Decisions Decided

Last week on Facebook and Twitter (on 11/20), I announced that I had met with a new spinal specialist, and that he had told me that I was an excellent candidate for artificial disc replacement ("ADR").  Immediately, I was overcome with emotion and said "I'm going to hug you now and again after the surgery." In other words, I told him then and there that I wanted to go ahead with the artificial disc replacement.

Two years ago, Dr. Yu--a colleague of Dr. O'Brien (the man doing my ADR Surgery)--told me "If there was a significant, operable change you'd know it." And now I know what he means.  So, you (and many people in my life) may think that this was a rash decision.  But if you've been following me for a while, or if you know me in person, you know that this isn't a rash decision at all.  In fact, I've been talking/thinking about it for a very long time.

Back in March 2007 when I was going through all the wonderful pain of the bulging L3-4, L4-L5, L5-S1, I researched artificial disc replacement in Europe. At that time, artificial disc replacement devices had recently been approved in the U.S. for use in the lumbar spine (October 2004 for the Charite Artificial Disc, and August 2006 for Synthes ProDisc-L) and not yet for cervical discs (that occured in July 2007 for the Medtronic Prestige Cervical, and December 2007 for the Synthes ProDisc-C ) (there are other devices I'm not listing that were approved around the same time).  Artificial disc replacement in Europe had about a decade more practical experience and application.

The standard of care for bulging discs is to start with conservative treatment (physical therapy, steroids, pain management) and to see if the discs would realign themselves or the inflammation that was causing nerve pain would decrease.  I was told many times that they couldn't/wouldn't do much of anything until their hand was forced -- until a disc herniated.  Until then, I wasn't a good candidate for either disc fusion or ADR.  For bulging discs, the more common surgical option would be a partial discectomy/laminectomy (I'm glad that I ignored the advice of one surgeon who wanted to operate, because the conservative treatment seems to be working for the most part (I have good days and bad, but the good days far outnumber the bad)).  I just wanted to know what all the options before my hand was forced into making a decision that wasn't good for me.

There are risks to this and any surgery.  There are also benefits. 

• Dr. O'Brien has a great track record with this surgery, and has performed more cervical ADR surgeries than any other surgeon in Washington, DC.  I think I'm in good hands.
• The benefits to ADR vs. Fusion is that an artificial disc replacement acts and functions like a vertebral disc.  I will still have flexibility and functionality (unlike a fusion that would limit it). 
• Many studies (now that there have been 5-year U.S. studies and 15+ year European studies) show that ADR surgery in the cervical spine are stable and require fewer revision surgeries (think Peyton Manning) when compared to lumbar ADR or cervical/lumbar fusions. 
• If I were to do nothing, I might not qualify for a single-level disc replacement because the disc below C5-6 is also bulging and could herniate.  This buys me some time and some stability.  It also gives doctors an inside look at what is going on with my discs.

But you all can testify to the one thing that my doctor is concerned about:  you know just how dedicated I am and will be to my rehabilitation.  You know I'll do ever exercise and heed every precaution.  You've seen me over the past few years and how I've applied myself and honored my body. 

I'm going to need you all.  While I'm not a religious person, I will say pray for my doctor (his eyes, his hands, his brain, his expertise) and for me.  Think happy thoughts.  Burn some incense.  Once we figure out if we can proceed (insurance, testing to make sure I'm not allergic to the metals in the device), I'll let you all know the date of my surgery [tentatively December 12th?], the terms of my release (I said to him, "If you can give me running, I'll give you/give up sparring"), and any other details I can give. 

But please, above all else, be happy for me.
I want this to work. 
I want this feeling of being hopeless to be replaced by an overwhelming feeling of being hopeful.
I hope that when all is said and done that the FatGirlvsWorld you all know and love will be returned to you.