Welcome to our CaringBridge website. The purpose of this blog is twofold: 1) to keep friends and family up-to-date with Pat's progress, and 2) to provide positive, yet realistic, updates as the next several months progress.
Pat had surgery on January 6, 2020 for a multi-level spinal fusion going from top of sacral (tailbone-S1), through lumbar (L5-L1), and up to of thoracic (T12 & T11) vertebrae. As most of you know, Pat has courageously been living with spinal stenosis caused by severe arthritis that he inherited (according to every ortho doc he has consulted). We are fortunate that the University of Iowa Hospital is so close to our home in Muscatine.
Pat has had a "sore back" most of his adult life. (He is 65.) He had two knee replacements before the spinal stenosis diagnosis in 2011. He went to an ortho doctor about his back when he tried to hike in Glacier National Park and could not go any further than about a quarter mile. Of course, as the not so understanding wife, I figured he was just in bad physical shape, but I knew this was different. Dr. Myles, a talented doctor at ORA in Davenport, gave up his lunch to patiently explain the "lay of the land." He referred Pat to the University of Iowa's Dr. Mendoza who gave him a choice of taking care of a herniated disk or having a fusion. Pat chose to get this disk repaired and had good relief for another three years. Shortly thereafter Pat had a shoulder replaced. By the time limiting back pain started up again, Dr. Mendoza had left and there was no other doc who conducted big fusions. He returned to Dr. Myles who sent him to Dr. Sundar for epidural steroid injections. These worked very well and only occasionally did Pat need pain killer such as Tramadol.
The spinal deterioration progressed. He would need to "rest his back" after walking shorter and shorter distances. Then he needed cervical spine fusion due to a completely dislodged disc in the summer of 2017. He happened to be at Mayo for other issues when this was addressed. Dr. Freedman performed a successful two-level fusion. (This talented man of faith was willing to tackle the lumbar area a year afterwards, but we decided to go back to the University of Iowa as they had a new young spine surgeon, Dr. Pugely, and it was close to home.) A second shoulder replacement was done shortly after. Thankfully all surgeries until now have given Pat relief and were successful.
Eventually the epidurals started to wear off. A heart attack in December 2018 necessitated that he stop the epidurals due to the use of a blood thinner. That is when the pain became unbearable. He moved to a cocktail of gabapentin, tramadol and rapid release Tylenol. (It is amazing how quickly the Tylenol takes effect. Especially when arising, the Tylenol would do its work so Pat could walk about 15 steps to a warm shower.) Pat does not like pain medication, but he learned quickly that it was important to adhere to the pain med administration timeline.
We also learned to make accommodations as he could only tolerate about a half block of walking before resting. He finally gave in and started using a handicap sticker even though he would choose to use nonhandicap-designated parking spaces nearby, if possible. He would also time his pain killer medications for full effect when he anticipated walking distances. We also like to travel so wheelchair assist was a given. In addition, Pat started to use a cane as his balance was also a concern. Recently we went to Portugal and hired a guide who specializes in making places accessible, including the use of a wheelchair equipped van. All along, Pat continued his regular exercise routine on a NewStep walker at the local Y.
Dr. Pugely and his cardiologist said that he needed to be one year post heart attack before he could be taken off of blood thinner and thus be a candidate for spine fusion surgery. His pre-surgery checks included a full day with seven appointments (i.e., anesthesiologist, MRI, CT, X-rays, internal medicine, orthopedics, brace measurement). Dr. Pugely's team provided a very thorough appointment and was not rushed. Dr. Pugely stated that he had only seen a couple of cases with this severe of arthritis. Eventually it was determined that the fusion would begin at S1 and progress to T11. Pat clearly understood that this was not going to be a cure; rather, it would hopefully relieve much of the pain and enable him to walk longer distances. Most importantly, it would allow him to participate more actively in the lives of his children and grandchildren. Thus, the journey begins - - -
This is a short post to let you know that Pat continues to make forward progress. We are very thankful that he has no pain radiating from the back nor down the legs. Needless to say, he no longer goes to the Y, but he is able to walk in our neighborhood on good weather days.
Yesterday he had a televisit with his surgeon, Dr. Pugely. Normally there would have been tests to make sure that everything looks fine, but his doctor is pleased and continued to ease up on restrictions. Pat can now do limited twisting and bending. Most importantly, he is now able to lift up to 30 pounds. Note that he has had a 10 pound restriction the last few years, and it has probably been at least eight years since he has had more than a 25 pound restriction. For those of you with severe arthritis/spinal stenosis, know that there may be something to help. We are feeling blessed indeed.
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