This inflammation can spread upwards to involve other parts of the spine and in the most severe cases; it can involve the entire spine. As the inflammation continues, new bone forms as the body tries to repair itself. As a result, the bones of the spine begin to "grow together" or fuse, causing the spine to become very stiff and inflexible. Even though new bone has formed, the existing bone may become thin, which increases the risk of fractures.
Those with severe AS may require surgery for badly damaged joints. Surgery usually involves replacing a joint with an artificial joint. The most universal symptom, however, is chronic low back pain that seems to come (flare) and go for no apparent reason. It is generally worse in the morning when rising from bed and improves with stretching and exercise.
For myself, I have had chronic low back pain for the last 16 years. It was getting worse and worse, and I was having a lot of nerve pain down my legs. Some days it was hard to walk more than a few hundred meters. I was not able to lie flat on my back or on my stomach and my right shoulder is messed up from a ski crash in 1999, so I was only able to lie on my left shoulder. Sleep was most definitely a challenge for a couple of years. However, I was able to maintain some fairly good level of fitness and despite the crippling pain I was able to have the best climbing season of my life this past summer.
Last spring, my doctor sent me for a round of MRI’s and CT Scans. They scanned my entire spine and the MRI (which was actually my 3rd MRI) lasted 2 hours. For those of you who have had an MRI before know it is not awesome, being crammed into the small tube on a hard tray. Now add nerve pain down the legs from lying flat on my back for an extended period of time and you get Jamie almost passing out from the pain. I had to hit the panic button and get out for a rest from lying down part way through. That was seriously rough!
So what did they find? Well essentially my back was a mess! Not much good news was reported, unfortunately. Lots of degeneration, blown and bulging discs L1/L2, L3/L4, L4/L5, L5/S1, severe narrowing of foramina canals L4/L5 and L5/S1 with extreme L5 nerve root compression. Basically, not good business!
What caused all of this damage? I am 34 years old; how could my back be in such bad shape? Good question. I think it is partly due to the degeneration associated with the AS, partly due to all of the weight lifting, plyometric jump training, and on snow training associated with my ski racing career, and taking a work related fall head first off a second story wall in 2003. All of this combined with hard training for climbing and most likely a genetically week spine and whammy, I am one hurting unit.
I got referred to a surgeon who works out of Lions Gate Hospital in North Vancouver. He sent me for a few more detailed scans of the lumbar region and recommended a disc removal and fusion of L5/S1. To be honest the idea of spinal surgery scared me, especially because I was still able to function at about 70%. The "what if's" started running through my mind. What if something went wrong and I am not longer able to walk? What if I die? There is always a risk when going under the knife. What if I cannot work again or be able to climb?
So I delayed the surgery from winter 2013 to fall 2014. This gave me enough time to finish the climbing season, deal with the surgery mentally, and actually get to a point where surgery was the only option. By the late summer/early fall I was suffering a lot. Suddenly it was very real for me; there was no other option and I was not going to get better on my own.
The date was set and all the arrangements were made such as taking time off work, both for myself and for my wife. Then one week before the surgery date I get a call from the surgeon's office and it was delayed. Apparently, they did not have the right "instrumentations" available. The surgery gets pushed back by one week. In the meantime I have had to go off my medication (strong anti inflammatories), which help me deal with not only the pain but the inflammation. Thursday Sept 25 was the new date. But wait, on Wednesday Sept 24 I get a call from the surgeon's office and apparently the brain-monitoring instrument was broken. Well ok, not something that should be messed with, I guess.
Now, 2 weeks into my withdrawal from lack of medication and I am in a lot of pain. The idea of surgery was actually very exciting now. Suddenly my perspective had completely changed. I think it was important for me to have the two weeks without my medication, to show me how much I was relying on the medication and that it was actually masking a lot of the pain. Many people asked me before how can you manage to go about daily life and climb at such a high level with a back that is in terrible shape? Well the answer was the medication.
The new date for the surgery was set for Friday October the 3rd. I had my fingers crossed that the third time was the charm and it was. I had to be at the Hospital at 6:30 am in the morning for a 7:45 am surgery. It will be great to get it over with in the morning and have the afternoon to recover, I thought. I was told before the surgery that the operation would be about 4 hours long and I would be in the hospital for 3 to 4 days. Natalia (my wife) and I left Squamish at 5:30 am. Off to the admission office and into the pre-surgical waiting area.
I had surgery before, in 1998. I was pre ski season training at Nakiska in Alberta and I fell and when into the trees. My helmet came off in the crash, I hit a tree, and my ski cracked me in the face, breaking my orbital bone. I had to have reconstructive surgery to repair the zygomatic bone. So I knew what was coming, a nurse was going to dig around in a vein and try to install an IV, I would fall asleep, then wake up with no recollection of the past few hours, get extremely sick from the after effects of the anesthetics, and feel like hell for a day. I figured I had this covered.
