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Cutting A Long Story Longer...

The (Sad) Story Of The (original) Webmaster's Unintended Leave Of Absence

We have all suffered from lower back pain at some time in our lives but when it gets the point when it totally incapacitates one, then drastic action has to be taken and normally your local GP is the first port of call.

Background
I have suffered from recurring back pain for years in varying degrees and it could probably all be traced back to a car accident I was involved in at the tender age of 16 while still a scholar in Port Elizabeth. One rainy evening back then, while travelling with three friends along a lonely coastal road on the way back home, the left rear wheel of the car burst causing the car to veer off the tar and onto the gravel. The driver, in trying to control the car, turned the wheel back towards the road and the left front wheel gave way. We must have been doing a fair speed as the car rolled eight times sideways down the road over a distance of over 40 metres. My partner in the back seat was thrown from the car through the door on the initial flip but I remained "suspended" in what seemed like mid-air in the back of the car for the full duration of the rolling; a sensation I will never forget nor the accompanying sounds of buckling and tearing metal that goes with it! On loosing momentum after the eighth roll, the car landed back on its wheels and violently spun round to face back the way from which we had been travelling. At this point I was thrown out through the back window (or what was left of it anyway), landed squarely on my back on the road and literally 'bounced' into the bushes over the embankment on the opposite side of the roadway. How no one was killed was a miracle. Besides for landing on my back, all I had to show for the horrific experience was a small glass cut on my left hand that didn't even require stitching.

I was off school for a time with an extremely sore back in the lumber (lower), thoracic (middle) and cervical (neck) areas. At the time, I was told that the muscles supporting the spinal column had (obviously) taken a pounding and that there was movement of the inter-vertebral discs causing nerves to be pinched. It was many years after this that the first recurrence of back pain occurred again, during my time onboard ship while in uniform in the South African Navy - luckily we were in dry dock at the time. Once I took up a career in IT after leaving the service, things were quiet again for many a year although now, in hindsight, I was busy weakening my back all the time - a problem faced by all people who spend many hours a day working in a seated position, as the majority of us never sit correctly or get the correct back support from our office chairs. We also do not take the regular breaks from what we are doing to stand up and take a short walk or just stretch the body out. Not picking up heavy weights correctly by using the legs and knees and not bending at the waist is another main culprit for causing damage to the back, especially in the lumbar region. Bear in mind that this lower section of the back supports all the weight of the upper body as well.

Over the last ten years, my lower back problems had become increasingly regular causing a lot of pain and discomfort at the time and almost always requiring a period of bed rest with full immobility. A fall down an outside staircase in rainy weather about five years ago did nothing to improve my condition either - in that instance my feet went out from under me on the wet stairs and I landed squarely on my coccyx eight steps further down. Needless to say I couldn't get upright again thereafter, was rushed for x-rays and bed rest was indicated once again. Last year, my back 'went out' once again and, being without a medical aid, took a full eight months of pain and discomfort to come right during which time life and work had to continue for me.

The First Warning Sign
On Sunday August 11, I had been sitting on the couch at home watching TV with the girls and, on standing up, felt a sharp, distinctive twinge in my lower back once again - the unwanted yet usual warning sign. It seemed fairly innocuous at the time and it was off to work as usual on the Monday with just a slight ache in the lower back. As the week progressed, the pain remained but started to worsen, albeit slowly, but to a point where sitting and getting up and down was becoming progressively more painful. Eventually, it got to a point where I could not sit at my desk at the office for longer than ten to fifteen minutes at a time and getting into and out of the car was a mission, not to mention the driving - the pain was going down my left leg and this is the one used all the time for the clutch. I resorted once again to bed rest, a problem in itself for me as I am a sub-contractor and the simple fact of "no work - no pay" applies mercilessly. On the second day off work, the pain was just increasing and mobility was becoming ever restricted. I dragged myself off to the GP for the customary shot of Voltaren (an anti-inflammatory) and then back to the prone position on the bed at home. The injection works well but can also only do so much - its time span of affectivity being limited. By this time, I could not sit nor stand for any period longer then a minute and this in extreme pain. Lying flat on my back was the only way to go but even this was hell. I had what felt like a red-hot coal in my left gluteal muscle, a burning pain all the way down the back of my left leg culminating in a second 'red-hot coal' burning sensation in the outside of my left ankle. On Tuesday 20 August, my fiancé arrived home from work to find me literally crawling around the bed in agony with no position that I could find giving any relief from the pain. There followed some frantic phone calls to a friend of ours who works for the Professor Of Orthopaedics at the Medical Faculty of the University of Stellenbosch at Tygerberg Hospital. She came back with the advice - "Get him to the trauma section of the hospital without delay". And there started my three weeks of what, at times, could easily be described simply as "hell".

