TLIF Surgery Day 5 Post Op

Today is day 5 post op. Today is Monday and it's the 30th of November and I do realize that it's what everybody says it's going to be post surgery - meaning there's going to be ups and downs.

Today I got up really early in the morning because my son had to go to school for his early morning cross country run and I was up at 5 o'clock in the morning. I came down the stairs and was literally on my feet for almost an hour shuffling between an Uber taxi ride and a normal taxi. That put a lot of strain on me and emotionally as well as physically and I am feeling really tired this morning.

Also it is being a really painful night last night up until this morning and the surgery surgery site has been very very painful to the touch and trying to lie on my back, or on my side has been very difficult  through the night. I probably had a total of maybe 4 hours of sleep and this is becoming a problem for me to manage because that's about the sum total of sleep. I'm getting on average per day and that's not good for my recovery process. When I'm when I'm trying to sleep which ever way I turn it's painful so I'm really not comfortable at all which is why I keep waking up and not having the kind of deep sleep that I should be getting that's good for a proper rest.

Quickly I'm on the same meds which means I am on antibiotics and paracetamol three times a day and that's all.

The pain situation is actually probably the worst its been in the last 3 days. Which means today being day 5 post op the pain is on a scale of 1 to 10 around a 8. That's not reassuring considering that I'm supposed to be improving every day., I must confess that I may have overdone it yesterday. I probably walked a total of an hour at a fairly slow pace but a pace faster than I have been walking from day one I have also been climbing the stairs up and down at least 4 or 5 times and that combined with the walking must have really escalated the pain situation this morning or last night. So there  is a reason why this is happening and I just don't want to blame it on whatever else is going on.

TLIF Surgery: Day 4 Post Op

Today is day 4. Post operation and it's Sunday and I am NOT feeling hundred percent at all. I feel really tired I feel exhausted from all the walking the climbing stairs at etc. that I'm trying to do because I just want to keep on my feet at the doctor had suggested but it is really getting to me and to the end of the day now I'm feeling quite tired.

Okay so let's talk about medication. I am on antibiotics twice a day as well as paracetamol tablets 500 milligrams three times a day and as all the medication that I'm having besides of course supplements and vitamin D vitamin vitamin C it's a truck that I routinely take. It has nothing to do with the surgery at all.

Okay so how's the pain? . The pain today is actually quite intense but it's only at the surgery site and I guess that's to be expected because it's only day 4 but it seems to have upped a notch from where it was yesterday and that's a little bit disappointing. But  I suspect that it is because I have been walking a lot, climbing stairs all day yesterday so I may have overdone it as some people have mentioned online and you have ups and downs. So I guess the surgical site pain is something that I just have to deal with. I don't have any other pain in any other area so all of the pre-op symptoms of pain down my butt, thighs and legs, tingling and numbness are all gone so far, and so I feel that the surgery (again I'm repeating myself) was a success. So all I have now  is pain related to the actual incision site which is in my lower back at the l4 l5 region.

I think I should mention that the pain actually escalated towards the end of the day probably because I had a very difficult bowel movement after three whole days of constipation due to meds and I suspect that that put a lot of strain on my lower back muscles as well as probably the hardware that was put in. I am convinced that this increase in pain is actually directly related to this difficult situation but I guess everybody gets constipated because of the pain medication and the morphine drip that I was on during immediate post-op. Luckily for me I am no longer on any kind of prescription pain medication and therefore I do not anticipate an ongoing constipation problem and and it's such a relief not to have that fear of a intensely painful time trying to get your junk out.

One suggestion that I really must add is that please increase your intake of fruits and vegetables particularly if you can have boiled green vegetables as well as fruits  or add some kind of stool softener or laxative around the second or third day so that you can have a relaxed session in the toilet - otherwise it is just intensely painful and it really really hurts your back a lot and it's just not worth it.

Emotionally and mentally I feel strong. To the day a couple of times I did check my temperature because I was feeling a little bit feverish but I always realized that it was just very low grade temperature hovering around the 99 point something degree Fahrenheit mark and that is not really cause for alarm so no I did not have a fever or chills or anything. If its just having to deal with the increase in pain as compared to the previous day that was a little bit of a downer but I came through with it okay. I had a normal lunch and a fairly ok dinner even though I didn't have much of an appetite through the day which was again expected so overall pay for was medium rare.

