As a spine surgeon I would say you did the right thing having a decompression surgery despite the lateness of the surgery, it can still be effective but it may take up a year for the L5 nerve root to come back. If you still have some muscle on the anterior tibialis that's a very good sign for recovery. For now the best course is to be patient and to continue to keep the range of motion of the ankle intact.
Out of curiosity, how 'major' is decompression surgery of this type compared with other disc surgeries? I hear about back surgeries such as what Steve Kerr went through (for pain, not foot drop) and get cold sweats thinking about it.
Maybe not. That L5 nerve it is really capricious and I've seen it go out just with the simplest pressure during the surgery. It also goes out more frequently like it's happened to alex. He's not bullheaded he's just reasonable and a little afraid of any surgery just like all of us are. I think it's going to work out it's just going to take some time.
Best of luck my friend. Here’s a tip from a surgeon who has had 2 microdiscectomies of his own: if you can afford to do so, don’t let insurance dictate your healthcare decisions, especially the important ones. You earn money for a host of reasons, but preserving your health should be right there at the top. In the grand scheme of things, having to pay $1,500 out of pocket for an MRI because of declined coverage or coverage that is not yet active is foolish if you have foot drop or something else that’s very time-critical. I would spend everything I have to properly diagnose and treat foot drop ASAP. You don’t get a second chance in life at walking. Here’s a second tip: if you’re financially strapped and have an important medical need, talk to your doctor about your predicament. There is nobody I would ever deny care to who is facing serious consequences without surgery. This is the reason I do this for a living - to help people and make a serious difference in their life. The money really is secondary. The profession has been better to me than I deserve in this regard. Imaging centers and doctors like myself will often work with you. There are lots of doctors out there like me who will come in at night or over the weekend or do whatever it is you need for free. In our line of work, we have been blessed beyond belief. The best joy I can have is sharing that blessing with someone in need. So, don’t harm yourself for financial reasons, but instead, look for one of us who really is using our abilities to help others whether we get paid or not.
Prayers and best wishes. My wife has had a bad back for years - primarily muscular and arthritis, and surgery would not help that. But some years back she developed what sounds like the same problem and had surgery which really helped (I don't recall the timeline). When it's pressing on the nerve root you have to do something.
The bad news is that her neurosurgeon, who was really top notch, had to move out of town (something about a scandal with the nurses - but I digress).
TRUMP 2024 Last chance to save what's left of America.
I don’t want to reread the article but didn't you indicated that you didn’t know that "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”. Why should you have known that fact? Shouldn’t that have been a fact the doctor informed you about? I’m not a fan of the US healthcare system.
Surgeons have become very circumspect in recommending surgery, largely due to our legal system. In some jurisdictions, as a surgeon you are guaranteed to be sued for any less than perfect outcome, and just for good measure in surgeries that went well! Since a competent surgeon can expect complications or a post op infection in about 0.5% of cases, then a busy practitioner can expect to be sued at least once a yr. If you wonder why my fees areso hi, realize that I once had to pay ~$100,000/ yr for insurance.. & had never been sued. So, Irrespective of the science saying early sirgery works best in this case. In a high malpractice risk area like NYC, most of California, Miami... I want you to insist on surgery..
Totally agree....but on the flip side, if the doctor doesn't say "there is a possibility that if you don't do surgery immediately, you could have permanent foot drop", then a patient can sue for NOT doing surgery. You are damned if you do and damned if you don't (family physician here - not an orthopedic surgeon). And all of our malpractice rates have doubled within the last 3 - 5 years, even without being sued. You can blame the multiple "mega-verdicts" (over $100 million) over the last 1 - 2 years (as well as other causes). The insurances have to cover their losses somehow, so we all pay the price. And we can't pass that along to the "customer" like a restaurant or other business can. People have no idea how bad access to healthcare is going to get over the next few years. It's bad now. It's going to get worse.
Plus,IF as a physician you are unfortunate enought to work for a lsrge institution or university,then you havensg admin & mba's young enough to be your children telling you how to practice medicine, based upon what tge inscos & medicare are paying... With EMR, they track everything you do, say or prescribe
As time will tell, IMHO, the misplaced financial incentives during the C19 times resulted in the deaths of at least thousands, especially among the elderly
I'm still in private practice (I have a rather focused practice, but it is still all insco and Medicare reimbursed - and it's just me in the office so I am my own "boss" after answering to said insco and Medicare). My thoughts on how C19 wiped out anything "good" that was still left in medicine would take me an hour to write out.