Admission
The journey to the hospital seemed to go on forever and, lying semi-reclined on a flattened front seat with a pillow for support under my lower back, I realised just what a bad condition some of the Cape Town roads are in! I arrived at the entrance to the Tygerberg Trauma Unit at 9pm that evening with bags packed. A metal gurney was brought out and I managed to get myself up onto it and into a position flat on my back. "Tuesday night", I thought to myself, "at least its not the weekend so the unit should be relatively quiet". It was in reality, but "being quiet" bears no real relation to how long one is going to wait before all the formalities are completed and one is attended to. All I wanted to start with was something to ease the pain. Dream on Mike… At 11:30pm I was eventually sent for x-rays along with a young gunshot victim. The only available duty doctor was in theatre and the houseman saw me initially - not too much help there except to tell us that I needed to see the duty doctor once he was out of theatre. All appeals for something to be administered for the pain fell on deaf ears - "not before the duty doctor has seen you" was the stock reply from all quarters. Eventually more phone calls were made by my fiancé to our friend at 2am on the Wednesday morning while I was still lying in excruciating agony on my hard metal gurney in a holding room in the Trauma Unit. At 4am, an efficient looking doctor walked in still kitted out in full theatre rig and commenced examining me in detail. Later I would discover that the duty doctor was in fact the main orthopaedic surgeon so I can be thankful that a doctor with a sound knowledge of backs was seeing to me first up. A thorough examination along with question and answer session and neural reflex testing etc. etc. was conducted and the diagnosis was simple - a chronically pinched nerve somewhere in the lower back (in fact he ventured an upfront "guestimation" of the L1, L2 and L3 vertebra at the time and he was subsequently proved correct - a recurring testimny to the excellent quality of the main departmental doctors at Tygerberg Hospital). I was to be admitted and further tests would be carried out. At nearly 5am in the morning with my wonderful fiancé ever present at my side throughout, I was injected with a painkiller - eight hours after coming through the front door. Pethidine, a schedule six narcotic analgesic drug, was injected into my arm. "Now what?" I thought at the time, "the pain is still killing me". Well! Approximately a minute later, the roof lights started revolving, the room spun and I felt nothing. With me slipping into a narcotic "feel no pain" world, my fiancé decided to take her leave of me and proceeded directly to her office down the road in Plattekloof Ridge, without having slept a wink all night - she was amazing - just being with me, fighting on my behalf with the powers that be and putting up with my pain and moans. An hour later, at 6am, I was wheeled to the Orthopaedic Ward and transferred into a slightly softer hospital bed.

