Mr Barham as the source of my pain and the reason why I would be a prime candidate for surgery. Luckily there were no other issues with my bones and the pain was likely coming from the muscles protecting this fragile area.
Rather than beat around the bush, I was invited to sit down and was immediately shown the picture of my lumbar spine from the SPECT-CT scan. Now I am no medical expert but I could clearly see a different colour visible over the vertebra around my damaged disc. This was then immediately confirmed by Mr Barham as the source of my pain and the reason why I would be a prime candidate for surgery. Luckily there were no other issues with my bones and the pain was likely coming from the muscles protecting this fragile area.
Another twenty minutes or so passed with me listening to the pros and cons of surgery and what the next steps were. Unbelievably, all I needed to do was write a letter to him at any point to state that I was aware of the risks of the ALIF operation he had proposed and give my consent for him to go ahead and book me in! As you can imagine, I went home fighting thoughts of positively improving my back and the associated pain, weighed up against the implications on my family and my job by having to take at least 6 weeks out. I don't know what I was worried about as everybody from Rik to my clients were all so positive in encouraging me to try and get better. It made making the decision to try and improve my quality of life so much easier. I'm only 45 years old and have loads of plans for an active life ahead of me, which were getting harder and harder to undertake as my symptoms escalated.
So that is how on Monday 22nd February at 1pm, Rik and the kids dropped me at the hospital doors to undertake my ALIF surgery that afternoon. The next hour passed in a bit of a blur! Before I knew it I had been seen by the surgeon and anaesthetist, consent forms had been signed and I was dressed in a glamourous hospital gown being wheeled to surgery. In the 4 hours I was asleep, a bone graft had been removed from my right iliac crest, the damaged disc between the S1/L5 vertebra had been removed and a cage filled with my graft had been inserted into the space (increasing the size by 7mm apparently) and it had been screwed into my spine (see x-ray pic). I came around in no pain, with good feeling in my legs (phew) feeling hungry-which is a good sign. Within an hour I was back in my room eating a jacket potato, drinking tea and Facetiming the family. I actually couldn't believe how well I felt. I later found out that this was probably a result of all the local anaesthetic around my wound site and a dose of opiate pain relief. There wasn't much to see apart from dressings but there wasn't a spot of blood or red patch in sight.
So that is how on Monday 22nd February at 1pm, Rik and the kids dropped me at the hospital doors to undertake my ALIF surgery that afternoon. The next hour passed in a bit of a blur! Before I knew it I had been seen by the surgeon and anaesthetist, consent forms had been signed and I was dressed in a glamourous hospital gown being wheeled to surgery. In the 4 hours I was asleep, a bone graft had been removed from my right iliac crest, the damaged disc between the S1/L5 vertebra had been removed and a cage filled with my graft had been inserted into the space (increasing the size by 7mm apparently) and it had been screwed into my spine (see x-ray pic). I came around in no pain, with good feeling in my legs (phew) feeling hungry-which is a good sign. Within an hour I was back in my room eating a jacket potato, drinking tea and Facetiming the family. I actually couldn't believe how well I felt. I later found out that this was probably a result of all the local anaesthetic around my wound site and a dose of opiate pain relief. There wasn't much to see apart from dressings but there wasn't a spot of blood or red patch in sight.
That night I didn't sleep at all as I was stuck on my back-full of caffeine and attached to pumps on my feet to prevent blood clots-which were annoyingly noisy. I really didn't care though-I had weeks to sleep if I wanted to, so I just went with what my body wanted. I knew I had to spend at least one more night in hospital so just needed to tick all the boxes to make sure I could go home the following day. I was seen by a physio that morning and scared the life out of her when I log-rolled my legs off the side of the bed and stood up before she was ready. She definitely didn't expect me to walk around the bed easily without too much trauma. I'm not going to lie-the wound site was very painful and I had a constant dull ache in my lower back, but the pain meant that I was careful and sensible.
After a much better second night of sleep and another visit from the physio (stairs up and down-check). I was told if I can shower I could go home...challenge accepted. I organised for Rik to collect me after lunch and did what I needed to do. Once dresses-medication was delivered, a porter was called and before long I was being wheeled to the car. We were self-isolating for a week, but then I could start the process of walking and building up my endurance.
So here we are 3 weeks later. Dressings off, wounds healing nicely and pain is very minimal. I'm managing a couple of walks a day and my step count is regularly over 10,000 steps again Everything seems pretty normal for me except for the fact that I need to rest more often in the day and I'm not allowed to hoover, drive, bend or lift! I have another appointment with the surgeon in a few weeks time and I'm confident that my prognosis is going to be positive and I'll be back working (sensibly) in no time at all. Unfortunately running and cycling will be off the menu for a long time yet, but hopefully when I'm given the all clear I will be able to do both activities pain free for the first time in a long time!
After a much better second night of sleep and another visit from the physio (stairs up and down-check). I was told if I can shower I could go home...challenge accepted. I organised for Rik to collect me after lunch and did what I needed to do. Once dresses-medication was delivered, a porter was called and before long I was being wheeled to the car. We were self-isolating for a week, but then I could start the process of walking and building up my endurance.
So here we are 3 weeks later. Dressings off, wounds healing nicely and pain is very minimal. I'm managing a couple of walks a day and my step count is regularly over 10,000 steps again Everything seems pretty normal for me except for the fact that I need to rest more often in the day and I'm not allowed to hoover, drive, bend or lift! I have another appointment with the surgeon in a few weeks time and I'm confident that my prognosis is going to be positive and I'll be back working (sensibly) in no time at all. Unfortunately running and cycling will be off the menu for a long time yet, but hopefully when I'm given the all clear I will be able to do both activities pain free for the first time in a long time!