The way I read the article he did not have any idea about the difference in surgery regarding a drop foot. How, exactly, was he supposed to know to ask about it? A good doctor would have made him aware of the situation and educated him on the various aspects of surgery.
Simple matter of describing to us what happened, at the time it happened, and there would have been some of us saying "you need to immediately get an MRI for the drop-foot symptom, and, you can pay cash for the MRI for about $150 and not be on a waiting list to get the MRI; and, you need to back to a neuro doc with the MRI results to discuss the need for emergency surgery." Very simple if communication had occurred with this group right away.
So you are saying he should ask his Substack followers for medical advice about a very serious situation instead of his doctors? Hummm? I’ll have to think about that for a while. Yeh. I thought for about 5 seconds. Bad idea.
BTW, I blew out the same disc in 2008, tried to race a triathlon ( that was stupid, right) flew back to the USA, got an MRI the next day, had surgery that evening.. I drank my own coolaide the time from injury to surgery was 3 weeks.. I recovered in about a week post op
Thank you for sharing the details of your experience. It can be very helpful to many others going through similar situations to know what to look for. You have a powerful reach and tons of caring fans. Be well.
Hang in there. You're a good man, doing God's work. Apparently, you're the only man doing God's work in the arena you're participating in, but not to digress. You'll get your foot back.
L5-S1 for me. Like you, I avoided and avoided and went through hell for a solid year right before I succumbed. I found a good neurosurgeon (after interviewing several). He operated on me for close to three hours and did a fusion. Didn't have any improvement until about six months later. It takes time. Hang in there, Alex, and good luck!
You are in my prayers, Alex. For healing, for good medical care and most of all, for peace of mind. I don't honestly know if you believe in prayer, but that doesn't matter. What matters is God believes in prayer.
I've had lower back surgery. Similar to yours. Your nerve to your foot will get better. It just takes a LOOOOONG time! (It took me several months). Good luck.
Best of luck. Back surgery is no joke and should be entered into with full knowledge of risks, benefits and alternative treatments offered. You did that. Even though results could be better (but not all the time) if a patient agrees early, a patient’s mindset is also worthy of thoughtful contemplation. “When you’re ready, you’ll know” is not necessarily a bad way to look at things. Take the time, do the therapy, ice is your friend, it takes a full year for nerve regeneration. It’s a marathon, not a sprint. Or at least in your case, at least you’re off the floor. Regards.
Best of the very best Luck , Alex! I went through this with a missed diagnosis of a slow rupturing appendix ( which can happen almost symptomless in older people.) You have to be your own advocate. And at no time should anyone ever nod their head in agreement like a bobble doll if you don’t understand or agree with what you’re hearing !!
I know it’s not the same. But, I suffered from severe facial pain for years. It was misdiagnosed, undiagnosed, mistreated and untreated. I took a lot of pain medication. Finally, in 2018 I found an oral surgeon, who had been a general surgeon, who correctly diagnosed Maxillary Osteomyelitis in the upper right quadrant (infected bone plus significant nerve damage from the multi year infection). It took two surgeries to remove all the infected bone, some bone grafts, 8 weeks on a PIC line and 6 months of oral antibiotics before all traces of the infection too were gone. But 80% of the pain remained, all from damaged nerves. There was no improvement for 24 months. But then I began to notice that I was having a few better hours on some days. And then better days. And then weeks. 6 years later the pain is only 10% of what it used to be and only occurs 3-4 days a month.
Prior to surgery the doctor told me there was no guarantee the pain would ever get better. But if it did, he said, it would happen very slowly and could take as long as 10 years for the nerves to calm down and then fully regenerate.
Alex, luck BIG TIME. We need you healthy, happy and fully functioning.
Yes! And good advice re general anesthesia. Best to avoid it if at all possible, but if you need it, you need it.
As a spine surgeon I would say you did the right thing having a decompression surgery despite the lateness of the surgery, it can still be effective but it may take up a year for the L5 nerve root to come back. If you still have some muscle on the anterior tibialis that's a very good sign for recovery. For now the best course is to be patient and to continue to keep the range of motion of the ankle intact.