The First Week
The same doctor (second in charge of the Orthopaedic Section after the Professor) came to see me at 9am during rounds - guess he never slept a wink either having to put assault and car accident victims together every other minute of the day. He explained that the next step was to have an MRI (Magnetic Resonance Imaging) of my lower back to determine exactly where the problem was. I was duly booked for one at the Radiology Department by the accompanying ward sister. I was permanently put onto Pethidine injections (intra-muscularly in the arm) every six hours, oral painkillers every four hours, Voltaren injections (intra-muscularly in the rear) every twelve hours and the added benefit of 10mg of Valium at night before sleep time to relax the muscles and body and to encourage sleep - this together with the Pethidine at that time. I soon learnt as well that once a person is on Pethidine for approximately six days, one becomes addicted to it. With the pain "sort-of" under control, I settled into the hospital routine awaiting my visit to radiology. Woken at 5am with a cup of coffee. Change of day-night staff at 7am. Enquire whether bathing equipment was required at 8am. Breakfast at 9am that consistently comprised of a bowl of lukewarm to cold porridge and two slices of brown bread with margarine and apricot jam. Doctor's rounds any time from 9:30am (if they came). Luncheon at midday that always comprised of a bowl of lukewarm to cold soup of the day, a plate of lukewarm to cold food of the day (total mass of about 3 tablespoons maximum but normally closer to 2) and, most days, a 5cm square block of jelly drowning in custard (at least there was something to look forward to every day!). Visiting time from 3 to 3:30pm. Supper at 5pm comprising without fail of a bowl of lukewarm to cold soup of the evening and a plate of lukewarm to cold food of the evening (2 tablespoons maximum). Change of staff at 7pm and the start of visiting that ended at 7:30pm officially but was allowed to continue until 8pm at the latest. Nighly cup of tea at 8:45pm and the final medication round that only got to my room at 10pm each night. Shortly thereafter, the passage lights were dimmed and it was sleep time. The ward was always full (approximately 40 patients) and was covered by a nursing staff of only five. Thankfully, while I was there, the nursing students were doing a practical phase and up to 4 or 5 of them supplemented the day staff. The old adage of "Silence - Hospital" no longer applies in this day and age and there was constant noise in and around the ward both day and night, the nursing staff themselves not the least guilty either. Even late night/early morning admissions were well heralded for one and all. All in all though, bearing in mind the fact that the hospital is terribly understaffed, the nursing services and personnel were wonderful on the whole.

The MRI
Eventually after a week of mostly sedated pain, I was summonsed to the Radiology Department on Monday 26 August for the MRI scan. After I was duly wheeled in my bed by a porter for what seemed like miles and one floor up, I arrived at the MRI scanner. For those of you who have never had an MRI scan and who are claustrophobic (which luckily I am not for the most part), I would suggest that you request to be sedated before embarking on this painless procedure. An MRI provides an unparalleled view inside the human body. The level of detail that can be seen is extraordinary compared with any other radiological imaging techniques. Using extremely strong magnetism in conjunction with radio wave pulses of energy, the MRI scanner can pick out a very small point inside the patient's body and ask it, essentially, "What type of tissue are you?" The point might be a cube that is half a millimetre on each side. The MRI system goes through the patient's body point by point, building up a 2-D or 3-D map of tissue types. It then integrates all of this information together to create 2-D images or 3-D models. MRI systems can even image blood flowing in virtually any part of the body without the need for contrast dyes!


The MRI Scanner

I was appropriately laid out on sliding examination table, my head placed in a braced area, covered lightly with a sheet (its always cold in these rooms!) and then physically strapped down in three places across the whole body. A "panic button" was placed in my left hand and its purpose was explained to me. MRI scans require patients to hold very still for extended periods of time as even very slight movement of the part being scanned can cause very distorted images that will have to be repeated. Headphones were then placed over my ears and light music was piped in. The machine makes a tremendous amount of noise during a scan. The noise sounds like a continual, rapid hammering. I was asked one last time whether I was okay by the radiographer lady and then I was slowly slid into the tube of the scanner that has openings at both ends and finally positioned. I was told to relax and close my eyes during the procedure which I did for the most part as when I did open my eyes now and then, the tube surface was a mere 2-3 centimetres from my eyes - that's how narrow the tube is. I could even feel it constricting my arms which were tied in on either side of me towards my body once inside. After two sessions of "hammerings", a voice came through the headphones asking again whether I was alright and once they had received an affirmation, another two "hammering" sessions followed. I was in the scanner for 50 minutes in total. Once the scan was completed, I was pulled out and 'released'. On the way out of the scan room, I stopped to admire the pictures of my spine that were being compiled on the computer screen in the control room. Wonderful technology! It looked as if they had cut open my back, photographed my spine with a high resolution camera and then miraculously closed me up again without a mark, and this from what seemed like multiple angles and views. I subsequently learnt that that session in the MRI scanner had been worth about R3500,00.

