Saturday, September 14, 2013

The Blessings of Suffering

It has been a long time.

That's often the case for me, as my numerous obligations don't often leave me time for the blogging pursuit.  It has been so long, in fact, that I have not posted here in over a year.  But, thanks to a somewhat random injury, it looks like I have a little free time.

This is for those who have not caught the random Facebook posts I have made this week, or perhaps who are looking for a little more detail on what happened.

The short story is I wound up with a severely ruptured disc between the numbers five and six cervical vertebra. "Cervical" vertebra are the ones in your neck; they are numbered one through seven, with the seventh being the very large bump you can usually feel along your spine at the very base of your neck.  The two surrounding my injured disc are short-handed to C5 and C6, medically speaking.

My chiropractor, who is also a good
friend, referred to this as "the biggest
[vol]cano of a rupture" he has ever seen.
As you can see in the image to the left, the disc ruptured posteriorly (backward), which is the most common way for cervical discs to rupture because of the generally backward curve or bend of the neck.  The rupture usually occurs at the point where there is the most pressure on the disc.

Warning - Scientific Content!: a vertebral disc consists of two main parts: the nucleus pulposus, which is the jelly-like material in the center of the disc that basically dissipates the shock constantly absorbed by each disc.  Vertebral discs provide two functions: shock absorption, and flexibility in an otherwise rigid structure (your spine).  The other part of the disc is the annulus fibrosus, a fibrous component that provides most of the structure of the disc.  To compare a disc to something, consider the shock assembly of a car: the nucleus pulposus is the shock absorber itself, and the annulus fibrosus is the spring that provides rigidity and "return" -- the ability for the disc to return to its normal shape.

There are two key parts to see in this first image.  The first is the primary bulge, which is pushing directly back against the spinal cord.  The white area in the cord is spinal fluid, and the darkish area is the nurve bundle.  You can see that there is a mild impingement on the nerves; however, there is still a small amount of white showing on the opposing side, which indicates that there is little to no pain caused by this impingement.

If you've ever seen the original movie
(not the remake) of The Blob, you can
think of this image as representing the
bowling alley scene.
However, if you look at this second image, to the right, you can see that the rupture was not centered, but rather to the left (this image is looking upward through my body, as if the perspective was from my feet looking toward my head, which is why right is left in the image).  This indicates that the impingement ("pinching") is directly on the "nerve root" -- the nerve that branches out from the spinal column between the C5 and C6 vertebra.  That was indicated even without looking at the MRI images because I have extreme pain and weakness in my trapezius and my left deltoid, which are both controlled by that nerve.  This image shows the slight movement of the entire nerve bundle, but clearly shows that it is completely covering up the nerve root.  That is the cause of about ninety percent of the pain I feel.

The final image, to the left, indicates a shadow on the disc.  This image is looking head-on at me, which is, again, why left is right.The shadow is a clear indication of the lateral location of the rupture, showing that it is entirely off-center and is pushing toward the nerve root, further corroborating the other evidence.  You can also see a considerably larger white "blob" of skin and fluid building up on the left (right) side as compared to the right (left) side.  That is a large amount of swelling occurring along the path of the nerve through my neck and shoulder area, indicating a great deal of inflammation resulting from the rupture.

I have dealt with this sort of image ever since August of 2000, when a motion similar to that of throwing a football, but without a complete follow-through (i.e., a sudden stop) resulted in an audible "pop" in my neck that had me down for the count for several days.  Over the last 13 years, I have probably had the injury recur 15 or more times. The diagnosis ultimately had become a possible sprain of one of the many ligaments that stabilize the neck.  The pain would subside in three days to three weeks.

Now, it has become obvious that it was much more likely a very small rupture that would heal itself over time.  This time, however benign the beginning may have been (literally, I stopped typing at my desk at work to rub itchy eyes, and that set it off; it then got dramatically worse the next day for no particular reason), the end result has been a worst-case scenario that landed me in the ER less than 48 hours after the first symptom, a first for a chronic injury.  But this is where the story becomes a testimony to the power and grace of God.

