The First Rule of Back Club

The Things We Choose -
There are many things in life that you wouldn’t choose to do more than once. We can all make our own lists based on our own life experiences, but safe to say that fairly near the top of mine is spine fusion surgery.

The Back Story -
I had an awkward and serious fall after hitting a pothole in 2011. The pain and lack of function and the fact that the wedge fracture was progressing pointed to less conservative treatment (euphemism). And so I had fusion surgery with in Sept 2013 at RNOH (Royal National Orthopaedic Hospital) in Stanmore. I did all the prep, lost 7kg thanks to my strict 5:2 regime - and went into 7 hours of fusion surgery, light, strong, positive and optimistic. I came out in even more pain and less function than before the surgery. Aside from increased pain in my back, I essentially had a cough for a year after the surgery and inflamed lymph nodes in my chest that was eventually diagnosed as sarcoidosis Xmas 2014 after a mediastinoscopy. It is unclear whether this is related to the surgery but if it isn’t then it is a hell of a coincidence, considering the errant lung was deliberately collapsed to allow access to my spine. Through all this the pain in my back just kept getting worse, when it should have been getting better all the time. Eventually the surgeon called for another MRI scan which showed there was no fusion at T12-L2.

The Bad News Habit -
Bad news, it seems, just sometimes gets to be a habit and follows you around. At that point further surgery was inevitable at some point. I guess I felt that if I could just hang out on painkillers long enough medical science would break-through with some nanotechnology injection that would straighten my spine and fuse the site all in one. Well that looks to be a way off so after almost four years so I have recently committed to more old-fashioned spine carpentry/surgery, of the revisionist kind, after a recent MRI confirmed what I guess we all already knew.

Belt and Braces -
Revision spine surgery, by nature, tends to be at the belt and braces end of the spectrum. The logic being that it failed once and nobody wants it to fail again (especially me actually). And the prevailing orthodoxy is to add even more titanium cages, rods and screws under the ‘mud against the wall’ philosophy. Quite so.

The First rule of Back Club - don't get fat!

Weak, Heavy, Out of Shape -

The first rule of Back Club - Don't get fat! Any spine surgeon will tell you with measured ferocity. So I came out of Christmas this year heavy, unfit and weak. This was foolish for someone in my position, because surgery could be needed at anytime. So after xmas I pre-emptively put myself back in to my old prehab state and take my conditioning seriously. As usual under the watchful and coordinated eyes of Fiona Troupe (Six Physio) and Alex Fugallo (Beyond Health). The broad aim was threefold -

• Lose weight 76.5kg to 71kg (currently 72.5kg – pre-easter, ahem)
• Gain strength – the more you go in with, the more you come out with
• Gain fitness – it is now well documented that increased fitness seems to be linked to positive surgical outcomes.

Alex and Fiona

We have worked with Alex and Fiona at Cyclefit over many years with shared clients, and it is now interesting to be the specimen in the jar rather than part of the MDT (multi-disciplinary team). Fiona and Alex have been incredibly insightful and supportive. Alex (osteopath above) has use industrial quantities of acupuncture needles and kinesio tape to keep me pain free and functional enough, for Fiona (physio) to get me strong enough for surgery. Which has not always been easy because there is not much physical that I can do that doesn’t cause immediate pain of the game-over nature.

The worst thing I can do is cycle because the combination of a flexed spine and flexed hip (top of the pedal-stroke) torques up the back pain in minutes. I can manage a short blast to Paddington station on my folding bike but not much more.

Accentuate The Positives -

And this highlights one of the few positives of six years of having back problems – that I have become very good at working with clients with chronic, acute or serious long term back issues. I am very interested in the mechanics of back pain as it relates to cycling forces and in point of fact I remain one of the few people that Cyclefit has so far been unable to help cycle in comfort.

Onward

Last time I wrote journals right up the surgery and very quickly afterwards and all through the failed rehab process (links below). I won’t be doing that this time for a few reasons –

1. It will be physically tougher this time and in this instance gallows humour would be disingenuous.
2. I am not at all sure that this is the kind of thing that people want to read about. It's a niche market to be sure.
3. it is much more prosaic to me this time - last time I stupidly had a misguided notion about how fast I could actually recover through sheer force of effort and will - I even secretly planned to ride 2014 Etape du Tour with Jules (he never knew).

This time my expectation is better measured. I want to get out: without any infection, without any nerve damage, my spine posture corrected, and with sound foundations for spine fusion. The rest can wait.

Rehab is Dull -

Having said that rehab is intrinsically dull and if I feel in a sharing mood I am sure I can clatter something out.In the mean time to all my fantastic clients and friends - please book in now if you would like to see me as my last day at Cyclefit will be May 3rd, otherwise it may be a wee wait to see me. I will sign onto my emails as soon as I can post op, and will therefore answer any messages.
Phil

For anyone facing back surgery of any description here are my tips after an almost six year battle with spine problems - I would love to hear your tips so I can add them to my own and put them up on this Journal.

​My Back Surgery Top-Tips

• Find your team aside from the surgeon. I am lucky that I have Alex Fugallo, Dr Dave Hulse, Graham Anderson and Fiona Troupe. Friends and colleagues that I have worked alongside helping our shared clients. Of those Alex is the quarter-back. He has called everything right from the day I had the accident.
• Dr Dave Hulse (ex-surgeon) says it best – “If all you have is a hammer, then all you are looking for is a nail”. Surgeons see medical problems through the prism of surgery. Sometimes they are wrong. Get other opinions.
• Become an expert in your medical issue – old style surgeons tend to hate this but open-minded ones like it. It gives them an opportunity to have a deeper and more honest clinical relationship with you the patient.
• If you are not sure the case has been made for surgery then pull out and go for more conservative treatment.
• If all else has failed and you just have to have surgery then try to mentally prepare by being as positive as possible about that fact and event. There is no point in worrying or becoming anxious about something that is inevitable. That would be irrational.
• DO YOUR PREHAB! This is the big one. However hard it is go in strong and as fit as you can be. Muscle loss after surgery is shocking. I will be in hospital for about two weeks and expect to lose about half the muscle I go in with! You can never go in too strong. I know there is an irony here because by definition it is probably hard to exercise
• Don’t go in neurally wired. Try and see your physical therapist enough that you go in as calm and pain free as you can. My elixir is Alex Fugallo and his acupuncture needles. Aside from industrial opiates it is the one thing that gives me a bit of relief.
• Don’t skimp on the rehab. Obvious I know but get it all in place early so the conveyor belt is pre-set. You may not feel like moving but in my experience movement is always good post surgery and you will feel better after.
• Eat well. Fast healing marches on your stomach. The quality of what you eat immediately after surgery is key. Get your family and friends to bring in copious amounts of the good stuff along with the Percy Pigs and Pringles.
• Be patient – look to those healing milestones, touch them and calmly move forward to the next.
• Make sure you will see your surgeon post operation. Not one of his or her Registrars but the actual Surgeon