TLIF Surgery Day 3 Post Op: feeling better already...

Today is third day post operation and I feel much better than I did yesterday and of course of the day before which was the day of the operation. Woke up fairly early in the morning with a lot of pain and at the surgery site but the sciatica and the other back and typing is completely gone and I feel that the surgery so far was really successful for what it was.

I have not taken any pain medication today at all. I have relied entirely on panadol and that's it have not even taken voltaren. The pain on the actual surgery location is quite a lot but it's certainly better than post operation day one which was Thursday and day 2 which was yesterday Friday so yes it is getting better everyday. I have not being to the loo yet for my big job because I'm still pretty constipated and even though I've taken laxatives nothing seems to be working so far. I have been walking 10 minutes per session at least and I've done three sessions today which really didn't cause me any pain. As well I have been going up and down the stairs without any real pain issues which is a good sign. Yesterday and also on Thursday which was the first day after the surgery I had a lot of muscle ache which was around the whole body and I think that's more or less gone today and I feel a whole lot better overall even though there's a lot of pain residual on the actual incision.

Emotionally and psychologically I feel better today than I did yesterday and I feel a little less depressed then I did first couple of days or are less fearful of what is ahead people have been calling today and I had a long chat with Udit which was quiet nice.

TLIF Surgery Day 2 Post Op. Going home from hospital.

Came home from hospital today in the afternoon at about 2 o'clock.

It was an exhausting morning at the hospital not sure whether I should be coming home or not or just hanging out in the hospital room with the available care until Saturday morning.

Dr. Choi was supposed to come in the morning at 9 o'clock and take out the draining pipes but he failed to show up which was quite surprising. So we call Sunny the nurse and she immediately came and attended to me with all the necessary things that needed to be done which was removing the drains and dressing the incisions.

As soon as those two little drains and plastic pipes came out I decided to go home. Removing the pipes was an experience to be believed because it felt like someone was sucking out something from inside my body which is essentially what was happening anyway.

The ride home was OK – just one quick lane change hurt a lot – but other than that, mostly just discomfort of being cramped in a car seat. Getting in and out isn't easy even though we have a fairly lux SUV.

Once home, it was settling down in bed, having the meds handy, being as comfortable as possible. Going up the stairs to the bedroom was not as difficult as I had imagined. Slow and steady won that race.

Once you are off the drips at the hospital, and are at home, it is hugely important to keep your fluids up. I did not have to use a wee-bottle (or bed pan) at the hospital, and at home it was business as usual. While the initial Day One post op pain meds via drip, the morphine pump hangover was all clear before I came home, I am still drowsy and tired. Really, awfully tired. And, oh, yes, my back hurts. The surgery site hurts.

TLIF Surgery in Dubai. Day 1 after surgery

Day 1 after surgery is a blur.

Well, it's a tough one. I am writing this post retrospectively, because, as much as I would have tried, I could not have written a post. Day One post, was a blur, still is a blur, a painful blur.

MIS TLIF Surgery Dubai. The Day of the Operation

Today Wednesday the 25th of November 2015 is the day I had TLIF surgery for my spine. The surgery was done by Dr Shim and Dr Choi of the Wooridul spine clinic and was conducted at the Saudi German Hospital in Barsha.

The surgery was scheduled for 12:30 in the afternoon and we had to check in at 10:30 in the morning for preparations and pre op procedures. I dropped Rohan to school in the morning and came back home to get ready to go to hospital.

Till about half an hour before we got in the car I was still undecided whether how is going to have the surgery or not because I was afraid of all the negatives that I read on several forums and blog posts. So, for those of you who are considering surgery, the second thoughts, the fear of the unknown outcome does not really go away. Not until you have put together the final ounce of courage to walk into the Pre-Op prep room and get it done. Just a word of advice from someone who didn't have a clear head till the very morning of the surgery – don't let anyone else, not your family, not friends, and certainly NOT google throw you off. Deep inside you know when you really need it – and just go through with it. Easy does it.

