Washington - The pain started to percolate up and down my lower body with each stride along the sand of Miami Beach.
A cramp? A strain? I'm running, I thought, it's supposed to hurt. Shake it off.
But the pain didn't stop when my run did, nor when my vacation ended. It lingered, long into that first night and into the next day. And then it made itself at home, like a squatter.
I wondered: Could just one run, one of thousands I'd taken in my life, have caused such a profound ache, stretching from my lower back and down the length of my left leg? I'd had muscle strains and pulls before. But this was something new.
I explored this new landscape for the next few months, as my lower body issued ever more urgent complaints.
Backs, I knew, can be treatment-defying enigmas. Everyone knows someone - or is that someone - who has suffered from some kind of back issue. There's a whole sub-industry devoted to back-pain relief, from pills to compresses to contraptions. Once I mentioned my trouble, I discovered a secret club of back-pain sufferers among my friends and colleagues. Elaborate personal histories poured out, along with a chaser of unsolicited advice. (“Have you tried Pilates?”)
The statistics on back pain are, um, painful. The Centres for Disease Control and Prevention household survey in 2012 found that 28 percent of adults said they had experienced low-back pain at some point in the preceding three months. The CDC also reported that an estimated 70 percent of people in industrialised countries will feel the burn over their lifetimes.
More than 40 epidemiological studies have concluded that people who engage in heavy lifting on their jobs are vulnerable, which seems obvious. Less obvious: Some studies suggest that people who have “static work postures” - that is, people like me, who sit at a desk for much of the day - are vulnerable, too.
My doctor thought she recognised my problem immediately. “Sciatica,” she declared, a common affliction affecting the sciatic nerve, which runs like an interstate highway from the lower back down both legs. She prescribed naproxen, an anti-inflammatory drug.
It was no help. If anything, the pain deepened. It dogged my footsteps throughout the day, yammering at me. I tried ignoring it, coddling it by moving gingerly or humouring it by making fun of my aging body. When all else failed (which was often), I cursed it.
Every simple physical activity, from hauling a laundry basket to merely sitting for longer than 20 minutes, sent spasms down the neural network in my body's lower half. When I wasn't swearing oaths against it, I almost came to admire and respect the persistence and insistence of these sensations, and their variety and variability - light, harder, excruciating.
I also tried endurance and stoicism, fending off my wife's entreaties to revisit the doctor. But my wife kept nudging. She branded me “the impatient patient.”
I relented. This time, the doctor prescribed stronger medicine: anti-inflammatory steroids. They had the same result as naproxen.
My distress increasing, I consulted a neurologist, Larry Einbinder, who suggested physical therapy. Off I went, to sessions of stretching exercises, massage and “stim,” the application of mild electrical current to my lower back and rear. I emerged from the first five appointments no better than when I went in. When my sixth appointment was cancelled due to a snowstorm, I was relieved.
At this point, daily functions had started to become a challenge. Walking was difficult; bending to pick up an object was out of the question. Even leaning too far forward over the sink while shaving brought on a stern reminder, a dagger strike below the waist. (Oddly, as long as I assumed a rigid, upright position with no leaning or bending, I was able to shovel snow; I still don't know why.)
I continued to work, though from home and with difficulty. Once, I started an interview seated at a desk but was forced to lie down on the floor as the pain gathered like a black fog. My handwritten notes from that conversation have a very odd, uphill skew.
At the end of a day of shuffling around, I'd crawl into bed, lying only on my right side. On some days, my wife would bring dinner to my bedside, where I would remain until morning.
At this point, two months after that run in Miami, Einbinder recommended an MRI.
The imaging clearly revealed the source of my problem: The lowest vertebrae on my spinal column had bulged out of alignment. A classic herniated, or “slipped” disk. (The latter term is a misnomer because disks don't actually slip; they stretch, twist or get squeezed.) The bone, in turn, was pressing on the surrounding spinal nerves. In other words, I had a pinched nerve.
An orthopedic surgeon, Brett Quigley, recommended a laminectomy, a scary-sounding but relatively common procedure in which doctors remove part of the disk - the part pinching the nerve - via a small incision in the lower back. The surgery had some risks (bleeding, nerve injury, the delightful sounding spinal-fluid leak), but Quigley described it as quite routine and minimally invasive.
Unlike a classic laminectomy, the minimally invasive kind involves a small incision in the lower back and the use of a microendoscope - essentially, a tiny surgical camera - that is inserted into the incision via a hollow metal cylinder. Once the surgeons have a clear path, they use a sharp cutting tool called a rongeur to remove bits of spinal bone. It's less invasive because the back muscles and other tissue are pushed aside rather than cut, which diminishes recovery time and postoperative pain.
I was game, but with a lingering question: How had this happened? Had I lifted something the wrong way? Had I run too many miles? Were my bones disintegrating?
In a word, no. “You can blame gravity,” Quigley said. Since humans began walking upright, he explained, our spines have been under gravitational pressure. “Sooner or later, nature finds the weak point. Basically, you get this by living past the age of 20.”
A few weeks later, neurosurgeon Alexandros Powers performed the laminectomy. It was as advertised: quick and painless. I was sedated for less than two hours and walked out of the surgery venter after the procedure. After three months of agony, the pain was instantly, blessedly gone. I was back at work about five days later.
Because insurance covered most of my treatment, I never saw the full price tag, but I'd estimate the whole ordeal cost in the tens of thousands, if you include first visits to my physician, the drugs, the physical therapy and the surgery. All I saw at the end of it all was about $1 500 (about R15 000) in bills for the anaesthesiologist and surgical venter. Without insurance, my choices would have been stark: Spend every dollar I had, or get used to my condition.
Four months later, I still feel fine. I'm not 100 percent; Powers warned me that I wouldn't be for a number of months. My left foot still tingles (normal, he said), and at times I can feel distant echoes of the old pain. Even jogging at a 12-minute-per-mile pace - which feels absurdly slow compared with my pre-Miami pace of eight to nine minutes per mile - is difficult. As I jokingly tell people who ask about my experience, my chance at an Olympic gold medal are shot.
Still, I'm grateful - for doctors and nurses, for modern medical science, for health insurance, for the ability to move again. A few decades ago, the procedure I underwent would have been much riskier, the recovery much longer. A few decades before that, my only option would have been... no option.
No, I'm not entirely back to normal. But this experience has taught me a valuable lesson: Normal isn't boring; it's a beautiful thing. I'll never take it for granted again.
Washington Post