 
MRI Imagery

The Prognosis
The day after the MRI scan, the doctor came to visit, images in hand. He went to great lengths to explain to me that two discs in my spine were extremely herniated (compressed) and that both were bulging out and compressing the spinal nerve. He also showed me a bone fragment that had also broken away from one of the vertebra and that was also pushing against the nerve. This in the exact region that he had 'guessed' that night over a week ago when he had first examined me at the Trauma Unit! He added that he had decided that the problem would be better handled by the Neuro-Surgery Department as it was main nerve related and not mainly to do with the bones of the spine itself. The following day, Wednesday, I was visited first thing in the morning by the head Neurosurgeon - 2nd In Charge (under the Professor) - and his assistant. They said that they would be operating but wanted to discuss the case with the Departmental Professor. This was duly done and the surgeon returned later in the morning to explain the procedure (that made little sense to me at the time except that it involved three procedures and gave the impression that it would take about an hour and a half to two hours depending on what they found when they "got inside". He added that even though he had only got my case that day, he was scheduling me for surgery the following day (Thursday) as second on the list. He already had a brain tumour removal operation first up. They only operate on ward patients on a Tuesday and a Thursday and then only get a maximum of two done a day due to the lengthy duration of most.neuro-surgical procedures. Of course emergency cases can suddenly arrive and upset all the planning too.

Things moved fast after that. I was bombarded with paperwork and consent papers to sign. A thousand and one other pre-operative forms arrived for pre-operative tests. The surgeon summonsed all the people to come and conduct the tests in my room due to my immobility and pain (yes, still dulled with Pethidine). Within the day, the mobile x-ray unit rolled into my room and took the required chest x-ray. Shortly thereafter, the cardiac people arrived and ran an ECG to check my heart functions. The young intern/ward doctor arrived and drew blood into at least 6 tubes for this and that test as well as for comparison purposes in case I needed a blood transfusion in theatre. At 10pm that evening I had the last medication, food and water.

False Alarm
At 5am the next morning, the anaesthetist popped in to get all my details and listen to my heart. At 5:30am the ward staff nurse marched in and unceremoniously proceeded to shave any remnant of hair from my whole back and smeared on that foul smelling antiseptic preparation for theatre. I was dressed in the traditional open-backed gown with a sterile green theatre sheet wrapped around my middle to protect the already prepared back. I was then left to my own devices to await my call to the theatre. As the morning progressed, so did the pain. The Pethidine had worn off and, being addicted to it already, my body was screaming for its morning "fix". My left gluteal muscle, leg and ankle were on fire and killing me again. I lay in agony hour after hour, getting up with great difficulty from time to time to make my way to the toilet. Eventually, after what seemed like a lifetime to me, the ward sister came in at 2:30pm and informed me that the tumour op had taken seven and a half hours and that there was not enough time to do me as well that day. I was not impressed to say the least - suffering from extreme pain and hunger and only going to be able to get the meagre offerings of supper in another two and a half hours time. Through the haze of now constant pain, I hastily shed the theatre attire and got back into my more familiar shorts and t-shirt. At 3pm my neurosurgeon arrived in my room still in full theatre gear and made his apologies while we discussed his recent success with a tumour removal. Thankfully, he immediately got the sister to "shoot me up" with Pethidine again and I sank into a fitful but releasing sleep till the supper trolley arrived. On Friday morning the surgeon stuck his head in again an proudly announced that I was now first on his list for Tuesday the following week provided that nothing else unforeseen cropped up on the day. Small mercies; another four days to wait. What can one do but settle back into the daily routine again.