One more point. If you are feeling really anxious, worried, fearful, whatever, and have access to a calming med of some sort (Ativan, Valium, whatever), that helps. It just takes the edge off. Clears the mind. Gives you a calm sense of purpose. 

I remember that what was important to us to get this fixed once and for all and I was going to do it and be brave rather than chicken out and not go for it. The last thing I had to say to Rohan Roy that I was going to have the surgery and he said yes. Go ahead and do it.

The first part of the surgery was getting through the process of anesthetics. Now because I have a somewhat restricted throat situation it did narrower than normal they had to go into my nose with a process called fiber optic nasal intubation. Apparently the process is a little bit more complicated than normal intubation to the throat so it was done by the head of department – the professor who actually is the top guy and Saudi German Hospital department. I must admit that he was fantastic. From the moment he said hi to me outside the OT to the time that I was wheeled in and actually under must have been about 5 minutes. I remember him saying hi and after that I told him that it was hurting a little bit when he tried to push the narrow fiber optic cable up my nose and while I was swirling the lidocaine paste around my mouth I actually passed out because they must have given me an anesthetic of some sort through my wrist while this whole intubation was going on. That's all I remember.

Honestly, that is all I remember.

Five hours later they wheeled me to my room (336) and hooked me up with a variety of IV pipes including a mild pain killer, and saline. I I also was hooked up to a PCA supply of morphine. This was meant to be Patient Activated but I barely really used it.

This post is not complete. I am going to fill in a lot more on this post...

This video is from my hospital bed: https://youtu.be/gCN4aiKG9sE

And here is what it looks like with the 'hardware' i place: The two titanium rods, the predicle scres, and the cages in between (cages is what replaces the degenerated disk)...

Wooridul Spine Clinic Dubai and the doctors

The doctors, the nurse, the clinic...

Chances are you may have already met at least one of the doctors, if you are considering getting work done with your spine (or your back) at Wooridul. As far as I know, the core team consists of three specialist Korean surgeons and the incredible Sunny – the Korean nurse, who is many things at one time: the nurse, the coordinator, the FAQ person, the one to call for reassurance, the angel.

Yoda. The zen guy from Star Wars. That's who one thinks of when you meet Dr Shim. Shim is a man of very few words, but those words are precious. Pretty much all zen, Shim is reassuring, confident, calm and poised. As a patient of his told me on the phone "If Shim says he'll fix it, he shall." Now that's a pretty big testimonial. And, I Amen that...

Dr. Chanshik Shim (I chose to call him Yoda)

MD, PhD
Consultant Neurological Surgery and Head of the Department of Spine Care 
(Wooridul Spine Centre)

• Consultant neurosurgeon with over 25 years of experience in South Korea and the UAE 
• Named Doctor of the Year at Wooridul Spine Hospital in Seoul, South Korea in 2006 and 2008 
• Has made presentations on spine surgeries at over 50 international conferences and symposia in Korea, Australia, Europe and the USA 

Professional Experience

• 1995: Began work as Staff Surgeon in the Department of Neurosurgery at Sungnam Central Hospital, Sungnam, South Korea 
• 1999: Began work as Staff Surgeon in the Department of Neurosurgery at Wooridul Spine Hospital, Seoul, South Korea 
• 2001: Began work as Director of Medical Affairs at Wooridul Spine Hospital, Seoul, South Korea 
• 2009: Became President of Wooridul International Hospitals, Seoul, South Korea 
• 2010: Began work as Medical Director, Wooridul Spine Centre, Dubai, UAE

__________________________________________________________________

Dr. Kiyoung Choi

MD
Specialist Neurological Surgery, Department of Spine Care (Wooridul Spine Centre)

Dr Patric Choi was the first doctor who was absolutely clear on what was wrong with me, and what needed to be done. He said it with precision and confidence, and he was reassuring about the results I could expect. Down the line, across all my appointments, Dr Choi inspired confidence and was just the right person who you wanted in that operation theater. Him, and of course, Dr Shim.