First of all, I left early from work Monday because of the pain, wanting to lay down to remove the weight of my head from my neck.  I slept for five hours that afternoon, but it didn't really do much. Tuesday was also an early departure from work to get to the chiropractor as soon as possible, after the pain went from about a four to a seventeen on a scale of one to ten, in a matter of about 10 minutes.  The chiropractor squeezed me into his schedule as an emergency case, and allowed me to stay and rest in one of the back rooms for about 15 minutes.  I actually went into mild shock in that time because of the pain.  From there, we went to my primary physician at the chiropractor's request to get a prednisone taper pack, trying to use steroids to limit swelling and increate my body's natural ability to heal.  That racing around allowed me to stubbornly make a very important meeting at church to finalize things for the Men's Ministry's annual study, which I am supposed to lead each week.

That night, I fought through, sleeping in no more than two-hour bursts as I had the night prior, as well.  I needed help to sit up in bed, to lay down, to walk -- basically, to do anything.  So I decided about four o'clock a.m. that I would go the the emergency room in the morning, once Kaylee was off to school.

The staff at the ER, who were almost universally fantastic, wound up ordering and performing the MRI, which revealed the issue.  They consulted with a local neurology clinic, the Raleigh Neurosurgical Clinic, led by a Dr. Allen.  He indicated that emergency surgery was not indicated, but that a followup would be needed immediately to determine the next step.

Roughly twenty-four hours after the ER visit, Christina went to her weekly Community Bible Study
at our church, Crossroads Fellowship.  It was there that a new woman showed up and joined her group.  When they discussed prayer requests at the end of the meeting, Christina noted my situation while the new lady looked on, interested in what was being said.  She then related that her husband, a Dr. Russ Margraf, works at the same clinic that the ER consulted, and that he had related a case to her that apparently stood out enough that he shared the details later that night.  The case was eerily reminiscent of the details of my case, leading the lady to believe that it was her husband, and not Dr. Allen, who had consulted with the ER.  She made a phone call, and we suddenly had an unexpectedly quick, 2:30 p.m. appointment for later that day.

Let me say here that Dr. Margraf has one of the best demeanors I have personally experienced, and I have seen a lot of doctors in my life.  He reviewed the MRI images and immediately felt that no amount of physical therapy would result in a full recovery.  He gave all the details, including that the pain would most likely subside with PT, but that the duration during which there would be pressure on the nerve root would likely result in permanent weakening of my left arm.  However, he never pressured us into making a decision.

From there, we drove about five minutes for a quick consult with my chiropractor.  He is generally adamantly opposed to surgery except in emergency situations (i.e., broken bones, etc.).  However, he stated that his best prognosis through chiropractic care would be about a fifty percent chance of full recovery after no less than six months of therapy.  In the end he, too, recommended surgery.  Quick prayers on the way home revealed to us that we were both at peace with surgery, and we opted for this coming Tuesday morning.

God smiled one more time on me, though.

I got a call yesterday informing me that a Monday slot had just come open, cutting by one more day the amount of time I would need to suffer with my current pain.  Praise God!  (I would praise him regardless, of course.)

The prognosis is that the pain in my shoulder and arm would subside immediately after surgery, and that the remaining pain would be in the area of the incision and internally where things would be moved out of the way.  I will have minimal activity for three weeks and a five-pound weight limit.  After three weeks, I will be allowed moderate activity and a return to work, with a fifteen- to twenty-pound limit.  After a total of twelve weeks from surgery, I will be clear to return to normal.

Detailing the procedure: an incision will be made in my neck, next to my esophagus.  The muscles and esophagus will then be retracted out of the way, giving clear access to the discs and the vertical vertebral surfaces.  The damaged disc will be removed in pieces and replaced with an artificial material.  A titanium plate will be attached to the anterior (front) surface of the C5 and C6 vertebra, using two screws in each.  The incision will be closed, and all will be done.  Afterward, I will have normal incision discomfort and a sore throat for two to five days from retraction, meaning softer foods for a little while.  That means I will be eating mashed potatoes, jell-o and a lot of milkshakes.

Oh, darn.

I will be out of work for three weeks.  That means I will lose the remaining eight days of vacation I have available, and will need to dip into short-disability.  We can handle it, because God has blessed us and I believe He will continue to do so.  My faith is in Him, and I hope that this testimony shows the clear hand of God in such a way that the objective person cannot deny it.  That is why I felt the need to share it here.

Thank you, everyone who has offered and/or given assistance.  We are blessed to have been surrounded by such loving, caring people.

And we are blessed in every other way, too.  He is good, all the time!

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