The Day Arrives
Eventually Monday arrived and the young intern returned to draw my blood yet again for the theatre tests - apparently certain of the tests are only valid for three days. Luckily that was all that had to be repeated as far as the pre-operative procedures were concerned. Later in the afternoon a new (and younger) anaesthetist arrived to go through all the details again. He seemed more professional than the other one of the week before and eventually left with a cheery "See you in the morning". Yeah right. The rest of the day dragged on tediously but without further event.

Off To The Theatre
Once again I awoke at 5am on Tuesday morning September 3. As if on cue, the ward sister marched in again at 5:30am brandishing a few disposable razors and an evil grin on her face. I had been on her case every night since the Tuesday because my back had been as itchy as hell since her last ministrations. Once again the back was shaved, the foul smelling icy liquid was applied, the upper body was wrapped in the sterile green sheet, the open-backed gown was donned and I was once again left to my own devices to contemplate the day ahead. The nursing staff had been checking my blood pressure almost hourly the whole of the previous day as my stress levels started to increase when I thought back to that agonising Thursday the week before. The sister came in and checked it again - it was still up; way up. I was giving the pre-operative medication (10mg Valium) and thankfully within minutes a porter arrived and between him and one of the student nurses, they wheeled me out of my room en route to the theatre. This time the journey was relatively short compared to the MRI excursion, Within 4 minutes my bed was pushed into the Neuro-Surgery theatre. There was my anaesthetist grinning down at me and enquiring after my health. Hmmm! What did he think - that I was feeling on top of the world?! He introduced me to his assistant who was a young student doctor doing his final year. He too looked as if there was nothing wrong in the world. I just wished that I was feeling the same as them. I informed him that my blood pressure was up and he just smiled and said there was nothing that they couldn't fix and that I must just relax.. I looked around as I lay there while everyone went about their business. There were glass-fronted cupboards all down one wall with a vast array of surgical instruments - I even noticed the saw thing they use to gain access to people's skulls and offered up a quick prayer thanking the Lord that it wasn't going to be used on me. Everyone else seemed preoccupied with getting their bits and pieces together for the procedure. There were the two anaesthetists, three theatre sisters and my neurosurgeon and his assistant who had already waved a jolly and optimistic "Morning" from afar. He was busy fiddling with his dual optic neuro microscope that he was soon going to be using on me. I had already offered to climb out of my bed and raise my rather sizable body onto the operating table for them otherwise they would all be in the ward with me the day after with back problems too. Who says that I can't still joke even in the theatre? The anaesthetist, along with the main theatre sister, then started going about his business. He explained all along the way what he was going to do and did his best to start reducing my blood pressure vocally. He injected my right hand with a local anaesthetic as he had to insert the main drip line and an arterial monitor. This was duly completed without me even feeling a thing and next minute the old "blip-blip" sound of the heart monitoring equipment filled the room. Yes, my blood pressure was still quite high. I glanced over at my right hand, seeing a multitude of pipes going in under a plaster cover, a huge syringe filled with a milky white liquid protruding out the top of my hand and the arterial monitor emerging out under the bottom of my wrist. Next minute an oxygen mask was placed over my face and I was told to breathe slowly and deeply and to relax so as to try and reduce the blood pressure. All the time this was happening, the theatre sister was slowly pushing in the plunger of the syringe every now and then. The oxygen treatment went on for about three minutes thereafter and then the theatre sister proclaimed "Try thinking of something nice". I glanced over at her and wryly replied: "That will just make my blood pressure go up even higher!". They all started laughing and I remember the sister making a comment about "You men…" and that was it - I was lights out!