• Experience: 15 Years
• Languages Spoken: English,Korean
• International Experience: South Korea,UAE

Professional Summary

• Specializes in neurosurgery with clinical interests including minimally-invasive cervical, thoracic and lumbar spine procedures, endoscopic spine surgery, image-guided spine surgery and spinal deformities
• Prior experience in clinical care and hospital administration in South Korea
• Member of several American and Korean medical associations

Professional Experience

2005: Served as Director of Neurosurgery at Jeil Hospital, Gochang, South Korea 
2008: Served as Public Health Doctor at the Gochang Public Health Center, Gochang, South Korea 
2008: Served on staff of Wooridul Spine Hospital, Seoul, South Korea 
2009: Named Wooridul Spine Hospital Fellow of the Year

__________________________________________________________________

Also...

Dr. Jongdae Park

Met him once, for the pre-op consent meeting, and he was just so re-assuring, very thorough and calming... Even at the pre-op consent meeting, I was having second thoughts. You read so many negatives on blogs and forums out there that you begin to wonder, what if...

Dr Park patiently shared my MRI and x-rays on the screen with me, and showed me where the problem was, and how, there was no actual way to fix it without the procedure. When I asked him if I could opt for physiotherapy instead of having the surgery, Dr Park smiled a bit and said something quite funny (in retrospect)... "You have a building. You have a problem with the ground floor and first floor of that tall building (meaning, I guess my L4 and L5), and you want to paint it instead of fixing the building?". I signed the forms.

MD Specialist General Surgery, Department of Spine Care (Wooridul Spine Centre)

• Experience: 20 Years
• Languages Spoken: English,Korean
• International Experience: Bangladesh,Mongolia,Nepal,South Korea,UAE

Professional Summary 

• Specializes in general and vascular surgery with extensive experience in performing minimally-invasive anterior spinal surgery, which he also helped to invent
• Performed over 2,500 orthopedic surgeries at Wooridul Spine Hospital in Seoul, South Korea
• Recognized presenter at international orthopedic trade conferences

Professional Experience 
1995: Began rotations as Visiting Specialist at hospitals in Bangladesh, Nepal and Mongolia 
2003: Began tenure as Chief of the Department of General Surgery and Vascular Surgery at Wooridul Spine Hospital in Seoul, South Korea 
2008: Began work as Visiting Specialist in Vascular Surgery at Wooridul International Spine Hospital in Shanghai, China, where he also trained doctors 



And...

Sunny.

The Nurse, the angel, the guide, the friend of the family. Without whom...

First contact: (6 days pre-op)

Sunny the nurse called

Asked how I was doing, and if I had decided or not. She asked me to text her latest by Saturday morning if I am going ahead. She has also put me down for Dec 9th just in case. She wounded amazing.

She has seen my reports and told me that Physio, electrotherapy were non options because my case was advanced. She said it was important that I go ahead and get it done sooner than later. She also assured me that in most cases the doctors try and avoid surgery, so if other conventional therapies would have helped they would have said so without a doubt.

She also was aware of my concerns with Saudi German. She says she would be there for me, and, while yes, SGH were quite bad during Dr Lalonde (she remembers him), they have improved a lot. But she will be there as well as the doctors.

And she was there, immediately before the operation , after, the next day – making sure I was comfortable, making sure I was taking my first few tentative steps, that I had the right walking aid, the food was ok, everything. She was checking and changing my dressings, removing the drainage. She was just God sent.

But the most wonderful thing was her calm reassuring bedside manner. Not just with me, but with my family. Sunny was just what her name says: a bright ray of sunshine.

TLIF Surgery in Dubai. 6 Days to Go. Decision time... How do I cure back pain?

Thursday 19th November: 6 days to go

I held back today, and bought time for more online research and also to try and speak to a couple of Wooridul patients who had the same TLIF surgery. I was called in the morning by Wooridul, as requested, with two names and numbers…

Patient Ambassadors, they're called.

Female patient

Had surgery in May 2015: TLIF on L4/L5
She is in her 50s, and has had a spine surgery 35 years ago due to an accident.

