Pain in the Neck
“Pain is inevitable. Suffering is optional”-Haruki Murakami
First time without nerve pain in nearly a decade, thanks Dr. Spiker!
Spine Surgery
In an artificial disc replacement surgery at C5-C6, the doctor makes an incision in the front of your neck skin. The surgeon then pulls your neck muscles to the side and moves your esophagus out of the way to get access the ventral aspect of your spine. Once the spine is exposed, a mechanism that acts like a carjack holds the two vertebrae apart from one another while he cuts the disc from the bone and vacuums it away being careful not to damage the spinal cord. Using a bone saw, he then cuts grooves or drills guide holes into the vertebra in order to anchor the replacement disc. Using a hammer, he then pounds the metal replacement disc into place and verifies the position by x-ray. He then sews up the incision site you up and leaves you in a bed in a groggy state to recover. The whole procedure takes about 2-3hrs, pretty similar to my qualifying exam in that way. The qualifying exam was only the start of the massive undertaking of the PhD and the surgery was only the beginning of a long road of work to recovering the use of my arm.
By the time I had the surgery, I could not lift my arm above my head. My thumb and forefingers of my right hand were completely numb and I suspected permanent nerve damage. Having just studied the neural pathways for spinal nerve reflexes during the first year of my Neuroscience PhD, I knew this was really bad. Peripheral neurons do not regenerate in mammals the way they do in salamanders, axlotls, or zebrafish. This fact was reinforced when I thought about my uncle Kevin, who for as long as I remember, had remained a wheelchair bound quadriplegic due to severe damage to his cervical vertebrae when he was young. The longer the signal from the brain to the arm and hand is obstructed, the higher the potential for long term damage.
Waking up from surgery, I finally realized how bad the pain had been. I had gotten used to suffering through the day for so long that it became the normal baseline for me. Waking up to that sort of relief was surreal, was this what everyone else felt like normally?! In the subsequent two days, I could not believe how long I had lived with that sensation. If this was the new normal, I must have been in rather severe pain even when the condition first began. The prescribed painkillers for post-op were hardly necessary, I already noticeably better. For six weeks after the operation, I could not turn my head to the side or look up or down which was not much different than normal. I wore a soft neck brace, and was prohibited from lifting more than 20lbs, which meant that I needed help getting groceries, cooking food, taking out the trash, and I had to sleep propped upright for a while. By three months, when I finally was cleared for physical therapy, it became clear that my entire serratus anterior muscle at my right flank was paralyzed. The uppercut motion with my right arm caused my shoulder to roll completely off of my ribs and wing outward, creating a clicking sensation reverberating in my armpit.
Repeating my qualifying exam went much better than the first attempt. I passed after heavily revising the documents and presenting an alternative strategy. My committee seemed pleased with my performance but I was just glad to have a literal and figurative weight lifted from my shoulders. I was overdue for a rendezvous with a very close friend who was getting married in Canada where I drank congratulatory scotch through a straw because I couldn’t tip my head back.
The steep and beautiful approach of Led By Sheep (5.7 YDS) in Zion National Park with Katt in the center.
Getting Back on That horse
I used to do 100 pull ups in 20-30 minutes before the disc failed. Afterward, I could do a grand total of 0. I was working to lead 5.12a (YDS) rock climbs prior to the degeneration of my spine, and afterward could not lift my right arm up above chest level. After 3 months, I was cleared for physical therapy. I still could not lift my arm straight in the air with my own strength. With training, I eventually could raise my arm upward, but could not straighten it fully. The last bit of the motion, getting my shoulder to touch my ear, felt like I was trying to lift an elephant overhead. My physical therapist wanted me to use a resistance band, but it was too much. I had to resort to pushing my arms up the wall while leaning into it as an assist to finish the motion. Every morning and evening turned into 30-60min of physical therapy with no noticeable progress from November 2015 to February 2016.
I was dying to climb outside again but still lacked full range of motion, a great deal of strength, and control over much of my right flank. I started getting treated by Carrie Cooper whose expertise in both physical therapy and rock climbing was encouraging. I still couldn’t climb properly because I lacked full extension with my arm and I had atrophied substantially. By Fall 2016, I was antsy and wanted to get on real rock but knew my own limitations. I chose an easy multipitch 5.7 in Zion called “Led by Sheep”. It was 5 pitches of smearing slab, all feet with occasional mantles. For non-climbers, going up slab meant that I could potentially avoid raising my arm above my head (which I couldn’t do anyway). It was a long drive, but in the event that I could not climb, at least there were some classic hikes that I could do with the lovely Katt. I was able to slowly work my way between the widely spaced bolts holding most of my weight on my calves and pushing into my palms at chest level or below with my fingers pointed downward. At the summit of this sandstone tower, I was very encouraged. Even if my right arm didn’t work, it meant that climbing was still possible for me in the future. I rappelled down with Katt as darkness set in. Out of the game for a year, I had forgotten a key element of extra layers. The cold November wind whipped hard through the desert canyons and we shivered violently while I struggled to pull the ropes down from the anchor of the first pitch. I couldn’t pull the dual ropes with my useless arm and Katt stared as I cursed and thrashed trying to get the rope down. After a brief meltdown, I was able to free them and hike out without a headlamp grinning the whole way. There was hope that I could climb again.
Cyborg (noun), definition: An organism, often a human, that has certain physiological processes enhanced or controlled by mechanical or electronic devices, especially when they are integrated with the nervous system
Prolonged Weakness
Climbing season had ended with the arrival of snow and drop in temperature. For the next four months, I went hard after PT and strength training. I talked with multiple physical trainers, performance athletes, and therapists to learn a variety of tortuous exercises targeting my paralyzed side. I struggled to get my serratus anterior muscle to engage when I raised my arm. Bit by bit, I was able to raise my right arm straight up in the air. My grip strength had weakened a great deal, and my left hand became my strong hand. To this day, the last half an inch at full extension of my right arm gives me slight resistance, which detracts from my already poor -2 ape index to make long reaches with my right arm a challenge. I could eventually do pull-ups with counterweights to remove 40lbs from my body weight. By the time winter came to a close and the warmth of spring dried the rock, I was ready to get outside again and so I opted to lead a Wasatch classic known as Mexican Crack. Perhaps not the best lead to jump back on as many consider it to be sandbagged and it requires a fair amount of strength that cannot be substituted for technique the way Led by Sheep could. I was able to work my way up through the two cruxes without falling, but I was absolutely wiped by the end. The road to to recovery is a long one, but each challenge leaves me more inspired than deterred. However, I would be lying if I said I wasn’t a little heartbroken by my complete lack of stamina following over a year of PT and strength training combined.
If I learned anything from the experience of completing a qualifying exam with a herniated disc, it is that I can put up with a whole lot more suffering than is wholly necessary. Toughing it out is definitely a macho bravado mentality amongst many males, and in the end it almost cost me the use of my arm. I am much more cautious than I used to be in terms of trusting my own judgement of my personal resilience. Paradoxically, it is nice to know that I can push through the pain if deemed necessary. However, I am very lucky to not have to make the choice daily like so many other people do. I also am amazed by the resilience, optimism, and success of people like my Uncle Kevin who are not deterred by the continuous setbacks associated with spinal cord injury. Kevin and others like him are an inspiration to us all, and a good reminder for to work harder and play safer. You can read Kevin’s story here.