I walked into the operating room and it really did look fairly similar to the operating rooms on TV, big lights, lots of machines, and a bunch of people looking busy. Let's hope they have had their morning coffees, I think to myself. Haha. The anesthesiologist introduces himself and lets me know I need another tube inserted into an artery, so they can monitor my heart and give me a blood transfusion if required. Great, just as I was feeling better from the last round of needles I have to have another one inserted into my forearm. I convince him that he can do it when I am "under" and he agrees.
Just as we finish chatting about the heart line monitor I feel a kind of pop in my forearm, the one that has the IV in it. I look down and there is a huge mass just "up stream" from my IV. The nurse who failed on her first attempt to install my initial IV, installed the second one "down stream." Therefore, the fluid had burst through the hole in the vein and was starting to fill up my arm. Well there goes my plan to not having another needle stuck into me. They have to have the IV "installed" before you go under because it is where they administer the anesthetic. To be honest I don't really remember much from here on in. They put the oxygen mask over my face and good night, even though it was the morning. I am sure glad that I was awake to notice my arm filling up with the saline solution. I wonder what would have happened if I was not conscious and in surgery? Would they have noticed?
I wake up dazed and confused in the recovery room. The nurse that was attending to me actually went to the same high school as me in Whistler and now lives in Squamish, small world. I had a tough time waking up and kept passing out for a few hours. Finally I was stable and transported to my new room. I had requested a private or semi private room. I have extended medical and it is covered, so I thought why not!
My surgery was scheduled for 4 hours and apparently it took longer because my back had gotten worse since the last scans. The doctor said he said he did a lot more work than he thought he was going to have to do and the operation lasted for about 6 hours. He seemed happy with his work, good news!
Before the surgery I had a pre-surgical screening meeting at the hospital, where they took my blood, did an EKG to check my heart, and went over the specifics of the surgical details. I was told that one of the potential risks was that I might go blind or have permanent nerve damage to my arms from being on my stomach with my arms above my head for an extended period of time. Really? Blind? Apparently this is really only a risk in elderly overweight men. How do you classify old? I am 34 years old, and I am a climber, I always think I am overweight. Hahah
Well it turns out that being on my stomach for such a long time during the surgery left me with a splitting headache. This might actually be an understatement; I thought my head was going to explode! I could hardly open my eyes and they were extremely light sensitive, my hearing was super sensitive, and my sense of smell was also hypersensitive. There was some talk about a possible cerebrospinal fluid leak which was causing the head pain. This resulted in me having to lie on my back for a day in the hopes that it would fix itself.
I basically did not move for two and half days. This was quite a scare for my family, seeing me lying almost lifeless in extreme pain and it was a terrible experience for me as well. They kept pumping my full of narcotics, which actually made it worse. I definitely know I will never be a drug addict! So they took me off the narcotics and put me on just regular tylenol and I started to improve slowly. This was now Sunday night.
My next goal was to get the hell out of the hospital as soon as possible. Natalia and I asked the nurse what hoops I had to jump through to be able to be released. We were given a list; walk without the walker, walk up and down a flight of stairs, and drink a litre of water. It was on! A challenge! Throughout the day I walked as much as I could circling the ward, ate a few meals, and pounded water! There was a covered balcony on the ward and it felt great to walk down the hall and get some fresh air! Being outside was an awesome feeling and I think it definitely helped me recover quicker.
I also had to have all of my tubes removed. At one point I had an IV, the heart line monitor, narcotic line in each shoulder, catheter, a drain tube in my spine draining into a bag, and an oxygen tube in my nose. During the surgery I also had the breathing tube down my throat. Pretty full on.
Being home was so nice. Finally peace and quiet! No more screaming people, no more beeping machines, no more tubes and probes. Time to recover and recover I did. Within a couple of days I was walking around freely, in less pain than I was in before the surgery and feeling great! I still have a long road to full recovery but my staples have been removed, I have very little pain, and I am able to function almost normally and it has been 2 weeks since the operation.
The support I received from my family was and continues to be absolutely incredible. My parents and in-laws were amazing, the visits were great and the help with our dogs was very much appreciated! Natalia has and continues to be my number one supporter and her help has been out of this world! She is truly amazing! I received so many amazing messages from friends that really helped me through the tough times. Thank you for all of the support!
Four weeks to go until I see the surgeon again to hopefully get cleared to get back into the gym and start training and building back up for the spring!