The end result was totally satisfactory, but she has some residual pain, which she feels is because of her previous surgery which needed realignment done this time.

She had the surgery at Saudi German Hospital with Dr Patrick Choi, and Dr Shim. The attending specialist nurse was Sunny (who was fantastic). Sunny was around all the time and made all the difference “marvellous”. She said the Wooridul team were amazing.

The SGH staff were not really the best – the nurses were distant and almost uncaring. It made a difference having someone with her through the time, but her husband was at work so wasn’t there always.

She was in there for 2 nights and was released on the 3rd day after surgery in the morning on a Friday. The surgery itself for her was painful, and debilitating, but she was expecting that. Five months post-op she does have some nerve related pain and stiffness – simple tests become difficult, but your body learns to adapt and relearn. And anyways, her case is different because she had a similar open surgery many years ago and has always had back problems. She is clear: the surgery does not fix your back, it finds ways of managing the pain and making it better.

Immediately post op, it is uncomfortable and the effects of anesthesia are somewhat overpowering. You are given a PCA (Patient Controlled) painkiller which is morphine and she just did not take kindly to it – it made her nauseous. She relied instead on Voltaren muscular injections which is given on-demand. On release from hospital, you are only given Panadol, antibiotics and Nexium.

As soon as the bleeding stops, possibly on night two, post op, they literally “yank” the two pumps out. That IS painful, because their pipes are deep embeded and it hurts a lot pulling out. The team will want you walking down the hall from the very next day, and the nurse helps. You still have a catheter for peeing. Your release date really depends on when the bleeding stops, and the pumps are out.

Walking is difficult, and she suggested an SUV for pickup. The staff take you to the car in a wheelchair. You have to be really careful getting in and out. You HAVE to wear the brace provided.

She was told to wear the brace for 3 months, but it was uncomfortable, so she got a different one after 5 weeks and wore that instead. The brace is important.

You will need to go see Dr Shim after 10 days and he will start you on 15 sessions of Physio. The Physio team is trained in Korea and are very, very good.

At home, the first few days (and weeks) getting in and out of bed, you have to use the ‘log roll’ method. There is no other way, or you will cause pain and damage.

Overall, she highly recommends Wooridul – they were fantastic. Dr Shim is very quiet and hardly ever speaks, but he does exactly as he says, and their whole team is based on Precision and doing exactly what is needed and what’s right.

Male patient

Had surgery at SGH at age 71. Surgery took 5 ½ hours even though was supposed to be only 4.5 hrs but he is a big guy. Had same TLIF surgery in March 2015. He seems English.
Had tried injections and many other alternatives, and finally heard of Wooridul through a hospital inspector who said that they were THE BEST i spine surgeries, so he went there.

The surgery was done by Dr Shim and Dr Choi. He thought Dr Shim has excellent bedside manners once he opened up, and a good sense of humor.

He felt better from Day 1 and has never looked back. He had minimal pain and discomfort but all his back problems have just gone. He stayed for 3 nights. They pulled his two drains out and that made it quite comfortable and then they let him go home anyways. He was driven all the way to his daughter’s home near Abu Dhabi and had no problems.

He had an attack of gout, post op, but Dr Shim explained that was because his nerves were now beginning to feel again.

He is on a full regimen of exercises with a personal trainer, and his work requires a lot of walking every day, and he is absolutely pain free. He can bend, lift etc no problems.

He wore the brace for 3 months and did not have a problem. Adjusted to it and got used to it and feels it actually helped him.

He said the Doctors, and particularly the nurse Sunny was fantastic. The SGH team were ‘poor’ and uncaring and almost unprofessional. It did help having his wife and daughter around.

The Physio sessions were amazing (trained in Korea) and it really helped his rehab. Overall, his recovery from the pain and discomfort was quick and the surgery very successful. He says if Dr Shim says he will fix you, he will do so, no questions. They are the best.

He has no pain now, no regrets and says in conclusion “The Koreans are miracle workers”.

Terrence requested that I call him and update him on “how well my op went”. He has cats.


Sunny the nurse called...

