Quick update: I know I haven't posted in a few days - I have a good excuse. I had surgery last Friday

I know, back surgery is a last resort. This was.

For the last three months, I’ve lived my own N of 1 medical experiment.

I’m still waiting on the final results.

If you’ve read PANDEMIA you know I’ve had a bad back for a long time. For the last 20 years it has gone out every once in a while, with pain ranging from bad to worse. Like crawling on all fours worse. (I try to keep the crawling to a minimum. No adult should ever be caught crawling, unless there’s an infant nearby.)

Some of you have tried to help me by suggesting exercises and books to read. I usually ignore them. I know, I’m an idiot. But I’d rather just forget the pain and move forward - and besides, I’ve always gotten better within a few days.

Until now.

My back went out Sun., Nov. 12. The night before I knew something was wrong. I’m still not sure exactly what happened, but suddenly I was limping down the street, barely able to walk. Not just because of the pain. I couldn’t raise my left foot.

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(Baby needs a new pair of (orthopedic) shoes! Help me out…)

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The pain got worse as the week went on, and I decided I’d better see a doctor. I called the local health-care oligopoly, which got me in within a couple of days. (This is not a story about how bad the American health-care system is, with two minor exceptions that probably didn’t matter much.)

The sawbones told me to raise my leg. I did. He pushed down on it and I pushed back. Then he told me to flex my foot. Nope. He pushed gently on it and down it went. You need an MRI, he said. As soon as possible.

Meantime, he outlined my options: wait and try oral prednisone as an anti-inflammatory, get a cortisone shot, or surgery. He wouldn’t be administering the cortisone shot or cutting me open. Thus he was a relatively neutral observer. He suggested the prednisone and scheduling a cortisone shot if that didn’t work, as well as physical therapy. I scheduled the MRI and the therapy and made an appointment with a pain medicine doctor.

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Back surgery, as most people know, has a terrible reputation. In a landmark randomized controlled study from 2007 on people with severe sciatic pain, people who did not have surgery and had essentially the same recovery rate after a year as those who did.

I didn’t want to rush into surgery. You may have noticed that I have a slight suspicion of the American medical establishment and its financial incentives. Plus, in 2006, during my very first episode of really terrible back pain, I’d had a foot drop. It had resolved on its own within a couple of weeks. This one would too.

So I hoped.

I took the prednisone; it didn’t do anything. I got the MRI, which came back more or less as expected, showed a nasty herniated disk at the L4-L5 root. By the beginning of December my pain was diminishing quickly but my foot was still useless.

The pain medicine doctor offered me a cortisone shot, which I scheduled (but ultimately skipped, since I wasn’t in pain). He also sent me down the hall to the orthopedist’s office. Again, they got me in quickly, in a matter of days. The orthopedist, who seemed like good and honest, took a look and said surgery would definitely be warranted if I did not recover. I should see him again in early January, roughly four weeks out.

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(Not me, not my doctor)

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Here’s where I made my mistake.

I didn’t want to have surgery - or read any of the papers about back surgery. I wanted to trust that I would get better on my own, as I had before.

Back surgery for pain is often a mistake. But back surgery for foot drop is basically a requirement. And several papers suggest that the surgery is best carried out as soon as possible - within weeks, not months. That’s especially true for people who have nearly complete weakness, as I did.

I didn’t know this in December, as I went to physical therapy a bunch, with no effect.

Then, unfortunately, I lost a little time in early January because my wife’s former employer switched health insurers and the company that managed our Cobra payments failed to transfer us to the new insurer (this wouldn’t be a story about American healthcare without some insurance headache).

So I had to reschedule my early January appointment with the orthopedist. Still, I got in a week later. By now it was over a month since I’d seen him, almost exactly two months since the Day My Foot Died (TM).

He pushed down on my foot again and shook his head. I thought you’d get better, he said.

Me too, I said.

You need another MRI, he said, and if that shows the same herniation you need a microdiscectomy.

(Per the Hospital for Special Surgery: Microdiscectomy is a surgical procedure for the relief of pain and other symptoms that occur when a herniated disc in the spine presses on an adjacent nerve root. During the operation, the surgeon frees the nerve by removing small fragments of disc, bone and ligament.)

Are you sure?

I’d do it if it was me. It can’t hurt, it can only help.

Then I lost a little time more when Cigna, our brand-spanking new health insurance company, declined the second MRI, on the grounds that I’d already had one. They reversed the decision when the orthopedist told them what they should have known already, that the scan was their best and only chance to avoid paying for surgery.

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(Health insurance: $30,000 a year! Back surgery: priceless.)

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In the event I got the second MRI in late January. It showed the same herniated disk pushing on the same nerve root. We scheduled the surgery for Feb. 19, then moved it to Feb. 16. It was then that I started reading about surgery for painless foot drops - and realizing the surgery was most successful if it was carried out in the first four weeks, sometimes the first two.

Alas, that window had now closed. Firmly.

To be clear, randomized controlled trials for surgery are very hard to organize, and nearly impossible for relatively rare conditions like this one. So these papers are based on retrospective data. In other words, surgeons look at people they have treated and then stratify rates of recovery by different variables.

And the retrospective data for this kind of surgery come with an obvious problem: a person who chooses to delay surgery and gets better on his own will never have the surgery at all. The papers essentially compare people who had early surgery (and might have recovered on their own without it) with people who failed to recover on their own after several weeks and were forced into surgery.

That said, early surgery seems to help.

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Oh, the irony.

If I had been a pushier patient or had a more aggressive doctor - the kind who gives surgeons a bad name - I might have had better odds.

I don’t blame the orthopedist for not being more aggressive, though. I didn’t even see him until early December, and I was pretty clear that I didn’t want to get cut open if I could avoid doing so. Back surgeries require general anesthesia, and in my view general anesthesia is best avoided. I know, the numbers say it’s very safe, but I’d still rather handle my own breathing whenever possible. (And they put you under so fast you don’t even get to be high for a minute or two before they get to work.)

Plus I had recovered once before on my own.

Still, the last three months are a classic example of why medicine is an art, not a science. I made a decision with incomplete information, but even complete information wouldn’t have necessarily given me the right answer. I got what I wanted, the chance to heal on my own, but the choice came with a cost, even if no one knows how high it might be (or if I will have to pay it - maybe I’ll make a full recovery after all).

I suppose in retrospect I wish I had had the surgery in January, not February. had Cigna not been in the way, I probably would have. Even so I would have been on the wrong side of the four- or six-week window that shows the best outcomes. The plain truth is that no one knows exactly how long a nerve can stay under siege before it gives out, or why some people recover and others do not.

In any case, I went under the knife last Friday. Everyone was friendly and nice. I arrived at 5:45 a.m. and was out before noon. I have a slight itch in my back to remind me where the good doctor cut me open, but no real pain. That’s the good news. (Yes, I’m even strong enough to write! Hallelujah!)

The bad news is that at least for now, the surgery has made no measurable difference to my foot. Of course, it might tomorrow or next week or even next month.

At this point, truly, there is nothing to do but wait.

Wish me luck.