Out of curiosity, how 'major' is decompression surgery of this type compared with other disc surgeries? I hear about back surgeries such as what Steve Kerr went through (for pain, not foot drop) and get cold sweats thinking about it.
He wouldn't have lost a year to recover if he had the surgery immediately after the first MRI. Bullheaded.
Maybe not. That L5 nerve it is really capricious and I've seen it go out just with the simplest pressure during the surgery. It also goes out more frequently like it's happened to alex. He's not bullheaded he's just reasonable and a little afraid of any surgery just like all of us are. I think it's going to work out it's just going to take some time.
Oh. you seem like the kind of doctor we all need.
Praying for your recovery!
Best of luck my friend. Here’s a tip from a surgeon who has had 2 microdiscectomies of his own: if you can afford to do so, don’t let insurance dictate your healthcare decisions, especially the important ones. You earn money for a host of reasons, but preserving your health should be right there at the top. In the grand scheme of things, having to pay $1,500 out of pocket for an MRI because of declined coverage or coverage that is not yet active is foolish if you have foot drop or something else that’s very time-critical. I would spend everything I have to properly diagnose and treat foot drop ASAP. You don’t get a second chance in life at walking. Here’s a second tip: if you’re financially strapped and have an important medical need, talk to your doctor about your predicament. There is nobody I would ever deny care to who is facing serious consequences without surgery. This is the reason I do this for a living - to help people and make a serious difference in their life. The money really is secondary. The profession has been better to me than I deserve in this regard. Imaging centers and doctors like myself will often work with you. There are lots of doctors out there like me who will come in at night or over the weekend or do whatever it is you need for free. In our line of work, we have been blessed beyond belief. The best joy I can have is sharing that blessing with someone in need. So, don’t harm yourself for financial reasons, but instead, look for one of us who really is using our abilities to help others whether we get paid or not.
suddenly, where are all these great, caring, doctors coming from? Love this. Love what you said!
Prayers and best wishes. My wife has had a bad back for years - primarily muscular and arthritis, and surgery would not help that. But some years back she developed what sounds like the same problem and had surgery which really helped (I don't recall the timeline). When it's pressing on the nerve root you have to do something.
The bad news is that her neurosurgeon, who was really top notch, had to move out of town (something about a scandal with the nurses - but I digress).
TRUMP 2024 Last chance to save what's left of America.
Alex, the damage to your nerve root will take weeks to months to heal. Keep going with PT and optimism. I am praying for your full recovery.
I don’t want to reread the article but didn't you indicated that you didn’t know that "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”. Why should you have known that fact? Shouldn’t that have been a fact the doctor informed you about? I’m not a fan of the US healthcare system.
Surgeons have become very circumspect in recommending surgery, largely due to our legal system. In some jurisdictions, as a surgeon you are guaranteed to be sued for any less than perfect outcome, and just for good measure in surgeries that went well! Since a competent surgeon can expect complications or a post op infection in about 0.5% of cases, then a busy practitioner can expect to be sued at least once a yr. If you wonder why my fees areso hi, realize that I once had to pay ~$100,000/ yr for insurance.. & had never been sued. So, Irrespective of the science saying early sirgery works best in this case. In a high malpractice risk area like NYC, most of California, Miami... I want you to insist on surgery..
Totally agree....but on the flip side, if the doctor doesn't say "there is a possibility that if you don't do surgery immediately, you could have permanent foot drop", then a patient can sue for NOT doing surgery. You are damned if you do and damned if you don't (family physician here - not an orthopedic surgeon). And all of our malpractice rates have doubled within the last 3 - 5 years, even without being sued. You can blame the multiple "mega-verdicts" (over $100 million) over the last 1 - 2 years (as well as other causes). The insurances have to cover their losses somehow, so we all pay the price. And we can't pass that along to the "customer" like a restaurant or other business can. People have no idea how bad access to healthcare is going to get over the next few years. It's bad now. It's going to get worse.
Plus,IF as a physician you are unfortunate enought to work for a lsrge institution or university,then you havensg admin & mba's young enough to be your children telling you how to practice medicine, based upon what tge inscos & medicare are paying... With EMR, they track everything you do, say or prescribe
As time will tell, IMHO, the misplaced financial incentives during the C19 times resulted in the deaths of at least thousands, especially among the elderly
I'm still in private practice (I have a rather focused practice, but it is still all insco and Medicare reimbursed - and it's just me in the office so I am my own "boss" after answering to said insco and Medicare). My thoughts on how C19 wiped out anything "good" that was still left in medicine would take me an hour to write out.
bless you. Hope to read that someday, with a calming beverage in hand
He could have asked us about it, then he would have found out immediately. Good grief!