Asked how I was doing, and if I had decided or not. She asked me to text her latest by Saturday morning if I am going ahead. She has also put me down for Dec 9th just in case. She wounded amazing.

She has seen my reports and told me that Physio, electrotherapy were non options because my case was advanced. She said it was important that I go ahead and get it done sooner than later. She also assured me that in most cases the doctors try and avoid surgery, so if other conventional therapies would have helped they would have said so without a doubt.

She also was aware of my concerns with Saudi German. She says she would be there for me, and, while yes, SGH were quite bad during Dr Lalonde (she remembers him), they have improved a lot. But she will be there as well as the doctors.

Fadi Salameh texted
after speaking to his Paris doctor again, who agreed that TLIF was the way to go. He also said to ask if I really needed the ‘cage’ put in...

Surgery or not? The Back Pain resolution

After a lot of backing and forthing, I went in to see Dr Choi at Wooridul Spine Clinic.

This was after trying ayurveda locally (just one session and 1 week meds), looking at non surgery options, and saying, to myself and others, I will not go for surgery.

I went to see Dr Choi mainly to give him an excuse not to have the surgery (and I did keep it open until tomorrow using a "no one to look after me now, so I will have it either on Dec 9th or during Spring Break".

He was really good. Took time to answer every question I had, and was very clear rather than beating around the bush.

Here is what I asked and what I heard:

THE BACK AND FORTH
So, I literally tried osteopaths, chiropractors (including Atlas methods), other surgeons, ortho surgeons last year  (Dr Ashraf Konchwalla at Saudi German), Physio (10 sessions at Saudi German prescrivbed by Dr Knonchwalla). Nothing worked.


THE SURGERY
It will be a MIS TILF. Minimailly Invasive Sugery: transforaminal lumbar interbody fusion

The choice is TLIF and not just laminectomy or disectomy is because once you remove the discs, ths lippage of the vertebrae (spondilosthesis in L4/L5) becomes even more pronounced and will cause even further vertebral slippage as there is no disc to support it. So, fusion is absolutely inevitable to strengthen and stabilize.

The slipped vertebra (spondilosthesis) and bulging disc are causing "Compressed Nerve Root" – which is the source of all pain down the butt, thighs, legs

The surgery because it involves three steps will take about 4+ hours
– mend the stenosis by removing bulged disc
– remove (carve out) and replace discs with PEEK material
– fix spondylosthesis by then inserting cage betwen vertebrae and putting rods and screws to connect and fuse the vertebrae

There are TWO draining tubes put in which are drained by staff, and removed end of Day 2. This is removed via the staples/stitches and is usually very painful,

A catheter is put in to drain urine/fluids. Removed end of Day 2. This is just removed and is usually very painful.

I need a TLIF surgery for my chronic back pain

Wooridul Spine Clinic Dubai and Dr Shim

Minimally Invasive Transforaminal Lumbar Interbody Fusion Using a Single Interbody Cage and a Tubular Retraction System

November 10th 2015
Met Dr Shim at Wooridul. He is the Head of the Clinic. He was in agreement that I needed a TLIF and said very little – but guaranteed that I "would be fixed".

The surgery is called MIS TLIF surgery or Minimally Invasive Transforaminal Lumbar Interbody Fusion Using a Single Interbody Cage and a Tubular Retraction System.

He actually laughed when I mentioned Failed Back Surgery Syndrome, saying that yes, that exists. mostly due to doctors who didn’t really have the experience or expertise.

Here is a great video which explains https://youtu.be/hO-sbVraM2I

Wooridul Spine Center in Dubai. Back pain solutions?

Dr Choi at Wooridul Spine Center, Dubai. Suggests MIS TLIF.

November 5th 2015

Met Dr Patrick Choi at Wooridul. Wooridul Spine Center was recommended by Dr Ron Lalonde, Principal of Middle School at ASD (American School of Dubai), who had his neck fixed by Dr Shim and Dr Park.

Dr Choi looked at my MRI, did some physical examinations of me, and said that surgery was really the only way to go, and explained that I would need to have a MIS - TLIF surgery done sooner than later. I could try Physio etc but he felt it would NOT really help long term.