I slowly came round in the recovery room four and a half hours later. The first thing I noticed that all pain in my gluteal muscle, leg and ankle was gone! Not a thing and full mobility. I was back in my bed and I could feel a catheter in me, something else under me (which I later discovered was a drain coming from the operative spine area out through the back muscles) and a drip in my right hand where I had last seen the syringe. The remnant of the arterial monitor was still attached to the underside of my wrist but this was soon removed my the recovery room staff and pressure applied on the entrance wound until the bleeding stopped. Not long after that, the student nurse and porter arrived to take me back to my room. Once safely back in my by now familiar haven and having already been addicted to Pethidine, the surgeon in his wisdom decided to up to schedule seven and I was promptly injected with my first dose of morphine; to be administered every four hours. Morphine is a similarly strong habit forming opiate narcotic analgesic with a shorter duration than Pethidine and that basically dulls all pain - in essence one knows the pain is there but you couldn't give a damn! Unlike Pethidine though, it did not put me to sleep but rather just kept me on a "high" and slowed down all my mental capabilities, even speech. Other than the morphine, I was still on the two painkiller tablets every six hours and the twice daily Voltaren injections. I spent the rest of the day (including visiting hour) in a narcotic induced haze and just rested. The operative area on the lower back was painful but I was instructed not to move off my back by the ward staff. The pipe from the drain was also eating into my right gluteal muscle and was uncomfortable to say the least.

What They Did
A laminotomy was performed on each of my L1 to L3 vertebrae along with a microdiscetomy on two of the intervertebral discs. The spinal bone fragment was also removed.

The vertebrae are separated by intervertebral discs which act as cushions between the bones. Each disc is made up of two parts. The hard, tough outer layer called the annulus surrounds a mushy, moist center termed the nucleus. When a disc herniates or ruptures, the soft nucleus spurts out through a tear in the annulus, and can compress a nerve root. The nucleus can squirt out on either side of the disc or in some cases both sides. The amount of pain associated with a disc rupture often depends upon the amount of nucleus that breaks through the annulus, and whether it compresses a nerve.

The surgeon first made a 15cm incision in my lower back, wide enough to gain access to the problem areas. The muscles covering the spinal column were then pulled out of the way using surgical metal retractors. The dual stereoscopic neuro microscope was then positioned - this instrument allows the surgeon as well as his assistant to see the operative area in a magnified view. A laminotomy is a procedure where all or a portion of the lamina (the bone protecting the spinal canal) is removed. The laminotomy simply opens up the spinal canal in order to visualize the pinched nerve root.


Laminotomy Procedure

Once this is accomplished, the second procedure, the microdiscetomy, is performed. The high powered stereoscopic microscope is used to provide illumination and magnification to allow the nerve and surrounding structures to be visualized clearly. The nerve root is carefully protected with a specialized retractor, and protruding disc fragments, along with any remaining loose or degenerated disc material, are then removed. The small hole left in the annulus (the outer covering of a spinal disc) regenerates in 4 to 6 weeks and fills in with new disc material.


Microdiscetomy Procedure

The surgeon completed the operation by positioning a drain and closing the back incision in several layers. Dissolving suture material was used internally where necessary while the outer cut was closed using 28 staples.

The Latter Days
I was very much left to my own devices the day following the operation after a brief early morning visit from the surgeon. I was very uncomfortable lying on the wound and the drain pipe was biting into me continually with my main body weight practically lying directly on top of it. A young physio arrived and told me through my morphine haze not to bend my legs more than 45 degrees but to try and flex the feet and so loosen up the calf muscles. Under no circumstances was I to twist my body in any way and he suggested that a pillow be used alternately on either side under my upper back to just lift me slightly and vary the weight distribution. This was duly done from time to time and gave short but welcome periods of relief from the discomfort. Sometime in the afternoon the staff nurse came in and told me that she had been instructed to remove the catheter. I shall not go into detail here except that it was a brief but burning experience. I still ate no solids as there was no way that I could organise myself on to a bedpan! The saline drip remained in place being replaced at regular intervals and soup, water, tea and coffee was the diet of the day.