Aren’t you a ray of sunshine.
Only because I actually care about him. I had an uncle who was similarly bullheaded about health issues, and he died of an early unnecessary death.
Happily this condition does not sound fatal😊
The way I read the article he did not have any idea about the difference in surgery regarding a drop foot. How, exactly, was he supposed to know to ask about it? A good doctor would have made him aware of the situation and educated him on the various aspects of surgery.
Simple matter of describing to us what happened, at the time it happened, and there would have been some of us saying "you need to immediately get an MRI for the drop-foot symptom, and, you can pay cash for the MRI for about $150 and not be on a waiting list to get the MRI; and, you need to back to a neuro doc with the MRI results to discuss the need for emergency surgery." Very simple if communication had occurred with this group right away.
So you are saying he should ask his Substack followers for medical advice about a very serious situation instead of his doctors? Hummm? I’ll have to think about that for a while. Yeh. I thought for about 5 seconds. Bad idea.
Cognition is clearly an issue for you. So is gaslighting.
BTW, I blew out the same disc in 2008, tried to race a triathlon ( that was stupid, right) flew back to the USA, got an MRI the next day, had surgery that evening.. I drank my own coolaide the time from injury to surgery was 3 weeks.. I recovered in about a week post op
Thank you for sharing the details of your experience. It can be very helpful to many others going through similar situations to know what to look for. You have a powerful reach and tons of caring fans. Be well.
One thing I LOVE about you ……you are so real. You are just like the rest of us. Thanks for sharing your story. Sending healing hugs
Hang in there. You're a good man, doing God's work. Apparently, you're the only man doing God's work in the arena you're participating in, but not to digress. You'll get your foot back.
L5-S1 for me. Like you, I avoided and avoided and went through hell for a solid year right before I succumbed. I found a good neurosurgeon (after interviewing several). He operated on me for close to three hours and did a fusion. Didn't have any improvement until about six months later. It takes time. Hang in there, Alex, and good luck!
You are in my prayers, Alex. For healing, for good medical care and most of all, for peace of mind. I don't honestly know if you believe in prayer, but that doesn't matter. What matters is God believes in prayer.
I've had lower back surgery. Similar to yours. Your nerve to your foot will get better. It just takes a LOOOOONG time! (It took me several months). Good luck.
Best of luck. Back surgery is no joke and should be entered into with full knowledge of risks, benefits and alternative treatments offered. You did that. Even though results could be better (but not all the time) if a patient agrees early, a patient’s mindset is also worthy of thoughtful contemplation. “When you’re ready, you’ll know” is not necessarily a bad way to look at things. Take the time, do the therapy, ice is your friend, it takes a full year for nerve regeneration. It’s a marathon, not a sprint. Or at least in your case, at least you’re off the floor. Regards.
Tiger Balm Patches
Best of the very best Luck , Alex! I went through this with a missed diagnosis of a slow rupturing appendix ( which can happen almost symptomless in older people.) You have to be your own advocate. And at no time should anyone ever nod their head in agreement like a bobble doll if you don’t understand or agree with what you’re hearing !!
I know it’s not the same. But, I suffered from severe facial pain for years. It was misdiagnosed, undiagnosed, mistreated and untreated. I took a lot of pain medication. Finally, in 2018 I found an oral surgeon, who had been a general surgeon, who correctly diagnosed Maxillary Osteomyelitis in the upper right quadrant (infected bone plus significant nerve damage from the multi year infection). It took two surgeries to remove all the infected bone, some bone grafts, 8 weeks on a PIC line and 6 months of oral antibiotics before all traces of the infection too were gone. But 80% of the pain remained, all from damaged nerves. There was no improvement for 24 months. But then I began to notice that I was having a few better hours on some days. And then better days. And then weeks. 6 years later the pain is only 10% of what it used to be and only occurs 3-4 days a month.
Prior to surgery the doctor told me there was no guarantee the pain would ever get better. But if it did, he said, it would happen very slowly and could take as long as 10 years for the nerves to calm down and then fully regenerate.
Have hope.