Friday, August 30, 2013

For 2013, Three Bike Tours and a Surgery...

By Angela Connolly, Certified Medical Assistant -

There is nothing more frustrating for anyone to endure than chronic pain. When you lead an active lifestyle, and are a transportation/recreational cyclist, it seems even more unbearable to endure. Sometimes it takes a brave decision and a leap of faith to become fully functional again, and that is what Frank Warnock, this Blog's Admin, was inspired to do, by his desire to become as proficient a cyclist as he had been before his chronic low back and leg pain began to slowly take away the high level of cycling that he had enjoyed all of his life.

Disc rupture at the L4/L5 and
L5/S1 levels. Blackening of the
discs indicates dehydration.

Frank had suffered from chronic low back pain due to problems at the L4/L5/S1 levels. This is a common site for disc herniation, and in Frank's case, both levels had ruptured, with L5/S1 off alignment and in a "bone on bone" state. Although there are several possibilities, including cumulative trauma, his Doctors were unable to determine the exact origin of the problem. Two prior Discectomies and multiple steroid injections did not bring permanent relief, so a decision had to be made. Had he taken a conservative approach to the pain and done nothing, he would have risked becoming incapacitated someday. The vertebrae could have eventually fused over time, but in an inappropriate position, causing deformity and debilitation, and increased pain. An avid cyclist who looks forward to a lifetime of cycling, well into his advanced years, Frank found this possibility unacceptable, and he began to realize that a permanent solution had to be found.

Because Frank wasn't in constant pain, however, it was tempting to put off the decision. He would be reminded of the problem only when he hurt his back (which was so easy to do), most recently while on an almost thousand mile round trip tour to Lake Erie, PA. On this occasion, the simple action of lifting the front wheel of his bike over a curb set off the terrible pain. With each new injury, he would have to cope with moderate to severe pain for several days. It didn't take much to cause pain, only a simple movement, like lifting something, which, when he was unprepared for, would set off yet another attack of pain.

Frank, en-route to Lake Erie - via the Allegheny
Mountains - in mid June.
Before making the decision to undergo surgery, Frank had set three goals for himself to achieve for the year. Knowing that he faced a lengthy recovery, he wanted to enjoy touring with his friends from the White Clay Bicycle Club. The Hershey Weekend Tour and the Hawk Mountain Weekend were the tours that provided the preparation for the 12 day long Tour of Erie in June, combining for a total of 1,440 miles. Filled with hills and challenges, completing these Tours successfully gave Frank the encouragement to seek a surgical solution to his pain, so that he could continue to have many years of touring in his future.

Dr. Louis Quartararo
The journey to surgery began with the decision to seek out the best, state-of-the-art procedure that modern medicine has to offer. Traditional Spinal Fusions are routinely done through invasive, "open" procedures, which are very difficult for patients to recover from. Through an online search, we learned about the NJ Spine Institute, and Dr. Louis Quartararo, who specializes in minimally invasive spinal surgery. "Dr. Q", as everyone calls him, is confident, reassuring, and very kind, and his office staff is exceptionally professional and helpful. Also caring for Frank was Jenny Reyes, Dr.Q's Physician Assistant. With this award winning and experienced team in place, Frank felt confident and certain that he had made the right decision to go undergo a PLIF procedure, which means Posterior Lumbar Interbody Fusion. Done Endoscopically, this highly sophisticated procedure is only performed by a few Surgeons around the country, as it takes additional training and expertise for a surgeon to master. Unfortunately, this advanced level of care is not available in Delaware, but it was well worth the 2 1/2 hour drive to Paramus NJ, one town over from Fair Lawn and the lovely planned community of Radburn, where he grew up.

Above: Xray from the front, post-
op. Note the Spinal Fusion Stimulator
wired in the upper left of the image.

Frank's surgery was performed on July 25th at the International Center for Minimally Invasive Surgery in Wyckoff, NJ. After the nearly four hour long procedure, he stayed overnight at the facility, and was discharged the next day, to recover at home. Dr. Q said that the surgery went very well, and now, at five weeks post op, the recovery period is well underway. In many ways, the surgery itself is only the first step. It will take several months of healing, physical therapy, and a good diet rich in protein and calcium, to insure a fully successful fusion. And there have been some bumps in the road, like severe nerve pain requiring a visit back to NJ, to the Pain Management Dr. Gregory Lawler, who works with Dr. Q to help control patients' post op pain. Dr. Lawler immediately understood the origin of Frank's post op pain and prescribed appropriate medication to help. With the pain under control, we are seeing real progress in his recovery. And although Frank can't wait to get back on his bike, he realizes that by resuming cycling, and other physical activities slowly, he is making an investment in his future health, and that once he is fully healed, he will be back on the bike stronger than ever. He is looking forward in the coming weeks to working with his Physical Therapist, Matt Hanling, to reach that goal. Matt has outlined his treatment plan and goals for Frank, and we are confident that with Matt's expert help and encouragement, the therapy will progress smoothly.

Frank would like to encourage anyone who suffers from chronic pain, and exhausted all conservative options, to investigate all of the surgical possibilities available for treatment. Also consider going outside Delaware if that’s what it takes to find the latest and greatest techniques available. Modern medicine and science have so much to offer, and the success rates are extremely encouraging! You can visit the NJ Spine Institute and learn about all of these treatment options.

Right: View from the side, post-op. Note the re-alignment and gains in vertebral spacing. Nearly 1" in lost height was gained back as a result.

Angela Connolly is a Certified Medical Assistant, most recently in practice with St. Francis Healthcare in Wilmington, DE. With prior experience in Gynecology/Urology, her experience caring for Frank has given her new insight and appreciation into the issues surrounding patients undergoing treatments for Orthopedic/Spinal conditions. As Frank's primary caregiver and companion in the surgical/recovery experience, she is happy to report that her patient has been positive, cheerful, and a pleasure to care for!

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