On the Thursday morning, regular as clockwork at 9am, my neurosurgeon walked cheerily (again!) into the room along with the ward sister and announced that they were going to inspect the wound and probably start removing the attached paraphernalia bit by bit. My first shock of the morning came when the two of then tried to log roll me onto my left hand side. Having laid practically immobile on the bed for over 24 hours, I was literally stuck to the sheet with blood and the plaster of the wound covering that had been put on in theatre. One could literally hear me "ripping" from the sheet as they physically rolled me on to my side - the sister from behind and me holding on to the surgeon's back on the other. Eventually I was on my side with one hand behind the surgeon's back helping to support myself. There then followed some utterances along the lines of "hmmm", "nice", and "yes" to name but a few while the surgeon's finger gently prodded the area here and there. Then he proudly proclaimed that he was about to remove the drain. Shock number two of the morning. As the drain was pulled out in one long action, the pain was excruciating. Unfortunately, I was still supporting myself by holding onto the surgeon's back so he suffered along with me as I literally dug my fingers into his right shoulder muscle and squeezed as hard as the pain of the action dictated. I'm sure he still has finger marks on his back! Notwithstanding this, the whole episode must have lasted about 3 to 4 seconds (that seemed like forever at the time) and then it was over and so was the accompanying pain. The drip was terminated shortly thereafter and removed too. The student nurse arrived within minutes to clean and redress the operative area once again. As the surgeon left the room totally satisfied with his recent workmanship, he called back over his shoulder that he was going to get the physiotherapist to come and visit again and show me how to get up - he wanted me on my feet and walking around that afternoon.

After being shown how to get out of bed correctly later that afternoon, the physio (along with his assistant) proceeded to walk me to the bathroom across the passage and showed me how to get myself down and seated on the toilet and then back up again. After a few more tips and hints, they left and I was once again left to my own devices.

The rest of the week passed without event. I made an impassioned plea to my surgeon to discharge me on the Friday morning when he did his rounds but he was not too enthusiastic. He intimated to me that he would probably allow me to go on the Monday. Another long and tedious weekend for me to lie in hospital - I was not as passionate as him about the idea but then again I was only the post-operative recovering patient and he was the "boss". I had already stopped the morphine injections of my own accord on the Thursday afternoon as the side-effects were not pleasant and I used to start sweating profusely shortly after its administration. At that point in time, I was basically only on the twice daily anti-inflammatory Voltaren injections and no other medication at all - certainly nothing for pain.

On the Sunday morning I had had enough of the hard hospital bed. I made contact with the assistant neurosurgeon (who was duty and about to go into theatre) and requested that I be allowed to discharge myself. He was not overly keen on the idea but eventually conceded that it was up to me and that I would have to sign the self-discharge consent papers. I quickly made arrangements for my fiancé to come and fetch me and asked the ward sister to get one of the student nurses to come and change the dressing before I left. This was duly done, I was given a saline drip package by the sister to take home for cleaning the wound area, the paperwork work was signed, my belongings were packed and I slowly walked out of the hospital in the company of my fiancé, son and his girlfriend - back to 'civvy street' after being in hospital for three weeks and eighty nine injections later (yes, I had been counting them meticulously!). They had prepared a "bed" for me in the back of the car (as I was not allowed to sit for any extended period for six weeks after the operation) and with a bit of effort I managed to get myself in and lying down on my side in a foetal-type position. The long ride home was uneventful although I did make involuntary mental notes of all the potholes and bumps in the Cape Town roads once again. Getting out of the car was another mission in itself once at the house after laying in the same position for over forty minutes but was soon accomplished and shortly thereafter I was back laying on my own double-matressed bed in the comfort of my own home - no comparison to the hospital and settled into the daily routine of the recovery period. An environment definitely more conducive for a speedier recovery and one that allows me to continue with my work.

The Final Prognosis
The twenty eight staples come out after ten days and I may not sit for extended periods or drive a car for six weeks from the date of the operation. In the future, I shall have to watch my weight, take meticulous care when bending, keep my lower back and abdominal muscles in shape, walk regularly, maintain a correct posture when sitting and standing, and possibly use an orthopaedic chair for work purposes (the ones that you kneel on). I may never again lift heavy weights nor do extensive labour-intensive tasks such as gardening. I shall do my part and we shall see what the future holds as far as my back goes…


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